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IN 'l'IH'l COUR'I' c)l" COMMON PLIllMl 01' CUMallll~LANO COUN'l'Y,
IllllNNSYLVANIA
I CIVIl. ACTION . LAW
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: CAlli! NO. 1~ -, j-ftJ(ll.. (1),-~~
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I JURY TRIAL ProMANOIllP
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Nonelil
You have been sued in Court, If you wish to defend a\lainlllt
PHYSICIANS al' IIIllHAIlU,I'rA'l'ION
MIllOICINIil, 11.C.
175 '.lInoa/JtlJr 1J0ulovard
P ,0, BOX 2020
Msohanicllbur\l, PA 1~055,
111a int if f,
v.
IllUGIllNIll PALM, an incapaoitated
person, through his wife Bnd
guardian, JOAN /{, PAt.M, anti
JOAN K. PALM, individually,
R.O. ~1, Box 320
Loysville, PA 17047
and
HEALTH AMIllRICA OJ!' CENTRAl,
PlENNSYLVANIA
5 Gateway Center
pittsburgh, PA. 15222
Defendants.
the olaims set forth in the following pages, you must take action
within twenty (20) days after this Complaint and Notice are served,
by entering a wrJ.ttan appearance personally or by an attorney and
filin\l in writing with the Court your defenses or Objections to the
claims set forth nqalnst you, You are warned that if you fail to
do so, the case may proceed without you and B jUdgment may be
entered against you by the Court without further notice for any
money cl.aimed in thfl Complaint or for any other claim or l:el1ef
requested by the Plaintiff. You may lose money or property or
other riqhts important to you,
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IN THill COUlt'l' 01' COMMON PJ..I!lAII 01' CUMI3/llRLflNO COUN'l'Y,
PIllNNSYJ..VANIA
PHYSICIANS 01' RIEIlAlHJ..I'I'A'I'ION
MIllPICINIIl, P. c.
175 LancAster. Boulevar.d
51,0. BOX 2020
Meohanioabul:g, PfI 17055,
Plaintiff,
CIVI~ ACTION . LAW
v.
CA/JIB NO, q", ~.(, ~,,:l. Ci.~ Ti,-~
IllUGIllNIIl PALM, an incapaoitated
per.son, through his wife and
guardian, JOAN K. PALM, and
JOAN K. PALM, individually,
R.O. Ml, Box 328
Loysvilla, PA 17047
and
HIllALTH AMIllRICI\. 01' Cl!JN'l'RAL
Pl!JNNIIYLVANIA
5 Gateway Canter
Pittsbul:gh, PI\.. 15222
JURY TRlf\L OI!MANDIllO
Pafandallts.
NO'l'ICIA
Le han demandado a ustad anla oOl:ta. Bi ustad quiere
defenderse de estas demandas expuestas an las peginas siquientes,
usted tiene vlente (20) dias de p1azo al partir de 1a feoha de 18
demanda y 1a not1ficacion. Usted debe presentar una I1parienaia
escrita 0 on persona 0 por abogado y archivar en 111 corte en forma
escr.ita sus defensas 0 sus objeciones alas demandas encontra de su
persona. Bea avisado qua si usted no se defienda, la corta tomara
medidss y puede ontr.ar una orden contra usted sin previo aviso 0
notificacion y pOI: cua1quier queja 0 alivio QUO es pOdido en 1a
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petioion dQ demanda. UBted puede perdor dinoro 0 SUB propiedadel
o otl:OB doreohoB impOl:tonl:UB para ulted.
Lt.IllVIll I!lB'l'A OIEMANOA A UN AAOOAOO 1MMI!101M'AMIEN'I'JIl. 81 NO TUNe
ADOOAOO 0 III NO 'l'1lllNIIl Bl, l'lINI!lIIO flUI'ICIIIlN1'1ll Ol!l lWlAR TAL SIllRVICIO,
VAYA IIlN PBJlBONA 0 Ll,AML~ POR 'l'I!lI,llll"ONO A LA OFIC1NA CUYA PIRlIIcCION Rill
IIlNCUIllN'l'M IllSCJU'l'A ABAJO PAllA AVJIlRIOUAR OONOIll Bill PUIIlPIE CONBIllOUIR
ABI8TI!lNCIA LI!QAL.
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Pennsylvania aal: Assooiation
Lawyel: Refenal SOl:vioe
100 S. StatQ Stl:eqt
H/lI:I:1sbul:ll, Pf\, 17108
(800) 93;1'0311
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I?ennllylvania.
3, Pefendant HealtMlllerioa of Centl:'al Pennsylvania ill iln
insul:anoe company exilltinq undel:' or authorized to conduot business
under the lawa at the State of Pennsylvania with its pl:inoipal
offioes located at 2601 Markllt Place Street, Ilarrisbul:Q, PA. 17110.
9339.
4. provider relldered profesllional medical treatment sel:'vioes
to Jl:ullene Palm from February 21, 1.993 throuqh July 10, 1995.
5, The \lAllal and customary charqelll for lIaid sel:'vioes wel:e
made by Provider and charged to Eugene Palm,
6, Eugene Palm had health inllurance coveralle pursuant to a
policy of inllurance wi th Defendant HealthTlmerica.
COUNT I
BRRACK or yONTRACT
PHYSICIANS or RBHAB, MBDICINR, P,C, V, KBALTK AHBRICA, 'T AL.
7. Pl:'ovidel:' incorpontes by reference paraqraphll one through
six of thh complaint, inelullivl!l, as if lIet forth in full herein,
8. The terms of coveraqe provided by Oefendant's contract
indicate, in partl
MBDICAL AND SURGICAL BBNBPITS . Plan doctors
alllo provide all neeesllary medical or lIurgieal
care in a hOllpital or extended care facility,
at no additional ooal: to you, except where
noted,
9. Pursuant to the terms of the insurance pOlicy, Defendant
HealthAmerica ill obligated to provide covQnqe for the medical
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bills inourl:ed by mUqene Palm while a patient of Plaintiff.
10, lJefendant HQalthAmedoa has failed and refused to provide
payment for the medioal aerviceB provided to its in/lUnd, llluqene
Palm,
11. 'l'he outstanding oharqeB for medical aervicea whioh remain
due and owing by the Defendant HealthAmerica total '7,546,00,
WHIRIPORI. Provider ruapectfully requesta thia Court to entel:
a jUdqment in ita favor and againat Pefendant for damaqes in excess
of '7,546.00, togel:her with costs, intorest and aUorneya' teea,
and such other and further relief aB this Court deems j Uat and
propsl: ,
COUNT II
BRlBACH or CONTRACT
PHYSICIANS or RBHAB. HBPICINB. P. C..-Y., BUGBNB PlWf, an
IncaDacitated Pel:son
17. Paragraphs one through aix are incorporllted herein by
reference ae thouqh fully Bet forth.
1B, Eugene Palm waa adjudicated an incapacitated pereon by
the Orphan'a Court of Perry County on November 14, 1994 and his
wife, Joan Palm, was appointed hie guardian.
19, On November 14, 1994 the Orphan'S Court with the Court of
Common Pleae of Perry County, adjudqad Eugene A, Palm as totally
incapacitated and appointed Joan Palm Plenary Permanent Guardian of
the Person and Plenary Guardian of the Estate of Eugene A. Palm,
A copy of aaid adjUdication is attached hereto and incol:porated
herein as Exhibit "A",
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20, On January 3, 1994 Joan Palm, on behalf of EUgene Palm,
completed PllJintlff'B Patient relJhtrlition on 11/19/94 wherein JOan
K, Palm ligrel'ld to pay any amount not promptly pa.l.d by insuranoo
caJ;'riers.
21. '1'0 date, no payment of Plaintiff's bill has been made by
any perBcm,
22. l'ldntiff has demanded payment from Oefondant Eugene A,
P~lm thrOUgh hia wife and quardian, Joan K. Palm, but deBpite the
demands Bhe has failClI1 and continues to fail to make payment on the
outstanding balance,
WHERI!Jl>ORE, PlaintJ.H Physioians of I~ahabilitative Medicine,
P.C,. demands judgmont in Its favor Bnd against lJ:ugllnc 1\, ralm
individually. and againl!lt hiB wife and guardian, Joan Palm, for and
on behalf of l1:ugene ^. l'alm in the amount of $7,546.00 plus
interest and cost of suit,
COUNT I II
~~H or CONT~
PHYB~CXANB or ReHAB, MEDICINe, P.C. V. JOAN l. PALM, Individuall~
23, Paragraphs one throu'lh six and paragraphs seventeen
through twenty two are incorporated herein by reference,
24. Defendant Joan K, Palm was at all times relevant to this
cause of action liable for medIcal serviceB supplied to her
hUBband, Eugene Palm,
25. Despi te repea ted demands I no payment has been made and
the outstanding balance il!l $7,546.00 despite the fact that such
services were reasonable and neceBsary.
4
9~ HOV 15 PP '. 113
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EUGENE A, PArM,
IN THE COURT or COMMON PLI!AS
PBRRY COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO, P-:J24
an incapacicat.d
penon
PINAL anoia OP COURT APPOINTING PLINAnY GUARDIANS
ANO NOW, I:his I.!/.A day of j.J.u/I./ltv
, 199~, a hearinq
in thil cue having been held on SQIi'I:Mmber 20, 1994, and il:
appearin'il to I:he Court I:hat tuglllne 1\, P.l\lm WIS Inved with 4
citation anr.l Nol:ice of this hearing on August n, 1994/ and !uqene
1'\. Palm was not presenl: Ilt the headn'il the Court finds thaI: I:he
phydclll or. lnenl:l!l oondil:ion of Eugene 1\, Pltlm would havs been
harmed by his presenoe Ill: the headllg, Ilnd furl:her Hnds from
I:estimony I
1. ThaI: Eugene f\. Palm sut~ers from injuries reSUlting from
a worK aooidenl: which I:otally impair his capaoil:y to reolllive and
evaluate infol:mation eftectively and 1:0 make and oommunioate
decisions concerning his managemenl: of financial aftairs or 1:0 m..t
essential requiremenl:s for his physical health end safel:y.
2. That I:here are insuffioienl: supports available to assist
Eugene 1\. Palm in such decisions and thaI: then exists no other
less restrictive all:ernative mechanism for decision making,
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), That ba..d on the total incapacity ot zuqen_ A. Palm to
reaeiVI and evaluate intormation and to make or communioate
deaiaiona, I plenal:Y Gual:dian ot the Perlon and a plenary Quardian
ot the Estat. are required on a permanent ba.il.
NOW, TIiERErollE, basad on the olear and ocnvinal.nq evidenae
supporting the foregoing Hndingl it ill OJ\DflRJlO, ADJUDGJlD and
DEORJlJlD that H~altheouth Sub Acute center ot Heohaniaeburg, xno,'1I
Petition to Intervene is hereby denied, Euqane f\, Palm ia hereby
adjudqed a totally inoapacitated penon and Joan Palm il appointed
Plenny Permanent Guardian ot the Penon and Plenary Permanent
Guardian ot the Eltata,
It then i. a sate deposit box in the name ot the
incapaoitated penon alone 01: in the name. ot the incapacitated
person and another or others, laid sate deposit box shall not be
entered by the quardian except in'the pl:esenoa of a repre$entative
,
of the tinancial institution where the box i. loaated or in the
presence ot a I:epresentative ot the ol:phans' court Oiviaion, The
representative present at the time ot entry shall make or caulle to
be made a record ot the incapacitated person's property, and said
rec;ol:d shall be tiled with the Cluk ot the orphans' Court
Division, None ot the J,ncapaoital:ed person's property may be
removed until after the atoresaid inventory is completed,
f\ uuonable he fOI: the IInvicu of the r.pu..ntatlv.
may b. and .hall be payable fl:om the IIItate ot the
incapaoitetld perlon.
If thl uh dlllcllt bON i. jl)intly
cwned, H VI (!l) daYI not iCI ot t:hl pl:opcud Intl:Y .hall bl
given to thl othlr owners by thl gual:dian,
An Inventory mUlt be Hied within ninety (90) daYll, A
rlpol:t by IIIch l]uardian .hall be filed within tWelVI (12)
month. and annually thereafter,
A Surety aond .h~ll not be I.'equired II all a..lt. are in
joint namls between the incapacitated pel:.on and the guardian,
lllugene A. Palm, an incapaoLtated perllon, hu the dght to
apPlal this ol:dlr of court by tiling INceptiona within tell day.
cf this date or tc petition this court for a review hearing to
modity or terminate the guardianship hereln eatabl1shld, A.
Bugene A, Palm Wlls not preunt at this hearing on appointment
of a guardian, petitioner .hllll aer.ved upcn and rlt8d to llluglne
A, Palm thl Statement. of Right., II copy of which i. attaohed
to thh ol:del: aB l!lKhibit nAn, and fUe proof of Buch "I:vice
with this Court within ten daya,
aY THE COUR'L'1
CCI Richard Oarl, B.q.
Oal:Y ~, Rothachild, BBq,
I'll.,
CEFITIFlED A TRUE COpy
~A:_'_J~~ _
~ CLERK OF RPHANS' COURT
9~ NOV 15 PH 31 43
......, r
IN RIll
IUOIN" A. PAut,
In inolpla1tlt.d
p.non
I IN THIS COURT or oormoN PLIAS
I PERRY COUNTY, PENNSYLVANT.A
I ORPHANS' COURT DIVISION
I
I NO, 1'-324
I
'TA'IKIKT or R~aHTB UPON APPOINTMIHT or A GUARDIAN
AN ORDER /tAS BUN ENTERED WHI!:REBY '{OU HAVE BEEN ADJUDICf\'rED AN
INCAPACITAT!!:D PERSON AND UNABLE TO CARE /TOR YOURSELF AND MANAGE
YOUR PERSONAL ArFAIRS. yOU HAVE 'fHE RIGHT TO FILE EXCEPTIONS TO
THE COURT'S PI!:CISION WITHIN TEN (10) DAllS OF THE DATE OF THE
COURT'S ORDER. IF YOU FAIL TO FILE EXCEPTIONS, THE ORDER WILL
BECOME FINAr,. IN TH!!: EVEN'r THAT YOU FILE EXCEPTIONS AND THE'l ARE
DENIED, YOU /tAVE A RIGIlT TO FILE AN APPEAL TO THE SUPERIOR COURT
IHTIlIN THIR'rY (30) DAYS OF THE PATE OF THE DENIAL or THE
f:XCEPTIONS,
IN ADDITION, YOU MAY Pt:TITION TilE COURT AT ANY FUTURE TIME TO
MODIJr't OR TO TI!:RMINA'rE THE GUARDIANSHIP IF THERE IS A CHANGI!l IN
YOUR CAPACITY OR IF YOUR GUARDIAN 'FAILS TO PERFORM HER aUTIES IN
ACCQRDANCE WITH THE COURT'S ORDI!:ll.
IF YOU WISH TO APPEAL THE ORDER OR TO PETITION THE COURT TO
MODIF't OR TERMINATE THE GUARDIANSHIP, YOU HAVE THE RIGlf'r TO BE
REPRESENTED Bll AN ATTORNEY. IF YOU DO NOT HAVE AN ATTORNEll, THE
COURT MAY APPOINT ONE TO REPRESENT YOU. Ill' YOU CANNOT AFFORD AN
ATTORNEll, THE SERVICES OF AN ATTORNEY WHOM THE COURT MAY APPOINT
FOR YOU MAY BE PROVIDED f\T NO COST TO YOU,
EXHIBIT "A"
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IN 'l'HIll COUlt'l' 01' COMMON PLI!lf\S Of' CUMlJISRJ"f\NO COUN'l'Y,
PIllNNBYLVf\NIA
'~I"
HISAL'l'HSOUTH 01' MIllCIIANICS13lJRQ
INC, ,
175 J"ancaBter 13oulevard,
MOQhanicBbur9, Pf\ 17055,
Plaintiff,
CIVIL f\CTION . LAW
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I!:tlOI!NIll PALM, an incapacitatod I
person, thl:ouqh his wife and I
quardian, JOf\N PALM, and I
JOAN PALM, individually, I
R,D, 111, Box 328 I
Loysville, PA 17047 I
Defendanta, I JURY TRIAL DEMf\NDIllD
*********************************************......*.............
IN 'l'HIll COUR'l' OF COMMON PLIllf\S 01' CUMBIllRLANO COUNTY,
PIENNSYLVf\Nlf\
v.
Cf\sro NOt 95.1059 Civil
PHYS rr.T ,.f>/fI c)P' RIr.'~MII1JITA'l'ION
MI!:DICINE, P.C.
175 Lancaster BoulevarQ
P,O. BOX 2028
Mechanicsburq, PA 17055,
plaintiff,
I CIVIL f\CTION . [.AW
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I CASI!l NO, 96'5602 Civil
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I JURY TRIAL DI!lMANDl!lD
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v,
EUGENI!l PALM, an inQapacitated
person, throuqh his wife and
9uardian, JOAN K. PALM, and
JO~ K, PALM, individually,
R.D, Ill, Box 328
Loysville, PA 17047
and
HEALTH AMERICA OF CENTRAL
PENNSYLVANIA
5 Gateway Center
Pittsburqh, PA, 15222
Defendants.
AND NOW THIS
OIUlIR.
day of October, 1996, IT IS HERI!lBY ORDERBD
that this action, case nOI 96.5602 Civil and case nOl 95-1059
IN TUIll COUR'l' 01' COMMON PLI1lAS 01' CUMIlI!lRLANP COUNTY,
PIllNNSYLVANlf\
PHYSICIf\NS 01' Rl!liAI3ILITATION
MlllllICXNIS, P.C,
175 r..anolUlter BoulevarJ
p.a, BOX ~02B
Mechaniosburq, 'A 17055,
Plaintiff,
v,
eUGISNlll PALM, an incapaoitated
person, throuqh his wife and
quardian, JOAN K, PALM, and
JOAN 1<' PALM, individually,
R,D, Hi, Box 328
Loysville, PA 17047
and
HEALTH AMERICA OP CENTRAL
PENNSYLVANIA
5 Gateway Center
pittsburqh, PA. 15222
Defendants.
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CIVIL ACTION ' LAW
CAse NO, 96'560~ civil
83~ a ~
~{ ~ 'tl'~
pi,. ~, f:!f
tf.f'l ... It
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JURY TIUAL OEM#,mEr! ~d
"', III ."
PBTITION roa CONSOLIDATION or ACTIONS
TO THE JUDGES OF YOUR HONORABLE COURT I
And Now, this 14th day of October, 1996 aomes Richard oare.
Bsquire, pursuant to Pa, R,C.P., RUle 213, counsel for Physicians
of Rehabilitation Medicine, P.C., and HealthSouth of Mechanicsburq,
Inc., and statee the following:
1. There is pendinq in your Honorable Court an action by
HealthSouth of Mechanicsburq, Inc, v, Eugene Palm, an incapaci tated
person, throuqh his wife and guardian, Joan Palm, and
Joan Palm, individually, defendants and HealthAmerica of Central
1
PQl1nsy 1 vanill, Ilddil:iOlHl L def ondllntli, Ilnd II.I Junk Lumber and
Rockwood Casuall:Y InliuranclJ Company, additional defendanta, in
Civil Aot.ion NtH 95 -1059 CIvil '1'0 on , Jury 'l'rLal JJemanded,
Currently tl1at oallo ill in the pluadinll lil:/ll}QS wil:h plaintiff's
l'irst Set of Inl;ort'oglltorlell to Oefondl1nt Palm and plaintiff's
I'irst RaQuast for ProduCltlon of lJoCluments to Defendant Palm and
Plaintiff'S l'irSI: Sot of. Inter.rogatorLali to DOf.ondant HealthAmerica
hllvinq been served en or about APl:il 3, 1996 to said partiea and
there bflin9 Preliminary Objections through I:he addl tional defendant
oomplaint f Hed on behalf of Rockwood Caaualty Inaurllnce Company
pending and listed for Argumont on May 29, 1996, No depositions
have he en ta ken.
2. The nature of the ceuae of action and the interrelated
olaims arise from the care and treatment provided to Eugene Palm
who suffered a ~raqic and substantial traumatic brain injury in the
fall of 1993 and carne to HealthSouth of Ml:lchanicsburg, Inc. ("MRS")
for inpal:ient medical treatment in their acute care hospital from
December 21, 1993 to May 23, 1994. plaintiff has not been fully
compensated for its care and treatment rendered to Euqene Palm and
expenses outst.anding claimed by Plaintiff are $254,187,92,
3, WhJ.le Mr, Palm was a patient at HealthSouth of
Mechanicsburg, he required medical treatment which was provided to
him by Pl1ysicians of l~ehabi1itation Medicine, P.C, They claim
profess ional medical treatment was provided by them to Euqene Palm
from February 21, 1993 throuqh July 10, 1995 and they claim that
the sum of $7,456.00 ia due from the Defendant.s, l!:uqene Palm, an
2
inoapaoitatod person/ I:hrou~h his wifo nnd ~uardian, Joan K, Palm,
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and Joan K. Palm indiv illua lly, Oefundanta / an<l lIunll:hflmer1oa of
Central Pennaylvania, Defendants,
4, It ia clll1mull by l'laintir.fu that I:he injury l!Iuatained
by Mr, Palm on Novemhor 3, 1 'J!/:I was lJ wor.k related incidenl: and
that Rookwood Casualty Insur.llnr;o Company, t.ho available wor.ker.B I
compellaatton carder, IlowL1vl3r, Hockwood CBHuall:y Inl;JlJrllnCe compliny
has donied that il: La a wr~rk relatod /J(lcidonl: and thereforo Mr.,
Palm's health inaurer, Ifealthlunerica, i/l l.iable f.or payment,
HealthAmerica has refIJlled 1:0 make payment to Plaintiff's Physicia.n
Rehabilitation Medicino, l',C, and lIelllthSouth of Mochanicllburg,
5, Defendanl:/I HeaJ.l:hAmorica, mUgone Palm, an incapacital:ll?
person/ through his wife and guardian, Joan I{, Palm, and Joan K,
Palm, individually have conl:lented to the consolidation of the
action.
\
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6, A conaolidation of theBe two actions will not prejUdice
any BUbstantial r1ghts of any put,y to the actions and will be
desirable becauset
a. Physicians Rehabilitation Medicine, P.C. claim and
HealthSouth of Mechanicsburq claim both arilse out of care and
treatment of Eugene Palm following his accident of November 3, 1993
and involve a question of payment of benafita either throuqh Mr.
Palm's workers' compensation carrier, Rockwood caaualty, or Mr.
Palm'a health insuranco carrier, HealthAmerica, or if neither of
those insurers are available, direCl:ly from Mr, & Mrs, Palm.
WHEREFORE,
Plaintiff,
Physicians of Rehabilitation
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2, A~~hlunull>ul~nllunl,IU. Junk 11l1/h/IIIU Junk l.ullIhur (huruhlUllur "IU, Junk
l.ulllbllr").ls lInln~I\'llluultrudlnllun~ dulng hUHlnu~K undul' thu IiIWH oflhu ('unllnunwuullh uf
l'llnlls)'lvunlu, with prlnclpul ulllcuH IUClllcllullU), I, lIu~ 441, IllII1U)' (jruw, Junlulu ('UUIll)',
l'unnH)'lvunlu 17lJH, IInd 1I11111rclcvulllIIIIIUS 1 Jcfcndllnl, hlllUllC Pnhn, \\'IIS Ihc UUUIll, HCI'\'UlIlur
ulllplu)'ul! uflU. JUllk I,ulllhcr,
3. Ad<llllllllul ncl~n<lunl, Rllckwuml ('usullll)' InHurullcu ('UIIIPIlIlY, IK u hUHhll!SH
clIllly l)rl!unl~.ulI ulI<I llPCl'IIlllIllun<lcl'lhc hl\\'s uf Ihc Clll1l1nllnWCllhh llf I'cnllHylvunlu, wllh ilK
prlndpulllmCCS loclIlc<I 11165.1 Muln SII'l!l!I, l~llCkwOll<l, SUI1WrHcl ('uunly, PCllns)'lvllnllll SSS7,
1111<1 ulullrcll!vUl1llllllcs WUS Ihc wllrllcrs' clllllpcnSlIlllll1 currlcr Illl' IU. Junk l.ulllbcl',
4. I'lulllllll' 11l1t11l1c<I thc uhuvc-capllol1c<I uCllul1 b)' C'lllllpluhlllllc<l unllr UbU!)1
OClubcr 10, 19'16, IIlruc un<l corrccl cupy llf which Is lI11uched hcrclo und IIII1<1e u pllrl hercof us
E~hlbll "A".
S, HculthAlllerlcu Illcd lis Al1swer, New MUllcr un<l ('uullIurdullllol1 evcl1 dute
hcrc:wllh. u lrue ulld CUI'recl cupy ufwhlch IK Illluchcd herelu nnd Illude II purl heruofus Exhlbll
HBU,
6. It Is bcllc\ed,lIl1d lhcrclllre IIvcrred. lhul the Injury sullered by Defelldunt, Eugcnc
I'uhn. occurrcd whllc he WIIK elllplllycd by IU, JUllk Lumber, ulI<l Inlhe Cllurse und scopc ofthut
clllplo)'lIIent.
7, The fUCIUlllllvcl'IllClIlS Clll1lllined Inlhc ullllchcd Exhlbll "11", purllgrllphs 6, g, 10
und 26 lhrough 47 lire hereby IncllrpllrUlcd by refercncc liS thuul!h fully selllmh hercln.
8. As u rcsullllflhc PUYIIIC:11I by or 011 behulf of Addltlonul Delelldanls. R.J, Junk
- 2.
J.ulllbl:r lind/or ItockwllOd Cu~uulI~ In~ul'unclI ("lII1IlUI1~, u,. $M,()()(), jllu~ unnull~ pu)'mllnl~ 0"
$/\llll p~r mOlllh lJuurunlllcd IiII' nnwn )'IIUI'H or Ihc IIti! llmc ufl)lIlimdulll, EU~lInc !'lIlm,
whlllhcvcr I~ hlt!lJcr, IIH ul'lI~ullu"u wUI'k.l'clull:d In.lul'~, IllIuhhAlllcl'lcul~ clllllllld tu dcclllrlllur)'
I'lIl1cl'ln Ihl: nUlul'Ilo,.u,lcllIl'llllnullun h)' Ihll ('ourl \\'hlllhllr wLlrklll'H' COIllJllll1HUllunllllldlcul
blll1111llH arl: 1l1l~lIhlll undllr ullol'lhlllill:l~ IInd c1rcUIIlHlunclIH Inl'lIl \IIId, 1I~ WlIlluH Huch ulher rlllh:,.
u~ lhl~ CUUl'l dcclll~ pl'ollcr, Inclulllnll, hnl nul II III Itlld 10, 1I1ll'lllllCllun u"lhll ~uhro~lIl1un rllJhl~ 0"
IlllllllhAlIlcl'iclI pur~uum hI lhll WurkllrH' l'ulllpllnNUllun ACI,
I), AH II rllHulI ul'lhc wurk.relullld InJul'Y Incnrrl:d hy l)ufi!ndunt, EUIlllnc I'ulm,
Addlllunllll>lIli!ndunl~, IU, Junk l.ullIblll' und/or Iluck\\'uud l'u~uull)' In~urllnclI CUlllpun)', IIrll
prhlll1rlly rll~jlun~lhlll IiII' IlU)'IIlCnl ul'lhc IIIl1dlcul cxplln~e~ llJIIlllre the ~UhJCClol'lhIH IIctlon,
10, 11'11 I~ dClcrlllhllld lhulmcdlcul hcncll1~ urlllluyuhle jlur~uunllu lhc Workcr~'
Complll1~allun Act by Addlllunlll Dclimdunl~, IU, Junk I.umhcr undhlr Iluckwuud Cu~ually
hl~uranclI CUll1pun)', lhcn Addlllunull>eli!nllllnl~, IU, Junk I.umber allll/ur Ituckwuod ('1I~ually
InHUl'lInCC ('ull1jlanl', urc NUlllly lIul1le und/ul'lIuble llvcr lu IlcllllhAlIlllrlcu IiII' unl' umounlH pllld
by IllluhhAmllrlcu IiII' medlcul bCucnl~ Ilur~uunllu the ufiJrcsllld Plun,
WIWREFORE,I)uf'cndunl,1 feulthAll1crlcu, dCf1lund~JudgmcnllnltH IilVur und ullulnHl
I'lulnllll' und ullulher Illlrllc~, und rCHpectflllly I'CljUCHtH the lilllllwlnl! rllllcf Ihl/lllhc Court:
(A) I>cl'cndunl. IlculthAlllcrlcu, dCll1undH a declurulury Judgment thutllledlcul
bcnelll~ under the Worker~' ('ulllpen~utlun Act ure pul'uble, and thUl, lhereliJre, Det\mdulll.
IleulthAlllerlcu, hud no oblll!Ullllt! under the terlll~ and eondltlunH o"lhe ul\Jrc~uld Pluntll pul'
mcdleul bcnent~ on behulf of Deli!ndunt. EUl!ene l'Uhl1~ und
.3.
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l'IIYKICIANIl ()II IU\IIA\lII.ITA'
'1'101'1 MIlPICINE. ",C"
I'lulnlll1'
IN 'I'll\! COlll~T OF COMMON I'WAIl
clJMIll!llLAND COUNTY .I'ENNIlVl.V ANIA
v,
CIVil. AcnON .I,AW
EUlIENE l'AI.M, nlllll~upudlUlcd
llersull. Ihrllu~h his wlfc ulld
lluurdlull, JOAN I'ALM, ulld JOAN
I'ALM, IndlvlduulI~,
NO, l)().SI\1l2 CIVIL TmlM
\1climdullls
v,
JUIW TIllAL DEMANDED
IIEALTIIAMElllCA OF
CIlNTIlAI.I'ENNSVLV ANIA,
ALIdlllunul DcfcndUlII :
v,
Il,J, JUNK lId/b/u Il,J, JUNK
LllMBEll und IlOCK WOOD
CASlJALTV INSUllANCE
COMI'ANV.
Addlllullul Dclimdulllll:
,ANSWER, NEW MATI'FR AND NEW ~ATrER
WlisUANT TO I'A R,C,P. 22511.dl
ANi) COUNTERCLAIM
AND NOW COMES \Jel'clldunl, IkullhAlllericu I'I:nn,~\vull\u,lnc,.IId/b/n
HcnllhAll'lcrlcu llfCelllrull'enn,~lvUlllu, by lIno Ihrough 116 u\lu\'lle~S !lnrlll1ull & MlIler.P,C"
ulld III rcsponse Il) I'lulnlll'rs clImplulnl uvcr,lIS 1'1Il1uws:
Answer
1-2, Ancr rcusolluh1e Illvcslll!ut\on, Ilelcndunl, lleullhAmcrlcJ l'clllls~lvnlllu, h1C..
IId/b/u IlcuhhAmericu or Ccnlrull'cnns~lvllnlu (hercllluncr "llenllhAmcrlcU"), lucks knowh:dllc
or Illl'ormnllullsuflic\CIlI III I'llI'm u belieI' liS llllhe trulh ul'the nvermcnls ~ulltulnerJ III purngruphs
1.2 ol'I'I~lllllll's COlllplulnH the U\'crIllelltK lire Iher~li.Jre delllctluntl slrkl prllllfthcNIII'Is
tlemuntled ~ttrlul.
3, llenlcd us sl~ted, It IN ~dmllled Ihulllc~lthAl1Ierlcu PeuIlK~I\'ulllu,lnc, IN ulll:~hh
m~hllcll~nce orl!ulll~J1III1IlUrIlUIlI~.l:tlund IIperulllll/. under the IUWN ufthe ('lInllnllnwc~lth Ill'
l'emlN~lvunlu, Irlldllll& und tllllnl/. hUNlncss us lIe~JthAlIlerlc~ III' ('cntrull'cnns~I\'~lllu, with Its
prlnclp~llIlllceK IlIculcd UI 2601 MlIl'kcll'luce Strecl, lIurrIKhurJ!,. l'ellns~l\'unlu 17110.9:)3'),
4." Allcr reusIlll~hle IllwstlllulllIll,lleulthAmel'iculucks klluwlcdllc III' Infill'lnutlllll
sulllch:nlllllimn n bellel'us 10 IhlllrUlh of Ihe UWrll1cnls clllllnlnc<<llu flurul/.ruphN 4.5 ul'
I'lulllllll's CumpJullll: Ihe uVCrlnents urc Ihcl\!IlII'II dcnled und slrlcl fllwflhereuflN tlcmuntled ~l
Irlul,
6, Denlcd ~N stuled, Ills udl1lllled 111ll1lJcfimdunl, EUI/.ene l'ull1l, WUK cowretl ullder
u Fetlerul Emplo~ee's Ilcullh lIenctlts I'lun with IlculthAl1lllrlcu (herelnullel' "1'lan"), alrue und
correcl COI'~ of which Is ullnched hcrelo und mnde u pnrl hercof UK Exhibil "A",
7, No lurther resflonKc Is necess~ry,
8, The awrlllcnls conlulncd In flur~graph 8 of 1'lullllll1"s COlllplulnlure concluslous
of law or IUCIIO which no reKflulISC Is neccssal'Y; lu Ihe exlcnlu respollse Is decl1lctlllecessary,
Ihe aWrlnenls ure dcnled liS SllIled, The ulilresllld I'llIlI, belnuu wrltllll/., speuks I'llI' Itself us 10 Ihe
lerl11s Ihereof, Ills udl1lltled 111lIIlhc IUlIguuge '1uolcd In flllrugruph 8 of I'lulnlll1"s COlllpluinlls
included Intllc aloresllld Plan, which lungulIge, by Its lerms, cruss rclerences exceplions und
IImltallons 10 Ihe Slaled co\'eruge lor medlclll or surgical ClIre, It Is spcclllcally tlenletllhllllhe
lunllulIlle quoled In paragrllph 8 of I'llIlnlilrs COlllplulmls complele or conlrollhllllll rel&urd 10
.2.
