Loading...
HomeMy WebLinkAbout03-0812 GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYL VANIA Plaintiff, ; NO. 03 -I' I~ c;o~ L '--r~ v. : CIVIL ACTION - LAW ARNOLD TRANSPORTATION SERVICES, INC. Defendant. NOTICE 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 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 Plaintiffs. 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 THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Bar Association 2 Liberty Avenue Carlisle, P A 17013 (717) 249-3166 NOTICIA LE HAN DEMANDADO A USTED EN LA CORTE. Si usted qui ere defenderse de estas demandas expuestas en las paginas siguientes, usted tiene viente (20) dias de plazo al partir de la fecha de la demanda y la notificacion. Usted debe presentar una apariencia escrita 0 en persona 0 por abogado y archivar en la corte en forma escrita sus defensas 0 sus objeciones alas demandas en contra de su persona. Sea avisado que si usted no se defiende, la corte tomara medidas y puede entrar una orden contra usted sin previo aviso 0 notificacion y por cualquier queja 0 alivio que es pedido en la peticion de demanda. Usted puede perder dinero 0 sus propiedades 0 otros derechos importantes para usted. LLEVE ESTA DEMANDA A UN ABODAGO INMEDIATAMENTE. SI NO TIENE ABOGADO 0 SI NO TIENE EL DINERO SUFICIENTE DE P AGAR TAL SERVICIO, VA Y A EN PERSONA 0 LLAME POR TELEFONO A LA OFICINA CUY A DIRECCION SE ENCUENTRA ESCRIT A ABAJO PARA A VERIGUAR DONDE SE PUEDE CONSEGUIR ASISTENCIA LEGAL. Cumberland County Bar Association 2 Liberty Avenue Carlisle, P A 17013 (717) 249-3166 2671 59-1;HBGl GREAT -WEST LIFE & ANNUITY INSURANCE COMPANY Plaintiff, : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYL VANIA : NO. 03 - ?/~ CI':',L't-~ : CIVIL ACTION - LAW v. ARNOLD TRANSPORTATION SERVICES, INC. Defendant. COMPLAINT Plaintiff, Great-West Life & Annuity Insurance Company, through its attorneys, Buchanan Ingersoll Professional Corporation, files this Complaint based upon the following: Parties 1. Plaintiff, Great-West Life & Annuity Insurance Company (hereinafter "Great- West"), is a corporation and citizen ofthe State of Colorado, with its principal place of business located at 8505 East Orchard Road, Greenwood Village, Colorado 80111. 2. Defendant, Arnold Transportation Services, Inc. ("Arnold"), is a corporation with its principal place of business located at 4410 Industrial Park Road, Camp Hill, Pennsylvania 17011. Jurisdiction and Venue 3. Jurisdiction and venue are proper in this Court because the alleged breach of the agreement in question, as described in detail below, occurred in this Judicial District and Defendant resided in this District at all times relevant hereto. Factual Backf!round 4. Arnold entered into a contractual relationship with Great-West for the establishment and maintenance of Arnold's Employee Health and Welfare Benefit Plan (the "Plan"), effective January 1, 1997. 5. Under the terms ofthe parties agreement, Great-West was to provide: A. Non-discretionary administrative claims processing services for the self- insured medical and prescription drug benefits offered by Arnold. B. Fully insured life, accidental death & dismemberment coverage. C. Specific and aggregate stop-loss insurance coverage for the self-insured benefits offered by Arnold. 6. Attached hereto as Exhibit "A" are true and accurate copies of the writings encompassing the agreement between Great-West and Arnold (collectively the "Contract"). 7. The Contract obligated Arnold to pay Great-West the following: A. The amount of claims paid by Great-West on Arnold's behalf for the self- insured benefits up to the amount of Arnold's contractual responsibility. B. Administrative fees for the services provided by Great-West in connection with the self-insured benefits. C. Premium for the fully insured coverage provided by Great-West. D. Premium for specific and aggregate stop-loss insurance coverage for the self insured benefits made available by Arnold under the Plan. E. Any self-insured benefits which Arnold chose and directed Great-West to pay, which were outside of the terms of the Plan or Contract. 8. Great-West fulfilled its obligations under the Contract. COUNT I BREACH OF CONTRACT 9. Great-West incorporates by reference paragraphs 1 through 8, as if fully set forth herein, except for those paragraphs that would be inconsistent with this cause of action. 10. By letter dated February 23,1999, Arnold notified Great-West of its intention to terminate the parties contractual relationship effective March 31, 1999. 11. Arnold did not reimburse Great-West for claims payments made by Great- West on its behalf prior to March 31, 1999, which are due according to the terms of the Contract. 12. The Contract obligated Arnold to pay Great-West for all amounts owed under the terms of the Contract for services rendered, which is currently $47,358.70. This amount reflects claims that Great-West paid on behalf of Arnold's plan participants under the terms of the Contract. Attached hereto as Exhibit "B", and incorporated herein by reference, is a breakdown ofthe amounts owed Great-West by Arnold. 13. Great-West has requested payment of the amount owed from Arnold. 14. Arnold has refused to pay the contractually obligated amount to Great-West. 15. Arnold's failure to pay the amounts owed constitutes a breach of the Contract, thereby entitling Great-West to the relief demanded herein. WHEREFORE, Plaintiff, Great-West Life & Annuity Insurance Company, respectfully requests that the Court grant judgment in its favor against Defendant, Arnold Transportation Services, Inc., in the amount of $47,358.70, together with interest, costs of suit and what other relief this Court deems appropriate. COUNT II UNJUST ENRICHMENT 16. Great-West incorporates by reference paragraphs 1 through 15 as if fully set forth herein, except for those paragraphs that would be inconsistent with this alternative cause of action. 17. Great- West provided Arnold with administrative services and insurance coverage, as requested by Arnold, and as more fully described above, with a reasonable expectation of payment from Arnold. 18. Arnold has benefited from and accepted the administrative services and insurance coverages rendered and made available by Great-West. 19. Great-West satisfied the self-insured benefit claims of participants, as requested by Arnold, and for the benefit of Arnold, with a reasonable expectation of reimbursement from Arnold. 20. Arnold has benefited from Great-West's satisfaction of the self-insured benefit claims of participants on its behalf. 