HomeMy WebLinkAbout00-02578
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RONALD E. SHERIFF,
Plaintiff
: IN THE COURT OF COMMON PLEAS
: OF CUMBERLAND COUNTY, PENNSYLVANIA
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: NO. 2000-;;157% CIVIL TERM
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SUN LIFE OF CANADA
Defendant
: CIVIL ACTION - LAW
: JURY TRIAL DEMANDED
NOTICE
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You have been sued in court. If you wish to defend against the claims set forth
in the following pages, you must take action within twenty (20) days after this complaint and
notice are served, by entering a written appearance personally or by an attorney and filing in
writing with the court, your defenses or objections to the claims set forth against you. You are
warned that if you fail to do so, the case may proceed without you and a judgment may be
entered against you by the court without further notice for any money claimed in the complaint
or for any other claim or relief requested by the plaintiff. You may lose money or property or
other rights important to you.
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YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU
DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE
OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP.
Cumberland County Bar Association
2 Liberty Avenue
Carlisle, PA 17013
(717)249-3166
II
RONALD E. SHERIFF,
Plaintiff
: IN THE COURT OF COMMON PLEAS
: OF CUMBERLAND COUNTY, PENNSYLVANIA
V.
: NO. 2000-;)578 CIVIL TERM
SUN LIFE OF CANADA
Defendant
: CIVIL ACTION - LAW
: JURY TRIAL DEMANDED
COMPLAINT
COUNT I
1) Plaintiff is Ronald E. Sheriff, an adult individual residing at 168 East Penn
Street, Carlisle, Pennsylvania, 17013.
2) Defendant is Sun Life of Canada, hereinafter "Sun", Defendant has an
office with an address of One Sun Life Executive Park, Wellesley Hills, Massachusetts
12481 and is believed to be a Delaware Corporation.
3) Defendant Sun provided to Plaintiff, a policy of disability insurance,
copies unavailable. Said policy was in effect during 1999.
4) The written information provided to Plaintiff by Defendant Sun or its
agents, stated that Plaintiff had insurance coverage that would pay disability coverage
during the time that Mr. Sheriff..." because of Injury or Sickness, is unable to perform all
of the material and substantial duties of his own occupation and is not engaged in any
occupation for wage or profit.", and during the time that Mr. Sheriff was under the
..."continuing care of a Physician providing appropriate treatment by means of
examination and testing in accordance with the disabling condition."
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5) Mr. Sheriff has suffered for a number of years from a disabling condition
diagnosed as petit mal/absence epilepsy. He has been treated and continues to be
6) There has been a worsening of the condition to the point where Dr
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treated by J. Craig Jurgensen, M.D. for this disorder.
Jurgensen has opined that Mr. Sheriff is no longer safe in the workplace.
7) Plaintiff has provided information to Sun in reference to this condition,
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most recently on or about March 2, 2000. A copy of that communication is attached
hereto and incorporated herein by reference and marked exhibit "/!\'.
8) Plaintiff avers that all conditions precedent to recovery have been fulfilled.
9) Plaintiff has been denied coverage under the policy of insurance issued
by the Defendant.
WHEREFORE, Plaintiff demands judgment against the defendant in an
amount in excess of $25,000.00 plus interest, costs and any other relief deemed just
and proper.
COUNT II
10) Plaintiff incorporates paragraphs 1 through 9 herein.
11) Plaintiff avers that the defendant's actions in denying the payment of
disability benefits constitute bad faith pursuant to 42 Pa.C.S.A. Section 8371.
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WHEREFORE, Plaintiff demands judgment against the Defendant in an amount
in excess of $25,000.00, interest, costs, delay damages and damages under 42
Pa.C.S.A. ~ 8371 upon determination by the Court that the insurer has acted in bad
faith.
II
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Respectfully submitted,
O'BRIEN, BARIC & SCHERER
By
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Robert L. O'Brien, Esquire
Attorney for Plaintiff
1.0. # 28351
17 West South Street
Carlisle, Pennsylvania 17013
(717) 249-6873
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I verify that the statements made in the foregoing Complaint are true and
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correct to the best of my knowledge, information and belief. I understand that false
statements herein are made subject to the penalties of 18 Pa. C.S. ~ 4904, relating to
unsworn falsification to authorities.
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O'BRIEN, BARIC & SCHERER
17 West South Street
Carlisle, Pennl1)llvania 17013
Roben L. O'Brien
DavidA. Baric
Michael A. Scherer
(717) 249-6873
Fax (717) 249-5755
E-mail: obs@obalaw.com
dlred:rob"'-@f>"Ilbrw.__
March 2, 2000
Shandy Page
Senior Claims Administrator
Sun Life of Canada
One Sun Life Executive Park
Wellesley Hills, Massachusetts 02481
RE: Ronald Sheriff
Group Policy No. 61302
Dear Ms. Page:
Mr. Ronald Sheriff has retained this office to pursue a course of litigation in the
event that his disability benefits cannot be resolved. Enclosed you will find a letter from
Dr. Jurgensen, his doctor, outlining his opinion of Mr. Sheriff's condition. Dr.
Jurgensen indicates that Mr. Sheriff is not capable of maintaining his safety in any type
of work place. I have also enclosed copies of Mr. Sheriff's records from Dr.