Ihu clulllIN sCllilrlh In I'lulnllll's l'lItllpllllnl, IiII' Ihc I'CIISUIlN SUI 'imh hcrcll1l1l1l1l' In Ncw MlIllcr,
I), Thc II\WllIenls cUllIlllncd In plll'llYl'lIph 'Iur PllIllllin's l'lIll1plllltlllll'C cllncluNhlllN
III' IlIw ur luclllI whkh nUI'CSllllllSC Is IlCCCSSIII')': IUlhu CSlc1lI1I I'IISpUI1SC Is dccnll.'.1 nCCCNNIII'Y,
Ihc IIwrlllcllIs IIrc .hmlcd IIN HllIlcd, ThclIlill'cslIldl'llIn. hclllY II WI'IIIIlII, spcllkN IiII' IINclf IIN tlllhe
IcrlllN thercuf, II IN IIdlllllled 1llIIllll.'lIllh^IllCl'kll hllN NlIllsl1cdllll CUI111'l1CIIIlIlllhllYllthlllN IIlldCI'
Ihe IIliJrusllld I'IUl1lill' Ihc rCIINUlls Ncl ,ill'lh hcrcll1l1llcl' In Ncw MIIIIUI',
10, Thc IIwl'lllcnls CUllllllllCd In plII'lIl.!ruph III ur 1'IlIIIIIIIl's l'lIlllplllllllllrc CllllchlNlunN
'lflllW or lilCIIII which 110 respUIlNC IN IICCI.'SNUI')': 10lhc CSICIlIlll'CSpllllNC Is dcclllcd ncccsNllry,
Ihu IIwrlllUIlIN IIrc dUll led IIN slUICd, Olllhc COlllrnl')'. It Is UI'CI'l'ud Ihulllcllllh^lllcrlclI hllN pllld
I'lultlllll'lhe UIllOUlllllr$3,2Hllll, "II'II'CUlIllCI1I provided hll>ulclHlullI, EUl.!cllu 1'II11ll, lill'lW()
lll'lIllhs ur sllllrHerlll rehllhllllullvc Ihul'llp)' III cOlllplelCIICCol'd wllh IIlllllud hCllentN e')VCl'lIge
provided l\ll>ulcndlllll. Eugellc 1'111 III , )lursIHlIlI 10 IhcIIlill'csuld fllllll, Thu IIlilrcNllld 1'11111. bulllH II
wrltlllg. spellks rill' ItNulf liS 10lhe lerllls Ihcrcllr, It Is IIdllllllcd IhlllllclIlth^lllurlell hilS NlIllsncd
1111 e'lIllrIlClulllobIlYIIII.lIls Ulldcl' Ihe IItill'CSllld 1'111111;'11' thc rCIISllns SClli)l'lh herdnllt\er In Nl.'w
Mallcr,
II, The IIvcrlllCllls COllllIlllCd III p"I'llYI'lI)lh 1101' 1'I1IInllll's l'olllplllllllllre cOllcluslolls
of IlIw or IUCIIO which 110 respollsc Is neCCSSIII')': tUlhe cSlCIll n respollsc Is deemed IlCCUNNlIry,
thc IIwrmellls lire dellled liS NIlIled, The 1I1;.lrcsllid 1'11111, hcllll!. II wrlllllY, spcllks 1i)1' Itsclf liS 10lhe
lel'll1s Ihereof. Ills IIdlllltled Ihlllllclllth^lllcrlcll hilS slIllsl1cd 1111 eOlllrnclUulllblll!lIll11IlS ullder
lhc uloresllld 1'111111;')1' Ihe rellsulls sel fOl'lh herelllllt\er III Ncw Mllllcr, Ills s)lecinelllly delllud
Ihulllny chllrlles lor llludlclIl scrvlces provided by 1'1 1I1t1l1 11' rCIllIIl1I due IIlld owlllg ullder Ihe
.3.
"1.1I11~'1I:n1l r~hllbllllllllw IlumlllY,"
31, IlIH b~lI~wd IIlld Ihc..~lill~ IIWI'I'1:d, Ihllllh~ Illcdh:1I1 ~lIlldllllllllll' l>~lillldlllll,
HUt.l~II~ 1'lIlm, 1I111111'~1~"utlllllll~N ul'hlN ~UI'~ ulld Il'ellllll~11l h)' 1'llIllllln; WUN Hu~h thutlh~l'~ WIIH
Illl rUllsllllubl~ medklll ~Spl:~IUlllln urNIUl1lllcUl1lllllpl'uWJl1~111ln hlN Illl:dkul ~lIlldllhlll Wllhlll
two Illlllllhs UN IlI'CNullll1' NhllJ'l'11:1'1ll I'l:huhllllllllw Ihcmp)',
32. Ilcllllh^lllel'kll hUN pllld PluIt1lIfl'$J,1:'iJ,IJIJ, I'l:pl'CNCIlIll11! thc UlllllUlll pur"llrl~dly
du~ IiiI' IWOlllllnlhN III'Nhlll'l-ICl'lll I'chuhllllullw Illl:dkul CIII'I: Ul1d I I'CIII III I: II I pl'ovldl!d 10
n~I~lldUIlI, ElIgC111! I'uhn, CI'Cl1lhllllllh Ihcl'C WUN 1111 mcJicul cvldl!llcc Ihul Nllllllllcllnt
hnprowllll!JlI clIlIld hc cspcclcd WllhllllWII mlllllhH, und pll)'l1ll!ll1 WUK, Ihl!rcfill'~, 1101 requlr~d
purNuUll1III Ihl! Illill'1!6Uld I'IUI1,
3J. Thc uli)I'C6uld pU)'mCnl h)' J Il!ullh^ml!l'lcu hI l'lllhllI fl', li)r Irl!ulmcnl provided 10
nlll~l1dllJll, Eugcnc I'ulm, IiII' 11I11 Jl1l11l1h~ Ill' 6hllrl-ll!rJll I'l:huhilllllliw Ihl!rup)', WU6 1111:1Iml,11!11!
KUllslilcllollol' un)' IImlll!d hCl1cl1lN CUWnll!c ul'glluhl)' Ilvulluhlc III I>cl~l1dul1l, hll!CI1C I'ulm.
pur6Ulllll10 Ihc uli'l'c611ld Plun. uhhuul!h IIU)' ClIVCl'lll!C 11l1dl:I'lhc uli)l'c611ld I'IuI116 dCl1lcd,
34, All)' c1ulmlll' CUlISC uruclllIll us KClliJl'lh 111 Pluhlllfrs ClIlllphlllllls hurrcd b)' lhc
ul'ol'cKuid pll)'mcnllll Plull1llrr IIi' ull UmllUl1lK pUl'pol'tcdl)' duc und OWhll! Ihllllllcuhh^lllcrlcuol1
bl!hulfoff)cl~l1dulll, EUl!cllc I'uhll. plll'NlIUl1110 lhc UIUI'CNllld I'lull, uhhoul!h UI1)' COVCI'UI!C Ul1dcl'
Ihl! ufiwsuld I'lun Is dCl1lcd,
)5, The ulill'CNUld I'lul1, IIndcl' Ihe heudll1g "{]cl1cl'ulllmltullllllS". sllbhcudll1g "Othcl'
60Url:I!S ofhl:l1cI1ls", suh.subhclldlng "Wol'kl!rs' clImpl!nSllllon", provldcs IIIpCI'III1el11 pun us
1i:)lIoWKi
- 5 .
("lInp~Il~lIlhlll ACI WII~ Ih~r~i1I1~r l1I~d ullur IIhuut FchrulII')' 1/,1')1)4 h)' Ih~ ~Il,plu)'~r, IU, Jllllk
l.ulllh~r.III1.llhc clllplu)'Cr'K wllrkcr~' CIIIllIM1~lIllull cllrrler, ItuckwlIud CIIKUllh)' IIIMII'IIIIC\!
('UIII(1I1I1)', dCIl)'lnlllhc c1l1lllllill' WllI'kCrK' CUllllMIKlltlull h~II~I1IK, ^ Irue IIlld currect C'IP)' ul'lhu
AnKlwr lul~lllphl)'CC Chlhn P~llllulI undcl' PCI1I1K)'II'UIII1I Wurkl1lCII'K l'UlllpCIIKllllulI Acll~
1I1111ch~d hcrclullnd IIIl1dc II 1'111'1 hcrcul' UK F~hlhh "11",
4ll, UII Mil)' 12, 11/1/5, 1l~1\:IllJulll, J'lIl11 Jluhn. UK CIIurlllppullllCd tlullrdlllllul'
J)cfimdlllll.Eul!clw Jluhn, Ill~d U Pcthlulllill' AI'prlll'l1luI'T~l11purlll')' nIKClllllIIlUIIIl~C ol'l.clllIl
ACllulI Fllcd ullllchllll' 'If FIII!~lIc A, 1'11hn ulld Jill' Apprul'lIlul' AcccplllllCC ul' eC1'11I11I FUlldK III
Ihc Cuurlu"ColIIlllOII PICIIK III'PI.'I'I')' COUIII)'. P~III1KylvulIllI, 101luckcI NUlllhcl' P.~2,I, cllpllulICd
III HI.': ElIllCIIC f.. l'ull11, K~l.'kllll!,UIllUllllolhel'lhllll!K, hI II'lihdl'llw thc pelldlh~ W,"k~...
('Ulllll~IIKIIII'111 CIIIIIll PelhlunwllhuUI preJudice, 11IIIcccpl $64,000 pi UK 11ll1lull)' pll)'lllelllK U,.
$600,00 (1cr I11Ulllh llulIl'IIlllel.'d IiII' 15 )'cllrK ur Ihe 1I1\:lllllc lIi'1l~lcndulIl. FUllellc Pllhn,
whichever IK lUll gel', UlllU he I'lIld h)' the el11pIU)'I.'I"K w'lI'km' CUIllPCIIKUllulI currlcr, Hockwuud
eusunll)' IIISUI'IIIICC CUIllPUIIY, A Il'uc ulld currl.'clcupy ul'lhe PCllllulI till' Appl'uvulul'
TClllpornr)' DiscUlllllluullc~ III' 1.~1l1l1 ACIIIIIIIK utluchcd herl.'lulllld Illudc u pUrl h~I'CU"UK Exhlhh
HEn,
41, Thc Court 1I1'('IIIllIllUn Jllcns III'Jlerr)' CUUIlI)',l'eIlIlK)'II'Ulllu,III Ihc uhove-
cupllullCd IIctloll. IKKul.'d llll Order dUlcd Jul)' 12, 19<)5 UI1Prul'llllllhc lill'ellolllll P'lllliulllllld
uUlhorlzlll1l Dcl\:lIdulll. Jouu ['i1IIll, luuccepl $M.OOO lInd UIlIIIlIIUII)' pll)'11l1l $(100 pCI' 1ll01l1h.
lluurulllccd 1<11' 15 )'eurK or Ihl.' IIlclhllC ul' 1J~1\:lldlllll, Eugclle Jluhn. whlchcver Is IUII!!cr, ulllu hc
puld h)' Ihc clll(1lu)'cr'K \Vurk~rK' CUIllPCllNllllullCurrlcr, Rockwuud CUKuuh)' IlIsul'unce CUlllpUII)',
- 7 .
A trUe ulILl ~uml~1 ~op)' uf the Ordllr I~ ullllchcll hcl'Clolllld llIudc U pllrt hCl'cuf us Exhibit
HIIH,
42, Thc ulincHuld Ordcl' Ill' Ihlll'lIl1rluf ('llllllllulll'lclIs Ill' l'1lr/'Y ('lllllll)',
I'CIlIlS)'lvUIlIII, WlIS llr.lllrcd 1ll1l~ldllllll)' Ill'llcecdlllJ.l~ purHUU1l110 Ihll WUl'kcl's' ('IlIllPIlIISUllolI AliI,
1I11d thc pU)'flIClllllf 1lI111l1l)' h)' Ihlllllllpl")'CI"~ \\"lrkcl's' CUflIPIlIHlIll,," cUl'rlcl" IlllckwllOd
ClIsuull)' IlIsurullcc ('llfllPUIl)', hll>lll'cndlllll, JUIIIll'lI1fl1,lIll hchulfllfl)cfi:lldulll, I:IIW,IlIl11I'uhn,
WUK Ilolllllldc UK purl of UIl)' PI'UC'llldllljt llurKulllll \II thc Worklll'K' l")flIIlIlIIKUtloll Act, or
Kuhfllllllld III or upproved h)' 1111)' ",,,,,kCI'K' CUl1Il'CIIKUtlull jUdjtll,
43. Mlldlclll hCllclltK, \Il1dcr llle WurkcrK' CIlInpcllKutlllll Ad, 1I1'C pllld Illlhclr clIllrCI)',
ulld 111'11 nol Kubjcct lolllnlllllloll b)' CUllll'lIClulllugl'CCIllClI1 Kuch UK III,C IlIcdlcul hlllllllllK ullder Ihe
lItilrllsuhll'lun IMwllclllleuhhAllllll'lclIulld IJcl'clldlllll, Eugcllc l'lIl1n,
44, ThllulilrcH41d pU)'IllCllt b)' IlcuhhAllIcrlculol'lulllllll', IiII' IrclIlflICllll'l'Ovlded to
Pclimdunt, EUl!clle l'uhn, lilrt\l'o lll11fllhH Ill' Khul'l-tel'lll rchubllltUllve tllcmp)', WUK Illude ~ollll)'
bCClIUKllof the delllulol' \l'orkers' cUlllpellHulloll belldltH h)' the Cllllllo)'cr, IU, JUllk Lumber, ulld
thc Cll1llloycr'H workllr~' cOlllpCIlKUlloll curl'icr, Rockw\lod CUHuuh)' IIl~urullcll COll1pUll)', nlld III
cOlllimnnllce wllh uppllcnblc rcgulullons of llle COll1l1lUII\Wullh of PClllls)'1 vUlllulllHuruncc
Dcpurtmellt, ulld WIIS lIotlllude UK UIlUdllllsHIOllllf lIuhllll)' by IlcullhAll1erlcn or cllllllefllclll b)'
Dcl'cndulIl, Euglllle Pulll1, therelll ulldcr the tcrllls ulld cOlldillollH of thc ulilresuld J'IUll,
45, Iflhe cll1ployer's wlll'kers' CUIl1PCIlSlIlloll currlllr Is Illuklllg PUYIl111llts III
IM'clldulll, Joulll'ulln,oll bcllulfoI'Dcl'clldullt, Eugcllc l'ullll, 111 cUllllectloll Willi thll work.
reluted Injur)' UK Ket lorth herelllllboVl! ulld IIpproved hy Ihe CllUrt ufColl1n1oll Pleus of Perry
. 8 -
.....
thu uwrlllUIlI~ llflilCI ~ulfhl'lh III Ncw MUIIUI', pUrul!l'Ullh~ ~(1.47, hUl'ulllUhllVU,
4'1, Thu fillllll'u lIf'I>cIclIlIulIl, JlIulll'ullIl, 10 pUI'SUU Itw WOl'kul'~' Cllmpull~ulllllI Clullll
PUlltlollllll hchulfl)f'llulcl\<Iunl, EII!!cIlU I'ulm, "IF mudleul hCI1u111~ Ulldcl' the Workcr~'
('ompul1~utlol1 ACI, whleh wOllld flllly I'c,plll1d 1IIIIw dllllllN IIfl'llIhllll1' II11hlN IIclt'HI, cOll~lltulU~
U hl'eudlof Ildlldlll'Y dlll)'llIllhe 1l1l1'l1lflklimdulll, JIHllll'lIlm, liS CUllrlllp(lOlnled !!ullrdlull of
!>ulcl1dlllll. EUl!elw I'ulm,
50, The U!!l'eCII1CIll hCII\'Cul1l lclimdlllll, JOlll1l'lIlln, IIl1d Ihe emllloyel"~ wOl'ker~'
cOll1pun~ullolI clIl'rlel', I{ockwood ('1I.~ulllly II1SlIl'lIllCe COmpIlI1Y, IiII' pllymclllllf$M,OOO plus
alll1ulty paymel1ls ofMl)l) pCI' mlllllh !!lHll'llnlccd li)1' I ~ yellrs 1I1' lhc 111l:llmc of Dclcl1dllllt,
EUl!cl1el'ulm, whkllc\'cl' Is 10llger, IIII hI hc pllld hy Ihc cmploycl"s \\l)rkcrs' COmpCI1~lllIOIl
currlur, I~uckwuod ('lIsulllly Il1SlIrnl1Cu t 'OlllpllI1Y. Is Il1vlllllllllll1l1flhe Workers' t.'1Il11p1msullon
AI;t; Is llullulld void liS II purporlcd sClllcmCI110fwol'kcI'N' compcl1SIUlll11 hCIlCfilS I'H'lilllurll tu
cOlllply with lhc Wlll'l~crs' Compcl1SlIllol1 ACI; IIl1d 11'1111 clllcrcd Il1lu hy I Jcfcl1dlll1l, Jlmn I'ulm, III
hrullch of hilI' Ildudllry dUly liS CIIlIl'llIppllll1lUd I!lHlrdllll1oflJclimdlllll, ElIgcllC 1'111111, ulld 1l1l' hcr
OWI1 purSOIlUII!II111111ld pcclIlllllr)' Il1lurllsllll1d/ur lill' prulcclloUlIf'hc fillulldlllll1lCrUsls oflhu
umployer's workcl's' ClIHlpUI1SlIlillll cllrrlcr, Ruckwoud t'IISlIlIhy 1l1surnllcc (\lInpIlI1Y, Ulld fill'
purpusus ofl'Cljulrll1l! IlcllllhAmcrleillo pill' covcrcd hClIllh hCl1cfits 011 bclllllfoflJclclldalll,
EUl!cllC Palm, dcsplllllhu cUlllrucllIlIlgcl1crulllmilllllul1s ul1dcr Ihc IIlill'cSllid 1'11111, prccludinl!
pllymllnl ,i)r hllllhh bUI111I11 SCI'\ Iccs whlcb IIru plIYJIW!: ul1dcr workcl's' comllllllslIliul1,
51, Tbll ullll'csllld COlldllCIOlllhc plll'lOfllclclldulll, JUIII1 Polin. illdlviduully and as
court llppollltlld l!uurdiul1ol1 bllhulf uf [)ulcl1dunl, EUI!UI111 Plllm, ClII1S111U1CS U hrcach of contracl
.10.
bclwccnllcallhAmcrlclIlIlIl1 Dcli!ndllll', Hu~cnc PII1I1I, ulldcr .hl! 1l!/'IllH and condltlon~ of.hl!
aliJrcHald l'lllll.
52, Thl! ulilrcHuld cUII.fUCluf Ill!limdalll, JUlllIl'llflll, IndlvldulllI)' IInd IIH court
appolmcd I&ullrdllln on bchulf uf Dclimdllnt, I'u~cnl! Pulm, cunHtllulcH II brl!lIch llf Impllcd
cOlltracl bctWl!llnlleallhAl1lcl'lcullnd Ilclimdlllll, EUl!cllc l'IIIIll, IIH UIllClllhcI' cnrolled Inlhl!
IIlilrcHald Pllln,
5J. AH u rllHult Orlhlllllu/'CHllld cOllductuf Ilcfimdunt, JOlln Pulin, IllIahhAlIllll'lca haH
In filct paid ~3,253,OO 10 Plulmlff un hllhulr or IlclcndulIl, EU~lIl1l1l'ulin,
54, Thll pa)'lIllllltH b)' Ihlllllllplu)'l!r'H wurkcrH' ':UIllJlI.!IIRllllun carrlllr, Rockwood
CUHuall)' InHUrllnCII COIllJlUII)', lu Dlllimdum, JUlin Polin, 011 bllhalr oflMclldunl, I'U~1I111.! pallll,ln
eOlln~etloll with Ihll work.rlllall!d InJur)' UH Hctl'lI'lh lillrclllaboVll alld aJlJll'Uwd b)' thc Court of
COIllIllOIII'll.!aH orPcrr)' COUIlI)'. pCIIIIH)'lvunlll,lIlllkcH II c1l.!or lllUlllll.!dlclll hl.!nl.!tllH url! pa)'obll.!
undcr thc Wllrkl!rH' COIllJlCIIHotlun Act, ollll should haw prl.!c1udcd applleoll'lll 1'01' pO)'IIlCIII of
Illedleal bCllctlt5 undcr Ihc aforcHal.1 Plall hl.!IIWCn IlcallhAIIll!riculIlIO Dl.!fcnoollt, EUl:!cnl.! I'allll,
55, AH II rl!Hult ofthl.! brl.!uch oftlduclor)' dUI)' h)' IJcfcnoanl, Juan Pallll, and othl.!r
actionable conducl onthc parl uf Dl.!lclloant. Joan Pohn, and thl.! ul'orllHalo pa) Illcnt b)'
UcahhAll1crlen 10 Plalnllll'. all us sl.!tl'lI'lh hl.!rl.!lnabow, IIculthAlllcricll hilS 0 u'irl.!ct rll:!htor
action allohlHI I'lolnllf1' ano [)lIlcnoantH, EUl:!cnl.! Polin 0110 JOlin 1'01111, iiII' rl!lul'llof IIl1l1lcolcal
bcnctltH palo on bchalfoflMcndalll, Eugl.!nc I'olln,lo PlolntlfrpurSUUnllO thc IcrmH and
conoltlons of thl! ot'orl.!5alo Plan, ond 0 rl~hlor oct ion ovcr o~ulnst both I'lolntill'uno DI.!Ii!noonlH,
Eu~cllc Palm and Joon Palm, tu Ihc I.!Xlcllllhatth05l! SOIllI.! mcoical hCllctlts arl! paid h)' an)' othcr
. 11 -
purl)' un hulllllf uf /)uli:nLlulll, EUlo!unu I'uhn,
51\, As u rusullorlhu ulilrusulLl ~onLlucl ofllulimLllllll. JOlllIl'llhn. Ih:llhhAlIIllrlcll hils
InliM plllLl $313,H1\3,14 10011\1:1' huullh CUN pruvlLlcrs III 1IL1L1ll1on 10 I'llllllllll'oll huhulf of
IMi:nLlIIIII. EUlo!cnlll'ullll,
57, As lhu rusuh of lhu hruuch or l1L1uclur)' L1ul)' h)' IMi:nLlulll, Jounl'ullll. unLl ulhllr
uCllunublc cUIlLlUCI unlhc purl uf I1climdunl, Joun I'uhll, unLllhc utilrcsuld flu)'mcllI b)'
IlcullhAtnllrlcu lu olhcr hcuhh cnnl fll'llvldcrs In udLllllolllu I'lulnlll1', ull us Hcl Ibrlh hurulnullllw,
lIuullhAlllurlcu hus u L1lrucI rlghl urucllun ullulnHI Duli:lldulllH, EUllunc I'ullll unLl JOllnl'ulrn, lilr
rclul'llofulln\l:L1lcul hunulllH PUIII un huhulrurlluti.'lldulIl, EUllullc l'ulrn,loulll)lhur hcullh curc
provlLlcrs In uLlLllllon 10 I'lullllll1' jlunUlIllIlll IhclCrlm ulILI cUIlLllllllllH uf Ihu ulilrcsulLll'lull, unLl u
rlllhlorucllon OWl' UI!UlllHllluli:nLlunls, EUllullu l'ulmunLl Juulll'uhn, IU IhCCXlcnllhUl IhoHU
sume muLllcul bunullls ure pulLl h)' 111I)' ulher purl)' '111 hchulf uflleli:nLlunl, EUllcne I'ulln,
5H, AH U rcsull uf lllll hreudl ur IlLluclury L1uly b)' Deli:nLlulll, Joulll'ulln, unLl olher
uCllonuble cunducI ulllhe purl uf Deli:ndu/ll, JUUIl Pulll1, us scl tilrlh hcrclnubuw, und Ihc clullllH
uf 1'IIlIllIIll'ulld Deli:lldllnls, EUl!cllc Pullllulld JUlllIl'uhn, IleullhAlllcrlc1l IH cllllllcd 10
declurulory rcliefllllhcnuluru ur u dClcrll1lllullull b)' thu COUl'l whulhcr workcl's' cllIl1pcnsullon
Illcdlcul bUIlUllls ure puyublc ulldcr ull uflhclilcls un,1 clrcumHlullccS Illvolwd, us wull us such
olhcr rullcr U5 Ihls Cuurl deems proflcr, Illcludllll!, bUI uOlllmlled 10. u dlrecllolllhul Dctillldlllll,
JOlin 1'111 III , liS CIlUrl IIppolnleLll!uurdlullof IJcli:lldulll, EUgCllcl'ullll, flrl)cecLl wllh Ihc clulm lilr
workcrs' compellslllloll bCllellls Illld prulecllhc SUbrolo!lIllull rlllhls of J lellllhAmerlcll pursullnllo
Ihe Workers' Compensllllon ACI,
.12 -
WIIHIU!FOltl'.. 1>~'~ndUIII. II~ullhAIlI~l'lcu, d~llIunLlA judlMlwlllln IlK Iilvnl' ulILl UllulllKI
I'lulnllll'unLlullulhur pUl'lI~K, und Ihul Plulnllll'K Cnlllplallll h~ dIKIlIIKK~d wllh pl'ujuLlh:e unLl
eUKlK nflhlK uCllun, uIIIII'~KpuclI\III)' l'eLju~~IK lh~ "lllo\Vln~ 1'~lIef Ihllnlhu {'UUI'I:
A. LMl:IIL1unl, I h!llhhAIII~l'lcu, dUlllundKjudMIlI~nlUl\ulnKI Plulnllll'lnlhe ulllnunluf
$3,2S3,OO. phlK Inll!rCKlunLl CI1~1~ 'lflhlK ucllulI;
n, Dull:lldunl, IlcuhhAIIl~l'icu. L1clllulll.lK judl\Ill~1I1UIiUhIKII )cJ~ndunlK, I (UU~IIU I'ullll
alld Juunl'ullll,llIlhc IIlllounluf$317,II(J.l4. phl~ hllcre~1 ulld COKIK uflhlK uCIII,n;
Co Dcll:lldulll,lIcullhAlIlurlcll, dClllundKjudfl,IllUIIIUl\ulnKI Plulnllll'lnlhu UXIUllllhul
UII)' portlonoflhc ulurcKuld $3,2~l(jO IK puld hy UIlY ulher purl)' 'lIT hchulfuflM~nLlulIl, EUUl!IIl!
I'ullll, plUK hll~I'CKllllld co~l~ IIfliJiK IIcdlln;
I), Dctl:lldulll, IleulthAlIlcrlcu, dClllunds judglllelll uliulllKt D~limdullls, Euuenc "ulln
ulld JoulIl'uhn, tuthu ~XICllllhullIlIY porlloll Llf lhc uforcKuld $317,116,14 IK puld h)' UII)' oth~r
pUrl)' on b~hulf of Dull:lldulll, EUIi~II~ PUhll, plu~ 1111~I'l:Kt ulld CO~IK of IhlK uctloll;
E, Dcll:lldulll, IlculthAlIlcrlcu, dClllunds II dcclul'lllory Judlimcntlhutlllcdlcul bCllcflts
ulldcr thc Workcrs' COIllPCIlKUtlol1 Act urc PmIIk, ulld llHll,lhcrclurc, OCIl:ndulll,
HcullhAmcrlcu, hud 11'1 ohllgullOI1 ul1dcr lhc tcrms IIlld CLllldltl\lI1s of Ihc ufiJrcsuld I'lullto pu)'
mcdlcul bCllcllts on bchulf of Ilc'~l1dullt, I':ugcllc I'ulm; nllLl
F, Dcll:lldul1l, IlculthAmcrlcu, rCLjucKlS such other rcllcf us lhc Court dccll1K Just und
propcr Illcludlng:
(I) R~Ljulrlnl! D~timdulll, JOUII J>uhn, us courtuppolllted guardlull 011 bl!hulf of
Dl!limdullt, EUUl!l1I: I'uhn, 10 pursuc u clulmlilr workcrs' compcnKutlonllll!dleul bClleflts undcr
- 13.
, '
'UJ~TIFICATE OF S1!Ii\!J.Cll
"
I, Jll~k M, Jlllrllllllll, EH'lulrll. hl!rl!ll~ Cllrllf~ Ihutlllln thl~ du~ Kllrvlnw u cup~ ofllle
lbrcl&olnw dllcullIent upulllhl! J111rHUII(K) ulld IlIlhc IllUIlIIl!r IlIdlculcd helmy, which Kllrvlcll
KlltlKl1CK the re'lUlrCIIICnlK uflhc 11l!III1K~I\'1I11111 RulcK IIrl'lvlll'l'occdurc, by dcpuKlllnw II cop>, or
KalllllIn lhc Unltcd tltute~ lIIull. J1rKl.c1uK~ po~lugc J1l'cJ1uld, II~ li)lIuw~:
(Jur~ I.. l~lllhKchlld. EKljull'c
Sel'rllllllll. Schlmnun, 1I1'llWI1 & Culhoon
:2040 I.Il1gl11~lllWIII~Olld, Sultc 106
lIurrl~burg. I' A 17110
, ,
Rlchurd Ourc. EKqull'c
1776 S, QUCCIl SI/'l~cl
York, PA 17403
,.
" "
I j I'
,
I,':
ThuIIIIIK T, Fl'llIllJ1loll, E~ljulrc
I'lctl'llgllllu, lIl)~lllck & Gurdon
Thc Thll'l~.Elghlh Fluor
OIlC O~liJrd CCIllrc
I'lll~burgh, PA 1521 'l
,
,
"
d.
Frllnk J, Lllwry. Jr,. E~qulrc
Lllvel'~ & KIIIIl
212 LOCUKI Slrect
Hllrrlllburt!. I' A 171 0 I
"
HARTMAN & MILLER. P.C,
,I,
By:
-
J C M, J-1ortllllln, EKqulre
rellle Cl. 1.0, 11:2 J 902
One Key~tol1e PI07.II, Suite 107
Front and Murket Streets
IllIrrlsburg, P A 17 J 0 1
(717) 232.3046
Datedl .I.1/ft./I.L
AltomeYll rur Defendant,
IlealthAmerlco ofCentroll'ennsylvlIIlla
II
"LonY-I~nn rllhnbllltallvc lhcrap>,,"
3 I , lll~ b~lIml! anI! lhcrllfllrll av~rrel!, thnt the m~dl~al ~llndltllln of Pllf~ndalll,
gUII~n~ )lulln, ut nil rlll~vnnt tll1l1l0 ofhlo ~urll anI! IrcullIll!nl b>, 1'laIl1lIl1', WilD ~u~h Ihullhllfll wu~
n') rlIuolll\abh: ,nedlculu~peclutl'H1of olUl1lllcant ImprovulIllllllln hlu 1Il1ldlcnl Clll1l!ltlllll within
IWO mOlllho aun ruuult ofuhllrt-lurm rchuhllltatlVll Iherup~,
32, UuulthAl11urlcu haH puld Plnll1tiff$3,H3,OO, fcpreounllnll thll ulllount purportcdl>,
due: tor two lnol1lho of uh.lr!-tenn ruhubllltUllvll tJ1edl~ul curl! al1d lrllumllll1t provided to
Dlltimdul1t, EUllene Pulm, eVlll1lhoullh thure waD 110 medlcul ul'ldel1Celhul ollll1lllcunt
IlIlprovement could bu U~pllclul! within lWll mont:lu, al1d paymenl wuo, thllfl:loru, l111t rlIljulred
puruuunt to thll uforeoul,l Plan,
33, The uforeould pUYlllel1t by UeulthAmerlcu tll Plalnllll', for lrealll1el1t provided 10
Defendunt., EIJllene Pulm, lor two monlho llf ohort-tenn rehubllltullw therupy, WUD 111 complele
sl1tlufa~llon of uny limited benents coverlllle urlluubly oVl1l1able to Deti:ndunt, EUlllll1e Pulm,
pursunnt to thlll1foresl1ld Plnll, ulthough UI1Y covllrul!e uOIler thu I1foreol1ld Plun 10 denied.
34. Any cluim or CUU5l! of UCtllll1115 6Ill forth In Plulntitr s Compll1lnt is bl1lTlld by the
aforesl1id pl1)'mllnt to PlalntltT of 1111111110unts purportedly due und owlnll from HealthAmericl1 on
behalf of Dd'endunt, EUllenll Pl1lm, PUl'suunt to the ntoreould Plan, although IlIlY coverl1lle under
the uforllsl1ld Plun Is denied.
35. The aforesaid Pll1Il, under the hCl1dlng "Generl1ll1mltl1tlono", oubheudlng "Otbllr
sources ofbenctlts", sub-subheading "Workers' compensation", provldllo In pertinent pm I1S
follows:
.5.
,
Th~ Plun wlllnol I'U)' 101' surl'lc~s r~4ulrcd us thll rcsult of llccupatlollul dlo~uijll or
Injury for which uny mudkul bllllllllto IIrC puyublelllldur wOl'kllrs' c11lllpCnijutlon
(un~er liwllln H Ill3 'lfTlllu 5, U ,S, elldc) Ill' slll1llur lUll'S, rll"unlles~ Ill' wlldlhdr
\)f 110\ Illddh;J)1 b~1I1l1l10 hUl'e beJlJUlDIllh:ll.JiJr.J)Ljllililllndur workers'
<;'Jmpellsutl,mor olmlllll' I'ltlvlslllllO, (ulllphusio IIddcd)
36. It Is bullllwd.lllld Ihurcf,)rllllVlll'I'uJ. Ihul UllllI rllluvunlllllllls OlltclldlllllU, EUlld1l1l
pulm ull,jJllr Juun Ilnlm, hUIIl rllprllSlll1lllJ Ihllllhll inJlIrlus III<:ul'lcd by lJulimJunl, EUI!IlIll! I'uiln,
wer~ Indeed in<:urrlld dul"iny lh,! Cl)UrOllllnd scop~ llf ulllploynwl1lof DclimJunl, EUI!l!lllll'ulm, b)'
hlo emploYllr, R,J, Junk, vdib/tllU, JUIlI, I.umbul' (h~rcllluf\llr "IU JUl1k Lumber"), ullJ lhut thll
employer, R..I. JUllk Lumber, hus lit 1111 n:IUVtIlH tlmlls nclil\llwludllCd thul DIlIClldlll1l, EUj!enc
I'ulm, wUHllljUrIld durlnll thu coursu anJ SC'I!,Il11f his clllplo)'m~lll,
37. A Notlcll ofW'lrl,urs' Compclloallon DClllul wuo Issu~djoinll~ by tllu Ilmployer,
R.J, Junk Lumbllr, nnJ thllllmploYllr'o workurs' compcnsutlon carrlur, Rockwoud CllSuulty
ln$urunce COllll'uny, dUIUd Nuvllmbllr 23, 1993, c1ulmlllll u luck ofllledlcullnfoll11utlolllllld un
onllolnlllnVllstlgutlon to cOllllm1 lhu umploymllnt ofDclilnJant, ElIl!ellll Palm, by lhllllmployc:r,
R.J. Junk Lumbllr. A lrull unJ corrllct cupy ofthll NOllclluf Workero' Compensl1llon Ollnlull$
uttuchllJ hllrllto und madllll purt hereof Ull E~hiblt "B".
38. A Claim Petition for Workers' Compensl1t(on WIlS thc:rellftcr med on or ubout
Decembllr 2.7, 1993 on behulf of Dllti:ndunt, Eugllnll Palm, signed by Deli:ndllllt, Joun Pl1lm,
lIllalnst lbll employer, R,J, Junk Lumbllr, seeking, l1Il1onll other things, payment ofllledlcal bills.
A true IlIld corrllct copy Oflhll Clulm Plltltlon for Workers' Compenoulionls uttl1ched hllretIJ IlIld
mllde a pl1lt h"reof I1S E:<blblt "C".
39, Dllfllndllnts' Answer to Employec Chum Plltltlon under Pennsylvunll1 Workmen's
.6.
