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9RHB-O 1008
LAW OFFICES OF .JACOBS & SABA
W. Darren Powell, Esquire
214 Senate Avenue, Suite 503
Camp Hill, PA 17011
Telephone Number: (717) 731-0988
Attorney for Defendant Nationwide Insurance
COREY R. LEES,
PLAINTIFF
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY , PENNSYLVANIA
VS.
No. 98-7326
NATIONWIDE INSURANCE,
DEFENDANT
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
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 Answer with New
Matter and Counter Claim of Defendant Nationwide Insurance to Plaintiffs Amended ComplaiQ!
and Notice are seNed by entering a written appearance personally or by attorney and filing in
writing with the COUll 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 Answer with
New Matter and Counter Claim of Defendant Nationwide Insurance to Plaintiff's Amended
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 TIllS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO
NOT HA VB A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE nIE
OFFICE SET FORTI! BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP.
CUMBERLAND COUNTY
Court Administrator
Fourth Floor
Cumbcrl:md County Courthouse
Carlisle, PA 17013
(717) 240,6200
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9!!HB"() JO()8
LAW OFFICES OF JACOBS & SABA
W. Darren Powell, Esquire
214 Senate Avenue, Suite 503
Camp Hill, PA 17011
Telephone Number: (717) 731-0988
Attorne for Defendant Nationwide Insurance
COREY R. LEES,
PLAINTIFF
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
VS.
No. 98-7326
NATIONWIDE INSURANCE,
DEFENDANT
CIVIL ACTION - LA W
JURY TRIAL DEMANDED
ANSWER WITH NEW MATTER AND COUNTER CLAIM OF DEFENDANT
NATIONWIDE INSURANCE TO PLAIN'rIH"S AMENUEU LOMPLAINT
AND NOW, comes the Defendant, Nationwide Insurance, by and through it's attorney,
W. Darren Powell, Esquire, and in support of this Answer with New Matter and Counter
Claim of Defendant Nationwide Insurance to Plaintiff's Amended Complaint, hereby avers as
follows:
I. Denied. After reasonable investigation. Ihe Defendant is without knowledge or
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;
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information sufficient to fonn an opinion as to the truth or falsity of said averment. Strict
.
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proof thereof, if relevant, is demanded.
2. Admitted.
3, Admitted.
4, Denied as stated By way offunhcr response, the contract of insurance entered into
between Ms. Keiter and Defendant is a written contract which speaks for itself
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5. Denied as slated. The contract is a written document which speaks for itself. By way
of further response. the tirst party medical benefit coverage under the policy provides for
payments for medically reasonable and necessary treatments for injuries related to motor vehicle
accidents, as set forth in the policy and in accordance with the Pennsylvania Motor Vehicle
Financial Responsibility Law and the regulations promulgated thereunder.
6. Denied. After reasonable investigation, the Defendant is without knowledge or
infonnation sufficient to fonn an opinion as to the truth or falsity of said avemlent. Strict
proof thereof, if relevant, is demanded.
7. Admitted in part, denied in part. It is admitted, based upon infonnation provided, that
Plaintiff provided services to Ms, Keiter. It is denied that such services were reasonable or
necessary or that such were provided in connection with any injuries which may have been
sustained in the alleged accident.
8. Denied. The avennents contained in ~8 constitute conclusions of law to which no
response is required. To the extent that it is judicially determined that a response is required, the
same are denied generally pursuant to Pa.R,c..P. ~I029(e),
9, Denied as stated. By way offurther response, Defendant retained an independent peer
review organization, Claims Review Associates, Inc,. to determine the re:l.sonableness and
necessity of the treatment in question, as provided for by the Pennsylvania Motor Vehicle
Financial Responsibility Law and the regulations thereunder. The peer review was accomplished
by Dr.. Jess P. Amline, who concluded that the care provided by Dr, Lees subsequel1tto March J,
1998 was not medically necessary or reasonable. It is further averred that Claims Review
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Associates was approved by the Commonwealth of Pennsylvania as a peer review organization on
April 25, 1990, and that the peer review was done in accordance with all applicable law and
regulations.
10. Denied. The averments contained in ~IO constitute conclusions of law to which no
response is required. To the extent that it is judicially determined that a response is needed, the
same are denied generally pursuant to Pa.R.C.P. ~1029(e),
I I. Admitted in part, denied in part. It is admitted that Dr. Armine, in his report dated
August 13, 1998, foulld that the treatments provided subsequent to March I, 1998, were not
medically necessary or reasonable. It is further admitted that Defendant, in accordance with said
report, denied further payment to Dr. Lees and, moreover, requested reimbursement for payments
made for services determined to be medically unreasonable or unnecessary, [t is denied that such
action is in any way, manner, or form, violative of the Pa. M. V.F.R.L or the regulations
promulgated thereunder.
12. Denied. The averments contained in ~I2 constitute conclusions ofIaw to which no
response is required. To the extent that it is judicially determined that a response is needed, the
same are denied generally pursuant to Pa.R,C.P. ~I029(e),
13, Denied, By way of further response, it is averred that Plaintifl: despite numerous
requests by the Peer Review Organization to provide his records, refilsed to do so, By letter from
the Peer Review Organization to Plaintiff, dated July 20, 1998, Plaintifl'was advised that he was
being provided an additional twenty (20) days to provide the same with copies of his records.
extending the thirty (30) day time prriod as prrrnitted by Act 6.
3
14. Denied. The averments contained in 1114 constitute conclusions of law to which no
response is required. By way of further response, to the extent that it is judicially determined that
a response is needed, the Act 6 regulations speak for themselves, as does Dr. Armine's report
Any implication that said report is in violation of the Act 6 regulations is specifically denied.
IS. Denied.
16. Denied, The avemlents contained in 1116 constitute conclusions of law to which no
response is required. By way of further response, to the extent that it is judicially determined that
a response is needed, the Act 6 regulations speak for themselves, as does Dr. Armine's report.
Any implication that said report is in violation of the Act 6 regulations is specifically denied.
Denied.
17. Denied. The averments contained in 1117 constitute conclusions of law to which no
response is required, To the extent that it is judicially determined that a response is needed, the
same are denied generally pursuant to Pa,R.C.P. sI029(e).
18. Denied. The averments contained in 1118 constitute conclusions oflaw to which no
response is required. To the extent that it is judicially deter.nined that a response is needed, the
same are denied generally pursuant to Pa,R.C.P. sI029(e).
19. Denied, By further response, Defendant acted entirely appropriate and in accordance
with Act 6 and other law in connection with this matter. Defendant engaged an approved Peer
Review Organization which through, Dr. Annine, determined that the care provided by Dr. Lees
was not reasonable or necessary,
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20. Denied. Dr. Armine's report is a written document which speaks for itself. Any
allegation or implication that said report is in violation of the Act 6 regulations is specifically
denied.
21. Admitted in part, denied in part. It is admitted that Dr. Armine's report refers to said
referenced book entitled Guidelines for Chiropractic Quality Assurance and Practice Parameters.
Any impropriety in referring to said book on chiropractic practice quality is specifically denied.
22. Denied. The averments contained in '\122 constitute conclusions oflaw to which no
response is required, To the extent that it is judicially determined that a response is needed, the
same are denied generally pursuant to Pa.R.C.P. 91029(e). By way offurther response, Dr.
Armine's report is a written document which speaks for itself.
23. Denied.
24. Denied, It is specifically denied that the reference to b'Uidelines set forth in Guidelines
for Chiropractic Quality Assurance and Practice Parameters is misleading or grossly unfair to Dr.
Lees.
25, Denied
26. Admitted in part, denied in part. It is admitted that Defendant denied Dr. Lees' bills
based upon Dr. Armine's peer review report. By way of further response, such action was proper
and provided for by the Pennsylvania Motor Vehicle Financial Responsibility Law and the
regulations promulgated thereunder. It is denied that Dr. Amline or Defendant violated Act 6 or
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that Defendant's denial was not based upon a reasonable foundation. By way offurther
response, it is averred that Defendant acted in all manners reasonable and in accordance with the
applicable law and regulations.
27. Denied as stated. Defendant based its denial of bills on Dr. Armine's report, in
accordance with Act 6 and applicable regulations, It is specifically denied that the decision was
based upon improper actions or violations by Dr. Armine. It is further denied that Defendant
denied the bills without reasonable foundation or that such action was wanton.
28. Denied as stated. The report is a written document which speaks for itself.
29. Denied.
30. Admitted in part, denied in part. It is admitted that Defendant, through its agents,
read Dr. Annine's report. It is denied that Dr. Annine committed violations or that Defendant's
agents were aware of the same.
31. Admitted in part, denied in part. It is admitted that Defendant based its decision to
deny payment based upon the Peer Review report of Dr. Annine, as permitted for by Act 6. It is
again denied that Dr. Annine committed "violations," It is again denied that Defendant acted
without reasonable foundation or that its actions should be considered wanton.
32, Denied, After reasonable investigation, the Defendant is without knowledge or
infonnation sufficient to fonn an opinion as to the truth or falsity of said averment. Strict
proof thereof, if relevant, is demanded.
6
33. Denied. After reasonable investigation, the Defendant is without knowledge or
information sufficient to fonn an opinion as to the tmth or falsity of said avenuenl. Strict
proof thereof, if relevant, is demanded.
34. Denied. After reasonable investigation, the Defendant is without knowledge or
information sufficient to fonn an opinion as to the tmth or falsity of said avenuenl. Strict
proof thereof, if relevant, is demanded.
35. Denied. The averments contained in 1[35 constitute conclusions of law to which no
response is required. To the extent that it is judicially determined that a response is needed, the
same are denied generally pursuant to Pa,R.C.P. ~I029(e).
36. Denied, The averments contained in 1[36 constitute conclusions of law to which no
response is required. To the extent that it is judicially determined that a response is needed, the
same are denied generally pursuant to Pa.R.C.P. ~I029(e).
37. Denied. By way of further response it is denied that Defendant has improperly denied
Dr. Lees's bills. It is further denied that Defendant's actions will cause Ms. Keiter to become
personally responsible for such bills, It is believed and, therefore averred, that Act 6 prohibits Dr.
Lees from attempting to collect from Ms, Keiter for services determined to be not medically
reasonable or necessary.
38, Denied, The avemlents contained in 1[38 constitute conclusions of law to which no
response is required. To the extent that it is judicially detemlined that a response is needed, the
same are denied generally pursuant to Pa,R,C.P. ~ I029(e),
7
39. Denied. The averments contained in ~39 constitute conclusions of law to which no
response is required. To the extent that it is judicially determined that a response is needed, the
same are denied generally pursuant to Pa.R.C.P, 9I029(e),
NEW MATTER
40. Paragraphs one (I) through thirty-nine (39) are incorporated herein by reference and
made apart hereof as if set forth in full.
41. Defendant has satisfied all duties under the applicable insurance policy and applicable
law.
42. Defendant has acted reasonably and in good faith at all times relevant hereto.
43. Plaintiff has failed to state a cause of action upon which relief may be granted.
44. Defendant has no duty to pay any m.::dical bills that have not been submitted for
payment.
45, Defendant has paid all benefits required under the applicable insurance policy and
applicable law.
46. Plaintiff's alleged damages are specifically limited to those remedies provided under
the Motor Vehicle Financial Responsibility Law,
47. The payment for said selVices was properly rejected by Defendant.
48. Defendant is obligated to pay only Act 6 amounts.
WHEREFORE, the Defendant respectfully prays this Honorable Court to dismiss
Plaintiff's Complaint and enter judgment in favor of the Defendant.
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COUNTER CLAIM
Nationwide Insurance v. Corey Lees
49. Paragraphs one (I) through forty-eight (48) of this Answer with New Matter and
Counter Claim are incorporated herein by reference.
50. On or about August 13, 1998, Dr. Jess Annine conducted a Peer Review in
accordance with the Pennsylvania Motor Vehicle Financial Responsibility Law.
51. Dr. Armine detennined that the care provided beyond March I, 1998 was not
medically reasonable or necessary.
52. By letter dated August 18, 1998, a copy of Dr. Armine's report was fOlwarded
onto Plaintiff. A copy of said August 18, 1998 letter is attached hereto as Exhibit "A".
53. Nationwide Insurance, prior to the PRO report, had paid $290.40 to Plaintiff for
visits between March 2, 1998 through March 25, 1998. The services provided on said dates
were determined by the peer review doctor not to be medically reasonable or necessary by the
PRO.
54. Defendant is entitled to the return of the $290.40, plus interest thereon at the rate
of 12% per annum.
55. Defendant has l'Cquested reimbursement of said amount, but payment has not been
made.
9
WHEREFORE, Nationwide Insurance respectfully requests that this Honorable Court
enter judgment in its faver and against Corey Lees in the amount of $290.40, plus interest and
costs.
Respectfully submitted,
LAW OFFICES OF JACOBS & SABA
Date:
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W. DaIren Powell, Esquire
Attorney for Defendant Nationwide Ins.
214 Senate Avenue, Suite 503
Camp Hill, PA 17011
Telephone No. (717) 731-0988
Identification No.68953
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98HB..{1I008
LA W OFFICES OF JACOBS & SABA
W. Dnrrcn Powcll, Esquirc
214 Scnntc Avcnuc, Suitc 503
CnmplliIJ, PA 17011
Tclcphonc Numbcr: (717) 731-0988
Altornc for Dcfcndnnt Nationwidc lusurancc
COREY R. LEES,
PLAINTIFF
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
VS.
No. 98-73.26
NATIONWIDE INSURANCE,
DEFENDANT
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
CERTIFICA TE OF SERVICE
I, W. Darren Powell, Esquire, hereby certifies that he is the attorney for the Defendant
herein, and that he caused a true and correct copy of Answer with New Malter and Counter
Claim of Defendant Nationwide Insurance to Plaintiffs Amended ComDlaint to be served by
regular first class mail upon:
Jana Butler, Esquire
The Butler Law Finn
500 N. 3rd Street
P.O. Box 1004
Harrisburg, PA 17108
Dated:
'u Q '--\l
W.o-airen Powell, Esquire
Attorney for Defendant
Dc{;cmbeL2..J 999
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NATIONWIDE
INSURANCE
ENTERPRISE
N;lllol1wlde Is on your sIde
POBOX 2655 . HAf1f~IS13UIlG PA 17105-9971 .
DIl COREY R LEES DC
6103 CARLISLE PII<E
MECHANICSBUf~G PA 17055
August 18, 1998
OUR INSURED: Barbara Keiter \
OUR CLAIM NUMBER: 5837 A 738330 11-29-199701
DATE OF ACCIDENT: 11-29-1997
PATIENT NAME: Barbara Keiter
After careful review of the attached Peer Review, we are denying payment of your care
from March 1 , 1998 thru present.
Pursuant to Pennsylvania Act 6 of 1990, Section 1797, as stated in Chapter 69.52(H):
"An insured, provider, or insurer may request, in writing, reconsideration of the initial
PRO determination wittlin 30 days from tile date the initial determination is effected. A
PRO may set a reasonable charge for a reconsideration but in no case shall the charge
for a reconsideration exceed the charge for the initial review. An insurer shall make full
payment of the charge for reconsideration to the PRO, but tile amount paid for the
reconsideration shall ultimately be borne by the party against whom a reconsideration
determination is made.
Also, Nationwide Insurance Company is requesting reimbursement in the amount of
$290.40 for the visits from March 2,1998 t11rough March 25, 1998 which Nationwide
paid to you on June 10, 1998.1 have enclosed a self addressed stamped envelope for
your convenience in remilling your payment.
Sincerely,
NATIONWIDE MUTUAL INSURANCE COMPANY
JULIE CARn
Claims Department
717,657.6588
cc:
nOY E COOl< (11(1[Ji!r;'1!,)
l3atL)llrJ I<Cllcr
Any person wl10 kno'.'.'inpl,,' 8nd \viO, intenl to delriwu ;Ill)! insurance comi'JllJlY or oilier person fdes an
applic31lonlor inSWi1flC(l Oi s\;':,.:.lrl)CClillJl cl:"lirn conlai!\if1~l 2!1Y nl1lcrit::i)' l;i!se inlo~m31ion or conceals for
1I1e purpose of rli!~.,lc.::d:np< It':'orn,;11Jofl cOllcernillfl any lacl /l1.:11CrI31 :l1c!(-:o C0Il11l1:1$;l fraudulent
inSllli1flCe nct, W~l1Ch is It crl:~lC' nrU f,lI\)JC'c\s SolH.:ll ~ PPIS{1!11o clim:n:J1 ~l"j v\':1 penJ.lties.
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COllEY Il. LEES, D. C. (j\ei ter)
Plaintiff
IN TIlE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
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v.
Nationwide Insurance Company
Defendant
NO. 98-7326
CIVIL
RULE 1312.1.
TIle Petition for Appointment of Arbitrators shall be substantially in the following fonn:
PETITION FOR AI'POlNTl\1ENT OF ARlllTRATORS
TO THE HONORABLE, TIlE JUDGES OF SAID COURT:
Robert F. Claraval
respectfully represents that:
I. TIle above-captioned action (or actions) is (are) at issue.
2. TIle claim of the plaintiff in the action is $ 25,000 (approx.) .
TIle coul1lerclaim of the defendal1l in the action is $290.40
, counsel for the plaillliff/dcfendant in the above action (or actions),
TIle following allomeys arc interested in the case(s) as counselor arc otherwise disqualified to sit as arbitrators:
Robert F. Claraval, Esq. (atty for Plaintiff) Girard Ilickards, Esq. (atty for Defendant)
WHEREFORE, your petitioner prays your Honorable Court to appoint three (3) arbitrators to whom the case shall be
submilled.
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AND NOW,
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foregoing petition,
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('OREY It LEES ("<.:iler)
Plaintiff
IN TIlE C()(J/{T OF COl'vl1'vlON PLEAS OF
('I livlll/':RL;\ND COt INT)'. PENNSYL VANIA
I'.
No. <)S,7J2(,
NATIONWIDE /NSURANCI,
COMPANY,
CIVil. MTION - LA W
DL'lcndant
.IIJRY TRI^,~ DUvlANDED
/'LAINTIFF'S REI'L Y TO DEFENDANT'S
NEW I\IATTEI~ AND COI1NTEnCLAl1\1
Nell' Matter
40. No answer is required.
41. Denied, Paragraph 41 is a eondusion oflaw to whieh no response is required.
42. Denied. Paragraph 42 is a L'Ol1dusion oflml' to which no response is required.
4~, Denied. Paraeranh 4,1 is a Cilndusiou oflaw to which no response is required.
44. Deuied, Paragraph 4.1 is a l'lIl1dllsion oflaw to II hieh no response is required.
.1:;. 1 knied, Par;li'raph 4:; is a l'Ondusion oflal\' 10 II hieh no response is required.
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54. Denied. It is dellied thai the Iklclldallt Nationwide is entitled to the return
orallY monies.
55. ^dmilled in part and denied in part. It is admitted that Nationwide has
rcquested reimbursellli:nt. It is denied that any reimbursemcnt is ill litet owing.
Dale: ~ll~IQL_______
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I:' ROHERT F. CL^R^ V M,
P.O. Box] 1965
lIarrisblll'g, I' ^ 17108-1965
(717) 233-4780
Supreme Court LD. II] 9222
^ttorney li)r I'laintirr
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Thc languagc of thc j()rcgoing documcnt is that of counsel and not necessarily my
own: however. I havc rcad the j()rcgoing documcnt and tothc cxtentlhat it is hased upon inrormation
that I havc gi\'cnto counseL it is truc and eorrectto the best or my knowledge. inl(mnation. and
bclicr: to the cx((~ntthatthe contcnt of the I(ll'egoing documcnt is that or counscL I ha\'e relied upon
counsel in making this vcrijjcation.
I understand that any !:llse statements hercin arc made subjcctto the pcnaltics of IS
l'a.C.S.A.. ~4l)()4. relating to unS\\On1 !:llsilication to authorities,
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COREY R. LEES (I-:~ikr)
Plaintiff
IN TilE CllLJRT (IF ('()tI,1MON Pl.EAS OF
('lltlfllFRIAND COlINTY. PENNSYL V ANI;\
v.
No. (lX-7326
NATIONWIDE INSURANCE
COMPANY.
CIVIL ACTION - LA \V
Dd'~ndant
.fURY TRIAL DEMANDED
CE.BTIFI.f'A'[E OI~S.ERVICE
I h~r~hy ~~rtiIY that I ha\'~ this day s~n'~d a tru~ and ~orre~t copy of the attached
I'lainlifl's Rcply to Dcr~ndant's New Mattcr and Counterclaim hy lirsl class mail. postage prepaid.
addressed 10 Ihe !cJllowing person:
(iirard I,:, Rickards. Esq.
21-1 S~nate A \'~nll~
Suite, ~(JJ
Camp I Iill. I'A J 7()J I
IWBFRTI,. CLARA VAL. LSQ,
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('OR!'Y R, II'I'S. D.C,
(1I;Irh:lr" "c'iln)
\
('1\'11. A( TIO:\-I.A II
1''''llIlill'
: IN Till; ('01 KI OI'TO:\I:\IO;-': PLEAS OF
: ('1 ::\lIll;RI..\ND ('01 ''\IY. PE;-':NSYL\,.'\NI..\
NATIONWIDE INSI :RA:\( T.
Ddelld:1Il1
NO. liS-7:l2lJ
.IUR Y TRIAL DEMANDED
.,onCE - ,\,"ENI)E1) COMI'L..\INT
YOU IIA \'L IlLE:\ Sl iFD IN ('OURT. If IUU wish to dt:l<:nd ag:llnstlhe claims
. ~
set I(mh ill thL' 1()llo\\'lng pages, )'OU IIIIISI take :IClioll with ill twent)' (20) days alicr Ihis
Cnmplainl and Nlllicc arc SLTI'cd hy enterillg a wrillcn "ppearance personally or hy "ltorney alld
liling in \\Titing \\ ith Ihe e\lUrI )'llur dell'lIses \II' uhjL'eli\llls 1\1 the claims set I(\rlh against you.
You arc W"J'Ill'd Ihal 11')'\111 1;lill\l dn S\I. IhL' L'ase m"y proeL'l'd lIilholll )'011. "nd "jlldgmt:l1ll11"Y
he clltered "g"llIsl )'Iltl hy the e\lllrl IIlth\llll l(trlhL'r IIntiee I(n "II)' mone)' c1"IIIICd in lhe
('\lmplaim \II' /ilr :1Il)' \llher cl:llm III' 1L'lid rL'qtlcslc:d hy the PI"inliff Y\l1I 111<Iy I\lse lIloncy or
proPLTI)' \II' otlwr rights imp\lrl:tlll 1\1 )'Otl,
YOU SIIOUI.D TAKE TillS PAPER TO YOUR LA \vYER AT ONCE, IF
YOU no NOT IIA \'1' A L\ WYI:R OR CANNOT AFFORD ONE. GO TO OR TELEPHONE
TIlE OFFICE SET l'ORTlI HEI.O\\' TO FIND 01.''1' WHERE YOU CAN GET LEGAL HELP.
('lll/lERI...\Nn COUNTY
( \lllrl ..\dlllillistratllr
I'otlrlh Floor
('lIl1llwrJ"nd C\ltlllt)' C,'tlrlh\luse
C"rlisiL'.I'A J 7tJ!:l
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COREY R. LEI'S. D.C.
(Barbara K<:ikr)
: IN Till' ('Ollln ()/o I 'O~I~I( IN I'II'..\S ()/o
: ('I1~IIlFRI:\ND COliN I Y.I'L:\NS\'JV.'\NI:\
1'1;,illlif'J'
CIVil, :\C IIOj\;,I:\\\'
\'.
NATION\\'IDI'INSl:R..\N(T.
Ikli:ndalll
:\0, '!S-7.12t,
.fURY TRI/\1. J)I'~I:\NIJLD
Al\IENIlEI) (,0i\1 PLAINT
f, Tb<: I'lailllift: Dr. ('or<:y R, L<:L's. is a liccnsL'd chimpr:,ctor \litb an oJ'iic.:
at (>I OJ Carlisi.: I'ikc. ~kcbanicsbur~. CUl11bcrland Counll'. I'cnllSl'lvania.
"- ...
,
Tbc Dcfi..'ndalll, Natiol1l\idc IlIsurancc. 's :In IIlsur:1l1CL' cOl11pany
autbori/cd to do busillcss inlbc ('on1l11on\lcal1b ofl'cnnsy!l'ania and spccifically in CUl11krland
County whcrc Ib;? Ilcll-nd:lI1t sells insura1lcc policics 10 tbc citi/cns ofCul11berland C'1II'lIY, Said
corporation bas :111 oJ'iie.: addrcss of 1'.0, 13,), 2(,55, Ibrrisburg. I'cnnsylvania 17! 05,
B,\('!..:(;ROUNIl
:;. Tb.: D<:/,:ndant L'llI.:rcd inlo a c,)ntracl ofinsllranc<: \lith Barhara K.:ikr.
~. ThL' polic\ of ilbllr;lncL' issll.:d hy Ih.: Ikll-l1d;lIl1 \las inIL'n,Ic'd 10 111.:.:tlhc
r.:quir<:l11.:nts of the I'L'l1nsy!l:lnia ~dolor VL'hick hnan<:ial R.:sponsibilily' 1:11\. 75 I'S ~ 1701 <:1.
SL'q... :IS ;nnL'ndL\1. ;lI1d 1,) pro\ idL' lirsl pany hL'11L'lils 1<\ ILuh:lla KcilLT in aCL'Ol\l:tnL'L' \I ith thL'
Ja\l ,
. . .' , : . ,~ ,~ '. '.' ',', .' !" .,'. " '.', :: \ '," '. '.' : . . , . ." - "
, 'I hL' h"I]L'Jils pl'lIlid,'d illcludc'd L'lIl"'l'age li,r 1I1,'diL'al alld chiropl'aL'tiL'
ScTl'ic'CS rC'lIdL'red tll Barhal'a K";Ic'r ill IhL' el'elll thai she \Vas injllred as the result of;] 1ll1l1,1]'
\'L'hie'" aeeidellt.
II, On Novelllher 2<), I <)<J7. !l;]rbara Keiler suffered pel'slInal ]IlJIll'les as the
resull of a nltllor \'L'hicle aL'L'i,knt.
7, B;nb;]I';] K,'ilc'!' slIlIghl alld Iwei\'L'd e;lre Ii-CIIII Plailllill Dr. Lees. \\'hich
L'lInsislL'd llf c'hiropr;]Clic tl'callllcllls. Illanipulations and olher nllldalilies III aid ill hL'l' recover\'
Ihlllllhe persoJwl illjuries shL' sul/ered as a reslllt Oflhe 1110101' \'ehielc aecidcllt.
~;, Dr, L,'l's mUlin,'ly bilkd thc IkklHbnl Itlr Ihc sen'lLes 11L'!'lllrllled ill
;]CC<1]'tbllel' 1\;lh Ihl' \lllllll' \'l'hick l'illallci;i1 Rl'spllllsibilny 1.;11\,
'), I hL' I >ell-lld:I]JI allL'gedly had a "pcL'r re\'ie\\''' acclllllplishL'd ;Illd upon thc
hasis lIf Ih,' pL'cT rl'\ il'lI ]l'(llSl'd 10 pay I"l' ;]11.1 ,'hil'opraclic treallllcnls Ill]' lbrbara Keiter aliL'r
\lardl I. J ')<)S, Thl' ;i1k",'d Pl'lT I'L'l ]l'l\ plTlilrlllc'd did 1101 prllp,'!'Iy' tillioll Ihc pcer revie\\'
Prol'l'SS oUllin,'d ill ;,' P;L (',S;\, ~ 17<n(h) ;l/1d Ihe applic;Ji)k r",glllatiOlls,
1]1, Ih ;Ipphjn,.' li)1' ;lIliJ h"Ill'iilill.l' Ihllllthe P"'T 1'L'liC'1I prOCess sel 1llJ111 al 7S
1',\ (' S,\, ,~I-"-. ]I'l' Ill',,"Il.!,]!]1 IS ]l'<j"ill'd I<l hl' l'lIllil",1' II Jlh "lid ]lIlikr.'I""d all "fth,' ;\,:t I>
1\';,!lJbI1l1Ih ;ll'plll.:,dlk In :l1v J1l'L'J 1\'\ h.'\\ Jlll)l'l'~S.
