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HomeMy WebLinkAbout01-5730BEVERLY HEALTH & REHABILITATION SERVICES, INC., Plaintiff V. CORESTAR, a Division of Coresource, Inc. Defendant · IN THE COURT OF COMMON PLEAS OF : OF CUMBERLAND COUNTY, : PENNSYLVANIA :NO. : CIVIL ACTION - LAW PRAECIPE TO WRIT OF SUMMONS TO THE PROTHONOTARY: Please issue a Writ of Summons to the Defendant. The Defendant's address is: Corestar P.O. Box 1195 Minneapolis, MN 55440-1195 Respectfully submitted, FENSTERMACHER AND ASSOCIATES, P.C. DATED: October 1,2001 By: Mark K. Emery #7/¢4'2~87 Supreme Court I.D. 5115 East Trindle Road Mechanicsburg, PA 17050 (717) 691~5400 Attorney for Plaintiff Commonwealth of Pennsylvania County of Cumberland BEVERLY HEALTH & REHABILITATION SERVICES, INC. CORESTAR, a Division of Coresource, Inc. P.O. Box 1195 Minneapolis, ~ 55440-1195 Court of Conunon Plea~ No. 01-5730 Civil Term 19 In Civil Action - Law To _ _C~3~ m_t ar, _ a _OiY~ior~ _Q f _ ~are~u~c~ L _Inc. You are hereby notified that Beverly Health & Rehabilitation Services, Inc. the Plaintiff has commenced an action in ....... C__i_yj-_l__A_g_t_i_c2_o__-__L__a_w ............................ against you which you are required to defend or a default judgment may be entered aga~inst you. ( SEAL ) Date October 2, 2001 19 .... Prothonomr~ BEVERLY HEALTH & REHABILITATION SERVICES, INC., Plaintiff V, CORESTAR, a Division of Coresource, Inc. Defendant : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : NO. 01-5730 Civil Term : : CIVIL ACTION - LAW CERTIFICATE OF SERVICE I, Mark K. Emery, do hereby swear and affirm that the Writ of Summons was served via certified mail, return receipt requested, on October 15, 2001, addressed as follows: Corestar P.O. Box 1195 Minneapolis, MN 55440-1195 Said retum receipt was signed by Corestar on October 18, 2001. FENSTERMACHER AND ASSOCIATES, P.C. Mark K. Emery Court for the Middle District of Pennsylvania on the ~ay of November, 2001. Respectfully submitted, PEPPER HAMILTON LLP By: A. Christopher Young J Shannon Chase Gierasch Attorney I.D. No. 84148 Attorneys for Defendant Corestar, a Division of Coresource, Inc. PHLEGAL: #1169832 vi P2NCO I!.WPD CERTIFICATE OF SERVICE I hereby certify that on November/¢ , 2001, a tree and correct copy of defendant Corestar, a Division of Coresource, Inc.'s Notice of Removal From the Court of Common Pleas of Cumberland County to the United States District Court for the Middle District of Pennsylvania has been served via regular mail upon: Mark K. Emery, Esquire Fenstermacher and Associates, P.C. The Jonas Rupp House 5115 East Trindle Road Mechanicsburg, PA 17050 Dated: November /¢, 2001 Marianne Sottile / - PEPPER HAMILTON LLP By: A. Christopher Young, Esquire Attorney I.D. No. 55742 3000 Two Logan Square 18th & Arch Streets Philadelphia, Pennsylvania 19103 (215) 981-4000 BEVERLY HEALTH & REHABILITATION SERVICES, 1NC. VS. Plaintiff, CORESTAR, a Division of Coresource, Inc. COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 01-5730 CIVIL ACTION - LAW Defendant. : NOTICE OF REMOVAL FROM THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY TO THE UNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA OF DEFENDANT, CORESTAR, A DIVISION OF CORESOURCE, INC. TO THE PROTHONOTARY: Pursuant to 28 U.S.C. § 1446(e), defendant, Corestar, a Division of Coresource, Inc., files herewith a certified copy of a Notice of Removal filed in the United States District PHLEGAL # 169832 v P2NC011WPD IN THE UNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA BEVERLY HEALTH & REHABILITATION SERVICES, INC. Plaintiff, VS. CORESTAR, a Division of Coresource, Inc. P.O. Box 1195 Minneapolis, MN 55440-1195 Defendant. : CIVIL ACTION : : : : NO. 01-2.149 NOTICE OF REMOVAL FROM THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY TO THE UNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA OF DEFENDANT. CORESTAR, A DIVISION OF CORESOURCE, INC. TO THE JUDGES OF THE UNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA: Pursuant to the Act of June 25, 1948, 62 Stat. 937, as