Clll1lPUIMUllon Act wuslhuNullllr lIIud Ollllr lllmut FubrulIf)' I), 11)1),1 by Ihllllltlplo>'lIr, R,J, Junk
Lumber, nnu lhll umploYllr'o workllr~' CUIIlPll'lolltlllll clIrrlllr, RllCkwOlllj CUKuuhy Inoul'unclI
C1lf1111uny, dllnylllJllhll clulmll)l' workuro' cOl11pemullll1l blll1l1lho, A IrUll un<l CIlITucl Cllp>, of lhlt
Anowllr to ElllploYlI1I l'lullll Pullllolllllhlllr PlIllllHylvlIlllu lV<lrkmUl1'o l'IIIllPllllHlIlllln Alii 10
auuchud hllrlllo ulld l11udu II pUI'l huruof ilU E~hlbll "D",
40. 011 Muy 12, 1'1'15, DUI'undunl, .1<11111 Pulm, uo courlllPllohltud llulIrdlun of
Dllti:ndulll, EUIlIIIlII P'III11, 11IIId II PUlillonllJr Approvullll'T<!lIlporury IJloconllnuuncu of LUUlIl
Action FlIll<l on l3uhulf of EUl!enll A, Pullll ulld Illr Apprlll'ulof ACCU/llilllCllof Curlllln FUlld$ In
U1U Court llfCOI1H11<lf1 PICII$ <If PUITY COUllIY, P<!111l5ylvulllu, 10 Docklll Number P.32~, cuptloned
In RIl: EUllllll<! A. I'ulm. ollukllll!. UIIlOllll olher thlllgs, to withdraw thu pllndlnlJ Workllrs'
Compllnoutl<m Clahn Pelltlon without prlljudk..:. 10 UCCllpl $64,000 pluo unnulty puyments of
$600,00 pilI' Illonlh lluarnl1llllld lor 15 Yllurs llr lh<! IIIi:llmll of DUIi:ndunl, EUl&llne Pulm,
whlchllver 1010111&111'. ull to bll puid by lhu 11ll1ployer's w'lrkllro' compllnsntloll CUITIIlI', Rockwood
Cusuulty Insuruncll Compuny. A tnJe und Cllrrect copy of till: Pllllllon tor Appruvul of
Tumporary Discontinuance of llll!ul Action 10 Ilttached hllrelo und IllUdllll pun hllreof I1S Exhibit
HE.',
41. Thll Coun ofC,)mm<ll1 PIllU5 of Perry County, Pennoylvnnll1, In thlll1bove.
cl1ptloned I1ctlon, Issuud un Order dutud July 12, 1995 upprovlnll tblltorllgolnl! Petition I1Ild
l1uthorlzlnl! Deti:ndunl, JOIlII Palm, to accept $64.000 and IlIl unlluity puyln!! $600 pllr month.
guurunleed tor 15 years or thll lifetime ofDlIfenul1Ilt, EUI!Unll Palm, whkhllver Is longer, 1111 to bc
pl1ld by thll employer's wflrkers' compensation currlur. Rockwood Cusuulty lnsurunce Compl1ll)',
.7-
"
^ trullllnd ~oln~l copy oflhlllJrdur 10 IIl111clied hllrelo IInd mllde U pUI"! hllrellfuN Exhlbil
111:111
42. Th~ utilrmld Order of lhu Court of COlllmon Jlleu~ Ill' Purry CIlUfllY,
Pcnnsylvunlu, woo entllrud llutoldll uny Ilrll~eedinllo purouunllll lhu W'lrker~' COI1l/lelluatl~JIl ACL,
lUlL! Lhu puymulll ormolley by Ihuull\phl>ur'K wllrkuru' ~lllllpUn~lIllllll ~lIl'rlur, RllCkll'ollL!
Cnounlty lnouruncll COl11pany, hl De(undulll, J'lW.l Pulin, on behulf or DIlI~ndullt, EUl&enlll'nlill,
WU8 nOlmudll us purt of any /lro~uedlnl& purOUl1Illl1l lhu Workur~' Compenoutloll A~t, or
~ubmittlld to or approved by allY workm' COmplll1~lIllon JuL!lle,
43, Medical benellls, undur lhu Workers' CllfllPllllUutlon Act, 01'11 puld III Ihulr elltlrely,
and are not oubJect III IImlrutillll b~ ","I'lI~IUul ug'""III""I.11.J... .1\: ,nudlcul bllnenlS ulldel' thll
I1toresuld PIM belwelln HUllhhAlllllrku und Dc:ti:ndunt, EUllene Palm.
44. Thllnfore6uld /layment by HeullbAmerku hl Plahnin: for truulment provided to
Dllfendunt, ElIgene P111m, for two mOl1lhs of short.lenn rehabilitative Iherl1py, wus madll solllly
because oflhe dllnlal ofworkero' ~ompllnsatlon bune/lts by the employer, R,], Junk Lumber, illld
the employer's workllrs' complllluallon cl1lTlur, Rockwood Casul1lty Insurance CompllllY, und In
contormun~e with upplkablll rll~ulallons of lhe Commonwealrh of PenllsylvIlIlln [nsurllllcll
Deportment, und WI15 not madllas un admission of liability by HealthAlllericu or entitlement by
Defendant, EUllenll Pl1lm, thc:reto under the terms I1I1d conditions of the lltoreS111d PIIlIl.
45. If the employer' 0 workers' compensation carrier Is mllkillg pl1yments to
Defendunt, Joun Palm, on behalf of Detendllllt, Eugene Palm, In connection with the work.
related Injury Q5 set forth herelnnbove und approved by the CoUrt of Common PlellS of Perry
'.8.
C1lunty, P~llIu>,lvunlu, I1llldlclIl blllWIllS uru t1WrlItilrll puyublll undllr thll W'lI'kllrK' Clll1lpllnolltion
I\Ct unu would pfllcludll UppllcUllontor l'uYll1unts llf I1llldlo:lIl benellto undllr IhllulorllKuld Plun
blllwc~n B~u.hhAlllllrlo:u und Dllli:ndunl, EUllllnll llall1l,
46. In nddltllln to lhll ul'ltuuuld I'IJYIllIlJlI tl) HllulthSoUlh, HuullhAl11llrlclI huo l1ludll
I'UYllllll1tK I,ll' m~dkul bllnllllu I'rlll'l.Jud III Dllli:JldUI1l, EUijllnll Pulm, urlolnll rl'llmlhe work-
rlllatlld Injury Inlhlltolal umoullt or $313,H63, I 4,
47, If 1.lllUhhAllwricu hUK muJu I'llymul1lo pursuunt to lhll uloreonlJ Plun tor I1llldlcul
benelllo which urll puyublll ullllllr thll Workllro' Cllml'llnKutlllJl ACI, und urll ultlmntllly detllnnlnlld
to be paid by thllllmploYIlI"s workurs' compllnKutlon cnlTler, HeuhhAmllrku hilS u Slulutory rlllht
ofoubrol!lItlon tor JlllmlldlclIl blllllllllK Ihlymllnto mudll (1II b(half <If Dllfundlllll, EUllllne Plllm,
under the Workero' Cl1l111'1lllolltlon Act; und/ur HcahhAmerlcl1 hUH 11 Clllllf1l0n IlIw r1llht of
oubrogutlon tor l1l11dlo:ul benllllts pnld on behalf of DlIti:ndullt, EUllllne Pulm, ullulnsl the
Ilmployer, R,J. Junk r.umbllr, undl'Jr lhu empluyer's workllrs' compenoatlon currier, ROllkwood
CllSualry Illsurnncll Compuny; und/or BeuhhAlllllrlcu hUS II contructuul right of aCllon IlgUhl0t
Delendun15, EUllenll Palm IIml Joun Plllm, tor rlllUm of Illll1ledlcnl bllnlll1ts puid on bllhalf of
Detendunt, EUllenll Palm, pursuant to thll tllmlS und conditions of the uforesuld Plun.
WHEREFORE, Dlltendunt, HlllllthAmllrlca, demunds judl!mllnt In 110 tilvor und allulnst
Plllintlff und 1111 other pllrtlllO, Ilnd lhllt Plulntlff S Compllllnt be dlsmlsolld with prejudice und
costs of this Betlon.
New MUlter lIursullnt to 1111, R.C-P. n52(d\ versus
pefendlllll~. Eugene Palm IlIlJ Joun K. Plllm. nnd Counlllrclulm
48. HealthAmllnca hllreby incorporlltes by referencellS thoul!h fully set forth herein
.9.
llw uwrrllllllts Ill' fuel oUIIllf1h III Nllw Mutlur, pllrllyrul'h~ 2t>.,17, hllrulllllboVll,
-II}, Thl! fallurl/ III' Dllfl!ndlllll, JOlin Pulm,lo pur~ulllhll Workur~' C"mllun~ullon Claim
I Pelltloll on bllhulf of DlIf~ndanl, EUYIlIlIl Pllhl1, lor me,lieal bUllulllo undllr thll Wllrkero'
Compunijutlon ACl, which would full>' tcspl)l1d III lhll o:IlIlmo ofPlulntln'ln lhlo llClllllI, conotllulllo
,I bruach 01' I1duo:Iur>' ,IUIY lllllhll 1'111'11)1' 111/1i:l1dlllll, )'llln PUIIll, 110 ,'uUtl 1I1'/lulnh:d iluurdlun III'
Deli:ndunt, EUIlI/IlC Pulm.
S\). Thu uilrcunWlll blllWUUII Dllf~lldullt, )1)11Il Plllm, ,\Ill! lhu IlmJlI<I>'er'~ workers'
COl1lpellOUllolI cllrrlllf, HllCkwood CllilUlllt>, Jllourlln~e C'll11pany. lor PUYIl111Ill11f $64,00\) I'lu~
annuity puymcnu ofSI\\)1l I'llI' mll'llh ilullrlmtucd 1\1I' 15 Ylluru ,)1' Ihllll/i:tlll111 III' Delcl1dulll,
EUilllnll Palm. whkhlll"'t 10101111'11',1111 hI b~ pllld by Ih~ llmploy~r'o worl,~ro' "'lmpllll~UII')Il
clllTier, Rockwood Cuuuulty Inourul1cu CIlI1ll'uny, 10 III vlolllllonlll'lhll WOrkllrij' COll1pllnslltlam
Act: Is null WId void I1S a I'ul'portud i1ullllll1lUllt ofworkllrij' compllllolllloll bunlltlru tor failure: 10
com/lly with thc Workllt~' Compllllilullon Act; und WllS IllltcrllU Into by DIlI\:ndul1t, ),)un Plllm, 'n
brcach of her tlduclury dUly aH court UPPOhltlld Iluurdlun ofDulclldufll, Eugllnll Palm, und for hllr
own personull!uln und pecunlllr>' Interl/Slolld/or tor pr<llllcllon of thll Ilnullclullnlllrcots of thll
Ilmployer's workllrs' compllnillltlon carrlllr, Hockwood Casualty IlIourunce Compuny, und tor
purposeo of ~equlrinil HealthAIl111rlculo pay covereu hllahh beneHls on bllhalf of Detcndllllt.
Eugene Palm, dllopltlllhe cOlltruclulIlllllllernlllmltutlons under thlluforc:suld Pllln, precluding
puyment for hllulth benellt servlclls which ure puyablc: under workers' complmsatlon,
S I, Thllllfore~ulu conduct on thll pm of Det\:ndl1l1l, Joan l)ulm, Indlvlduully and I1S
court appointed IlUllrdlun on behulf of Dllfend:mt, Euge~e Palm, constltuteo a brellCh of contract
. 10.
b~lw~en H~ullhAI1l~rl~u alld O~fllllllulIl, EUllulle Puln!. lllld~r lh~ lumlU und ~ondltlon~ of Ihl#
ufor~uald Pllln,
52, Thu uforuoulu cllnllucl of O~limllunt, Joun Pulln, Indlvldunlly und u~ court
appolntlllllluurdlun on buhulf of PllfllndulIl, Ellllenll pulm, ~onulltutu~ u bruuch of Itnpli~d
contract bl/twulln HuullhAJIlllrkulllIJ DulimuulIl, fiulll/lIl/ Pulm, us u l1Iumbllr ul1rolh:llln thl!
uforlloulll Plun,
53, Ao u rUiulll)I'llll: utoruiald condll~l of Pl/li:ndallt, JOUII Pultn, Hl!uhhAmurlcn huo
In tallt pllld 53,253.00 10 Plaintiff 1111 buhnlf ofDefundunt, EUlle'lIl Pulm,
54, Thu puyml/lIlti b~ thu umplllYllr's workun' cllIIlplln6nll'lIl currll/r, R'lckwood
Clllluulty IlItiUranCll Compuny, to DufUl1dunt, Joan Pulln, on buhulf of Dl!ti:ndnlll, EUI!UM Plllm, III
co,,"~ctIQn with thu wl1rk.relUlud Injury Uti Ollt forth hl!I'l/ll1uboVll und uppr<Jvud by thu Court of
Common PIIlIlll ofPmy County, Punn6ylvunlu, mukeo It c1eur lhut ll111dlcul bunul1to orl/ Pllyublu
under the Workeru' Compllnsntlon ACI, UI1U ohould huve pruclu..Iud applkullon for puyment of
mlldllllll bllnllllts undur the aforeould Plun bUlween l-IealthAmedca und Dllfundunt, Eugenu Plllm,
55, As a result of thl! bruallh of t1uuclury dUI~ by Ddi:ndant, Jl)Un Pulln, and other
actionable conduct on thll purt of Defendl1l11, loun Palm, und thu uforemld puymllnt by
HeulthAmericll to Plaintiff, ulll\:; setlorth hllflllnublwe, HeullhAmerlcu has a direct right of
Ilctlon Ilglllnst Pllllnllff unu Dllfcndunts, EUl!,cnc Palm und Joal1 Pulm, for retum of ull medical
benlltlts pllld on behalf of Deti:ndant, EUl!enll Plllln, to Plalllllff pursullIltto the tenns und
conditions of the aforesaid Plan. und a rll:!ht of action over against both Plaintiff IlIld Defendllllts,
Eugene Palm IlIld Joun Palm, to thll uxtllnt thut those sWlle medical benlltlts ore paid by uny other
- II .
..
purt~ oil b~hull\)f O~timdulll. f!ullcnu Pulm,
56, Au U re5uIt ofllw uforcuuld conduct of Defendunt, JO/lnlJulm, HeulthAlIlIlrh:u ho~
In till:l paid $3 I 3,HI\3, 14 10 oth~r heulth curll provld~rs In uddlllonlo Plulnlltr on b~holl'of
Dc:tcndant, EUlllll111 Pulm,
57. Ao lhu r~ulJlt 1)"lh~ bruuch llt'thluclury duty by [)cfi:/1dullt, )I)un Pulm, ulld olhcr
uctlo/1ubfll conduct on thl! purl of DUlimdul11, JOU/1 Puhn. und lhll atilreoald pUYI1l~nt by
HuulthAmllrlco to othur hculth cure prol'lders In oddltlll/1 tI) Plulntll)', 011 uo set Illrth hllrulnubovll,
HuulthAmllrlca hU5 u direct rll!ht ofuctlu/1 Ul!Ulnul DlltC/1dlJJlts, ElIl!c/1c Polin und JOU/1 Pulm, tor
rerum of ullmc:dlcul bc:nlllllo pllld un bchulf of /)~Ii:/1dunt, ElIl!~n~ Pulm, l<J allothllr hr:ulth carll
provldero III uddllloll to PlulJ1lllY 1l1lrSUIIJ1Il0 th~ lerms Ull" C11ll"1t111l10 of the ul'lruoald Plun, a/1d u
rlllht of uCllon over alllllnot Dllli:/1dants. ElIl!llnu Pllfmlllld Jl.lan Pulm, tll lhlleXtent thut those
sume medleul benel1to urll puld b~ IIny other purty 011 behlllf of Dlllcl1dllnt, EUllulle PlIlm,
58, As u reoult l)fthe breuch of Ilduclury dUly by Dlllcndullt, JOU/1 Palrn, und other
Ilcllonuble: conduct on lh.: port of Delcl1dunl, JOlin Puhn. as sUll,mil hllrlllnuboVll, WId the: claims
of Plulntltl' und Defelldanl5, EUl!enu Palm and Joun Palm, lIc:ulthAmllrku 10 entitled 10
declorlltory relief In lhll nature of 0 detennlnlltlon by thu COUrt whelher workers' compensutlon
medlcrll benel1ts ore ~ under all of the lucts und drcumslunceo Involved, 00 well us ouch
othllr relief us this Court deems proper, Indudlrll!, but not IImitcd to, 0 direction thul Detcndllllt,
JOIlll Palm, I1S court uppolnted Iluardlllll of Delcndulll. Eugene Palm, proceed with Ihll claim tor
workers' compensutlol\ bllnel1ts and protect the 5ubrol!ntlon rights of He:lllthAm~ricll pursullIlt to
the Workers' Compenslltlon Act.
.12.
,
WHEREFOIU~, Petimdunt, H.:ollhAmurlcu, d.:mundo judllm~nllnllo IilVllr und ullulnol
Plalnllll'l1Ild ull LlI,her purtleo, und lhut Plulntlff~ CLlmpllllnt be dl~ml~~ed wllh rr~judlo:u IInd
co~ls ofthl~ u~IILln, und re~pl:ctfully rUljUl:otN the tilllowhlll r~lIef Irom the Court:
1\. Outcndllnt. HuulthAlllurlclI,l!lllllund~ judlllllenl ullulnul Plulntlfl'lnlhe Ul1llJunt l)f
$3,253,00, p1U511ll1:rl:~1 ul1d CO)510 Oflhl~ UCII'lIl:
B, Pefl:nolunl, HuullhAml:r1~u, dUll1undo judUlIlllnl uguln~1 P.:timdunlo, EUllllne Pulm
und Joun Pulm, In lhllUlllount Llf $317, \\ 6.1", (llu~ Il1lereot ulld COUlD \If this uCllon;
C, Pe'~ndunt, HuulthAIll~r1clI, dUlllllndo juulllllunl ul!ulnsl Plulmlff to lhlle:<lunt thul
uny portion of the utoru~uld $3,253.()1) 10 pllld by Ilny olher purly on buhulf of Defendant. EUllenu
Pulm, plus Il1lereot und ~llOt~ Ill' Ihls lI~II'lI1;
D, Detclldullt, [-Ia:ullhAmurku, dUlllundo judl!ll111nt al!ulnut Peti:l1dulllo, EUlIllnll Pulm
und JOIlll Pulm, to thlle:<lenlthut Ull)' pllrtlon of the ufor0:5uld $317, \\6,14 Is puld by UIlY Llther
puny on buhulf of Do:ti:llllunl, EUllene Plllm, plus II1lereOl11l1d costs of lhi~ uctlon:
E, DelcndulIl, l-luulthAlllericu, dlllllundo u dllcluratol'Y judlllllunt thut mudlcul benetlts
under the Workers' Compllnsutlon A~t ure po.>,abl~, uno! lhut, therefore, Defcndunt,
HeulthAmericu, hud no oblilllltlon under thll teml~ 11Ild conditions ofthll utorlloald Plun to puy
medic 111 benetlt5 on bllhulf of Dllflllldwlt, Eugen~ Palm; IlIld
F, Dc:lcndunl. HllulthAmericu, requests ~uch other rellef 115 the Court dUllms jU~llllld
proper Includlnlli
(I) Requiring Dllfendllllt, Joun Plllm, I1S court uppointed guurdlun on behalf of
Defendlllll, Eugene Palm, to pursue a clulm tor workers' compensutlon mudiclll bunut1ts undllr
. 13 .
'.
In spe.ct-or Gener-af-adVls o'ry.:'s.t-op.-heaTth c a re.fraUd!
____ ------ __I -----.--------
j ':r(JlJtJ 'PI:'.nU'1I ,,'. ';CIII 'll h.~lJllt1 ';0/1' ,,~( ','III,.,lJ"l! """'I~I1" ""~IJ ,,~IIII1II':l1l1l1y m.I/t1l1t .l tUllt" ijllllll,1111,1l ';1 .) 'ulllll ,-:IQIIl1 ", 'HI"1f IQ
:UIOII' ','UUIIII''':lI t.:lI'lt.fUIS, ,;r I' .;Ilflll tl) 1',;'lfU.. !I'1t ""'CIJ/1l:I,'lSlJrlu't.:I, 1;.",.,11111. III I"t,".;t II, ,:,r.llIIl;t,III,n 1m pp,,"UC WI'II:" II\a'l
'JI~\JIIII' C~tI\UN"L Pl:.NAL TIE S 1:'I,nsl' III\t1ftW ,JII It1.,tJII;UllJllIll /t'II'W:Ul11f':C/fJIt "t'LJ .j1I1l,t'II'~lI 'iIIJIQ"'lf/lllj ':i1rltll4l1y II tOIJ /II'IJ It'llla
';,I"lltJltt,llIef' ill a 'JI;I;I,;, 1"1;1$i;IILlI ~".,'mQ"(. fie.. ':I'i1'~IN fl;IJ{ "'111,'."':11 r;14" '0' ~""III;"15 (Ijl) :ul {1tJI Iftl:lIp"., "IIIIN '4' 't'ltt .,.rnlJ
~.,rlll:1I thlt.:II, ,~, 1111I1fltl:",Uf1l1ftJ ;Jf"f ,:11'", "":"'~aIIGt'. I/JIII' 'r... /qlla:W1111} 11.;111:"'0:
c.:.lIlt'., IJIlJ\tIU., IIJr.t,;h;r MI)ISUII/l1 .,I~) ""13 u~ Iqr ." If)plfll'tllh,,' ... 'lJ/l,.,IIf"1111S tl"lt (:'~l:llfm 'IS 1 ,1"'1.l:11t .',,;f
1111" ~IO"O" oou 001 {UO". 1I'.'"III.r, or ,I ~o~ {dlll.'O ~OO~dr>'~O, ,.,IIOI/r "'I~I.r~. Pl." dll'~GGITJ~ ...,. 'I' PIII.~~r?" 0'
I 'UOOI7Q~,Q"a 'I' C~oIr.,llq""lyl'IOI. .ro I.pl.,,, I~d .II~IIIO",
II 11'1 "'Inll 'I "01 luol,.o 1"1' 'P"~I"Q 10 lo~r 'OI~fG"CI plOO I.M lOll '1II11~IP~~llr.~o h.. Qun oommllllol, 0111 or wnl.,
Confidentiality
Audits
It you are a
new member
THI HloAt. TH CoARI PAoAUO HOTI.INl!
(1001 GOQ,QQU
T~. C/fI~1 01 P"looo~1 MlroUI",I"'
Clllol 0/ 1111 "'IP~CIC' a~OIlII F{I~lIl-'olll"1
2~OO <::11II"oon BI,o" S~1I1 I ~O I
.AIII"Qlo", VA 22201
-
General Information
MIOlol' I"" olhl' In/cr>IlBIlC" ~ro,'o~o Ie II'~ IlIp" II klPI eonlldlnll.' ."., Will 01 ~..o Dy Ihl fJl.n
..\0 III .un~o""'Olorl Ol'ly '0' Inltfl'lll domlolltrlllon 011"1 PI.n, CO". 1101 mloloal r"III~" 0' IOU-
oaUOII, ooo,olnallo" 01 o~nl/ll ~rO"IIO". Wllh 01~1I pla"l. .~~rouallon 01 OIGJml, or by OPM .00 Ila
OOIlIlIOle/$ 11\ ''''IWIOU . 011r.~1t0 Olllln,
CPM 100 '/I. (lq""al .A~co~"lInu Clllc~, wl',O COI'C~CIII'U Iuolll Ql ..OWl" oy Ihl FEHB law, hlvlt
.00." 10 olulm llIea 01 FIQ~ral 1"'011.., .M Ihl" CO, Ired Ilmlly mamlllla,
It I~U "I I nlW mllllnlr 01 I~I. Plao. b~"allll .00 IIIU Olglo on 1M 1"1011"1 dllD 01 you, ~oroll,
menl. .. IUI by yo~, IInr.loylng olllr,a or "I"lml'" lylllln, (';ovllau, uodll lour nlw plao may bl
OlllYld 1/ 10~ 0' I ,0v,,,Q family ml'MII are Mlpllailuo 00 I~lt '11f1C1IVI 001.01 you, Inlollm.ot,
,'1 I l11.mear 01 Ihla Pia", ooca YO~I anr01lma"lll ~llICII", yOU will b. oovered only 10' 111"11010
p,oVldlO 0' Irranged by . Plao doclo" If ye~ a" ccollnld ,,, a nolr.llal co Ihe ~lIlcllve cale, you
m~11 OOllly the PliO wOlen may a"aoQI 10' [lid IIa"lllI cl YOlJr CJre 10 a PII" ccOler, 511 /I you ,ra
hO'P.,"'"<1 co r.ol)' ~,
,\ cllay mlY ccour belo" ycu 'ace"l lo~r 10lnllllcallcn taro aOd mlmCII ,nlo,malicn Irom Iha Plao,
IJIIIIIIO~ IlclI,e lour 10 ooro, lo~ may ull ya~r coPy 01 1111 SF 2e~9 .nrc1lme",lerm 0' yo~r .no~l-
Ilnl ~onll'mallo" II"" "em CPM n preol 01 a,,,cllml"I, I/IOU 00 ncl 'acelVI IcuI 10 ClIO 'lfllhlO eo
day. all" Ih. ~'fICIIVI 0011 af le~r enrellmenl, yc~ 1I1Oulo oerlact yo~r Plan, IJlt 1~la broc~~ra II a
Guloa 10 covllaGe aoo oblalolou bln.llla,
e~clpl U Ilalld In any oOlm.llc IUIglry 0' denial benlllla 084Crlplloo 10 Ihl FEHB broclturl, no
FllHS plll/1 m.y ..fun 10 P'OVI<11 OOVIIUO bltnlllla 10' 1II1y conolllOo yoU 0' a OCVlre<llamlly memb"
mly haVI lolely on In. oUla IMt It waa a PII-UllllnG ocoollloo bIle,. yO~ In'cllld In a pllI1 uno"
lItl FllHB ProGram,
3
..-,--
---------
It you aflt
hospltl1l1:zed
Your
re5ponl!llblllty
Things to ketlp
In mind
Coverage atter
your enrollment
ends
Former spouse
coverage
4
-~-,-----_.__.._-,-~-._----_.....,....~-,---..--_.._-,
General Information ",""IIIIM.I
---_._-...__.,-_._,~_.
--.
;1/1;IJ :rllf'CJ.'~ 1;IUI'~ ,;, ':I;It~H'rt. !:I"..-hllJ ."It." 11:1.' '-i/ll;' 1111111 ,;, ':l:lhJIl ,;lfjJ~" .:n II.~ ,,'ft't:tl'lIt ,'"III
,:1 f~lJr .,,.',r::II'"flf'I,' 1':'1' ,O"'N !:llJIl :, ';0111111, 'J"I"Ii~ 1'=" ':' .. '.~C~tf'''IJ IlI/I1dy 1""I"t:", +1$ ';~nli",,~ ;"
.. flCIiJ;111I1 :r ,;1"." ,;t:\II,fl'lJ 11lt;lllly 'J' 11f(1I1'11I'1] (-"tttJII;QI ':11'" .f' II" 4U."'I1II'1" .;/Slff I.nllll~ ~1" '''" IUI
'14Y .:1 11:1., .."rClltT'llflll '~"LJf" If~1f aN:r 1:11l"~r 'JJ:IIl':" II' /tHaI ":lltltt. tlf,,,,IIII 14"(f"r I"" n"w CJhl,' rJr
'11:1Ir.t' ..,IJ ."1171 "..qll\ 'r;, 'l'tI .:r:"fll'lIlJ ::"'~.:,, 'jrlll ,,-., tflltU", \11 , 'I ,,,., .71lY ,':IIIU '11J1~' ,~t1~""IJ temlly
IIlIW'r:"t 'Ii '".llS..;rUI?"IJ ItQIf' It"" ,1tJtir;1141 :' ,:111." ,:I;V"IIN 'lIl.:rjll', t /I rnr;~lf !IJ 'I' ,,14'"01l'Of ':lltl' ..',
Il"~ 11~'" "'()I ':O'16111~lIf .. ';1I51:r"U'~1f ,jrth., 'hilt IUC'tl"q,'I, ':, I ~l 'tlfl 'JAY alII" ,,.,. I'''Y .11 "'CIlIUft'l
e,,'Ii" ~I'" OUII ""0"0'.') ,.,q,r Iro allql ~IOII qr q~IiOIl ql 111'~' 'IJre qay ~11" I~O "01 'MY ql
QeV'l/'q' 'JIIP" 11'1 p,'q, pl4n ';' cplIO". rh, p,'m Pi'" ql cpli.,,, ,,,II ,CIIII/I"'I'O P'O,,'QI e"'I'"o '0'
ceVI"'l UfllP" O"P J"PP"'O lor I~' COIIIIIIIQ PIIOP/I 'J'lIIl QO"IlIq' "lIel' I~' "IW PIIII or cPliell
019'114 II y"ur al'I/I l"mI1l4111 PII1IClp'''ell 111 I~' Fe"'B P'OqI4"" 111 N/lPI, 'II '11 POll, '11 II I~,
~1\OPII" O",QIQr W ",.,,,,,n','1 ."Q l/loure/lC' o,e"o '/1 1I1Itll"."", '~'"91. 1~1Q ,01l1i1lU01i01l cl
Qe'I119' PIO""'OII ttll /1.11 opply: '11 I"C~ cau. e",.,IIO "Mil l/'l, /I'W alll\ c'ql/l OIlIMl ,'I't"'"
4'" 01 111Itll".,11I1.
III' your IIIPOllllblllly 10 bl IlIformoo IOoul your hnllh blMII'O Y';I,I '''''QIOY'IIQ 0111,;, or'
'''''1'''''"' lylI"n ell' Ole,IO' '/lIo,m411011 .eo", 'NI'III yc" ,nlY ':114"9' /0'" 1111011".,1111: 'N11lJ '1IITllly
I11qmeNre' ,rl: 'N~Q' h4PPNII' 'NI'", yt" 1r01'oll" 90 QII'.... ""~O"I P4Y. 1"'" mllll.r'/ """'CO, CI
""": ....h'" your ""Olhn,,,, 111""/101..: II'N ",., OQ'/I 01100" 101 l/lrollmo"l. YOUI 'IIIQIOY'~O e/ll"
PI , 1111 "n 111 I oyo"/I' ....,11 .110 PIO"'O~ yo" '1;1111 I" E"'Ollm'nt III/Olma"OI1 0"'0' 1110 Flo/l
CCmp'"S011 C~lrI, ~rocll'II". 11'0 alMr m"III4I1 you 0"0 '0 m41.a '" IIIIOlm,o
Qa~lololI,
, For Inou I""oy 1"'011'0 'II II''' PIIII. Iha O,,,allla 'iI 1/110 eloP~w' "a l"aoll'Ia Oil J4~ulr/ I
.110 I~' rllll ahow/I 011 1/'. IrOlll 01 I~" erophu" ar. "'IO"~I I~. "111 Olr 01 tr.a ,"'oil.. I 11111
lUll pay pallPo 1~41 b'9'111 Oil 'II I"ar JOllulr/ I IJOIIUOf/ I lor III I"/lulln/lll .
O'"11II1Y, you "no 10 b' ,;o/lll"uouOIy '''rolllo III Ihl FEHG FrOOI."" IQr 1M 1411'I"a y,a" caiOla
ytU 11",a lor yOV! 4"1011""/1110 CO/l"""1 101 you 4110 any "'~II;I' 10",lIy mambar. altll yeu "'"..,
, You ....,11110' e. 1/lIOlm,O by your '''''PloY'/l9 q"'~. lOr YOV! ral",mam lyOllm) 01 your FI411 'Nil'" I
II".,"Y mamb" leoso 'IIQll;llIly.
, e/lloll"."", .lIQ .'I~lt.IIIY 0"0110111 mUOI b' erouQ~'lo Ih' 1"'"11011 01 yqvr l".,pleY'lIg oHlcD ql
"I""nlnlsyola",. Tha 1~'4n qqll 001 O.,lImlll. 1110,1;1111'/ ""J qallllol q~'/lqa an '"lellmallllolul
....,lhoUIIM ",o"oorl'/l,c"nlllO/l /rom I~S ,mpIOY'IIO '9l/1cy or 1411""'I"'IY""",
, No P'"OII (Imployn, Innullo,,' clllmlly mamear) II .,,"l1ao Ie "ca",a bl/ltl"l U/Ill" mo" I~an
0/11 ,nrOlll"sl1l '/lI~11 FEi-'G Progro"."
, enOnOal, aoolllo,'o Ino Ollt"OIlO '/llomlly ",a".,ball COVl..d u/Illar 14""ly 'MollmllllO I/'oulo e,
raponlo 1".,,,.,aOllll'Y 101M FII/I,
Whon 111 amplOy., 0 ,,,rcllmll1l IermlllolU eacluu 01 laQllIlIon Iro"., F'Olr.' larlloa or 'NMn I
I.mlly m.me.r I~ "0 ICI'Oll 111011;/. ICI eo"".o, uMal 1/1 I",p/oy.a 01 III/lUIIIIII'I l"'Ollmll1l, 1110
Ihl p."on 111101 01~'1W1.4 ,1I0'bl' '01 FEHB eo~.,.o', hI 01 1M 0.n.r4lIy....,1I b, allglbll lor, 3',
alY ".. IxllllOlon 01 ,~,"4Q" Tha a"'p,oyI' olll"."ly mamear al50 ""y ba alllllbl. '010'" clthl
ICllcwl1I9'
'lVI'," 111. SPOUU 01 I Ft<l.rll Implcy.a 01 lnr.u.111I1 ICUI ';0~"40' "I\QQI Iha FEf'B "'rcoram
bIC4UGI II ol"orcI, t~, lOlml/1 IPCUU may ""I cO"'''Qa UII<lII Ihe I~C"" 'ClIJII'/'aw ulI<I.r ell'
111/1 o"cumlllllcas. II you ." "cal1Uy ClIVOlcell or .nIlPID"a 01'lor01119, oonl.CI Ihl ,mployu'l
II11Dloy'no Q~lc4 (PlrSO~/l11 atflc,1 01 r'lIr,,'1 "n"".,anllyll."., III gel mo" "PIS IDOUII~e "quilt.
