The URL can be used to link to this page

Home My WebLink About98-01713 . j . ~ ......., ~; ~I 11 J\ ~.I 1 ~ ,...., I ~" ! \J E'\, " \, \ \ \ " ! ! I I ' I I j / , " , j' if p ~ i ___ '(3 ('() r ___ r - LA/; ,w'-":!'. '" '-/;,"M ,-,' "~fr""r ""11." F',_,--,! "I"U n_" ,,",,' '""NN, t'''~''-~Hn'fr.. (1-'''11 L',., ,"'_;,,,,,,,, IN mE COURT OF COMMON PLEAS, CUMBERLAND COUNTY, PENNSYLVANIA No. 7'5' /") / '5 (l1.'(I~'tl JAMES E. McREYNOLDS, Plaintiff I I I CIVIL ACTION. LAW v. . . GENERAL ACCIDENT INSURANCE CO., I Defendant JURY TRIAL DEMANDED Nm'lCE YOU HAVE BEEN SUED IN COURT. If YOll wish to defend against the claims set forth against )'OU 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 attorney and filing in writing with tile 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 default 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. 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 TillS OmCE SET FORni BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. CVMBERLAND COVNTY BAR ASSOCIA nON Lawyer Referral Service Two Liberty Street Carlisle, Pennsylvania 17013 (717) 249 - 3166 1-800-990-9108 IN mE COURT OF COMMON PLEAS, CUMBERLAND COUNTY, PENNSYLVANIA JAMFS E. McREYNOLDS, NO. Plaintiff l'. CIVIL ACTION. LAW GENERAL ACCIDENT INSURANCE CO., Defendant I JURY TRIAL DEMANDED COMPLAINT 1. The Plaintiff, James E. McReynolds, is an adult individual residing at 1540 Palm Springs Drive, Chambersburg, Pennsylvania 17201. 2, The Defendant, General Accident Insurance Company, is an insurance company licensed to transact business in the Commonwealth of Pennsylvania with offices sltualed, 1ntcr allil, I.\t 100 Corporate Center Drive, Camp Hill, Pennsylvania 17001. 3. On July 6, 1996, the Plaintiff was involved in a motor vehicle accident in which he sustained personal injuries. 4. Prior thereto Defendant issued a policy of automobile insurance under which Plaintiff, James E. McReynolds, was an insured. S. This policy was in effect on July 6, 1996, the date of the accident. 6. The automobile insurance policy provided for first party medical benefits in accordance with the requirements of the Pennsylvania Motor Vehicle Financial Responsiblllty '."~' ,.' ,-,,':,'~ '" Law, 75 Pa.C.S, 11701 et. seq., as amended, 7, As a result of the aforementioned accident, the Plaintiff has been obliged to receive IWi' II..,," """.'" ',li" , t ""HW, I'''~'''M~IY'N'' 1I1O~ 1"':;"""1""+1'''.._,. ..-..ft,,,,,,,,,;; and undergo medical attention and care from various health care providers, including but not ....... VERIFlCA TIOJli I HEREBY VERIFY that the information set forth in the foregoIng COMPLAINT is true and correct to the best of my knowledge, information and belief. I understand that any false statements contained herein are subject to the penalties of 18 Pa.C,S, 04904, relating 10 unsworn fnlslflcatioll to authorities, !::t-><<<A 2..' }~". P'~., ..~J?l ~ "JAMES E. McREVNOLD Date: :J /;t,/9~ , - IN THE COURT OF COMMON I'LEAS OJ<' CUMDERR,"ANI> C.!!illITv, PENNSVINANIi\ JAMES E, McREYNOLDS, Plaintiff No, 98.1713 CIVil, v, CIVIL ACTION - LA W GENERAL ACCIDENT INSURANCE CO" Defendant JVRY TRIAL DEMANDED CERTIFICA TE OF SERVjCE AND NOW, this -1i- day of April, 1998, I, Ann Margaret Grab, Esquire, a member of the firm of GRIFFITH, STRICKLER, LERMAN, SOL YMOS & CALKINS, Esquires, hereby certify that I havc, this date, served a copy of the Praecipe for Entry of Appearallce on behalf of Defendant, General Accident Insurance Company, by Vnited States Mail, addressed to the party or attorney of record as follows: Gregory E, Martin, Esquire Law Offlees of Dale E, Anstine 2 West Market Street York, PA 17401 GRIFFITH, STRICKLER, LERMAN, SOL YMOS & CALKINS BY ~~A ANN MARGA 'T GRAB Supreme Court 1.0, No. 55986 Attorneys for Defendants I ] 0 SOllth Northern Way York, PA 17402 Telephone No, (717) 757.7602 fN THE COURT OF COMMON PLEAS OF CUMBERLANlJ COUNTY, I'ENNSYL VANIA JAMES