amended, November 19, 1988, 102 Stat. 4669, 28 U.S.C. §1441, the defendant, Corestar; aD~¥isi.on of PHLEGAL: #1169889 vi P2_X01 !.WPD Coresource, Inc. ("Corestar"), hereby petitions this Honorable Court to remove the above-captioned action from the Court of Common Pleas of Cumberland County to the United States District Court for the Middle District of Pennsylvania. In support of this petition, moving defendant avers as follows: 1. On October 2, 2001 a Writ of Summons was filed in the Court of Common Pleas of Cumberland County, Pennsylvania, in civil litigation captioned Beverly Health & Rehabilitation Services, Inc. v. Corestar, a Division of Coresource. Inc., No. 01-5730, Civil Term. A true and accurate copy of the Writ of Summons is attached to this Notice and identified as Exhibit 1. 2. The Summons identifies the plaintiff as Beverly Health & Rehabilitation Service, Inc., an entity known to the defendant as a provider of health and medical services. 3. The defendant is a claims administrator of employee group health benefit plans. 4. The plaintiff has not yet filed a Complaint. 5. On October 18, 2001, the defendant was provided with a copy of the Writ of Summons, Interrogatories and Requests for Production of Documents addressed to the defendant by way of a transmittal letter dated October 15, 2001 from the plaintiff's counsel. A true and accurate copy of the Certificate PHLEGAL: #1169889 vl P2~X01 !.WPD of Service is attached to this Notice and identified as Exhibit 2; a true and accurate copy of plaintiff's counsel's October 15, 2001 letter is attached to this Notice and identified as Exhibit 3. 6. The Writ of Summons, together with counsel's letter and accompanying discovery, inform the defendant that the instant action is based upon its denial of benefits under an Employee Group Health Plan, to wit: a. Counsel's letter discusses the basis for the instant action as "your bad faith refusal to provide payment for services." See Exhibit 3. b. The instruction and definition section of both the Interrogatories and Requests for Production of Documents state that "all matters referred to herein refer to plaintiff's services provided to Edna C. Neil, ... Group Name/#Lipton/20573-7." A true and accurate copy of the Interrogatories is attached to this Notice and identified as Exhibit 4; a true and accurate copy of the Requests for Production of Documents is attached to this Notice as Exhibit 5. c. Interrogatory number 4 states, "[i]dentify the specific basis for your determination that Edna Neil was not eligible for benefits." See Exhibit 4. PHLEGAL: #1169889 vi P2_X01 !.WPD d. Request to Produce number 3 asks the defendant to produce "[t]he complete group health plan covering John Porter Neil and his dependents." See Exhibit 5. 7. This Notice is timely under 28 U.S.C. § 1446(b). 8. The action filed in the Court of Common Pleas of Cumberiand County is and was subject to the original jurisdiction of this Court pursuant to 28 U.S.C. § 1331 and is properly removed to this Court pursuant to 28 U.S.C. § 1441 et seq. because the plaintiff's cause of action is alleged to be a suit by a provider of health and/or medical services to collect benefits under an employer sponsored, self funded health benefit plan. Accordingly, this action and the defendant's liability, if any, are governed by the Employment Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § I001, et seq. PHLEGA[2 #1169889 vl P2_X0 I!.WPD WHEREFORE, the Defendant, Corestar, a Division of Coresource, Inc., hereby gives notice that the above-captioned action against it in the Court of Common Pleas of Cumberland County, Pennsylvania is removed to this Court. Respectfully submitted, PEPPER HAMILTON LLP By: 3000 Two Logan Square 18th & Arch Streets Philadelphia, PA 19103 (215) 981-4190 - Phone (215) 981-4750 - Fax Shannon Chase Gierasch 200 One Keystone Plaza North Front and Market Streets Harrisburg, PA 17108-1181 (717) 255-1155 - Phone (717) 238-0575 - Fax Attorneys for Defendant Corestar, a Division of Coresource, Inc. PHLEGAL #1169889 vi P2_X01 !.WPD Exhibit