1111/115 I<lr ."cunq qO~era9"
..--
Tl!fnporary
continuation
ot cO'llfraglf
Conversion to
Individual
coverage
,-_._-_.-.--~._--....._"---_.-
General Information ,,,ml/lI/oll
-
I' f';IJ 411. ~I' t/llf,hJY"., ","IJij., of n,,; ,f", ,,,, I Iii ItJ""II'lJlttt; t:tll:iJ1Jtlll 1"IJ .,"JO'4111 ',r:m 111/',11:", YIN
,,~t1y 1::. lfIIlJIl:I~ "1 IIIW';I:/rlfrl'/:I:IIII1'ljll 11;IJr h"lJllf1 !;.w,lfilll O:Q"lt,~~" '~"r:1..r Uh' Fe~a PtQII'l:Il11 4U.r
UIJ4tl)IIt;I' A,II" l'llJt tJll1l:ltJ't'l1l1 ,;1111.;1' h:r PI :',J.a Et1tt;llmlt"l I,HI1tmllluJn .:jIJhJ" JI1r1 PI/J"
':I;lrUIJllIfI:n :t'/ltt ,,~, I'j11';'11IJlJlij olllli1tht 'er '11"'1:1:"11", :QI'III'~I1"t:n.;I t:;Qvlfflllllt l';II:~: ree lei .villl'
'Cl" !12 11:11 './"lttfi;S ,':I.r i~,.'ttl.lllI:"" 'I:' J'~lflS Illl'~Qt"I:IJr:tJrl1 I':'J h"::IJI':: l'tJl IJlhttrNI'If ell "1I~lhl"
'tJ, :t;t'llrl.lJll ':';1.;1'''11,'' ,/'1:'" ,or'" !J1r:(JtI.un p,;, ""1"'1:1" ":I~ ...r:~"t !';lit "H'1I~lIt I.:, ref: N""" t'N
'''l:lltOI, ":I Ifllr'ff1'''''1 I I'~I,J JII' 4/'UI;II. It.: ;""..1 't'1I '1"14".,4' ~"'I:II,.rll'lI 1"~~I""~""1 'r:, -:tWU"lJt1.
llQn ~, ..,'tQllm""1 oIfhtr IIIUII,I11I1I'I. "':I~' rl:': 1:"1;1"15 IIn..r l':lJf '~r:lttt'lJqlf U <1/1 .rf"tJ:h:~lf" 11"r:tl,tltW'J
I~' l' "ny I,~, """ll~" .11 .:u"'a~" ,""a ~I'11 ':Q"""~'a I~r 'm '11 I ~ m~"'hl .,,,r 111~' IMga,allan
'ram I'''''~' yo~ m~" pay 'h' 10lal praml~," 'bo'" I~. 'jqy"n,",,,' aM o",playaa l~arul ~I~I I
~~1r9' lor 'oml"",rall" 1.ponlU 12~'. ~, 'h"'Olal Q"ml~"", 'tIh'1110~f ~ay'raqa 1"011..capl ay
~a"Q""IIQI1 C' ng"PMy,nal1l 111 pr,'M,m). IQ~ ~I' "1111100 IQ ~"al/'.r 11 'o,Joy ,."nIlO" ~I ~aY.r'~Q
Ipr CQl1y'/llon 10 nonq'e~p ~OY"OQ"
111 Clll0111 ~aUI, I chtla ""Q 'ou'1I1qlolllly lor ~Q'I,rI9a 11~~n ~INI1,n I "ol1,FIQarolly ,,"p"lYMa
c",la '''C~'I Jqd 2~ 01 ma,",,' J"a ~ Iq""., 10lyQredO) Ipq~a. '11M 10UI '"QlbllllY lOr coyeraQa
1l,IP '11M " nal IlIqltla IQ 0.,,011 cr eanlll1~d ''''Cllm'l1l 'n "', FE"e Pre9,am QI III .mplay.. cr
~nalr I~e IPO~U 'O~lly 'Iwl Olla moy a~IIII'I'or rec. f,'MY alia m~" .oy I~' Iplll p"I11I~m .I~I
Ihl 2% aomlllllllall'l' cII4/~a. feel1lh..M ';4141 COI1I1"~'IIQr ',g 10 1'1 ma"'''1 AIt., IhM Q~llIly',,~
eYIII' ~~c~ri. ~,~.. Ie, J6 m~nl~' all" Ih" oeln II'. cIII14 'UCII" IQa 22 er I~e 4aln ellM 'llYare..
Wh"l1lha" ree fMI ,"eael by 'lll"ealloIlO" cr "O"oaymd,,1 01 pftmll,m). ""ie AM lorm,r IIPO~"
."rOIlMa' III' anlllleo la lI"OI~,r J' "lay 4>IM""an CI cOY4/'oa lar eO"yallll0l110 "a"Qra~g ~Oy"aQM,
Nore: 1/ Iha a"'~llm'l1ll1 praeauea aller Ihe Ilnal daln 01 ~~"'aOM al a" amploy" lar c~lI<l or ia"
mar 'pa~ul, I~a .IIMCllva aet' CI 11\8 '"'Ollm.nl may nel ba '0'" 1M" Mine above. fha ree
II1'OIlI.NIII te rU.0"1I11:11 lor .I.ml~m peym'l1l11 ""aA~lIy, 10 11\8 II'''Cllyl oal.. 0"0 COYaraQM
mBY 110".c~ad Iha I ~ c, 16 mo"'~ 0'''00 MllcJ lacYa,
NOlllleallall 1M eleOllal1 ,epwe",."II:
. Slplnall"O EmplqYMu-Wlthll1 61 aey' a/I" IlI1 .mgloy.... ,,,,ollmM"! 1"",II1MIII bMdOV" 41
IIplralla" I,om '"/"1lce. nla or 11" .m.lqy'"g clllee Will nall/y I~M ,moloya. of 1M oppanv"lIy 10
,'.el Tee, f"" .mploy,e hBII 60 eeYI a"" IM.orallo" W altar 'aCalYlI1Q IhM 11011011 Iram IhM
ImploYll1Q cHloM, 1II01Ql1la MlnCI rec.
, Childlll1 1M larmar IpouI..-Ye~ m~11 nallly ye~r ,mplaY'"g oHio. 0' '"IIMmM"' IYlllm
W"III a eMa or lo,ma' !olyoroeell.o~la I:.comu MIIQlb" lor ree. For a c~lle, yo~ m~" Milly
1/'11 Im.loyl"g ollloe wlI~l" 60 caYI IIl1er IhM o~aJlly",o ,y'lIl coc~rll, I,g.. ehlla lOll. allOlolllty lor
CQyar'OI iluellU I~e 22 or marl1al). Fer a 101m" lIea~u, ,/a~ or y~~r 'e,mar igO~" m~1I1 "011'
Iy 1/'1. emoloyl"9 cllica or relllllm.", IYllam 'NII",n 60 eeYI alter IhM la,mar ipo~le'l eM"QM ill
IIl1va, a.g" la,mar IPo~a. ,ema/n,a 1:"0'1 /uomnO aoe 55. The am.laY'l1g clllce 0' rell"mO'1I
1\I'em mel1 nOllllea Ine el1llo 01 1M lermer IPouae 'l11111 ar nar "Ohlll ~M" ree. II a ehllO wal1l11
Tee, h. c, 11M m~11 ,',ell! 'NII~111 60 oOYI altar 1M cola ollh' ~~0IlfYI"9 "'.1Iler allar IICMlYl"g
ml nOIlC., ilia",:' 1/ I lo,m,r leo~'. '110"11I ree, "I e, II"' m~1I1 iMaM IH' IIeClIo" wll~l" 60
caYI INI' I"y ollM /0110"""9 ~""Ia, "'hIO"".' '. 'Ile'~ IHM COli ollM 0~01l1)1"9 .""1: IhM calM
H. or lI~e 'Oilell ,;gy.,lg. "Me' II'M $.O~.M '0~11'f 'aw eQCOUile 01 'amal/laga or 101111 01 a~01IlY'''9
co~rt o,aR': or Ihe ORII n. or 5"' raoelYaa 1M "OllC',
Impon.1Il1 " Ihe .m.loY'l1g olfloM e, rall/Mmam IY"Mm I. not nOIIIl.o 01 a chllo cr larmer apa~u'l .11.
91blllty far ree WIIHI" IH. ~O'<lIY 11m. Ilmll, IhM oopommllY la .,aCI fee M"OI 60 oOYI alter Ihe Q~all.
tyl"Q "1111111 IhM 001. el a cnlla 1M eo oeYI aner Ihe cha"gM ," ilal~. ," 1M 00111 of a larme,
I.O~U,
When nOli' cf Ih' al:o" Chalcn 1/. Iyollal:l, - c, CMII" - whel1 eoyelaOI .. In Mmglay.. or
Ilmlly meml:er '''01. cr 'N"M" fee Coyerago enUI (.Xc.pt lor M".aym.'" 01 pra",I~"'), lI'd P./lOII
may t. 11191bll 10 convert 10 a" IncIYla~al, nang'o~o eOI1I"OI. Illa~ or a lomlly mMmber ","hell 10
COlly.nlo II1I"oIYla~al Ce"lraot, ye~ cr Ine Ilmlly mMmber mVIII a.ply 111 'NnllI1Q 10 Ih. earn.r OII"M
pllI/1l11 WIIICII ,,,,alllo WIIHII1 31 oaYllnMr oOYllaQI yno., Ih. FE..e f'rc9ram ~ro~p pia" eno8,
5
---Facts- a b-o uTHe a I th A m-e-rl ca'''Pen n s y I v-anTa;Tn-c~-"----"--'''-'-
.- ....-. -.-- .-
';"~'III Ft"" 'll oJ .:CII.Cft',..".l$i..... '''''':1';1)1 ~llJ", Gl;I\..,lu1,.,II -:111111.1 J to,.,4111' ~t[J"'''JI~I'''I:1f ':'-;Qf.tl~;IlIl,;'~ ;r ,..~'l': ,I "'ill hUW.;"" t~ 11 ,I;IJ
IrlJIII JIlIJIf'ltll,'1j IJ"lq/ll ':"'~llJlI"J ,.rtJrt"il' I 1$ r,.... "'irt ':"01';11 1';1 ,1}1,J ..,": ,':1.;1 '1I/f'lly 'Nhtl,..." ,';Ii:/"CI;U '''1,:1111;/'''1 11ISI,I/II'r." '1' .,1/1
,..MO "'A~" 11.1111 ,Q\J.lrlJ.""lrlJ "'11 ;"I'f ","41 I ell)1S Il1/ l;1.;1 ~I:W ,I NGt)li!$. r'lltJlIl'JI'UI '\ijl.'Q"I~" '1$ 11 ,.,.11', ';' nOI.;/WIl PII'lm."I' 'tlt
,T"'at "'IIt;tt:111 tlir/lCIIII, ,-I'~"~'" 1:'~'I,q... !I'ItI", "'"1.1 ,-rll'''''''' ,r-,*~ ;1; r.l.,j I 'tNt' 4,1 ...Mt..i I':IJ ,.111 ,a"'ll"l; ,lI' .;t'IDr'IlI': IYISI,"" 'JI "'11I11(1
:iJ(I' (to,U .1"111......" ." a"':'I.rt:lt hllr JC",~;IIr: 'lCI:tCf" ,,'tJ I'lIU!:I'BI/i '~ 'Wilt :IJ'" 'Q /TII,/fottl', .J'o" /:ll'/lS '''''''''Jlf,t;lIy "11 '''lflf ,.".,11:1111
:;'/If,.lJ t:tfl,.,Iil'S ..1f, JV'llattlf QrW,. "1'" pI." i:n:\fflJIf'1 .,(IIef :'../1"1" '"It!jIt.:111 ~,M.,rll"'~'/ MIIll1btl'" 11'" I.,t1~I'ltlj II' 1I"'''~' .. PII"
'''''01 !jl)I:lIlr Itl)1l1 01110"\1 fUUtllJlIullln9 PIB" p"fnllr/ ell'" IJlJ&:IQIII, ~..r~'J;"" 'i' J 'f:'fr:IIIII', ';4f1f ,h;.;lc, ':4/1 ';f'ly r:,. '''I!III'~1f1J ?y
,.,'.."41 "Gmlt'.. ,,,"..;llIlJ I:f',"l1rt>;Q'1f .1C,:;IQf n'IIr. .'11"0 ':1"1," '~f,"1 Wt'l..', Pldl' ,:~t:IC'lS "II 'JIIlf'J
a.eauu I~' Plln ~QII' ~'QVIQU IQUr ~I" 'I'Q ~aYI II" ~CII,I I"~I .,lIel.,,1 1M '''.cll'' Qlh'l.r, '1' null~ l.r/leU I!y ~Q,,"-'lIh"l
'Jf'(\.';lUJllor', ~I ,,'IlI:JJ'lJl:I'III, ellt'. '1':'" .IIQrQ 10 qUIt, I ifllJ" .:QI~I:'V"..".IY" ,.,,~., ql 0..".,1111 r~d" I"""Y '''11.11''11(' gl."II- I" IlJfJllllJ"
IQ ~'QvIQII'Q ,;emc"n.nllvo nUIII' ur,ICU 'M ~.n.III1ICr .eeICl.nll ,lIn.u II'Q '''I'''Y, I~. PI,,, Pile.. 'I,nl .mcn.." ':n Q"v.,rll'/.
~,,'~lIlIluen al;"h:~ '111111, pnYIICIll, Imm~nllall~"" aro NIII'~aQY ':". M.me,'III. ~nce"IGII'e IQ 7"' mlOICII .1I111uen II In. I""
II';f',:I,lI~liU
Who provld~s care
to Plan members?
Role ot a primary
care doctor
Choosing your
doctor
e
~II ..""q~""Qe.1 ~rqvlQlr t-0.111""m,"eo P,rnlylVorlq, Irc.. ~cnlllll ~I co'n ;'Q~P P'ICUCI .r.J
'M,,'q~11 Pllcue. nUlln ':". p,e"OI'", >Jro., a ~'Q~C "'co.1. l11.mo,'II.e."1 'n." c"m"1111~'J'
'CIII.,r,leu III 9,euc IICIIII'I. I>;en II . nUllh ~ln"r Th. ~celQfl wno croVlo, m.QIcol elre uro~r
Ih. '"ol"ICI~al pIOCIIC. 1110QOI U. IhQ ",uIII'''",.nca m.m~." '1IhO" ewn P""" cllic",
Voo" 10ln'ng II" Plan, I~~ .",ell.. aM ucn '"mlly m,mcer '"UII encel' or. ",.<.lleol c,eVlO.,
wnfl"" Ih.111 I crcvlo.r Ircm In. ~rcup Qr IrclVleuUI OrlClle. Inca"" ',cm WhC'" ncn Ilmlly ",."',
C." "OIlVl Mtlh.ml/q.no', m.olell Clrq.
r", cnm.r, care QCClor. uI~olly I ~'n~ral or 'Imlty ~r.ClIlIcn." In"n"II, or o.olllflclan, ~reVlo'l
II', m.mc,,', pn",111 "..oleol ~alt, mO~'1 1"1/101, Ie I~'CIIII"I, aM arranqu ler hCIClllIlUIIQn,
n Me.nor,
Th. ,Irll .nQ mell 'm~ononl o~OI"on ucn m.m~.r m~1I mok. 'I II'. Ullellon 01 U pnmory ",a
4cc:lor, fhlt <311':111\,:1'1 -I~r:~"at'lt 'I~C:. " I" t"'1"119'" IhlM; .1r.~1e:, that 411 ~Ih.' h"II" s1tr\'1l:'IS. ca,.llC:t,;.
IIIIY IrOI. of IP'CI.,IIII, If. oClall',Q, II 'I I~I ,upenllclllly el yQ~r ~nmory CIII CCeIC, 10 ,;Cllln
'hY nlc.nar, a~I/1Q"Ullenl I,om 1M Plan ~./Qr. I""""q yeu Ie . lo.ellllll er mnklnQ arrl"q.'
mlnlllClr hClPllallullon, 5.,."cu of Oll'.r p,evlo". ." eov"l~ only wnln 11'''' nu CIOn a',""
rll 'h aQvanc. bY th~ m.mc.n ~"mar, call ccelcr, YQU 'lIay Ullet a qynlceluqlll en a 1III,,.'e,,1I
~"'I lor. rQulln. .nnull Cl1QekU~ QnIY: III Qlne, 9yn.eeleqlell ';1" aM lellQw YP "111 reClwn I"'
wIII"n ra/a"al''''''' II'. memo~r'I cnmary ea,e ~~e'Qr,
Th' plan', Plltlel~llIrq ProvlQer e"aelery 11,," ~rlmary cara ceele" Iqanerll1y lamlly p'lctlllenerl,
p,ol.IrICI.n" Ino Inll""SIII Wllh I"." 'eCallQnl InQ cMna n"mear. 10 till' a ,"amear may OOnllQIr
IhOU oeclers eQn.."'Inl Ie "ernl er WQ'~' e",cIQn.s a" prcVlQ.c 10 III en,olle.. II tM 11m. el
,n,ollm.nl cr yoen 'Iellnl cy ~nlllnq I~. Corium" Mla"l C.panml"l ,n Plnl~urgn al 41:2! 563.
!~75 or eOOI~3e,..>;., or In <:.nt,al P,,,nl',,,anla Ih. MamOlr Sarllon Oaoanm."1 1\ ~ \ 7,6.0.
eJ\5 or l,ecC,~ee,d"5' e",ele"n ar. luCI~.;! 'e ~nanga ,ro Ira uecaleo e" II,g~lar CI5I1, y,;IJ
Ihoulll oh.ok Ih. .;u,,,rlllal~1 :I.ny pre"cll cy ';hQeklng c"'elly wllh In. ~'ovlo.r or ey calling I~'
numc., IIII1Q aOQva.
Whlth.. YQU III ."UQ'I a Plann.meor cr ar.;r.nllc.n"q .nrclllnq ,n I~II Plan, ,eu Inc~IQ ,,'/Iaw
lna PrOYIQar O"Iele,.,. " you arl nwnl.CI ,n ,.eDlvlnq ellt I,em I .p,olllc prevlCler, le~ Ice.'c
~lIllha provlc.r '0 ',erlly nlll,h., ~enll"U,CI ~at\lc:~allc" wllh I~D plan, 1I111mportanl 10 know Ihal
wh.n you Inrollln Ihle Pia", urllo.D "' prQYldld IhrQugh Ihl Plan'l alllvlry Iyalem, Cut
Ih. cllnllnuad av.lllblllty anew partlclplllen er .ny on. aoelor, hQlpllll, or olher prQvloer,
cannlll b, guaranluo, ,Mulo ,eu e.CICla Ic .nrcll, you Will e. U~'Q IQ comp,.1I . ~nmarl care
acctar Ulacllen 10''" .nICI' I~ url clllclly IQ IhI Plan, InQleallnq 1M name 011114 ~"mlrl .;,.'" coo'
1011$1 ycu uI.el'er leu al'Q IIch mamc.. 01 leur lamlly M,me,," mlY chanq. In." ocetor lallC'
lion oy nOIl/ylnq Iha Pl~h JO olYS n IQvane..
In Ina ",.nl . mamcer 'I rlcelVlcQ S,,,,'OI5 Ircm . ceelor .no I.rmlnall. I QQt11e10a1lQn Ig,,,m,nl,
In. Plan 'HIli areYlc. payment Ie! cO',.reCl sarllon 'Jhllllh. Plan can maka ,nsenae,. anQ mloleally
IPoropflate provllICnl Icr 'hI lu.mollon ot lueh UNICII cy . panlclpallllq oeeler
I
,
I
I
I
..J
---'-r='actsa bo utHeafih Ame'rTcaup'e ri'ii'syiva'i1'fi3;-, ric :~~~:~Jff'1
---- _._--.__......_........,.__.._...._--_.._----~~.-
Ruterra I s tor
specialty care
For new members
Hospital care
Out-of.pocket
maximum
Deductible
carryover
Submit claims
promptly
Other
consideratIons
The Plan's
Service Area
E.1C:1I1~1 '11 oJ '1'lf~I~31 .,,,,.,ltJltl'I;'/ .:t .v'~'''' ,) 1;1 . "'/WI :,jf If ~1:1:I.:;t 1'1'14 ,w~U,,';J"Jlt U'~tJlth,r ',l;,;ICr II;) :I'''.
r:4I1'fI\llJ N"IJI' ,'tf ,,:,- 1/'11 'IS 'J",J'dIIIUl:ltt. .f1'JI111:1"!$tlIJri! ';I;"liI~1 'I"'t( i:fJI1l,JI't ,;.Jt.. .Jt;';lcr r"r 11 'lflllfflJI
l:lflrlllf SIf"lrl, ""Y 'JU'", ,:CI;lor .:t .;I:lilH'I/~rt 1j;t'i;lill U,',I!.;IU 1:1"",,'"I'O J r:Ur11C1IHIU"9 $p"';loIIISI ,tI
~I"''''' lit It." ;;r1mlfrl ':lIfl' ,tl;I;ICI S 'll'l;rlflt~" I ~Ptl.'I,\lllJIS .:' :~"ISIJII""III .". 'lfI.1lJlrlftJ bllYQ"l1 "'~ISI'
f:etll/; !:41If"J 0" I"., 1-"01" I',., !:,tma,', ':lJtl' 'N,:l(t NIII r"I'II'.' 1)"III"1"m.,nll$ kr llppr~l3rlallf
'1111'''41"
W~.," {""m~..rlS "'';1111/'' ""'trqllS "fJm r'~Htr ':,II1'.1r( .:,.,., lJa:.:tCrlS. '''''V ('H.lIll 'ltH.IfM rq II~" pmnllr(
CO" 4~C101 .It" Ih~ COn'"lloll~1I ~II Ir.II~W"JU COI~ 1111111 ou ~":"ouo 0' ...,hO/lUQ ~V Ih" um"Orl
C." 4~r.101 en 111/11"01" 'h' PI'mo,v ':0'0 '10r.1Qt .,1/ ~I'" 'U,r.l/h: 'n,',"l;lIo"O 10 Ih' .;onllllta", II 10
wnll """OU "11 4111nOIlU~, II '001l1~"01 lur".;" 01 ""'I' 4,. '"qU'"4Il ~V 'n. oo""jlla"" mum,
~"llnolllo 11111 .;n,o. willi IMII olllnory ';.IU 4or.1Cr Co "01 ';11 10 Ir,O 1.'OI.II,llInl"IO VOIII p/lmarl
C." ooelO, na. ."."9uo la, 1M Inu Pl." 1114 'UIIUO ." 11I1t'OIIUlIon 101' '1"'1."" Ill".",,,,
Il yOIl II" II/UOV ',"'IU' "'~ ':I" ';1 . '01101011'1 ."0 '. . P'4" UlnlI;IOII'1. yOIl mllll 11111 4~laln ",,,,
,"ltom a PII" pII/"arl 00" 40,10,10""" ':0" 10 QU ';0"U'"0 ev 'h~ PI4n 1/ 'h' 000101 WhO 0"9,nallv
1./11110/011 CIIOIIO YOl;I,0Inln9 'hI, PI." 'I now 10111 PI." p/lmllY 0'" 00,101, VOII ""0 only 001/ 10
"pllln IMII VOII "OW o"OI'Q 10 IMiI PI4n In., I,k Inl' I "'"1"'111 101m ~I I~nl 10 Ih" 'u"r.lal/4I 10'
y01l1 n"JllpOOlnlmll1l,
II VOII III I4I.OltnQ I nuw .llm4r/ 01/1 400101 YOII "''''' len'Ollll In OPOOlnlm,", 10 In" p/lmlry
CO" 000101 ';On '~""OU wh"MI 10 IIUllhl oonolllon cll'~lIy 01111111 VOII !l4~k 10 In, 4PIC141111,
" ICU 11011I/4 na4p1101I1l1IQn, YOIII .lImlry 041' coclql ~, IlIlnc"~'d IPIOI01l41 Will mOk4 I". n"cu.
urlltlonQ,m,nl4 Ino conllnu" 10 IUPlr"4" VCUI CO",
YOIII Olll"ll,pcckal ..plnlU 101 Illn,lill CC~I"O llnoll Ihll Pion "' Ilmllld 10 Ih" ilOilO COP"y,
""nll whiCh OIl "'OUI/BC 10/ I IIIW !l,n.lIl1,
Wilen In. '''"011'11 OBII 01 In op,n 4auon Inlcllm'nl lor In In'oll", '11'0 ChanQu 110m cna plan
which nal I 0lallcUIl14 11M pnol plln) 10 4nolh'l pion 14 Iltal J4nllll'/ I, any CO""I'~ ,,~p"nuI
InoW'd 110m Jenllary I 10 Iha '""011''' oale COllnllOWl,d Ih' P"OI yeal cuollcllbla 01 1111 ~nol pion
.. 101l0w,: 101 " Ih" 04all~Ubl8 no6 I:..n pII"'01l6Iy m41, Ihl pllOI pion Will '11mbl"14 00"1110
opdnu, 'rCI/IIIll 110m J4n1l4"1 I 10 Ih4 "/'01'" 001e, 'bl It 1M o~ollcllbl, nBl ~.en ponlelly me/,
In4 pllor plln Will 11," apply CO~IIEO 0.ln064 10 UII"Y me fUI cI I". CIOII01lbl8 OM Ihen ,erm.
~III'4 lor CO""140 up,nUlln.1.ltlIO Ilcm Ihel pOlnlllnul In. I/lcoll'" 0"4,
'Nh,n VOII I'" "011II40 I~ lllbml/ 0 olOlm 10 Ihll Pion 10/ CO"""O "P4nlla, IlIl:ml/ YOllr clerm
Olomplly TII, P'on Will nol poy e~nllilllOI Claim, luemilt40 'OW IMn C'CdmCII J I 01 the oollroo,
yll, 10110wlnQ Ih" lear In .rloh Ih4 ..oenU WU 'nOI/ll40, ',rI166 IIIn41V !IUrg wOO "",,,anteo Ily
10mlnll"01l,,e CP'loIIonl 01 ~o""Mm''', CII"OOI 'n.;oPO<.Il1l1on, prc"'o,O Ina claim W04 'u~mll1"O as
Icon a. "'lIonlPly POIIII:II,
FI4n plo"lll411 WllIlollaw g4n8101ly 4COBPII0 m"clcol procuo, In prucllblng Iny OOllloa 01 Ilao"".m,
el/oll YOII 4nl01l In Inll Plln, YOII 'nolllo o"'almlnl Whllh"l YOII wll/ 1:1 lei" 10 IcoapI 1llllm"nl 01
.10ceOIl"'1 WhICh mov ~, IIComm'n040 ~V Plln p,o"IO'16,
II ycu or I m'm~", 01 VOllr lomlly 110""6 I'I<llllnlly 01 " a ","mP4111".. oway 110m nOI", porr 01 In"
1111, VOII IMllld be aW414 IhOl bln41i14 lor cOle clllllae Ihe 5,,,,'oe ~'II ale "alnOled 10 Imll'
911nov oall, rnl S,,,,'ce ~'eo 'I 'he area wllnln wnten Ih. Flon'l P'O,,104l1 31e mOlllcoelSlbla, F'JI
Ihll Flln, Ihe 51""04 Alea '4 1M 10m. as Ihe Enrollm4nl AIU IIlleo c" 1M Ilonl 00""1 0/ Ihl4
crnCMllle (Ihe 11GB In 'NnlOn yOIl mll'llI"e 10 4nrollln Ihl4 Pion),
II you 01 0 cov'lall lomlly m'm~4I mo,," CIIIIIO' Ihl S'I'"oa Alea, VCII moy ''''011 In Inoln,1
app,o",o pion, II II MOl nlC"IOry 10 'NOll unlll ycu mo", 01 101 lhe op,n IdBO~n 10 mal<a SIICh a
chln;l; oontOe! y01l1 .mployll'Q oHI" Qllellllm,nllVll4m ler Intolmallon " YOII ore InllclpallnQ a
mO"I,
7
Important notice
ClrcumlStances
beyond Plan
control
Othar sources
at benefits
Mradlcl1re
Group health
Insurance and
automobile
Insurance
CHAMPUS
MedicaId
8
---.__._------~----------------
Generalllmitatlons
--
.A11I'lJIJ9" a ~p"~t'h: SSt','Il;" muy 1;1' :Hihlt'J iJl$ J ';CVIUllll.r.""fllll, I hill t;I' ~fI)';UJ"IJ ""'y .t, ,It '''lfjI.M'1'
11"""1 ,:1 Y~lJr Pld~ tleCICt, I ~ l''''IJll:lJlly ,1111;I'UiJl'I'I~' 1f'III:r"ylf,'IICn, IJliltJth':lSltl. Cf l"U.II11"'1 rJI 1Qur
'''''UI ~r ':U"UIIIU". NQ OIUI IIUI.""'111 ,,, u"y /l01~'J/l 1I,.lIl11oully or 01l1.rwlu o'loul II'. b.n...
III., 1ll11l1allon. u"u ..~IUUlO'" 0' ""0 hroul1ur., co"voy or V.'U "'y u.v.,aQ., '''ur.... .r
r,lJUUO uny bonolll. uMor II". PI." .r bo UI.lJ '" ",. 11I'.UCIJII." or ,Jolonu ., a c/a/," undor
"11" PI,,,, TI'IIS CIC';"IJIIJ '6 "'11 ,:IIil;llIl SIIIII,II1I1'" 'JI r,II"IfIIlU .hull"CI" 'e f=E~a 1tllfll1IJrlt15 ilf1t' 'IS I""
IGIII lJQt;lJll1l1f\1 ~GIJ srU.;lJIIj fitlY IJ~I:r1,
r" rhlt "',"ruIJI f1H1jlJr 1J11UI~1l", "J,':UJIJ'''''I~, wdr, ""I, r.1\l11 "'IUJ"4~1I~". "'tuttllty IJI . SI.',11,h:l1nl "1J"'blfr
'1I Plan prov"l.", cornp'SIS cr pal1l~1 ~Ulru~lIon 01 /a~IIIII". ~r .Insr ~IICUlrGla"c.M o'y',,,u In.
Pial' I ~CI'lrql. 11'0 Pill" WIll ma". 4 'IOC. lann ./10" IC prc"oo or '''O''Q. Iur ~cv.roo """OUM.
"'.w.,or. In, Plan will nOI ~. r,upr.""Cla lor o"y o"ay or 1411uru 'n pro,'OI"Q """~. 01,. 10 'aCI< 0/
avallabl. laullIl,u or P...CM.,
(
fI,,. ueUon .ppllU wnon ,ou cr a momP.r 01 your lamlly 'U 0",,11.4 Ic b,",'II, /rol11 onoln" lourc.
PUldOM In,. Plan, y~u mUll ollelo.. Inlcrmallcn oboul eln.r Icureu c/ b,,,.III~ 10 In. Pia" '"0 all
n.cu..,,/ oe~um'nll OM .uIM"~4110'" muGl b. eOI"pl.l.u I' r'.uUI,O by Ine Pion,
1/ you or a ~ov."o Itmlly m,mb.r " o",olleo '" Ihll Plan ,no Pan A, Part B, or Part. A OM B 01
MOlllear., b.n.IIII will b. eoorolnalell wllh M'ol~a,. acuololnu 10 M..,car.'. o.lormll1allcn of Wlllun
coy.,aQ' II pnmar/.
Tn,. co%lnaUon 01 b.nolll. p/QVIUl4n apPlI1l wMn a p'/lon ,:OV."4 by In,. Pion al,o hU, or '.
onllll.o 10 b,nolll' U I re,ull cl. any olher group houlln cuv.rag., or Ih. payr,l.nl 0' m.dl~al and
hOlpllal COli. und.r no./aull cr el/'.r '1JIumob,l. '''Iural'uu 1n41 PlY. bon,III. wllnOUI rU9ard 10 laulI,
Inlormallon aboullho olnor ~ov.,aQ~ mlJGI b. 4la~loUlllO '"'' Plan,
Wnen Ih". I, oOlJble COVI/lg. lor ~.vell. bon,/i", .111.r Inon ,,".r9anuy UIYICIl /Iom non,Plan
prO"d"a, Inl. PllII1 will cenllnw 10 provlco da ban,'lia In lull, bUll' ,nllll'O 10 r.CIIV8 poymOnll.r
III. ..""UU '''01 lupplle. cro"ouo, 10 111" .'I,nllhal 1I,0y ar. coverao by Ine olh.r cov"aQ., n..
Ilull or Olh" aUlomobll.. Inlurunc. cr any oll,.r p/lmatjt plan,
For um"gan~y U""U.' Ir~m non,~lan prOVIC"I, cnu plan normally paya II' banallla In lull Ulh.
pl1mllrf pay.r, ana the ell14l olan pay. a "cu~ec bunolil a. 111. I.conooty payer. When Inla Plan "
"'. uuenoar/ payer, " WIll pay In. I.B.~r 01 {II,la benelill I" IUil, Or 12: a reouuoo omounl Wnlcn,
wnen aooeo 10 lI,e COMIi,. ~ay.blo by 1/1d olner ~ov.raQe, 'HIli nOI exuaec rauonable cnargu, Th.
o.'Ermlnallon 01 Wl1lcn plan la .P/ll11utjt. 'pays III bal1ulila ilrsil ,a mMa a~~oroln9 10 ~uloellnu pro.
Viae. by the Nallunol ,Iaauclullon ,:llnuurancu (;~mll1llaIOno,., nll. prov'"on opplleu Wnolhar or nol
8 clalnl 'I liIec "ncer 1M ~I"er ccvora~e, When appllc3bld, aUlr,~/I:allon mUll be ~,ven Ihla Plan 10
ot:1t4ln I"tcrmatlcn atClJt ClJnelilG .;;r Sfin,tCQrs avallatl9 Irem !he GfI~ltr ceverag.. cr to rq~ovlQr e\ler-
Plymenlllrom olner covera,.I,
" you ara uovared by balM I",a Plan ano Iha CiVIlian I-'88l1h ano Maolual ProQram ollne IJn,'ormeo
ServlulB (CHAMPIJSI, 1I11a PllIJ1 'HIli PIlY benull" lillI, ,Ie a memb.r 01 a pllpald plan, spaCial IImlla.
Ilona on your CHAMPIJS cov"'Q. apply; .e. your CHAMPIJS HUlin e.nollla ,AllYllor,
1/ you II. OOV."o by bOln Ihla Plan 'nil Maolclld, Inla Plan Will PlY bun.llla lira I,
I
~
_._-_..---'-.-----_..-~.-..-.-.-.- _.~....,..-.-. ----_._-,._._-~----_..-. ----...-
Med I ~~ n ~~_r.~_!(;a!_.be n e !!!.~____._
Whalls covered
Limited benefits
10
'" .:t;W,.'IfI~I".rjl...1f nWljl' 'J' (;,,",""11'0'. ';1011;"1:1:111'; ,1r1J r"'''II1~",q 1t1""ClU G i:!~\t'JJII~ cy P'll" 'J<JI:1C''S
""'J ,;lI'lJ! Plitt' C'~"'Il:"'G ThG ,'CII,I;I'1S .111 '''''';UI$~hWI ;/fIl;lf jltJllli I 'ttJu f,IJY 1~':'t'I"'(J 'or "III~., 11111115 ",
'tJf 'iltl;,,,ICI','lfIiIS Jl'tJ ("1:1,1$; .t~III'''' 1/'., J",..m;1t ,1'''11, t'CIJl$tf ';':UI$ NIII elf !:'O~IC"iJ ,I'll U'" jlJ'l'J'
,,'../', 'll IMII PljJ" ,;~t.:hJr Stj(M .:0(1' ,e ""':1'''''11''1 oI/'Itj oIJ,;I;I'JfJt1qll, I 'f1J1.J P'Y (11:111''''3 ler . 'JCCICr S "!tIt
~, 'r::r '1IISIItI ~v 111,1"11 iI,'IJ IC""!JII'J rl""'JJ,;I'I~J ':;lfi";lI 11111111 ..',., /lJ~~11It 1~!:~I"lm""1 MIJIJn. YQU ,HIY
,I 't 'J ~C:C.1V t:iI' '11.1
~14" .JlJ&:IO'~ ,1111 I:/C:'J1tJlt .\11 ""&:""'511/" 'lllfl,JICQ.1 'J' 'IJ"~'t:tll ';11'" ,,, . "Q'~lt41 'J' ..II.,"JatIJ 1iJ'"
Ilc,IIIY, .1 MQ 1~~IIIQn~1 ~QIIIO '/O~, .,,:u~1 H".'. "al~~.