21. Arnold has failed to pay Great-West $47,358.70, for claims that Great-West paid or provided on behalf of Arnold, and has thereby been unjustly enriched. 22. Arnold retains amounts requested by Great-West, which it is equitably entitled to be paid by its performance of services, and the additional benefits conferred upon and accepted by Arnold. WHEREFORE, Plaintiff, Great-West Life & Annuity Insurance Company, respectfully requests that the Court grant judgment in its favor against Defendant, Arnold Transportation Services, Inc., in the amount of $47,358.70, together with interest, costs of suit and what other relief this Court deems appropriate. Respectfully submitted, B~ lliGERSOLL P OF SIONAL CORPORATION B.~~ UQ~ Thomas G. Collins, Esquire J.D. No. 75896 Stephen Moniak, Esquire J.D. No. 80035 One South Market S~uare 213 Market Street, 3r Floor Harrisburg, P A 17101 (71 7) 237-4800 Date: February 20, 2003 -,... . - '-~..'- June 21,2001 Dennis Machemer Arnold Transportation Services 4410 Industrial Park Road Camphill, PA 17011 RE: Arnold Transportation Services Outstanding Claims Plan #54015 Plan Termination Date: April 1999 Dear Mr. Machemer, We have recently completed an audit of the Arnold Transportation Services Employee Benefits Plan and found the following discrepancy. Your plan terminated with Great-West Life in April 1999. Prior to termination of your plan, there were outstanding claim payments that were not received for the month listed below. The last tap did not include the period 3/29/99-3/31/99 for which there were claims. Your payment in April 1999 did not include claims payments in this period. Based on the time period of reconciliation for your plan, the following claim payment amounts remain outstanding: Claims Month March 1999 Total Claims Amount $47,358.70 $47,358.70 Reason 3/29-3/31 1999 claims payments The detail of this outstanding amount is attached. Please send a check for $47,358.70 from your company within ten (10) days of receipt of this letter, in the enclosed postage paid, self addressed envelope. Or, if you wish to discuss our findings, we would be happy to speak with you or a representative of your company, to discuss how we may proceed with the resolution of this outstanding amount. e C!> e SERVICES CONTRACT This contract entered into 0 JANUARY 1, 1997 hereinafter referred to as the Effective Date) Between -':;'!,. GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY, hereinafter referred to as "Great-West" -and- ARNOLD TRANSPORTATION SERVICES hereinafter referred to as "the Contractholder." The Contractholder has established a Health Care Payment Plan or Health Care Payment Plan and Trust for the benefit of its Employees and Dependents (hereinafter referred to as the "Plan"). The Plan is an Employee benefit plan within the meaning of the Employee Retirement Income Security Act of 1974 and the undersigned fiduciary (hereinafter referred to as the "Fiduciary") of the Plan hereby retains Great-West to provide services for the Plan in accordance with the following terms and conditions contained herein. Page 1 e e ARTICLE 2 - ADMINISTRATIVE SERVICES AND FEES (Continued) The Contractholder and Fiduciary agree to pay Great-West the fees specified in the Schedule of Fees marked Schedule "8" which is attached hereto and forms part of this contract as reasonable compensation for services necessary for the Plan's operation. The Contractholder and Fiduciary will be jointly and severally liable for the payment of such fees. Such fees will be paid as described in the attached Schedule 8. A grace period of 31 days will be granted for each payment of fees falling due after the first payment during which period this contract will remain in force. If any payment is not made within the days of grace, this contract will automatically terminate at the end of the grace period. No written notice of such automatic termination is required. If this contract terminates for any reason, the Contractholder and Fiduciary will be liable for all payments due and unpaid, including a pro-rata payment for any time this contract is in force during the grace period. ARTICLE 3 - FURNISHING OF INFORMATION; ACCESS TO RECORDS The Contractholder and Fiduciary will furnish Great-West, on request, with correct and complete information required by Great-West to provide the services which Great-West has agreed to perform under this contract, including, but not limited to, a copy of the Plan and any amendments thereto. The information will be furnished at the times and in such manner as Great-West may request. Great-West will assume that all such information is complete and accurate and will be under no duty to question the accuracy of such information. Great-West, at its discretion, may charge additional fees for its services where information is not furnished, is incomplete or inaccurate or is not furnished at the time or in the manner as requested. The Contractholder agrees to give Great-West the right to inspect and copy the records of the Contractholder which are pertinent to the operation of the Plan. Such right will continue for the 5 years immediately following termination of this contract. All communications sent to the Contractholder or Fiduciary from Great-West will be transmitted to the Contractholder at the address appearing below or to such other person and address as may from time to time be designated by the Contractholder in writing. Notice transmitted to the Contractholder as aforesaid will be considered received by the Contractholder and Fiduciary. Notice sent to Great-West will be directed to the address shown below or to such other address as Great-West may designate in writing from time to time. Page 3 e e ARTICLE 6 - CONTRACT TERMINATION This contract may be terminated at any time by either the Contractholder and Fiduciary or Great-West, provided written notice of such termination is given at least 31 days in advance. In addition, this contract: (1) may terminate immediately upon termination of the Stop-Loss Contract, if any, between Great-West and the Contractholder, or (2) may terminate upon amendment of the Plan in a manner deemed unsatisfactory by Great-West, provided that Great-West gives 31 days written notice of such termination to the Contractholder; or (3) will terminate immediately upon failure of the Contractholder to comply with any term or condition of this contract, such as but not limited to failure to: (A) pay the Administrative Fees as specified in the Article of this contract entitled Administrative Services and Fees; or (B) fund the bank