Jurgensen's office. Mr. Sheriff continues to see Dr. Jurgensen on a regular basis as
evidenced by the office notes. He was seen, most recently by Dr. Jurgensen on
February 28,2000.
Please review the enclosed materials and respond to this office. In the event
that your company continues to disclaim liability please forward a copy of the .insurance
policy so I can correctly reference the applicable provisions in the Complaint I have
drafted.
Sincerely,
O'BRIEN, BARIC & SCHERER
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Robert L. O'Brien, Esquire
RLO/af
Enc.
cc: Ronald Sheriff
EXHIBIT "A"
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BELVEDERE MEDICAL CORPORATION
850 WALNUT BOTTOM ROAD
CARLISLE, PA 17013
Internal Medicine
J. CRAIG JURGENSEN, M.D.- NEUROLOGY
STEVEN l. HATLEBERG, M.D.
DAVID P. ALBRIGHT, M.D.
SEVOALlNA V. BOSHNAKOV, M.D.
Sephen J. Hogg, Esquire
19 S. Hanover Street, Suitc 101
Carlisle, PA 17013
February 15,2000
RE: Ronald Eo Sheriff
DOB: 1111153
Dear Mr. Hogg:
I examined Ronald initially in June 1982. He presented at that time in status epilepticus. His
seizures are generalized, and major, and feature total loss of consciousness (inattention, unresponsive
to caU, movement). He came under control during hospital treatment, and was placed on
antiepileptic medication with Zarontin. Depakote was started thereafter, but initially caused adverse
digestive side effects. He had had infrequent convulsive seizures earlier in his life. Seizures hwe
unfortunately not come under control despite maximal doses of standard antiepileptic tr ~atment with
three medications (Zarontin, Depakote, and Ativan). Electroencephalograms have documented the
presence of infrequently recurring attacks of generalized spike-and-slow wave activity -
characteristic of petit mal (absence) epilepsy. Ronald has attempted to live, work, and support a
family with this very serious diagnosis. He has in fact risked driving safety by operating his car in
the hopes of low frequency seizures. He has also been troubled by headaches. No structural or
anatomic pathologies were identified in his brain scanlMRI. He required a short hospital sta:' in
1993 and again in 1997 to manage prolonged epileptic seizures. There has been confusion in the
disability board and insurance companies related to the fact that his seizures are "nonconvulsive."
I have the feeling that the use of the word "nonconvulslve" has wrongly suggested to non-medical
reviewers that his seizures are nonpathologic or harmless. Seizures in fact are recurring fairly
frequently, on a daily basis and in fact during sleep. Prolonged electroencephalographic monitoring
recently in January revealed frequently recurring epileptic discharges - which fortunately do not
express clinically in every instance. He is at risk, however, for an attack of unconsciousness and
epileptic stupor on a daily basis. Ron is unfortunl:\tely'refractory to maximal antiepileptic treatment.
No surgical or interventional measures are available to treat this type of epilepsy.
The diagnosis of petit mal/absence epilepsy makes l1im incapable of operating any machinery,
driving a car, or working in a factory.
. . Thank you very much.
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Very .truly yours,
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J. Craig Jurg~sen, M.D.
JCJ/gmj
MEDICAL REDJlIOO IlELJY\SE
1. I hereby authorize [M;; lN1'E1lN/\L MEDICINE to release any illfolll11111oll
regarding the medical, dental, mental, alcohol or w:ug auuse hislol)'
and/or treatment to the I'I."OVider. Insurance COIIPilIlY, 1:lllvloyel- or
Organization listed below.
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2. I hereby authorize:
to release any infoDl1alion regat:ding the medical, dental, menlal,
alcohOl or drug abuse histOlj' and/or treilbl1ent lo:
UC lNl'EllNllL MEDICINE
050 wM.tur 001"101 1101\I)
Cl\!U,lSl.E, l'A 17013
(717)243-3944
Patient's Name: (l'lease Print)
Dale of 01rlh:
Social SecU1-ily " 1-'/'/- V J. - :;; 3 V /
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~URB (Parent or Gua ian if Minor)
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CLIENT INFORMATION
PATIENT DATA
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OMEGA
MEDICAL LABORATORIES
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toll free in PA
(800) 222.4493
AX (610) 378.1399
2001 STATE HILL ROAD
SUITE 100
WYOMISSING. PA 19610
(610)378-1900
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SHER I FF , RON~\U)' E i
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ACCESSION: X'~I;/1('41112 I;,
~GE,DOB: 45,11/01/53 SEX I.
PHONE: 171 7 1 258-0508
DRAWN: 0,,/16/'39 8:27[;:
10: 1774223418 II~
REF: ".
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"the blood test centers"
FASTING? NO
--TEST--
--RESULT--
--UNITS--
:~l
--REFERENCE RANGE--
HFPATIr. FIINr.TTnN PANF1
ALKALINE PHOSPHATASE
SGOT lAST
f.;GPT IAL T
ALBU~lI N
TOTAL BILIRUBIN
nIRFr.T RlI I RI m IN
INDIRECT BILIRUBIN
98
17
15
4.4
0.4
0-L
0..3
U/L
30',1',0
U!L 5-45
U/L 5-l.5
G/DL 3..5-5.5
MG/DL 0.1-1.2
_J1GLDL____~'\._0=_0...lI___"___
t~G/DL 0.1.-1. 0
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~ALPROIC ACID (DEPAKENEl
109.2 HI
MCG/~lL The,'apeut ic:50-100
Valproic Reid levels above
lS~ mrg/ml may be needed
to treat some patients.