T"II lollQw,nq "rlleu '" .~cl~OIlO:
. PI'VII","~ CDII. I~C'v'll"~ HI"'Olby CDII "'0 PUflCG'C cnl~~"JP'
. Po~II~~ Im,"u~IUIIQ~1 '''~ COOol'"
, CO~II,jIlIIlO~1 ~y IPI,;IOIIIII
C:'09~0"'C QICCUOl,jl.. '''~II,jQlr9 Iltlllllol'I'nlll~O X"OYI
ComPIIII1I101l1l1lCDI IIn4l~lnllYI ';0" I';, ,'I CO""~ I,mlln. Ircl.cl~Q PIII~IIII, o~II""y .n~
IN'I~IIII.;DII oy I P',~ 10CIQ/ II ~I"all,nllntln Inll PII~ .f '''''''~I''O Ol,jMq pll9M~e'l. Ollnll"lI
wl" nOI CII l,a'II0'0 .,111 ';0"r0911 .,nOIl "'II P"~ nil ''''''0. CIO''''ry nYI"I"/ CIII 01 Inll n,,,,.
born en,'. 1UII"9 Irl ';0.,'110 PQrtle~ 01 In, 010'"1/" hO,pllIl ';O~"~lmllnt lor "'IIIIMy Will 0'
CCVIIIIO u~all "Intl 0 S~II onlY 01 Sill .ro 11""ly 'Mollm,nl: 11hll QIlt. 01 Inll 'nl,nl "OlilflnQ
ollllnlllvlI "Ulm.~' HIli C~ ,;OVllla o~IY II In. .nllnl 'I CO~'"Q ',nolI I Sill .no I.mlly ,MolI"'.",.
. '{ol"nlll"/'O""ly pl.nnl~9 I.rllC~1 '1'0 IlIflllulIO~ (You p.Y I $\0 COPIY '01' oloPM/oqml (1111"'9
only): I se~ ';UPIY 101 ~'UCIO""1I1 Iro I $ \ 00 COPIY 101 luo"1I9'lIa~11
Inl,rt,'lIy ",."cn (ol.q~aell Ino ""lInllnll (You P'Y I S~OO ';OP'y cr e~~'. 01 co" 01 ur,ICI.
wnICn.VII '1"11, ell m~lnPQI PilI cou,.. ct 'I4II",.nl.)
. OllgMolIs IMa IIU'''''Mt 01 01...... ~II". .y.
. ""I/~Y 1..IIMg .no IIUI"'lnl"M~luOIM~ 1..1 1M IIU,,,,,MI "'"."al~
, None.ptllmentall",pllnll
, Com.., nUtllM klOM'Y IIlnoplanll, 'M 'IvIr IIano.l.nll'ar "nllortn v/lllftl I;. 18 '",Ih I:III.ry .WI'
"' 01 olh" Ino lIage 11.., 01...... ~llog.nle (oUMII cene ",.,10'11 IlInlpl.nlo: .~laloqoYo Penl
"'UIOW ~1~lpl"'" ('Ulol~r,O~1 lI.m CIII .no P,Mpn.,al 111m :111 l~t~Qnl 'el 'I IC!.:II lympnccyllC
or ~on,lynlpnoc:'IUU I.~~.""., 21 'o~lnc.o Heoq~Il'" Iy",pnoma, Jllu~.no'c IIcn,Hooqk"'-a Iym'
pnum., ~I lavanclc M''''OoIUIO'''', 5) 1.'hc~III. m.oluhM", '.IIOP'"ICnllll lIJ10 eVln.~ qal", CIII
l1.Imo/S 1M 611:IIul caMcer, W/'.M luln~nUd 101 Plym.m I:y '"11 PI.n ""dleaJ ~Irtotor, Pal.o an en.
lanl ..Iaollln.o I:y "'II MIolcal e..cuIIV. C~mm,"'., Palll.c ,".olc~ "'0 nOlplI1I ..p'~I" 01 tn.
<lonor.,. ';0.".0 II 'hi l,p.nlul Irt ~ol cu..r.o ~y "'. ounor'1 ""UI'~C'.
. OIIlYIII
, C".molherIPY, 1I0lalle~ In.,uPY, 1M .nnallllon '"IIIPY
, SUIgloal ~u"".nl 01 ",alClo Ol:lllty
. Onnopllulo O.VIOIII, I"cn II 1:11011I
PIOlln.IIC O'VI~U. suCI' u anlllClalllmtl
, CUllol. ",.olcal ICUIP",.MI, au on as onllllen.lIll/14 nouCllall;.ol.
, I"em. nlllln ur,lCu ~I .'uIUI aM .Ic",uo 'nl/aplIlI, ",,,,n pr..~rl:.o py 'IO~I PI.n OOolor.
",nO Will panColcally ''''''11 Ih. ploQlam 101 conllllulng 'P.IOP"."M'II 1M M.O.
Oral surgery 1$ PIOVIOIO lor MMIMlal I~Ig'oul .M hOsPllallzallo~ pree.ouI.. leI congllnllal
ollllell, Iu~n .. CI." lip "'0 01." p.'all, arlllol ",Idloal 01 ''''gICOl ploo.cyr.. OCculting wllMln ':1
lolle.nllo Ih. ulal caVity CI Iln~l.olnuluolnQ, but ~olllmll.o 10, lIu"".nl 01 fllCIUI.. Ino ..CIOlcn
0/ tumorl 'M ",1/1, ,lIIOlhl/ Ploo.ourn InvolvIM9 '"1 IlIItn 01 .,101 IwoYMlng I". 111I1" II. nel
OOVI/.O, Incluolng IhQrt'~IMr, 01 tn. ",.ncICI. or ",011111I 101 COlm.1I0 ~urCOIII$. Corr.ClIon 01 maloc,
Ol,,"on, .na any c.nlal car, In.,OI.,eo 1M lIu"",m .;t lempOlomanolbulll 10lMi TMJ) p.,n aystYMOIIOM
Iynolom..
A.conII/UOllv. lyrq.I"/ ""II Pe prevlc.d 10 COrrlct , .:onollloM HnIC~ Mil rll~llld in a 'ynCIIOMal
eelacl or ",hlc~ nil ,,,,,11'0 110m 10CIO.MIII .Mlurl CIllo", II.:I91rl .1 I~I 'coloenl cr IUlq.r, nu PIC'
ovc'O . malel all.ct an Ir.. me",c.r'I apPulane. Ino In. cCllolllon ,3~ I...enaoly C. ..eaClllO 10
1:. co".oIIU ~y SUCM 1"'~lry.
Shon'lelm IIhlOllllollv. 1".IIlPY IpMYIICII. louch Ino cceupallo~11I .1 :IOVlO.d eM .,, ,n.all.nl
or OYIOIU.Mloaall 101 .,p 10 two menlnl p., ,;oMell1on It IIgnlllol1m ,,,,prov.,,,.m oan 01 ..ceCIIC
WII",n rHO momnl (You p'Y nolnlnr, PII allllonl. So.een '"elUPY '1"",,1.0 10 ~'"ml"1 01 ClnalM
fCa.en ImpllI",.nll ot aloanle 0"9,n, CeoUO.llonll I".,BOY ID 11""110 10 lerllOIl Inll aUIII In,
m.",P., 10 Icnllv. ano ",aIMI.ln IIII1.CIII ano ''''PIOVld 'unellonlM9 'n Clnel 10l1vllln 01 oally 1I."ng.
Se",'I,.".d gyn.color,laal chock'"PI all IImlllo '0 on. Pfl '''' 'JO 10 5 I 00. ,0,1/ n'~I".ry ~ynl'
C~109'oal call cPll/n.d Il1le"..h '.'I"a,I'em ,e~,' pM",ary call ooCIOr.1 ~OV.'IO In '~II.
C"AE MUST Be RECElveo FROM OA ,lRRMIOEO BY PL"N OCCTORS
-
What /s not
covered
.-
What Is covered
Hospital care
Extended care
Hospice care
MedicAl and surgical benefits ~U/llln"'1/
, Phyel~ol ,.O""il': C'I 'ilOI I" ill/t ",';nurl Ic, n"~I~1I 'taIC"G, I~Cil .1 IhOU "OW,q /0'
,O'"ill"9 q, conur.', .".ploym,"I, 'ne~'I"e', q, o;o',,,nm.nl.,llctnllil9
S'rll~U 1"C'OI Ir. '''" numIr0",n,.ut"eI10 'h. cOPIY Ic, ,nf"tlllly IIr,,~.,1 ,,111'0 II/ CO",
elPllo" ty ,,,,lIe:, - ""I, 'il"'UI/I"9 ,nilI/O 1,l1ll1ulIOn ,no ,mtrlO I,onel,/" '''0 OIlJVINMoII
PII""rl r.~'POII '. 'Ill':',.nt Q/ ,,,f,,,,lily
, Colli 0/ OOilOI 10"-
, R'''''llt 0/ VOI~r'lr. 1.1"'Cllly",,ouc.~ "."llIy
, 101"110 ,",...rl or,....,.' '01 COlm.lle P~'oou,
. T"".plll/111 nl/IIIII.: U CO".,'O
. H..""V 1101
, 1"0",a",lI<a, IIrllCIl
, R.pla"m,nl 01 c"rc:i':I~ 0' ..It",,1 P'Ollh'"c O''''CII
, ~o"v,t"m 11'110,11I.'.." 'J'lll.PY
,llll/VY u/\Im
0'9'" lran.pl,ntl:,. ,.rIICU .nd lupplI'l 11I01t0 100'90" OOnOIlI/II, u"'''' "". 'IOIPII"II. I
mambtr
, 100<11,"" """et'
Hospital/extended care benefits
Tha 1011" P'OVlOU I ::-;I'h,nllY' 'a""' 0/I:,n,1I11 Wllh no 0011" 0' day I/""t wM" hOlpll.lIl1o
u"~,, "'. ~III 01 I F'it ::cIC,. You pay nolilln", All nlCu..ry UNlolI Ira cov"ad, l"cluol"V:
S'''''P''''I'' ,oom a.:::,-mOOIIlO"I: wil,,, n PI." 00~10' d'lelnllnU 1II1 m'olellly n'CUUIIy, IhIt
oeetor ",uy prUclll:' :rll" l__ommoo.1I0ne 0' pn"alt oury "UII"'9 CII'
S"'~I,lIuo ~'" "r,1I I.~n II 1/11'''''''' c.re 0' cardl'd care vnill
Th. Plan p'o"lon I ~;,-;"n'nSI'" ""~. of il.n.flls lor ~p 10 100 dlYS per calandlr YII' wh.n hJlI.
11m, Ikllllld nursing WI 5 -."uury Ind cantln,manlln I sklllao nu,sl"g /.~lIlly II In lI.u Of hOlpl.
IllIzellen, You pay nO[:'I'" All nec....ry uIVlcea Ira cov"ad, induol"g:
, B.d, bellJ'o .nd "".rL 'u,sln" care
, OI1.lVI, bIClO~ICBII, I.,;,:as, "'0 .Qulpm,nl oral",,,,y p,o"ld'o 0' Irr,n...o by Iha sklllad nvrslnV
/IClllry wh,,, p,ueret: :y I PI." dealor
SUPl:lcrtJ", and PBlIlIlr.t ::Iia lor I I"mlnully III m.mbtr II ca".rao In Ih, hom' or heIple, fUClllly,
S'N"U Inclvou Incatt.~ 1.110 culpa"u", "", .no fl""ly ccunullllg: thus. SIN"" Ire p,Qvldad
uMar ,hu alll~1I0" Cf I :'L~ CCCIC' 'Hhe c"tlll,s Ihlllhe pIII,nll' In Iha II,mlnal slaVn a/llln...,
wllh a Ilfa up'Clan~y :1 l:C/oxlmlrely SIX manlllS 0' lau,
Ambulance service B,,,IIlls are P'C"'O'O 'c, L-culun~' tra"spon.llon :'oar,o 0' aUIMllUO ily I PI,n oeelor,
I
:hat Is not
OVered
Ho,pUallalUQn lor c,,,,,,n a.nlll proc,aurn II co,,"uo wha" I lOll" oo~lcr 01'1/"""" Ihtra II I
n'lId fer help"III~.,,~r. '" '\Iuon, lotllly vnrlll"O Ie Ihu o,nlll proctoura: Ihu Plan will CO"I/ the
hOlplllllZlllon, bUI nOI 'fa :aSI Of Ih. pra/.Ulollll oental s'Nlcu, COMIIIOIl' fer whlen hesp"llIrl'
lion weuld b. ca,,"tc r~CI h,mophlllo ano hnn 015....: 'h' n'ld fo, Ill,slhe"I, by Itllll, II Ml
IU~h , concltlon,
HOlpUalla,Uon ler mtc'~1 Irfllm.h' d/ sublllnca .bu.. Is IIml"<1lo ,ml/venO'1 CIIII, allVno,
115, 1I..lmunl c/ m'cl~ ::1101110111, '''0 meclClI mll"lg,m.nt 01 'HllhOllWIl sy",Pto",s (lou18
a,'oxttlClIlIOn) II 'h, lOll1/' :r.:cr allll""nu IMII culplllenl mll/1l..um.nlll net m.QI~llIy Ippropna18,
Sit pIva I ~ lar non.mf\:,:;aJ IUC"lno' SOUU e,",/Ils,
Plllena' ccm/Ort 11,r-s, r.ch as lelUphan, Ind Illa',llIon
, CUlleolaJ call, 'Ul ::.ru, ~omlClllary a' can",luctnt carl
CARE MUST BE RECEIVEC F:;CM OR ARRANGED BY P~AN DOCTORS
11
-
---
What Is a
medical
emergency?
Procedure to
follow
Benefits within the
Service Area
Plan pays, , ,
You pay, , ,
Benefits outside
the Service Area
Plan pays, , ,
You pay, , ,
What Is covered
What Is not
covered
FlUng claims for
non-Plan providers
12
- .
Emergency benefits
.. mldh:al .m.,g."uy 1$ an .~Clq'''lal "IIJI"( Qr lhlt '~l1c::ltn ..fit] 14"UQIfCltr:a ,:""'1 of . .;q"lJllI~n
'~qUlrln~ 'mm~qllll ,.,,~ql~al ~, ,uI~I~al ~a" Sqml DIoCI.mo I" ~,"~'~.n~11O o~~auu 111\OllrlOI~q
Dlompl/Y. In. V m"ln, o~~oml moll' '0"0"1. ..amDI~O "~'''O~ '1~~D ~VII .no OlOl<'n oonoo, CIM~'a
er' 1t"lr~lr~IU e.~~"U Inov arl DqrerllQlly lill,'nruren"~, I,,~n n nlO/1 'lIa~I<O, 11101<1.. DC"
Iqn,n90, g"n,nOI 'NINnOO, ~r ,,,OOln nltlli'y 10 e'IOII'. rh." "."orv ~Ino' ,~,," .;onOIlIQnO 11'0'
't":1f PIa" m.y 1.1.,mlf'lt I'., mltlJll:OI tmlf'9"",jIU-W"41 1""'1 III MI1VIt In ,:omrl'lIJ" 115 ,,,.. '''UIl1 IQr
OUI~I< 'CIIOII
II you 'rI ,n In ~m~r9'ne'/"I"a"~'\. D'UII ~oJI '/0'" Dllmar/ ~arl '10~10' In I"r'mo ,mll9.n~IU. ,I
you IrI "nlOle 10 con'o~1 yo"r ~c~IO'. ~o 10 Ih, n,aru' hOODllI1 omarg,ncy '0011'. el 0"" 10 "IIIMI
,marg,r,c'/ loom DlrOOMII'''11 you "I 0 ~lln m,moll N Ih'V ,Oil nOlllv Ih, ~lln, 'fOU or Ilomlly
mlmel' IhO"'O no Illy Ih~ Pl,n wllhln 24 hO",O.
" you n'IO 10 t, hOI~lIollno, Ihl ~lln mUll e~ nOlllllO wll",n 24 ho"" IlIlr you 000011'1 Itll 10
~"'I hOIlC'. "rIUO ,I NU rOI r,uonOOIY DOU,!:I, 10 nOIl~/,nl ~'O,\ 'Nllnln Inllllm~. II you arl rOIDl'
'IIIUO In nor'P'on 10CIIIIIU orO Plln qO~IOtO Olll,,~ 'lor' .:on 01 0111" DrOvIO"1 ,n I Plan hOOPIl41,'
IOU 'NIIIIlI 1I0rol'''I'1 whln mlOloally IUOlt" 'NIl" Inv 'mll",on~1 ,nergu ~O"'rlO In ,,,,1
1/ you hlv, o"UII~nl 000'" o~ull ,lIrUO OlhO' '''In Im~'~er'~lu, you ,no"IO CIII yo", pllmlr/ OOrl
<JOOlor
e~n,'1I1 1/1 'Y"llbl~ 10' ~a/l "011' non,~lln proVloero In . m~Olonl ,mero,ncv only II oll,V In
'IUCnlno I ~lln D'OVlOU' 'NOuIO luullln qum, 011101111'1 c, "o",llcn"II'dClrov 10 your conolllon.
Fl,lIonlel. C"lrgdl 'c, ,mltg,ncy CI/I """~dlIO In, "lfnllh' """Cdl woulO nu", Illtn coy.
"'0 1/ 'IC'''''O 'rom Plln prOVloerl,
526 per ,m,'gancy 'ocn' villi or u'ganl cs" camar VlOII 'or ,marg,ncy CB/I .I""CU wnlch 1/1 COy,
'/ld b,nallll ollnll PI'n, 111M ,marglno'/ ,",,111 In IOmll$lOn 10 I hOIDM!, 1M ImerOln<1'1 en,.
~op,y II WRIY,o.
eln,II11 I" IVIIIIIlI, 10' "V rllolcllIV n'Ollnry ""11" "r"~a In It 10 Imm,olllllV r'oWld
~~cnu.. 01 U"'O'dlUh IlIn'lI 0' Inlury.
P~olonlll" 0"1l10'1 '0' 'm'ro'ncy es" l.rllCU 10 '''1 ..tlnll"l $lrllCdI woulo ",y, tun coy.
arlo " rlC"V'o Irom Plsn prOVlnarl.
526 per amar9,no'/ ,ocm Villi or "'O'rl ~nll ~Inlar ',1111 lor .margl"C'I cera """040 w"'c" 1/1 COv'
,reo clnallll 011"" Flln. I' 1"1 amarOlno'/ '1Iulllln aOmll$lOr 10 a hOIDIIII. 1M ImlrO'"c'/ car,
~opav II WIlV'o,
!!ma'glncy cnre 01 s OOCIOr'! olflc.e
Em"Olnc'/ es" II an "rgl"' C3ra canlar
EmerOlncy call aB an euIDI",nl e' InDa",m 31 I noacllll, 'ncluolno ooeIO/l' """~dI
;lmO"'Inc.1 IIr"CI ,f apDrov~O bV '''' PIIr
Ellell'" ~nre 0' non.mart;lroy Clll
EmerOlncy cerl 1"0111010 0"'1101 '''1 S'''''CI ;lrn Illnl nuo lor oarl coula naVI Illtn lore$l'"
tafcr, O,panl"g '''1 SI",'CI ;lrea
M,oloal sno hOOp1111 COllI lIa"llInG Irom I no,mlllull'larm c.llvar/ olllllbV oul5ldl In, Sac"oa
;IriS
'Nlln you, lul"Ctl;Sllon. 1M F'ar will pay Iml'g,noy b,nlllll clrecllv 10 '''' p'OVlaaro 01 you, ,mer.
..Ino'/ C4/1 "DO" IICalPI of 1M" Clalml, If IC" are reoweo 10 pay 10' Inl .,,,,,cas, lubmll Ilfmluo
PillS Ind you, l'O"P'5 to thl Flan alorOMln In u'DIInlllon 10' '''1 ..rllcel Ina '''1 10,"nll~300n
'nlo'mlllon "011' ydu, 10 caro. ;I Dsyment 'N,II p, slm 10 yo" 10' Ina DrOYloar 1/ vou 010 nOI pay In,
Illll), unlll$ In, Claim IS OlnllO, " II '0 OlnllO. you 'N'" 'aOl"'l nOIlOI 0/ ,''' OIOlllon, Incluolng In,
'"Ions 10' '''a oanlll ano 1"1 D'OVlllonl of the contrlct en 'Nhlcn olntal 'Nil CI$lO. You may
IIOU'II "COtllldarl"on in accoroanc, wlln I"a OISP"IIO Clllml DIocao"re "' lOl1h on PIO' Ie.
Non-FEHB benefits available to Plan members
TI'I' 1:""1111111 1IH5I:f1l::1ilJ 'J" tl~llS f;U';1f tUff "~lth"r ClttJlfltl "cr 'JUUtllr1fttllJ 'J'~~II' !~,., .:crlr:Jcl ~Ilh ,,,.. FEI-'o8. t:lJl ij(lt malls iI'IlJlll1t;ll.
Ie III "",cll.u .lnlJ lal11lly /lhf/l.t:tfnS .....,..c arlt mlfrlltllt'$ <)/ !/'"tl$ PIO(1. n~" ';0151 -:, "'. CII"..'il$ alfl$Cttl:IN 'J" ""HI 1:8911 'rJ "CI ,r.;rtJtJ.d
I" 'hll Fel~e arlf"'IIjfT1, ~r.y .:t"iSflJtll$ 'r:r Ih~t!. $tfr,II:U 1Q r~1 ':ClJr'1 rCWtltlJ any FEH8 ljlllJl,ji;!ICIIIIS. ~lJl'oJl'~CCItIlI nl'U:I,"UIn ~CPlJY
O:r'l4ffJlIA. tile, r~lflSlt r.llrlfli15 .'1' f'ef ~Lt:llft.:t IQ 'tI" FEHl 'JIIS~lJll,cJ ";11J1fl'lS prCC::lfqwr.
TI,. (irUI" Plllab~rgh 6'1'110" Aru
Vi'lM Ca.'rla. - All f'UllhA",."ca ",,,n~,,, a~lomalloally ~~allly lor a "2CI20. '''''00 c,o,lIl \/'InlCn .'OYI~U I 2C~', ol.omJlll
olllhl oo,mul letall ."e. 'or "0101, Ira,nu 1M COOlacll.na.a " .Ian .lr1IOPllln9 VI"On p,o"l1.r.,
. 0,,,,,, Co..,aa. , '" la~IIt~" 10 tn. 512 CQP.ym."1 '~r '" 01.1 .u",. CIUnlOIJ Inll t\/'lO {21 ~1"wln9 ,,'ay. all
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111111'91, ano danluru,
HUll" eaUCllle" CI,u.a - Clas.., '" 4val'I~I. Iru 01 ~nl'?' I' ,....lInA",.",. H.allh C.n", I~Call~na, 'CI'''d"
~I.~ Clan., Inclll~' S"'Q~ln9 C"S4I1~", NullillOll, ~1"'Ua, Pr.,,"a' C.", PMS, SPOil. M'<1ICln'. 014b"." Slra..
Ma"ag,m'nt, SOIl eflU"',
H4III" Clllb OIlCQunr. - f'ftallhA",enoa m'm~"1 '" '1lglbla lor olloountad InIU,UQn I... .nd alacaumad manl"'y manlb"."lp
"41 Plan paltlclpellng nul/h clubl,
Th, Canlrll P,nnIV'V4nl. Sarvlc, Ar..
. Ha.lln eauc.lla" Cllu~, -W'.ryle,"
H"II"Am,rlca I. pl....d 10 011" our m.mb.rs "'mbur.amanl 0' \ 00'''' 10Wllrli lIla (a.t at apPloVad Wa"neu plollram.
offered /hIOU"" 10~1\J Mapltllll Ind orOlmllllon., Pro9ram. InclVda: ,
Pranalal EdUO.IICn (InClUding ~Imue) Stre.. Managemant
W"ght M.".g.mantlnd Reducllon' Stop Smo~lng
Wellneaa Flral Aid
Back CIII
'Nole: Welgnt 10.. cl.U.. ." "Imburno UP 10 5160,00 per COntrlcl year par memb" lor In epprOy.d \/'Ie"1"1
Iou progmm.
To obtain .Wfulylu I:coklllwhlcn contalnllll" ~f epprovOl<l prellraml, call Memo" :Se,.,lc.. 1II,eCO-7ee,eul3.
H,,"" Club Oiscau"" 'Plus S.IVIO.. Pregram'
,....,lhA",.nca m.mbdl! mlY rlCIIV' dlacauMla by pral4nllng /hair 1,0, caro. II 'IIMO~' n"Jlh 'nd IIUl.U ~lubllnO lparTIng ~ocd
.10111. For moll InlormlhOn, ~IllI Me",o., 5'1'110" all,800,788.8....5,
BENEFITS ON THIS PAali AIlE NOT PART OF THE FEHB CONTRACT
17
-.-
Questions
Disputed olalms
18
How to obtain benefits
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I'" provloer wll/, '19.ro 10 Inll PI"'Culll clllln,
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OPM "VI.W may ~I obl"n.o by wMII"Q 10:
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WII/II" 90 dlY. el tn. Fl.,,', IIlIrm,lIon 01 I'" ""Ill,
YOu mlY "10 uk CPM lor I "VIIW II I'" Plan ",,. 10 '"Pond wlI"l" ~O dlYI 01 your w"".,, tllO~nl
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f40IlV. I r.Qvll' 'ar "VltW wlllll" 120 o'Y' 01 YOllr "ou..t 10 In. Plan 'or ,'.eMII04l111l0" 0' 1/1,
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No I,w.vl! mlY b. b'0~9nllo "ooy" on . CI.lm lor IlIiS PI,n', ban,III' unlll yo~ ar, In '''" coae 0' In
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"tll 1/1," O"oemt41 alai I'" Inlro ,'11 1/1" I'" lur '" wnlon In. """en or I~ppll.. ~Po" ""'en
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F4d4laJ I,w ,xOI~IIY4ly 90...."'. 'II cII.,ma lor railal ,n I 'IWIulll"lt rail'" 10 1/111 PI.n'. b.nall" or
cav.rI9' or p'yma"" ...."" rnp.o! 10 '''0.. ba".fi,s, A. pravlO.d u"CII Ih. '9r..,".nl b'l'II..n
tnll Plan I"d iIIl Cfilet A, p"IOM" "'1"lo.m,"" Ivolollll ICIIO" on IVO" clllms lor ,.11., II IIm'''1l
10 I "View 01 OPM'IIIMI O'CII'O" 10 o."rml'" II "I~ IIbltrary or C~ptlCIOUI ~"a" ill. !trml c',n.
Stll.m.,,' of a'"lfill, OlmlOIl /I~oV"OOlf ,,, IUO" "WSLJIlI .,. "m,l.o 10 In. Imount 01 '"'' PI,,,'S
contflo' b.nl'lIs ," CIIO~II. oIVIl/mol. P",~oom.nll"""'"lll'''' /III prno"~.o by IIIlCIlO" 1981
(I) at 1111.28, U,S, Coo'II"d court cOilS,
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OPM'I 040Illl0" 0" 1/1, olapulIO olllm,
S:Jmmary of benefits for HealthAmerlca Pennsylvania, Inc, -- 1993
OQ llnl ,.IV ll" Ihlll ql\,,11 ,,1..,1'.. ,\lll:lflll,'IIG ~PI j;,Ij';H1ltIJ ", '~jll ,jf'hflUJ lJII'II""""UiI "\1II;:1II./J, 5LJr.lltl:I,," q'" 1111l"llltJ/111, Hl'dlJlh:rlS, .)1~11
....':hHSIQrlll SIll '~"I' ", !M" l:(';l:"I;",. n'llS .;tlqn mlt,Qly IUI11I1"J1~ltJfI ,:,,/11111 ""IJ4It0l1' .,~atf,.tJ'G CcvlJflflJ IJ'f "'it 'JIB" II 'tr:lJ NIISI' IQ tfl1tlJll
or t;r'\QI"~" ~ClJr ilnf/Jlll'ntll'l I" II"" 1:214111. I'll' 'IJr" tl) '1rJIt:lllll rj'lf .:cnl'I:1 """;III""'~I ,:t;~1f .;f' jl)IJr .."t~lh1''','llmtn tCCtJlf15 4J:plfltr ~" ftllt
CC'1' "' Ihl~ I:ICCI'IJI~I ;l.1.L BEIWICHe COVIWHO lJNOI!R THI!J PL,lN, WITH THI! eXCepTION OF I!Ml!!ROENCY <;;l.AH, ;l.AIl
COVHAIiO ONLY WHI!N "ROVIOI!O OR ;l.1~AM'lOeO BY l'I.,lN OQCTOI~6,
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InplllI.nl
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OUlpalhlOt
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Emergency cor.
HO,pllll
hl.ndld co,.
Mlnlal
condlllona
S~balancl
.b~..
Homl health
Clrl
Mlnlal
condlllona
S~ballnca
.b~al
Pruerlpllon drugs
Dental core
Vision CO"
Out.ot.pocketllmll
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Plan P'YW!HI)YIIJU _ P")I
C~mp'el'~"IIV~ I~n~e ,11 ml~lcal 1M Sllrglcul U"M" wilM~1 ~Qlllr Or ~IlY IlIntt.
I"CII/On 'n'/IQ~I:111I1 IICCIOI C~", lOllm "'0 ~lIa'O, g'''II~1 "1/11'"0 co,e, p"vlle lellm '''0
p"vall n~I~I"9 ca,e " mlolcallv "ICUU"/, cleo"o~M lUll, ""101 1M ""olell! I~ppllu,
~u .:1 01l"~1"'9 IlIlIm, 'n""~lve carl 1M ,0mple'l 0101,,"11'1' eare, Yo~ p'Y "elhl"O ""'" "
,III neCU5Qr/l~r,ICI'~,"p Ie ,~O cavs pa, eOIIlI'IIa1 1~I' Yo~ I'lY nelhl"g"""...". '" .., ".
Cllllne." Ir'l l'UII".rllll aCIJ" PIvchlllrlC ,;crOlllc"l Ie' IJP '0 30 lIaVI ~I '"pa"enl el'l
p~r yelr, Yo~ PlY I $~6 ,epav pa, eav Ie, 'hI /lrsl "" (51 IIIVI "'0 nOlhll'O Ie, daV~ 5
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Up Ie JI) '10V~ ," an ~lceMI C'llo"lIcalloll e' R'"ICllllolle" eM11r p~' ecnl,aCI yU', 90
cOY' PI' 11I1"ml. YII~ pay nelhll'9,"" '''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' q
C~mp"nl"~I"1 lOlllle 01 urilCu I~ch U olallllom I"C IrUlm,,,' III ,IIMU er '''I~ry,
'''cl~elnl/ ~p'clall,"~ ea,.: PII"""'" CU'I, ,nel~elng WIll CI~Y ea'l, Pltlcllle chlek",ps
1"0 'e~l'n' Imm~nlu"on.: laco'Blcry lallO 1"0 X"OVI: eOnlplll. mlllrnlly eo,n, vo~ PlY
Mlhlno /0' In oHloe 'II~II 0' l'OIJ~e cull by u neclc,. YII~ pay ~ 510 cOPIY par oltlo' ,,,.11
an., "'~lJhl' Ip~clnlfl"'''\ l'OlJ'II.."." ",..,.. "..."."."" ....".,. """,,,,,, ",. ,,,,,,,,,,,,,,,,,,.,,. ,..." ", """" 10
;1.11 nle.5S~1'f "Slls cy nl/IU' allll "ca"..e U'I'lp"ll, Yo~ pay Mlhlng ,,"'''''''' '"""". """" 10
lJp 10 20 oYlpaUlnl vlolll p.r VII" vo~ pay I 520 eopoy lor lIeh indl"'d~"' Villi OM 510
cCP~Y lor loch ,.'c~p vl5I1 """"""""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,.,,,,,,,,,,,,,,,,,,,,,,,,,,,,..,.,,""'''' 1~
lJp Ie ~O Villi. par conllocl Veo" \20 ,"110 p"lIflllm., vo~ PlY nOlhlno"""""",.,,,.,,,,,,,,,,, IJ
Reuonabll cl,arg.. Ic, ~1""":B5 and I~ppllu "<lIllfIC baCUI/.. ~I I m,olcul eml'ganc'/
Yo~ pay I 525 ccpoy 10 Iha helPllOI 101 "oeh 1,nl'glllCY loom "Ill wllhln 0' 0~1I1~' 111~
S''''''CQ "'10 ancllny ",o,g.. Ie, sar,leU Wnlch are nOI eov"la bl"al"s clll,,, Plln ,,,," '2
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717 204 64081'll/l2
X, ~ur"ote, ..k l:b.l.l Honor C:Ola't to I
., Approve the temponzy d.bco~t,l,n\l&nO. 01 thAI
p~,I,~g No~kor.' CQD~.a.ation a.../
b, Aur.borile acceptance or "4,000.00, '20,000,00 to
1:1. pdd to Attorney Rcna14 t.. c:.lblxln,
a, Appro".. acceptance or an UII1\lil:y pay:l.ng "00,00
pe~ mont~, guaz&Uteer:l for eiel:een (15) ~&r. o~ tbe lilltlme
.of HI', Pallll, wbichever .I., long. X' .
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l't \II, "lmolhy Owarllluchelll, Esquire, hcrcby verify nnd Illllt thot thc fl1ClIlCl forth In Ihc
fOrllaolnlJ dOllumenlllfc lrull und Cllrrcl~t to the b~st of illY Intonnotlon, knowledllC ond bllllclf, I
undel1l111ld Ihl1l false sllltements herllln ur, made ~ubJect 10 Ole penullleo of 18 Pu, C,S,A, SC~llon
4904 rc:lutlnlllO unswom verltlcatlon to nll'horhlcK,
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Cl!I.t'I'JII'CAT1~ OF llJ.iQ.YIr:ili
,. Jllllk M, HlII'UUDlh ~6qulrc, hCf'I!b>, cCrllI'>' 1111111 UlIIlhl6 dll)' 6e,,,lnjl II llOp)' ofthll
rorcjlohljl dOCUIl111nl uponlhll persolln IIl1d In thlllllllllllllr Indllluted below. which 6ervh:c '1I1Isl1e.
the rcqulrlllllenlll oCtile 1)lllln6)'1 vllnlu Rulun of Clvlll'roclldurll, b)' deposhlll~ a ~op>, oftlllllll In
Ihe United S1ll1ll61l1ull. nrsl.cll1lls pOSlllll1l prepuld, I1IIliJllows:
Our)' L. Rothllchlld, Esqulru
SUll'ulelll, SchlOiIlIlIl, Drown & Culhoon
2040 1.1IlgleslowII Roud, Suite 106
Hurrlnburg. I' A 171 J 0
Rlchurd 0111'11. Esqulrll
1776 S, Quellll Streel
York, I'A 17403
Tholllas T, Frl1l1lploll. Esquire
Plelrllgullo, llo51llck & Gordon
The Thlrty.Elghth Floor
Onll Oxford Cenlrll
Plllsburgh, I'A 15219
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Frullk J, Lllvery, Jr,. Esquire
Lllvery & Kuln
212 Locust Street
Harrisburg, I) A 17101
HARTMAN & MILLER, P.C,
Dated: 1/~/9'6
By:
k M, Hu mllll, Esquire
upremll Ct, 1.0, 1121902
One KeY5tone PII1Zl1. Suite 107
Frontllnd Market Streets
Hl1lTlsburg. PA 17101
(717) 232.3046
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JlI.IIIUI'fs cumpllllllt stilh}. Il good rlllh" fur which rell.f can be
JlI.lnllffs clAims worllllmely med,
Jllllllltl(fs c1l1lllls IIrll brought wlthlllthll SCOpll of defendant'~ policy
Plltlllllffs dllhlls Ill'll brought wlthlllthll IIcope of defendant'a policy
31. Dellled. III flld plalllll(fs cal'll did hllpl'ove Ihn medial con,fltton of
Eug/i!lIe P"IIII,
32. Plaintiffs Cill'lI beyolld the (Irst two months did Improve Eugene
PIIIlIl'S Illedlclll cOlldlllonlllld Is cover'ed by defend""t HealU1Amerlca's PIIln of
Insurllllce for defend lint Eugene Pllhn, the p'IUen!.