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II, :\s illdlcakd hy thL' I'l'er rL'\'iL'1I rL'port d;lll.'d :\lIL:llSI 13. 1 qq~. Ikklldalll
dL'llied all paymellt Il)r care relldered 10 Ilarhara KeitL'r alier \Iareh I. I')')S, Said aL.tioll hy
lklClld;lIlt violates the Motor Vehicle Fillallcial Respol1sihility Law lI'hich is set Il)rth at 7S 1':\,
l'..S,:\, ~ 17\)7 (COllllllOllly kllOWll as :\CI (,) alld Ihe ;Ipplil'ahle rL'~IlI;ltiollS.
12, 111 additioll 10 the ahm'L' rel,:rel1ccd violatiolls or :\ct (). the Iklclldallt also
violated Act (i alld ils re~ulatiolls ill sc\wal other illstallcl's. First. pllrsuallt to Act (, reglllatioll
()').52(d). a I'RO's illitial determillatioll shall he c,'mplcled \\ithinthirt)' (311) d;l)'s alier receipt ot'
requestL'd illl,mllaliill1,
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13. The Lkklldalll sellt the llecessary dllclIlllelllatiilll 10 Ihc PRO Oil JlIlle I.
I')LJS. ThL' PRO repnrt was llot COlllPIcted ulltil :\U~lIS1 i.'.I'i'JS, :\ trlle alld correct cnpy ot'tllL'
PRO rL'lll)rt is allaclled hereto ;lIld 11IadL' a part hLTL'Ot' ;IS hhihit ...'\,.. Thercll'I\'. the PI{() repnrt
"'.IS nul L'l'1lllplclL'd \\ithinlhirly (,Ill .Lly.... ;l1llT I"l'l'l'ipl drlllc rl'I.!I1L'skd iilfi.mll;l1inn S;lid ;u'liIHl
"
,
is ill \ iolatiolll't' AL't () rqClilalioll _' I 1';1.. ('ode ~()'),S2(d),
,
'.
14. Pursuallt It. Act (1 rL'glllali'Hl :'1 1';1.. (',,,Ic ~ (,'),S3\l'). " PRO sh;1I1 ;Ippl)'
n;l1inn;d tll" \,hl'll ;1J1prupri;llc. l\.'~~lt\ll;l! l1(\rlll~ 111 l'(ll1dlll'ljl1~ lkilTllllll.llllll1:-. Ill' l':-.Lthli:-.h \\ritlL'n
lTItCli;J ha:"l'I,J lllh\l\ \~Pll';ll p:llkll1S {l( jlLIl.:lll......'. III Ill..., IL'\ iL'\\. i )r, .k...,.... 1'. '\l'Il1illl' ;lpplll'S :1
1111.:111\1(1 nr' tll..';IIII1I..'111 lJll:lll'l'I'h...'d h." 111\\:-,1 \l{ till' l'hllnpr;lllil' phdl"~"hlJl .llld \\111l-IlI'" III 1111 \\;t~
l'l'I1:'ldl'I\'d ;111;lli\1ILd Ill' rl'~!IUI[;lll1\ll"ll1, \1\l/\'11\ l.T. I h .-\l"lIlllli.: ;jPJll;l'~ Ill'" 0\\ II Ilplll11\l1.
"
21, III his p~~r rc'\'i~\\', Ik Arl1lill~ rd~rs 10 th~ CiljiddillL's li'r CjJiropractic
Oualilv Assuralll'~ alld I'r:lcticc l'ar:il1l~t<:rs as stalldards 1(,1' chiropracti~ ~arl', It is aVl'rr~d thai
th~s~ guidelill~s ar~ Ilot to b~ us~d as stalldards 01' chiropraclic car~ by thc books 0\\'11
illstructiolls,
1) Dr. Arl1lillc I'urthcr violates thc Act Il regulatiolls by slatillg that because
Dr. Lces did Ilot li,llo\\' the i'vkrcy Guidelill~s that his car~ \\'as unr~asollablc :iIld ullll~c~ssary.
l'
_.1.
It is a\'clwd that th~ opilliolls alld r~l'llI1lIll~I](latioIlS 01' Dr. Arl1lille arc
il1lpropcT alld his a~liollS d~l1lollstrate a \\illl'ul illtellt Oil thc part 01' DeJ<:lldallt to d~IlY Dr. L~es
paym~lIt li'r his car~ alld tn::ltm~llt "I' Barbara Kc'it~r.
24, It is lilrther :l\wr~d that USlllg th~ guiddill~s li'oll1 Ih~ (juiddill~s fill:
,Chirolwl!:!ic Oualil\' Assllr:IIlC~' :l1l~LlJ:;I~'licc'-P:JIiWl<.1crs as stalldards of c:lrc cOlltrary to the
blJt1k's dirc;.'l:ollS. to lTaluak illt..: l'dle gi\"L'11 hy Dr. Lel's. is l1lislcadlllg and ~rossly llnj~lir to Dr.
I,~es,
~). It is <l\l'ITl'd tl1at thl' npinitlJls ;lIld fCCOllllllL'IHlatinIlS of Dr. Armine an:
IlIlprc'p~r :ll1d his actiolls d~lI1l1llstrate a \\illfill illtellt Oil the P:lrt 01' Dc1l:lldallt 10 dell}' Dr. Lecs
p.:lYIlli.'1H I~lr his C;lrL' ;lnd lrl';llllll']ll \l( Ibrh;lra Kl'illT.
clJ, Ikklld:lllt IC';HI 1), ,\lIlIil1"'-' il1l\i:d Pl'lT rc'\ il'\\' alld ,kllicd Ih~ claim "I'
Dr Il'l'-' ha,,'d Oli Dr. ,\rillllll"-' "PIIlIl1I'" l'\l'll th(\u,,1: Ihl'\ \\'LTe ;11\ arc Ih;Jt 1)1, Armillc h:ld Ilot
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appli~d national ur r~giunal slandards or c;lr~ .IS r~quirL'd in A~I (, rL'gulation } I I'a, ('od~
~(11).52(~) or ~slahlish~d \l'rillen critcria to conduClhis rc'\iCII as required hy Acl (, r~gulalion}1
I'a, Code ~(I').5}(e). Such actions demonstrate "no reasonahle Itllllldalion" and should b~
CDnsidered \\'anlon.
27, ThL' Ikll:ndant, hy its o\l'n admission. con"id~red such improJ1~r actions
and \'iolations hy Dr. Armine and us~d Ihal hnJ1roJ1~r rCl'o/'IIO dCII,I' Ih~ claim or Dr. Lees. Such
aClion hy Ih~ Dcll:ndanl dcmonstrates "no r~ason"hle Illlllldalioll" and should he c()nsidcr~d
lIanton.
2S. In his p~er rc\i~\\. Ilr. Arminc aL'knil\\kdgcs that ~LTlain ohjecti\'e lests
produ~ed ahnol'lllal l'c'sults 1111 Barhara KeilLT, ""L'n tlli)ugh Ih~se r~sulls \\'~r~ ProdUCL"/. Ilr.
Arminc's linal opinion \\as that IHI car~ ali~r i\larL'h I. I ')I)S ,hould hL' considercd rcasonahle and
n~cessar\', This dL.tel'lllination hy Ilr. ,\rminc is contradictury to ohjLTti\e lest results,
2'), It is IhL'rL'llll'~ assert~d thai Ihe pL'n re\iL'\\ rl'porl conductcd hy Ilr.
Armine is imJ1mp~r and sholdd not he CDnsidLTL'd a pL'L'r re\iell rcport.
311, It is <I\~rrL'd tl1at th~ Ikll-lld<lnt ,,'.Id thL' pL'L'r IL'\ iL'I\ rcport Ji'om Ill'.
I\rmin~ <lnd \\.IS tl1l'rel(lI'~ <1\\ <Ire orll1e 1ll.IIlY \i,'blions I 11 <It I)r. Arrllin~ ,""11nlillcd,
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31, Th~ D~r~lId:l1l1 d~lIiL'd p:lYlJ1ellt to Dr.. L~~s h:ls~d 011 the p~~r r~I'I~\\'
r~port hy Dr.. Arl1lil1~ L'WI1 IIl\lugh Ih~ l'iol:lliol1s l'lllJ1l11ilt~d hy Ilr.. /\rl1lil1~ ~.\istcd. Su~h :I~tioll
hy D~Jcl1d:l111 dClllol1stmlcs "1111 rC:lson:lhle J(,ul1datillll" :ll1d should bc ~ol1sidercd \\':111 tOil.
3~. Thc trc:ltmcl1t :ll1d ~:lrL' th:lt B:lrh:lra Kcit~r r~c~i\'~d rl'llm Dr.. Lccs hclpcd
to IesS~11 thc pail1 th:lt shc c.\pcricl1ced li'0I11 the crash.
.13. Barbara K~ilcr continued to rClJlIest trcatJlIl'nt Ji\)I1l Dr. Lees bl'C:lLlSL' his
carc cOl1til1u~d to IeSSCI1 her pail1.
,\.j, It is :I\'crrcd Ih:lt :III hills il1currcd heJ(lI'~ al1d ;lIhT the pc~r re\'iL'\1 ;Ire 1:lir
al1d rcasollahle :ll1d thai said Ircall1l~l1t \\;IS l1I~dieally 11~~~ssar~" alld rL'i:lt~d to Ihc :I~~ideI1L
:,5. Thc 1:lir al1d rcasoll:lhl~ sum duc to Dr, LeL's Itlr his ~:lre al1d tr~:ltlllL'lll or
Barhara KcitL'r is Sl~.()~.j.llltog~thcr \lith il1tercst at Twell'e p~re~l1t (I~",,) pL'r YC:lr. pCl1:1lty as
Pl'll\'ilkd hy th~ stat'ltL' ;ll1d reasol1ahk alld ;lclu;1I :lttorncy's ICcs,
,\(), IlcIClld:ll11 h:ls r~rusL'd to pay the h;1I:lllCL' du~ IIl1dcr Ih~ Ienlls ;lI1d
cOllditinl1s nr th~ policy nr iIlSUr;lJ1eL' ;llld thL' PL'l1l1syl\'al1i:l \Iotnr \'L'hick Rcspollsihility' LI\\,
AS:I rL'sl1It or thL' :lttlres;lid. Plailltirr has hL'~11 rl'quired III hirL' llie SL'tTiel's 01':111 attorney 10
eolket the lllL'di,,;1I hills dllC, TherL'lt1re. p"rSU;1I11 to SL.,.tioll J ;'F(h)((>1 or the I'cl1llS.I'iI;1I1ia
:\I,llnr \'ehi,'k Fil1;lJ1L'ial R,:spoIlSlhiJity I ;1\1, I'Liil1lit't'ls l'lItitkd In a 1I1;llld:t't<ry ;I\\;ll'd "r
attorne~"s J'ees. intcrL'st and costs associated \\'ith bringing this action. Sce Stcl:lI1ik 1'. St:lte
Farllllnsuranl'L' ('olllj1am: I J:, D:lllph, 277 (I')l):,).
n. Defendant has undertakcn a coursc oj' action \\'hich has bccn designcd to
unilatcrallv. alld \\'ithout justilication. reJ'use claim li)r medical bellelits and cause l3arbara Keiter
, ,
to become personally responsible Ii)!' medical bill;; arising out oj' the maintenance or use oj' a
motor \'ehicle'. in contradiction to the terms oj' the contract. Pennsylvania )\010101' Vehicle
Financial Responsibility I ,a\\' and the case la\\' oj' the ConlllHlI1\\'ealth oj' Pennsyh ania.
:1~, 7:' I'a, C.S,A. ~17'>7 grants standing to the prol'ider (Dr. Lees) to
challenge bL'ii)re:1 Cllllrt an insurer's rclils:d to pay IiII' past or lillure medicaltreallnent. Conduct
considered 10 be \\':lI1ton shall be snbjccI to :1 payment 01' treble damagcs to the injured party,
See Stcl:lI1ik \" SI:IlL' Fann !nsur~I1ll'L' ('on!jl;JJD: 11:' Dauph, 277 ( I l)'):,).
,\<!, 'I he abuse oj' thL' PL'L'I' relie\\ syslL'm by Defendanl as described ablll'e is
"\\'anton" lill' the reasons speL'i lically set li,rth :lbOlL',
.\
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\\'IIEREFORE. I'lail1lilT dcnwnds judgmcnt against Defcndant Illr compcnsatory
damagcs of S 12,024.1 O. trcblc damagcs of S~(),072,,10. intcrcst atthc ratc llf 12'~';, pCI' annull1 and
reasonable and actual attorneys' tces and Cllsts llf sui!.
Rcspectfully submilled.
BUTLER LAW FIWvl
Allorneys Ill!' Plaintiff
Dale:
(1 k~ i ~il
'.'1-1,
!
By
./j' .. { /
I? (i;/'0:~.{"[:(
l{l;~';llI6~I31ItiL:I:: Es,,;,ire
I D iiO')S2(,
.Iana C. Bntler, Esqnire
Ii) 'iSOS74
SOIJ Nllrth Third Str,'L'l
1'.0. IJO\ if I( 14
Ilarrisburg. I'A 171 OS
(7171 n(l-14SS
')
P. 002
VF.RJF1'CA TION
The language of the foregoing document is thai of counsellllld not nece5Jlarily my own;
however. 1 ha\'c read !he foregoing document and 10 the extent that i. is based upon information
!hat 1 bave given to COUllScI, it is lnJe and oorrccl to the best of my knowledge, infonnation lD1d
belief; to the extent that the content of the foregoing document is thai uf cOUllsel, I have relied
upon coUnsel in making this verilicatio:,.
r understand that any false statements herein are made subject 10 the penalties of 18
Pa.C.S.A. ~ 4909, relating to unsworn falsification 10 authorities.
Date:
q,);)-s('~
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,"'\ /' ~. -~-"'"
':. t (. . . _
Dt' foriy R. Lees
.
;!) _ C'?
.:r~sS P. ARMINE, R.N., D.c., DABEM, DABFE
2710 TOWNSHIP LINE ROAD
UPPER DARBy, PA 19082
August 13, 199B
Cla~ms Rev~ew Assoc~ates
700 Amer~can Avenue
Su~te 300
K~ng of Prussia, PA 19406
Attn:
Suzanne Sehl, RN
RE:
SSN:
DOI:
CRA #:
Barbara Rei tel'
211-34-8268
11/29/97
002214396-01
Dear Ms. Sehl,
I received a request to perform a peer review concerning the
reasonable~ess and necessity of the chiropractic care afforded
the above captioned patient. My opinion is based on a review of
the enclosed documentation and reference to the Guidelines for
Ch~ropractic Quality Assurance and Pract~ce Parameters also known
as the Mercy Conference Guidelines.
DOCUMENTS SUBMITTED FOR REVIEW
Application for benefits dated 12/12/97.
From Corey R, Lees, D.C. narrative report dated 1/15/95,
ha~8Written office notes dated 12/1/97 through 5/11/98 and copies
of bills dated 12/1/97 thro~gh 5/29/98,
SUMMARy OF RECORDS
This 53 year old female was the driver of a vehicle involved in a
motor,vehicle accident on 11/29/97. The records show that the
patient was proceeding through an intersection when another
vehicle came through the stop sign hitting her vehicle on the
driver's side "'ith enc.ugh impact to spin her vehicle
approxirna:cly 180 degrCEs, There was no record of e~ergency care.
'.
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COREY R. LEES (Keiter)
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY. PENNSYLVANIA
: .' . ',.' :,' <' . ' '\., " <, ".. , '\: ,<" ,. '., " '
vs.
98-7326 CIVIL
CIVIL ACTION - LA W
NATIONWIDE INSURANCE
COMPANY.
Defendant
JURY TRIAL DEMANDED
ORDEI~
AND NOW. this 10 . day of March. 200 I. a brief argument on the within discovery
motion is set for Thursday. April 26. 2001. at 1:30 p.l11. in Courtroom Number 4, Cumberland
County Courthouse. Carlisle. I' A.
BY THE COURT.
.+d.
Robert F. Claraval. Esquire
For the Plaintiff
Girard E. Rickards. Esquire
For the Defendant
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COREY R. LEES (Keiter)
I'laintil'f
IN TilE COURT OF COMMON I'LEAS OF
CUMBERLAND CO! JNTY. PENNSYLVANIA
v.
No. 98-7326
NATIONWIDE INSURANCE
COMPANY.
CIVIL ACTION - LA W
Dcfcndant
JURY TRIAL DEMANDED
ORIlER
AND NOW this
day of
.___.2001. a discovcry
confcrcnce is set for
.2001 at
.111. in Chambers.
BY TilE COURT:
JUDGE
, ':, ' ", 1"" J '." '" ,': " ", ' .,' .', . " ","',"" \ '. ,
It is assumed that by the time the conlcrence occurs that there will be answers but likely with
objections. In addition. I'laintilrs counsel has prepared a subpocna to be issued to the peer review
organization in this case. Clail11s Revicw Associates. It is anticipated that delcnse counsel will also
objcct to that subpoena and thcrel(lre an Order Ii'om this Ilonorable Court scheduling a discovery
eonfcrence is requested.
3. Counsel 1l1r the Plaintil'l' Dr. Corcy Lees is Robert F. Claraval. P.O. Box
I 1965. Harrisburg. P A 17108- I 965. (717) 233-4780. Counsellllr the DelCndant Nationwide is
Girard E. Rickards. Esq.. 214 Senate Avenue. Suite 503. Camp IliIl. P A 170 I 1. (717) 731-0988.
4. The Honorable Judge Kcvin Hess previollsly issued a Discovery Order in this
case regarding Plaintiffs Answers to Dekndant', Interrogatories.
WHEREFORE. the parties respcctlidly request that this I IonorabIe Court schedule
a discovery confercnce to rcview these mallers and to issue an appropriate Order.
Date: .....3t2?:ig----..
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ROIlI:R"! I.. CLARA V,\1.
P.O. ll,lX 11 %5
lIarrishurg.PA 171OX-l%5
(717) ~3:;-.17X()
Supreme Court I.D. '11')222
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COREY R. LEES (Keiter)
Plaintiff
IN TIlE COURT OF COMl'vlON PLEAS OF
CI !MIlERLAND COUNTY. PENNSYLV ANlA
v.
No. lJX-7326
NATIONWIDE INSURANCE
COMPANY.
CI VII, ACTION - LA W
Defcndant
; JURY TRIAL DEr-dANDED
CEI~T1FICATE OF SERVICE
I hcreby eertifY that I have this day scrvcd a true and correel copy oflhe allached
Plaintin's MOlion/(lr a Discovcry Confcrence Pursllantto Cumbcrland County Local Rule 206-1
and 246-2 and Local Rule 4001-1 by first class mail. postage prepaid. addressed to the f(ll/owing
person:
(Jirard E. Rickards. Esq.
214 Senate A venue
Suitc 503
Campllill.PA 17011
ROIlERT F. CLARA VAL. ESQ.
Dale: _ 2~ )>) KJ I
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DENISE l. WILLIAMS. Seerelary
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COREY R. LEES
PlaintilT
IN TilE COURT OF COMMON PLEAS OF
CIH'vlllERI.AND COUNTY. I'ENNSYLV ANIA
vs,
'iX-7.12(, CIVIl.
CIVIL ACTION - LA W
NATIONWIDE INSURANCE
COMPANY.
Dcfendant
JURY TRIAl. DEMANDED
IN RE: OBJECTIONS OF DEFENDANT. NATIONWIDE INSURANCE COMPANY
ORDER
AND NOW. this %. <;! duy of May. 2001. Jollowing argument thereoll. thc
objections ofdclcndant, Nationwidc Insuranee Company. to a subpoena to produee documcnfs or
things addrcsscd to Jess P. Armine. D.C.. are DENIED and the dcJcndant ;s dirccted to respond.
IW TilE COURT.
/lL
Robert F. ClaravaL Esquire
For thc Plaintiff
Girard E. Rickards. Esquire
For the Dc fend ant
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COREY R. LEES (Keiter)
I'laintilT
IN TIlE COURT OF COMMON PLEAS OF
CUMBERLAND Cot JNTY. PENNSYI. VANIA
v.
No. ')X-7326
NATIONWIDE INSURANCE
COMPANY.
; CIVIL ACTION - LA \V
Dclcndant
; JURY TRIAL DEMANDED
CERTrFICATE OF SERVICE
I hereby certifY that I have this day served Plaintilrs Response to Dclcndant's
Interrogatorics (Set I) by first class l11ail. postage prepaid. addressed to the Illllowing pcrsons;
W. Darren Powell. Esq.
Rubinate. Jacobs & Saba
214 Senate A venue
Suite 503
Call1pllill.l'A 17011
ROBERT F. CLARA VAL. ESQUIRE.
Date; _:a.jlCJ~.L'.L__
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lly_LL() U.L.l.()JJliLLcu Il\!)
DENISE I. WILLIAMS. Secrct;ry
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COREY R. LEES (Keiter)
Plaintiff
IN nil' ('Oll/n OF COMMON PLEAS OF
('lll'vlIlERI.AND COlINTY, PENNSYL V AN/A
, .'
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v.
Nil. ()X-731()
NATIONWIDE /NSlJRANC/:
COMPANY.
; CIVIl. ACTION - I.A \V
Delendant
: JURY TRIAL DEMANDED
n:nTlFICATE OF SEnVICE
I hereby certifY that I have this day served Plaintifrs Rcsponsc to Defcndant's
Requcst for Production Ill' Documents by first class mail. postage prepaid. addressed to thc following
pcrsons:
Girard Rickards. Esq.
Ruhinale. Jacobs & Saba
214 Senate A venue
Suite 50.1
Camp I lill. PA 17011
IWIlERT f-. CLARA VAL. ESQUlRE.
Dale; .aJ81/0L
By j1nA~..LD~(-~
Df-NISI'1. W/L1.1AMS. Secretary
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98HB.0 1008
LAW OFFICES OF JACOBS & SABA
214 Senate Avenue, Suite 503
Camp Hill, PA 17011
Telephone Number: (717) 731-0988
Attorneys for Defendant Nationwide Insllrance
IN THE COURT OF COMMON PLEAS
COREY R. LEES, CUMBERLAND COUNTY, PENNSYLVANIA
PLAINTIFF
VS.
No. 98-7326
',.". . "', '., ' I ','" .,~, . . , . " ;0' '.. .", , k',' . '
NATIONWIDE INSURANCE,
DEFENDANT
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
OBJECTIONS OF DEFENDANT NATIONWIDE INSURANCE
TO SUBPOENA TO PRODUCE DOCUMENTS OR THINGS
ADlJRESSED TO JESS P. ARMINE, D.C. PURSUANT TO P A. R.c.P. 4009.21(C)
I. This lawsuit arises from the denial of payment of chiropractic bills submittcd by the
Plaintiff to the Defcndant as a result of a pcer review under the Pennsylvania Motor Vchicle
financial Rcsponsibility Act.
2. On February 8. 2001, defcnsc counsel reccived a copy ofa Noticc oflntcntion to Scrvc
Subpocna attachcd hcrcto as Exhibit "A" and incorporatcd hcrcin by rcfcrcncc,
3. The subpocna is impropcr on its facc in that it contains a caption in thc Court of
Common Pleas of Dauphin County. Pcnnsylvania. whcrcas this action is pcnding in thc Court of
Common PIcas of Cumberland County. Pcnnsylvania.
4. Thc targct ofthc subpocna, Dr Jcss P Arminc, is a liccnsed chiropractor who will
testify as an cxpert witness on bchalf of Defendant Nationwide Insurance Company,
5. The proposcd subpoena seeks information regarding Dr. Arminc's incomc from Claims
Review Associatcs, a peer revicw organization from \994 through 1999. Claims Revicw
Associates is not a party to this lawsuit.
6. The Plaintiffs proposed subpoena also requests financial information, advcrtising
literature, research materials, etc., all of which are beyond the scope of discovery pcrmillcd by
Pa.R.C.P.94003.5.
7. The Defendant's expert would be required to expend substantial time, effort and
expense in order to compile the materials requested by the Plaintiff.
8. Defendant Nationwide Insurance Company objccts to the Plaintiffs subpoena on the
basis that it is beyond the scope of permissible discovery under the Pennsylvania Rules of Civil
Procedure, it is unreasonably burdensome and oppressive upon the Dcfendant's expcrt, and is not
calculated to lead to the discovery of information relevant to the facts at issue.
WHEREFORE, Defendant Nationwide Insurance Company respectfully requests your
Honorable Court to sustain its objcction to the Plaintiff's Noticc oflntentto Scrve Subpocna
upon Dr. Jess P. Armine.
Respcctfully submittcd,
Date:
March 9.2001
LAW OFFlCJ.OS OF JACOBS & SABA
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/ Girard'E Rickards, Esquirc
214 Senatc Avcnuc. Suitc 503
Camp Hill, PA 1701\
Attorncy 1'0. Dcfendant
Court 1'\), No. 58867
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Exhibit A
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COi\Ii\IONWEA J:rll OF PENNSYLVANIA
COUNTY OF DAUI'IIIN
COREY R. LEES (Keiter)
Plaintiff
v.
File No.
7326 S 1998
-
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NATIONWIDE INSURANCE COMPANY,
Defendant
~llJ.J:.!.JElB__TLU~Bim!lLE12!JL!lrlU~0i'I"S ()ll.TIlJl~~5.!"'''-
H)l>,Jll~CUn;KL!j,lH 0l[A~i:J':':'L<HU)J,.c!'; 4()()'} ,~1
TO;
Dr. Jess P. Armine
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\\'jthin {WL'nty (20) lb;:,'; ilfter :;en'jcL' oflhi..... :";llbpiil':il;\, ymi ,1ft:' 1,1i\ki'ld bj' till' 1.,.'ulIr( III plOdUL'l' till' fullilwillg d()("IlIllL'lltS Or' 111!1:;:\'
Legible copies __Q,L~ll...Qocum~nt;s i~?Ilt;Hieq,.J.l1__thE!...!'ttacJ:led Ad.Qendum
________.Lo_Subpoena.._____.__ _. __._____________
at
125 Locust Street, Harrisburg, PA 17101
U\ddrL"')
You may deliver or m:tillcgible copics Ill' tbc dOCUIIll'Ilh or produc~ lhin,~,; rC<jllestcd by tbis subpocna, t"~L'll"'1
witb tbe certificatc or l"ompliance,to tlte pany making tbis reqn~st altltc IIddress list~d "bovc. 'You bav~ thc ri"b:
to seck. in advance. {hL~ r~asol1;lhk cost of preparing the L'opies or producing the things sOllghL
Iryou rail to prodll~c tb~ dl1CIlIl1L'nts or thiogs rl'quircd by Ibis sllhp""II:1, \\'ilhilltW~III)' (20j ,bys :Ii"t~r its SCIY;,,'.
Ihe p;uty scrying this subl'OClJ:l Illa)' seck a COllrl order l'lIlnl'~llilli' ) lIlI II) cnnlply with i!.
THIS Subpoena WAS ISSUED AT TIlE RUJUEST OF Ti IE j'()L1.O\\'INli I'EI\S00:;
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_J.l0rf)SC..cT.J d'il.JOZlllli:..J.965_. ..._.
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(717) 233-,1780
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COREY R, LEES (Keiter)
Plaintiff
IN THE COURT OF COf\livlON PLEAS OF
DAUPIIIN COUNTY. PENNSYLVANIA
Y.