account(s} (referred to in the Article of this contract entitled Administrative Services and Fees) established to handle payment of the benefits provided under the Plan. In the event of termination of this contract, Great-West will have the right to stop processing claims immediately on the effective date of such termination. Complete information regarding all outstanding claims which are unpaid or received after such date will be returned by Great-West to the Contractholder. In addition, the Contractholder and Fiduciary will notify each Employee covered under the Plan of such termination. ARTICLE 7 - AMENDMENT OF SCHEDULE OF FEES Unless otherwise indicated in the Schedule of Fees, the fees shown are for the first Contract Year. Great-West has the right to revise the Schedule of Fees: (1) when the Contractholder's Plan is amended; and (2) on or after the first anniversary of the Effective Date of this contract but not more than once in any 12 month period, except as provided in (4) below; and (3) when the services described in the Schedule of Services are changed; and (4) at any time during the first or subsequent Contract Years: (A) if the Coverages under the Contractholder's Plan are changed; (B) if the provisions of the Contractholder's Plan have to be changed because of a change in law; or (C) if there is a change in the number of Employees and/or Dependents covered under the Con- tractholder's Plan for any Coverages provided under the Contractholder's Plan which equals or exceeds: Page 5 e e ARTICLE 8 - MISCELLANEOUS (Continued) NOTE: Employees and/or their eligible Dependents who are eligible for the COBRA health continua- tion coverage provided under the Plan, will only be able to apply for Health Conversion Coverage at the end of the applicable 18 month or 36 month maximum period of continuation allowed under COBRA. This will be the case unless: (A) the Plan terminates in its entirety and isn't replaced by similar group medical coverage within 30 days; or (B) the Employee becomes ineligible for disability benefits under the Social Security Act after 18 months but before the end of the 29 month maximum period of continuation allowed under COBRA if the Employee is eligible for disability benefits under the Social Security Act. Issuance of the Health Conversion Coverage will be subject to all of the following conditions: . (A) No evidence of insurability is required. (B) The Employee or Dependent is not eligible for Medicare. (C) The Employee or Dependent is not covered by or eligible for similar benefits, as a result of termination of his Medical Coverage, under any policy, contract, or other arrangement for group insurance benefits or services. (0) Written application and the first premium for the Health Conversion Coverage must be delivered or mailed to Great-West at its Executive Offices in Englewood, Colorado within 31 days after the date on which the covered Employee or Dependent's Medical Coverage under the Plan terminates. (E) The Health Conversion Coverage provides coverage customarily issued by Great-West at the then current rates. Benefits provided under the Health Conversion Coverage may not be the same as those provided by the Plan. (F) The Health Conversion Coverage is effective on the next day after the date on which coverage under the Plan ceases. (2) Great-West will have the sole right to make claims under the Subrogation and Right of Recovery Provision contained in the Plan. In its sole discretion Great-West may litigate, negotiate, settle, compromise, release or waive any such claim. The Contractholder hereby assigns to Great-West all of its rights to make, litigate, negotiate. settle, compromise, release or waive any such claim. All money recovered by Great-West under the Subrogation and Right of Recovery Provision will be distributed as follows: (A) first, to Great-West to be applied to reduce Great-West's payment of Specific Stop~Loss Benefits pursuant to the Article entitled Specific Stop Loss Benefit, if any, of the Stop-Loss Contract, if any, issued by Great-West to the Contractholder with regard to any Employee or Dependent against whom the Subrogation and Right of Recovery Provision is enforced; and (B) secondly, to Great-West to be applied to reduce Great-West's payment of Aggregate Stop-Loss Benefits pursuant to the Article entitled Aggregate Stop Loss Benefit, if any, of the Stop-Loss Contract, if any, issued by Great-West to the Contractholder, and (C) thirdly, to the Contractholder. Page 7 e e ARTICLE 9 - ENTIRE CONTRACT This contract contains the entire agreement between the parties and sets forth in full the services to be rendered by Great-West. It may only be modified or amended by written agreement of the parties hereto and any representation or statement not expressly set forth hereunder will not be binding on any party hereto in any respect. ARNOLD TRANSPORTATION SERVICES By Q"._~- Signature .bltt~crt'k..) Title Ul2. 4-- 7-97 Oate Fiduciary Signature Title Oate Mailing Address of Fiduciary GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY By ~~/\ Svvwo. ~I~ A~....;;:t ~. Mrmch l %' tq q, Signature Title Oate I 8505 E. Orchard Road Englewood, CO 80111 Page 9 e e SERVICES CONTRACT SCHEDULE 8 - SCHEDULE OF FEES The Fees for the Services provided under the terms of this contract will be as set forth in the following paragraph. The Contractholder will pay to Great-West an amount equal to the sum of the items listed below: .'::!,. On the first day of each Contract Month, the Contractholder will pay to Great-West, for each Employee covered under the Plan during the Contract Month in question. an amount equal to (1) for Oentalcare Coverage, $1.42. (2) for Hospital, Medical, Prescription Orug, Visioncare and Short Term Disability Coverage. $17.35. (3) an amount equal to $500.00 for each Employee or Dependent who purchases the Health Conversion Coverage referred to in Article 8 of this contract during the Contract Month in question. Page 1 Transfer Frequency e e SERVICES CONTRACT SCHEDULE C Page 1 Weekly "::;,. .. (j) e e SERVICES CONTRACT Between GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY, hereinafter referred to as "Great-Wesr -and- ARNOLD TRANSPORTATION SERVICES hereinafter referred to as "the Contractholder." The Contractholder has established a Health Care Payment Plan or Health Care Payment Plan and Trust for the benefit of its Employees and Dependents (hereinafter referred to as the "Plan"). The Plan is an Employee benefit plan within the meaning of the Employee Retirement Income Security Act of 1974 and the