However,the probability of
toxici.ty 0. e. hepatotoxicity
or thrombocytopenia)
increases with concentrations
) 11171 mcg/ml (females) and
)135 mcg/ml (males).
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LAST DOSE ~ALPROIC ACID
4/16/99 7:00 AM
*** FINAL REPORT ***
SHERIFF,RONALD E
320 S MIDDLESEX ROAD
CARLISl_E, PA 17011-,
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Patient: Ronald Sheriff
Date: January 19,2000
SLEEP CONSULTATION
Chief Complaint: "I can't tell between tiredness and my seizures."
Identifying Information: Ron is 46 years old, presently unemployed, with absence epilepsy.
Present lllness: Ron has had seizures since he was young. He presented in nonconvulsive epileptic
status in 1982. Electroencephalogram showed nearly continuous generalized 3/sec spike-and-wave
activity. He was placed on treatment with Depakote. The seizures came under fair control. He was
able to return to work as a janitor. In the past few years though, seizures have returned. Additional
medication has been ordered - including Depakote, plus Zarontin. In addition though, he reports
a nearly constant feeling of tiredness and fatigue through the day. At night he goes to bed at II p.m.
He reports sleep is restless, and "I keep waking up." There is an observed report of obstructive
snoring. He wakes in the morning teeling poorly rested. He has had wake-up cramps and hand
spasms. He recently gained ten pounds. His wife observes that he is frequently inattentive and quiet
through the day, suggesting absence seizures. The differential between daytime sleepiness and
seizures needs to be decided.
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Past Medical History: He has not had previous surgery. There is no history of head injury. Current
medication consists of Depakote 500 mg four per day, Zarontin 250 mg six per day.
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Family History: His father died of abdominal cancer. There are no siblings. He and his wife have
two sons who are well.
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Social History: He finished a high school education. There is a prior history of bicuspid aortic
valve. He has been married for 20 years. He previously worked for Cumberland Valley School
District as a:janitor. About five years ago he operated a delivery truck.
Review of Systems: ENT - Negative. Cardiorespiratory - He does not smoke cigarettes. GI - His
weight has increased. No history of vomiting, diarrhea. GU - Negative. Neurologic - He has
frequently recurring headaches. MRI scan of the brain was negative in July 1999. Interictal EEGs
in the past have shown frequently recurring symmetric spike-and-slow wave activity.
Physical Exam: Weight 242 pounds, blood pressure 140/80. Eyes - Pupils are equal and reactive
to light. Mouth - Dentition is poor. Uvula is minimally enlarged. Chest - The lungs are clear to
auscultation. Heart - Heart tones are normal. There is no murmur. Abdomen - No masses are felt.
There is no tenderness. Extremities - The joints are normal. There is no edema. Neurologic-
Mood level is depressed. His voice is clear. Muscles are soft. Tendon reactions are hypoactive.
There is no tremor.
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January 19,2000
RE: Ronald Sheriff
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Plan: He'll undergo a polysomnographic study.
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Impression:
1. Absence epilepsy.
2. Possible obstructive sleep apnea.
3. Excessive daytime sleepiness.
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BELVEDERE MEDICAL CORPORATION
850 WALNUT BOTTOM ROAD
CARLISLE. PA 17013
Internal Medicine
J. CRAIG JURGENSEN, M.D.- ~EUROLOGY
STEVEN L. HATLEBERG, M.D.
DAVID P. ALBRIGHT, M.D.
SEVDAlINA V. BOSHNAKOV, M.D.
OcLobcr 12, 1999
Sun Life of Canada
Alln Pamcla E. Allard
Onc Sun Life Exccutive Park
Wellesley Hills, MA 02481
RE: Ronald E. Sheriff (DOB 11/1/53)
SSN: 177-42-2341
PN: 61302
Dear Ms. Allard:
I have sent records previously on the medical condition of Ronald Sheriff. I understand there
is concern for his epilepsy diagnosis and the effect it has upon his work ability. He is troubled by
noneonvulsive seizures. This means that he has seizures that do not feature motor convulsive
activities. His seizures consist mainly of quiet spells of inallenLion. The spells have bccn
documented on numerous occasions in the EEG laboratory. Somc individuals with absencc cpilcpsy
like this are resistant to antiepileptic medications. I have observed him in the office when he has
additional quiet spells of inattention - during which time he is unable to listcn, respond, or speak.
The episodes last from onc to morc minutes in duration. I havc indicaLed LhaL for this rcason it's noL
permissible lor him to drivc a car. Physically though hc is wcll cnough such that hc is able to do
work at home.
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His present treatment schedule con . sts of Depakote, ZaronLin, and Dilantin.
Please give consideration to Ronald in his serious n-;~~oiogie-diagoosisihat'prevcnts him [rom
doing physical work.
Thank you vcry much.
Very truly yours,
r~t~ I~~fu~,_
J. CraigJm~lSen, M.D.
JCJ/gmj
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RONALD E. SHERIFF,
Plaintiff,
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY,
PENNSYLVANIA
v.