1\:0, 9t{-7326
NATIONWIDE INSURANCE
COMPANY,
CIViL ACTIO:-': - LA \V
Defcndant
.JURY TRIAL DEMANDED
ADDENlltJM TO SUBPOENA TQ
DR ,JESS P. ARMINE
1. All billings to Claims Reyicw Associates by Dr. Annine for services rcndcred
to Claims Review Associatcs li'om I <)94 through 1999. The Respondent may simply list thc dollar
amount by year.
') A certilied statcment lrom counsel !()r Dr. Arminc that he has cxamincd the
lax returns of Dr. Armine from 1 <)(J4 through 1999 and \\'hat thc pcrcentagc of income gencrated
by billings to Claims Rc\'ie\\' Assoeiales by year is as compared to Dr. Arminc's gross incomc from
his practice.
3. All billings 10 N;!tion\\'ide Insurance by Dr. Arminc for scrviccs rcndercd to
NatiOI1\\'ide Insuranl'C li'om I 9().lthrough ] 'J')'). ThL' Rcspondcnlmay simply list thc dollar amount
by year.
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4. A certified statement I'rol11 Dr. Armine's counselllJr that he has examil1l~d the
tax returns 01' Dr. Arl1lillC from I 'N.) thwugh I 'Jl)') lUld I\hatthl' pCrCl'lltllge of incomL' gellL'l"ated
by billings to Nationl\'ide Insurance hy year is as compared to Dr. Armine's gross income li'om his
practiee.
5. Copy of eurrent curriculum vitae.
6. Any advcrtising literature that you send to either peer rel'iew organizations
and/or insurallce companies.
7. Any advertising literature. brochures or other materials 1l1r patients.
8. Any materials. research literaturc. trL>alises.lext orotherdocuments which you
reIy on in l,mllulating your PRO report inthis case ollly. including but not limited to any documcnts
which purponedly state nJtional or regionalnOl"I11S or typical paltcrns of practice I'll' chiropraetors,
9. The number of PRO's. lmO's or J\lI:'s done ~J.:ill 1"c)r Claims Reviel\'
Associates by Dr. Armine ji-om I ')').) to I I)')'),
10. TIll' :llIml1l'r of PHO',. I JI(O'" or 1\11', dtt 11 l' hy_year 1(11' Natiolll\'id,'
IIlSlll'dlll'l' h~ Dl. .'\rJI1Jll~' IJI'llI I \)').1 hI II;",}.
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LA W OFFICES OF ./ACOBS & SABA
214 Senate Avenne, Snite 503
Cnlllp Hill, PA 17011
Telephone Nnmber: (717) 731-0988
Allorne s for Defendant Nationwide Insnrnnce
. , .' , . ' T "', , " ," ,I ~-". . " '."'; '.' , . _ .
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COREY R. LEES,
PLAINTIFF
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
VS.
No. 98-7326
NATIONWIDE INSURANCE,
DEFENDANT
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
CERTIFICA TE OF SERVICE
I, Girard E. Rickards, Esquire, hercby certifies that he is the attorney for the
Defendant herein, and that he caused a true and correct copy of Obiections of Defendant
Nationwide Insurance to Subpocna to Produce Documcnts or Thin~s Addressed to Jess P.
Arnlinc. D.C. Pursuant to Pa.R.C.p. 4009.21 to be scrved by regular first class mail upon:
Robcrt F. Claraval, Esquirc
P.O. Box 11933
125 Locust Strcet
Harrisburg, PA 17108-1933
--
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Girard E. Rickards, Esquire
Attorncy (or Defendant
Daled:
March 9. 2001
"', '. , .
"
9RIIIl-O I OOR
LAW OFFICES OIl.JACOBS & SABA
214 Senate Avenue, Snite 503
Camp Hill, PA 17011
Telephone Number: (717) 731-0988
Attorneys for Defendant Nationwide IUSurlluce
IN THE COURT OF COMMON PLEAS
COREY R. LEES, CUMBERLAND COUNTY, PENNSYLVANIA
PLAINTIFF
VS.
No. 98-7326
NA TIONWIDE INSURANCE,
DEFENDANT
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
ORDER
AND NOW, this
311'L- D f
ayo
200 I, upon considcration
;li; tJ" II-It- '7
of the Defendant's Motion to Compcl Answers to Intcrrogatories, said Motion is hereby grantcd.
The Plaintiff is ordercd to providc::s'::~~o thc Defendant's Inlcrrogalories within ;::: 0
days ofscrvice of this Ordcr, or suffcr sanctions pursuant to Pa.RC.P. Rulc 4019.
BY THE COURT:
Datc:
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LA W OFFICES OF ,JACOBS & SABA
214 Senate Avenue, Suite 503
Camp IIiIl, I'A 1701 I
Telephone Number: (717) 731-0988
Attorneys for Defendant Nationwide Insurance
COREY R. LEES,
PLAINTIFF
VS.
NA TIONWlDE INSURANCE,
DEFENDANT
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
No. 98-7326
CIVIL ACTION - LA W
JURY TRIAL DEMANDED
DEFENDANT'S MOTION TO COMPEL ANSWERS TO INTERROGATORIES
I. This lawsuit is an appeal from a decision rendcrcd by District Justice Placey in favor of
Defendant Nationwidc Insurancc on Dccembcr 17, 1998.
2, The Plaintiffs Complaint was filed on or about January 28, 1999 and sceks rccovcry of
chiroprac.\ic bills incurred by Barbara Keitcr, a Nationwide insured, following a motor vehicle
accident of Novembcr 29,1997.
3. Dcfcndanl Nationwidc Insurance dcnicd paymcnt ofthcsc chiropractic expcnses as a
rcsult of a pccr rcvicw.
4. On March 29, 2000, Dcfendant Nationwidc Insurance scrvcd upon Plaintiffs counscl a
sct oflntcrrogatories. A tme and corrcct copy Oflhc Dcfcndant's Intcrrogatories to Plaintiff are
attached hcrcto as Exhibit "A" and incorporatcd hercin by refcrcncc.
, -:. - - , \ ' ',' , " . ' '.:' ~:'" - - ," , - , ",.', ,,' , .:' :
5. On scvcral occasions, defcnsc counsel has writtcn to Plaintiff's counscl requcsting thc
answers to Defcndant's Intcrrogatorics.
6. As of this date, the Plaintiff has failed to respond to the Defendant's Intcrrogatories,
cither by answering or objecting to the Interrogatories.
7. The Plaintiffs answcrs to Defendant's Interrogatories are overduc.
WHEREFORE, Defendant Nationwide Insurance respectfully requcsts your Honorablc
Court to enter an Order compelling the Plaintiff to answcr the Defendant's Interrogatories by a
date certain, or suffer sanctions pursuant to Pa.R.C.P. 94019.
Respcctfully submitted,
Datc: January 26. 200 I
LAW OFFICES OF JACOBS & SABA
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_.." Girard Ii, Rickards, Esquire
214 Senatc Avcnue, Suite 503
Camp Hill, PA 17011
Attorney for Dcfcndant
Court J.D. No. _ 58867
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I. Slate your full name and currcnt address.
ANSWER:
2. State your social security number.
ANSWER:
3. State and itemize by date of service the total CUITCnt amount of "outstanding" invokes
for your services which you fecI Dcfendant is responsible. Identify whether the
amounts so identified are Act 6 amounts.
ANSWER:
\ ., \, ",: " , .",..', -", ,..', ' ' , , , . ~ , ,." . , ' '. , . ',' , .
4. PIC<ISC idcntify whethcr you havc a standard billing schcdulc(s) for scrviccs you provide
to customcrs. If you do, please provide a copy(ics) of this schedulc(s) by attaching a
copy hereto, Pleasc statc whether your fee schedule is thc same for all customers~
whether covcred by insurance or not.
ANSWER:
5. Please identify the person or persons who acts or has acted as the bookkeeper for your
office during the last five (5) years.
ANSWER:
"
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6. Please idcntify with panicularity your professional edueation and cmploymcnt
history. You may attach a copy of your current curriculum vitac, if such
infomJation is contained therein.'
ANSWER:
7. Identify with particularity all licenses or certifications held. Also, identify
whether you have been under investigation by any licensing body and whether
you have had any professional license suspended or revoked.
ANSWER:
~
8. Have you been involved in any othcr lawsuits against any Insurance company in
which you sought recovcry of bills for payment of scrvices you rcndcred to thcir
insured? If so, please idclllify such cascs with particularity, including the court
and dockct number of each such casc.
ANSWER:
,
98HB..() 1008
LA W OFFICES OF JACOBS & SABA
214 Senate Avenue, Suite 503
Camp Hill, PA 17011
Telephone Number: (717) 731-0988
Attorne s for Defendant Nationwide Insurance
IN TilE COURT OF COMMON PLEAS
COREY R. LEES, CUMBERLAND COUNTY, PENNSYLVANIA
PLAINTIFF
VS.
No. 98-7326
NATIONWIDE INSURANCE,
DEFENDANT
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
CERTIFICATE OF SERVICE
I, Girard E. Rickards, Esquire, hereby certifies that he is the attorney for the
Defendanl herein, and that he caused a true and correct copy of Defendant's Motion to
Compel Answers to Interrogatories to be served by regular first class mail upon:
Robcrt F. Claraval, Esquire
1'.0. Box 11933
125 Locust Strcet
Harrisburg, P A 17108-1933
Dated: January 26, 2001
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_/ GirJrd'E. Rickards, Esquire
Attorney for Dcfendant
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COREY R. LEES (Keiter)
Plaintiff
I N TilE COIJRT OF COMMON PLI~AS OF
Cllrvllll'RI.ANIl COUNTY. I'ENNSYI. VANIA
v.
No. <JX. 73~(,
NATIONWIDE INSURANCE
COMPANY.
CIVIl. ACTION -I.AW
Delcndant
JURY TRIAl. DEMANDED
RIlLE TO SIIOW CAliSE
AND NOW. this ____.:?;,,~ del)' 01'__ 1<.~~-,-_. 2001. upon consideration
of Plaintilrs Petition Illl' Rule to Show Cause why sanctions should not be entered. a Rule is hereby
issued upon Dr. Jcss Armine that within -....J.S"'-_ days he show cause ifany he has why sanctions
as requested by Plaintiff should not be issued.
Scrvice shall be made by PlaintilTon Dr. Armine by cali lied and reuglar mail and
on Nationwide's counsel bv rel,ular mail.
IIY TIlE COURT;
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4. It is the pr:lctice 01" Dr. Armine 10 refilsc to cooperale with Orders issned by
Judges ol"the Courts ol"Comlllon Picas with respeclto similar Subpoenas. For e,\ample. in the c:tSl'
of Dr. David n. Smilh v. Slate Farm. No. 50X5 S I 'i'lX. Judge Todd I/oovcr ol"the Court ofCollllllon
Picas of Dauphin County ordered Dr. j\nnine to comply with the Subpoena. No response was
forthcoming and Dr. Armine was precluded fi'ollltestil)'ing inlhat case. A copy of Judge Hoover's
Ordcr is allaehed hereto as Exhibit B.
5. Judge IloOlw's Order fines Dr. Armine the SUIll 01"$150 for willful contempt
and precludes li'om testifYing at the arbitration or trialoflhe aClion,
6. A similar Order is requested to be issued by Ihis Cour! givcn Dr. Armine's
rcfusal to comply with the Order issucd by Judge Hess and givcnlJr. Armine's provcn course of
conduct in refusing to comply with Cour! Orders.
WIIEREFORE. the Plaintiff respL'ctlul!y rL'quest that Ihis Honorable Court issue a
Rule to Show Cause why monetary sunctions should not be enlc'red against Dr. Arminc in thc
amount 01'$150 and why he should not he precludcd li"Om tcstif)ing at the arbitration or trial Oflhis
action. A pmposed Rule is allachcd.
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Respectfully submitted.
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Ily~ti;{':!,J.~ ~_,_,'_(~~,L :"IV}/
, ROllFIU F. CLARA VAl. I"
1'.0. Box 11%5
lIarrisburg. I' A 171 OS- J 965
(717) 233-4780
Supreme Court I.D. II I 9222
Attorney j,))" I'laintifl'
, :. . . ., " , '" - '~:" ,,':' , -,' .' ,. ':' : ,', ", ~ , .' .' : " ,.
COREY R. LEES (Keitcr)
Plaintiff
v.
NATIONWIDE INSURANCE
COMPANY.
Defendant
IN Till: Cot !In OF cm.IMON PI.I,AS OF
l'lJi\lIlI'RI.ANIl COlJNTY.PENNSYLVANIA
No. 'iX-732()
CIVIL ACTION - I.A \\'
.I11R'r' TRIAl. 1li'~lANDED
CERTIFICATE OF SERVICE
I hereby certify thall have this day served a true and corrcct copy or the attached
PlaintiIrs I'ctition I"l' Rule to Show Cause Why Sanction,; Shonld Not Be Entered by lirst class
mail. postage prepaid. addresscd to the Illllo\\ing persons;
Date:.~' IliA /
Girard E. Rickards, Esq.
~ 14 Senate A \'enUL'
Suite 503
Camplliil.PA 17011
Ilr. .less 1'. Arminc
~71 0 Township l.ine Road
llppcr Darby. P/\ I ')()X~
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COREY It LEES
Plaintiff
vs,
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COlJNTY, PENNSYLVANIA
NATlON\VlDE INSURANCE
COMPANY,
Defcndant
<)S.7326 CIVIL
CIVIL ACTION - LA W
IN RE: OBJECTIONS OF DEFENDANT. NATIONWIDE INSURANCE COMPANY
JURY TRIAL DEMANDED
ORDER
AND NOW, this :c::! day of May, 200 I, following argumcnt thcrcon, the
objcetions of dcfcndant, Nationwide Insurancc Company. to a subpocna to producc documents or
things addrcssed to Jcss 1'. Armine. D.C., are DENIED and the defcndant is dirceted to respond,
BY TIlE COURT.
Robcrt F. Claraval. Esquire
For thc PJaintilr
Kevin . Hess, J.
Girard E. Rickards, Esquire
For thc Dcfendant
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DR, DA VID II, SMITJ I,
(Magaw),
IN TIlE COURT OF COMMON PLEAS OF
DAUPIIIN COUNTY, PENNSYLVANIA
PlaintilT
: CIVIL M:TION-Li\ \V
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STATE FARM INSUI{ANCE
COMPANY,
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: JURY TRIAL DEMANDEIJ.;::-:',
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Defcndant
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ORDI~R
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ANDNOW.this~ dayof~":y'-!~_, 2001, upon consideration
ofPlaintiWs Motion for Contempt and Sanctions, it is here hy ORDERED that Dr. Jcss Armine pay
the sum 01'$150 within _3.0_ d:JYS~~this Order as a sanction for his willful contcmpt
in refusing to comply with this Court's Orders of October 6,2000 and Deccmber 20,2000.
Furthcr, Dr. Armine is precludcd from testifying at the arbitration or trial of this
action.
IIY TIlE COURT;
/7
~4!e!2~iIf!~,{~l.
TODD A. IIOUVER, Judge
JAN 2 f, 2001
Plolhonolary
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Pfioor OF SEHV:C~E 'JF Nealei,: .JF /\PPEl.L Mil::, RULE TO FILE COMPl.AINT
(TfilS (J!()(:f c-! d\'!!> ,"-~i;:':1 i"! ; Ii;
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COMMONWEftLfH ()! ;-'H/!'hil Vld{lh
COlJt"ril' ~)r_
AFFIDAViT;
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, COMMONWEALTH OF PENNSYL VANIA
r.OUNTY OF: CUMBERLAND
g8~'73~(, Civ;(
..
NOTICE OF JUDGMENTiTRANSCRIPT
CIVIL CASE
PLAINTI,:r: NAMI: Md "Oflflr~;~;
'LEES, DR. COREY '"l
6103 CARLISLE PIKE
MECHANICSBURG, PA 17055
L ~
Mdg DI~I No
09-3-04
OJNalno H(1fl
THOMAS A. PLACEY
''''''''' 104 S. SPOR'rrNG HILL RD.
MECHANICSBURG, PA
VS.
'",,,,,,,,, 1717 I 761- 8230
DEFENDANT: t,AML: 3nd AOOfll:)!J
INATIONWIDE INSURANCE
P.O. BOX 2655
HARRISBURG, PA 17105
L
Docket No.; CV-0000578-98
Dato Filed; 11/05/98
'"l
17055
DR. COREY LEES
6103 CARLISLE PIKE
MECHANICSBURG,PA 17055
~
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THIS IS TO NOTIFY YOU THAT:
Judgment: FOR DRFRNnANT
[i) Judgment was entered for; (Name) N1<'I'TnNWTnR HJ!'lTTR1<NC"R
[i) Judgment was entered against; (Name) -LEES----..DR...-.CORE~
in the amount 01 $
--.alL on;
(Date of Judgment)
1?/17.~_
o Defendants are jointly and severally liable.
o Damages will be assessed on;
o This case dismissed without prejudice.
(Date & Time) ..
Amount of Judgment
Judgment Costs
Interest 011 Judgment
Attorney Fees
Total
$-
$
$
$
$
.00
.00
.00
.00
.00
O ArMunt 01 Judgment Subject to
AttachmenVAct 5 ot 1996 $
o levy is stayed for __ days or 0 generally stayed.
Pos' Judgment Credits
Post Judgment Costs
$
$
------------
------------
o Objection to levy has been filed and hearing will be held;
I Certified Judgment Total $
EV'"
Time;
'--
Place;
I
,
J
ANY PARTY HAS THE RIGHT TO APPEAL WITHIN 30 DAYS AFTER THE ENTRY OF JUDG'-!ENT BY FILING A NOTICE
OF APPEAL WITH THE PAOTH F COMMON PLEAS, CIVIL DIVISION, YOU
MUST INCLUDE A C F THI 0 CE OF JUDGMENTfTRANSCR T FORM WITH YOUR NOTICE OF APPEAl..
J.a. \ l-q~ Date
. District Justice
Ja..:.f1::_<L8. Date .__ _. ___
, District Justice
I cel1ify that fhis is a truo and .
~
'e ocord ollhe proceedings cor aining the jud[lmenl.
SEAL
~_.
My commission expires first Monday 01 Jafluary,
AOPC 31 5,9G
004
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COMMONWIALTH Of PINNSYLVANIA
COUAT OF COMMON FLEAS
NOTICE OF APPEAL
FP.OM
JUDICIAL DISTRICT
DISTRICT JUSTICE JUDGMENT
COMMON PUAS No. (I 8 - '7 J A. L. t, v,
NOTICE OF APPEAL
Notice is given that the appellant has filed in lhe obove Court of Common Plea< on appeal from the judgment rendered by the District Justice on the
date and in the case mentionod below.
r ~DREY LEES _
\:!r at
AI''tTo'3l1AHc'Of k::Je
DATE or ~Nr
CV11!
lT 19
This block will be ~gned ONLY when this notation is required under Po. RCPJ.I',No.
100811.
This Notice of Appeal, when received by the District Justice, will operate os 0
SUPERSEDEAS to the judgment for possession in this case.
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IN THE ASf (PItI,rt,ft}
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aTr STAre
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"" N iA1L,nu)lc! t:,J(~ '1I ,-'(.1-\(.(..._
5lGNATlIllE Of APPELLANT HIS AnORNt;y OR ....GENT
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If appellant was CLAIMANT (see Pa. R.C.P,J.P. No.
1001 (6) in action before District Justice, he MUST
FILE A COMPLAINT within twenty (20) days after
filing his NOTICE of APPEAL
P1nLti
CODE
I'lur'c.-
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Signature of Prothonotary or Deputy
PRAECIPE TO ENTER RULE TO FILE COMPLAINT AND RULE TO FILE
fT/lis section of form to be used ONLY when appellant was DEFENDANT (see Pa, HC.P.J.P, No. 1001(7) in action before DistJict Justice.
IF NOT USE.D, detEch from copy of notice of appeal 10 be served upon appeliee).
PRAECIPE: To Prothonotary
Enter rute upon
, oppellee(s), to file a complaint in this appeal
Name of awe/lac( sJ
(Convnon Plt.as No.
) within twenty (20) days oller service of rule Q( suffer entry of judgment of non pra~
Signature 01 appellant 01 hts attomGy Of agnrI
RULE: To
,oppellee(s).
NNne 01 _k1e(sl
(1) You are no~fied thot a rule is hereby entered upon Y"" to liIe 0 <""l'loint in this appeal within twenty (20) days after the dote of
service of this rule upon you by peroonat service Q( by certified Q( registe<ed mtlIt
(2) If you do not file 0 complaint within this time, 0 JUDGMENT OF NON PROS WIll BE ENTERED AGAINST YOU,
(3) The cY.lte of ><rvice of this rule if .<<vi<<! was by moil is the dote of moiling.
Dote:
,19_.
Sq10Ilre 01 Aul/lo'lohry Of ~
N:lJI'C311-64
COURT FILE
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PROOF OF SERVICE OF NOTICE OF APPEAL AND RULE TO FILE COMPLAINT
(This proof af MlIVico MUST BE FILED ~""1THIN TEN (10) DAYS AFTER fi/inU Ifw nnticlJ of appeal, C/liJck [~pp/icablo boxes)
COMMONWEALTH Of PENNSYLVANIA
COUNTY OF_(\.\.~~tf.~....L_____-_--
;u
AFFIDAVIT: I hereby swear or affirm that I served
/'h i1 COPV 01111& ;~oliCd 01 Appcr,l, Common PJL';)~ NC' _9~;)?" 3-~'~-.- tJ~on H~f:;) District .J,u5tice designated ~tlerein o,n
(dal" of servico) _______....____________..__ , LJ by per'onal SOl vice LJ by (CertltlfHi) (reglstcrclj) mall, sender s
receip1 attacherlllcrelo, 31111 upon the app~lIee, (/laf1l(:) ._,,_i{q...'ft':~W~(..-J,.~S- -, on
-I "-:.~.!:....___ ,19.Y-;7- 0 11Y r:er;wni11 sI;rviro:; l(9by (certilicd:, (regIstered) mall, ~fmder's receipt attaclled hereto.
~ ;,n,d t:Jr.I~c,rtl1at I S8:~,C,d tile RulLO 10 Fb~a Complain I acevnl\J;fnY:,'Hl tl;!' "~uv" r:O:i~e of AP:e~I,:JPOn tile ~ppel.ICe(S) IO,w:'om
,hI r":dl.. I;\dS .Hj()le.,,-,cd on _.__1-__.1:._______..___.__,__,_ , 1.1.:7-2 I J b." IJ~r,:,ondl SHVIl.C f11 by (certified) (registered)
.. . .
mail. ~"(~fldpr'~ receipt attached tWIl'tt)
SWORN (AFFIRI.'ED)i\ND SUf.\SCHIBED 5[FO[<[ ME
TH~IS ~_._._. !JAY OF )JI..!:'!I~-'-1- _, , 19_I,~..,
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COREY R. LEES,
PlaintifT
IN TilE COURT OF COMMON PLEAS
CUMBERI.AND COUNTY. PENNSYLVANIA
v.
No, '1:?' 7J}, 6' 19<jll"/
NATIONWIDE INSURANCE,
Defendant
COMPI,AllIT
AND NOW cOl11es Plaintitl: Pro sc, Corey R Lecs, and tilcs this Complaint, based upon
the following:
I. Plaintiff. Dr. Corey R Lccs, is a Doctor of Chiropractic who has an officc
at6103 Carlisle Pike. Mechaniesburg. Cumberland County, Pennsylvania 17055.
2. Defendant, NATIONWIDE INSURANCE, is a corporate cntity doing business at 1'0
box 2655 HarTisburg PA 17105-9971
3. On 0811 8/97 Defcndant refused paymenl for services on thcir insured. Barb Kcitcr,
for dates of service 03/02/97 through present for care regarding thc motor vehicle
accidcnt of 11/29/97.
4. The Defcndant's refu~al to pay IVas based on the recommcndations of a Peer Rcview
rcport.
5, The Plaintiff contests that the care is mcdically necessary.
WHEREFORE, PlaintilTrequcsts Your Honorable Court to entcr a Judgmcnt against the
Dcfendant in thc amount 01'$5504.85 plus Judgment costs and interest.
Respectfully submillcd,
Date ) - ), ~ ~ <17n~
._-../----~._--)..._-"'. -/--. ( '.
Dr Core\' R L~
V~".,~,..~:~~
I
YERlELCAIlOl'J
I, PLAINTIFF, COREY R. LEES. verify tbat tbe facts set forth in the foregoing
Complaint are truc and correct 10 the best of my knowledgc, inlilrlllation and belief.
I understand thai false statements herein are made subject to the penalties of 18
Pa. C.S,A. 4904 relating to unsworn falsification to authorities.
..--/
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Co > R Lees, Plaintiff
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PROPIEDAD 0 OTROS DERECHOS IMPORTANTES. USTED
DEBE LLEVAR ESTA NOTICIA A SU ABOG~DO EN SEGUIDA.
SI USTED NO TIENE ABOGADO 0 NO TIENE CON QUE PAGAR
LOS SERVICIOS DE UN ABOGADO, VAYA 0 LLAMF. A LA
OFICINA ESCRITA ABAJO PARA AVERIGUAR A DONDE USTED
PUEDE OBTENER LA AYUDA LEGAL.
Cumberland County Bar Association
2 Liberty Avenue
Carlisle, PA 17013
Telephone: (717) 249-3166
or
1-800-990-9108
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LA W OFFICES OF JACOBS & SABA
W. Darren Powell, Esquire
214 Senate Avenue, Suite 503
Camp Hill, PA 170/1
Telephone Number: (717) 731-0988
Attorne for Defendant Nationwide Insurance
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COREY R. LEES,
PLAINTIFF
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
VS.
No. 98-7326
NA TIONWIDE INSURANCE,
DEFENDANT
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
ANSWER WITH NEW MATTER AND COUNTER CLAIM OF DEFENDANT
NATIONWIDE INSURANCE TO PLAINTIFF'S COMPLAINT
AND NOW, comes the Defendant, Nationwide Insurance, by and through it's attorney,
W, Darren Powell, Esquire and in support of this Answcr with New Matter and Counler
Claim of Defendant Nationwide Insurance to Plaintiffs Complaint hereby avers as follows:
1. Admitted.
2. Admitted.
3. Admitted in part. denied in part. It is admitted that Barhara Kcitcr was, at times
relative hereto, insured with Dcfcndant under an automobile insurance policy. It is further
admitted that Defcndant dcnied paymcnt of bills for dates of scrvice beginning March 2, 1997.
All other avcnncnls are dcnied pursuant to Pa.R.C.P. I029(c).
4. Admitted. By way of furthcr responsc, a copy of thc PRO report issued by Dr. Jess
AmJinc is allached hcreto as Exhibit "A".
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5. Dcnied. Paragraph 5 is gcncrally dcnied pursuant to Pa.R.C.p. gI029(c). By
furthcr responsc, it is averred that thc carc was ncither medically neccssary or reasonablc.
NEW MATIER
6. Paragraphs one (I) through six (6) are incorporated hcrein by reference, and madc a
part hereof as if set forth in full.
7. Defendant has paid all benefits required under the applicable insurance policy and
applk.able law.
8. Plaintiffs alleged damages are specifically limited to those remedies provided undcr
the Pennsylvania Motor Vehicle Financial Responsibility Law.
9. Plaintiff's claims are barred by the applicable statute of limitation.
10. Plaintiff has failed to state a cause of action upon which relief may be granted.
I L The Pennsylvania Motor Vehicle Financial Responsibility Law and the regulations
thereunder govern the payment of first party benefits under the Pcnnsylvania Motor Vehicle
Financial Responsibility Law.
12. Said laws, including the Health Care Cost Containmcnt regulations sets forth a
comprehensive system for payment of first party medical benefits for persons covered by
automobile insurance policies.
13. Said regulations providc paymcnt at certain rates for bills for scrvices and goods
provided in aecordance with thc act and regulations.