E, McREYNOLDS, Plaint I 1'1' NO, 98-1713 CIVIL v, CIVIL ACTION - LA W GENERAL ACCIDENT INSlJRANCE COMPANY, Defendant JVRY TRIAL DEMANDED To; James E, MeRcynolds c/o Grcgory E, Martin 2 West Market Street York, PA 17402 NOTICE You are hercby notificd to filc a writtcn rcsponsc to the enclosed New Matter within twcnty (20) days from scrvice hereof or a judgment may be entered against you, GRIFFITH, STRICKLER, LERMAN, SOL YMOS & CALKINS BY; -a~~Ji{{ Ann Margaret G ab Supremc Court I.D, #55986 110 S, Northern Way York, PA ] 7402 Attorney for Defendant Tclcphone No,; (717) 757-7602 J,'". ,~. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JAMES E, MeREYNOLDS, Plalnti 1'1' NO, 98-1713 CIVIL v, CIVIL ACTION - LAW GENERAL ACCIDENT INSURANCE COMPANY, Defendant JVRY TRIAL DEMANDED ANSWER AND NOW, comes the Defendant, General Accident Insurance Company, by and through its attorneys, Griffith, Strickler, Lcrman, Solymos & Calkins, Robcrt A. Lcrman, and Ann MlII'garct Gl'Ub, Esquire and file this Answer and New Matter in response to Plaintiffs' Complaint, and state as follows: I. Denied, After reasonable investigation, Answering Defendant is without knowledge or informlltion sufficient to form a belief as to the truth of the allegations set forth in plll'lIgraph no,l of Plaintiffs Complaint and same are dcnied and strict proof thereof is hereby demanded, 2, Admitted. 3. Dcnied, After reasonable investigation, Answering Defendant is without knowledge or Information sufficient to form a belief as to the truth of the allegations set forth in plll'agraph no.3 of Plaintiff's Complaint and same are denied and strict proof thereof is hct'eby demanded, 4, Admitted. 5, Admitted, 6, Admitted, 7, Denied, Aller rellsonuble investigation, Answering Defendllnt is without knowledge or infol'matloll sufficient to form a belief as to the truth of the allegations set forth in plll'agraph no,7 of Plaintill's Complaint and same are denied and strict proof thereof is hercby demanded. 8, Admitted, 9, Denied, It is specifically denied that as a further result of the accident and his resulting if\juries, the Plaintiff was disabled from his employment. On the contrary, it is averred that the Plaintiff was disabled from his employment prior to the July 6, 1996 motor vehicle lIccldent and therefore is not entitled to wage loss benefits under his policy of insurance with the Defendant. 10, Admitted in part, denied In plll't. It is admitted that the Plaintiff has requested that the Defendant PllY wage losses incurred as the result of injuries allegedly arising out of the motor vehicle accident. It is specifically denied however thatllny disability sustained by the Plaintiff resulted from the motor vehicle accident as the Plaintiff was disabled prior to the July 6, 1996 motor vehicle aecident. II. Denied, It is specifically denied that the Defendant has refused to pay wage loss benefits due, which is violation of the policy of insurance and the Pennsylvania Motor Vehicle 2 3 FinlU'lclal Rcsponslbillly Law, On thc contrul'Y, it is averred thllt the Defcndant hils ucted at all times In complillnce with its policy of insurance as well us the Pennsylvania Motor Vchicle Financial Rcsponsibility LIlW, 12, Admittcd in part, denied in purt, It is admitted that the Defcndaot contacted a pcer review orgunlzution, Claims Review Associlltes, to perform a pccr review in this casc, It is specifically denied that the purpose was to allegedly confirm that such treatments, products, services or accommodutions conformed to the professional stllndards of pel'formance and are medically necessary, On the contrary, the purpose for the peer review was in complete compliance with thc Pennsylvania Motor Vehicle Financial Responsibility Law, 13. Admitted, 14, Denied, It is denied that based upon the conclusions provided in Dr, Close's report, the Defendant has denied payment for certain medical treatment