33, Dellled, PhllnU((s l'lIrl! beyond the first two months of defendants
P.Illn stllY did provide II medicll' benefit 10 the defcndant which WIIS pilyable
from defend"nt HelllthAmuric,,'s Plan of Insufilnce (or defendant Palm.
34, Denied, PllllnU((s cllre beyond the flt'st two months of defendants
Palm stay did provide II medical benefit to the dllfendant which was payable
from defendant HealthAmerica's Plan of Insurance for defendllnl Palm,
35, Admllted Ihat the Plan of Insurance Is not obllgall!d to pay for any
work relawd Injuries to the extent thllt there Is workers' compensation Insurance
available, Until It Is determined that workers' compensation 'n~urance Is
available HealtArnerica has the obligation to pay for plallltiffs charges for
services rendered to defendant Palm.
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36, Admitted, Uy WilY of further anlwer even tf the allesatJllnl ....
truo III lllIled, defendanl HelllthAnwrlca hn thlt obllgllthm to I'"Y for defendant
1)lllm'l sllrvlclll I'IIndlll'lld by the pllllnu(h, Plaintiff IltblChea hel'lllo a directive of
thll PennaylvlllIIII InSUflllICO Dop"I'lIuont rL'tjulrh18 IU!I,lth IIISllranl:1I carriere to
1'1')' for Injurod workf1ra llUlIlth Cill'O whoreln workerll' compensation coverage III
dl.putud, SIIILI exhibit I. I'I!ferrl!d till'S Exhibit II A",
37, ALhnltteLl, lIy WilY of furthllr IInswor defendant HoalU1Amorlca by
I'l!allons ablted III pllllnUrr. Cmul'llllnt IInd for llmaons Iblted herntn above I.
obllRatud to PIlY ~lnUff. chllrgel for lervlces I'l!lIdered 10 EUReno Palm,
38, AdmlttJ!d. \ly WilY of further answer defendant HealthAmorlca by
l'IIalons Iblted III phllllUffs Complaint Itlld for l'I!aaonl ltated hel'l!ln above I.
obllgatud to PilY pllllnUff. dlltrges for services relldered to Eugene Palm,
39, Admltwd, \ly WltY of further I,"swer defendltnt HelllthAmerlca by
ll!ftlons sblwd In plainUffs Complaint and for l'I!uonl ltated hel'l!In above I.
obllgatud to pay plaintiffs chargel for services rendered to Eugene Palm,
40, Admitted. \ly WltY of further answer defendant HealthAmerlca by
1'l!810nl stated in plalnUrrs Complaint and for reil50ns stated herein above III
obllgatud to PllY pl"inUffs charges for servlcns rendered to Eugene Palm,
41, Admitted, \ly way of further anlwer defendant HealthAmerlca by
I'l!allolls atated In plaintiffs Complaint and for rell50llS stated herein above I.
obligated to pay plainUffs charges for services rendered to Eugene Palm.
l
42, Adm/tllld,
43, Admltllld,
44, Admltwd, Ily WilY of furlhor IInlwor defendilnt HOillthAmllrl(il by
rllllsons .llIwd In plalnllrfs Cmlll'hllnt IInd fur flllUionl IlI\lIId ho",ln above I.
obUgllllld 10 I'"Y pllllnll((s dllll''''"S for 6ervkllS rendered 10 Eugene Plllm,
45, Wl\I!rl! WIl,'kl!I"1 clllllJ1l!n.IIUon II dlll'utl!d IlIld thl.!re exlll hl!IIlth
Insurllncl! for the InJul'lld workl!r, III II Ull.! Clllll hul'l.!, thl! hl!llllh Insurance carrier
Is obUgawd to plIY illHI Il!tJk rllllllhul'll!llIl!nt frum till! worker'1 comptlnQIIUon
nrrler, To the I.!xtenl hllllllh "ISUnll!':1! II obllK"led to p"y, HelllU1Amcrlca III
I)bUgllwd to I"'Y "' sll\tl!d III pll\lnll(('1 l'lllllpll\lnl,
46, Aflllr rl!lllOlll,blll InVl!sllgl.Uon pllllnUff Il\cluJ kllowledgl! or
Information luHldl.!nllo form 1\ belll!f liS 10 thc Irulh of thl! Ilvermenbs conlalned
In paragl'llph 46, Thl! lIVl!rnll!n15 are t1ll!refore donlcd and slrlcl proof I.
demanded al trial.
47, Admitted,
WHEREFORE, plaintiffs prllY entry of ludgment In Ita favor asalNt
defendanl HeallhAmerlca,
48-58. No Reply rL'qulred by plalnllff,
WHEREFORE, plaintiffs pray enlry of Judgment In Ita f"vor against
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'~bj.ctl Cov.r'~. Oilput.. aetw..n Wo~k'~I' Co=p.n'l~ion
rn.ur.r~ and Accidlnt and n..lth rn5Ura~1
Tell Carl tca'in., Oil:ec:tor
Bur.au ot Worker.' CQm~.nsat~on
'r~v1at:ick Musick, CPCU
BU:lllu Oi.:actor. .
proparty Lnd casual~' Insurance
As wa. diM CU. I ad at lGn~~ in today" =.etinq, the
Insurance O'pl.~:::en~ hu' t"olO ,rlll)'Ull11:::!.ons 9'C1ve%.'tlinc;; '1:.'11 Usa
o~ ,xclusionB'~or workars' cOQpensation insurance ~~
accid.ne "n~ hul~ inSu:a.nCII. 'l'he ralllva.,t: re'i\1be:.ons
lL%'at Ti.-.:le J1 566,H(1)(iii,and 5a9.77(1) (1'1). T~elll:nau
ot AccidLnt ~d Ke~ltA Insurance has consiseently
i,%1'Cal:ilrll;ed t.':la lanquaqe in the regUlations to taG:'..:.:.rll
\:ha t: '\&K cc=pl.n,1.u pay clai:ns it tho loIorkns I o:;olDW.ro5lll;ion
carriar ~e~u.s1S coveraqe. The ~o~s supervisors .~ tte
Bureau have con~i-~ed ~'1at policy to~-s ~or acciden~ And
b8ll,lth insu::'lIJ,ce ~r8 cons1ste.nl; lIi~ l:.'1is L,terpt8t.l.1:ion.
If an accidllnt and hllalth insurl!.r ::'lltuSIS to pay a chi::!
~h'n a wor~ers' co=pensation carrier has Qenied coverag./
than our Consu:a:: So1rvicl!liS Bureau can be Cl!lllld, and to'l.v
will. take appropr:iatll action to have t..'1e acc.!.dllnt arod .
baalth insu::er provide its policy'!! bel1a!i'::.s \';0 tl':e
!....,st.:::.d.
~ It: is ou::: understand1ng tl:la:t: you I?lan to publiciz. "'-he
tmsu:rllnce Oepart:uent' s role in thJ.S lDat't:.r and i1-o5
r.qula~ions by into~L~g your reterees and i~cludinq an
It~achlDenl; to wo::'kers' compen~a~ion clai~an~s wllan a c:lai=
hu bean ~iled with L&!.
Th. Insu::ancn Oepa::-::::llnt has
Offices i."'l ':.'1. CClll.monw"lt:.~.
nul:l.bers a::- a:
four Consl::Ie::' S.rl ieas
The locations &nd telephone
Philadelphia
Pit~1::U::ql1'
Har=~s::l:.:''i'
!:ria
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215-560-215:30
412-1565-5020
717-787-ZJ 17
1J14-871-4466
.
The BU::la~ ~ ~=QC:":.::r ~cr Ccr:~U::e= S.tr-/:'C8S ~.s i.t~.,Q::':
Ha:tino, a~d na can be reached at the Har::i&cu:r; o~~.!.=a,
cc Craqo::,i' :-fa:::i:lo
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J)EI1t:NI)AN'I' C()MI'I.AIN'I'
AND NOW, collies Addillonw Peli:ndalll Rockwood Cn5uolly Illluranco Company, by and
Ihrough lIs COUIIIICI, 1'lctragoJlo, Boslck & Gordon, and IIII~U Ihe within Al1Iwer and New MaUer 10
Additional Dcfendllll COlli plaint, setthlglill1h us tollow5
I, After rwonablc Investlllllllon, Rockwood Cosually hlluranco COI1lPlUlY locks
knowledgo or inronllnllon sulllclent 10 fonn u belief us to the IIulh ot'tllt.: mailer" merted In parallf1lph
I of tho AdditlonoJ Defendanl's COl1lplnJnt. The SDllle ore, therelore, dClded IIld Slricl proof Is
dellllUlded at tho time oftriaJ,
2, AI\er reasonAble Investlgotlon, Rockwood Casually Insursnce COl1lpllllY lacks
knowledge or inr\1rmallon sulllclent to fonl1l1 belief D8 10 the truth of tht. mallen merted In paralll'aph
2 of the Additional Defendant's ComploJnt. The lame are, therefore, denied and strict proof Is
d"'ltllIlded at the time of Ilia!. By way of further Dllswer, the avunllents that the Defendant, Eugene
Palm, wu the Bgent, servant or employee ofJlJ. Junk Lumber conslltule conclusions of law to which
no responsive pleading Is required. To the extent a responsive pleading Is required, It Is specifically
denied that Eugene Palm WIlS the employee of R J. Junk Lumber, By woy of funhcr answer, and to the
contrary, Eugene Palm WII.8 at all limes Dllll1dcpendent contraclor,
3, The avennents ofparallfaph 3 ofthu Addillonal Dcfendant's Complaint ore admitted.
4, The avemlents of paragraph 4 of the Additional Oefendallt's Complaint are admlua:d,
5. The avennents of paragraph 5 of the Additional Defendant's Complaint are admlued,
6, Aller realll)nable Invesllgallon, Rockwood Cuuwly Insurance Company lacks
sufficient knowledge or Infonnallon 10 fonn a belief as 10 whnt the Additional Defendant "believed" as
IICt forth in paragraph 6 of Its Additional Defcndal1t's ComplaJnt. By way of t\111her answP.r, It Is
IpCl:1l1caJly denied Ihll Ihe Injuries IlUllcrcd by Defendant, l~ullene I'alln, occurred while he was
employed by IU, Junk l.umb~r, and Inlhu courle and ICIll'e oflhal employmenl, Ily WAY ofl\Jrther
IIlllwer, and 10 Ihe contrlll)', J.:ullcnu l'ulm. al allllmel, Op~'I'lllcd 81 1II1 Indepcndenl conJr8l:I.or Gnd, al
no lime, waa he employed by It J, Junk l.umber
7, Plllgraph 7 of the Additional Defendlllll Complalnl Incorporatel by reference
paragraphl 6, 8, 10 1II1d 26 through 47 of thc Addhlonal IJelcndlllll' s Answer, New Maller and
Counlc:rclalllllo the Addillonal Dafendanl Complulnl ol'Defendanll Eugcnc l'ahlland J08ll1'wm,
. AReI' rea50lIable InvC:lll~tlon Rockwood Casualty Insurance Company laekl
knowledgc or Infonnltlon sulllclelll 10 fonn a belief oalo the truth of lhe IIvennc:nlland responlCs
conlalned In parl1graph 6 of Health America's Allswer and New Matter, The IIVllmlenll11ll tharc:forll
denied and strict prooftherc:ofls demanded at the time oflrial,
. The avemlc:nts lInd responses contalnc:d In paragraph 8 of Hc:a11h Amctica'a Answer
and New Maller I1ll conclusions of law or facllo whIch no respon6C Is necclsary. Addlllonally IIId
avemlentsand respoll5es refc:r to a writing which speaks for Itllllf as to the lenns thereof
. After reasonable Inveillgatlon Rockwood Casualty Insurance Company lacks
knowledge or Infonnallon sulllclent to fonn 11 belief I1S 10 the truth of the avennenlland respon6Cs
contained in paragraph 10 ofUea1thAmerica's Answer and New Matter, By way ofll1l1her answer,
Ihe remaining avennenls and re5ponses lie conclusions oflaw to which no response Is necessary,
· Rockwood Casualty Insurance CompallY InCOl'p0l'l11eS by reference as though fully set
forth herein Its responses to paragraphs 6, 8, and 10 hereinabove.
. The avemlents of paragraph 27 of HealthAnlerica's Answer and New Matter are
conclusions oflaw to which no re5ponse Is necessary.
. Tho aVllmlenla or parallrallh 28 or HewlhAmenca's Answer and Now Maller are
conclusions oflaw 10 which no reuponac Is necenal}'.
. Thll avenncnls orparllll'aph 29 ofH~wlhAmerlca's Answer and New Maller refer 10 I
wrllhlll which speaks ror It IIelf IS to Ihclennalhereofand no responlle Is required.
. The uvenllenla orparlgruph 30 orllewthAmerlca'a Amwer and New Maller relm- 10 a
wrlllnll whJch sp"aJu ror Ilaelfus to the lcnlllthereorand no responlle Is required.
· After reuonablc lnvesllllatlon, Ilockwood Cl15ualty Insurance Company lacks
knowledlle or lnfumllllon sufficlenllo ramI a belieI' IS 10 the trulha or the mailer Blllel1ed In plll1lg/'aph
31 ofUwlhAmmca's Answer and New Maller. The avemlents arcthererore denied and slncl proof
thereofls demanded sllhe time oflrlal
. After rca50nnble Invesllgation, Ilockwood ClIsually Insurance Company lacks
knowledlle or Informallon sufficient to ronn a belief as to lhe lruths of the lIIaller Blllerted In paragraph
32 of HeallhAlIlerlu's Answer and New Maller. The avennents are thererore denla:d and slnct proof
thereofls demanded at the time oflrial.
. After rea50nable Investigation, Ilockwood Casualty Insurance Company lacks
knowledge or Infurmallon sufficient 10 fonn a belief as to lhe truths of the mailer Ullerted In paragraph
33 of HeallhAmenca's Answer and New Maller. The avemlents are therefore denied and stnct proof
thereof Is demanded at the time of trial
· The avemlents of paragraph 34 of HeaJthAmenca's Answer and New Matter are
conclusions oflaw to which no response is nece55l1l')'.
. The avenncn15 contained ill paragraph 35 ofHeaJthAmerlca's Answer and New Maller
refer to a document which Is In writing, which document speaks for Itself. Accordingly, no responsive
pleading Is required.
. Aller rellOnable Invest1iltlon, Rockwood CIsuallY hlllll'l/1ce ComplllY lick.
knowledge or Infum14l1on nulllclenllo limn I bellcf 1.10 Ihe lruth ol'lhcmlllera which HeallhAl1lerir;a
believe. 15 lOt forth In plU'lllI'lph 36 of II. An.wer Ind New Maller 10 the Additional Dolillldl/1l
Cml1plalnl. The 5DIlIU lU'e lherefore denied Ind alricl proofll demunded Illhe lime oflri.l, ay wuyof
furthcr I/1Iwer, It II.peclfically denied lhallU Junk Lumber wu, II MY lillie, Ihe employer of Eugene
l'alm. 1'0 Ihe comnuy, Ind by way of further answer, Eugene I'&lm, at all tllnel, acled U III
Indc:pendcnl colltrllClor. By wlY of further Inswc:r, Ills alia speclllcaJly denied IhallU lunk Lumber
hu, il all lime. relavallt, acknowledged Ihal EUgl:11I1 I'nlm wa. Injured duringlhe courl4 ond IICQpe of
IUI employment. Stricl proofoflhc oIlelllllons contained in plU'alll'aph 36 ofHeallhAmerica'. Answer
I/1d New Mauer to lhe ComplaJllI to loin I. demanded at the time oflrial.
· ilia adnuued a. set forth In paralll'allh 37 ofHeollhAmerica'l An.wer ,,"d New Matter
that a Notice of Workers' Compen5Dllon DenJoI WIl.8 issued by ItS. lunk Lumber and Rockwood
CuuallY Innurlllcc Company, wluch Notice Is dated November 23, 1993 Indicating a lack of medical
Infurmation Illd 1/1 ongolnglnveltlgatlon to conflml the employmenl of Mr. Palm by R.I. lunk Lumber
wu ISllled. By way of further I/1swer, It II specifically defiled that ItS. lunk Lumber WU, at illY time,
lhe llIllployer of Eugene Palm. By way of lulthc:r anlwer, the Notlcc of Workers' Compenllldon
DeNalls a document wluch II In writing I/1d, wluch document speaks for Itself.
· I.t II adnutted u set forth In paralll'aph 38 ofHeaJlhAlIlerica's Answc:r and New Mallc:r
thaI a Claim Petition lor workerl' compensation benefits wu flied on or about December 27, 1993 by
loan Palm on bc:half of Eugene Palm against R.J. lunk Lumber. By way of further answer II Is
Ipeclfically deNed that R.J. lunk Lumber was, at any time, the c:mployer of Eugene Palm, To the
conlrary, Mr. PIIlm, at all times, opc:rated B5 an Independent contractor.
. 1111 admllted as set forth In paralll'lph 39 ofHwthAmerica'l Anlwer IIld Now Miller
that on or IIboUI February <), 1994, III Aluwer 10 tho Clalml)edtlon WIlS med on behalf of 1l.J. Junk
Lumber dc:nylllj tho claim for workers' COll1pc:nllllon belleftls By WIY of further wwer, that
docull1enlls In writing which IpeakS for 115111f. By WIY 01' further IIlswer, 1IIIIpeclficaJly dlll'lJed lhll
ItJ. Junk Lumber WI8 the employer ofl!ugc:ne Palm Ilony lime. By WIY of further Inswer, IIld to the
contrlll}', Eugc:no PallI\, It 1111111101, operlted 18 IIllndependc:nt conlractor. By WIY offurther I/l.Iwer,
It II specifically denied thlt the Answer to Ihe Claim Pc:tltlon for workers' compellllltlon benefltl WII
filed on behalf of Jl.ockwood Cuualty Insurlllce ComplllY To the conlrll}', the Answer W8I med 011
behalf of the alleged employer, R.J, Junk, Il.ockwood Cuualty Insurlllce Is limply Idellllfied II the
Insurlllce canier,
. It II admltted IS set forth In plrolVaph 40 of HeaJthAmmca's Anlwer IIId New Matter
that on May 12, 1995, Joan PoIm, IlS court appointed guardllll of Eugene Palm filed I Pc:tlllon for
Approval of Temporary DllCOnlinulllcc of Legal Action IlIIld on behalf of Eugelle A. Palm, and for
approval of acaptance of cmoln funds in the Court of Conunon Pleu of Perry County, PllI'IIIIylVanJl
at Docket No, P.J24, captioned II, In Rc:: EUllene A. PoIm. It Is admltted, further, that the Pc:tlllon
BOUght, among other thlngl, to withdraw the plll'lding workc:n' compenllldon Chum Petlllon w1thOUI
prejudice, to accept $64, 000.00 plus BIUlulty paymentl of $600.00 per month gul/'lllteed for fifteen
(15) years or the UIe of the Defendant, Eugene Palm, whichever Is longer, to be paid from an annuity
owned by Rockwood CBlUoIty Insurance Company. By way of further IIlswer, the documlll'lt
referenced In psregraph 40 of HealthAmerica'l Answer to Complaint to Join is a document which Is In
writing IIld which speaks for It511lf. By way of furtber unswer, a.,d to the contrary, It il specUlcally
denied that R.J. Junk Lumber WII, at lilY time, Eugene Palm's employer. To the contrary, Eugene
PoIm, at 011 tlmel, operated as all Independent conlractor. By way of further answer, It II specifically
denied lhal any paymellls madlJ 10 Mr, or Mrs, 1)lIlm were made by IloI:kwllOll CasuallY InlUrll/lCO
Company II IlJ, Junk Lumber'a workers' complllllltJon clnier, By wlY ot'ful1hc:r I/lIwer, and 10 Iho
contrary, any pl>'lllCllla IlIldo by Rockwood Ca....alty InlUra/lC4 Company were paid II Ill/lcral
corporalo expenaea,
. It la admitted II set lorth III /laragraph 41 onl~lhAmcrlCA'a Anawer and New Miller
Ullttho Court Ot'COllUIIOIII)lw ofl)crry County, Pe,ulaylvDIlJa, Inued III Order dated July 12, 1995
approving Iho Potltloll med by Mrs, Palm 10 accepl 564,000,00 and an wululty paying S6OO,oo per
monlh guaranteed Cor Of\een (I 5) years or Ih~ IICotlllle oC Eugene l'ahll, whJch~ver II longer, By way of
funllcr amwer, the document reCerenced In paragraph 41 oCHeaJthAmcrlca's An5wer 10 Complalnlto
Join Is a document whIch Is In writlllg and which speaks Cor 116C1f. Oy way of further answer, and to tho
contrary, II is apeclOcaJly donled that IU Junk Lumber WII, at any time, Eugene Palm's employer, By
way of further amwer, and to the contrary, Eugene Palm, at all times, operated II III Independent
contractor, By way of further answer, It Is specifically denled that any pa>'lllCl1ts made to Mr, or Mrs,
Palm were made by Rockwood CBaUalty Insurance Company u IlJ, Junk Lumber's workers'
compelllltJon canier. To the contrsry. any payments made by Rockwood Casualty lmurance
Company were paid II general corporale ellpenaes,
. The avennents contained In paragraph 42 of HealthAmerica'. Answer 10 Complaint
constitute conclusions oflaw to which no responsive pleading Is required, To Ihe elltenla responalve
pleading Is required, the avennellts contained In paragrsph 42 of HeallhAmerica's Amwer to the
Complaint to Join are admitted,
. The avelnlents contained In paragraph 43 of HealthAmerlca's Answer to Complaint
constitute conclusions oflaw to which no responsive pleading Is required. To the extent a responsive
pleadlnl4 Is rcqull'ed, Ihe IllUne are hereby dtllied and Itrict proof of which II dcmanded It the lime of
ttial.
. Aller realll1l1able Inve5tl140110ll, Rockwood Casually IIlsurlUlCll COl1lplUlY lIu:k.
knowledl4e or 1111011111111011 bulllclellt II) 101111 0 belief os to the lnllh of the Ilvennellto C4I1lIWl\ed III
panlll'oph 44 of IlcnllhAmeliclI'o Alluwer 10 lhe Complllillt to JoIII. The IIvenl1enlS l1I'e Iherefore
denied and 5ttiCl proof Iherl'Of 10 demandcd 01 Ihe lime of lIial By WilY 1)1' furthcr anawer, It II
speclllcally del1h:d thut IU. Junk Lumbcr WIIS, III UI1Y lime, Eugcne I'uhn'u employer.
. The avenl1cnu C<lI1lalned In porallraph -IS of IlcllhhAmudclI's Anower to the
Compllllnt to Join conMltute cOllduslol1s of luw 10 which no responsive plclldlng Is required. By way
of further IlIlIWer, nnd to lhc contrary, It Is opl'Clllcnlly dcnled Ihnt any pllY111entl made to the
Delendwll, JOlln l'nhl1, on beholf of the Dcli:ndunl, Eugene Palm, were In clJIlllccllon with a work.
relaled Injury Ily way of IlJrthcr unswer, Ills speclllcally denied lhut uny pllyments wCl'e mode 10 Mr.
or Mrs. 1)l1l1n In conllcctlon with 0 work-relatl'<llnJllIY. Mr Palm's InJulicu Wl:re IU51alned OIJ15lde of
11I\ employment relntlonshlp ond were sustulned In his capacity os an lIldependcnl contractor.
. Mer reasonable Invesllllatlon, Rockwood Cosually Insurance Compuny lB(ks
knowledlle or Infol1llullon sullklent to fonl1 a belief as to the truth of thc Ilvenncnts conlwned In
parslll'oph 46 ofHcnllhAmerica's Answer 10 the Complaint. The aVCllllents are, thereforl', denied and
strict proofthcreofls demanded at lhe tlmc ofll;al By way ofllJrther answer, the Injuries 5UstaJned by
Mr. 1'lIlm aroSll outside of any employment relationship with Ill. Junk Lumbcr and occurred when he
was aCIlll1l as anlndcpcndent contractor.
. The oIll'llatlons contained In paragraph 47 of HealthAmeliea's Answer to the
Complaint constitute conclusions of law to which no responsive pleading Is required. To the eKtClIt B
responsive pleadlnlllo required, Ihe aVemlenlS contained III parallraph 47 arc denied, Slncl proof
Ihmofls demanded allhe time oftrlal
8. The avemlenls colllallled In puralVa/lh 8 of Ihe Additional Oefendanl Complahll
constltutc conclusions of hlw to which 110 resllonslve pleadhlllls required. To Ihe eKlenl a responsive
pleadlnllls required, Ills specifically denIed IhalallY paymenls Wllre made to Delimdsnt, EUIlCfle l'all1l,
on behalfofR.J. Junk Lumber. Dy way offurthllr answer, Ills ~1'ccUlcally dCIIJed Ihat lilY payments
wC'flll1lldelo EUllenol'alm ss a result of a work. relined injury. To the contrary, Iny Ilayments made
by Rockwood CllUalty IlIIlurunce CompllllY 10 EUlllllle I'alm were 1101 made on behalf of IU JUllk
Lumber. Mr. l'aJm'sIIlJunes did not ari511 III the cour511 and IlCOpe of any ell1ploYll1enl relatlollshlp wllh
R.J. Junk Lumber.
9. The avemlenls C:OlllaJlled In puragraph 9 of the Addltlonlll Defendant Complalnl
constitute conclusions of law to which no responsive pleadilll! Is required. Dy way of further answer,
any Injury sustained by Mr. (lalm ar0511 when he Will actlnll as aJ1ll1dependent contrsctor,
10. The averments contained In pU81!raph 10 of the Addlllonal Defendant Complalnl
constitute conclusions of law to which no responsive pleadlnl! Is required.
WHEREFORE, the Additional DefendlU1t, Rockwood CasuallY InlUl'ance Company, demands
judl!l1lentln Its IiIvor and against the Additional Defendanl, HcahhAmerica I)f Cenlral Pennsylvania.
NEW MA11'ER
,
By way of further answer to the allel!atlons contBlned III HealthAmerica's Additional
Defendant Complaint, Rockwood Casualty Insurance Company selS forth the followinl! New Matter:
II. H~aJlh^lllerlca'l Addlllonall>efendll1l COIII/llllnl, read In Its cnllrety, falll 10 11110 I
claim or cauao of sellon 19aJnlllwckwood Cuwalty Inluranu COlllpuny UpOIl which relief lIIay bo
WlIlted.
12, Rockwood Casualty Inlurnncu COIllIl811Y ralsel the eXlllrlllon of the slalulo of
IhllhalJoflJ II I col11lllelo defense 10 5011I0 or all ofllealthAmerlca'l claims.
13. The CI)Urt of Co nUll on Pleas ol'Cumberiand County lackl subjecl malter jurisdlcllon
over Iho claims mlde by HeallhAmerica.
14. Rockwood Casualty Insurance COlllpany I~ Immune I\'om suit wllll regald 10 the claims
made by I-lcaJthAn,mca In50fl1l' 05 the IOle and excluslvc llIe811S of recovery against employers and
their workers' c0l111lensationln5urers for all Injuries allegedly arising out oflhe course ond IICOpe ofan
alh:ged employee'l employmenl re5t~ wllh the workel'l' compenllllon BUthoritles through Section 303
of the l'ennsylvanJa Workera' Compensation Act, ACl of June 2, 1915, I'L, 736, asamendlld, 77 P.S.
~ 481(a).
15. HeallhAmerica's claim requesting mllef requiring Joan Palm, lIS Court appointed
guardian on behalf of Eugene Palm, 10 pursue a clalm for workers' compensation medical bene81s
under tho Workerl' Compensallon Act Is barred by the doclrines of collateral estoppel and ra~'
jlldlcala.
16. The Court of Common Pleas of Cumberland County does nol have the jurisdiction or
authorily 10 compel Joon Palm, os the guardian of Eugene I)alm, to "take all steps necesllBl)' to prolect
the Interests of Additional Defendont, HealthAmerica."
17. The Court of Common Picas of Cumberland County does not have jurisdiction to
direct Joon Palm, as Court appointed guardian of Defendant, Eugene I)alm, to enforce ony subrogation
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IIl1d Mpund III DL'.limlllllll, 11L'lIlthAII1L'I'h.'1I111' ('l!'III'l1II'l!'lIlnylvlIlIllI's Nl!w Mllller IInll New
MIIIlL'r PIIIMIIIIII Iu l'II,lt(',P 22~2(11) 1111I1 ('uuIIIl!l'duhn ulld IIWI' UN I'uII llWN:
2fl. . 2K, Nu HL'NpUIIW hi UL'I'I'NNII'Y IIN 1I'l!NC plll'lll!l'IIphN 1I1l! III I'l'SI'llIISIl tu
PIIIlullfI'N CUlIlpllllllt. Tu IhL' l!~1l!1I1 Ihllt II I'l!SpUIIOl! IN I'Cllull'cd, thl! IIvl!rnll!lIl11 III
1'II1'111!I'IIpllll 26 Ihl'uIIgh 21l1l1'l! dl!lIll'd,
21), . 30, Thl! IIVCnlll'IIIN l'llllllllll III I'nl'llgl'llphll 21) IInd 30 ul' DdcIIllnll1
Ul!lIl1hAlll'l'klluf('I'"lrllll'l!lIl111ylvlIlIllI'N NI'W Mllllcr 1I1'l' 1'llllduNluIHLULlnw "I' fU,'lllIwhlch
UUI'l!~flulllle I~ ""l'l'llllIIlY: III thl' l'~1l'1I1 II ll'llpUlIlll' III dl'l'IlIl'd 1Il!I'l!lllllll)', lhl! ,1Vl!1'1lIl!1I111 Me
dl!lIll!d 1I1111tllll!d, Thc lIful'l!llIclltlullcd PIIIIl, hl!llll! 1\ wrlllllg, llflcllkll fur lI11dl' 1I11llllhl! Il!rlllll
thcl'cllf,
31. TIlL' IIVl!I'IllCllls 1'llllllllllCd III J'itl'lll!l'lIph ,'I uf Dcl'l!lIdnllt IIclllthAIlll!rlcn of
CCIIll'llll'cnIlNylvllllln'll Nl'w MIIIIl!IIIIC l'ulldulllulIllllf Inw UI' flll't tu whil'll 1111 I'CllpUIISl! Is
IICI'l!NSIIIY: tulhc l'~tcIIIII rCSplllllll! IN dCCII\l'd IICl'CllOIIIY, Ihc 1II'Cl'lIIcllts IIrl' dl!lllcd ns 6lntl!d,
;12, - 31 Dl!IIIl!d ns IIIIIll'd, Mtl'rl'Cnllllllnhlc lllVl!sllglltlllll, ncrclldllllts I'nhnlnck
klluwll!dgc III' infol'llIl1tlulI llurrlcll'nt III 1'111'11I n 1ll'l1l'1' liS to Ihl' Inllh of the nVl!l'lllelllll
conlllllled ill l'llrllgl'llphll 32 IIl1d 33 Ill' Dl!fclldllllt UenlthAIlIl'ril'lI11f ('clllrnll'ellllllylvnllln's
Nl'w Mlltter liS tu flllYIIICIIIll hy Defclldllllt Hl!lIlthAIlIl'l'ku uf Celltrlll 1'l'lIl1sylvlIlIllI tu
1'IIIIIIIIff, Uy WilY uf furthl'1' IInsWCI', Ihl' rl'lllllllllllg 1IVl!I'II1CIIls l'lllllllhll'd III I'lIl'11grnflhs 32
lIud 33 uf I>cfclldllllt IIl'ulthAIIIl'I'h.'1I of Cl'lIlrnll'l!lIllsylvlIlIllI's Nl'w Mllllcl' IHl' cUllcluslons
2
of hlw or fll~!1 10 which 1It1 re~JlulI~c '~lle~'c~~lllY, Tu the eXlenl /I rcsllUn~c 10 decmcd
lle~C~sIlIY, the IIvcrmllllls IIrc dClllcdlls sllllcdllllll sll'kl prllllf 111l!I'cllf Is dCllllllldclllllltlll1.
34, The IIVcrmclIls 1'llIIlllhll'd III I'lIl11t!f'llph ].I Ill' lJl'felldll/l1 lIellllhAlllcrkll uf
Cc III I'll I I'clIlIsylvlIlIllI'S New MIIIII'r 1111.' 1"lIldllSI'IIIS Ill' IlIw Ill' 111"1 III whkh 1111 )..'SpIlIISC Is
IICrCK~II1'Y; tulhe l'~trlllll rCSIHlIIH' is dCl'IIII'" 1II'I'CSSIIIY, lh,' IIVI.'IIIII'lIls 1I1'l' dl'III"lllIs stilled,
,1,'\, Th,' IIVClIIlClIls 1'1111111111 ill 1'1I1'11[\llIph l~ Ill' 1 ll'lt'lIlllIlI1 I klllthAlIlCrlc/I of
Cc II If III I'clIlIsylvlIlIllI'S Ncw Mllllelllrl' Clllldllsj'IIIS of IlIw Ill' flll'l III wllkh 1111 rC~flollsc Is
IICI"'''''))!: III Ih"' "'~II'1I111 rcspllllSl' Is dl'I'III"" IICI'I'SSIIIY, lh,' IIVCl'lnl'1I1~ Ill'" delll,'dlls SllIlcd,
Thc IIrUl'clII.'llliullcdl'lall, hcllIl( a WI'IIIIII!, spcllks ttll ilsclf liS III lhc 11'I'II1S Ihcrcllf.
.16, D"lIicdlls sllIll'd. 11 is IIdlllilll'd Ihlll IJd"llllallls 1'111111 1l1lVl' rcpl'cselltcd lit
tllllc Ihllllllc injul'Il's IlIcurred by Ddcl""II, l:ugl'lIc 1'111111, WI'I'I' 11I1'IIIlI'" dUl'illg the coul'se
IIl1d swpc of Mr. PIIIIII'S ClllploYIIII'11I wilh IU, JUlIk J.lIl1lbcr. ^ftel' I'CIISOllllble
illvcSligltliUII, Dcf<'lIdllllls 1'111111 1III'k kllllWkd!!c UI' infOl'lllalioll slIffkiclIllo 1'111'11I11 hellef 115
10 lhc II'Ulh uf Ih,' I'clllllilldcr of th,' 11Vl'l'Il1ellls l'lllltlllllcdlll 1'III'IIgmph 36 of IlclllthAlllcrlcn
uf CI'IIIIIII PClIlIsylvallia's Nl'w Malin; lhl' al'l'l'InClIls arl' thcldul'l! dCllkd 1111.1 sll'kl pl'oof
Ihcl'l'uf is dCllllllldcdllt trill!.