14. In addition, the law providcs for a pccr review procedure under which thc
reasonableness and necessity of the treatmcnt or goods can be asccrtained prior to.
reimburscmcnt or paymcnt of a bill.
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15. Thc paymcnt systcm sct forth by the Pcnnsylvania Motor Vehiclc Financial
Rcsponsibility Law and the regulations promulgated thcrcundcr require that Plaintiff or his
providcr submit a bills for scrviccs or products provided. Plaintiff has failed to submit any
such bill.
WHEREFORE, thc Dcfendant respectfully prays this Honorablc Court to dismiss
Plaintiff's Complaint and to enter judgment in favor of the Defendant.
COUNTER CLAIM
Nationwide Insurance v. Corey Lees
16. Paragraphs I through 15 of this Answer with New Mattcr and Counter Claim are
incorporated herein by refcrence.
17. On or about August 13, 1998, Dr. Jess Armine conducted a Peer Review in
accordance with the Pennsylvania Motor Vehicle Financial Responsibility Law.
18. Dr. Annine determined that the care provided beyond Mareh I, 1998 was not
medically reasonablc or neccssary.
19. By letter dated August 18, 1998, a copy of Dr. Arminc's report was forwarded
onto Plaintiff. A copy of said August 18, 1998 letter is attached hereto as Exhibit "B".
20. Nationwide Insurancc, prior to thc PRO report, had paid $290.40 to Plaintiff for
visits between March 2, 1998 through March 25, 1998. Thc scrviccs provided on said datcs
wcre determined not to be medically reasonable or necessary by the PRO.
21. Defcndant is entitled to return of thc $290.40, plus intcrest thcreon at the rate of
12 % pcr annum.
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22. Defendant has requested reimbursement of said amount, but paymcnt has not been
WHEREFORE, Nationwide Insurance respectfully requests that this Honorable Court
enter judgment in its favor and against Corey Lees in the amount of $290.40, plus interests
and costs.
Date:
Respectfully submitted,
LAW OFFICES OF JACOBS & SABA
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W. Darrell Powell, Esquire
Attorney for Dcfcndant Nationwide Ins.
214 Senate Avcnue, Suite 503
Camp Hill, PA 17011
Telephone No. (717) 731-0988
Identification No.68953
98HB.{IIO08
LA W OFFICES OF JACOBS & SABA
W. Darren Powell, Esquire
214 Senate Avenue, Suite 503
Camp Hill, PA 17011
Telephone Number: (717) 731-0988
Attorne for Defendant Nationwide Insurance
COREY R. LEES,
PLAINTIFF
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
VS.
No. 98-7326
NA TIONWIDE INSURANCE,
DEFENDANT
CIVIL ACTION - LA W
JURY TRIAL DEMANDED
VERIFICA TION
W. Darren Powell, Esquire, hereby Slates that he is attorney for Defendant,
Nationwide Insurance, in this action, and is authorized to verify that the slatements made in
the foregoing pleading are true and correct to the best of his knowledge, infonnation and
belief. The undersigned understands that the slatements therein are made subject to the
penalties of 18 Pa.C.S.A. g4904 relating to unsworn falsification to authorities.
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'W:Darren Powcll, Esqui
Attorney for Dcfcndant Nationwide Insurance
Dated:
July 23. 1999
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98/18-1) 1008
LA W OFFICES OF JACOBS & SABA
W. Darren Powell, Esquire
214 Senate Aveuue, Suite 503
Camp Hill, PA 17011
Telephone Number: (717) 731-0988
Attorne for Defendant Nationwide Insurance
COREY R. LEES,
PLAINTIFF
VS.
NATIONWIDE INSURANCE,
DEFENDANT
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
No. 98-7326
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
CERTlFICA TE OF SERVICE
W. Darren Powell, Esquire, hereby certifies that he is the attorney for thc Defendant
herein, and that he caused a tme and correct copy of Answer with New Matter and Counter
Claim of Defendant Nationwide Insurance to Plaintiff's ComoJaint to be served by regular first
class mail upon:
Dr. Corey Lces
6103 Carlislc Pike
Mcchanicsburg, P A 17055
Dated:
July 23. 1999
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w. D;mcn Powell, Esquire
Allorncy for Defcndant
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Exhibit A
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JESS P. ARMINE, R.N., D.C., DABFM, DAB FE
2710 TOWNSHIP LINE ROAD
UPPER DARBY, PA 19082
August 13, 1998
Claims Review Associates
700 American Avenue
Suite 300
King of Prussia, FA 19406
Attn:
Suzanne Sehl, RN
RE:
SSN:
DOl:
CRA #:
Barbara Keiter
211-34-8268
11/29/97
002214396-01
Dear Ms. Sehl,
I received a request to perform a peer review concerning the
reasonable~ess and necessity of the chiropractic care afforded
the above captioned patient. My opinion is based on a review of
the enclosed documentation and reference to the Guidelines for
Chiropractic Quality Assurance and Practice Parameters also known
as the Mercy Conference Guidelines.
DOCUMENTS SUBMITTED FOR REVIEW
Application for benefits dated 12/12/97.
From Corey R. Lees, D.C. narrative report dated 1/l~/96,
ha~dwritte~ office notes dated 12/1/97 through 5/1:/95 a~d copies
of bills daced 12/1/97 thro~9h 5/29/98.
SUMMARy OF RECORDS
This 53 year old female was the driver of a vehicle involved in a
motor vehicle accident on 11/29/97. The records show that the
patient was proceeding through an intersection when another
vehicle came through the stop sign hitting her vehicle on the
(jrjvcrl~ sjejo with ~rl(!uatl irnp~c1: to Spill tlPr vehic1c
2pproxim2tel~' 180 degre~s. Ttlere was no ~ecord of ~~elge~cy care.
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.RE: BARBARA KEITER
PAGE 2
According to the records the patient presented to Dr. Lees on
12/1/97. According to the narrative report the diagnoses were
739.1 nonal1opathic lesions of cervical region, 847.0 neck
sprain, 847.2 lumbar sprain and 739.3, subluxation. According to
the bills the diagnoses were 719.4 and 723.2. The treatment was
chiropractic adjustments and adjunctive therapies.
According to the records an EMG and thermography tests were
preformed. It appears that each test was done twice once in 1997
and once in 1998. The dates and results are partially illegible
due to poor copy quality.
The records show that the patient was seen by Dr. Lees 15 times
in 12/97, 13 times in 1198, 12 times in 2/98, 13 times in 3/98,
13 times in 4/98 and 10 times in 5/98 for a total of 76 visits.
There are no notes'concerning the last visits.
TELEPHONE CONFERENCE WITH ATTENDING PHYSICIAN
None requested.
CLINICAL OPINION
It is my opinion that the care rendered this patient from 12/1/97
through 3/1/98 was reasonable and necessary in this case. It is
my further opinion that the surface EMG's are not appropriate in
this case.
According to the Me~cy Co~fe~ence Guidel~~es care for an
~ncornplicated case sho~ld take app~oxim~:s:y E-6 weeks of care.
The presence of conplicatio~s wil: exte~~ :he amount of ca~e
required to bring a patie~t to a level 0: ~aximum benefit.
Estimates of care are based on multiples c: the care of an
uncomplicated case.
The complicating factors identified that would delay recovery are
the severity of the accident and the report of the patent's
obesity. According to the 11ercy Guidelines approximately 1.5
timos the care of an uncClmplicdtcd cC::~_~c ,:J2 weeks) wou]d be
consi.dc!r2d rc;()~;C)Ilr.:t1] t: tJlld nc~c:es~:;(jl-Y i 01" :~;e care 0: the
docurne::~ed cO~ldi~io;~. A=ca~di~g to :tj~ F~c~osed pee~ =evie~
documen~ ~r0~ tt;e P0~~s~'2v2r~la Chiropra=:~: Society thi~ patient
would have 2r~ Objective Cc~plicating Ra:ing of 40, placing this
case i:~ t~e "~~co~plic2:0j/ c~t~go~y,
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98HB-O 1008
LAW OFFICES OF JACOBS & SABA
W. Darren Powell, Esquire
214 Senate Avenue, Suite 503
Camp Hill, PA 17011
Telephone Number: (717) 731-0988
Attorne for Defendant Nationwide Insurance
COREY R. LEES,
PLAINTIFF
VS.
NATIONWIDE INSURANCE,
DEFENDANT
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
No. 98-7326
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
PRAECIPE
TO TIlE PROTIlONOTARY:
Kindly substitute the attached Verification to Answcr with New Matter and Counter
Claim of Defcndant Nationwide Insurance to Plaintiffs Complaint, for the attorney's
Verification that had been fil(".d with the Court on or about July 23, 1999.
Dated:
Aucust 5. 1999
Respectfully submitted,
LAW OFFICES OF JACOBS & SABA
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W. Darren Powcll, Esquire
Attorncy for Dcfcndant
214 Senate Avcnue, Suite 503
Camp Hill, PA 17011
Telcphonc Number (717) 731-0988
Idelllification No. 68953
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9SHB.O 100S
LAW OFFICES OF JACOBS & SABA
W. Darren Powell, Esquire
214 Senate Avenue, Suite 503
Camp Hill, PA 17011
Telephone Number: (717) 731-0988
Attorney for Defendant Nationwide Insurance
COREY R. LEES,
PLAINTIFF
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYL v ANfA
VS.
No. 98-7326
NATIONWIDE INSURANCE,
DEFENDANT
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
VERIFICATION
I, Ellen Smithers, verify that the statemcnts made in the foregoing Answer with New
Matter and Counter Claim of Defendant Nationwide Insurance to Plaintiffs ComQlaint are tme
and correct to the best of my knowledge, information and belief. I understand that false
statements herein are made subject to the penalties of Pa.C.S.A. ~4904, rclating to unsworn
falsification to authorities.
Dated:
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Ellcn Smithers, Rcprescntativc of
Nationwidc Mutual Insurance Company
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LAW OFFICES OF .IACOBS & SABA
W. Darren Powell, Esquire
214 Senate Avenue, Suite 503
Camp Hill, PA 17011
Telephone Number: (717) 731-0988
Attorney for Defendant Nationwide Insurance
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
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COREY R. LEES,
PLAINTIFF
VS.
No. 98-7326
NATIONWIDE INSURANCE,
DEFENDANT
CiVIL ACTION - LAW
JURY TRIAL DEMANDED
CERTIFICATE OF SERVICE
W. Dan'Cn Powell, Esquire, hereby certifies that he is the attorney for the Defcndant
herein, and that he caused a true and correct copy of Praecipe to Substitute Verification to
Answer with New Matter and Counter Claim of Defendant Nationwide Insurance to Plaintiffs
Complaint to be served by regular first class mail upon:
Dr. Corey Lees
6\ 03 Cariis\c Pikc
Mechanicsburg, PA 17055
Dated:
A\Il!ust 5. 1999
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W. Darren Powell, Esquire OJ
Attorney for Defendant
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DR. COREY LEES.
I'laintilT
v.
NATIONWIDE INSURANCE
COMPANY.
Defcndant
IN TilE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY. I'ENNSYL VANIA
9S-7356
CIVIL ACTION - LA W
JURY TRIAL DEMANDED
CERTIFICATE OF SERVICE
I hcreby certi fy that I have this day served a truc and correct copy of the attachcd
Praccipe to Enter Appcarance by first class mail. postagc prepaid. addresscd to the l(lilowing person:
Datc: __J I (())((
W. Darrcn Powell, Esq.
Rubinate. Jaeobs & Saba
214 Senate Avenue
Suite 503
Campllill.PA 17011
ADLER & CLARA VAL
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DENISE L WILLIAMS. Seeretary
For Robert F. Claraval
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ROBER! r. ClJ\RAVAI
Prothonotary's Oflice
Cumbcrland County Courthouse
One Courthousc Squarc
Carlislc.PA 17013
Re: Lees (Keiter) \', Nationwide
No, 98-7326
Dear Prothonotary:
Robert F. Clara val
Attorney at Law
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SOO NOR III lllH~1J SI RJll, }"0I11 OOR
IIA!.:l\lSBU!.:C, I'A 171tJn.1%:i
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August 29. 200 I
lOUIS I, AIlII R
(I '1'i9.1 (J~I'J)
Ani I R lI. CLAR,\ V AI
(1')7.1.20001
Kindly enclosc this leiteI' in the above lile as all indication that Dr. Jess Armine has complied
with Judge Hess's discovery orders with respe~t to the above matter.
Thank you.
RFC:di\\"
cc: Ll.:l.: !\ 1. I lerman. ES4.
(jirard Ril.k:trds. Esq.
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Plaintifl'
IN TilE COURT OF COMtvl0N PLEAS OF
Cl IMIlERI.AND COUNTY. PI'NNSYLV ANIA
v.
No, <)X-73~6
NATIONWIDE INSURANCE
COMPANY.
CIVIL ACTION - LA W
AND NOW, this
day of
.2001. Dr. Jess P.
Delcndant
JIIRY TRIAL DI'I'v!ANDED
!)IWER
Armine shall answer within ~o days the Subpoena isslIed by PlainliJrs counsel in the above maller.
II) IJIECOURT:
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KEVIN A. IIESS. Judge
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COREY It LEES (Keitcr)
I'laintiff
IN TilE COURT OF COMMON PLEAS OF
CUMIIERLAND COUNTY.PENNSYLV ANIA
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v.
No.9S-7326
NATIONWIDE INSURANCE
COMPANY.
CIVIL ACTION - LA W
Delcndant
JURY TRIAL DEMANDED
PLAINTIFF'S MEMORANDUM IN SUPPORT OF
SUBPOENA TO I'RO DR .IESS 1'. ARMINr<:
The I'ennsylvania Motor Vehicle Financial Responsibility I.aw (MVFRL) at 75 P.S.
* 170 I. et. seq. mandates that health care providers submit billings to the patient's automobile
insurance earrier in the event that the patient/insured was injured in a motor vehicle erash. The
Insurance Department has implemented regulations \\hich are IlHl11d at 31 Pa. Cod<: Chapter 69
*69.1. el. seq.
In this particular ease Dr. Corey l.ees is a chiropractor. Ilis patient Barbara Keiter
was injured in a motor vehicle accident which occurred on November 29. 1997. Ms. Keiter sought
and received care li'ol11 Dr. !.ecs. Aner a pcrio\l of time Nationwide retained Claims Review
Assoeiates of King IlfPrllssia. Pennsylvania to review the care prOl'ided by Dr. Lees 10 dctennine
if the care was reasonable and necessary. Cbims Re\'iell Associates is known as a peer review
organi/~ltion, In turn, Claims Re\'iell' Associates hired Dr. .Ie,;s P. Al1nine. a chiropractor. to review
Dr. I.l'es' rl'cords. Dr. Armine is II ell known (,I the chiropractic community in that he has been
retained literally hundreds of times to review the care that his /Cllow chiropractors have provided to
their patients,
Dr. Armine. as is his usual practice. IllUnd that Dr. Lees' care was not reasonable and
necessary alier March 1. 19'>S. Dr. Armine specilically relt:rred in his written opinion to the Mercy
Conft:rence (iuiddincs. Those guidelincs lIIay 1I0t be used /(Jr the purpose that Dr. Armine bas used
them. In IiICt, a general disclaimer appears at "page iv" of the Mercy Guiddines which reads:
"These guidelines. which may need to be modi lied. are intended to be flexiblc. They arc not
standards of care. Adhercnce to them is voluntary." Further. it reads: "This document may provide
some assistance to third party payers in the evaluation 01' care. but is not by itself a proper basis for
evaluation."
The undcrsigned has rcprc,ented scores of chiropractors in peer review litigation. As
a routine part of that litigation a subpoena is issucd to the peer review chiropractor seeking to
establish \\hat financial ties and othcr bias exists which might sen'c to color the peer review
chiropractor's opinion. That subpoena \\as issued in this case. A copy of the subpoena is attached
as Appcndix A. The insurance carricr Nati\Hl\\ ide has objected to this subpoena. tbus thc necessity
fi.lr the ('<nil"\' s examinati,'n.
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This is not the lirst time that this particular subpoena has been the subject of Court
review. In each case wherc the subpoena has bcen subjeetto scrutiny by the Court. which has most
oftcn been in Dauphin County, the Court has approved the issuancc of the subpoena, To datc.
Dauphin County Judges Clark. Iloover. Evans. Turgeon and Lewis have all upheld the subpocna,
Thc subpoena was Jirst uscd in a Fedcral court casc known as Ko!!od v. Span~ler,
Civil No.1 :CV-97-0608. The subpoena was addressed to both Dr. I'erry Eagle, an orthopedic
surgeon, and to Dr. Cavallo. another peer review doctor. Motions to Quash were tiled, tvlagistrate
Judge J. Andrew Smyser uphcld the subpoena as did Federal Judge William Caldwell. Copies 01'
both the Magistratc's Order and Judge Caldwell's Order are attached as Appcndix B.
In 191)9 the subpoena was again re\'iewed in the case 01' Dr. (Jarv I.cidy v. Allstat<;.
No, 251 S S 1995 (Dauphin County). In that case the peer revicw doctor. again Dr. Cavallo, was
.
instructed by Judge Clark to answer the subpoena. Dr. Caval", rd.uscd to answcr thc subpoena and
on June 10. 1999 Judge Clark precluded him Ihl\l1 testifying in the case and lincd him $ I 50. Copics
of Judge Clark's Orders and othcr relevant documents are attached as Appendix C.
Thc subpoena was next addressed. by Judge I lo()\'er. in thl' l11atter of Ik David 1\,
Smith \'. Statc Farm. No. 50S5 S 11)I)S. ill\'oJ\'ing Dr. Jess Armine \\ho is the same doctor hired by
Nation\\ ide in this case. Judgc 111\(I\Cr (lrdcrcd Dr. Arminc to ans\\cr the subpocna. No answer was
,
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I'orthcoming and he was precluded li'om testifying in the ease, Copies 01' thosc documents are
attached as Appendix D.
The other cascs involving Judges Turgcon, Evans and Lewis did not involve the
issuance of Orders but simply an oral instruction by thc Judge that the subpoenas be answered.
With respect to the applicable case law. the subpocna comports with discovery that
IS permitted of expert witness,~s. For example. in Coward v. Owcns-Cornin!.\ Fibcr!.\lass
Corporations. 729 A.2d (i 14 (Pa. Super 1999). the Court ruled that an expcrt witncss may bc askcd
the amount offccs he was paid in other asbestos litigation over the past ycars. In Smith v, Celotc~.
564 A.2d 209 (Pa. 19__). the witness' linancial intcrest that are demonstrative of any bias hc may
harbor 1l1r the linn retaining him are diseoverable.
A review of the subpoena issued by Dr. Lees indicates that it comports with thc casc
law. Questions fixus on Dr. Armine's billing to Claims Review Assoeiates who was the
intermediary that hired him and the billings to Nationwide lnsuranee. thc carricr that hircd the
intermediary. Dr. ,\nnine's actual income fJ"(\m thosc two sources as wcll as the perccntagc of
income that Dr. Armine eamed as "l"npal\:d to his 0\ erall ,income is requested. Thosc constitute thc
!irst t'Hlr paragraphs of the subpocna.
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Paragraphs 5. 6. and 7 simply ask I,l!' his currem curriculum vitae. any brochures or
advcrtising literature that he sends out to either insurance companies or patients. Paragraph 8 asks
lor the researeh litenHure that he relied on in completing his peer review. Finally. paragraphs 9 and
10 simply request the number of peer reviews. II'vIE's or LJRO's that he has done lor Claims Revicw
Associates and Illr Nationwide Insurance.
Nationwide has o!)ieclcd 10 all orale inillJ'/llation sought. Respeetfully. a copy of his
currieuIum vitae eannot under an)' stretch be objectionable.
The objections liled by Nationwide assert as a basis that Dr. Arminc would be
required to expend substantial time. emJr( and expens(, in order to compile the materials rcqucstcd
by PlaintiO: There is no Af'lidavit attached to the objections of Nationwide to support that
proposition and in luet Dr. Armine has provided the l11aterials subpoenaed in atlcast onc other case.
That inf'lJ"Jllation was provided Ill!' a diOi:rent insurance company and therdl)re would not be
rclevant to this case. but that docs indicate that Dr. Armine has the materials and can producc thcm
when required. Whether or no! Dr. Armine will have to spend substantial timc and Cmlrt is
something that Dr. Armine will have to explain rather than simply an assertion by counsel.
l\:ationwide asscrls that inl'lI'Jl1ation is requested outside of I'a, R.C.P, 4003.5.
Respectfully. Rule 4003.5 has nothing to do \Iith the inlll!malion being sought by this subpocna.
5
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4003.5 pertains to the expert report on the subject matter at issue. Tlull report has becn provided by
Dr. Armine,
Attorney ("1' Plaintiff
The subpoena in this case is directed toward infiJrmation sceking to disclosc the bias
of Dr. Armine and as noted above has been approved by many Judges. The subpoena also comports
with thc applicable case law for questioning that would be permitted of the doctor at the trial ofthc
case.
For all of those reasons. it is respectfully subl11itted that thc Dcfendant's objections
bc dismissed and that an Order requiring Dr, Armine to comply with the subpoena be entered. A
proposed Order is attached,
D",::tLJ.3,)o I
Respectfully submitted.
By~-rt?:&~_ J1
ROBElfflrtr_ARA V AL ~-
P.O. Box 11 %5
Ilarrisburg. I' A 17108-] %5
(717) 233-47S0
Supreme Court I.D.III'J222
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COUNTY OF CUMBERLAND
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COREY R. LEES (Keiter)
Plaintiff
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NATIONWIDE INSURANCE COMPANY,
Defendant
SUBPOENA TO PRODUCE DOCUMENTS ORTHINGS
FOR DISCOVERY PURSUANTTO RULE 4009,22
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F TO; ~~ Jess p-,--Armi.!l~_,__.__._.
INamo of Person or Cntlty)
Within twenty (20) days after service of this subpoena, you are ordered by the court 10 produce tho following
documents or things:
Leqible copies of all documents identified in the attached Addendum to Subpoena.
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!;,' You may deliver or mail legible copies of the? documents or produce things requested by this subpoona, together
l.: with ttle ,certilicate 01 compliance, to the party making ttllS request at the address Iistod above. YOL1 have the right
y;,to seek In advance the roasonable cost of prepallng tlle copies or producing the Ihlngs sought.
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, ~you fail to produce the documents or things required by this subpoena WI 111 in twenty (20) days after its serVice,
~he party serving this subpoena may seek a court order compelling you to comply with it.
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125 Locust Street, Harrisburg, PA
l710l
;(; ~ THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWiNG PERSON:
Name Robert F. Claraval! Esg~____,
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(Rev Bl8:2)
UNITED STATES DISTRICT COURT
FOR THE MIDDLE DISTRICT OF PENNSYLVANIA
SANDRA KANU KOGOD,
CIVIL NO_ 1:CV-97-0608
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(Judge Caldwell)
v.
(Magistrate Judge Smyser)
ANITA M. $PANGL~R,
Defendant
v.
LIAME WHITE,
FILED
HARRISBURG. PA
Third-Party
Defendant,
DEe 17 1997
ORDER
MARY Emf\RE!\. GV,"'!(
Per '
- -
The plaintiff commenced this action by filing a
complaint on April 18, 1997. On May 12, 1997, the defendant
filed an answer to the complaint, and on May 14, 1,997, the
defendant filed a third party complaint. On July 17, 1997, the
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third-party defendant filed an answer to the third-party
complaint.
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custodian of Perry A. Eagle, ~1.D. The subpo.=na requested the
follO\~ing :
All financial records specifically
concerning any Independent Medical
Examinations performed or
depositions of Perry A. Eagle,
M.D., on behalf of Richard Wix,
Esquire, or any other person or
attorn~y of the law firm of Wix,
Wenger and Weidner, of behalf of
State Farm, within the last three
years. Please include the number
of examinations, amount charged for
these examinations, amount charged
for reports, and testimony
concerning those examinations for
the last thirty-six (36) months.
On November 12, 1997, the defendant filed a motion for
a protective order and to quash the subpoena served by the
plaintiff on State Farm Insurance Company. Also, on November
12, 1997, the defendant filed a brief in support of this
motion.
On November 13, 1997, the defendant filed a motion for
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a protective order and to quash the subpoena served by the
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plaintiff on the records custodian of York Hospital. Also on
4
November 13, 1997, the defendant filed a motion for a
protective order and to quash the subpoena served by the
plaintiff on the records custodian of Perry A. Eagle, M.D. On
. November 13, 1997, the defendant filed briefs in support of
these motionq.
On November 24, 1997, the plaintiff filed briefs in
opposition to the three motions filed by the defendant. No
reply briefs have been filed.
The defendant contends that the subpoena to State Farm
Insurance Company should be quashed because evidence of
insurance is not admissible, because evidence of other exams
performed for State Farm or at the direction of defense counsel
are not relevant, because an expert may not be cross-examined
with regard to receipt of fees for medical or legal cases other
than the one being tried, and because the subpoena is unduly
burdensome. The defendant contends that the subpoena to the
records custodian at York Hospital should be quashed because
evidence of Dr. Eagle'" hospital pri.vileges, operating schedule
,
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and procedures performed is not relevant, because the
information requested exceeds that which an expert must provide.
under Fed.R.Civ.p. 26(a) (2) (B), and because the subpoena is
undgly burdensome. The defendant contends that. the subpoena to
the records c~stodian of Dr. Eagle should be quashed because
evidence of insurance is not admissible, because evidence of
other exams performed by Dr. Eagle on behalf of State Farm or
defendant's counsel is not relevant because an expert may not
be cross-examined with regard to receipt of fees for medical or
legal cases other than the one being tried, and because the
subpoena is unduly burdensome.
Federal Rule of Civil Procedure 26(b) (1) provides:
Parties may obtain discovery
regarding any matter, not
privileged, which is relevant to
the subject matter involved in the
pending action, whether it relates
to the claim or defense of the
party seeking discovery or to the
claim or defense of any other
party, including the existence,
description, nature, custody,
condition, and location of any
books, documents or other tangible
things and the identity and
locat.ion ot pt~r:';iOl1~ havill<]
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The plaintiff contends that evidence of other
examinations or work performed by Dr. Eagle on behalf of State
Farm or defendant's counsel which is requested in the subpoenas
to State Fa~~ and the York Hospital is relevant to the issue of
Dr. Eagle:s bias of prejudice. We agree.
Impeachment of an expert witness by demonstrating
partiality to the party for whom the expert is. testifying is
permissible. Smith v, rp.lotpx Cor])...., 564 A.2d 209, 213 (Pa.
Superior Ct. 1989) (citing Gnltski v, Kline, 43 A.2d 142
(1945)). It is proper to elicit from an expert the fee that
the expert is being paid to testify and whether a personal
relationship exists between the expert and either the party
calling him or that party's counsel. Ia. at 214. " [E]vidence of
an ongoing relationship between the witnesses and defense
att.orneys is information which the jury would want to know
about, and ,
. is entitled to kno'N about.n Til2J.u:ziO-Kf'l'y-Y:.....
MontC1,....m'~.J.:;t:, 681 JI..2d 757, 767 (Pa. Superior Ct. 1996) (holding
that plaintiff's counsel should have been allowed to cross-
8
AO 7':.14.
(RevB.'8:'1
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examine the defendants' experts to attempt to show a
professional relationship, beyond the confines of the case at
bar, of the experts and the defense attorneys).
The ~iscovery sought by the plaintiff regarding Dr.
Eagle's wprJc for State Farm and defendant's counsel may be
relevant to Dr. Eagle's bias or prejudice. The discovery
sought by the plaintiff regarding Dr. Eagle's hospital
privileges, operating room schedule and procedures performed
may be relevant to Dr. Eagle's qualifications as an expert.