Contractholder, who is both the Fiduciary and Administrator of the Plan hereby retains Great-West to provide services for the Plan in accordance with the following terms and conditions contained herein. Page 1 e e ARTICLE 1 - DEFINITIONS In this contract unless otherwise specifically provided: (1) "Anniversary Date", "Contract Months" and "Contract Years" will be calculated from JANUARY 1, 1999; JANUARY 1 of any year will be known as the Anniversary Date. (2) "Contract Year" means that period of 12 consecutive months which begins on the Anniversary Date. (3) "Coverages" provided under the Plan and covered by this contract are: Medical Coverage Short Term Disability Coverage Dentalcare Coverage Visioncare Coverage Prescription Drug Coverage (4) "Dependent" and "Employee" mean Dependent and Employee as defined by the Plan. ARTICLE 2 - ADMINISTRATIVE SERVICES AND FEES Great-West agrees to perform such services involving the performance of non-discretionary duties as are specified in the Schedule of Services marked Schedule "A", which is attached hereto and forms part of this contract in accordance with the terms and conditions of this contract. To facilitate the performance of such duties: (1) the Contractholder has advised its bank that Great-West is authorized to demand moneys payable by the Contractholder for checks issued for benefit payments made by Great-West under the Plan. (2) Great-West will initiate transfers from the Contractholder's designated bank account with the Transfer Frequency shown in Schedule "C". The Contractholder agrees to maintain funds in such account both before and after termination of this Services Contract which are adequate to cover benefit payments made by Great-West under the Plan. Page 2 e e ARTICLE 2 - ADMINISTRATIVE SERVICES AND FEES (Continued) The Contractholder agrees to pay Great-West the fees specified in the Schedule of Fees marked Schedule liB" which is attached hereto and forms part of this contract as reasonable compensation for services necessary for the Plan's operation. The Contractholder will be liable for the payment of such fees. Such fees will be paid as described in the attached Schedule "B". A grace period of 31 days will be granted for each payment of fees falling due after the first payment during which period this contract will remain in force. If any payment is not made within the days of grace, this contract will automatically terminate at the end of the grace period. No written notice of such automatic termination is required. If this contract terminates for any reason, the Contractholder will be liable for all payments due and unpaid, including a pro-rata payment for any time this contract is in force during the grace period. ARTICLE 3 - FURNISHING OF INFORMATION; ACCESS TO RECORDS The Contractholder will furnish Great-West, on request, with correct and complete information required by Great-West to provide the services which Great-West has agreed to perform under this contract, including, but not limited to, a copy of the Plan and any amendments thereto. The information will be furnished at the times and in such manner as Great-West may request. Great-West will assume that all such information is . complete and accurate and will be under no duty to question the accuracy of such information. Great-West, at its discretion, may charge additional fees for its services where information is not furnished, is incomplete or inaccurate or is not furnished at the time or in the manner as requested. The Contractholder agrees to give Great-West the right to inspect and copy the records of the Contractholder which are pertinent to the operation of the Plan. Such right will continue for the 5 years immediately following termination of this contract. All communications sent to the Contractholder from Great-West will be'transmitted to the Contractholder at the address appearing below or to such other person and address as may from time to time be designated by the Contract holder in writing. Notice transmitted to the Contractholder as aforesaid will be considered received by the Contractholder. Notice sent to Great-West will be directed to the address shown below or to such other address as Great-West may designate in writing from time to time. ARTICLE 4 - AUTHORITY TO CONTROL AND MANAGE THE PLAN The Contractholder acknowledges that the Contractholder has authority to control and manage the operation of the Plan. It is expressly agreed that under no circumstances will Great-West be designated as plan administrator or a fiduciary of the Plan. Nothing herein will be deemed to .constitute Great-West a party to the Plan or to confer upon Great-West any authority or control respecting management of the Plan, authority or responsibility in connection with administration of the Plan or responsibility for the terms or validity of the Page 3 e e ARTICLE 4 - AUTHORITY TO CONTROL AND MANAGE THE PLAN (Continued) Plan. Great-West will not be responsible for any tax liability which may be imposed upon the Contractholder, any fiduciary or any Employee or Dependent under the Plan. The Contractholderfurther agrees that nothing herein will be deemed to impose upon Great-West any obligation to any Employee or Dependent under the Plan. ARTICLE 5 - INDEMNIFICATION AND LIMITATION OF LIABILITY The Contractholder will indemnify, protect and hold Great-West harmless from any loss, liability, claim or expense (including attorneys' fees, court costs and expenses of litigation) arising out of any act or omission of the Contractholder in connection with the Plan. The Contractholder agrees to indemnify Great-West and hold Great-West harmless against any tax relating to this contract, including any accrued interest and penalties levied on such tax, but excluding any tax based upon Great-West's net income. The terms of this provision will survive the termination of this contract. Great-West will not be liable for any act or failure to act, in the exercise of its powers and performance of its duties hereunder, which act or failure to act is performed by Great-West in good faith. Great-West agrees to indemnify the Contractholder and hold the Contractholder harmless against any and all loss, damage, and expense with respect to this contract resulting from or arising out of the dishonest, fraudulent or criminal acts of Great-West's employees, acting alone or in collusion with others. Upon termination of this contract, or in the event of termination of individual employee coverages, it is the Contractholder's responsibility to collect any and all 1.0. cards from the Contractholder's