A fl ;!q!qx3~ BEVERLY HEALTH & REHABILITATION SERVICES, INC., Plaintiff V. CORESTAR, a Division of Coresoume, Inc. Defendant : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : NO. 01-5730 Civil Term : CIVIL ACTION - LAW CERTIFICATE OF SERVICE I, Mark K. Emery, do hereby swear and affirm that the Writ of Summons was served via certified mail, return receipt requested, on October 15, 2001, addressed as follows: Corestar P.O. Box 1195 Minneapolis, MN 55440-1195 Said retum receipt was signed by Corestar on October 18, 2001. FENSTERMACHER AND ASSOCIATES, P.C. Mark K. PYS510 Page i 200f-05730 BEVERLY HEALTH & REHABILITATIO Cumberland County Prothonotary's Office Civil Case Inquiry (rs) CORESTAR Reference No..: Case TvDe ..... : WRIT OF SUMMONS Ju~gmeh% ..... ~ - .00 Juage Assignea: Disposed Desc.: ............ Case Comments ............. Filed ........ : Time ......... : Execution Date Jury Tria~ .... Disposed uate. Higher Crt 1.: Higner Crt 2.: 10/02/2001 2:38 o/oo/0ooo 0/oo/o00o General Index Attorney Info BEVERLY HEALTH & PLAINTIFF EMERY MARK K REHABILITATION SERVICES INC CORSTAR DEFENDANT PO BOX 1195 MINNEAPOLIS MN 55440 1195 * Date Entries * ............. FIRST ENTRY .............. 10/02/2001 PP~AECIPE FOR WRIT OF SUMMONS IN CIVIL ACTION-WRIT OF SUMMONS ISSUED I0/24/2001 ..... .............. LAST ENTRY .............. * Escrow Information * * Fees & Debits Beg Bal Pymts/Adj End Bal * WRIT OF SUMMONS 35.00 35.00 .00 TAX ON WRIT .50 .50 .00 SETTLEMENT 5.00 5.00 .00 JCP FEE 5.00 5.00 .00 45.50 45.50 .00 * End of Case Information * Exhibit C FENSTERMACHER AND ASSOCIATES, P.'C,,,,.. A'FI'ORHEYS ~ COUNSELORS AT LAW ~.~__~B~I~II~~, , MARK K. EMERY. ESQUIRE ~ DIRECT DIAL (717) 691-5439 October 15, 2001 VIA CERTIFIED MAIL 7000 2870 0000 3479 6911 Corestar P.O. Box 1195 Minneapolis, MN 55440-1195 RE: Beverly Health & Rehabilitation Services, Inc. v. Corestar No. 01-5730 (Cumberland) Dear Sir or Madam: Beverly Health & Rehabilitation Services, Inc. has instituted suit against you for your bad faith refusal to provide payment for services. I have previously written to Stephen Splan explaining the basis for this suit. A Writ of Summons is enclosed for service. In addition, you will find enclosed Interrogatories and Requests for Production of Documents. Please respond within the time alloted by the Pennsylvania Rules of Civil Procedure. Very truly yours, FENSTERMACHER AND ASSOCIATES, P.C. I~ark K. Emery crs Enclosures cc: Amy Ranger-Jeffries (without Enclosures) MECHAJflIC. SBURG OFF~CE: (717) 691-5400 FAX (717) 69'1-5441 Exhibit D BEVERLY HEALTH & REHABILITATION SERVICES, INC., Plaintiff V, CORESTAR, a Division of Coresource, Inc. Defendant : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : NO. 01-5730 Civil Term : CIVIL ACTION - LAW PLAINTIFF'S FIRST SET OF WRITTEN INTERROGATORIES TO: Corestar P.O. Box 1195 Minneapolis, MN 55440 These Interrogatories are propounded pursuant to the Pennsylvania Rules of Civil Procedure and are to be answered by the Defendant in accordance therewith. Defendant is required to answer these Interrogatories in writing under oath, based upon all information available to them and to their attorneys, employees, and other agents, or representatives. Defendant is also required to serve answers to these Interrogatories within thirty (30) days, to the offices of Plaintiff's counsel, Fenstermacher and Associates, P.C., 5115 East Trindle Road, Mechanicsburg, Pennsylvania 17050, and supplement their answers in accordance with the Pennsylvania Rules of Civil Procedure. These Interrogatories are to be answered by the Defendant, Corestar, a Division of Coresource, Inc. Instructions 1. The following Interrogatories are to be answered in writing, verified, and served upon the undersigned within thirty (30) days of service upon you. Objections must be signed by the attorney raising the objection. In answering, you must furnish any and all information available to you, your employees, representatives, agents and attorneys. Your answers must be supplemented and amended as required by the Pennsylvania Rules of Civil Procedure. 