37, The IIVC 1'11I C II Is I'olllllincd in PlIl'IIgl'llph 37 uf Dcfclldlllll UCllllhAlllcrlclI of
CClllml I'cllllsylvllllill'S Ncw Mllllcl' are l'olldllSiollS or IlIw 01' filet to which 110 l'espOIlSC 15
lIereSSIII)'; tUlhc c~lellllll'eSpOIlSC is dccllled lIel:eKSIIIY, thc IIVCl'lncllts IIl'e dellied liS slnlcd,
The IIfOl'CSllld NUllee, bclllg II wrilillg, spcllks for Itself liS to lllC tel'lllS thcl'cof,
:\
J8, Admlued,
JI), Denied Rlltllted, 1110 IltllIIllIl!d thlll Defendllnll'lllllla' "Answer 10 Elllploycll
Ch.lm 1'l!lIl1ulI undllr Ihl! l'eJllllylvllnlll WorkmL'n'lI COlllpl!lIll1l1un Ael" WIIH llIl!d un or IIbout
FcbrulIl)' 9, 1994. The 1'l!lIIlIlnlllg 1IVl!l'IllCIIII ('olllllhll!d III I'lIrllllrlll'h 39 or Dcfcndnllt
UCllllhAmcl'll'lI11f Ccnlrllll'clln~ylvlIlIllI'o Nl!w Mllllcr IIrl! cullchlKltll1lor IlIw tlr rllello which
nil rl!lpllll~C II Ill!I!CIIIIIY; 10 thc I!xtl!lIt II rcopolllC II dcclllcd IIcCClllll)', Ihc rl!mnllll1l8
IIVl!rllll!lIllll1.... dl!lIlcd 115 1IIIIcd, Thc IIrOr"'llIld AIISWllr, hchlg II writing, HJlellka ror Ilaelf III
10 Ihc tC1'1II1 IIl1d l'olllelll Ihne!)f.
40. Adllllllcd,
-II, Adllllllcd,
42, Adlllltlcrl.
43, Thl! IIvermell\!; COlllllllled III Pllrngrnph 43 of Defcndlllll HenllhAmerl.,n of
CCllt1'll1 I'clllllylvlIlIlll'l New MillieI' IIrc ctlllduslolllOr lrlw or fllcl to which 110 respollse Is
III!CCSSIIJ)': 10 th... cxtl!lIt II respollsc II dcclllcd III!CeSslIl)'. thc lIVl!rlllellllllrc delllcd liS slAled.
44. Aftcl' reAsonllblc IlIvcstlglltloll, DefendAllts I'lIlm IlIl'k kllowledgc: or
IlIronlllltioll sufl1c1cllt 10 1'01'11I II bcllef liS to the trulh of .he Avcl'lncnls cOlllAincd In
Pllrngrnph 44 of Derclldnlll 1-lelllthAmcrfcll of Cl!lIlrnl Pl!llfIlylvllnlll's Nl!w Mllllcr, The
IIvcrlllcllllllrc thcreforc dcnlcd IIl1d IlI'll't pl'ool' thcrl!of Is dC/IIllndcd lit trllll.
..
~ I. . ~2, 'I'hll IIWrllIl!IIIK l'lllllllllll!d III l'/lrIIllrllphK ,H /11111 ~2 lIf Ul!fl!lIdlllll
l'Il!/lllhAIIWI'IrIl lIf rClltrllll'l!lIl1sylvlIlIlll'~ Nllw MIlIIl!1' l'III'HIIIlIIIIU ,,^, IU'.I', 22~2(d) Illld
ClIlllIll!l'l'lllllll III'I! l'lIl1l'luHllIlIO Ill' lllw Ill' fllct III which IIlI I'l'HpllllHI! IH lIl'l'l!HHUIY, To the
l'xll!lIt IlI'C~pllllnl' 10 dClllIIl~c.lIll'l'CHOIIIY, Ihl' nVCI'llll!lIls Ilrc dl!lIlclluH HtlllclluH thl! IIcHlIllS uf
l>dclldullt JllUIl PullII dllllllt l'lIl1HtllUh' II hl'Clll'll Llf 1'1111 I I'IIl'I , IlIIpllcd Ill' IllhclWlsc, hetwcclI
l>I'll!lIdulIlllculthAIIII!I'lcu uf CI!IIII'III Pl!lIl1Hylvlllllu Illld IMl!lIdullt 1~IIp,CIll' PullII,
~,l. Aftl!l' rellNlJlIUhlc illVl!OllllUllLlu, DdelldulIlH PUhll IlIck kllLlwlcdgl! Ill'
I II fllf'l II II I 11111 slIllldclll 10 fU1'I1l U Iwlld us III Ihc fl'lIth Llf IllI,! UVI!l'lIIcllt l'Ulllullll!d III
Plll'IIgl'llph ,~3 uf I>cll!lIdllnt Ill!ulthAlllel'kll LltTCllt1'll1 Pl'IlIlHylvlIlIlll'H New Mutlcl' p"rHUillll
lu Pu RC.I', 22~2(di Illld CLlU II lc I'l'I II 1111 , Thl! UVCI'IIII!IlIH lII'C Ihl!rl!ful'e dl!llll!d IIlld slrlel
prLluf thel'cuf Is dl!lIIl1lldl!d ul trlu!.
~4. Thc IIVCI'Illcllts CLlllllllncd III PurngrnJlh ~.. uf Ddclldllllt IlelllthAlllerlclI of
('cllll'll1 PellusylvullllI's Ncw Mlltlcr I'UI'SlIlIllt tLl I'A, It C. 1', 22~2(d) IIl1d C'llll IIlc rcl U 1111 lire
CllllduslllllH uf Illw Ill' fllct tLl whkh IIU I'CSJlLlIlHC Is IIcrcHslIlY, 'I'll Ihl' l'xlClll II l'eHJl~)1l5e Is
dccllwd lIel'l'SSIlIY, Ihc II\lCnllCllls III'C dell led liS stilled,
~~, Thl' IIV1!l'lIICllls l'Lllllllllled III PlIl'IIgl'IIJlh ~~ Llf l>cfelldlllll IIclllthAlllerlcll Ill'
Ccntntl l'ellllsylvlIllllI's New MillieI' I'UI'Sllllll1 III P^, ltCI', V52(d) rllld ClIlllltel'c11111lJ IIrc
cLlllclllSlulIS Ill' Illw Llr filet tLl whkh 110 respullHe iH IlCI'CHOIIIY' 'I'll the cxtclIllI rcsJllllIse In
declllcd IICl'CHHUIY, thc IIVcl'lllellts IIl'e dCllled liS sllItcd, Uy wu)' Llr furthcr IIIlHwcr, It is
7
sJlI!"'"kllll>, LlL'lIh.!lllhllllhl!"L' WIIS III1Y Ill'L'lwh uf f1duL'lulY dUlY hy IML'lItlullt ,'UIIII 1'11111110
Pl!fL!I'111I1II I~Ulll!lIl! I'llllllllur IIIIY ulhl!r IWlIUUllhlL' "'lIllthlt'l UU thL! P"l'Illl' 1J1!1i!lIdllut JOIlU
1'11111I,
51\, AftL'I' rCIIKllllllhl1! IIIVL'SII/I,lIlll1u, Ddi!udllllls I'lIhll IlIl'k kllllwledllL! or
IllfllJ'lUlIlllIU suftkleut III fill'll 1 II Ildid liS III IhL' 1l'1I1h Ill' IhL' 1IVL'1'I1lL'1I1 L'lllllllllled III
1>IIJ'II/I,l'IIph ,~(Illt' I !l"L> lid 1111 I I kllllh,\llll'lkllllt' ('I""J'11ll'l'llIIsyl\'IIIlIII'~ Nl'w MlIlIL'1' pUI'KUIIul
hI PII Itc',I', '!]5'!(d) IIlId ("lllllll'I<'IIIIIII, Thl' 1IVL'1IIll'lIls 1IIl' thL'I'dolL' dL'lIlL'd IIl1d olrlcl
pl'lIl1t' thL'I'L'lIt' Is dL'lIIl1llllcdlll 11'1111. By WilY ot' t'u/'IhL'I' IIl1sIWI', II I~ dl'llkd IhlllllllY 111.'11011
Ill' L'lIUdllct hy I )L'/c lid II III JOIIII 1'11111I hilS IL'Milll'd IlllhL' IIIIL'/l.l'd PllYIJI~lIls hy 11L'lIllhAlIIl'rkll
of CL'IIII'IIII'L'llIIsylvlllllllloothL'1' hL'lIlth I'lIll' plll\lhlL'l's IIl1d sllkl PIllOfllll'I'l'lIf Is dL'lIll1l1ded
111111111.
n, Thl' 11Vl'1'1IIL'1I1s l'Olllllilll'd III PIII'lI/l.I'IIph ,~7 Ill' DcjL>mllllll 11L'lIlIhAlllcl'iclI of
Cl:lltl'IIII>ClIllsylvlIlIllI'S Ncw MIIlll'I' PIII'SUIIIII III PA, I{,C.P, 22,~2(d) IIl1d CllUIIIL'l'dllhu lire
cOllduslllllS of IIIW or fllL'1 hI whkh 110 ICSpOIlSC is lIL'l'CSSIIIY, 'I'll Ih~ extL'1I1 II rcspOllse is
dCl~medllel'essllry, the 1IVL'I'II1Cllb IIrl' dl'lIil'd liS sllIled, By WilY of flll'lhel' IlIIswcr, II 15
spcdlklllly dL'lIkdlhllllhel'e WIIS III1Y hl'elldl lIf fidlldlllY dllty hy Ikfl'lIdnlll JOIIII Palm to
Pcfl'lIllllllt ElIgelll' PIIIIII 1I0r IIIlY olhL'1' IIcllollnhlL' 1'01ldlll'101l lhe fllll" lit' DL'/clldlllll JOIIII
PIIIIII,
56, The Ilverllll!II15 L'olltllllll!d III PlIl'IIgl'llph 58 Ill' Dl!fl!lldlllll Hl!lIlIhAIIII!I'lcR of
Ceutl'llll>ellllsylvlIlIllI's New Mnllel' PUI'SUlIllllll I'A. Kef', 2252(d} III1lI ClIUlllel'c1l1hu lire
8
cOllcluslolls of lllw or fllcl 10 which 110 respollsc In 1111 CC5I11 1)', To Ihc cxtcIII II rcspollsc I~
dcclllcd IICCCSSIII)', Ihu IlVUl'lIIclIl1 IIrc dClllcd III 1llIled, By WilY uf furlhcr IIl10wer, II Is
speclfklllly dellicd lhlll lhel'c Will 1111)' Imllch Ilf fldudll'Y dUly by DdcUllllllt JOlin I'lIlm 10
Ddclldllllll~ugcllc 1'11111I lIur III1Y 11lhcJ' 1Il'llllllllhle 1'lllldul'IoII the pllll of Ddelldlllll JOIIII
Pllhn,
WIIEI~EFOI~F, Ilclclldllll15 l:ugcllc I'lIlm, 1111 1IIl'IIIlIIdted I'cl~oll, by IIl1d through
hlu GUIIJ'dfllll, hlllll K. I'lIlm,lllld hlllll K. I'lIlm, IlIdi\ Idlllllly, dCllllllld Jlldglllcllt III thell' ftlVor
IIl1d IIglllll~ll'llIillllff IU1I11I11 olhel' plll'lIe5 IIl1d Ihllt I'lllilltlfl's Clllllpllllnt IIl1d Defclldllllt
IlelllthAmerk'I of CClltrnl l'ell1l5ylvlIlIllI'S ('oUlllerdllhll he d1511115~cd with prejudice nlld
costs of this lIeUm\,
NJ~W MA11'ER
59, I-JeRlthAmericR of Centl'lll Jlelln5yl\'lInhl's IIvcnnent nnd rcquest for relief
requlrillg Oefendllnt, JOlin Jlllhn, liS Court nppolntr!d GUllrdlll1l of Defelldllnt, Eugene Pnlln,
10 "proceed with the c1nhn fur Workers' COlllpensllllolI flellcflts nnd protect the lubrogllllon
rights of lIenlthAmcrkll pursunllt III the WOl'kers' Compcnsntioll Acl," IHC 1101 wlthlll the
Jurisdiction of thc Court of COIllIIIOII Jllcns of CUlllberlnlld COllnty,
60, I [enlthAmcJ'icll of CClllrnl I'cIIIIsylvlIllln's nvcnncnt IInd rcquelt for relief
directing Dcfclldllnt, JOIIIII'IIIIlI, 115 Court nppolnlcd GUllrdlnll of DcI'endllllt, Eugene Pnlln,
9
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I verity that the atatemunts made in ths foregoing ~ocument
are trUe and cornet. I undsntand that fal.. statement a herdn are
made ~ubjeot to the penalties of 18 Pa. C,8. Seat ion 4~04, relating
to unsworn falsifioation to authorities,
Datil
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"Of ADDITIONAL DEPF.NDANTS
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VOII m herebYllotlfl~u 10 pJ~~d 10 Ihe enclosed New M~lter Pu"u~nt 10 PA.I\.e,p,
2252(d) wlthh. twenty (20) d~Yi from service hereof or il def~ult Judgment m~y be med ~g.lnlt
you,
"
Relp~ctfully submlned.
LA VER V & KAIN
DA'l'E,
!h1!r~
Allorn~Y5 for De(~nd~l1t.
R.J, Junk Lumber
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D~(endilJ1l 15 ~ he~llh millJllel1~nce orl\~1111.iltl0I1 operilllnl\ In the ComJl\onwl!~Jlh of
PeI1l11ylvilnhl, By Will' o( (unhl!l' ilnswer, ~(ter 1'l!ilS0l1ilbll! hIVl!illlliltl'lll, Al15wel'll1l\ Addlllolul
Det'~l1dilI11 15 WllhoUI knowl~Ul\e OI'II1(ul'milllon 5uWdel11 tll (orm ~ bl!lie( ilS III the truth Il(
the r~Ill~lnll1l\ IIVI!I'lIlel115 of this p.lml\l'IIph 1111<1 thl! 5.lIIle IIJ'C thl!rt'(orl! dcnll!d, strict proo(
thereof bllll1l\ denulldeu, If rrtll!vilnt,
2, Admlued 111 pill't, Dcnl~d In pill't, The idemlty of Answerll1l\ Addltiol1ill
D~fendillll 15 ildmlued. By Will' of (urtlll!l' 11115 WI! 1', II 15 Ildl11l11~d only th.lt ill tllll~S relllv~nl
10 thl, ilcllon, Defel1dillll EUIl~n~ 1'",1111 WI15 111I I!ll1ploy~~ of Al15w~rlnl\ Audlllon~1 Defel1d~l1t,
At olher 11111~5 which 11150 l1l~y be rdeVill11 10 Ihl5 ilctlOI1, Mr. (>illm WilS ill! Independel11
~olllrllclor ilnd 110t ill1 I!mploYl!e of thl! Al15weril1l\ Addltloml Defel1dill1l,
3. Adl1llmd,
<4, UpOI1 Il1fortlutlon ilnd belief, ,I true nl1d correcl copy of Ihe pleildlng document
r~f~rred to 111 this pnrilllrnph 15 1Illllch~d 10 Ihe Addltlol1ill D~fel1dill1t Complilll1t.
5. Upon Il1fortlliltlon ilnd b~lil!f, il true ill1d correcl copy of the pleildlng documel11
r~ferred to In Ihls pill'i1l\rllph I, IItli1ch~d to the Addlllonill Dl!f~l1dlll1t Complilll1t.
6. Upol1lnform~tlon ~l1d bel let', iltrll~ ill1d correcl copy of the ple~dll1g document
r~ferred to 111 this pilrilgrnph 15 ~tuch~d to the Additlonlll De(cl1dant Complillnt.
7. Admimd in pilrt. Denil!d in part. II is admillcd only Ihat at the time of his
Injury, Eugcne Palm was iln employce Ilf the All5werlnK Additional Defendant and In the
cOllrse and scope of thllt cmploymcnt. II 15 furthcr ildl11iued only thnt a Notice of Workers'
Compenutlon Denial WilS i$Sued on behalf of both the Answering Addidonill D~fend;ll1t and
thc workers' cOl11pensatlon carrier, Rodtwood Cil$ualty Insurance Company, however. s~ld
2
Notlcl! llf 'Worlll!l'" COlllpflmllon Ollnl~J wu 155I1~d only by I~od\w"od C~su~lty Il\5ur~ncu
Compillly, IUld 11111 by thl! Answ~rllll\ Adulllonill D~fl!l1d~lIt. II is fUI'lh~r ~dllllul!d '1I11y Ih~1
a Claim Putlllon illld Answer 10 s~ld Clillm Pl!thlon wcre fIIcd as Sl!t forth III p~r~l\r~plu ,18
ilnd 3') of Addltlollill DI!(elld'llll Hl!illlhAml!ric,1 of Cl!nml I'l!nl15ylvml'l'5 Answer, New
Mallei', Illld CouJll~rd~ll1llo the Additional Ol!fl!nUilnt COlllplillnt of Defl!lHl~n15 EUl\cnl! P~111I
md Joan P~II1I, bUI It Is dl!nled t1Ut ulJ Answer WII5 fII~J by Ihe An5wurlng AJditlon~1
DIl(cndilnt, but rill her WilS fII~d by till! AII5wel'lnl\ Addltlllnill Oefcndilnt's workers'
cOl1lpenutlon cmlfr, Rockwood CilSlIillty Il\5urilll~C COlllpilny 'lI1d by cOllnsul hired by uid
inSUril/1Ce COl1lpllllY' Thl! remainlllK ,'v~rl1lent5 of Ihose portions of the Answ~r, New Milltl!r
ilnd Counlerclilllllllf Additional Dl!fendant Hl!llllhAllIerlca o( Cenlral Pennsylvani~ which ~re
Incorpor~led by refcrencl! in tbi~ p~ragraph pl!l'tllin to pmons or clltiti~s olher than the
Answ~rlng Addltiol1nl Dl!fcndant, ilnd/or COl15tltUt~ conclusions of I~w 10 which no respons~
Is nl!Cl!5ury under the rennsylvllllla J\ull!s of Civil Procedllre ilnd/or constitute lllalll!l'5 which
ilfter r~ilsollilble Invmlgiltion, Answcring Additional D~(~ndant is without knl)wl~dge or
inform~tiol1 sufficlenl to (orm il belief ilS to thc lruth of Ihesc aVcrl1l~n15 and the samc lire
therefore denied, wllh strict proof Iherl!of being demanded, if rdevant. By Will' of addltion~l
fllrthcr answcr, II is ,wcn'cd thaI nil dcn/ill. o( workers' COmpllllSation bcncfits and th~
ilRreem~nt rcfcrr~d to in the parilgrnphs of thc Answer, Nl!W Mattcr and Counterclillm of
Additlonnl De(clldilnt I-IcalthAl11cricl1 of Cc 111 1'1I1 Pcnnsylvanj" whicb MC incorporatcd by
rcfcrcn~e in this p'lragraph wcre madc and cntcrcd into by Rockwood Cnsuillty Insurnnce
Comp'IIlY with EUllcne Palm nlld Joan Palm and were notm~de or ncgotial~d by Answering
Additlonnl Dl!(endilnl.
3
8, Denll!d. Thesu ~V~rnllln15 ill'l! dcnlud ~~ Cllndu5101H of J~w to which no re5poruu
15 necesury pursu~11t to Ihu JlclIIUylvllIIl~ Rul~~ of Civil Pl'omhlJ'l!. 'I'll thu ullte/ll th~t ~n
ilddlllollill ilnswur Is neCt$5~I'y, it 15 spedfk'llly dell Iud 1I1,It IlIlY PllYl11l!l1tS WUI'Il ll1~de by
AlUwcrlnll Addltlollill Dl!fUlld'lllllll Defelld.Ull EUl\l'UI! PIIIIl1, Rlldlt'I', 'IllY such pilYl11en15 wllre
I11lldu soldy by Additiollill Dl!fulld~nt l~od\W'llllt C;ISll.llty IlIbllr,IIlI'e COl11p~IIY'
9, D~lIied, Theliu IIVl!I'I1lt'fIl~ IIrc denicd .11i ,:ondllliloll5 of 1.lw to whkh 110 rusponsc
i5 IWCI!'5ill'y pUI'511llfllto Lilt' I'cllllliylvlllli.l '~ulcli or Civill'roredllre, '1'0 tilt' UXll!flllh,lt fllrdwr
answ~I' may bl! del!l11l!d IIcrcslillry, it ili dCllicd thlll AnliWl!rllll\ Additiolllll Dcfl!nd~fll is in any
WilY l'e5poll5ible 1'01' Lilt' I)'\YI11I!IH of .1I1Y mdl nwdklll eXpCII51!Ii, '1'0 thc COIHI'IIry, Ilny such
l11udical CXpCIl5CIi IlI'e I Ill' ,'clipollliibility of Addilioll,11 Ddclldillll Rockwood C.1511~IIY III~lIrance
COl11pany, ~nd/or Addiliolllll Ddl!ndlllH IlellhhAl11erkil of Cenll'~1 Pl!lIll5ylvmill, and/or
Dcfcndllllls ElIgl!lIe ,Ind jOllll l"llm,
10. Dcnied, 'I'hu~1! IIVeI'l1W/H1i Ilrl! dcnil!d 11/i condUllon/i of lilw 10 which no responsc
i~ neccs51lry pllrSlI'l1H 10 thl! Jlennsyl vllni,1 RlIlcs of Civil Procedul'c. To the extcnt th~t Iln
ildditionill,ll1swer l11'IY be necessllry, It 15 d~lIicd Ih,lt Answl!r1ng Additional Defendant iii Hable
in ally milnncr, ddlcl' solely. 01' liablc OVCI' 10 Ilny party 10 Ihis acdon.
NEW MATTER
II. The Addilional Dcfl!nd'"11 COl11pl'lim fails to stIlle dllims or callSI!S of action
upon which relic( mill' bc gl'lllllcd '11l.linst Answl!rllIg Addilioll'll Ddcndllnt,
12. At thu til11U of lhe illjury suffcred by Eugclle Palm, workcrs' compcnutlon
Insur~ncc had bucn Pllrchaced (or Ihc R,j, junk LUl11bcr bUliness from Rockwood Insurance
Company, thc premium paid. and workcrs' compl!nsation covcrllgc with Rockwood WilS in
4
~ffl!cI (or Ihe It], Junl~ LUlIlbtr bushltU,
13, PUr5l1illll 10 S~OI of the Workllrl' COl1lpens~tloll A~tl Rockwood C~,uillty
IIl,umnce Compilnyls H~bJe unUer the Act for IlIly benefll P~Yllll!llU to whkh Eugllnll Pillll1
15 legillly cntitled pur511~ntlo lh~ Act,
1<4. In Ihl! I!velll t1ut il is d~tl!l'll1ln~d thilt Eugene Pilhn w~s ~11 Indeplll1denl
conlrilctor at the til1le of his InjurYI then In lhilt I!vent lhere 15 no dUly under lilW (or
An5werlng Addition ill D~fenJilnlll) pill' MI'. P~IIll'~ l11edkillellpensu.
15. This cOUrt hIcks jurisdiction ovcr the subll!ct IIlml!r o( this wlon ill ellclu~lv~
Jurisdiction to decide the lI~billlY o( AlIsw~rlng Additiolul D~fend~1Il ilnd Rockwood C~su~lty
Insul'ilnce COlllp~nylles within the workers' cOl11pl!nS'lllon systl!ll1.
16. Answering Addltlonllt Defendilnl ple'lds elHlllelllem 10 ~IIIIllIllUnitles from sull
~nd c:<cluslvl! r~lIll!die. provisions ilfforded und~r lhc Workers' COl11p~nsiltion ACl.
17. Thc d'lltm or CilUS~S of action set forth ilg~II1S1 Answel'il1g Addltion~l Defendant
~re bmed lind/or Hllllt~d by the appllc~ble SliltUlC of Iimltiltiol1s.
18. Any liabllllY for PilYI11CI1l o( ll1~dlcille)lp~l1ses on b~hill( of Eugene Palm rem
with persons or entities othcr lhan the Answering Addlllonal De(~nd~111 and not within th~
control of lhc Answ~rlng Additional D~fendilnt.
19. Additional De(~nd~nt, 1-I~~llhAm~ric'I of Ccnlral Penl1sytv~nia Is obligaled to
pay the medlcill e)lpens~s of Eug~ne Palm pUrSUill1t to lheir ilgreel11cnl with defendant Eugene
Palm.
20. Answering Additional D~(endanl is ndth~r a necemry or indlspensilble p~rty
to this ~ction.
5
21. Addltlonill De(~I1lI~llt, HeillthAllmk~ of C~lllr~1 Jlennsylv~nl~ II enoppl!d fl'om
purlult o( 115 dillllu lind/or c~um of IIctlon ~l\illllSI All5werlnl\ Addltlon~l Defend~lIl.
WHEREFORE, Addhloll~1 Pe(~nd'lllt, Iq, Junl~ Lumber, rl!spwfully prill'S lhilt Ih~
Alldlllol1ill [)e(~nd~nl COl1lplill1ll ~I\l\ all claims illlilln51 11111 connection with thll m~uer be
dismissed wllh prejudice and thilljudgl11enl be el1ler~d In lIS filvor 10llelher wilh tilt ~lIow~ble
l:os15 o( lhll IIctlrll1.
~ MATTER PURSUANT TO RULE
lZ521d) v. ROCKWOOD CASUALTY INSURANCE <;OMPANY
iWJJ HEALTJ:l.LiMERICA or CENTRAL PENNSYL V ANI^,
22. POI' purposcs of lhls crossclallll ol1ly, thll ilV~rl11~l115 of Ihe Compl~inl ~g~lnll
Addllionill D~fend~lIl. HealthAlllerlca of Ccnlrill Jl~nnsylv~ni~ are Incorpor4ted hy r~(erenr.e
a~ If fully s~t forth ~t lcngth hcr~ln.
23. The IlVerl11en15 of lhe COl11pllllm o( Addlllollill D~fend~lIl, He~lthAl11crlc~ of
CCIIll'~1 Pennsylvilni'llll\uil1!1 Addltion'll Defelldam Rockwood l/1$urilnc~ Company only IIr~
incclI"pomed by rcference as If fully ~el (orth allenllth hcreln for purposes of this crol~c1all11
only.
H. Additional Def~ndant, I-IcalthAml!rka of C~nml Pennsylvania and/or,
Addition~1 Dcfcndant Rockwood Casllalty Insllrance Company, or bOlh of lhem ~r~
responsible for payment of the m~diclll cxpcnscs of Eugel1c Palm. I( It is d~t~rmincd judicially
that any party [0 lhls action is liable for paymcnl of said cxpenses,
26. Additional D~frndilnu I-IrallhAmerica of C~nlral Pennsylvanln and Rockwood
CIl5U~llY Il1surancc Company are hereby joincd for purposcs of contribution al1d/or Indemnity
to Addltion~l Dcfendanl, R,J. Junk Lumber.
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IhOUli!h 1\J1l~ ~Ull,)rth hurl:ill PUrul!l'UphH 1'(1 Ulld I K.25 of ilK AIIHWl:r Illud Nuwlllhur K, 11)11/1, hI
I'lullIlll1'1 COlllplullIlllllhl: nhllw,cul,llunud nclllln, To lh~ I!NIl!nt Ihulllurullrllph JlI of NIIW
Mnlll!l' PurlunllllO Pu, ItC.P, 22S2td) IlIl!d on hl!hulf of lI~l~ndIIllIK, EUllunl! I'uhllund Juun
Pllhll (hurl!lnulll!r "PllhllK' Ne\\' MUlIUI''') IlIcllIdl!~ udlllllunuluwrtlll!lIlK uf'lilclln PUrllllrllphH 1'/1
Ulld 1 K.2') Ihurl!uf und pUl'pllrlK hI I'l:ljulru UI\ll'lhl!r I'CHpOnlll!, Ihl! UWrtnllnlK IIru cUlluhllllonK uf
luw lIr IiIUl hI which nUl'I:KpUll5111K nI!CI!HIIUI'~; llllhl! C>lll:lIlu rl!Hll0llKI! IH dl!l!lIIcd nccuHHury, Ihu
UWI'/llI!IIIK uru dl!l1ll!d UK HlllIl!d, IIIH udllllllud 1IIlIIIMi:lldulIl, EUlIl!nlll'uhll, WUH cuwrc:dundur It
Fcdl!rul Ell1plo~I!I!'K Ill!ullh UUlIl!t1lK PIIIII with IluullhAllll!rlcu <lum:lllllllul' "I'lun"), ulrUI: ulld
currl!cl COp~ of which III ulIuchcd UII Eshlhil "N' lulll:llhhAIlII!,.lcu'H AIIKlwr hI I'lulllllll'H
COll1plUIIll, AlIl:r rcuKunuhlu hIWIIIII!"llon, Ill!ullhAIIIC:l'lcu luckH knllWll!dl!u ur Intllrtlllllloll
Kumelcntlo "lrtll U hl!lll:f UlIllIlhc IrUlh lIf lhl! Nll1ulnlllll UWrllll!lIl11 ellllllllnl!d III PUrllllrllphll 1./,
IInd I K.29 of l'ulll1l1' Nl:w MlIlll!r; Ihc UWrtllUIIIK IIrUlhl:rl!J'lrl! dClIll!d ulld Hltlel pmof Ihl:rllllf"H
dCll1l1ndcd IIllrlul.
31, Dl!lIll!d UlIlIlUlcd, IIIH udll1lllcd Ihllllll:uhhAmurhlu 1'l!lInll~I\'lInlll, Ine, IK n huullh
Il1UlnICI1UIll:C orl!unl~Jlllollllrl!ulIl~.I!d und opl:rutllll! ulldl!r Ihl! luwK of Ihu l'U1lllllullwcullh uf
Pl!nns~lvulllu. IId/b/u Ill:ullhAllll!rlcllof CI!1I1rul PI!III1Kylvulllu, wilh illl prlllclpulull1cllK hll:uh:d ul
2601 MUl'kl!t Plucl! SINl:t, Ilurrlllburl!, PA 17110.9,139,
32. Aller rcullonuble InwllllllullolI, IleuhhAl1ll!rleu luckll kllllwludllllur IlIlitrlllullun
lIul11cll!l1tlo tlmll u blllll:f UIIIII lhc lruth of'lhllllWrtllCI1II1 cllnllllllcd 111 1111rullrllph J2 ul' 1'lIhIlH'
Ncw MUlIcr, lhc UWrl1ll:111s UN lhl!rl!li.lrc IIUl1lud IInd Klrlel proof IhUNlIf IK dUlIIlIl1lluLlullrlul.
33. Dl!l1lud UIl KtUll!d, IIIK udll1iltl!d Ihut Ouli:ndlllll, EUli!unl! I'uhll, WUH cuwrllLl undllr
2
Ihll PIUIl, Allllr rl!u~olluhlu hIWSII/JUII'IIl, IluulthAllIurlcu IlIck~ kllowlcul.!lIor IlIlill'lllllll1111
~lImcIUIllIl) forJII U hullufu~ to Ihl! Irlllh orlhu rl!muIIlIIIIlIIWI'lllI!III~ COllllIlIIUd III /lllrullruph 33 uf
Puhll~' Nuw MUllUn lhl! UWt'lll1!1l1~ ul"ullwrl!liw dl!lIlud UIIU 5lrlcl prool'lhl!rl!of I" dUllulIldcd III
IrluL
34, Thu uwrmulll~ cOlllullIC,111I pnl"u/olrul1h 34 orpuhn"' Nuw MlIllur UI'I! c'lIIclu"lolI"
of Iuw or Inctlo which 110 rC~I1OIl~1! IH lIeCI!~NUI'Yi 10 IhellXll!1ll U rU~floll~1! I~ deel11ed III!CIl~~UI'Y.
unllr l'eUSUllllblulllvcNllgollolI, 1II!IIlthAI1ll!rlclllnllh kllowll!u/oll! Ill' IlIlill'lI1nlloll HlIlllulcnllo limn
n bcllcru~ Illlhllll'lIlh orlhllll\wl11l1nlS c'lI1lnllll!d 11l1111l'Ugrul1h J4lll'llnlll1s' New Mntll!n lhll
nwrml!lIls tll'lllhel'eli1\'1! dl!lIled nlld Slrlct prool'llwrl!ol' IH ul!lI1nllded nllrllll.
1~ P"III,',lns SHlllld, Ills ndmllled IhUlllctlhhAl1Il!l'lcn hns pltht-Phlllllllrlh~ "",uul1t
of $3,253,00 Ii1\' U'l!nUlllIlI1 provided 101 lclimdlll1l, Eugelle Pnlll1. IiII' 11l'1lll1l11llhs Ill' shol'Hl!nn
I'l!hnhllllnllve lhul'llpy III clllllplclll tlccol'd \\lIh 1I111\llId henul1ls CllVCl'llgll prllvldlld Illllclimdulll,
EUltu1I1! Pnhn, pUI'Sunl1l10 lhll olill'lI~nld I'lnll, Thllnlill'eHtlld PIIIIl. hdllg IIl1'rlllnl!, ~pl!uks 1'01'
Ilsclr us 10 lhllllll'lI1S Ihllrl!Or. It Is ndl11hll!d IhlllllellllhAl11erkll hilS slIllslkd 1111 C'lllll'llCllllIl
obllllnllon~ tinder the nlilrll,snld Plnll fill' IhIlI'1I0S11IlS SlIllilrlh hereinlll\,'1' III Nllw MlIllllr. Allllr
rcuHolluble InVllsligutllln, IleullhAII1l'rlclIllIcks kllllwledge 01' IllliH'll1l1ll111l suflicielltlo 1'01'11111
belieI' us lolhe rlll1lnlllillg UVCl'll1ents cOlltllilled ill pllrngnlph 35 or I'nlll1s' New MUller; lhe
IIwrmellls tire Ihel'eli)l'e dellled ulld strict proorlhereor is dCl11l1llded IIllrinl.
36. TheuVCl'l11elllS clllllllincd ill plll'llgl'llph 36 or Pnll11s' Nell' MlIllcl' tll'e cOlleluslol1H
of law or tnello which 110 respollse is necllssnry; to Ihll cxtelllll respllllslIls deel11ed IIl!ce~sary,
thlluVerll1l1nlS tlrll dllllllld liS Slllll!d, It Is udl11llted 111111 I'lailllllThus IiIlld II COl11pllllllt which.