employees and dependents. The Contractholder agrees to indemnify, protect and hold Great-West harmless from any loss, liability, claim or expense (including attorneys' fees, court costs and expenses of litigation) arising from payment of claims which were incurred outside the contractual eligibility period of the group or of any employee or dependent. ARTICLE 6 - CONTRACT TERMINATION This contract may be terminated at any time by either the Contractholder or Great-West, provided written notice of such termination is given at least 31 days in advance. In addition, this contract: (1) may terminate immediately upon termination of the Stop-Loss Contract, if any, between Great-West and the Contractholder, or Page 4 e e ARTICLE 6 - CONTRACT TERMINATION (Continued) (2) may terminate upon amendment of the Plan in a manner deemed unsatisfactory by Great-West, provided that Great-West gives 31 days written notice of such termination to the Contractholder; or (3) will terminate immediately upon failure of the Contractholder to comply with any term or condition of this contract, such as but not limited to failure to: (A) pay the Administrative Fees as specified in the Article of this contract entitled Administrative Services and Fees; or (B) fund the bank account(s) (referred to in the Article of this contract entitled Administrative Services and Fees) established to handle payment of the benefits provided under the Plan. In the event of termination of this contract, Great-West will have the right to stop processing claims immediately on the effective date of such termination. Complete information regarding all outstanding claims which are unpaid or received after such date will be returned by Great-West to the Contractholder. In addition, the Contractholder will notify each Employee covered under the Plan of such termination. ARTICLE 7 - AMENDMENT OF SCHEDULE OF FEES Unless otherwise indicated in the Schedule of Fees, the fees shown are for the first Contract Year. Great-West has the right to revise the Schedule of Fees: (1) when the Contractholder's Plan is amended; and (2) on or after the first anniversary of the Effective Date of this contract but not more than once in any 12 month period, except as provided in (4) below; and (3) when the services described in the Schedule of Services are changed; and (4) at any time during the first or subsequent Contract Years: (A) if the Coverages under the Contractholder's Plan are changed; (B) if the provisions of. the Contractholder's Plan have to be changed because of a change in law; or (C) if there is a change in the number of Employees and/or Dependents covered under the Con- tractholder's Plan for any Coverages provided under the Contractholder's Plan which equals or exceeds: (a) 10% in any Contract Month when compared to the prior Contract Month; or (b) 20% at any time within a Contract Year. In this case, the change in the number of Employees and/or Dependents covered will be determined by comparing the number of Employees and/or Dependents covered for any Coverages under the Contractholder's Plan at the beginning of the first Contract Month of the Contract Year in question with the number of Employees and/or Dependents covered for any Coverages under the Contractholder's Plan Page 5 e e ARTICLE 7 - AMENDMENT OF SCHEDULE OF FEES (Continued) at the beginning of any subsequent Contract Month. The Contractholder agrees to make available to Great-West all information necessary to determine such change. If the change in the number of Employees and/or Dependents covered under the Plan is such that a change in fees results, then Great-West will advise the Contractholder of its intention to change the fees. (0) upon addition or deletion of coverage for subsidiary or affiliated companies or corporate divisions. The effective date of the change in fees will be the effective date of the event in (A), (B), (C) or (0) above that causes such change. ARTICLE 8 - MISCELLANEOUS (1) An Employee or Dependent under age 65 whose Medical Coverage under the Plan ends due to: (A) termination of employment; (B) termination of employment in an eligible class; (C) change in marital status (in the case of a Dependent); (D) attainment of the limiting age specified in the Plan (in the case of a Dependent child); or (E) death of the Employee (in the case of a Dependent); or (F) termination of the Plan but only if the Plan is not replaced by similar group medical coverage within 30 days and such Employee or Dependent had been covered under the Plan for at least the 90 day period prior to the date the Plan terminated; will be entitled to purchase medical insurance from Great-West. This medical insurance is referred to as Health Conversion Coverage. If such Employee has Dependents who are also covered under the Plan, the Health Conversion Coverage may also cover such Dependents. NOTE: Employees and/or their eligible Dependents who are eligible for the COBRA health continua- tion coverage provided under the Plan, will only be able to apply for Health Conversion Coverage at the end of the applicable 18 month or 36 month maximum period of continuation allowed under COBRA. This will be the case unless: (A) the Plan terminates in its entirety and isn't replaced by similar group medical coverage within 30 days; or (B) the Employee becomes ineligible for disability benefits under the Social Security Act after 18 months but before the end of the 29 month maximum period of continuation allowed under COBRA if the Employee is eligible for disability benefits under the Social Security Act. Page 6 e e ARTICLE 8 - MISCELLANEOUS (Continued) Issuance of the Health Conversion Coverage will be subject to all of the following conditions: (A) No evidence of insurability is required. (B) The Employee or Dependent is not eligible for Medicare. (C) The Employee or Dependent is not covered by or eligible for similar benefits, as a result of termination of his Medical Coverage, under any policy, contract, or other arrangement for group insurance benefits or services. (0) Written application and the first premium for the Health Conversion Coverage must be delivered or mailed to Great-West at its Executive Offices in Englewood, Colorado within 31 days after the date on which the covered Employee or Dependent's Medical Coverage under the Plan terminates. (E) The Health Conversion Coverage provides coverage customarily issued by Great-West at the then current rates. Benefits provided under the Health Conversion Coverage may not be the same as those provided by the Plan. (F) The Health Conversion