rendered to Plaintiff by Chambersburg Imaging Associates, the Chambersburg Hospital alld Physical Therapy Associates of Chambersburg, On the contrary, it is averred that payment for the mediclll treatment was denied based upon the injuries sustained by the Pluintiff in the motor vehicle accident as well as the conclusions provided by Dr, Close, 15, Denied, It is specifically denied that the Defendant's refusal is in violation of the terms and conditions of the policy of insurance issued to the Plaintiff and the Pennsylvania Motor Vehicle Financial Responsibility Luw, On the contrary, It is averred that at all times relevant hereto Answering Defendant General Accident Insurance Company acted carcfully, lawfully, prudently and iu full compliance wlth the l'ennsylvnnla Motlll' Vehicle Financllll Responsibility Law, 16, Denied, It is spccifically dcnicd thaI all mcdical cxpenscs wel'c reasonnblc lIud necessary and II direct result of the lIccidenl in question, On thc contrary, it is lIvcrrcd that the medical treatmlJllt for which PlaintilT seeks paymcnt were unreasonablc, unncccssnry, and in no way relatcd to the motor vehiclc accident. 17, Paragraph 17 constitutes u conclusion of law to which no responsive pleading is necessary and same is deemed denied, WHEREFORE, Defendant demands jUdgment in its favor and against the Plaintiff together wlth interest and costs of suit, NEW MATTER 18, Paragraphs I through 17 of Defendant's Answer are incorporated herewith as though fully set forth at length, 19, Plaintiff Complaint fails to state a cause of action against Answering Defendant Upon which relief can be granted, 20. No act or failure to act by Dcfendant has resulted in damage or detriment to the Plaintiff, 4 I 21, Plaintill's claim for payment fhr mcdieul bills urc Ihr medical sCl'vlces which ure not rellsonable and necessary pursuunt to the requircments of' the PIJI1I1sylvlInill Motor Vehicle Financial Responsibility Luw (75 Pa, C,S,A, * 170 I ct scq), 22, Defimdllnt's denial of' PllIintift's claim thr payment of'mediCIlI hills is lawtlll and proper pursuant to the policy of' insurancc Issued by Defendant issued to the Pluinti ff 23, Plaintiffs denial of the puyment of l11edicul bills and wage losses submitted by Plaintiff is based upon u reasonable good fuith intcrpretation of the policy {If insurance issued to the Plaintiff and pursuant to the provisions of the Pennsylvuniu Motor Vehicle Financial Responsibility Law (75 I'll, C,S,A, ~ I 70 I ct seq) and in Ilceordanec with and pursuant to the Pennsylvania Code Rcgulations for the peer review proccss set forth at 31 Pa, Code ~69,51 et seq, 24. Defendants denial of Plaintiffs claim which is the subject of this suit was proper and was based upon applicable pmvisions of the Pennsylvania Motor Vehicle Financial Responsibility Law and the Pennsylvania Code Regulations with respect to administration of that law in addition to the policy of insurancc issued by Defendant to Plaintiff. 25, At all times relevant hereto Defendant acted carefully, lawfully, properly and prudently in accordance with the provisions of the Pennsylvania Motor Vehicle Financial Responsibility Law and the Pennsylvania Code Regulations with respect to administration of that law relating to submission, consideration, payment and denial of first party medical benefits, 5 I I ~ I, Ann MlII'glU'et arab, Esquire, do hereby verify tlUIl I alll the attorney of record fOI' the pleading party herein, and that the facts set forth In the til/'egoing plclIdlng lire true to the best of my knowledge, Information and belief, upon Intarnlation supplied, I understand that false statements Illade herein are made subject to the penalties of 18 Pa,C,S,A. ~ 4904 rellltlng to unswOI11 falsification to authorities, . /') . / ~ c::~(/ DATE:(JptJ (:h/? /0 . GRIFFITH, STRICKLER, LERMAN, SOLYMOS & CALKINS BY: /)t1JJ1/)kc' A~RaI\RET GRAB Supreme Court tD, No, 55986 