No. 2000-2578 CIVIL TERM
SUN LIFE OF CANADA,
CIVIL ACTION - LAW
Defendant.
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PRAECIPE FOR APPEARANCE
TO: PROTHONOTARY
Please enter the appearance of the undersigned on behalf of Defendant, Sun Life of
Canada, in the above-captioned matter.
Respectfully submitted,
KLETT ROONEY LIEBER & SCHORLING
9'rAJ ~ #~
TODD P. PRUGAR, E~
PA ID No. 72889
240 North Third Street, Suite 600
Harrisburg, PA 17101
(717) 231-7700
Attorneys for Defendant,
SUN LIFE OF CANADA
KRLSHAR: 14~28.1
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CERTIFICATE OF SERVICE
I hereby certify that a true and correct copy of the foregoing PRAECIPE FOR
APPEARANCE was served on this 16th day of May, 2000, by First Class U.S. Mail, upon the
following:
Robert 1. O'Brien, Esquire
O'BRIEN BARIC & SCHERER
17 West South Street
Carlisle, P A 17013
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TODD P. PRUGAR,~
KRLSHAR: 14828.1
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RONALD E. SHERIFF,
Plaintiff,
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY,
PENNSYLVANIA
v.
No. 2000-2578 CIVIL TERM
SUN LIFE OF CANADA,
CIVIL ACTION - LAW
Defendant.
NOTICE OF FILING OF NOTICE OF REMOVAL
TO: PROTHONOTARY
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
Robert L. O'Brien
17 West South Street
Carlisle, P A 17013
NOTICE is hereby given that on the 19th day of May, 2000, Defendant filed a Notice of
Removal of the above-captioned action from the Court of Common Pleas of Cumberland
COUllty, Pennsylvania, to the United States District Court for the Middle District of
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Pennsylvania. A true and correct copy of the Notice of Removal is attached hereto as Exhibit
"A."
KRLStIAR.: 14843.1
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KRLSHAR: 14843.1
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Respectfully submitted,
KLETT ROONEY LIEBER & SCHORLING
5'{/;tAA~
TODD P. PRUGAR, ESQUIRE
PA ID No. 72889
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240 North Third Street, Suite 600
Harrisburg, PA 17101
(717) 231-7700
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Attorneys for Defendant,
SUN LIFE OF CANADA
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IN THE UNITED STATES DISTRICT COURT
FOR THE MIDDLE DISTRICT OF PENNSYLVANIA
RONALD E. SHERIFF,
Plaintiff,
v.
No.
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SUN LIFE OF CANADA,
Judge
Defendant.
Magistrate
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NOTICE OF REMOVAL
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AND NOW, comes the Defendant, SUN LIFE ASSURANCE COMPANY OF
CANADA (incorrectly denominated as "Sun Life of Canada"), and respectfully notifies this
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Court of the removal of the above-styled action from the Court of Common Pleas of Cumberland
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County, Pennsylvania, to the United States District Court for the Middle District of
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Pennsylvania, pursuant to 28 U.S.C !l1331, !l1367, !l1441, and 29 U.S.C" !l1132, and in support
thereof states as follows:
1. This action is being removed to federal court based upon the following alternative
federal jurisdictional bases: federal jurisdiction under 28 U.S.C. !l1331 and under the Employee
Retirement Income Security Act of 1974, 29 U.S.C. !l1001 ~ seq. (hereafter "ERISA"); and
supplemental jurisdiction under 28 U.S.C. !l1367.
KRLSHAR: 14841.1
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2.
On or about April 26, 2000, plaintiff filed in the state court, a Complaint in the
above-entitled civil action in the Court of Common Pleas of Cumberland County, Pennsylvania,
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at Docket No. 2000-2578.
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The aforesaid state court action is a suit of a wholly civil nature of which the
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United States District Court for the Middle District of Pennsylvania has original jurisdiction
under 28 U.S.C. 91331, 91367, and 29 U.S.C. 91132, and is one that may be removed by
petitioner pursuant to 28 U.S.C. 91441.
4. This Court has federal question jurisdiction over the action because plaintiff, as a
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participant and/or beneficiary under an employee welfare benefit plan, seeks recovery of benefits
under said employee welfare benefit plan. The plan is controlled by ERlSA:
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a.
At all times relevant hereto, Fry Communications, Inc. established and/or
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maintained an employee welfare benefit plan and plaintiff was covered
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under said employee welfare benefit plan, and, as such, plaintiff was a
participant and/or beneficiary under said employee welfare benefit plan;
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b.
The plan is one established or maintained by an employer as defined by
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ERlSA, 29 U.S.C. 91002(5). That section defines an employer as "any
person acting directly as an employer, or indirectly in the interest of an
employer, in relation to an employee benefit plan. . . .";
c. The plan was established and is maintained for, among other things, the
purpose of providing, among other things, disability benefits for
participants and/or beneficiaries of the plan;
d.
The plan was and is therefore an employee welfare benefit plan within the
KRLSHAR: 14841.1
2
meaning of29 U.S.C. SI002(1);
e. Plaintiffs claim is one for recovery of benefits and other relief under said
employee welfare benefit plan; and
f. Pursuant to 29 U.S.C. sI132(e), the district courts of the United States
have original jurisdiction over actions brought by fiduciaries, participants,
and beneficiaries to recover benefits or other relief under employee
welfare benefit plans.