Coverage is effective on the next day after the date on which coverage under the Plan ceases. (2) In its sole discretion, Great-West may undertake initiatives which go beyond the services described in Schedule A attached hereto, having as their objective saving additional money for the Plan. Examples of such initiatives are subrogation and right of recovery, and provider bill negotiation and discounts on claims from providers outside the Great-West network of providers. All savings realized under this provision will be distributed as follows: (A) first, 25% to Great-West for its services in obtaining the savings; and (B) secondly, to Great-West to be applied to reduce Great-West's payment of Specific Stop-Loss Benefits under the Stop Loss Contract, if any, issued by Great-West to the Contractholder for the Employee or Dependent in respect of whom the savings were realized; and (C) thirdly, to Great-West to be applied to reduce Great-West's payment of Aggregate Stop-Loss Benefits under the Stop-Loss Contract, if any, issued by Great-West to the Contractholder; and (D) fourthly, to the Contractholder. All savings realized will be applied to the accounting for the Contract Year in which the claim giving rise to the savings was paid. If claim expenses were paid in more than one Contract Year, the savings will be applied on a pro rata basis in accordance with the amount of claim expenses paid in each of the Contract Years. For purposes of subrogation and right of recovery, Great-West will have the sole right to make claims under the Subrogation and Right of Recovery Provision contained in the Plan. In its sole discretion Great-West may litigate, negotiate, settle, compromise, release or waive any such claim. The Contractholder hereby assigns to Great-West all of its rights to make, litigate, negotiate, settle, compromise, release or waive any such claim. Action taken under the Subrogation and Right of Recovery Provision contained in the Plan may result in the incurral of legal expenses. Such legal expenses will be borne by Great-West and the Contractholder in the same proportion as any money recovered under the Subrogation and Right of Recovery Provision Page 7 e e ARTICLE 8 - MISCELLANEOUS (Continued) is distributed between Great-West and the Contractholder. If no money is recovered, the legal expenses will be borne by Great-West and the Contractholder in the same proportion that each party's share of claim payments bears to the total amount of claim payments. Legal expenses will not be used when calculating the Specific Stop-Loss Benefits, or the Aggregate Stop-Loss Benefits, if any, issued by Great-West to the Contractholder. For purposes of pursuing savings under this provision, Great-West may retain third party vendors. Page 8 e e ARTICLE 9 - ENTIRE CONTRACT This contract contains the entire agreement between the parties and sets forth in full the services to be rendered by Great-West. It may only be modified or amended by written agreement of the parties hereto and any representation or statement not expressly set forth hereunder will not be binding on any party hereto in any respect. ARNOLD TRANSPORTATION SERVICES By Signature Title Date Mailing Address of Contractholder GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY By dJ. Y2tu I Signature () ./l./Jr !lU'A":f;. y?~ 1w Title 0.Q/99 Date 8505 E. Orchard Road Englewood, CO 80111 Page 9 e e SERVICES CONTRACT SCHEDULE A - SCHEDULE OF SERVICES The following services will be provided for the administration of the Contractholder's Plan: .::<'- Drafting Assistance - Booklet - Booklet Amendments Standard Allowance for Booklet printing 1.0. Card Preparation Standard Allowance for I.D. Card printing Preparation of enrollment procedures Assistance in plan enrollment Late applicant underwriting Claim form preparation Standard Allowance for Claim form printing Check preparation Standard Allowance for Check printing Benefit determination in accordance with the Plan Verification of eligibility Benefit payments in accordance with the Plan . Claims Reports: - Monthly detail list of plan payments - Monthly summary by benefit type Issued Check Listing Preparation of Physician payment reports Actuarial cost estimates: - Open and Unreported claims liabilities - Review of Past Experience - Projection of future cost - Legislated changes in benefits - Plan modifications Expenses incurred by Great-West for services not covered or for covered services beyond standard allowances will be charged as incurred. For verification of persons eligible for the Coverages provided under the Plan, Great-West will rely solely upon information in its computer records at the time eligibility verification is requested. These records will be based upon eligibility information provided to Great-West by the Contractholder. The Contractholder agrees to furnish Great-West's Benefit Payment Office with accurate eligibility information on a timely basis. Page 1 Transfer Frequency e e SERVICES CONTRACT SCHEDULE C Page 1 Weekly Exhibit B Please review this information and contact Steve Hardine at 1-800-537-2033, extension 72041 if you have any questions or documentation to show this amount has been paid. Our apologies for the delay in bringing this matter to your attention. We thank you in advance for your prompt response. Sincerely, Darlene Herman Associate Manager Employee Benefits, Large Case Operations, 7T1 Enclosures cc: Judy Coufal, Historical Reconciliation's/Suspense, Large Case Operations Washington D.C. Group Sales Office }:!J (:) iQ tJ-~~ ~ i} en ~ W 0 ....0 ~ -oo"1J F Y- .".- c ~..\ ~;;] I... '- ..J' . :~ n (' r... ~ ~~ 1 , _1 ....,.'} 8 :.1 ,.1 .