2. With respect to any claim of privilege or immunity from discovery, you must identify the privilege or immunity asserted and provide sufficient information to substantiate the claim. 3. In lieu of identifying documents in response to these Interrogatories, you may provide copies of such documents with appropriate references to the corresponding Interrogatories. 4. These Interrogatories shall be construed and interpreted in accordance with the Pennsylvania Rules of Civil Procedure. 5. All matters referred to herein refer to Plaintiff's services provided to Edna L. Nell, Social Security No. 178-14-3027, dependent of John Porter, Social Security No. 188-20-9005, Group Name/~ Lipton/20573-7, Patient Control No. 0028598205. Definitions 1. "Document", when used herein, means any record, including any object which contains written, printed, typed or magnetically recorded information, a graphic or photographic representation or sound, however produced or reproduced. Document includes an original or any copy of any statement, report, letter, memorandum, book, article, note, blueprint, drawing, sketch, photograph, motion picture, videotape, phonograph, compact disc or any other sound recording. Document also includes any card, disc, magnetic tape, printout, data cell, drum and any other data compilations designed for the storage of information in conjunction with a computer or any other word/data processing system. 2. "Identify" or "Identity", when used herein with respect to: a. A natural person means to state: i. the person's full name; 2 the person's present or last known address; and the person's employer and employer's address at the time of the events referred to in the Interrogatory. b. An entity other than an individual, including a corporation, partnership, limited liability company or partnership, unincorporated association, governmental agency, etc. or a subsidiary, division, or subdivision thereof, means to state: Its full corporate name; the date and place of incorporation, if known; the present or last known address of the entity; and if applicable, the full name and present or last known address of the entity's subsidiary, division or subdivision. c. A document, as defined above, means to state: the nature of the document (i.e. whether it is a report, statement, letter, etc.); the title of the document, or if no title, a description of the document sufficient to identify same; the identity of the person(s) who prepared the document; the identity of the person(s) for whom the document was prepared or to whom the document was directed; the date the document was prepared; and the identity of the present custodian of the document or any copy of the document. d. An oral communication means to state: vi. the date the communication occurred; the place where the communication occurred; the substance of the communication; the identify of the person(s) who made the communication; the identity of each person to whom such communication was made; and the identity of each person who was present when such communication was made. 3 e. Any other context means to provide a description with sufficient particularity that the thing may thereafter be specified and recognized, including relevant dates and places, the identification of relevant people, entities, and documents. 3. "Person", when used herein refers to a natural person, association, partnership, corporation, or government agency. 