5. In addition and alternatively, this Court has federal question jurisdiction under
ERISA of this matter and, to the extent this Court should determine that any of plaintiff's claims
are not preempted by ERISA, this Court would have supplemental jurisdiction over such claims
because such claims are so related to claims in the action within the Court's original jurisdiction
that they form part of the same case or controversy under Article III of the United States
Constitution.
6. This action is therefore one of which the United States District Court for the
Middle District of Pennsylvania has original federal question jurisdiction under 28 U.s.c. S 1331
and 1441(b), as well as 29 U.S.C. SI132, and/or supplemental jurisdiction under 28 U.S.C.
S1367 and this action may be removed to this Court by petitioner pursuant to 28 U.S.C. SSI441.
Cumberland County, Pennsylvania is within the venue of the United States District Court for the
Middle District of Pennsylvania.
7. This petition is being filed pursuant to 28 U.S.C. S 1446 within thirty (30) days of
service of the initial pleading in which a removable claim is asserted, and is removable in that:
a.
The time for filing this petition under 28 U.S.C. SI446 has not expired;
3
KRLSHAR 14841.1
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b.
Plaintiff artfully crafted his pleading based wholly upon state law causes
of action, claims and/or theories of recovery; and
c.
In the companion cases of Metropolitan Life Insurance Company v.
Taylor, 481 U.S. 58 (1987), and Pilot Life Insurance Co. v. Dedeaux, 481
U.S. 41 (1987), the United States Supreme Court established that state law
claims such as those asserted by plaintiff herein are preempted by ERISA,
in that ERISA, 29 U.S.C. S 1132, provides the plaintiffs exclusive cause
of action and displaces entirely any state cause of action, thus rendering
plaintiff s case, however pleaded, exclusively a federal question case
removable to this Court;
d. To the extent any of plaintiffs claims are governed by state law, this
Court has supplemental jurisdiction over such claims.
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8.
Therefore, defendant files this Notice of Removal of this action from the Court of
Common Pleas, Cumberland County, Pennsylvania, in which it is now pending, to the United
States District Court for the Middle District of Pennsylvania. There are attached to this notice,
marked Exhibit" A" and incorporated by reference, true and correct copies of all process,
pleadings, and orders served upon defendant in this action.
WHEREFORE, defendant notifies this Court of the removal of this action from the
Court of Common Pleas of Cumberland County, Pennsylvania, to the United States District
Court for the Middle District of Pennsylvania.
KRLSHAR: 1484 Ll
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Respectfully submitted,
KLETT ROONEY LIEBER & SCHORLING
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TODD P. PRUGAR, ES~
PA ID No. 72889
240 North Third Street, Suite 600
Harrisburg, PA 17101
(717) 231-7700
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Attorneys for Defendant,
SUN LIFE OF CANADA
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KRLSHAR: 14841.1
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MFlY 15 '0FJtb~L~~.l.E~F;t!iTE1~~SS.~~t.Dl~t;; b~~~64 1401
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II RONALD E. SHERIFF,
,I Plaintiff
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: IN THE COURT OF COMMON PLEAS
: OF CUMBERLAND COUNTY, PENNSYLVANIA
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\1 SUN LIFE OF CANADA
I! Defendant
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: NO. 2000-.2518 CIVIL TERM
: CIVIL ACTION ~ LAW
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j i You have been sued in court. If you wish to defend against the claims set forth
. Ii in the following pages, you must take action within twenty (20) days after this complaint and
'I notice are served, by entering a written appearance personally or by an attorney and flling in
I' writing with the court. your defenses or objections to the claims set forth against you, You are
;1 warned that if you fail to do so, the case may proceed without you and a judgment may be
II entered against you by the court without further notice for any money claimed in the complaint
I; or for any other claim or relief requested by the plaintiff. You may lose money or property or
,\ othe!' rights Important to you.
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: JURY TRIAL DEMANDED
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NOTICE
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU
DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO ORTEL.EPHONE THE
OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GeT LEGAL HELP.
Cumberland County Bar Association
2 Liberty Avenue
Carlisle, PA 17013
(717)249-3166
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d EXHIBIT
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l RuE. COP" FROM RECOt~1lO
In 1 estIfnOiIy wnereol. \ Mfe unto sat my
anO lSlI $lIII at said court at ,~'~o..
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MAY 15 '00, tg}13~~~A.:.TE,;~~~ctl~I'p~~2J~;-~!=,4-1401
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938 PI2I4 r'IH,'pi'2' 813 16: 1;;
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RONALD E. SHERIFF,
Plaintiff
: IN THE COURT OF COMMON PLEAS
: OF CUMBERLAND COUNTY, PENNSYLVANIA
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III SUN LlFE OF CANADA
'I Defendant
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: NO. 2000- ;ln~ CIVIL TERM
: C!VIL ACTION - LAW
: JURY TRIAL DEMANDED
COMPLAINT
COUNT I
1) Plaintiff is Ronald E. Sheriff, an adult individual residing at 16S East Penn
Street, Carlisle, Pennsylvania, 17013.