The defendant states in a conclusory fashion that the
subpoenas are unduly burdensome. If information sought through
discovery is relevant, the burden is on the party opposing
discovery to show that the request is unduly burdensome. See
~er3~ Cip0)lone v~Liggat~ GrQUp. Tnc., 785 F.2d 1108,
1121 (3d Cir. 1986) ("Broad allegations of harm, unsubstantiated
by specific examples or articulated reasoning, do not satisfy
the Rule 26 (c) test."). The defendant has not explained how or
why the subpoenas ari~ unduly burd'2I1som,.:o.
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The fact that the information sought through the
subpoena to the York Hospital is beyond the information that
must be supplied by Fed.R.Civ.P. :l6(a) (2) (B) in connection with
an.~xpert report does not necessarily mean that the information
is not relevant or is unduly burdensome.
"
Finally, we address the defendant's contention that the
plaintiff is attempting to introduce the fact of liability
insurance at trial.
The defendant contends that evidence of
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insurance is not admissible and cites Federal Rule of Evidence
411, which provides:
Evidence that a person was or was
not insured against liability is
not admissible upon the issue
whether the person acted
negligently or otherwise
wrongfully. This rule does not
require the exclusion of evidence
of insurance against liability when
offered for another purpose, such
as proof of agency, ownership, or
control, or bias or prejudice of a
witness.
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First, we are not at the time of trial. Second,
as discuS:~l:,d ab()vc', Dr. E.j'Jl~'s relationship with State Farm
10
A07:..A
(Rev 8/8:?)
and defense counsel may be relevant to the issue of Dr. Eagle's
prejudice or bias.
Based on the foregoing, the defendant's motions for
protective orders and to quash subpoenas will be denied.'
pJ
AND NOW, this /1 day of December, 1997, IT IS HEREBY
ORDERED that the defendant's motions (docs. 16, 19 & 22) for
protective orders and to quash subpoenas are DENIED.
r-
r Smyser
Magistrate Judge
Dated:
December /1, 1997.
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1 We note that although not ra,ised by the parties there is
a seriou~.:; i~:::.Jue ccncera:ing the detendant' s standing to move to quash
the subpoenas at issue since th,~ subpoenas were not iSS\led to the
defendant. s.~ 9A Wright & Miller. E!.:dp r,1. 1 Pr1~i. i ("'(... .1nd Pr()(""pd'ln:r. ~
Civil 2d ~2459 (1995) ("Ordinarily a party has no standing to seek to
qua~::;h <3 :;:;Ubp()l~n;-'. l~:;::;u,~~ti t..) :)("f'nt-:"t]ne \Jho i~:; not a party to t.he action
un l\~~,:;:; th\~ P,:l!:r. ':' CL1 j m:') ;:;I-,m\~ pt;rsc,na 1 ri(?ht or privilege with regard
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AD 72A I
(R.Y.ll!O~1 .1
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IN THE UNITED STATES DISTRICT COURT
FOR THE MIDDLE DISTRICT OF PENNSYLVANIA
SANDRA KANU KOGOD,
Plaintiff
vs.
CIVIL ACTION NO. 1:CV-97-608
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ANITA M. SPANGLER,
Defendant and
Third Party Plaintiff
FILED
HARRISBURG. PA
vs.
LIAME WHITE, JU~J 2 1908
Third Party Defendant I - v
MARY 'NDREA, CLERK
Per
o ROE R
I eputy Cieri<
THE BACKGROUND OF THIS ORDER IS AS FOLLOWS:
This is a personal injury action, arising out of a moto
vehicle accident in 1995. Before us is Plaintiff's motion to
compel (captioned as a motion for contempt) .
On October 30, 1997, Plaintiff subpoenaed certain
financial records of Dr. Perry A. Eagle, Defendant Spangler's
medical expert, as well as certain financial records of State Fa
Insurance Company, pertaining to Dr. Eagle. Defendant moved for a
protective order, and on December 17, 1998, the United States
Magistrate Judge issued an order denying Defendant's motions,
ruling that the records ~n question are discoverable.
On February 4, 1998, Plaintiff filed a motion for
contempt, alleging that Dr. Eagle and State Farm had failed to
comply with the subpoena. This motion was withdrawn by Plaintiff,
after Defendant indicated that she does not intend to call Dr.
Eagle at trial or introduce his report.
Defendant provided Plaintiff with the report of her new
expert, Dr. Mark Cavallo, on March 25, 1998. Dr. Cavallo lists
Dr. Eagle's rep~rt as one of the documents which he reviewed in
preparing his own report. Plaintiff therefore reissued her
subpoenas seeking financial records from Dr. Eagle and State Farm,
and issued new subpoenas seeking similar records from Dr. Cavallo.
Neither the d.oct~r S~qte Farm, nor Defendant responded to the
..--- l,t-e
subpoenas. (Defendant then filed the instant motion, seeking the
......_~~.,-----
production of the subpoenaed documents, as well as sanctions.
Our examination of this issue is somewhat hampered by
the parties' handling of the matter. We note first that while
Plaintiff presents her motion as one seeking contempt sanctions
against State Farm and Doctors Eagle and Cavallo for failure to
the doctors but only on counsel for the Defendants. Because the
comply with the subpoenas, Plaintiff did not serve her motion on
doctors have not received service, we must construe the motion as
one seeking to compel discovel~ from Defendant Spangler.
We note also that Defendant has failed to properly
oppose the motion under the Local Rules. Defendant has indicated
her oPposition to the motion by filing an "Answer. If Local Rule
7.6 requires that:
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M1Y party opposing any motion shall file
an original and two (2) copies of a responsive
brief. . . wi.thin fifteen (15) days after
service of the movant's brief. Any respondent
who fails to comply with this rule shall be
deemed not to oppose such motion.
M.D. Pa. R. Civ. P. 7.6 (emphasis added). Defendant has not file
a brief in opposition to the motion. We could therefore construe
the motion as unopposed and grant it on that basis alone.
Even if we were to construe Defendant's "Answer" as a
brief, and consider the motion on its merits, we would still find
that Plaintiff is entitled to the requested discovery. The court
has already decided, in the December 17 decision of the Magistrate
Judge, that the requested information is discoverable. Defendant
has offered no grounds for us to question the Magistrate Judge'S
conclusions.
Accordingly, this 2nd day of June, 1998, it is ordered
that Plaintiff's motion to compel, filed May 8, 1998 (Doc. No.
45), is granted:
1. Defendant Anita M. Spangler shall
produce the requested discovery within fifteen
(15) days of the date of this order.
2. Defendant, or her counsel, shall pay
Plaintiff's reasonable attorney's fees and
costs for the preparation of the motion to
3
compel. The parties shall amicably determine
the amount of those fees and costs among
themselves.
0dt~({v~
William W. Caldwell
United States District Judge
4
GARY J. LEIDY D.C., P.C.
(Rita Forcman),
IN THE COURT OF COMMON PLEAS OF
DAUPHIN COUNTY, PENNSYLVANIA
Plaintiff
: CIVIL ACTION-LA W
v.
: NO. 2518 S 1998
ALLSTATE INSURANCE COMPANY,
Defendant : JURY TRIAL DEMANDED
ORDER
AND NOW thiS~} 7J!:. day Of~,yE.
, 1999, the following
discovery sanction is entered as against thc Dcfcndant and its expcrt witncss Dr. Mark Cavallo:
Because Dr. Cavallo failed to comply with this Court's Ordcr of April 19, 1999, he
is hercby prccluded from tcstifying on bchalf of Allstate in connection with thc captioncd mattcr
In addition, Dr. Mark Cavallo shall pay to Dr. GalY Lcidy as attorney fecs in
connection with thc filing of this Motion the sum of$150.
BY TilE COURT:
JIm ]J 199tl'
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GARY 1. LEIDY D.C., P.C.
(Rita Foreman),
Plaintiff
v.
IN TIlE COURT OF COMMON PLEAS OF
DAUPHIN COUNTY, PENNSYLVANIA
CIVIL ACTION-LA \V
: NO. 2518 S 1998
ALLSTATE INSURANCE COMPANY,
Defendant : JURY TRIAL DEMANDED
AND NOW, this
ORDER
I q [! day of --,#r? I ~
, 1999, following a
discovery conference held February 23, 1999, it is hereby ORDERED that Dr. Mark Cavallo shall
.
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answer within thirty (30) days the subpoena issued by Plaintiffs counsel and attached to this Order
as Appendix A.
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two arx:J COff. 't .... . "U tS A
fllud. tiL Lt/fJ\O! II",' oflginal
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2518 S 1998
.Tenn 19
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..
DR. GARY J. LEIDY, D.C., P.C.,
<!Iomtllon(ucIlItIl of 1~Tclmsul6l1nill
QIll1mtu of JIlllup1lin
Plaintiff
VS.
ALLSTA'rE INSURANCE COMP~
Defendant
"
.'
SUBPOENA TO ATIENO ANO TESTIFY
.il
.,
"
TO ". DR. MARK CAVI\I.J..D
1. You are ordered hy thc coull 10 comc 10 ..Ml eL&_Cli!Iii'ii!1JZ5 [1)CI.l'l.L StrggL
.__:11 Ilarrishurg. Pcnnsylvania on ~~ 29~99 a.t 10:00 A,M.
to testify on hchalf of _____J:~a i r1.t:.it'f
in the ahove case, and 10 remain until excused.
2. And hring with you the following: .J!O~ible copi~s oL~ and all documents identified in the
attached !\ddendl!f11 to S\l\:>~r1.~...Qt.lc;l:'~~c::~.m
IC you fail 10 attend or (lhxlucc e,kX:U111cnts tn' tllings 1('quir"L'd hy tllis Mlhpocn:t, you Inay he suhjCA.:II:O the sanctions aulh()riz.ed by Rule
234.5 of the Pennsylvania Ihlks of t ~lvil PJT)('('IIU1i" inrlwling hut nOllimitctllt\ costs, .lllomey kes ;.uHI implisonmclll.
Rcquested hy: 1~()l)(,I~t:.F._.<::Jarav..) ,.""q, !l~').l~)Cllst;.~trl:'.e_tLl~a . _ i ~\)~lr~,__PA.....!?]gl
A(ltmu.~y's naml', ~j(1tlf(~s~;. icl('1111l1l1l.' IIlulllx~r & idl'nlific:ltion Hum c.r,
lIy:~l!:.'I;1 y-f..
(717) 233-4780
l.D. #19222
Date: March 2'3
---..-..-..----.....,
Seal of lhe (~(ml1
1'l'1'l.
.'.,
GARY J. LEIDY D.C., P.C.
(Rita Forcman),
IN TilE COlmT OF COMMON PLEAS OF
I>AI JPIIIN COUNTY, PENNSYLVANIA
Plaintiff
v.
CIVIl. ACTION-LA W
NO. 2518 S 1998
ALLSTATE INSURANCE COMPANY,
Dcfcndant : J[JRY T1UM. DEMANDED
AI>DENIllJM TO SllBl'OENA IHJCES TEClJM TO
J)Jt MAil/( CA VAUD
I. All hillings to Rchahilitation Plnnning hy Dr. Cavallo for scrvices rendcrcd
to Rchabilitation Planning from 1993 through 191)8. The Respondent may simply list thc dollar
amount by year.
2. A cel1i/ied statement from counsel that he has examined thc tax returns of Dr.
Cavallo from 1993 through 191)8 and what thc perccntage of income gencratcd hy billings to
Rehabilitation Planning, Inc. hy ycar is as comparcd 10 Dr. Cavallo's gross incomc from his practicc.
3. All hillings 10 Allstate Insurance hy Dr. Cavallo for scrvices rcndered 10
Allstate Insurance ii.om I ')1)3 through I <)1)8. The Rcspondcnt may simply list the dollar amount by
year.
4. A ccrtified ~Iatcmenlli'olll mun~e1lhal hc has cxamincd thc tax rclnrns of Dr.
Cavallo li'olll 1993 throngh I ')')X and whal (hc pcrccnlage of incomc gcncral<:d by hillings to
Allstalc Insurancc by year is a~ comparcd In Dr. Cavallo'~ gro~~ incolllc from his practicc.
5. Copy of currcnt curriculum vital'.
6. Any advcrtising litcralurc Ihat you send to eithcr pccr review organizations
and/or insurance cOlllpanies.
7. Any advertising literalure, hrochures or other materials for patients.
8. Any materials, research literature, treatises, text Dr other documents which you
rely on in formulating your PRO rcport in this casc only, including but not limited to any Jocuments
which purportedly state national or regional norms or typical pallerns of practice I'lr chiropractors.
9. The nUlllher of PRO's, URO'~ or IME'~ done hy year I'lr Rehahilitation
Planning, Inc. from 1993 to J 999.
10. The numher ofPR()'~,lIR()'s or lME's done hy year j'lr Allstate Insurance
from 1993 to 1999.
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DR. DA VID Il, Srl-flTlL
(Magaw).
I N TIlE COURT (IF COM1\ION I'I.Ei\S OF
IMUI'IIIN COl iNTY, I'I~NNSYI.V ANIA
I'binliff
v,
CIVil. ACTION-LA \\1
STAlE FARM INSURANCE
COMPANY,
NO. 50S5 S I '.In
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Dcfcndant
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: .IlJRY TRIAL DEMANDE/J. '
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ORDER ~
AND NDIV, 'hi.' J'2--d'4-d,y or.?~ ,200 I, "p"" ,"...,id""i,..
of Plain tift's Motionl(n. Contcmpt and Sanctions, it is herc by ORDERED that Dr. .less Arminc pay
thc sum of$] 50 within 30_ da)'s~lhiS Order as a sanction for his willful contempt
in refusing to comply with this COllrt'S Ordcrs orOctobcr ii, 2000 and Dcccmbcr 20,2000,
Further, Dr. Arminc is precludcd 1"om tcstit)'ing at the arbitration or trial of this
action.
BY TIlE COURT:
/i
f/L~~i!r!~~?~
'I ODD A. IJUOVER. Judgc
~ 2 fl ZOOl
Prothonotary
. 'l'oIoii. ',~'tJII'"
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COMMONWEAUII OF PENNSYLVANIA
COUNTY OF DAUPIIIN
File No.
5085 S ] 998
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SUBPOENA TO PIWDUCE DOCUMENTS on TIIINGS
FOR DISCOVERY PunSUANT TO IWLE 4009.22
TO: Dr. Jess P. Armine
(Name or Person or Entity)
Within twenty (20) days after service of this suhpocna, you arc ol'derc.d hy the court to produce the following documents or things:
All documents identified in the attached Addendum to Subpoena Duces Tecum
al 125 Locust Street, Harrisburg, PA 17101
(Addrcss)
You may deliver or mail legible copics of the documcnts or producc things requested by this subpoena, together
with the certificate of compliance, to the party making this request at the address Iisled above. You have the right
to seek, in advance, the reasonable cost of preparing the copies or producing the lhings sought.
If yeu fai! 10 piOduce the documcnts or things required hy this suhpoena, withinlwenly (20) days aftcr ils service,
the pally serving this subpoena may seek a court order compelling you to comply with it.
TI-llS Suhpoena WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON:
NAME: Robert F. Claraval,_~sq. ________
ADDRESS: 125 Locust Street
.llarrisbu~~-1lLQL________
TELEPHONE: (717) 233-478~_______________
SUI'l<EME ClJUl<T ID #
19222
AT10RNl.Y FOR:
PI ainti ff
B~' llll" (\'11:1:
.-:~/ \_fJ.. .~_
~tllll\IIl\lary
DATE: 11arch 27, 2000
\1.;.1 (>1111(' (',"In
r'roll1, " 7j Dl"PUI)'
DR. DA VI D II. SM ITlI.
(Magaro ),
IN TIlE COURT OF COMMON PLEAS OF
DAt JI'IIIN COUNTY, I'ENNSYLV ANIA
": .;" , " ,: ,', ,...'. r,",.-",' ": ';, ". ,'. " .,;'. 1 '
Plaintiff
CIVIL ACTION-LA W
v.
NO. 50S5 S I <)<)S
STATE FARM INSURANCE
COMPANY,
1>Clcndant
.IlJRY TRIAL DEMANDED
ADDENIHJJ\1 TO SIIIII'OENA mICI~S TECUM TO
J)Jt .JESS P. ARMINli;
I. All billings to Claims Rcvicw Associatcs by Dr. Arminc for scrviccs rcndcrcd
to Claims Rcvicw Associatcs Ii-om I <)<)4 through I C)<)<). Thc Rcspondcntmay simply list the dollar
amount by ycar.
2. A cCl1ilicd slalcmcnt fi-om counsel for Dr. Arminc that hc has cxamincd thc
tax rcturns of Dr. Arminc linin I <)()4 through I C)<)l) and whatthc pcrccntagc of income gencratcd
by billings to Claims RCl'ic'.'.' Associates by ycar is as comparcd to Dr. Anninc's gross incomc from
his practice.
3. All billings to Stalc Farmlnsllrancc hy Dr. Arminc for scrvices rcndcrcd to
StalC Fann Insurancc li'om I ')().lthnHlvh I')')'). Thc Rcspondcntmay simply list thc dollar amount
by ycar.
.1. ,\ cC11ilicd statclllcnt l;om I )1' ,\rminc's nnmsd I"l' Ihat he has cxamined thc
lax retllms "I" Dr, ,\rlllillc li'''1ll I ')').llhr"III'h I I)')') and \\ hatlhc perccntage of income gClwratcd
~ ~. ~~ ~ w,
'~~<o:r",c
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hy hillings to Stale Farm Insurance hy year is as compared tn Dr. Armine's gross income fi'()m his
practice.
5. Copy of current curriculum vitae.
6. Any advertising literature that you send (0 either pecr rcvicw organizations
lmd/or insurance companies.
7. Any advertising lilcrature, brochurcs or other materials for patients.
R. Any materials, research litcrature, treatises, text or other documents which you
rely on in formulating your PRO reporl in this case only, including hut not limited to any documents
which purportedly state national 01' regional norms or typical pattcl'lls of practice for chiropractors.
9. The numher or PRO's, URO's or IME's done hy ye;u: 101' Claims Review
Associates by Dr. Arminc from ]<)<)4 to I 99').
10. The numher or PRO's, URO's or IMF's done ~\:ill for State Farm
Insurancc by Dr. Arminc from J ()I).llo J <)99.
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il;tt;.'Y,9':')ARE ,HE.REBv 'NOTIFiEO TO FILE
~t.1~~~b~~'~~;~:':';~,\,in;~,~~,~~~,~,~:',?~~~:':'::,:-:~~.~::
~~llw'T~'N'.'.1'WEN'fV',: <<:iO). OIlYS 'FROM
l'n~Eif~~~e%~~~'~~T~9~~~E~~
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. ...... RECT . COpy :.'OFi..,THE:.>ORI.G.INAL,:'".'.
. FILED INTHIS'ACTION~"';.):""'!;/:;":~:"::",i':,,'r:" 'j"
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ATTOR~EY' ",j" ).;",
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. LAW OFFICES
JACOBS & SADA
214 SENATE AVENUE.
, SUITE 503
.CAMPlllu.,PA17011
. ; (717) 731.0988
FAX. (717) .731-0987 .
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4. On July 23, 1999, Defendant Nationwide liled an Answer wilh New Matter and
Counterclaim, with a Notice to Plead and properly served the PlaintilT by Iirst class mail.
5. On or about September 27, 1999, Jana C. Butler, Esquire, filed an Amended
Complaint on behalf of the Plaintiff.
6. On or about December 13, 1999, Defendant Nationwide filed an Answer with Ne~
Matter and Counterclaim to the Plaintiff's Amended Complaint and served it upon Jana C.
Butler, Esquire, as Plaintiff's counsel by first class mail. The aforementioned pleading
contained a Notice to Plead in accordance with the Pennsylvania Rules of Civil Procedure and
the local rules of the Court of Common Pleas of Cumberland County.
7. On or about December 14, 2000, Robert F. Claraval, Esquire entered his
appearance on behalf of the Plaintiff.
8. On or about June 14, 2001, the Plaintiff filed a Reply to the Defendant's New
Matter and Counterclaim.
9. Pa.R.C.P. g1026(a) requires that a pleading shall be filed within twenty (20) days
after service of the preceding pleading.
10. TIle Plaintiff's Reply to New Matter and Counterclaim was filed approximately
fifteen (IS) months after service of the preceding pleading, the Defendant's Answer with New
Matter and Counterclaim to the Plaintiff's Amended Cl)Jnplaint.
2
11. 111C Plaintiff's dclay of fifteen (15) months in filing a Rcply to New Mattcr and
Countcrclaim represents a blatant disregard for the time limits established by the Pennsylvania
Rules of Civil Procedure.
12. The Trial Court should strikc off a pleading of the party that blatantly ignores the time
limits set by the Rules of Civil Procedure, even in the absence of prejudice to the objecting party
and even though the moving party has not sought a default judgment. Peters Creek Sanitary
Anthority v. Welch, 681 A.2d 167 (Pa. 1996); Francisco v. Ford Motor Company, 397 Pa.Super
430,588. 2d 374 (1990) appeal denied, 527 Pa. 633, 592 A.2d 1301 (1991).
WHEREFORE, Defendant Nationwide Mutual Insurance Company respectfully requests
your Honorable Court to strike the Plaintiff's Reply to New Matter and Counterclaim.
Rcspectfully submitted,
Date:
AprilS. 2001
. -
""GIrard E. ckards, Esquire
214 Senate Avenue, Suite 503
Camp Hill, PA 17011
Attorney for Defendant
Court LD. No. 58867
3
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98HB-O 1008
LAW OFFICES OF JACOBS & SABA
214 Senate Avenue, Suite 503
Camp Hill, PA 17011
Tch~IJhone Number: (717) 731-0988
Attorne 's for Defendant Nationwide Insurance
COREY R. LEES,
PLAINTIFF
VS.
NATIONWIDE INSURANCE,
DEFENDANT
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
No. 98-7326
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
CERTIFICATE OF SERVICE
I, Girard E. Rickards, Esquire, hereby certifies that he is the attorney for the
Defendant herein, and that he caused a true and correct copy of Defendant's Preliminary
Obiections to the Plaintiffs Reply to New Matter and Counterclaim in the Nature of a Motion
to Strike to be served by regular first class mail upon:
Dated:_ April 5. 2001
Robert F. Claraval, Esquire
P.O. Box 11933
125 Locust Street
Harrisburg, PA 17108-1933
~-::;-, -
C-?~-;/
~~
'-=-(Th;ftr'"RRickards, Esquire
,\ 'll'T!1 1'\ '1 1" J , 1,1 '.~
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~;).j!WOU' ARE .IlEREBV . NOTIFIED TO FILE
,",:iI'" : WRITTEN. RESPONSE TO.' TilE
!fi:~~~~~~lv.i20)O"VS fROM
!1,'~'SEl\VICI!<.IlEREOf.: OR " JUDGMENT
',:'::,;. M"V BE ENTERED AG"INST yoU .
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.LAW"O.-FU:l!S
Ji\cOBS& SABA
214 SENATl!: AVENUE
SUITE 503 .
CA~IPHIL";PA 17011
(711) 731-09118 ...
FAX. (7i7) 731-0987
, .
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~. E. 00' ,IlEREBV.", CERTIFV:-?,.THAT:.,',"
E' WITHIN.ISb. A'.TRUE. AND.. "COR.-"S,;
. ECT . COpy fTIlE..,tlRIc;IN~L,"':
'APQ () 9200' . fiLED IN THISAqTI~N:",:'::L,r):i'0~'
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98HB.()I008
LAW OFFICES OF JACOBS & SABA
214 Sellate AVl'lIul', Suite 503
Calllp Hill, PA 170II
Telepholle Number: (717) 731-0988
Attorneys for Defendant Nationwide Insurance
IN TilE COURT OF COMMON PLEAS
COREY R. LEES, CUMBERLAND COUNTY, PENNSYLVANIA
PLAINTIFF
VS.
No. 98-7326
. .
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NATIONWIDE INSURANCE,
DEFENDANT
CIVILACTION-LAW
JURY TRIAL DEMANDED
ORDER
AND NOW, this
Day of
200 I, upon consideration
of the Defendant's Preliminary Objections to the Plaintiff's Reply to New Matter and
Counterclaim in the Nature ofa Motion to Strike, said Motion is hereby GRA.l\JTED. The
Plaintiff's Reply to New Matter and Counterclaim arc hereby stricken with prejudice.
BY THE COURT:
Date:
)
98HB-o 1008
LAW OFFICES OF JACOBS & SABA
214 Senate Avenue, Suite 503
Calli 11 iii II, I'A 17011
Telephone Number: (717) 731-0988
Attorne s for Defendant Nationwide Insurance
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
COREY R. LEES,
PLAINTIFF
VS.
No. 98-7326
" ( " ') ': " "::.' , ,,,,' '. " ,'; , " ',' .,:.' .' . ; " :. .' r '.,.' " " , " '
NATIONWIDE INSURANCE,
DEFENDANT
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
DEFENDANT'S PRELIMINARY OBJECTIONS TO THE
PLAINTIFF'S REPLY TO NEW MATTER AND COUNTERCLAIM
IN THE NATURE OF A MOTION TO STRIKE
I. This lawsuit arises from a dispute over the reasonableness and necessity, or lack
thereof, of chiropractic bills charged by the Plaintiff.
2. ll1is lawsuit was originally filed by the Plaintiff pro se, before District Justice
Thomas A. Placey who awarded a judgment in favor of Defendant Nationwide on December
17, 1998. On or about January 8, 1999, the Plaintiff filed an appeal to the Court of Common
PIC<1s of Cumberland County.
3. On or about January 28, 1999, the Plaintiff apparently filed a Complaint without a
~<~\:i,'t' ~,' P!"I'~!l1d 'L ill!!,,, I,;:, ill:' '.,"" I' ~ 111' lj,'; \ 1,1'"
2
4. On July 23, 1999, Defcndant Nationwidc filed an Answcr with New Mattcr and
Counterclaim, with a Notice to Plead and properly served the Plaintiff by first class mail.
5. On or about September 27, 1999, Jana C. Butler, Esquire, filed an Amended
Complaint on behalf of thc Plaintiff.
6. On or about December 13, 1999, Defendant Nationwide filed an Answer with Ne~
Matter and Counterclaim to the Plaintiff's Amended Complaint and served it upon Jana C.
Butler, Esquire, as Plaintiffs counsel by first class mail. The aforementioned pleading
contained a Notice to Plead in accordance with the Pennsylvania Rules of Civil Procedure and
the local rules of the Court of Common Pleas of Cumberland County.
7. On or about December 14, 2000, Robert F. Claraval, Esquire entered his
appearance on behalf of the Plaintiff.
8. On or about June 14, 2001, the Plaintiff filed a Reply to the Defendant's New
Matter and Counterclaim.
9. Pa.R.C. P. ~ 1026(a) requires that a pleading shall be filed within twenty (20) days
after service of the preceding pleading.
10. The Plaintiffs Reply to New Malter and Counterclaim was filed approximately
fiftecn (15) months after service of the preceding pleading, the Defendant's Answer with New
Matter and Counterclaim to the Plaintiffs Amcnded Complaint.
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9XHB-O 100X
LA W OFFICES OF ,JACOBS & SABA
214 Senate Avenue, Suite 503
Camp Hill, PA 17011
Telephone Nnmber: (717) 731-0988
Attorneys for Defendant Nationwide Insurance
COREY R. LEES,
PLAINTIFF
IN THE CounT OF COMMON PLEAS
CUMBEnLANI> COUNTY, PENNSYLVANIA
VS.
No. 98-7326
NATIONWIDE INSURANCE,
DEFENDANT
CIVIL ACTION - LAW
JURY TnlAL DEMANI>EI>
ORDER
AND NOW, this
Day of
200], upon consideration
of the Defendant's Preliminary Objections to the PlaintifTs Reply to Ncw Matter and
Counterclaim in the Nature ofa Motion to Strikc, said Motion is hereby GRANTED. The
Plaintiff s Reply to New Matter and Counterclaim arc hereby stricken with prejudice.
BY THE COURT:
P\eaSe ~\C
1\ , '\r ,', . J ' .