-J SHERIFF'S RETURN - REGULAR CASE NO: 2003-00812 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND GREAT-WEST LIFE & ANNUITY INS VS ARNOLD TRANSPORTATION SERVICES RONALD HOOVER , Sheriff or Deputy Sheriff of Cumberland County, Pennsylvania, who being duly sworn according to law, says, the within COMPLAINT & NOTICE was served upon ARNOLD TRANSPORTATION SERVICES INC the DEFENDANT , at 1700:00 HOURS, on the 3rd day of March 2003 at 4410 INDUTRIAL PARK ROAD CAMP HILL, PA 17011 by handing to EVANS WAGNER, DIRECTOR OF SAFETY, ADULT IN CHARGE a true and attested copy of COMPLAINT & NOTICE together with and at the same time directing His attention to the contents thereof. Sheriff's Costs: Docketing Service Affidavit Surcharge So Answers: 18.00 9.66 .00 10.00 .00 37.66 r~~.'f-;"(,,~~ R. Thomas Kl ine 1 03/04/2003 BUCHANAN INGERSOLL Sworn and Subscribed to before By: ~~ Deputy She iff u::- /0 - day of me this ~ c2t'tJ3 A.D. ~Q hu(~.. ~ rothonotary I Plaintiff, : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYL VANIA '8"~ : NO 03.:M CIVIL TERM GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY v. : CIVIL ACTION-LAW ARNOLD TRANSPORTATION SERVICES,INC. Defendant. ANSWER. COUNTERCLAIMS AND NEW MAT11g Defendant, Arnold Transportation Services, Inc. ("Arnold"), by and through its attorneys, responds to the Plaintiffs Complaint as follows: Parties 1. Denied. Arnold is without knowledge and information sufficient to form a belief as to the truth or veracity of the allegations contained in tij.is paragraph and, therefore, denies the same. 2. Admitted in part; denied in part. Arnold admits th<lt it is a corporation. Arnold denies the balance of the allegations contained in thi~ paragraph. Answering further, Arnold's principle place of business is 9523 Florida Mining Blvd., Jacksonville, Florida, 32257. Jurisdiction and Venue 3. Denied. Factual Back2round 4. Admitted. I-HNIOS771.l 5. Denied. The allegations contained in paragraph 5 seek to characterize and/or summarize the terms of the agreement attached as exhibit A to the Complaint, the terms of which speak for themselves. A. Denied. The allegations contained in paragfaph 5(A( seek to characterize and/or summarize the terms of the agreement attached as hhibit A to the Complaint, the terms of which speak for themselves. B. Denied. The allegations contained in parawaph 5(B) seek I to characterize and/or summarize the terms of the agreement attached as Jxhibit A to the Complaint, the terms of which speak for themselves. C. Denied. The allegations contained in para*aph 5(C ) seek ! to characterize and/or summarize the terms of the agreement attached as ~xhibit A to the Complaint, the terms of which speak for themselves. 6. Admitted. 7. Denied. The allegations contained in paragraph 7 seek to I characterize and/or summarize the terms of the agreement attached as exliibit A to the Complaint, the terms of which speak for themselves. A. Denied. The allegations contained in paragtjaph 7(A) seek to characterize and/or summarize the terms ofthe agreement attached as qxhibit A to the Complaint, the terms of which speak for themselves. I B. Denied. The allegations contained in paragfaph 7(B) seek I to characterize and/or summarize the terms of the agreement attached as ~xhibit A to the Complaint, the terms of which speak for themselves. 1-HA/I05771.1 2 C. Denied. The allegations contained in paragraph 7rQ seek to characterize and/or summarize the terms of the agreement attached as exhibit A to the Complaint, the terms of which speak for themselves. I D. Denied. The allegations contained in parawaph 7(D) seek I to characterize and/or summarize the terms of the agreement attached as hhibit A to the I Complaint, the terms of which speak for themselves. E. Denied. The allegations contained in paragraph 7(E) seek to characterize and/or summarize the terms ofthe agreement attached as $xhibit A to the Complaint, the terms of which speak for themselves. 8. Denied. The allegations contained in this paragra~ constitute a legal conclusion to which no response is required. To the extent that a re~ponse is required, the allegations contained in this paragraph are denied. COUNT I BREACH OF CONTRACT 9. Arnold incorporates by reference its responses to pjaragraphs 1-8, as if fully set forth herein. 10. Admitted. 11. Denied. The allegations contained in paragraph 111 seek to characterize and/or summarize the terms of the agreement attached as exliibit A to the Complaint, the terms of which speak for themselves. Furthermore, Arnol~ denies that it failed to perform its obligations under the agreement attached as Exhibit A to Plaintiffs complaint. Rather, Plaintiff has sought the identified sum without acco~ting for how this alleged obligation accrued, in spite of requests from Arnold for such ~ accounting. I-HNI05771.l 3 12. Denied. The allegations contained in paragraph 12 seek to characterize and/or summarize the terms of the agreements attached as exhibits A and B to the Complaint, the terms of which speak for themselves. Arnold specifically denies i that it owes the sums identified in Exhibit B. Furthermore, Exhibit B si~ply states the amount without accounting, with specificity, for how this alleged obligation accrued. Plaintiff repeatedly has failed to address this critical omission. 13. Admitted in part; denied in part. Arnold admits that Plaintiff has requested the sum of$47,358.70. Arnold denies that it owes Plaintiff this sum, as Plaintiff repeatedly has failed to accurately account for the accrual of thi~ obligation. 14. Admitted in part; denied in part. Arnold admits that it refuses to pay the $47,358.70 demanded by Plaintiff until Plaintiff provides Arnoldi with a specific accounting for how the alleged obligation accrued. Arnold denies that it ~s contractually obligated to pay the sums requested by Plaintiff. Furthermore, Arnold d~nies the allegations contained in paragraph 14 to the extent that they seek to chardcterize and/or summarize the terms ofthe agreement attached as exhibit A to the Complaint, the terms of which speak for themselves. 15. Denied. The allegations contained in this paragraph constitute a legal conclusion to which no response is required. To the extent that a r($ponse is required, the allegations contained in this paragraph are denied. WHEREFORE, having denied any liability to Plaintiff, Atnold denies that Plaintiffis entitled to any of the relief it demands in this Count of the Co~plaint. I-HN105771.l 4 COUNT II UNJUST ENRICHMENT 16. Arnold incorporates by reference its responses to paragraphs 1-15, as if fully set forth herein. 17. Admitted in part; denied in part. Arnold admits th.h it did have an agreement with Plaintiff to provide the services identified in Exhibit A, tlie terms of which speaks for themselves. Arnold denies Plaintiffs attempt to characterize the agreement, attached as exhibit A of the Complaint, the tenns of which sp~ak for themselves. 18. Admitted in part; denied in part. Arnold admits th*, during the term ofthe agreement attached as Exhibit A, it did receive services from ~laintiff. Arnold denies that it failed to compensate Plaintiff in accordance with the! terms of the agreement for any benefit derived. Answering further, Plaintiff was aske4 by Arnold for a specific accounting for the alleged obligation. To date, Plaintiff has fail~d to provide Arnold with any accounting that justifies the alleged obligation. 