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II office with an'address of One Sun Life Executive Park, Wellesley Hills, Massachusetts
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2)
Defendant is Sun Life of Canada. hereinafter .Sun". Defendant has an
12481 and is believed to be a Delaware Corporation.
3)
Defendant Sun provided to Plaintiff, a policy of disability insurance,
copies unavailable. Said policy was in effect during 1999.
4)
The written information provided to Plaintiff by Defendant Sun or its
agents, stated that Plaintiff had insurance coverage that would pay disability coverage
during the time that Mr. Sheriff..: because of Injury or Sickness, is unable to perform all
of the material and substantial duties of his own occupation and is not engaged in any
occupation for wage or profit.', and during the time thal Mr. Sheriff was under the
....continuing care of a Physician providing appropriate treatment by means of
examination and testing in accordance with the disabling condition.'
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5) Mr. Sheriff has suffered for a number of years from a disabling condition
diagnosed as petit mal/absence epilepsy. He has been treated and continues to be
I treated by J. Craig Jurgensen, M.D. for this disorder.
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II. 6) There has been a worsening of the condition to the point where Dr
Jurgensen has opined that Mr. Sheriff is no longer safe in the workplace.
7) Plaintiff has provided information to Sun in reference to this condition,
most recently on or about March 2, 2QOO. A copy of that communication is attached
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hereto and incorporated herein by reference and marked exhibit "A".
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'1 by the Defendant.
8)
Plaintiff avers that all conditions precedent to recovery have been fulfilled,
9)
Plaintiff has been denied coverage under the policy of insurance issued
WHEREFORE, Plaintiff demands judgment against the defendant in an
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and proper.
COUNT 11
10)
Plaintiff incorporates paragraphS 1 through 9 herein.
11) . Plaintiff avers that the defendant's actions in denying the payment of
disability benefits constitute bad faith pursuant to 42 Pa.C,S.A, Section 8371.
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MAY 15 '00, Wi 3~!;:BQI~IEIlI~!?c.tI!1I'pT.!Sfi:_ 2J.lh'\64-1401
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I, in excess of $25.000.00. interest, costs. delay damsl;)es and damages under 42
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WHEREFORE. Plaintiff demands judgment against the Defendant in an amount
Pa.C.S.A ~ 8371 upon determination by the Court that the insurer has acted in bad
faith.
Respectfully submitted,
O'BRIEN, BARIC & SCHERER
By
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Robert L O'Brien, Esquire
Attorney for Plaintiff
l.D. # 28351
17 West South Street
Carlisle, Pennsylvania 17013
(717) 249-6873
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MAY 15 '121121 1121:34 EBENSTEIN&SCHMIQT~E.~1~~494 141211
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I verify that the statements made in the foregoing Complaint are true and
correct to the best of my knowledge, information and belief, I understand that false
,I statements herein are made subject to the penalties of 18 Pa. C.S. ~ 4904, relating to
'1 unsworn falsification to authorities.
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Dated:
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"'HY 1:' '0k! 1,;l!'J,4 ~ti~l!I~iU~~~t~I'1IJII(( ~19 464-1401
;-"'dl-"to.JJ.-"4-~ ~l'l ,-ire:,....,..",." VL.., I.
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938 ?<18
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O'BBlBN,lWUc.. SCHZItBR
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J 7 Well South SlnItl
CQrli.l~ P*IlIUJIIwm/Q J TIJ/J
Ro"", L. O'Bri*"
DDvIci A. BQrl~
Miclw.tl A. Schenr
(/17) 249-6873
F_ (/11) 149-S7S$
E-mail: ob4@oM_.com
6-L~~a..L-... ~.-
March 2, 2000
Shandy Page
Senior Claims Administrator
Sun Life of Canada
One Sun life Executive Park
Wellesley Hills, Massachusetts 02481
RE: Ronak:l Sheriff
Group Policy No. 61302
Dear Ms, Page:
Mr. Ronald Sheriff has retained this office 10 pursue a course of litigation in the
event that his disability benefits cannot be resolved. Enclosed YOI.I will find a letter from
Dr. Jurgensen, his doctor, outlining his opinion of Mr. Sheriff's condition. Dr. .
JUrger1S$!'1 indicates that Mr. Sheriff is not capable of maintaining his safety in any type
of work. place. I have also enclosed copies of Mr. Sheriff's records from Dr.
Jurgensen's office. Mr. Sheriff continues to see Dr. Jurgen$en on a regular basis as
evidenced by the office notes. He was seen, most recently by Dr. Jurgensen on
February 28, 2000.
Please review the enclosed materials and respond to this office, In the event
that your company continues to disclaim liability please forward a copy of the ,insurance
pollcyso J can correctly reference the applicable provisions in the Complaint I have
drafted.
Sincerely,
O'BRIEN, BARIC & SCHERER
<;
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Robert L. O'Brien, Esquire
RLO/af
Ene.
Co: Ronald Sheriff
EXHIIlI'I' "A"
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9313 F'lQ9
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BELVEDERE MEDICAL CORPORATION
850 WALNUT BOTTOM ROAD
CARLISLE. PA 11013
IIIlemlll Medicine
J. CRAlGJURGENSEN. M.D.- NEUROLOGY
STEVEN L. HATl.E8ERG, M.D.