4. "You" or "Your", when used herein, refers to Corestar, a Division of Coresource, inc., Defendant, its agents, representatives, servants, and/or employees. Interrogatories 1. Identify all individuals who were involved in making the determination to deny coverage for the services provided and, in addition, identify their home address and telephone numbers, job titles, and education and training backgrounds. ANSWER: 4 2. Identify each independent physician consultant who reviewed the records provided by Plaintiff and, in addition, identify: a. their complete educational background and training; b. the amount paid to said consultant by you each year from 1995 to the present; c. the number of claims reviewed for you by said consultant each year from 1995 to the present; and d. the number of claims said consultant has advised you to not cover, from 1995 to the present. ANSWER: 5 3. Identify all documents, including internal directives, memos, policy manuals or other documentation relied upon or reviewed by the independent medical consultant. ANSWER: 6 4. Identify the specific basis for your determination that Edna Nell was not eligible for benefits. ANSWER: 7 5. Identify each lawsuit filed against you within the past 5 years wherein you determined that services provided were not covered as they were not "skilled nursing care", and plaintiffs claimed that such denial of benefits/coverage was made in bad faith. ANSWER: 8 6. Identify the complete factual basis for your determination that tube feedings are not skilled nursing care. ANSWER: 7. Identify the complete factual basis for your determination that Plaintiffs treatment of decubitus ulcers was not skilled nursing care. ANSWER: 10 8. Identify all documents, including manuals, texts, memos or other documentation in which "skilled nursing care" is defined, or which you otherwise relied upon in making your determination to deny coverage. ANSWER: Respectfully submitted, FENSTERMACHER AND ASSOCIATES, P.C. DATED: By: K. Em~j Supreme Court I,D. #72787 5115 East Trindle Road Mechanicsburg, PA 17050 (717) 691-5400 Attorney for Plaintiff 11 CERTIFICATE OF SERVICE AND NOW, on this r~ 5- day of October, 2001, I, Mark K. Emery, Esquire, hereby certify that I have served the foregoing Plainti~s First Set of Written Interrogatories, by mailing a true and correct copy by United States certified mail, addressed as follows: Corestar P.O. Box 1195 Minneapolis. MN 55440 FENSTERMACHER AND ASSOCIATES, P.C, By: r~ark K. E"mery Exhibit E BEVERLY HEALTH & REHABILITATION SERVICES, INC., Plaintiff V. CORESTAR, a Division of Coresource, Inc. Defendant : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA NO. 01-5730 Civil Term : CIVIL ACTION - LAW PLAINTIFF'S FIRST REQUEST FOR PRODUCTION OF DOCUMENTS TO: Corestar P.O. Box 1195 Minneapolis, MN 55440-1195 YOU ARE HEREBY REQUESTED, pursuant to Pa. R.C.P. 4009, to produce the following documents and other physical objects for inspection and copying, within no more than thirty (30) days after service hereof, at the offices of Plaintiff's counsel, Fenstermacher and Associates, P.C., 5115 East Trindle Road, Mechanicsburg, Pennsylvania 17050, or alternatively, by delivering copies of the same to the Plaintiff's counsel at the aforesaid address. This Request for Production of Documents is deemed continuing so as to require a supplemental answer if Defendant, or Defendant's agents or representatives obtain other information between the time the answers are served and the time of trial. Documents for which a proper claim of privilege can be substantiated are expressly excluded from this request, except that Plaintiff requests that Defendant identifies all documents for which privilege is claimed, and specifies the exact grounds upon which the claim for privilege is based. DEFINITIONS AND DIRECTIVES The following request to produce is governed by the following definitions and directives: 1. "You" and "your" shall mean Corestar, a Division of Coresource, Inc., jointly or singularly, their agents and employees. 2. "Document" shall mean all forms of recorded data or information, including writings of any kind, including the originals and all non-identical copies, whether different from the originals by reason of any notation made on such copies or otherwise (including, without limitation, correspondence memoranda, notes, work sheets, diaries, statistics, letters, telegrams, telex, telefax, minutes, contracts, reports, studies, checks, statements, receipts, returns, summaries, pamphlets, books); notations of any sort of conversations, telephone calls, meetings or other communications; bulletins or printed matter of any type, and all forms of drafts, notations, workings, alterations, modifications, changes or amendments of any of the foregoing; graphical or oral records or representations of any kind (including, without limitation, photographs, films, charts, graphs, videotapes, recordings, and motion pictures); and electrical records or representations of any kind (including, without limitation, tapes, cassettes, disks and recordings). 