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I') 't\L \M.)( U '
Date:
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9RI1B-OIOOR
LAW OFFICES OF .JACOBS & SABA
214 Senute Avenue, Suite 503
Camp Hill, PA 17011
Telephone Number: (717) 731-0988
AUorne s for Defendant Nationwide Insurance
COREY R. LEES,
PLAINTIFF
VS.
NATIONWIDE INSURANCE,
DEFENDANT
IN TilE COURT OF COMMON PLEAS
CUMIlEllLAND COUNTY, PENNSYLVANIA
No. 98-7326
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
DEFENDANT'S PRELIMINARY OBJECTIONS TO THE
PLAINTIFF' S REPLY TO NEW MATTER AND COUNTERCLAIM
IN THE NATURE OF A MOTION TO STRIKE
I. 111is lawsuit arises from a dispute over the reasonableness and necessity, or lack
thereof, of chiropractic bills charged by the Plaintiff.
2. 111is lawsuit was originally filed by the Plaintiff pro sc, before District Justice
Thomas A. Placey who awarded a judgment in favor of Defendant Nationwide on December
17, 1998. On or about January 8, 1999. the Plaintiff filed an appeal to the Court of Common
Pleas of Cumberland County.
3. On or about January 28. 1999, the Plaintiff apparently filed a Complaint without a
Notice to Plead and without having served the Defendant.
, " I " _ . " , . :',' { . \'. .). -'" ',' , , " . , : '. . ',' ,.' ~' , , . ~ . ',' I ,. " - ",
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4. On July 23, 1999, Dcfcndant Nationwidc filed an Answer with Ncw Mattcr and
Countcrclaim, with a NOlice to Plcad and properly SClVed the Plaintiff by first class mail.
5. On or about September 27, 1999, Jana C. Butler, Esquire, filed an Amcnded
Complaint on behalf of the Plaintiff.
6. On or about December 13, 1999, Defendant Nationwide filed an Answer with New
Matter and Counterclaim to the Plaintiffs Amended Complaint and selVed it upon Jalla C.
Butler, Esquire, as Plaintiff's counsel by first class mail. The aforementioned pleading
containe.d a Notice to Plead in accordance with the Pennsylvania Rules of Civil Procedure and
the local rules of the Court of Common Pleas of Cumberland County.
7. On or about December 14, 2000, Robert F. Claraval, Esquire entere.d his
appearance on behalf of the Plaintiff.
8. On or about June 14, 2001, the Plaintiff filed a Reply to the Defendant's New
Matter and Counterclaim.
9. Pa.R.C.P. 91026(a) requires that a pleading shall be filed within twenty (20) days
after selVice of the preceding pleading.
10. The Plaintiffs Reply to New Malter and Counterclaim was filed approximately
fifteen (15) months after selVice of the preceding pleading, the Defendant's Answer with New
Matter and Counterclaim to the Plaintiffs Amended Complaint.
2
';;<."#IIli. ^~t:.>;~__~"""'''..';i.:.'",.'~",",,, -
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nHB.OIOOR
. ~
LA W OFFICES OF .JACOBS & SABA
2J4 Sellllte Avenue, Suite 503
Camp Hill, PA 17011
Telephone Number: (717) 731-0988
Atlorneys for Defendant NlItionwide Insurance
COREY R. LEES,
PLAINTIFF
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY,PENNSYLVANIA
VS.
No. 98-7326
NA TIONWIDE INSURANCE,
DEFENDANT
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
CERTIFICATE OF SERVICE
I, Gimrd E. Rickards, Esquire, hereby certifies that he is the atlomey for the
Defendant herein, and that he caused a true and correct copy of Defendant's Preliminal)i
Obiections to the Plaintiff's Reply to New Maller and Counterclaim in the Nature of a Motion
to Strike to be served by regular first class mail upon:
Robert F. Clara val. Esquire
P.O. Box 11933
125 Locust Street
Harrisburg.PA 17108-1933
Dated: April 5. 2001
,/
.'/
"? . ..-c.)
'."--' ~.. .-;-;
Gilird E. Rickards. Esquire
Allonley for Defendant
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COMMONWSALTH OF PENNSYLVANIA
COURT OF COMMON PLEAS
JUDICIAL DISTRICT
NOTICE OF APPEAL
FROM
DISTRICT JUSTICE JUDGMENT
NOTICE OF APPEAL
Notice is gib,eft that the app4dlant has filed in the above Court of Common Pleas an appeal from the judgment rendered by the District Justice c~n the
date and in fha case rnentloaed below.
aTY
LTl9
Th~ ~k ~11 ~ ~ ONLY ~n this ~m~ is ~ui~ u~ P~ R~ ~ I~ ~t ~ OLAIMANT (~ ~. ~.O.P.d.P. NO.
1~8& 1~1 ( 6 ) in ~ti~ ~t~e DisEict J~t~e, ~
~ ~t~e of A~, ~ ~ ~ t~ ~s~id Jus~e, will ~ m a
~PE~EDEAS ~ ~ j~ ~ ~s~ in this c~ FILE A CO~AINT wJlhJn ~n~ (20) dS~
filing HiS ~TICE of A~EAL.
PRAECIPE TO ENTER RULE TO FILE COMPLAINT AND RULE TO FILE
(This section ol form to be used ONLY when appellant was DEFENDANT (see Pa. R.C.P.J.P. No. 1001(7) in action before District Justice.
IF NOT USED, detach from copy of notice of appeal to be sen/ed upon appellee).
PRAECIPE: To Prothonotary
, app4dlee(s), to file a complaint in this appeal
Enter rule upon Name o,' appe#ee~s)
(Common Pleas N~ ) within twenty (20) days after service of rule or suffer entry of judgment of non pros.
RULE: To , appel~(s).
Name ol a~le~s)
(1) You are notified that a rule is hereby entered upoe you to file a complaint in this appeal within twenty (20) days after the date of
service of this rule upcm you by personal sen, ice or by tariffed or registered maiL
(2) If you do not file a complaint within this time, a JUDGN~NT OF NON PROS WILL BE ENTERED AGAINST YOU.
(3) The date of se~ice of this rule if service wcJS by mail is the date of mailing.
Date: , 19 .
COURT FILE TO BE FILED WITH PROTHONOTARY
PROOF OF SERVICE OF NOTICE OF APPEAL AND RULE TO FILE COMPLAINT
(This proof of service MUST BE FILED W/THIN TEN (I0) DA YS AFTER filing the notice of appeal, Check applicable boxes)
COMMONWEALTH OF PENNSYLVANIA , ~ , /
COUNTY OF
AFFIDAVIT: ~ hereby swear or affirm that I served
J~] a copy of the Notice of Appeal, Common Pleas No , upon the District Justice designated therein on
(date of service) , [] by personal service [] by (certified) (registered} mail~ sender's
receipt attached hereto, and upon the appellee, (name) , on
,19__ [] by personal service [] by (certified) (registered) mail, sender's receipt attached hereto.
[] and further that I served the Rule to File a Complaint accompanying the above Notice 0f Appeal upon the appellee(s) to whom
the Rule was addressed on _, 19 . J~ by personal service [] by (certified) (registered)
mail sender's receipt attached hereto.
SWORN (AFFIRMED) AND SUBSCRIBED BEFORE ME
THIS DAY OF ,19
Signature Of affiant
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF:
09-3-04
THOMAS A. PLACEY
104 S. SPORTING HILL RD.
MECHANICSBURG, PA
(717) 761-8230 17055
DR. COREY LEES
6103 CARLISLE :PIKE.
MECHANICSBURG,:. PA 17055
98 - I'
NOTICE OF JUDGMENT/TRANSCRiPT
CIVIL CASE
PLAINTIFF: NAME ar~l ADDRESS
~LEES, DR. COREY
6103 CARLISLE PIKE
MECHANICSBURG, PA 17055
VS.
DEFENDANT: NAME and AODRESS
P.O. ~OZ 2655
HARRISBURG, PA 17105
Docket No.: CV-0000578-98 ]
Date F ed: 11/05/98
THIS IS TO NOTIFY YOU THAT:
Judgment: ~oR DEF~DANT
[~ Judgment was entered for:. (Name) NamTnt~.rrn~ T~'~IlWa~Z~I~
r-~ Judgment was entered against: (Name) ~'.m~.q, mn _ c,nn~lt'
in the amount of $ _ ~ on: (Date of Judgment)
[~ Defendants are jointly and severally liable.
~ Damages will be assessed on:
"-]This case dismissed without prejudice.
[] Amount of Judgment Subject to
Attachment/Act 5 of 1996 $
[] Levy is stayed for days or [] generally stayed.
(Date & Time)
Amount of Judgment $ o 0(~
Judgment Costs $ .0¢
Interest on Judgment $ o 0(
Attorney Fees $. .00
Total $. .00
Post Judgment Credits
Post Judgment Costs
Certified Judgment Total
]Objection to levy has been filed and hearing will be held:
Date: Place:
Time:
ANY PARTY HAS THE RIGHT TO APPEAL WITHIN 30 DAYS AFTER THE ENTRY OF JUDGMENT BY FILING A NOTICE
OF APPEAL WITH THE PROT~ F COMMON PLEAS, CIVIL DIVISION. YOU
I a' [~ q ~ Date /I.--~ , o,str,ct Justice
I certify that this is a true and /e~ pr°ceedings~c~aining the judgment'
I~'1-~00 Date ..... ~/~ / ~....,~_/- ,District Justice
My commission exPires first Monday of January,// 200~ SEAL
AOPC 315-96 -
NOTICE OF APPEAL
C~_..u~,NWEALTH Of PENNSYLVANIA
C~T OF cOMMON PLEAS
JUDICIAL DISTRICT
DISTRICT JUSTICE JUDGMENT
COMMON PLEAS No.
NOTICE OF APPEAL
NoSe is given that the appellant has filed in the above Court of Common Pleas an appeal from the judgment mndored by the District Justice an the
date and in the case mentioned below.
This block wdl be s~gned ONLY when th~s no q ~ n,~ ·/~ ~; ' before District Justice, he MUST
1008~ ~uu,~,-,/,n actlor~
This Notice of Appeel, when mceived by the District ~Jstice, will operate as a
SUPERSEDEAS to the judgment for possessian in this case FILE A cOMPLAINT within twenty (20) days after
filing his NOTICE of APPEAL.
Signature of Prothonotary ~r Deputy
------'--~RAECIPE TO ENTER RULE TO FILE COMPLAINT AND RULE TO FiLE
(This section of fon'n to be used ONLY when appellant was DEFENDANT (see Pa, R.C.P.J.P. No. 1001(7) in action before District Justice.
IF NOT USED, de~ach from copy of notice of appeal to be served upon appellee).
PRAECIPE: To Prothonotary
Enter rule upan
(Common Pleas Nc~
, appellee(s), to file o complaint in this appeal
within twenty (20) days after sorvice of rule or suffer antry of judgment of non ~
RULE: To ~ o~ ~o~s~
(1) You am notified that a rule is hereby entered upon you to file a complaint Jn this appeal within twenty (20) days after the dote of
service of this role upon you by personal service or by certified or registered maiL
(2) If you do not file a complaint within this time. a JUDGMENT OF NON PROS V~LL BE ENTERED AGAINST YOU.
(3) The date of service of this rule if service was by mail is the date of mailing.
COURT FILE
PROOF OF SERVICE OF NOTICE OF APPEAL AND RULE TO FILE COMPLAINT
[This proof of service MUST BE FILED WITHIN TEN [10) DA YS AFTER filing the notice of appeal. Check applicable boxes)
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF__ ~ ~ /' ; ss
AFFIDAVIT: I hereby swear or affirm that I served
t~ a copy of the Notice of Appeal, Common Pleas No, _ P~'~'~ ~--~' -, upon the District Justice designated therein on
[date of service)
, E~ by.Personal service E) by (certified) (registered) ma , sender's
receipt attached hereto, and upon the appellee, (name)
t/ <~ ..... 19-:~<:7~ E] by personal service ["~:~hv ,'certift-~, ,~ ............... -------'-"----- --, on
-t- -z · "'~1 t-='~u) mall, senoers receipt attached hereto.
~ andfurtherthatlservedtheRutetoF~leaComplaJntaccompanying_[.heaboveNoticeofA ealu ont
the Rule was addressed on ....... /~'~ ~,~ . <:~,=~ ~ PP P he appellee(s)to whom
m ..... ~ ' ~ ~ '~ ,~. LJ by personal service ,~ by (certified) (registered)
~., senaers receipt attached hereto.
SWORN (AFFIRMED) AND SUBSCRIBED BEFORE ME
. ,191~
J John P Fetrow, Notary Public
/Silver ,S, prin0 f\,vp. Cumberland County
~ My Co qmissicn Expires Aug. 27, 2001
Member t~em~,~h~}~-';:'~;,,,iat~n of Notaries
COREY R. LEES,
Plaintiff
NATIONWIDE INSURANCE,
Defendant
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
AND NOW comes Plaintiff, Pro se, Corey R Lees, and files this Complaint, based upon
the following:
1. Plaintiff, Dr. Corey R Lees, is a Doctor of Chiropractic who has an office
at 6103 Carlisle Pike, Mechanicsburg, Cumberland County, Pennsylvania 17055.
2. Defendant, NATIONWIDE INSURANCE, is a corporate entity doing business at PO
box 2655 Harrisburg PA 17105-9971
3. On 08/18/97 Defendant refused payment for services on their insured, Barb Keiter,
for dates of service 03/02/97 through present for care regarding the motor vehicle
accident of 11/29/97.
4. The Defendant's refusal to pay was based on the recommendations of a Peer Review
report.
5. The Plaintiff contests that the care is medically necessary.
WHEREFORE, Plaintiffrequests Your Honorable Court to enter a Judgment against the
Defendant in the mount of $5504.85 plus Judgment costs and interest.
Date:
Respectfully submitted,
I, PLAINTll~, COREY R. LEES, verify that the facts set forth in the foregoing
Complaint are true and correct to the best of my knowledge, information and belief.
I understand that false statements herein are made subject to the penalties of 18
Pa. C.S.A. 4904 relating to unswom falsification to authorities.
Co~v/R Le~s, Plaintiff
COREY R. LEES,
Plaintiff
VS.
NATIONWIDE INSURANCE,
Defendant
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
: NO. 98-7326
: CIVIL ACTION -
IMPORTANT NOTICE
TO: Nationwide Insurance
(Defendant)
DATE OF NOTICE: July 15, 1999
YOU ARE IN DEFAULT BECAUSE YOU HAVE FAILED TO
TAKE ACTION REQUIRED OF YOU IN THIS CASE. UNLESS
YOU ACT WITHIN TEN (10) DAYS FROM THE DATE OF THIS
NOTICE, A JUDGMENT MAY BE ENTERED AGAINST YOU
WITHOUT A HEARING, AND YOU MAY'LOSE YOUR PROPERTY
OR OTHER IMPORTANT RIGHTS. YOU SHOULD TAKE THIS
PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE
A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE
THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU
CAN GET LEGAL HELP.
Cumberland County Bar Association
2 Liberty Avenue
Carlisle, PA 17013
Telephone: (717) 249-3166
or
1-800-'~'0- 9108
NOTICIA IMPORTANTE
A: Nationwide Insurance
(Demandado)
FECHA DE NOTICIA: July 15, 1999
USTED NO HA COMPLIDO CON EL AVISO ANTERIOR
PORQUE HA FALTADO EN TOMAR MEDIDAS REQUERIDAS
RESPECTO A ESTE CASO. SI USTED NO ACTUA DENTRO DE
DIEZ (10) DIAS DESDE LA FECHA DE ESTA NOTICIA, ES
POSIBLE QUE UN FALLO SERIA REGISTRADO CONTRA USTED
SIN UNA AUDIENCIA y USTED PODRIA PERDER SU
PROPIEDAD O OTROS DERECHOS IMPO~TANTES. USTED
DEBE LLEVAR ESTA NOTICIA A SU ABOG~DO EN SEGUIDA.
SI USTED NO TIENE ABOGADO O NO TIENE CON QUE PAGAR
LOS SERVICIOS DE UN ABOGADO, VAYA O LLAME A LA
OFICINA ESCRITA ABAJO PARA AVERIGUAR A DONDE USTED
PUEDE OBTENER LA AYUDA LEGAL.
Cumberland County Bar Association
2 Liberty Avenue
Carlisle, PA 17013
Telephone: (717) 249-3166
or
1-800-990-9108
98~3..01005
LAW OFFICES OF JACOBS & SABA
W. Darren Poweil, Esquire
214 Senate Avenue, Suite $03
Camp Hill, PA 17011
Telephone Number: (717) 731-0988
Attorney for Defend_*nt Nationwide Insurance
COREY R. LEES,
PLAINTIFF
VS.
NATIONWIDE INSURANCE,
DEFENDANT
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
No. 98-7326
CIVIL ACTION = LAw
jURy TRIAL DEMANDED
NOTICE
YOU HAVE BI=.I=~N SLTED 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 ~
..... ~,~.Xn~rnnce to P'~ and Notice
are served by entering a written appearance personally or by attorney and filing m wriUng with
the court your defenses or objections to the claims set forth against you. You are warned that ff
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 Answer with New Matter and
........ · _.:A__.:% Insurance to plalnfiff' s Complaint or for any other claim
(~vo. ater Clalm OI L~rePnnm $?~tuouw~u ..... '~' or other rights important
or relief requested by the Plaintiff. You may ~ose money or ptot~.~
to you.
YOU SHOULD TAK~ THIS PAPER TO YOUR LAWYER AT ONCB. IF YOU DO
NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TF.I.I:tPHONE THE
OFFICB S]~T FORTH BELOW TO FIND OUT WHERE YOU CAN GET LBGAL HELP.
,AND COUNTy
Court Administrator
Fourth Floor
Cumberland County Courthouse
Carlisle, PA 17013
(717) 240-6200
98ITB-01008
LAW OFFICES OF JACOBS & SABA
W. Darren Poweil, Esquire
214 Senate Avenue, Suite 503
Camp Hill, PA 17011
Telephone Number: (717) 731-0988
Attorney for Defendant Nationwide Insurance
COREY R. LEES,
PLAINTIFF
VS.
NATIONWIDE INSURANCE,
DEFENDANT
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, pENNSYLVANIA
No. 98=7326
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
ANSWER WITH NEW MATTER AND COUNTER CLAIM OF DEFENDANT
NATIONWIDE INSURANCE TO PLMNTIFF'S COMPLMNT
AND NOW, comes the Defendant, Nationwide Insurance, by and through it's attorney,
W. Darren Powell, Esquire and in support of this Answer with New Matter and Counter
Claim of Defendant Nationwide Insurance to plaintiff's Complaint hereby avers as follows:
1. Admitted.
2. Admitted.
3. Admitted in part, denied in part. It is admitted that Barbara Keiter was, at times
relative hereto, insured with Defendant under an automobile insurance policy. It is further
admitted that Defendant denied payment of bills for dates of service beginning March 2, 1997.
All other averments are denied pursuant to Pa.R.C.P. 1029(e).
4. Admitted. By way of furtber response, a copy of the PRO report issued by Dr. Jess
Armine is attached hereto as Exhibit "A".
5. Denied. Paragraph 5 is generally denied pursuant to Pa.R.C.P. §1029(e). By
further response, it is averred that the care was neither medically necessary or reasonable.
6. Paragraphs one (1) through six (6) are incorporated herein by reference, and made a
part hereof as if set forth in full.
?. Defendant has paid all benefits required under the applicable insurance policy and
applicable law.
8. Plaintiff's alleged damages are specifically limited to those remedies provided under
the Pennsylvania Motor Vehicle Financial Responsibility Law.
9. Plaintiffts claims ale barred by the applicable statute of limitation.
10. plaintiff has failed to state a cause of action upon which relief may be granted.
11. The Pennsylvania Motor Vehicle Financial Responsibility Law and the regulations
thereunder govern the payment of first party benefits under the Pennsylvania Motor Vehicle
Financial Responsibility Law.
12. Said laws, including the Health Care Cost Covtalnn~ent regulations sets forth a
comprehensive system for payment of first pa~y medical benefits for persons covered by
automobile insurance policies.
13. Said regulations provide payment at certain rates for bills for services and goods
provided in accorr~nce with the act and regulations.
14. In addition, the law provides for a peer review procedure under which the
reasonableness and necessity of the treatment or goods can be ascertslned prior to
reimbursement or payment of a bill.
15. The payment system set forth by the Pennsylvania Motor Vehicle Financial
Responsibility Law and the regul~tlons promulgated thereunder require that plaintiff or his
provider submit a bills for services or products provided, plzintiff has failed to submit any
such bill.
WHEREFORE, the Defendant respectfully prays this Honorable Court to dismiss
plzintiff*s Complaint and to enter judgment in favor of the Defendant.
Nationwide Insurance v. Corey Lees
16. Paragraphs 1 through 15 of this Answer with New Matter and Counter Claim are
incorporated herein by reference.
17. On or about August 13, 1998, Dr. Jess Armine conducted a Peer Review in
accordance with the Pennsylvania Motor Vehicle Financial Responsibility Law.
18. Dr. Armine determined that the care provided beyond March 1, 1998 was not
medically reasonable or necessary.
19. By letter dated August 18, 1998, a copy of Dr. Armine's report was forwarded
onto plzintiff. A copy of said August 18, 1998 letter is attached hereto as Exhibit '*B".
20. Nationwide Insurance, prior to the PRO report, had paid $290.40 to Plaintiff for
visits between March 2, 1998 through March 25, 1998. The services provided on said dates
were determined not to be medically reasonabie or necessary by the PRO.
21. Defendant is entitled to return of the $290.40, plus interest thereon at the rate of
12% per znnum.
22. Defendant has requested reimbursement of said amount, but payment has not been
WHEREFORE, Nationwide Insurance respectfully requests that this Honorable Court
enter judgment in its favor and against Corey Lees in the amount of $290.40, plus interests
and costs.
Date:
Respectfully submitted,
LAW OI~i~iC]~S OF JACOBS & SABA
W. Darren Powell, Esquire
Attorney for Defendant Nationwide Ins.
214 Senate Avenue, Suite 503
Camp Hill; PA 17011
Telephone No. (717) 731-0988
Identification No.68953
98HB-01008
LAW OFFICES OF JACOBS & SABA
W. Darren Powell, Esquire
214 Senate Avenue, Suite $03
Camp Hill, PA 17011
Telephone Number: (717) 731-0958
Attorne~ for Defendant Nationwide Insurance
COREY R. LEES,
PLAINTIFF
VS.
NATIONWIDE INSURANCE,
DEFENDANT
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY~ PENNSYLVANIA
No. 98-7326
CIVIL ACTION - LAW
JURy TRIAL DEMANDED
VERIFICATION
W. Darren Powell, Bsquire, hereby states that he is attorney for Defendant,
Nationwide Insurance, in this action, and is authorized to verify that the statements made in
the foregoing pleading are true and correct to the best of his knowledge, information and
belief. The undersigned understands that the statements therein are made subject to the
penalties of 18 Pa.C.S.A. §4904 relating to unsworn falsification to authorities.
arren Powell, Esqu~r~
Attorney for Defendant Nationwide Insurance
98HB-01008
LAW OFFICES OF JACOBS & SABA
W. Darren Powell, Esquire
214 Senate Avenue, Suite $03
Camp Hill, PA 17011
Telephone Number: (717) 731-0988
Attome}, for Defendant Nationwide Insurance
COREY R. LEES,
PLAINTIFF
VS.
NATIONWIDE INSURANCE,
DEFENDANT
IN Ttig COURT OF COMMON ]~LEAS
CUMBERLAND COUNTY, PENNSYLVANIA
No. 98-7326
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
CERTIFICATE OF SERVICE
W. Darren Powell, Esquire, hereby certifies that he is the attorney for the Defendant
herein, and that he caused a tree and correct copy of Answer with New Matter and Counter
Claim Qf D~fendnnt N~tignwide Insurance to Plaintiff's Comolaint to he served by regular first
class mail upon:
Dated: July 23. 1999
Dr. Corey Lees
6103 Carlisle Pike
Mechanicsburg, PA 17055
Attorney for Defendant
JESS P.
August 13, 1998
ARMINE, R.N., D.C., DABFM, D~BFE
2710 TOWNSHIP LINE ROAD
UPPER DARBZ, PA 19082
claims Review Associates
700 American Avenue
Suite 300
King of prussia, PA 19406
Attn: Suzanne Sehl, ~
Barbara Kelter
R~: 211-34-8268
SSN: 11/29/97
DOI:
cRA %: 002214396-01
Dear Ms. Sehl,
I received a' request to perform a peer revieW concerning the
reasonableness and necessity of the chiropractic care afforded
the above captioned patient. My opinion is based on a review of
the enclosed documentation and reference to the Guidelines for
Chiropractic Quality Assurance and Practice Parameters also known
as the Mercy Conference Guidelines.
DOCUMENTS SUBMITTED FoR REVIEW
Application for benefits dated 12/12/97-
From Corey R. LeeS, D.C. narrative report dated 1/19/98,
handwritten office notes dated 12/1/97 through 5/11/98 and copies
of bills dated 12/1/97 through 5/29/98-
SUMMARX OF RECORDS
This 53 year old female was the driver of a vehicle involved in a
motor-vehicle accident on 11/29/97. The records show that the
patient was proceeding through an intersection when another
vehicle came through the stop sign hitting her vehicle on the
driver'S side with enough impact to spin her vehicle
approximately 180 degrees. There was no record of emergency care.
RE: BARBARA KEITER
PAGE 2
According to the records the patient presented to Dr. Lees on
12/1/97. According to the narrative report the diagnoses were
739.1 nonallopathic lesions of cervical region, 847.0 neck
sprain, 847.2 lumbar sprain and 739.3, subluxation. According to
the bills the diagnoses were 719.4 and 723.2. The treatment was
chiropractic adjustments and adjunctive therapies-
According to the records an EMG and thermography tests were
preformed- It appears that each test was done twice once in 1997
and once in 1998. The dates and results are partially illegible
' due to poor copy quality-
The records show that the patient was seen by Dr. Lees 15 times
in 12/97, 13 times in 1/98, 12 times in 2/98, 13 times in 3/98,
13 times in 4/98 and 10 times in 5/98 for a total of 76 visits.
There are no notes'concerning the iast visits.
TELEPHONE coNF~p~NCEWITH ATTENDING PHXSICIAN
None requested.
CLINICAL oPINION
It is my opinion that the care rendered this patient from 12/1/97
through 3/1/98 was reasonable and necessary in this case. It is
my further opinion that the surface EMG's are not appropriate in
this case.
According to the Mercy Conference Guidelines care for an
uncomplicated case should take approximately 6-8 weeks of care.
The presence of complications will extend 5he amount of care
required to bring a patient to a level of maximum benefit.
Estimates of care are based on multiples of the care of an
uncomplicated case.
· · actorS identified that woul~ delay ~?~ry are
The complicating ? --~nt and the repor~ oS the
the severity of tne_a t ercy Guidelines approx ma et
bes~t According to un
o ' Y' -~= ed case (12 weeks) wo~±u
times the care of ~ ~ ~essary for ~he care of t~e
~=4dered reasonaD±e ~ ~ ~ ~ ~,~oDosed peer
~°~nted condition. Accord~ng_~? =~a~%i~ Society this patient
~cument from the Pennsylvania cnlrow of 40, placing this
would have an objective Complicating Rating
case in the ,,uncomplicated" category-
~6-~8-98 TU£ 10:!7 ~H OR8 OLMOS FSX ~0. 6~03371637 ?.04/04 '
RE: BARBARA KEITER
PA~E 3
There are no re examinations or objective outcome measures
documented. Therefore, there is no objective rationale for
continuing care beyond 3/1/98.
The surface EMG's are rated as ~investigationa]" by the Mercy
Guidelines as they are used in this case. Also, the use of this
test does not seem to have altered the treatment of this patient.