3
b\!llIll u wrhlllll, HpeukH lill' hHl!lrUH III lhl! lel'mH lh\!rl!uf, IIl1d III I"\!~PUIINI! lu which 1Il!lIlthAmurl~1I
hu~ l1I\!d UII AII~wl!r IImt N\!w Muller 1'1IrMIlllll hI I'll, R,(',P, 22S;2(d) IIl1d Cuulllureluhn, IIH Willi
u~ UII AddhlolluIIMi:Ilt1ulIl CUlIlfllllllll, whkh tlll\!UIllI1I1IN, hdllll WI'IlIIl~H, Nfll!uk IiII' II\l!lllN\!lwH
u~ I,u Ihl! Il!l'InH Ihl!rl!uf,
37. Ul!lIll1d U~ HlUII1t1, II IN udlllllletllhlll bl1~lnlllll~ wllh lhl! elli:cllw llllle uf JlIlIlIury
I. IlJH9. Dl1fi:lldulIl, EUlIl!lIe l'ull11, WUN I1l1rulll1t1l11 lhl! Illorl!5111d I'lulllll'UvltlllIlI hl1l1lth hllllUlllK hy
Hl1uhhAlIll1rku 11I1I~~llrdullcl! wilh thu 1I!I'IllH 1I11d cOlltlltlollH 5111111d Ihl1rl!llI,
38, Thu UWI'I1lCIIIN C'Hlllllllutll1l pu/'U~ruflh 3H llrJlllhns' Ne\\' Muller ur\! clllll1lllHlunH
uf luw 'II' lucllU which IIU rUNponsu IN nucUHNUI')'; III Ihl1l1Xll!nllll'l1NpUIINI! IN L1wmudlle~UHHIII'Y,
Ihl1 UWnnl!lIlH IIru tlUlIll!d UN NIUled, Olllhe CUlllrll!'Y, II IN IIWrl'eLllhnllhe WUI'~el's' ~lImrllllHUllull
cnrrll!r lor Ihl1 elllploYl!r of U\!li:lldulIl, r":u~l1nl1 I'uhn, IN prlllllll'lIy rl1HfllllIHlhl11 IiiI' fl1IYIllI1111 uf lhu
medical UXrun~UN un bl!hulf 'If DI!Ii:ndnnl, EUllulIU PlIhn, Incurred wllh I'IlIllIlIlr, IlllrHlIUlI1 hllhl1
Il1rms IInd condltlulls uf Ihe ulilrl!Nuld I'lnll. IInd tilrthu n:usollN Sill 'ilrth herdlllllll1r III Nl1w
MUlll!r. It Is udmltlcd 0111)' Ihutlll!lIllhAIllCrku b)' IClll1r dlllcd JUIII1 2(t, I')I)~ ullrlll!d hI "lIrl'UlIl&l1
for pn)'l1ll!nt of ull churl!l!~ fi.lr curc 10 Mr, I'uhn urlsll1l! outufhlN Nuvclllhl!r, 11)1).1 uecldl1l1t, III
lhe extentthuI such cure Is covcrcd under thl! t\!nns uf hl~ Ill!ullhAmurlc1l OruufI SuhHcrlpllun
Al!rccll1l!lIl", und thutlleulthAl11erlcu hus sUllslled Ihllt rl1f1rCN\!lIll1llulIUIllI nlluhllunllunN ullder
Ihe uforcNuld Plun for the reusulls Sl!t forth herl1ll1nhllW 111111 hl!rellllllll1r III Nu\\ MlIlll!r. AlIl!r
rensol1l1blc II1VuNtI~ulllln. IlulllthAlllel"lclIllICkN knll\\'lud~u III' Inlill'lnnllllll HufIlclulIl hI limn n
bullcf nN 10 thl! Iruth ofthu rUlllulnlll~ UVCnnUl1lN COIIUlllIl1d In fllIl'Ullrnph 38 uf I'nll11N' Nl1w
MUllcr; lhe uvcrmentN urc thl!rulill'l! dell Iud nml Nlrlcl fll'llllf Ihcrl!llr IN ,ll1l1llllldud ntlrlul.
..
39, The uwrlllellls clInllllllcLlln plll'lIl!rllph 39 01' 1'111 illS , New MillieI'lli'll cOllcluNlol1s
of IlIw or IUCllll which 1111 rc~plln~1! Is nI!CI!N~lII'~~ IlIlhll eXlenl1l l'eSfllln~1l Is del!l1ll!d Ileces~ury, II
Is spl!clllclIlIy dl!nlcLllhllllll!lIllhAlIIllrlclllN ~lIle'~ IIl1blc III 111111nllll' ol'l>el\mdIlIllN, llr 15 IIl1bll!
llwr III DI!I\:ndlllll~ 1<)1' UIl)' nl11l1l/Jlt~ Jlnld b)' nd\~lIdnnls 1<11' Ihl! l'Cl/SOnN ~cllill'lh hel'l!lnllboVl.! ulld
her\!llIlIlIcr III Nl!w MillieI',
40. NlIlilrlhel' respollse Is lIeCI!Sblll'~,
4\. The IIWl'lllents ClIllllllned III pnl'lIgrllph 41111'1111111I5' Ncw Mnllel'lIl'll clIlIcluNlollS
of luw III' fuctlo which 110 rI!Sp<Hl~1! Is lIeCI!SSlll'~: IlIlhe extl!lIln reSflllllse Is dCl!lIICLllll!CCNNury,
Ihe UVel1l1ClIlN IIrl! dellled us slnll!d, Ills IIdl11l1ll!d Ihnt beglllnlll~ wllh lhl! I!llhllvc dnlc of
Junuar~ \, 1'J1l9, LJc/i:ndnlll, Eugclle flnhll, wns ellrolled IlIlhe nlilresnld I1lnll provldlll~ hl!lIl1h
bencl1lN by IlcullhAl11erkllIn nccol'dnn('e with Ihe lel'lllS nlld C<llldlll()IJS Slnled Iherdll,
42. The nvennenls conlnllled III pnrngl'llph 42 ol'Pnlll1s' New Mnller nre COllc1u~lonN
of Juw or l\1ctlo which no resp\lnse Is lIeCI!Ssnl'Y: 10 Ihc eXlcnln resJlollse I/i deell1ed III!CCSNUI'Y,
the UVCrll1ClIts url! dl!lIled us SllIIl!d, It Is IIdll1ll1ed 111IIIllellhhAII1erlcn hns sntlsl1ed lis obll~nllolls
undl!l'thl! uforl!snld Plnn for Ihe I'l!nSOIlS sell<lrlh herdllnbovc nlld hel'cillnliel' ill New MUller, II
is spccll1cully dellied IhuIulloflh<: Il'enll11enls provided h)' PltllllllfflO Ileli:lldnnt. Eu~enc pull11,
wcre eithcl' rcusol1nble ulId lIeCeSSIII')'. pel'lill'lllcJ nll\1lr ulld rcns<)lInble chnrges,or cOVl!rcd by
uny Il1surancc ugrecl11enl wllh IIcnllhAl11l!rlcu,
43. Thl! nVl!l'l11CIllS Cl)llllllned III pnrngl'uph 43 of Pnll11s' New Mnlll!r nrc conclusions
of Juw or fact to which no respollsc is necl!ssllry; 10 lhc CXlentll rcsponse Is dCl!mcd necessary.
the IlVcrl11el1ts IIrc dl!lIled us Slllll!d, Ills ndmllll!d lhlll, pursulllltlo the Icrms ulId cOl1dlllons orlhe
5
Ullll'l!suld l'lull, Ihu wlllkul'S' ~OlllflUIISllllolI cllrl'll!r fOl' Ilw I!lIIplll~ur Ill' l>ulul\llulll, I!UIlUIIU Puhn,
IN prhllurll~ rusPllllslhl1! IiII' pll~1I1UtIlllr Ihu mudl~1I1 UNIIUII~I!N 1I1l huhulr Ill' IMi.:lldul\l, EUllllllll
Puhn,l/luurl'l!d wllh Pllllnllfl'ul1lllhul, Ihul'ulill'u,l hlllhhAl1lurlclI hu~ll1o IIhllllUlllIII hllllUkll
PUYllluI111ll1dur Ihll ufill'usuld 1'lul1 IiII' lhu I'UIISIIIlN NUlliu'lh hUl'l!lllUhllw ulld hl!l'lllllUnllr In Nl!w
MUlIl!r,
44.46, Thl! UWrl1ll!IlIs conlullll!d 11I~luNlw pUl'llllrnphs 44,4Clllr Puhns' Nnw MUllllr UI'I!
uonuluslolls Ill' luw IIr IhulllI whluh 1111 I'CSpOIlNI! Is nccl!~~lIr~i IlIlhu CNII!IlIUI'I!SP~lI1Nllls deemed
lI11cussur)', Ihu uwnnllllls uru dClllud UN NllIlcd, It Is udmltll!d Ihlltlll!uhhAmcl'luu ruuulVlld IIOllcll
Ihullhu workl!rs' UOlllpl!ll~lIlloll curl'lul' Illl' Ihl! Ul1lplll)'cr Ill' I>lllimdlllll, EUIII!IlI! Puhn, ul1d Ihl!
Illllplo)'l!r dl!nllld lhulllltlul ~IIIIIII ~lr DI!Ii:lldlllll, ElI~~1l1! Puhn, lill' wlIrkurs' COlllpl!l1sutlon
bl!llllllls, IIlld IhutlluulthAlIIl!r1cu hUK rucl!lw\1 dl!lIIunds iiII' pu)'ml!llllilr l11udlculllNI'UI1SeS of
Plulnllll'lllcurrl!d 011 bdllllroflMi:ndulll, EUIII!IlI! Pullll, It IN 1\1I1hur udmlttl!d Ihllt
HUllhhAmcrluu haK ~1I11~lll!d II1111hllllutl0llN uudl!r lhe uli.l,u~uld PIIIII Illr Ihl! rl!lINlIllS setlorth
hl!rulnllbovc und hl!rulnulll!r III Nuw MUllur, It I~ ~l'uclllclllI~ dUlIll!d IhlltlluulthAlllel'lcu hus
cOlltlnuully refused to puy IIll!dlcul henclllN on buhul I' llfl)l!li:I1~llIl1t, EU~1!1I1! Pllhn, lor which
IlllulthAlllerlculs oblll!utl!d undur the ururl!suld Plul1, Allcr rCl16111111ble InwNllllulloll,
Ill!ahhAIIlI!r1cu lucks knowll!dllullr Inli.mnlltlon Nulllclenllo forlllu belll!r liS 10 the truth or thu
l'I!ll1ull1ll1l! lIwrll1l!llls C01111llnl!d IlIl'urllllruphs 44.46 or Pnlms' Nl!w MUllcri lhuuwrll1l!llts IIrc
lhl!rclore dl!nlcd Ill1d strict proof Ihereofls dellllll1dl!d IItlrlu!.
47.49. The UWrnlUllls clll1tulned In pUrllllraphs 47,49 ofPuhns' Nl!w MUlter ure
cOllcluslons oflaw or luctlo which no rl!spol1suls I1cceSSlll')li to the Clltcl1tll ru~pollsc IK dCl!nlud
(\
~
I verify "lit "" .tablllumll IIIl1dll III Ull! REPLY TO Nl!W MA'ITER ....true .nd
CQI'I'SCt 10 lhu beet o( my kf1.owludgll, InformllUon Ilnd bellof, [undo/'llland th"t f.l..
s\alemonla homln 11m /I111l1u subJed III Iho IXlllAlllos of 18 Pa,C.B. 4904 1'111.11"8 10 uJ\lworn
flllslrlcllUon 1.0 ilulhorlUl'lI.
Dille: Janullry.t!:.. 1997
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C l!L LU ~ M:O:
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~ Richard O.re, Elqulre, horeby corUfy that I htwO Ud. 29th day of Jlnulry, 1997,
IIIInt.. true and rllrl'llCt copy of Ule fOl'l!golllg/{EPL.Y ro NEW MA1ifR OF eUGfNe &
lOAN PALM vII, UlIlled SIaIl1ll MIIII, POSlJtgll JlllhJ, addl'l!illlCd liS folloWl1
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,
(lllry l., RothllChlld, &q.
SI!I{RATELU, SCHll1flMAN &: BROWN
2040 L1nglLlfilnwn Road
5ulllll06
Harrisburg, PA 17110
JlIck M, Harhl1l1n, Esquire
HARTMAN &: MIl.Um, P.C.
Ono KeYllolll! PlaZll, Sulle 107
Front IInd Marlu!t Stn!clrl
p,O, 80x 786
Harl'lsburg, P A I'll 08.0'786
l'hollllls T.l'riIl11l'ton, Esq.
Pletrllgllllo, BOlick &: Gordon
Thl! Thlrty.Elgth Floor
011ll Oxford Centre
Pittsburgh, PAt 15219
Frank J. LaVl!ry, Jr., !!sq.
Lavory &: I<lIIn
The KUl1kel Bulldlng
301 Mllrket Stl"l!C!t, Sulle 800
P,O. BOX 1245
HftrrlsburlY)'A. 17 08-1245
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Rich rd DIIl'I!, E~ufl'l!
Attorney LD. No. 18631
1776 SoUUl Queen Street
York, PA 17403
(717) 846.3000
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IN TilE COURT OF COMMON PLEAS OF
CUMDERUND COUNTY. I'ENNSVLVANIA
I'IIVSICIANS OF REIIADIU'I'ATION
MEDICINE, PC,
l'I8111111T
I'
v,
NO.1 96.5601. CIVil. 'l'I~RM
EUGENI!~ I'AI.M, All 11IcllllllclluII!d
I'erlillll. thrullllh hl~ wlfc ulId IlUlII'dhlll,
JOAN K. !'AtM, ulld JOAN K, I'AI.M,
hldlvldulllly, IIl1d IIEALTIIAMEIUCA
Olr CENTRAL PENNSYI.VANIA,
Dl!fcfldlllll~
CIVIL ACl'ION . LAW
JURY TRIAL D";MANOItD
ANSWER, NEW MATTER AND NEW MATTER
PURSUANT TO PA It.C,P. 2252(d) AND
CQ!Jl!T-E~LMM
AND NOW come Dcfendunts, I\U(;ENI~ I'ALM, All hlelKllucltoted I'erslln, throullh
his wife Bnd Iluord\llll, JOAN K. I'ALM, 11Ild JOAN K, I'ALM, 11Idlvhluolly, by und througb
tbelr IIttorney, Gury L. Rulh5child. EsIIIlII'l~ IInd the IIIW firlllof SeHlltdll, Scblffmlln, Brown
IInd ClIlhoon, PC, "lid, III response to 1'1lllntift'5 COll1plillllt, IIVl!r 115 follows:
A~ SW..lli!
I. After rellsollllhll! illvesllgllllun, Dcfendllllts IlIck knowledge or InformBtlon
sufficient to form " belief 115 the trllth of the IIverJnenls contlllncd In PRrIIgrRpb 1 of
Pllllntiffs Comphllnt. thl! IIvel'll1cnls lire tberefore denlcd IInd strict proof tbereof Is
delllRndcd Ilttrllll.
1
2. Admlllelllll pllrlldellled III PUI'1. Ills IIdlllhludlhlll Eugelll! I'nhn IInd JOlin
1'lIlm lire hUHIlIIlld Iwd wlfc IIl1d Ihlll JUIIII 1'lIhll rCHldcH III ltD.' I, Dox 328, LoYHvllle.
1'l!III1Hylvnllht, IIIH denied 111111 Eugl!lIl! l'uhu 1'l!shJl!s IIllhc Loysvlll~ IIddre5l,
3. Aftl!r rl!115111111ble IIIW~IJglltloll, lJefclldllnlli IlIck knowledge or InformAtlolI
sufflclelll to fU1'I1I II belief ilK Ihl! truth of the IIvermellls CUIIIIIIIIl!d III 1'lIrugl'llllh 3 of
Pllllllllff5 ('ulllplllllll; lhc II\1Cl'lllfllls IIrl! Ihl!refore dCIIIl!d nlld slrlcl pruof Ihereof Is
dl!lIIl1l1dcd lit 11'1111.
4. Aftl!r I'CIIKUllllhle IIIW~;1I811I1oll, DI!felldllll15 llll'k kllowll!dgc ur JllforlllllUolI
suffllffiflll 'urlll II he lief ilK lu Ihc Irulh u( lhc IIvellllllllls l'unlllllled III PlIl'IIgrnph .. of
l'IIIIIIIIfl'H COlllpllllllt; Ihc IIVel'llll!lIlli IIrl! therefore dCllJl!d 1I11d 51rkl proof Ihereof Is
dellllllldedllllrJlI1.
~. Aftcr rellSOllllble JIIVCsllgllthm, IJcfelldllllt5 IlIck klluwledge ur IlIfonnAllolI
sufflclelll 10 (01'111 n he lid liS Ihe lrulh u( the ll\lerllll!lIls cOlltnllled '" PlIl'llgrnph ~ of
Plllllllln's CUlllpllllllli Ihu IIVCl'lnell15 IIrl! lhcrefore denied Iwd sliM proof Ihereof Is
dllllllllldcd lit 11'1111.
6. Delllcd AS stilled. 1115 ndmlllcd Ihlll Defendllnl Eugelle Pllhll hAd heAllh
Insurnnce cO\lcrnge pUl1luAnl 10 II Fcdcl'IIl Employel!'s Hellllh Bcnefil5 1111111 whh
HelllthAlllcrlcJI.
~QUN'{ I
7.11. PIIl'llgl'llphs 7 Ihrough II o( 1'lnlnllfrK COlllp11l11l1 lire 1101 dlrecled III Ihls
Allswerlng defendlllll IIl1d 110 furlher I'cspunle Is II eCl!5S11l)'.
2
COUH'J' II
12.16, 1'11I11I11fl's COlllpllllllt cUlltllh,K IIU ll"rngl'llllhK IIl1mhllred 12 thrllugh 16 IIlId
thl!rl!fllr~ IIll l'eKllulIKl! IK IlIlCI!KKIIIY,
17, 1'lIl'lIgl'llphs I thruugh 1\ uf Defl!lIdllnt'K AIISWIlI' lu Clllllpllllllt lire III(,Llrporllted
herelll by re(erellcc III If fully sct fllrth h,:I'l!lu,
Ill. Adlllllled.
19. Denll!d liS sllIlcd, It Is 1Il1lllllll!d Ihlll MI', Pllhll WIIS IIdJudlc:lted nn
11I(,lIpllcltllted flersulI by Ihl! Ol'flhllll's ('lIUl'I uf I'I!I'IY ClIuuty UII Nll\llHnbl!I' 101, 19901. IInd
thllt his wife, JOIIII 1'11111I, WIIS IIflfloltlled 1'l!I'IIII1UclIlglIlIl'dlllll of the pl!I'MJIl IIl1d Ihe Eslllle
of Eugt'n" "Ultll "IN .1l!lIll!d tllIll Ihl! Ol'phllll'S C'llUl'I'S Onlll Ol'lh',' dllh.d NOVl!llIher \4,
\994 Is fully Sl!t forth liS Exhibit "A" 10 I'llIflltlfrK COlIIl'llIllI1. By WilY Ill' furthl!r lInswcr,
pllBes two IIl1d Ihree of till! C'lllll'I's fllIlIl Ol'dl!r dllted NllVClllh1!1' 14, \994, WCI'C Ulllilll!d (rom
1'llIlntlfrs COlllp11l11l1.
20, Dl!lIll!d liS sllllcd. It Is lIdllliucd thllt Jlllln PII It II , 'JIl hchnlf Ill' EIIIll!IIl! I'lIlall.
cOlllplell!d II fllllll!lIt I'l!lllsll'lltlllll. Thl! rl!lIlllllldl!1' Ill' PIIIIIIIII"I's IIVI!l'Il1l!lIls ill Pllntlll'llph 20
lire IncolIslstl!lIt, cOlltl'lldlctolY or 11!1\1I1 Cllllchlslllns to which 110 resflllllsl! Is III!Cl!SKIIIY. TlI
the extent II respollse Is deelllcd nI!CeSSIl'Y, the AVerllll!ntK lire dellied liS slulcd.
2 J. Aftl!r rellsonllble invl!stlglltloll, De(endllnls Jllck kllowledlle or IlIforllllltion
sufficient to 101'11I II bclief AS Ihl! truth of the IlVertncnlK contAincd In l'Arngrllflh 2\ of
1'llIllItift'1I COlllflJnlllli Ihe nverllll!1I15 lire therefore dellled IIl1d sll'lCI flroof Ihereof 15
delllllnd.:d lit 11'1111.
22. DCllled 115 5111tcd, It Is Admltll!d thllt PIAlllllff hilS dClllllllded PAYIIll!lIt from
DcfelldAllt Eugl!lIl! \'lIhll, Ihrough his wlfc nlld gURrdlnll. JOIIII K. Pllltll. IIl1d thllt PIlYlIlcllt
by Mr. IInd Mrs. 1'11111I hllS not beenlllllde. However, It IK dell led thlll IIny 1I1110Ullt5 lire owed
3
by Mr, or MI'Il, l'ltllll to 1'llIlnmr liS Mr, 1'111111'5 henllh CllI'e l'ruvlder, Ilenllh AllIllrlcn, II
rlllpon.lbll! for pllyllll!lItll fur thl! CllrL!, If IIny, provided hy l'lnlnllrf.
WJfEIUWotU~, Ddelldll/llH de III It lid Judgllll!lltllllhelr fIlVor IIlld IIg"ln~II'llllnllff' IInd
nlll'llher pnrlll!l, IInd Ihllt l'lnflllff'l's eOUlplnlnl he dl.UlIlscd wllh prL!JlldlcL! nnd c0515 ur Ihls
ncllon,
COUNT III
23. Answerlllg DllfendlllllH hCl'l!hy IllclIlvornlc hy l'eferellcl!, liS lhongh rully set
forth herelll, Ihc IIvcrmellls or filet Het-WHh In flllrngl'llphH OIlC (I) Ihrollgh .111 (Ii) nlld
eighteen (18) Ihrough Iwellly.lwo (22).
24. The IIvennellls COllllllllcd III I'nrngl'llph 2,l of 1'llIlllllfrs COlllplnlll1 IIrc
conclu.lolIs of Inw or fncl which no response I. lleCesllll')l. 10 Ihc cxlelll II relpOllse 15
deemed IICCI!SSlllY, Ihe IIWrllIl\ll\ll IIrc dl!lllcd 115 slnlcd, By wny or furlher IIllswer, It 15
IIverred thllt HelllthAlIlcrlcllof Ce III I'll I Jll!llllSylVlIllIlIls fully respollslbll! 1'01' Ibc p"Ylllento(
PllIlllllrrs llIedlclIl fecs IIssochlled with IIny IIlcdfcnlservlccs which were supplied 10 Eugelle
PRim.
25, After rellsollllble Illvesllglltlon, Dllfendnnls IlIck kllowledgc or Inrorllllltlon
sufficlellt to form II belief 115 Ihe Irulh o( Ihe IIverlnellls cOllllllned III Jlllrngl'Rph 25 of
Pllllnllfrs COIllJllnlnt. Ibe IIVCl'lllenls IIrl! Ihcrllforc dCllled IIlld sll'lcl proof thercof 15
dellllllldcd lit 11'1111.
WUERIWORE, DllfellrJlIll\ll dCllIlInd judglllent In Ihelr (IIvor IIl1d IIgnlllst 1'1 II I Iltf 1'1' IIlld
All other plIrtles, nud thllt Jlllllllllft's COlllplnlnt be dismissed with prejudice IInd cos\ll of Ihls
Action.
4
N~W M~1"'EB
211, AllawlIrhll Dllrendllllla hlltllhy hlCorpotlll1l by I'llrerlllllle AI If fully alii forlh
herein IhellVl!mlllnla of fllclN acl furth In 1'lIrllllrupha IInll (I) Ihruulh Nllc (6) nnd al!vl!nlllen
(17) Ihl'lIl1Bh IWl!nly-flve (2~),
27. ThllllVertllenla alii (orlh In 1111111111""K COlllplA11I1 (1I111u alnle II Clllhll or A cnUNe
of ACllon Itgllhlalthe I'RIIIII UpOIl which I'l!llcf nlllY blllltlluled,
28, AllY duhll or CIIUKI! lIf IIclIolIlIK KI!I furlh In l'lllhlllfrs COlllplllllllla hlltl'cd by
thll IIppllcllble SIIIIUII! of Lhnltllllllns.
29. AllY dllhlllJr CIIUKlIlIf IIcllollllK KI!I Illtlh In 1111111111f1's ('lIlII pi III II I Is 11m lied 10
IIIcdll'lIl ,"'/vl..,I, II'" 'lIly PIlYllll!lIls I'llclllwll thun III1Y KlIUI'Cll,
WIIEltlWOIm. Pefelldllllls dlllllllllrJ Judglllelll hllhl!lr (IIvor IIl1d nllllhllt 1'IIIInllrf nnd
1111 olher pllrlll!s, IIl1d Ihllt 1'llIllIlifI's ('olllplllllll he dlamlsKed wllh preJlldlce Alld cosla of thiN
RcllolI.
NEW MA11'ER l'UR!llJANT TO I'A R,C.I'. 1152(d)
v. DIWENI>ANT IIEAI:I'IIAMERICA OF CENTRAL l'ENNSVI,vANIA
ANI) COUNTI~RCLAIM
30. AIIKwerlng Dcfcndllnts hl!rehy Incorpotlltl! by I'eferencc, liS II' fully Ket forth
herein, the nvermcnt of fRcts Ket furth ill Pllrngl'llphK onc (1) Ihrougb (6) nlld clghtcen (18)
through twentY-lIlne (29).
31, Addltionnl Dcfelldllnt, UI!II11hAmcrlcllofCI!II11'111 PcnnKylvnlllll, Is nn illSUrAlICe
colllpnny exlsllng under or lIuthol'l~cd III cunduct hUKllll!SK under Ihe Inw5 of the Stlltc of
Pellllsylvnlllll, with Ils prlndpnlllfflccK IllCllled lit 2601 MlIl'kl~1 Plllcl! Sll'eel, HlIl'I'lsburll, PA
17110-9339.
~
32, ElIgclIl! IJnll1l SII((cl'l!d scwrl! IIl1d flC 1'11I II 1111 II I 11IL'lIflllL'llnllllg IIIJurlr:~1 on
Novl!lIIber 4, 1993,
33, MI',I'1I11ll'ij IlIjlll'll!ij rl!llull'l!d L'xlL'II~IVl' IIll!dklllllUd rl!llllhllllllllw 11'1!1l11l111ll1 hy
levl!rnl dlrrCl'lOlI1 IlrovldlOu, Mr, I'lIl1n Will L'llvl!rl!d ulldlOr II Fl!dlOml EllIplllYlOlO's IllOlIhll
lJl!lIefllJll'llIlI ("1'11111") with 1II!1I11llAIlIlOl'kll, A II'UI! IIl1d Cllnl!l'II'lIpy Ill' IlIhl l'lIvl!rllglO Rlld
l'lnll II 1I!111dll!II III Ellhll111 "^" III Addltllllllll Pc(l!lllllIlIl, 1II!II1111AIlII!rlcII or Celltrnl
PelllllylvlIlIllI's, AUIWI!I', Nl!w MIIIII!I' 111111 Nl!w MlIlIel' p1l1'1U11I1l III I'A ltCI', 2252(d) IIl1d
CoulIll!n:lllhn.
34, Mr. I'll I III rl!cclwd pl'llrl!lllllUlI1 IlIl!dklll Irl!lItllll!lIl Ihlln I'hyslclllll or
l~ehllhllltlltlOIl Ml!dlcllll!, 1',('. durlllg Ihl! pl!l'Illll IIrthlll! whl!lI Mr, 1'111111 Will cllverl!d by
HellhhAllIl!rlclI'1 "1'11111".
35, Mr, 1'lIlm's 111115, ISSUl!d hyl'hysldlllls or lh:hllhllltllllllll Ml!dlellle, IJ.C" hllvc
1101 bC1!1I pllld Iu rulI.
3r" l'hYllel II III of Itl!llllhllltlllillll MI!IlidllC, P.C, fill!d II Civil ClllllplllllllllglliuSI Mr.
11IId Mrs, Plllln lIud IItlle... ill 1111 1I111!1II111 III I'cl'clvc pnYllleUI rul' IlOlvkl!s rlOudl!red.
37, Atlllltlllll!srl!ll!vllul hCrl!tll, Eugcllt: 1'111111 wn~ llllured ulldl!r II policy orhlOlIllh
IIISUI'lIIICI! wllh Detclldlllll, 1h'lIl1hAlllcrkllllf Ct:lIll'11ll'l!llIIsylvlIlIllI,
311. l'UI'MlIIIII 10 Ihl! tCl'lIIS or thl! IUSlIl'IIlICI! ngrCl!lIIl!lIt, IIl1d III IIccordllllCC with
Pefelldlllll's lid III Illiolll, Dl!tcudnllt, IICllllhAIlII!rkll Ill' CClllrnl 1't:llIIsylvlIlIllI, I',C., II
pl'hnlll'lIy 1'l!spouslhllO 1'01' pnYllllOlIlllr Ihl! IIIl!dklll CXpl!lISl!1 Ihllllll'C Ihc luhjCl'1 or 11115 Rclloll.
39, If II Is dt:tl!rtnilll!d Ihlll Dl!lcudllllls IIIl1lt pill' I'hysldllllS Il( Relmbilltniloll
Ml!dldlll!, 1',('" thclI DlOrcIIlIIIUI, IlclIllhAlIIl!rkll or CClllrnl 1't:nllsylvlIlIllI, II solcly IIRblc
IIl1d/or IIl1blc OWl' 10 DlOrlOlIdllUII rill' III1Y 1I111111111ls pllld hy DcI'l~lllllIlIl.
WHEREFOI~E, AIIIWl!l'IlIg DlOlcudllllls dCllllllld judgllll!nl IIglllust DereudRIII,
Hl!lIhhAllIcrlc1l or Celllrnll'l!lIulylvlIlIllI, fill' III1YlllllllUlI1 Auswerlug Defl!IIdlllllS lire deelllcd
III owc III PlltlUIIf(,
6
tU.LUfrJJ
JSt\I) IfAITH Ct.,\lM
40. Anlwerlni Dlll'endllnlll hl!ll!hy Incol'plll'llll! hy reference, III If flllly sui forlh
herein. thu IIvennelllof fllctli Hl!tfUl'lh 1III'I1I'IIgrnphH UIIC (I) Ihl'llllgh (1\) IInd eighteen (18)
Ihrllllgh thlrtY-lIhll! (39).
41. I'l'lul' tu Novl!lnhl!l' .1, 1')93, II lid through thc pl'I!Helll, Defl!ndllnt,
HellllhAlIlerlc1l 01' ('clllrnl 1'I!II115ylvIIIIIII, Willi uhllgllll!d Iu pl'uvldl! hl!lIllh IlIld IIlcdfclll
hlHUrllIlCC cllwrngc IIl1d bl!II1!\'ltH to Ellgl~1I1! 1'111111 IIl1dcr Ihl! ICI'IIlH uf Ihe IIIHllrllllce
IIgreclIlcllt III II 1Illlllllcr Hct furlh lhl! rdll,
42, All uf thc IrCIIIIIll!1I1K IJdclldllllt, ElIgclIl! I'lIhll, I'l!cclwd WCI'I! I'CIIHl1l1Able Alld
nCCI!HHlIlY Irelltmclltli pl!l'ful'lIll!d lit filiI' IIlId I'CIIHOllllblc chllrgcH lhnt lire cuvlHed by hili
hlHUrn/lcC Agrcl!lIll!nt with Dl!\'clld n/l I , 1II!IIIthAIl1I!r1cllu( Cl!lIlmll'c/l/lHylvllllhl.
43. Dl!fclldll/lt, 1II!IIlthAIl1crll'II uf Cl!lItrnl I'clI/lHylvlI/lIII, urlgl/llllly dl!clllled
PIlYlllcllt for Ihc ICI!H IIHsuclllll!d with Ihl! the III I!d lcll 1 Hl!lVll'CH pl'uvldl!d by fllllflltlff,
J>hYlilclAIIH of Rl!hllhlllllltlo/l Ml!didlll!, 11,('" to Ddclldllllt, E'lgclIl! I'll It II , duc 10 Ihc
pendcllcy of Defendllllt. Eugcllc 111I11ll'S, WurkcrH' COlllpCIIHlIllolI Bl!lIcflt CIAIIll,
4<1. UpOIl rl!cl!lvl/lg II dr:llilll of AIIHwcrlllg Defclldllllt'S CIII"" 1'01' Workers'
COlllpclllilltloll BCllcflts 011 UI' IIbuut Dl!cl!lIldll' 23, 1993, AlIlIWCrlllg Defc/ldlllltS Advllied
Defclldlllll, Hl!lIhhAlIll!rlcll uf CI!Ill/'llII'cIIIIHylvll/llu, lhut It WIIS I'cHpulIslhlc for covel'llgc.
45, DCllllllldH 1'01' 11IIYIIlcnt huvl! heclI lIludc rl!pl!uh~dly UpOII DefclldAllt,
HCllhhAlIlcrlcu uf Cl!lItrnl I'cllllsylvlIUIIl, lllld Dcfl!lIdlllll, IlclllthAlIlerlcll uf Clllltrnl
J>cllllliylvAlllu, hilS cllprcHslYlldlllllled Its IIl1bllity IiII' thc c1l11rgl!s cowl'cd IIl1der Its "IIiUrR/lCC
agreelllent with Ddclldllnt, Eugcllc 1'11111I,
46. DcfelldAllt, HClllthAlllcrlcllof CClltrullll!llllHylvulIllI, hllll cUllthlltlly reflllled to
PllY for the IiClvlc:cli provided bythc PI III utlff, J>hyslcllllls of RchllbllllltfulI Medlcille, P.c.
7
worken. Cllllll1ellSullolI bellelll~ ure Cl)lllpllllsohle 10 EUllelllll'uhn, slIeklnllll relum Ilf IhlB IlUIltar
b) Ihe wllrkers' ClllllpllllSallll1l forum for further I1rllceedhllls, und Neekhllltll prolecllls
subroIlAIllllllnlllrl15111, HeahhAllIerlcll hOll alwuys luken Ihe 110shlon Ihul worken' compcll8lltJon
benelllll cun w:tUllllyonly be Ilwurded In Ole workers' COlllpellJlllloll forum. Now Ihllla workers'
compe/lllulllllI proceedlnllls a~a'n pel1dlnH, HealthAlllllrlcu Is IUllst1ed lhallt will be Ilble 10
proll!cIlllllnlercsl' In Ole worken' COIllJl~n9Ullol1 forum on allluues I'l\lsed In cOllntMloJI with Ita
Joinder of Rockwood Il1lhe ubllvI-Cuptloned W:llonll,
7. By wuy oftlJrther unswer, Itl9 uverred thUI Rockwood hDlllncurred fees und costa
In the ubove.cuptlon~d uCI\cms 9ol11ly by virtue of lIs unfounded und Inapproprlull! denial ofthc
Initial workers' compensutlon chllrn l1l~d on behulf of EUllelle Pulm,
WHEREFORE, HeulthAmcrlcu relpr.cltully requeslJl Olulthls Honorable Court deny the
MoUon for Rcconllldenl\lon tiled by Rockwood, und UIUI Ole Court order uSlllyln both of the
above-cuptloned lICUons uppllc~ble 10 ull discovery, Including depoaillol15 currently scheduled
for Seplllmbt;r 17-19, Sepll!mber 29-30, und October 22-24. 1997,
Respectfullysubmllll!d.
.
.
HARTMAN & MILLER. P.C.
Dall!dt 9/R/11
By:
k . HI1I1JrtRll, E9quire
uprcme Ct \.D, /121902
One Keystonc PhlZl1, Suite 107
Frllnl and Murket Stre~lIl
Hurrisbur8. PA 17101
(717)-232-3046
Altomeys for Addidon111 Oefendunl,
HealthAmericll of Ccntral Pennsylvunla
- 3 -