Attorney for Defendant 110 South Northern Way York, PA 17402 Telephone No. (717) 757-7602 8 CERTIFICATE OF SERVICE AND NOW, this 6 day of May, 1998, I, Greaory E, Martin, Esquire, a member of the Law Offices of Dale E, Anstine, P,C., hereby certify that I have, this date, served a copy of the within and foregoing Plaintiff's Reply to New Matter Q/ Defendant by first class United States Mall, postage, pre-paid, addressed to the party or attorney of record as follows: Ann Margaret Grab, Esquire 110 S. Northern Way York PA 17402 Respectfully submitted, LA WOFFICES OF DALE E. ANSTINE, F.C, BY:G gory E. artin, Esquire l.D, No.: 38894 Two West Market Street P.O. Box 952 York, Pennsylvania 17405 (717) 846-0606 PALIIl II. ^".....NM. ,~ (', ,~" ..." ~.",,' ~'"'" ,0,.. """.[~ '" ."."""....... ""u I"""'n\h'~ ,,~," .,-" .". ,......~ 3 ""'.. " ('" ir.f.) ("l \:~, ,-j.) ",' ,:,'t J "P', n '..,01 ',\:q \ "' .,i ..~ .. ,\~) '.' ., II..: (' 0' ..'.'-, ,tel "',' . '1\ ~ }'... . (.'1 t.~ /1\ ..,: ., .. \ \" '..\ :':-' .:1]. <, .::> 'i k, ~_.- IN THE COllltf 0' COMMO" PLB^S 0' OIM"'.RL^"D COllNTV, ph""SVL V ^NI^ NO. 9\\-\7\3 C\'JlL li\MES \I. McRE'lNOLDS. p\alntlff C\\,lL ACTlON - LAW V. lURY lRli\L DEMANDED GENERA\.. i\CClD\lNl lNSURi\NCE COMPi\NY, Defendant O'.R'TIF\C~ ^NO "OW, "'" ~/.<l" .f M", \ "S, I. """ M~"'" 0.0\>, E"""" -"" .f"" fl"".f OI>I."T\\, STlUCKL..R, I.ERM^", SOl. VMOS & C^I.KINS, ""'~"', """" ""If, ,b.1 I "''', Ib" """, "",00 . "''' ,f O,r,."""" p,,,,11" to Sobol\l"'" V ",,,,,,I,n '" U~IOO S~.. M.\I, "'","" to ,ho port, " ,rt,,,,,, · f """j .. f.\I,.' Gregory E. Martin 2 West Market Street york. fA \7402 GR\Ff\1H. STRICKLER, LERMi\N, SOl..'lMOS & CALKINS BY: j)J ~ 0 - J\nn Margaret Gta~ Attorney fot Defendant Supreme Court \.D. # 559\\6 1 lO South Northem Way Y ot", pennsy\vanla l7402 Telephone: (7\7) 757-7602 YERIFICATlON I verify that the foregoing facts are true nnd correct, upon my personal knowledge or I,'on,,,,",, "" boll 0'. 1'hl. ""'."lion I, ".d, "bJ"", " "" P"'ltI~ ., I' p,. C. S. I ''''', relating to unsworn falsi Ilcatlon to authorities. Date: 1~j,7 IF .-- ...-...-.--..... t1 .'7) / / /J ;)l';~, u Stair/CPClJ 9 . ~, \', ., '.1 I Id'i~ }~ 'I 1~';'~ ,. HbG eLl'I";'::> IN THE COlinT OJ? COMMON I)LEAS m' CIJMHlmLANI> COIJNTV,I'F,NNSYL VANIA JAMES E.McREYNOLDS, Plaintiff NO. 98-1713 CIVIL v. GENERAL ACCIDENT INSURANCE COMPANY, Defcndant CIVIL ACTION - LA W JURY TRIAL DEMANDED CERTIFICATE OF SERVICF, AND NOW, this 4~ay of Augustl, 1998,1. Ann Margarct Grab, Esquire. a member of the Ilrm ofGRIFFITI-I. STRICKLER, LERMAN, SOLYMOS & CALKINS, Esquires, hcreby certify that I have, this date, servcd a copy of Defendant's Responsc to Plaintiff's Interrogatories by United Statcs Mail, addrcssed to thc party 01' attorney ofrecol'd as follows: Gregory E. Martin 2 West Market Street York. PA 17402 GRIFFITH, STRICKLER, LERMAN, SOL YMOS & CALKINS BY: ~~ /'~~1 Ann Margaret OralS' Attomey for Defcndant Supreme Court!./). # 55986 110 South Northern Way York, Pcnnsylvania 17402 Telephonc: (717) 757.7602 ark/generaJ.rtl IN THE COIJnT OF COMMON I)LEAS 01<' CIJMO.:IU,ANIl COlINTY, I).:NNSYLV ANIA JAMES E. McREYNOLDS, Plaintiff NO. 98-1713 CIVIl. v. CIVIL ACTION - LA W GENERAL ACCIDENT INSURANCE COMPANY, Defendant JURY TRIAL DEMANDED CEnTmCATE OF SF,--~VIC~ AND NOW, this ) /t~ day of August, 1998,1, Ann Margarct Gl'Ub, Esquire, a mcmbcr of the firm of GRIFFITH, STRICKLER, LERMAN, SOL YMOS & CALKINS, Esquircs, hereby certify that I have, this datc, served a copy of Dcfendant's Rcsponsc to Plaintiff s Requcst for Production of Documents by United States Mail, addrcsscd to the party or attorney of record as follows: Grcgory E, Martin 2 West Market Street York, PA 17402 GRIFFITIl, STR.ICKLER, LERMAN, SOL YMOS & CALKINS BY: ~iL\ ~a Ann Margare~~~ Attorney for Defendant Supreme Court J.D. # 55986 110 South Northern Way York, Pennsylvania 17402 Tclephone: (717) 757- 7602