3. "Pertain to" shall be interpreted to include relating to, referring to, reflecting, regarding, constituting, concerning or having as its subject matter, in any manner whatsoever, directly or indirectly, expressly or implied, the subject matter of the specific request. 4. "Communication" includes, but is not limited to, all written or oral discussions, statements, conversations, memoranda, notations, letters, notices or any document. 5. If any request for documents is deemed to call for production of privileged or work product materials and such privilege or work product is asserted, identify in writing each document so withheld. If only a portion of a document is privileged or work product, then redact and identify such portion thereof that is withheld. With regard to all documents or all portions of documents withheld, provide the following information: (a) The reason for withholding the documents; 2 The statement for the basis of the claim of privilege, work product or other ground of non-disclosure; (c) A brief description of the document, including: (i) (ii) (iv) (v) (vi) the date of the document; number of pages, attachments and appendices; the names of its author, authors or preparers and an identification by employment and title of each such person; the name of each person who was sent, or shown blind copies or carbon copies or has had access to or custody of the document together with an identification of each such person; the present custodian; and the subject matter of the document and in the case of any document relating to or referring to a meeting or conversation, identification of such meeting or conversation. 6. All matters referred to herein refer to Plaintiff's services provided to Edna L. Nell, Social Security No. 178-14-3027, dependent of John Porter, Social Security No. 188-20-9005, Group Name/~ Lipton/20573-7, Patient Control No. 0028598205. 3 REQUEST TO PRODUCE 1. Your complete claims file, including any and all independent reviews, internal memoranda or other documents regarding services provided by Plaintiff to Edna Nell, dependent of John Porter Nell, Social Security No. 188-20-9005, Group Name/~ Lipton/20573-7, Patient Control # 0028598205. 2. Any and all claims manuals, educational materials, underwriting policies and guidelines, or other written documents setting forth the procedure for handling claims, existing from 2000 to the present. 3. The complete group health plan covering John Porter Nell and his dependents. 4. Any and all documents, including manuals, texts, treatises or other documentation in which you define or otherwise identify "skilled nursing care". By:__ Mark K. Emery Supreme Court I.D. #72787 5115 East Trindle Road Mechanicsburg, PA 17050 (717) 691-5400 Attorney for Plaintiff DATE: October 9, 2001 4 CERTIFICATE OF SERVICE AND NOW, on this/ I ~'- day of October, 2001, I, Mark K. Emery, Esquire, hereby certify that I have served the foregoing Plaintiff's First Request for Production of Documents, by mailing a true and correct copy by United States certified mail, addressed as follows: Corestar P.O. Box 1195 Minneapolis, MN 55440 FENSTERMACHERANDASSOCIATES, P.C. K. Emery 5 CERTIFICATE OF SERVICE I hereby certify that on November /4,2001, a tree and correct copy of defendant Corestar, a Division of Coresource, Inc.'s Notice of Removal Prom the Court of Common Pleas of Cumberland County to the United States District Court for the Middle District of Pennsylvania has been served via regular mail upon: Mark K. Emery, Esquire Fenstermacher and Associates, P.C. The Jonas Rupp House 5115 East Trindle Road Mechanicsburg, PA 17050 Dated: November /~'g, 2001 Marianne Sottile L/