DAVID P. ALBRIGHT, M.D.
SEVDALlNA V. BOSHNAKOV. M.O,
Sephen J. Hogg, Esquire
19 S. Hanover Street, Suite 101
Carlisle, I> A 17013
Febroal)' IS. 2000
RE; Ronald Ii. Sheriff
DOS: 1l/1I53
Dear Mr. Hogg:
I examined Ronald initially in JWle 1982. He presented at that time in status epilepticus. His
seizures are generalized, and major, and feature total loss of consciousness (ina!ltntion, unresponsive
to call, movement). He Cam.8 under control during hospital treatment, and was placed on
antiepileptic medication with Zarontin. Depakote was started thereafter. but initially caused adverse
digestive $ide effects. He had had infrequent convulsive seizures ear\ier in his life. Seizures h;we
unfortunately not come under control despite maximal doses of standard antiepiIeptic It latment with
three medications (Zarontin. Oepalcote, and Allvan). Electroencephalograms have documented the .
presenCCl of infrequently recurring attacks of genenUi:zed spike-and-slow wave activity -
chan.ctenstic of petit mal (absence) epilepsy. Ronald has attempted to live, work, and support a
family with this vel)' serious diagnosis. He has in fact risked driving safety by operating his car in
the hopes of low frequency seizures. He has also been troubled by headaches. No structural or
anatomic pathOlogies were identified in his brain scanlMRl. He required a short hospital sta:. in
1993 and agUn in 1997 to manage prolonged epileptic sei2Ures. There has been confusion ill the
disability board and insurance companies related to the. ~act that his seizures are "nonconvulsive."
I have the feelillg that the use of the word "nonconvuls.ive" has wrongly suggesred to non.med:cal
reviewctS that his seizures are nonl'athologic or hannless. Seizures in fact are recurring fairly
frequently, on a daily basis and in fact during sleep. Prolonged electroencephalographic monitoring .
recently in January revealed frequently recurring epileptic diSCharges - which forrunately do not
express cliniCally in every instance. He is at risk, how<lver, for an attack "r unconsciousness :md
epileptic stupor on a daily basis. Ron is unfortunately'refractol)' to maximal antiepileptic treatm~nt.
No surgical or interventional measures are available to treat this type of epilepsy.
The diagnosis of petit mal/absence epilepsy makes him incapable of operating any machin..:l)',
driving a car, or working in a factol)'.
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. . 'I'halIk. you very much.
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C4~~~.
J. Craig Jurg~sen, ~.D. .
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." . . 464 1401
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1. I hereby l.luthorize IH:: INl'ElH\[, Ml!m.ClN& to re.lease any i1,(ol1l...lio"
ru94ttl.I.I\g the l11G4iCQ1, l1ental. lIlental, al.coho.\. OJ.' tl.nIg nl.>uSEI hlatu..>,
Uld/or: tJ:eal:.mlml: to the l'J.'OVider, InBUJ::Qnce CO'II,liJIlY. I:l'\lloyer' or'
Oc:ganhlltiCll1 listec1 \)e].cw.
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2. 1 he.ce'oy aut:ho,,'ue:
to release any infOl:ll1l:l\:ion reg.utling the nled.i.c!ll. dental, mental,
alcohbl or lkug ..we.. hi.story WId/OJ: \;reabr~l1t tOl
\JC 1Nl'EI~ HEDIClNt
350 WIiLNJr 00l"1.Ut lIJI\I)
Cl\1tt.1SLe, Ph 17013
(717 ) Z43-39""
Patient's ttane: (Pl.ease Print)'
D<lle of Olrlh:
Socilll Security II /"7'7- t/rJ.-;)3 ~ I
:L\llll!: {Fa rent or Q.l" !.an if Minor I
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Date:
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Date:JJ 27j60
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MAY 15 '00 10:36 EBENSTEIN&SCHMIDTKE 219-464 1401
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*** FINAL REPORT ***
SHERIFF. RmJALD E
320 S MIDDLESEX ROAD
fARLISLE, PA 17011
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, Patient: Ronald Sheriff
Date: January 19,2000
SLEEP CONSULTATION
Chief Complaint: "I can't tell between tiredness and my seizures."
Identifying Information: Ron is 46 years old, presently unemployed, with absence epilepsy.
Present Illness: Ron has had seizures since he was young. He presented in nonconvulsive epileptic
status in 19&2.E1ectroencephalogram showed nearly continuous generalized 3/sec spike-and-wave
activi ty. He Wll3 pll.\ce<l on tl:eatment with Depakote. The seizures came under fair eonll'Ol. He Wlls
able to return to work as ajanitor. In thllpast few years though, seizures have returned. Additional
medication has be,en ordered - including Depakote, plus Zarontin. In addition though, he repons
a nearly constant 'feeling of tiredness and fatigue through the day. At night he goes to bed at 11 p.m.
He reports sleep is restless, and "1 keep waking up." There is an obsClVed report of oDsuuctive
snoring. . He wakes in the morning feeling poorly rested. He has had wake-up cramps and hand
spasms. He recently gained ten pounds. His wife observes that he is frequently inattentive and quiet
through the day, suggesting absence seizures. The differential between daytime sleepiMSS and
seizures needs to be decided.