19. Admitted in part; denied in part. Arnold admits thajt it did receive services from Plaintiff as identified in Exhibit A, which speaks for itself. Arnold denies Plaintiffs attempt to characterize the agreement, attached as exhibit A of the Complaint, I because the terms of the agreement speak for themselves. 20. Admitted in part; denied in part. Arnold admits that it did receive services from Plaintiff as identified in Exhibit A. Arnold denies Plaintiff$ attempt to characterize the agreement, attached as exhibit A of the Complaint, because the terms of the agreement speak for themselves. l-HAl105771.1 5 21. Admitted in part; denied in part. Arnold admits that it has not paid Plaintiff the sum demanded. Arnold denies that Plaintiff is entitled to this sum. Plaintiff repeatedly has failed to provide Arnold with an accurate accounting of th~ alleged obligation. Furthermore, some ofthe allegations contained in this paragr~ph constitute conclusions oflaw, to which no response is required. To the extent a resI1>onse is required, these allegations are denied. 22. Admitted in part; denied in part. Arnold admits th~t it has not paid Plaintiff the sum demanded, and, therefore, retains the same. Arnold dentes that Plaintiff is entitled to this sum. Furthermore, some of the allegations contained in Ithis paragraph constitute conclusions oflaw, to which no response is required. To the e~tent a response is required, these allegations are denied. WHEREFORE, having denied any liability to Plaintiff, A$old denies that , I ! Plaintiff is entitled to any of the relief it demands in this Count of the COl~plaint. COUNTERCLAIM I: ACCOUNTING 1. Arnold brings this counterclaim in equity under Pe~sylvania law seeking an accounting of the disputed $47,358.70. I 2. The agreement involved in this matter created a fid~ciary relationship between the parties. 3. Plaintiffs assertion that Arnold owes it $47,358.70Iis a I misrepresentation. Plaintiff failed to provide Arnold with documentation to support this assertion. l-HA/I05771.1 6 4. The accounts at issue are complicated, as several hundred transactions took place. Plaintiff has been unable to provide accurate and detailed information demonstrating the flow of funds. 5. Arnold has no adequate remedy at law. 6. Arnold sought this accounting from Plaintiffbefor~ Plaintiff filed its complaint in this matter. WHEREFORE, Arnold asks this Court to order Plaintiff t@ provide a full and complete accounting of the source ofthe alleged $47,358.70 debt ow~d it by Arnold. AFFIRMATIVE DEFENSE A. Plaintiff fails to state a claim upon which relief maV be granted. iJMJG ~I. JAMES N. BOUDREAU 1701 Market Street Philadelphia, PA 19103-2921 215.963.5106 G. SCOTT PATERNO One Commerce Square 417 Walnut Street I Harrisburg, PA 17101-19$4 717.237.4035 Of Counsel: MORGAN, LEWIS & BOCKIUS LLP Dated: April 7, 2003 I-HAlI0577\.l 7 , , ' " , 04'104/2:a:,,"3 I 15: 14: 7172374884 ~ [ ~WIS !'AGE 89/10 : ; I I · i Ii ~., I ; :: 1 ~ i I : I " !:' I i' ., :1' I: ~RlnCA.TION I, Glenn A.. Guest, Di~or, Corporate Human RelatfotUI for 4mold Transportation Services, hereby state that the facts set forth in the foregoing 1'nlwer. Counterclaim and Affirmative Defense are true and correct to 1he best of my Jcnowledge. iDformation and belief. I understand that the statement is made subject to thelpenaltics of 18 Ps. SlII. AIm. ~ 4904 relating 1ll1lllSWDlll fa~~ ~ Aprit.::L 2003 Glenn A. Guest ' I ' : I , ; I, " ' ! ; , ! " ! ! I , '! ::' I' . 1: i; , " ~ 1 ; I; . , 1 , ::11 :!: ' , , I " I' J-J.WIOS7'7l.1 ~oo /~oO' a onu oan arrOmIV ~~:80 €OO~I~aV'LO CERTIFICATE OF SERVICE I hereby certify that a true and correct copy of Defendant Arnold Transportation Services, Inc.'s Answer and New Matter to Complaint has peen served via First Class, U.S. Mail on this 7th day of April, 2003, upon the following: Thomas G. Collins, Esquire Stephen Moniak, Esquire One South Market Square 213 Market Street, 3rd Floor Harrisburg, P A 171 0 1 Attorney for Plaintiff )t~p G. SCOTT PATERNO l-HAI105771.l 0 a 0 c- ,~) -q ..;;:,: ~ ;:g cr. -TJ -J -> L" '-:'J 2 c"' (/) '-.1 -< ,'--, ~~ I ", lJ -;-, :1: -"~"1 ;:--~ .....- J , .J :r;. \.. ~ ") Iil C. " I ~- ::J ~- ~=j -<: .&:- -<: p~ PRAECIPE FOR LISTING CASE FOR ARGUMENT (Must be typewritten and subnitted in duplicate) TO THE PROTHONOTARY OF CUMBERLAND COUNTY: Please list the within matter far the next Argunent Court. --------------------------------------------------------------------------------------- CAPTION OF CASE (entire caption must be stated in full) Great-West Life & Annuity Insurance Company ( Plaintiff) vs. Arnold Transportation Services, Inc. ( Defendant) No. 03-l't2 Civil TERM 19 1. State matter to be argued (Le., plaintiff's rrotion for new trial. defendant's danurrer to canplaint, etc.): Plaintiff, Great-West Life & Annuity Insurance Company's Preliminary Objections to the Counterclaim asserted by Defendant, Arnold Transportation Services, Inc. 2. Identify =unsel who will argue case: (a) far plaintiff: Thomas G. Collins Address: One South Market Square, 213 Market Street, 3rd Floor Harrisburg, PA 17101 (b) for defendant: James N. Boudreau Address: 1701 Market Street, Philadelphia, PA 19103-2921 3. I will notify all parties in writing within 1:1010 days that this case has been listed for argurent. 4. Argunent Court Date: July 23, 2003 Dated: 0 h3/ z::, -:> ~\~ Attorney far Plaintiff, Great-West Life & Annuity Insurance Company (") 0 0 c w " ~ S= -, cJ L-;;:1 rn L) .-- "T"l Z 'j::':": -:;;:- ,- tOO, :-~: cTi 0' .' -< ) r::: , - l. :r;: ~ :;Q :2" r".n j.~ :..) :.) --I :"J -~. :..c~ (,) --- GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff v. A.>l), No. 03~-CIVIL TERM ARNOLD TRANSPORTATION SERVICES, INC. CIVIL ACTION - LAW Defendant PRAECIPE TO DISCONTINUE WITH PREJUDICE TO THE PROTHONOTARY; Kindly mark this matter as discontinued with prejudice. BUCHANAN INGERSOLL PROFESSIONAL CORPORATION homas G. ollins, Esquire J.D. No. 75896 Stephen Moniak, Esquire J.D. No. 80035 One South Market S~uare 213 Market Street, 3' Floor Harrisburg, PA 17101 (717) 237-4800 Counsel for Great - West Life & Annuity Insurance Company Dated: May 16,2005 CERTIFICATE OF SERVICE I certify that I am this day serving a copy of the foregoing Praecipe to Discontinue with Prejudice upon the persons and in the manner indicated below, which service satisfies the requirements of the Pennsylvania Rules of Civil Procedure, by United States mail, first class, postage prepaid upon: Vincent Candiello, Esquire Morgan, Lewis & Bockius LLP 417 Walnut Street Harrisburg, PA 17101 BUCHANAN INGERSOLL PROFESSIONA CORPORATION Date: May 16,2005 -- -- '~~. \ ---I '.'\."f' " ",,' r-. f'...J ~