The rationale for the use of this test is questionable and
therefore inappropriate.
The opi~ions rendered in this case are the opinions of the
reviewer. This ~eview has been conducted without a medical
examination of the individual reviewed. The revzew is based on
documents provided to us by the provider. If more information
'becomes available at a later date, this will be documented ~nd
reported. Such information may or may not change the opinions
rendered in this report. This report is a clinical assessment and
opinion conducted with the information available..It does not
constitute per se recommendations for specific claims or
administrative functions to be made or enforced.
Sincerely,
p/~mate of~ ~erican Board of Forensic Examiners
~GE, 04
P O BOX_2655 * HARRISBURG PA 17105-9971 *
DR COREY R LEES DC
6103 CARLISLE PIKE
MECHANICSBURG PA 17055
.NATIONWIDE
INSURANCE
ENTERPRISE
Nationwide is on your $~de .
August18,1998
OUR INSURED: Barbara Keiter 7'
OUR CLAIM NUMBER: 58 37 A 738330 11-29-1997 01
DATE OF ACCIDENT: 11-29-1997
PATIENT NAME: Barbara Keiter
After careful review of 'the attached Peer Review, we are denying payment of your care
from March 1, 1998 thru present.
Pursuant to Pennsylvania Act'6 of 1990, Section 1797, as stated in Chapter 69.52(H):
"An insured, provider, or insurer may request, in writing, reconsideration of the initial
PRO determination within 30 days from the date the initial determination is effected. A
PRO may set a reasonable charge for a reconsideration but in no case shall the charge
for a reconsideration exceed the charge for the initial review. An insurer shall make full
payment of the charge for reconsideration to the PRO, but the amount paid for the
reconsideration shall ultimately be borne by the party against whom a reconsideration
determination is made.
Also, Nationwide Insurance Company is requesting reimbursement in the amount of
$290.40 for the visits from March 2, 1998 through March 25, 1998 which Nationwide
paid to you on June 10, 1998.1 have enclosed a self addressed stamped envelope for
your convenience in remitting your payment.
SincerelY/,
NATIONWIDE MUTUAL INSURANCE COMPANY
JULIE CARR
Claims Department
717-657-6588
CC:
ROY E COOK (#0005215)
Barbara Keiter
Any person who knowingly and with intent to defraud any insurance company or other person files an
application for insurance or statement of claim containing any materially false inforn~ation or conceals for
the purpose of misleading, information concerning any fact material thereto commits a fraudulent
insurance act, which is a crime and subjects such a person to criminal and civil penalties.
98HB-01008
LAW OFFICES OF JACOBS & SABA
W. Darren Powell, Esquire
214 Senate Avenue, Suite 503
Camp Hill, PA 17011
Telephone Number: (717) 731-0988
Attome for Defendant Nationwide Insurance
CORE¥ R. LEES,
PLAINTIFF
VS.
NATIONWIDE INSURANCE,
DEFENDANT
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
No. 98-7326
CIVIL ACTION- LAW
JURY TRIAL DEMANDED
PRAECIPE
TO THE PROTHONOTARY:
Kindly substitute the attached Verification to Answer with New Matter and Counter
Claim of Defendant Nationwide Insurance to Plaintiff's Comolaint, for the attorney's
Verification that had been filed with the Court on or about luly 23, 1999.
Dated: Au_~uat 5. 1999
Respectfully submitted,
LAW OFFICES OF JACOBS & SABA
W. Darren Powell, E.squire
Attorney for Defendant
214 Senate Avenue, Suite 503
Camp Hill, PA 17011
Telephone Number (717) 731-0988
Identification No. 68953
98HB-01008
LAW OFFICES OF JACOBS & SABA
W. Darren Powell, Esquire
214 Senate Avenue, Suite 503
Camp Hill, PA 17011
Telephone Number: (717) 731-0988
Attorne~ for Defendant Nationwide Insurance
COREY R. LEES,
PLAINTIFF
VS.
NATIONWIDE INSURANCE,
DEFENDANT
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 98=7326
CIVIL ACTION- LAW
JURY TRIAL DEMANDED
VERIFICATION
I, Ellen Smithers, verify that the statements made in the foregoing Answer with New
M~t~0r ~tn~l Counter Claim of Defendant Nationwide Insurance to Plaintiff's Complaint are true
and correct to the best of my knowledge, information and belief. I understand that false
statements here'm are made subject to the penalties of Pa.C.S.A. §4904, relating to unswom
falsification to authorities.
Ellen Sn)i~er ,s,~, Representative of
Nationwide IViutual Insurance Company
RECEIVED
JUL 2 2 1999
HOg. Medical Dept.
98HB-01008
LAW OFFICES OF JACOBS & SABA
W. Darren Powell, Esquire
214 Senate Avenue, Suite S03
Camp Hill, PA 17011
Telephone Number: (717) 731-0988
Attorne for Defendant Nationwide Insurance
COREY R. LEES,
PLAINTIFF
VS.
NATIONWIDE INSURANCE,
DEFENDANT
IN ~ COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
No. 98-7326
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
CERTIFICATE OF SERVICE
W. Darren Powell, Esquire, hereby certifies that he is the attorney for the Defendant
herein, and that he caused a tree and correct copy of Praecipe to Substitute Verification to
Answer with New Matter and Counter Clainl of Defendant Nationwide Insurance to Plaintiff's
Cornplalnt to be served by regular first class mail upon:
Dated: Au~st 5. 1999
Dr. Corey Lees
6103 Carlisle Pike
Mechanicsburg, PA 17055
W.~rren Powell, Esquire '~
Attorney for Defendant
COREy R. LEES, D.C.
(Barbara Keiter)
Plaintiff
NATIONWIDE INSURANCE,
Defendant
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
:
: CIVIL ACTION-LAW
:
NO. 98-7326
JURy TRIAL DEMANDED
NOTICE - AMENDED COMPLAINT
YOU HAVE BEEN SUED 1N 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 Plaintiff. You may lose money or
property or other rights important to you.
¥ YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE
OU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEP ' IF
THE OFFICE SET FORTH BELOW TO FIND OUT WHERE y ..... HONE
tvt~ cAN GET LEGAL HELP.
CUMBERLAND COUNTy
Court Administrator
Fourth Floor
Cumberland County Courthouse
Carlisle, PA 17013
NOTICIA
Le han demandado a usted an la corte. Si usted guiere 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 o en persona
o por abogado y archivar en la corte en forma escrita sas defensas o sus objeciones a las
demandas en contra de su persona. Sea avisado gue si usted no se defienda, la corte tomara
medidas y puede entrar una orden contra usted sin previo aviso o notificacion y por cualquier
gueja o alivio gae es pedido en la peticion de demanda. Usted puede perder dinero o sus
propiedades o otros derechos importantes para usted.
tzb L}INIgRO SUFICIENTE DE PAGAR TAL
SERVICIO, VAYA EN PERSONA O LLAME POR TELEFONO A LA OFICINA CLryA
DIRECCION SE ENCUNENTRA ESCRITA ABAJO PARA AVERIGUAR DONDE SE
PUEDE CONSEGUIR ASISTENCIA LEGAL.
CUMBERLAND COUNTY
Court Administrator
Fourth Floor
Cumberland County Courthouse
Carlisle, PA 17013
COREY R. LEES, D.C.
(Barbara Keiter)
Plaintiff
NATIONWIDE INSURANCE,
Defendant
: IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION-LAW
:
: NO. 98-7326
:
: JURY TRIAL DEMANDED
AMENDED COMPLAINT
1. The Plaintiff, Dr. Corey R. Lees, is a licensed chiropractor with an office
at 6103 Carlisle Pike, Mechanicsburg, Cumberland County, Pennsylvania.
2. The Defendant, Nationwide Insurance, is an insurance company
authorized to do business in the Commonwealth of Pennsylvania and specifically in Cumberland
County where the Defendant sells insurance policies to the citizens of Cumberland County. Said
corporation has an office address of P.O. Box 2655, Harrisburg, Pennsylvania 17105.
BACKGROUND
3. The Defendant entered into a contract &insurance with Barbara Keiter.
4. The policy of insurance issued by the Defendant was intended to meet the
requirements of the Pennsylvania Motor Vehicle Financial Responsibility Law, 75 P.S. §1701 et.
seq., as amended, and to provide first party benefits to Barbara Keiter in accordance with the
law.
5. The benefits provided included coverage for medical and chiropractic
services rendered to Barbara Keiter in the event that she was injured as the result of a motor
vehicle accident.
6. On November 29, 1997, Barbara Keiter suffered personal injuries as the
result of a motor vehicle accident.
7. Barbara Keiter sought and received care from Plaintiff, Dr. Lees, which
consisted of chiropractic treatments, manipulations and other modalities to aid in her recovery
from the personal injuries she suffered as a result of the motor vehicle accident.
8. Dr. Lees routinely billed the Defendant for the services performed in
accordance with the Motor Vehicle Financial Responsibility Law.
9. The Defendant allegedly had a "peer review" accomplished and upon the
basis of the peer review refused to pay for any chiropractic treatments for Barbara Keiter afier
March 1, 1998. The alleged peer review performed did not properly follow the peer review
process outlined in 75 Pa. C.S.A. §1797(b) and the applicable regulations.
I 0. By applying for and benefiting from the peer review process set forth at 75
PA. C.S.A. §1797, the Defendant is required to be familiar with and understand all of the Act 6
regulations applicable to the peer review process.
11. As indicated by the peer review report dated August 13, 1998, Defendant
denied all payment for care rendered to Barbara Keiter after March 1, 1998. Said action by
Defendant violates the Motor Vehicle Financial Responsibility Law which is set forth at 75 PA.
C.S.A. § 1797 (commonly known as Act 6) and the applicable regulations.
12. In addition to the above referenced violations of Act 6, the Defendant also
violated Act 6 and its regulations in several other instances. First, pursuant to Act 6 regulation
69.52(d), a PRO's initial determination shall be completed within thirty (30) days after receipt of
requested information.
13. The Defendant sent the necessary documentation to the PRO on June 1,
1998. The PRO report was not completed until August 13, ~998. A true and correct copy of the
PRO report is attached hereto and made a part hereof as Exhibit "A." Therefore, the PRO report
was not completed within thirty (30) days after receipt of the requested information. Said action
is in violation of Act 6 regulation 31 Pa. Code §69.52(d).
14. Pursuant to Act 6 regulation 31 Pa. Code § 69.53(e), a PRO shall apply
national or when appropriate, regional norms in conducting determinations or establish written
criteria based upon typical patterns of practice. In his review, Dr. Jess p. A/mine applies a
method of treatment unaccepted by most of the chiropractic ... . . .
Considered a national or regional norm. Moreover, Dr. ~--' Pr°felsl°n and which is m no way
- ,'umme applies his own opinion.
15. It is averred that Dr. Armine's personal opinions, which he Used to support
his conclusion in his peer review, are not national norms, regional norms or even typical, but
rather are considered controversial and are Unused by the majority of the chiropractic
community.
16. In his report Dr. Armine, by his own admission, uses his professional
opinion instead of applying the national or regional norms. Said action by Dr. Armine is in
violation of Act 6 regulation 31 Pa. Code § 69.$3(e).
17. It is averred that Dr. Armine's ambiguous opinions are not based on
national or regional norms and do not measure up to the "specific
regulation 31 Pa. Code ~ 69.52(e). reasons" required by Act 6
18. Dr. Arrnine further violates the Act 6 regulations by stating that since Dr.
Lees did not follow Dr. Armine's own personal
unreasonable and unnecessary, opinions, Barbara Keiter's care was
19. It is averred that Defendant demonstrated a complete fa/lure to comply
with Act 6 regulation 31 Pa. Code § 69.53(e) by using Dr. Armine's professional opinions that
do not equate with such national or regional norms.
20. In his review, Dr. Arm/ne did not establish any wr/tten criteria based upon
typical patterns of practice.
-4-
21. In his peer review, Dr. Armine refers to the · .
as standards for chiropractic care. It is averred that
these guidelines are not to be used as standards of chiropractic care by the books own
instructions.
22. Dr. Ann/ne further violates the Act 6 regulations by stating that because
Dr. Lees did not fo/low the Mercy Guidelines that his care was unreasonable and unnecessary.
23. It is averred that the opinions and recommendations of Dr. Arm/ne are
improper and his actions demonstrate a willful intent on the part of Defendant to deny Dr. Lees
payment for his care and treatment of Barbara Keiter.
24. It is further averred that using the guidelines from the ~
b , . . as standards of care contrary to the
ook s directions, to evaluate the care given by Dr. Lees,
Lees. is misleading and grossly unfair to Dr.
25. It is averred that the opinions and recommendations of Dr. Arm/ne are
improper and his actions demonstrate a willful intent on the part of Defendant to deny Dr. Lees
Payment for his care and treatment of Barbara Keiter.
26. Defendant read Dr. Armine's initial peer review and denied the claim of
Dr. Lees based on Dr. Armine's opinions even though they were aware that Dr. Annine had not
-5-
applied national or regional standards of care as required in Act 6 regulation 31 Pa. Code
§69.52(e) or established written criteria to conduct his review as required by Act 6 regulation 31
Pa. Code §69.53(e). Such actions demonstrate "no reasonable foundation" and should be
considered wanton.
27. The Defendant, by its own admission, considered such improper actions
and violations by Dr. Armine and used that improper report to deny the claim of Dr. Lees. Such
action by the Defendant demonstrates "no reasonable foundation" and should be considered
wanton.
28. In his peer review, Dr. Armine acknowledges that certain objective tests
produced abnormal results on Barbara Keiter. Even though these results were produced, Dr.
Armine's final opinion was that no care after March 1, 1998 should be considered reasonable and
necessary. This determination by Dr. Armine is contradictory to objective test results.
29. It is therefore asserted that the peer review report conducted by Dr.
Armine is improper and should not be considered a peer review report.
30. It is averred that the Defendant read the peer review report from Dr.
Armine and was therefore aware of the many violations that Dr. Armine committed.
-6-
31. The Defendant denied payment to Dr. Lees based on the peer review
report by Dr. Annine even though the violations committed by Dr. Armine existed. Such action
by Defendant demonstrates "no reasonable foundation" and should be considered wanton.
32. The treatment and care that Barbara Keiter received from Dr. Lees helped
to lessen the pain that she experienced from the crash.
33. Barbara Keiter continued to request treatment from Dr. Lees because his
care continued to lessen her pain.
34. It is averred that all bills incurred before and after the peer review are fair
and reasonable and that said treatment was medically necessary and related to the accident.
35. The fair and reasonable sum due to Dr. Lees for his care and treatment of
Barbara Keiter is $12,024.10 together with interest at Twelve percent (12%) per year, penalty as
provided by the statute and reasonable and actual attorney's fees.
36. Defendant has refused to pay the balance due under the terms and
conditions of the policy of insurance and the Pennsylvania Motor Vehicle Responsibility Law.
As a result of the aforesaid, Plaintiff has been required to hire the services of an attorney to
collect the medical bills due. Therefore, pursuant to Section 1797(b)(6) of the Pennsylvania
Motor Vehicle Financial Responsibility Law, Plaintiff is entitled to a mandatory award of
-7-
attorney's fees, interest and costs associated with bringing this action. See/Stefanik v, State
Farm Insurance Company 115 Dauph. 277 (1995).
37. Defendant has undertaken a course of action which has been designed to
unilaterally, and without justification, refuse claim for medical benefits and cause Barbara Keiter
to become personally responsible for medical bills arising out of the maintenance or use of a
motor vehicle, in contradiction to the terms of the contract, Pennsylvania Motor Vehicle
Financial Responsibility Law and the case law of the Commonwealth of Pennsylvania.
38. 75 Pa. C.S.A. 31797 grants standing to the provider (Dr. Lees) to
challenge before a court an insurer's refusal to pay for past or future medical treatment. Conduct
considered to be wanton shall be subject to a payment of treble damages to the injured party.
See/~efanik v. State Farm Insurance Company 115 Danph. 277 (1995).
39. The abuse of the peer review system by Defendant as described above is
"wanton" for the reasons specifically set forth above.
-8-
WHEREFORE, Plaintiff demands judgment against Defendant for compensatory
damages of $12,024.10, treble damages of $36,072.30, interest at the rate of 12% per annum and
reasonable and actual attorneys' fees and costs of suit.
Date:
Respectfully submitted,
BUTLER LAW FIRM
Attorneys for Plaintiff
ID #09826
Jana C. Butler, Esquire
]D #80574
500 North Third Street
P.O. Box 1004
Harrisburg, PA 17108
(717) 236q1485
~r.-22' 99{~DJ 08:41 BUTLER LAW FI~ TEL:717 236 7777
I unders~u~ that any ids= sfa~cuents hewn am mad-. subject lo thc permlti~ of 18
Pa.C.$.~ ~ 4909. reJming r~ uuswom fahifi¢~on to nflmriii~.
August 13,
·ESS p. ARMINE, R.N., D.C., DABFM, DABFE
2710 TOWNSHIP LINE ROAD
UPPER DAR~y, ~A 19082
1998
Claims Review AssoCiates
700 American Avenue
Suite 300
King of Prussia, PA 19406
Attn:
Suzanne Sehl,
Barbara Keiter
SSN: 211-34-8268
DOI: 11/29/97
CRA #: 002214396-01
Dear Ms. Sehl,
I received a'~request to perform a peer review concerning the
reasonableness and necessity of the chiropractic care afforded
the above Japtioned patient. My opinion is based on a review of
the enclosed dOCUmentation and reference to the Guidelines for
Chiropractic Quality Assurance and Practice Parameters also known
as the Mercy Conference Guidelines.
DOCUMENTS SUBMITTED FOR REVIEW
Application for benefits dated 12/12/97.
From Corey R. Lees, D.C. narrative report dated 1/19/98,
handwritten office notes dated 12/1/97 throuoh 5/1!/98 and copies
of bills dated 12/1/97 through 5/29/98.~
SUMMARy OF RECORDs
This 53 year old female was the driver of a vehicle involved in
motor, vehicle aCcident on 11/29/97. The records show that the
pat'ie~t'was proceeding through an i - a
veh!cle came through +~ ...... ~tersectlon when another
= ~,= o~p Sl~n ~i~ ~ -
~ =u~ng net vehicle on the
driver,s side with enough impact to spin her vehicle
approximately 180 degrees. There was no record of emergency care.
EXHIBIT "A"
COREY R. LEES, D.C.
(Barbara Keiter)
Plaintiff
NATIONWIDE INSURANCE,
Defendant
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION-LAW
NO. 98-7326
JURY TRIAL DEMANDED
CERTIFICATE OF SERVICE
I, Jana C. Butler, Esquire, hereby certify that on the :t~TX:~ day of September, 1999, I
served a tree and correct copy of the foregoing Amended Complaint by depositing same in the
United States Mail, postage prepaid in Harrisburg, Pennsylvania, addressed as follows:
W. Darren Powell, Esquire
Jacobs & Saba
214 Senate Avenue, Suite 503
Camp Hill, PA 17011
J. ana C. ~
Attorne~ for Plaintiff
I.D. #80574
500 North Third Street, 12th Floor
P.O. Box 1004
Harrisburg, PA 17108
(717) 236-1485
ii
BUTLER LAW FIRM
ATTOI~NEYS AT
98HB-01008
LAW OFFICES OF JACOBS & SABA
W. Darren PoweH, Esquire
214 Senate Avenue, Suite 503
Camp Hill, PA 17011
Telephone Number: (717) 731-0988
~Attorney for Defendant_ Nationwide lnsura~._-e
COREY R. LEES,
PLAINTIFF
VS.
NATIONWIDE INSURANCE,
DEFENDANT
I~ Tm~ CO~T OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
No. 98-7326
CIVIL ACTION- LAW
JURy TRIAL DEMANDED
NOTICE
YOU HAVE B~N SUED IN COURT. If you wish to defend against the clalras set forth
in the following pages, you must take action within twenty (20) days after this Answer with N~w
Matter and Counter Claim of D~fendaqt Nationwide In~,~_mne~. to l~lahi;;rf.s Amended
and Notice are served by eaiering 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 Answer With
New Matter and Counter Claim of Defendant_ Nationwide Insnrance to Plahi:;ff's
~ 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 LAWYHR AT ONCE. IP YOU DO
NOT HAVE A LAWYER OR CANNOT APPORD ONE, GO TO OR TELEPHONE THE
OFFICE SET FORTH BHIX)W TO FIND OUT WI-II~RE YOU CAN GET LF_~AL I~.r.~.
CUMBERT.~D COUNTY
Court Administrator
Fourth Floor
Cumberland County Courthouse
Carlisle, PA 17013
(717) 240-6200
98HB-01008
LAW OFFICES OF JACOBS & SABA
W. Darren Poweli, Esquire
214 Senate Avenue, Suite 503
Camp Hill, PA 17011
Telephone Number: (717) 731-0988
Attorney for Defendant Nationwide Insuranc_-
COREY R. LEES,
PLAINTIFF
VS.
NATIONWIDE INSURANCE,
DEFENDANT
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
No. 98-7326
CIVIL ACTION - LAW
JURy TRIAL DEMANDEO
ANSWER WITH NEW MATTER AND COUNTER CLAIM OF DEFENDANT
NATIONWIDE INSURANCE TO PLAINTIFF'S AMENDED COMPLAINT
AND NOW, comes the Defendant, Nationwide Insurance, by and through it's attorney,
W. Darren Powell, F_zquire, and in support of this Answer with New Matter and Counter
Claim of Defendant Nationwide Insurance to Plaintiff's Amended Complaint, hereby avers as
follows:
1. Denied. After reasonable investigation, the Defendant is without knowledge or
information sufficient to form an opinion as to the truth or falsity of said averment. Strict
proof thereof, ff relevant, is demanded.
2. Admitted.
3. Admitted.
4. Denied as stated. By way of further response, the contract of insurance entered into
between Ms. Keiter and Defendant is a written contract which speaks for itseff.
5. Denied as stated. The contract is a written document which speaks for itself.. By way
of further response, the first party medical benefit coverage under the policy provides for
payments for medically reasonable and necessary treatments for injuries related to motor vehicle
accidents, as set forth in the policy and in accordance with the Pennsylvania Motor Vehicle
Financial Responsibility Law and the regulations promulgated thereunder.
6. Denied. After reasonable investigation, the Defendant is without knowledge or
information sufficient to form an opinion as to the truth or falsity of said averment. Strict
proof thereof, if relevant, is demanded.
7. Admitted in part, denied in part. It is admitted, based upon information provided, that
Plaintiff provided services to Ms. Keiter. It is denied that such services were reasonable or
necessary or that such were provided in connection with any injuries which may have been
sustained in the alleged accident.
8. Denied. The averments contained in ¶8 constitute conclusions of/aw to which no
response is required. To the extent that it is judicially determined that a response is required, the
same are denied generally pursuant to Pa.R.C.P. §1029(e).
9. Denied as stated. By way of further response, Defendant retained an independent peer
review organization, Claims Review Associates, Inc., to determine the reasonableness and
necessity of the treatment in question, as provided for by the Pennsylvania Motor Vehicle
Financial Responsibility Law and the regulations thereunder. The peer review was accomplished
by Dr. Sess P. Armine, who concluded that the care provided by Dr. Lees subsequent to March 1,
1998 was not medically necessary or reasonable. It is further averred that Claims Review
2
Associates was approved by the Commonwealth of Pennsylvania as a peer review organization on
April 25, 1990, and that the peer review was done in accordance with all applicable law and
regulations.
10. Denied. The averments contained in ¶10 constitute conclusions of law to which no
response is required. To the extent that it is judicially determined that a response is needed, the
same are denied generally pursuant to Pa.R.C.P. §1029(e).
11. Admitted in part, denied in part. It is admitted that Dr. Armine, in his report dated
August 13, 1998, found that the treatments provided subsequent to March 1, 1998, were not
medically necessary or reasonable. It is further admitted that Defendant, in accordance with said
report, denied further payment to Dr. Lees and, moreover, requested reimbursement for payments
made for services determined to be medically unreasonable or unnecessary. It is denied that such
action is in any way, manner, or form, violative of the Pa. M.V.F.R.L or the regulations
promulgated thereunder.
12. Denied. The averments contained in ¶12 constitute conclusions of law to which no
responseis required. T° the extent thatit isjudiciallydetermined that a response is needed, the
same are denied generally pursuant to Pa.R.C.P. §1029(e).
13. Denied. By way of further response, it is averred that Plaintiff, despite numerous
requests by the Peer Review Organization to provide his records, refused to do so. By letter fi.om
the Peer Review Organization to Plaintiff, dated July 20, 1998, Plaintiffwas advised that he was
being provided an additional twenty (20) days to provide the same with copies of his records,
extending the thirty (30) day time period as permitted by Act 6.
3
14. Denied. The averments contained in ¶14 constitute conclusions of law to which no
response is required. By way of further response, to the extent that it is judicially determined that
a response is needed, the Act 6 regulations speak for themselves, as does Dr. Armine's report.
Any implication that said report is in violation of the Act 6 regulations is specifically denied.
15. Denied.
16. Denied. The averments contained in ¶16 constitute conclusions of law to which no
response is required. By way of further response, to the extent that it is.judicially determined that
a response is needed, the Act 6 regulations speak for themselves, as does Dr. Armine's report.
Any implication that said report is in violation of the Act 6 regulations is specifically denied.
Denied.
17. Denied. The averments contained in ¶17 constitute conclusions of law to which no
response is required. To the extent that it is judiciaily determined that a response is needed, the
same are denied generally pursuant to Pa.R.C.P. §1029(e).
18. Denied. The averments contained in ¶18 constitute conclusions of law to which no
response is required. To the extent that it is judicially determined that a response is needed, the
same are denied generally pursuant to Pa.R.C.P. § 1029(e).
19. Denied. By further response, Defendant acted entirely appropriate and in accordance
with Act 6 and other law in connection with this matter. Defendant engaged an approved Peer
Review Organization which through, Dr. Armine, determined that the care provided by Dr. Lees
was not reasonable or necessary.
20. Denied. Dr. Amine's report is a written document which speaks for itself. Any
allegation or implication that said report is in violation of the Act 6 regulations is specifically
denied.
21. Admitted in part, denied in part. It is admitted that Dr. Armine's report refers to said
referenced book entitled Guidelines for Chiropractic Quality Assurance and Practice Parameters.
Any impropriety in referring to said book on chiropractic practice quality is specifically denied.
22. Denied. The averments contained in ¶22 constitute conclusions of law to which no
response is required. To the extent that it is judicially determined that a response is needed, the
same are denied generally pursuant to Pa.R.C.P. §1029(e). By way of further response, Dr.
A_rmine's report is a written document which speaks for itself.
23. Denied.
24. Denied. It is specifically denied that the reference to guidelines set forth in Guidelines
for Chironractic Ouaiitv Assurance and Practice Parameter,, is misleading or grossly unfair to Dr.
Lees.
25. Denied.
26. Admitted in part, denied in part. It is admitted that Defendant denied Dr. Lees' bills
based upon Dr. Armine's peer review report. Byway oflhrther response, such action was proper
and provided for by the Pennsylvania Motor Vehicle Financial Responsibility Law and the
regulations promulgated thereunder. It is denied that Dr. Armine or Defendant violated Act 6 or
5
that Defendant's denial was not based upon a reasonable foundation. By way of further
response, it is averred that Defendant acted in all manners reasonable and in accordance with the
applicable law and regulations.
27. Denied as stated. Defendant based its denial of bills on Dr. Armine's report, in
accordance with Act 6 and applicable regulations. It is specifically denied that the decision was
based upon improper actions or violations by Dr. Annine. It is further denied that Defendant
denied the bills without reasonable foundation or that such action was wanton.
28. Denied as stated. The report is a written document which speaks for itself.
29. Denied.
30. Admitted in part, denied in part. It is admitted that Defendant, through its agents,
read Dr. Armine's report. It is denied that Dr. Armine committed violations or that Defendant's
agents were aware of the same.