Past MediclIl History: He has not bad previous surgery, There is no history of head injury, Current
medication consists of Depakcte 500 mg four per day, Zarontin 250 mg si~ per day.
Family History: His father died of abdominal cancer. There are no siblings. He and his wife have
two sons who are well.
Social History: He finished a high school education. There is a prior history of bicuspid aortic
valve. He has been married for 20 years. He previously worked for Cumberland Valley School
District as a-janitor. About five years ago he operated a delivery truck.
Review of Systems; ENT - Negative. Cardiorespiratory - He does not smoke cigarettes. GJ - His
weight has increased. No histolY of vomiting, diarme3. GU. Negative. Neurologic - He has
frequently recurrillg headaches. MRI scan of the brain was negative in July 1999. lnterictal EEGs
in the past have shown fr;:quently recurring symmetric spike-and-slow wave activily,
Physical Ell-am: Weight 242 pounds, blood pressure 140/80. Eyes - Pupils are equal and reactive
to light. Mouth. Dentition is poor. Uvula is minimally enlarged. Chest. Th6 lungs are clear to
auscultation. Heart. Heart tonQS are nonna!. There is no murmur. Abdomen - No mllSses are felt.
There is no tenderness. Extremities. The joints are nonnal. TIlere is no edema. NeUl'ologi~-
Mood level is depressed. His voice is dear. Muscles are soft. Tendon reactions are hypoactive.
There is no tremor.
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Page 2
January 19,2000
R.E: Ronald Sheriff
Impression:
1. Absence epilepsy.
2. Possible obstructive sleep apnea.
3. Excessive daytime sleepiness.
Plan: He'll undergo a polysomnograpbic: study.
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850 WAlNUT BOTTOM ROAD
CARLISLE. PA 17013
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tnlemal Medicine
J, CRAIG JURGENSEN, M.D.- NEUROLOGY
STEVEN L. HATLESERG, M,O:
DAVID P. ALBRIGHT. M.O.
SEVOAUNA V. BOSHNAKOV. M.D.
October 12, 1999
SlIn Life of Cam.da
Altn Pamela E. Allard
One S\ln Life ExcclItive Part.:
Wellesley Hills, MA 02481
RE; Ronald E. Shcriff(DOn 11/1/53)
SSN: 177-42-234\ .
PN; 61302
Dear Ms. Allard;
I have sent records previously onlhe medical condition of Ronald Sheriff. I understa.nd there
is coneern for his epilepsy diagnosis and the effect it has upon his work ability, He is troubled by
nonconvulsive seizures. This means that he has seiz= that do not teaturc motor convulsive
lIctivities; His seizures consist mainly of quiet spells of inatlcmion. The spells have been
documented on numerous occasions ill the EEG laboratory. SOI1\O individuals with absence epilepsy
like this are resistant to antiepileptic medications. I have observeu hiln in the office when he has
additional quiet spells of inattention - dllring which time he is unabte to listen. respond. or speak.
The episodes last from one 1.0 Inorc tninules in duration. I have indicated that for this reason it's 1101
p.mnissibte for him to drive a car. Physically though he is well ellough such that hc is able 10 <10
work at home.
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His present treatment schedule COI\~ of Depakole, Zarontil1, alld Dilamin.
-
Please give consideration to Ronald ill his serioUs l1eu"f;iogie-diagfltlSis1hat'prevcnts him from
doillg physical work.
Thank you very much.
V cry tnily YOUI'll.
O~~ l~~~"
J. Craig J 1I.-g~1SI:1I. M.D.
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RONALD E. SHERIFF,
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY,
PENNSYLVANIA
Plaintiff,
v.
No. 2000-2578 CIVIL TERM
SUN LIFE OF CANADA,
CIVIL ACTION - LAW
Defendant.
PRAECIPE FOR APPEARANCE
TO: PROTHONOTARY
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Please enter the appearance of the undersigned on behalf of Defendant, Sun Lifi of co
Canada, in the above-captioned matter.
Respectfully submitted,
KLETT ROONEY LIEBER & SCHORLING
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TODD P. PRUGAR, ESQ IRE
PAID No. 72889
240 North Third Street, Suite 600
Harrisburg, PA 17101
(717) 231-7700
Attorneys for Defendant,
SUN LIFE OF CAL"JADA
KRLSHAR: 1482~.1
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Robert L. O'Brien, Esquire
O'BRIEN BARIC & SCHERER
17 West South Street
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CERTIFICATE OF SERVICE
I hereby certify that a true and correct copy of the foregoing NOTICE OF REMOVAL
was served on this 19th day of May, 2000, by First Class U.S. Mail, upon the following:
Robert L. O'Brien, Esquire
O'BRIEN BARIC & SCHERER
17 West South Street
Carlisle, PA 17013
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TODD P. PRUGAR, ESQ IRE
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I hereby certify that a true and correct copy ofthe foregoing NOTICE OF FILING OF
NOTICE OF REMOVAL was served on this 22nd day of May, 2000, by First Class U.S. Mail,
upon the following:
Robert L. O'Brien, Esquire
O'BRIEN BARIC & SCHERER
17 West South Street
Carlisle, P A 17013
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TODD P. PRUGAR, E QUIRE
KRLSHAR, 14843.1
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