31. Admitted in part, denied in part. It is admitted that Defendant based its decision to
deny payment based upon the Peer Review report of Dr. Armine, as permitted for by Act 6. It is
again denied that Dr. Annine committed "violations." It is again denied that Defendant acted
without reasonable foundation or that its actions should be considered wanton.
32. Denied. After reasonable investigation, the Defendant is without knowledge or
information sufficient to form an opinion as to the truth or falsity of said averment. Strict
proof thereof, if relevant, is demanded.
6
33. Denied. After reasonable investigation, the Defendant is without knowledge or
information sufficient to form an opinion as to the truth or falsity of said averment. Strict
proof thereof, if relevant, is demanded.
34. Denied. After reasonable investigation, the Defendant is without knowledge or
information sufficient to form an opinion as to the truth or falsity of said averment. Strict
proof thereof, if relevant, is demanded.
35. Denied. The averments contained in ¶35 constitute conclusions of law to which no
response is required. To the extent that it is judicially determined that a response is needed, the
same are denied generally pursuant to Pa.R.C.P. §1029(e).
36. Denied. The averments contained in ¶36 constitute conclusions of law to which no
response is required. To the extent that it is judicially determined that a response is needed, the
same are denied generally pursuant to Pa.R.C.P. §1029(e).
37. Denied. By way o£further response it is denied that Defendant has improperly denied
Dr. Lees's bills. It is further denied that Defendant's actions will cause Ms. Keiter to become
personally responsible for such bills. It is believed and, therefore averred, that Act 6 prohibits Dr.
Lees from attempting to collect from Ms. Keiter for services determined to be not medically
reasonable or necessary.
38. Denied. The averments contained in ¶38 constitute conclusions of law to which no
response is required. To the extent that it is judicially determined that a response is needed, the
same are denied generally pursuant to Pa.R.C.P. § 1029(e).
7
39. Denied. The averments contained in ¶39 constitute conclusions of law to which no
response is required. To the extent that it is judicially determined that a response is needed, the
same are denied generally pursuant to Pa.R.C.P. § 1029(e).
NEW MATTER
40. Paragraphs one (1) through thirty-nine (39) are incorporated herein by reference and
made apart hereof as if set forth in full.
41. Defendant has satisfied all duties under the applicable insurance policy and applicable
law.
42. Defendant has acted reasonably and in good faith at ail times relevant hereto.
43. Plaintiffhas failed to state a cause of action upon which relief may be granted.
44. Defendant has no duty to pay any medical bills that have not been submitted for
payment.
45. Defendant has paid all benefits required under the applicable insurance policy and
applicable law.
46. Plaintiff's alleged damages are specifically limited to those remedies provided under
the Motor Vehicle Financial Responsibility Law.
47. The payment for said services was properly rejected by Defendant.
48. Defendant is obligated to pay only Act 6 amounts.
WHEREFORE, the Defendant respectfully prays this Honorable Court to dismiss
Plaintiff's Complaint and enter judgment in favor of the Defendant.
8
Nationwide Insurance v. Core~v L~
49. Paragraphs one (1) through forty-eight (48) of this Answer with New Matter and
Counter Claim are incorporated horein by reference.
50. On or about August 13, 1998, Dr. Jess Annine conducted a Peer Review in
accordance with the Pennsylvania Motor Vehicle Financial Responsibility Law.
51. Dr. Armino determin~l that the care provided beyond March 1, 1998 was not
medically reasonable or necessary.
52. By letter dated August 18, 1998, a copy of Dr. Armine's report was forwarded
onto Plaintiff. A copy of said August 18, 1998 letter is attached hereto as Exhibit "A".
53. Nationwide Insurance, prior to the PRO report, had paid $290.40 to Plaintiff for
visits between March 2, 1998 through March 25, 1998. The services provided on said dates
were determined by the peer review doctor not to be medically reasonable or necessary by the
PRO.
54. Defendant is entitled to the return of the $290.40, plus interest thereon at the rate
of 12% per annum.
55. Defendant has requested reimbursement of said amount, but payment has not been
made.
9
~ORE, Nationwide Insurance respectfully requests that this Honorable Court
enter judgment in its favor and against Corey Lees in the amount of $290.40, plus interest and
costs.
Respectfully submitted,
LAW OFFICES OF SACOBS & SABA
Date: \'~.
W. Darren Powell, Esquire
AtWmey for Defendant Nationwide Ins.
214 Senate Avenue, Suite 503
Camp Hill, PA 17011
Telephone No. (717) 731-0988
Identification No.68953
10
DEC 88 1999 14:J4 FR NATION~ID~ CLAIMS ?17 65? 6812 TO 97J10987 P.02/02 .
LAW OFFICF~ OF JACOBS & SABA
W. Darren Pow~, Esquire
Camp ~al~ ]PA 17011
T~lephone ~umbe~. (717) 731-0988
~ttorue~ for Defendant N~_an~ide fn_~;,,.~.,-,~
PLA.TNTG~
VS.
NATIONWIDE ~NSUP. ANCE,
I~T~ Cou~T O~ ¢
No.
Ov~ ACT~O~.
VERIFICATION
~, ~ea~e Ro~, v~ib/that ~ ~m~U m~_~ i
~ a~ tru~ and correct to the best of my ~nowi~ige,
under,tied Rat ~als~ mxements hm*ei~ are made subject to tl~
relating to umwm, n Ialstt~i~n to authorities.
belief, I
of Pa.C..~.A. §4904,
1999 13:00
91' ?~1 ~?
98HB-01008
LAW OFFICES OF JACOBS & SABA
W. Darren Powell, Esquire
214 Senate Avenue, Suite 503
Camp Hill, PA 17011
Telephone Number: (717) 731-0988
_Attorney for Defendant Nationwide ln~nrance
COREY g. LEES,
PLAINTIFF
VS.
NATIONWIDE INSURANCE,
DEFENDANT
I~ Tm~ COURT Or COMMO~ PLZAS
CUbmERLAND Coul~wy, PENNSYLVANIA
No. 98-7326
CIVIL ACTION- LAW
JURY TRIAL DEMANDED
CERTIFICATE OF SERVICE
I, W. Darren Powell, Esquire, hereby certifies that he is the attorney for the Defendant
herein, and that he caused a true and correct copy of Answer with New Mu-,~r and Counter
Claim of Defendant Nationwide Insurance to Piai,;;Ci~s Amended Compla;.t to be served by
regular first class mail upon:
Jana Buffer, Esquire
The Butler Law Firm
500 N. 3rd Street
P.O. Box 1004
Harrisburg, PA 17108
December 9. 19~)
W.~n PoweH, E. squire
Attorney for Defendant
P O BOX 2655 * HARRISBURG PA 17105-9971 *
NATIONWIDE
INSURANCE
ENTERPRISE
Nationwide Is on ~u~ side
DR COREY R LEES DC
6103 CARLISLE PIKE
MECHANICSBURG PA 17055
August 18, 1998
OUR INSURED: Barbara Keiter.~
OUR CLAIM NUMBER: 58 37 A 738330 11-29-1997 01
DATE OF ACCIDENT: 11-29-1997
PATIENT NAME: Barbara Keiter
After careful review of the attached Peer Review, we are denying payment of your care
from March 1, 1998 thru present.
Pursuant to Pennsylvania Act '6 of 1990, Section 1797, as stated in Chapter 69.52(H):
"An insured, provider, or insurer may request, in writing, reconsideration of the initial
PRO determination within 30 days from the date the initial determination is effected. A
PRO may set a reasonable charge for a reconsideration but in no case shall the charge
for a reconsideration exceed the charge for the initial review. An insurer shall make full
payment of the charge for reconsideration to the PRO, but the amount paid for the
reconsideration shall ultimately be borne by the party against whom a reconsideration
determination is made.
Also, Nationwide Insurance Company is requesting reimbursement in the amount of
$290.40 for the visits from March 2, 1998 through March 25, 1998 which Nationwide
paid to you on June 10, 1998.1 have enclosed a self addressed stamped envelope for
your convenience in remitting your payment.
Sincerely,
NATIONWIDE MUTUAL INSURANCE COMPANY
JULIE CARR
Claims Department
717-657-6588
CC:
ROY E COOK (#0005215)
Barbara Keiter
Any person who knowingly and with intent to defraud any insurance company or other person files an
application for insurance or statement of claim containing any materially false information or conceals for
the purpose of misleading, information concerning any fact material thereto commits a fraudulent
insurance act, which is a crime and subjects such a person to criminal and civil penalties.
DR. COREY LEES,
Plaintiff
Vo
NATIONWIDE INSURANCE
COMPANY,
Defendant
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
: 98-73~6
CIVIL ACTION - LAW
: JURY TRIAL DEMANDED
PRAECIPE
TO THEPROTHONOTARY:
Please enter my appearance on behalf of the Plaintiff Dr. Corey Lees in the above
captioned action.
Respectfully submitted,
By[ ~ ~ ~
ROBERT F. CLARAVAL, ESQUIRE
125 Locust Street ~
P.O. Box 11933 ~
Harrisburg, PA 17108-1933
(717) 233-4780 ~
Supreme Court ID# 19222
Attorneys for Plaintiffs
DR. COREY LEES,
Plaintiff
NATIONWIDE INSURANCE
COMPANY,
Defendant
: 1N THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
:
98-7356
CIVIL ACTION - LAW
: JURY TRIAL DEMANDED
CERTIFICATE OF SERVICE
I hereby certify that I have this day served a true and correct copy of the attached
Praecipe to Enter Appearance by first class mail, postage prepaid, addressed to the following person:
W. Darren Powell, Esq.
Rubinate, Jacobs & Saba
214 Senate Avenue
Suite 503
Camp Hill, PA 17011
Date:
ADLER & CLARAVAL
DENISE I. WILLIAMS, Secretary
For Robert F. Claraval
98HB-01008
LAW OFFICES OF JACOBS & SABA
214 Senate Avenue, Suite $03
Camp Hill, PA 17011
Telephone Number: (717) 731-0988
Attorneys for Defendant Nationwide Insurance
COREY g. LEES,
PLAINTIFF
VS.
NATIONWIDE INSURANCE,
DEFENDANT
IN THE COURT OF COMMON I~LEAS
CUMBERLAND COUNTY, PENNSYLVANIA
No. 98-7326
CIVIL ACTION- LAW
JURY TRIAL DEMANDED
ORDER
AND NOW, this :3 ) ~ Day of ~7'~ ,~n~ ¥ 2001, upon consideration
&the Defendant's Motion to Compel Answers to Interrogatories, said Motion is hereby granted.
The Plaintiff is ordered to provide ~a~s-to the Defendant's Interrogatories within Z c>
days of service of this Order,
Date:
or suffer sanctions pursuant to Pa.R.C.P. Rule 4019.
BY THE COURT:
98I--IB-01008
LAW OFFICES OF JACOBS & SABA
214 Senate Avenue, Suite 503
Camp Hill, PA 17011
Telephone Number: (717) 731-0988
Attorneys for Defendant Nationwide Insurance
COREY g. LEES,
PLAINTIFF
VS.
NATIONWIDE INSURANCE,
DEFENDANT
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
No. 98-7326
CIVIL ACTION- LAW
JURY TRIAL DEMANDED
DEFENDANT'S MOTION TO COMPEL ANSWERS TO INTERROGATORIES
1. This lawsuit is an appeal fxom a decision rendered by District Justice Placey in favor of
Defendant Nationwide Insurance on December 17, 1998.
2. The Plaintiff's Complaint was filed on or about January 28, 1999 and seeks recovery of
chiropractic bills incurred by Barbara Keiter, a Nationwide insured, following a motor vehicle
accident of November 29, 1997.
3. Defendant Nationwide Insurance denied payment of these chiropractic expenses as a
result of a peer review.
4. OnMarch 29, 2000, Defendant Nationwide Insurance served upon Plaintiff's counsel a
set of Interrogatories. A tree and correct copy of the Defendant' s Interrogatories to Plaintiff are
attached hereto as Exhibit "A" and incorporated herein by reference.
5. On several occasions, defense counsel has written to Plaintiff s counsel requesting the
answers to Defendant's Interrogatories.
6. As of this date, the Plaintiff has failed to respond to the Defendant's Interrogatories,
either by answering or objecting to the Interrogatories.
7. The Plaintiffs answers to Defendant's Interrogatories are overdue.
WHEREFORE, Defendant Nationwide Insurance respectfully requests your Honorable
Court to enter an Order compelling the Plaintiff to answer the Defendant's Interrogatories by a
date certain, or suffer sanctions pursuant to Pa.R.C.P. §4019.
Date:~01
Respectfully submitted,
LAW OFFICES OF JACOBS & SABA
~'~Girard E Rickards, l~squtre
214 Senate Avenue, Suite 503
Camp Hill, PA 17011
Attorney for Defendant
Court I.D. No. 58867
98~-01008
LAW OFFICES OF JACOBS & SABA
W. Darren Powell, Esquire
214 Senate Avenue, Suite 503
Camp g/ill~ PA 17011
Telephone Number: (717) 731-0988
Attorney for Defendant Nationwide Ins. Co.
COmfY R. LEES,
VS.
NATIONWIDE INSURANCE,
DEFEND~
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
No. 98-7326
CIVIL ACTION - LAW
JURY TRD. L DEMANDED
INTERROGATORn~$ (SET I)
ADDRESSF-.D TO: plaintiff, Corey R. Lees
The Defendant propounds the following Interrogatories to be answered under oath
pursuant to Pa. R.C.P. 4005, 4006 by Plaintiff within thirty (30) days after service.
The foregoing Interrogatories are to be regarded as continuing and you are requested to
provide, by way of supplementary answers thereto, such additional information as may
hereafter be obtained by you, or any person on your behalf, which will augment or otherwise
modify any answers now given to the foregoing Interrogatories pursuant to Pa. R.C.P. 4007.4.
Such ~upplemental responses are to be served upon the Defendant seasonably after receipt of
such information.
State your furl name and cu...n~,nt address.
ANSWER:
State your social security number.
ANSWER:
State and itemize by date of service the total current amount of "outstanding" invoices
for your services which you feel Defendant is responsible. Identify whether the
amounts so identified are Act 6 amounts.
2
Please identify whether you have a standard billing schedule(s) for services you provide
to customers. H you do, ple~se provide a copy(les) of this schedule(s) by attaching a
copy hereto. Please state whether your fee schedule is the same for all customers~
whether covered by insurance or not.
Please identify the person or persons who acts or has acted as the bookkeeper for your
office during the last five (5) years.
ANSWER:
Please identify with particularity your professional education and employment
history. You may attach a C~Py of your current curriculum vitae, if such
information is cont~ned therein.~
Identify with particularity all licenses or certifications held. Also, identify
whether you have been under investigation by any licensing body and whether
you have had any professional license suspended or revoked.
Have you been involved ia any other lawsuits against any Insurance company in
which you sought recovery of bills for payment of services you rendered to their
insured? If so, please identify such cases with particularity, including the court
and docket number of each such case.
Set forth with specificity the..,amount of attorney's fees claimed and the method of
calcuhtion.
Date: March 29 2000
Respectfully submi~ed,
LAW OFFICES OF JACOBS & SABA
W. Darren Powell, Esquire
Attorney for Defeoaant Nationwide Ins. Co.
214 Senate Avenue, Suite 503
Camp Hill, PA 17011
Telephone No. (717) 731-0988
Identification No. 68953
98HB-01008
LAW OFFICES OF JACOBS & SABA
W. Darren Powell, Esquire
214 Senate Avenue, Suite 503
Camp Hill, PA 17011
Telephone Number: (717) 731-0988
Attorney for Defendant Nationwide Insurance
COREY R. LEES,
PLAINTIFF
VS.
NATIONWIDE INSURANCE,
DEFENDANT
IN TIEE COURT OF COMMON PLEAS
CUIVIBERLAND COUNTY, PENNSYLVANIA
No. 98-7~26
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
CERTIFICATE OF SERVICE
I, W. Darmn PoweR, Esquire, hereby certifies that he is the attorney for the Defendant
herein, and that he caused a true and correct copy of Interrogatories (SET D of Defendant
Addressed to the Plaintiff to be served by regular first class mail upon:
Dated: March 29. 2000
Robert F. Claraval, Esquire
Adler & Claraval
P.O. Box 11933
125 Locust Street
Harrisburg, PA 17108-1933
Attorney for Defendant
98I-IB-01008
LAW OFFICES OF JACOBS & SABA
214 Senate Avenue, Suite 503
Camp Hill, PA 17011
Telephone Number: (717) 731-0988
Attorneys for Defendant Nationwide Insurance
COREY R. LEES,
PLAINTIFF
VS.
NATIONWIDE INSURANCE,
DEFENDANT
IN THE COURT OF COMMON PLEAS
C01VH~ERLAND COUNTY, pENNSYLVANIA
NO. 98-7:~26
CIVIL ACTION - LAW
JURy TRIAL DEMANDED
CERTIFICATE OF SERVICE
I, Girard E. Rickards, Esquire, hereby certifies that he is the attorney for the
Defendant herein, and that he caused a true and correct copy of Defendunt's Motion to
Comoel Answers to Interrogatories to be served by regular first class mail upon:
Robert F. Claraval, Esquire
P.O. Box 11933
125 Locust Street
Harrisburg, PA 17108-1933
Dated:~
Attorney for Defendant
COKEY R. LEES (Keiter)
Plaintiff
NATIONWIDE INSURANCE
COMPANY,
Defendant
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
No. 98-7326
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
CERTIFICATE OF SERVICE
I hereby certify that I have this day served Plaintiff's Response to Defendant's
Interrogatories (Set I) by first class mail, postage prepaid, addressed to the following persons:
W. Darren Powell, Esq.
Rubinate, Jacobs & Saba
214 Senate Avenue
Suite 503
Camp Hill, PA 17011
Date:
ROBERT F. CLARAVAL, ESQUIRE.
DENISE I. WILLIAMS, Secretary
COREY R. LEES (Keiter)
Plaintiff
NATIONWIDE INSURANCE
COMPANY,
Defendant
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
No. 98-7326
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
CERTIFICATE OF SERVICE
I hereby certify that I have this day served Plaintiff's Response to Defendant's
Request for Production of Documents by first class mail, postage prepaid, addressed to the following
persons:
Girard Rickards, Esq.
Rubinate, Jacobs & Saba
214 Senate Avenue
Suite 503
Camp Hill, PA 17011
Date:
ROBERT F. CLARAVAL, ESQUIRE.
By ~ ~)b~;(2xdls/~
DENISE I. WILLIAMS, Secretary
981-~-01008
LAW OFFICES OF JACOBS & SABA
214 Senate Avenue, Suite 503
Camp Hill, PA 17011
Telephone Number: (717) 731-0988
Attorneys for Defendant Nationwide Insurance
COREY R. LEES,
PLAINTIFF
VS.
NATIONWIDE INSURANCE~
DEFENDANT
IN THE COURT OF COMMON PLEAS
~ERLAND COUNTY, PENNSYLVANIA
No. 98-7326
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
OBJECTIONS OF DEFENDANT NATIONWIDE INSURANCE
TO SUBPOENA TO PRODUCE DOCUMENTS OR TmNGS
ADDRESSED TO JESS P. ARMINE~ D.C. PURSUANT TO PA. ILC.P. 4009.21(C)
1. This lawsuit arises fi.om the denial of payment of chiropractic bills submitted by the
Plalntiffto the Defendant as a result ora peer review under the Pennsylvania Motor Vehicle
Financial Kesponsibility Act.
2. On February 8, 2001, defense counsel received a copy ora Notice of Intention to Serve
Subpoena attached hereto as Exhibit "A" and incorporated herein by reference.
3. The subpoena is improper on its face in that it contains a caption in the Court of
Common Pleas of Dauphin County, Pennsylvania, whereas this action is pending in the Court of
Common Pleas of Cumberland County, Pennsylvania.
4. The target of the subpoena, Dr. Jess P. Armine, is a licensed chiropractor who will
testify as an expert wimess on behalf of Defendant Nationwide Insurance Company.
5. The proposed subpoena seeks information regarding Dr. Armine's income from Claims
Review Associates, a peer review organization from 1994 through 1999. Claims Review
Associates is not a party to this lawsuit.
6. The PlaintifFs proposed subpoena also requests financial information, advertising
literature, research materials, etc., all of which are beyond the scope of discovery permitted by
Pa.R.C.P. §4003.5.
7. The Defendant's expert would be required to expend substantial time, effort and
expense in order to compile the materials requested by the Plalntifl[
8. Defendant Nationwide Insurance Company objects to the Plaintiff's subpoena on the
basis that it is beyond the scope of permissible discovery under the Pennsylvania Rules of Civil
Procedure, it is unreasonably burdensome and oppressive upon the Defendant's expert, and is not
calculated to lead to the discovery of information relevant to the facts at issue.
WHEREFORE, Defendant Nationwide Insurance Company respectfully requests your
Honorable Court to sustain its objection to the Plainfrff's Notice of Intent to Serve Subpoena
upon Dr. Jess P. Armine.
Date: March 9, 2001
Respectfully submitted,
214 Senate Avenue, Suite 503
Camp Hill, PA 17011
Attorney for Defendant
Court I.D. No. 58867
& SABA
COREY R. LEES (Keiter)
Plaintiff
NATIONWIDE INSURANCE
COMPANY,
Defendant
IN THE COURT OF COMMON PLEAS OF
DAUPHIN COUNTY, PENNSYLVANIA
No. 98-7326
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
NOTICE OF INTENT TO SERVE SUBPOENA TO
PRODUCE DOCUMENTS AND THINGS FOR DISCOVERY
PURSUANT TO RULE 4009.1
Plaintiff Dr. Corey R. Lees intends to serve a subpoena identical to the one that is
attached to this Notice. You have twenty (20) days from the date of this Notice in which to file of
record and serve upon the undersigned an objection to the subpoena. If no objection is made the
subpoena may be served.
Date:
Respectfully snbmitted,
P.O. Box 11965
Harrisburg, PA 17108-1965
(717) 233-4780
Supreme Court I.D. #19222
Attomey for Plaintiff
FEB u b
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF DAUPHIN
COREY R. LEES (Keiter)
Plaintiff
NATIONWIDE INSURANCE COMPANY,
Defendant
File No. 7326 S 1998
TO:
SUBPOENA TO PRODUCE DOCUMENTS OR THINGS
FOR I)ISCOVERY PURSUANT TO RULE 4009.22
Dr. Jess P. Armine
(Name of Person or Emily)
Within twenty (20) days after service of this subpoena, you are ordered by thc court to produce tile folloxving documents or thim s:
Legible copies of all documents identified in the attached Addendt~n
at 125 Locust Street, Harrisburg, PA 17101
(Address)
You may deliver or mail legible copies of tile documents or produce tilings requested by this subpoena, togethcr
with the certificate of compliance, to tbe pm'ty making this request at the address listed above. You have thc right
to seek, in advance, the reasonable cost of prepm'ing tile copies or producing the things sought.
If you fail to produce the documents or tlfings required by this subpoena, within twenty (20) days after its scrvicc.
the party serving this subpoena may seek a court order compelling you to comply with it.
THIS Subpoena ~VAS ISSUED AT THE REQUEST OF TIlE FOLLOWING PERSON:
NAME: Robert F. Claraval, Esq.
Al)DRESS: P.O. Box 11965
Harrisburq, PA 17108-1965
TELEPHONE: (717) 233-4780
SUPREME COURT ID # 19222
AT I'ORNI.~T FOR:
DATE:
Seal of the Courl
-] Prothonot~ary
Froth. - 73
COREY R. LEES (Keiter)
Plaintiff
V.
NATIONWIDE INSURANCE
COMPANY,
Defendant
IN THE COURT OF COMMON PLEAS OF
DAUPHIN COUNTY, PENNSYLVANIA
No. 98-7326
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
ADDENDUM TO SUBPOENA TO
DR. JESS P. ARMINE
1. All billings to Claims Review Associates by Dr. Armine for services rendered
to Claims Review Associates from 1994 through 1999. The Respondent may simply list the dollar
amount by year.
2. A certified statement from counsel for Dr. Armine that he has examined the
tax returns of Dr. Armine from 1994 through 1999 and what the percentage of income generated
by billings to Claims Review Associates by year is as compared to Dr. Armine's gross income from
his practice:
3. All billings to Nationwide Insurance by Dr. Armine for services rendered to
Nationwide Insurance from 1994 through 1999. The Respondent may simply list the dollar amount
by year.
4. A certified statement from Dr. Annine's counsel for that he has examined the
tax returns of Dr. Armine from 1994 through 1999 and what the percentage of income generated
by billings to Nationwide Insurance by year is as compared to Dr. Armine's gross income from his
practice.
5. Copy of current curriculum vitae.
6. Any advertising literature that you send to either peer review organizations
and/or insurance companies.
7. Any advertising literature, brochures or other materials for patients.
8. Any materials, research literature, treatises, text or other documents which you
rely on in formulating your PRO report in this case only, including but not limited to any documents
which purportedly state national or regional norms or typical patterns of practice for chiropractors.
9. The number of PRO's, URO's or IME's done by year for Claims Review
Associates by Dr. Armine from 1994 to 1999.
10. The number of PRO's, URO's or IME's done by year for Nationwide
insurance by Dr. Armine from 1994 to 1999.
98HB-01008
LAW OFFICES OF JACOBS & SABA
214 Senate Avenue, Suite S03
Camp Hill, PA 17011
Telephone Number: (717) 731-0988
Attorneys for Defendant Nationwide Insurance
COREY R. LEES,
PLAINTIFF
VS.
NATIONWIDE INSURANCE~
DEFENDANT
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
No. 98-7326
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
CERTIFICATE OF SERVICE
I, Girard E. Rickards, Eaqu'u'e, hereby certifies that he is the attorney for the
Defendant here'm, and that he caused a true and correct copy of O~ections of Defendant
Nationwide Insurance to Subooena to Produce Documents or Things Addressed to Jess P.
Armine. D.C. Pursuant to Pa.R.C.P. 4009.21 to be served by regular first class mail upon:
Robert F. Claraval, Esquire
P.O. Box 11933
125 Locust Street
Harrisburg, PA 17108-1933
Dated:
March 9. 2001
Attorney for Defendant
COREY R. LEES (Keiter)
Plaintiff
NATIONWIDE INSURANCE
COMPANY,
Defendant
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
No. 98-7326
: CIVIL ACTION - LAW
:
: JURY TRIAL DEMANDED
PLAINTIFF'S REPLy TO DEFENDANT~
N.~EW MAI'TER AND COUNTERCLAI~J~
New Matter
40. No answer is required.
41. Denied. Paragraph 41 is a conclusion of law to which no response is required.
42. Denied. Paragraph 42 is a conclusion of law to which no response is required.
43. Denied. Paragraph 43 is a conclusion of law to which no response is required.
44. Denied. Paragraph 44 is a conclusion of law to which no response is required.
45. Denied. Paragraph 45 is a conclusion of law to which no response is required.
46. Denied. Paragraph 46 is a conclusion of law to which no response is required.
47. Denied. Paragraph 47 is a conclusion of law to which no response is required.
48. Denied. Paragraph 48 is a conclusion of law to which no response is required.
Counterclaim
49. No answer is required.
50. Admitted. By way of further answer, it is denied that the peer review was
done properly.
51. Denied. The peer review speaks for itself. Further, it was no done properly.
52. Denied. The letter of August 18, 1998 speaks for itself.
53. Admitted in part and denied in part. It is admitted that Nationwide made
payments to Dr. Lees. It is denied that those payments were for services that were not medically
necessary.
54.
of any monies.
Denied. It is denied that the Defendant Nationwide is entitled to the return
55. Admitted in part and denied in part. It is admitted that Nationwide has
requested reimbursement. It is denied that any reimbursement is in fact owing.
Respectfully submitted,
P.O. Box 11965
Harrisburg, PA 17108-1965
(717) 233-4780
Supreme Court I.D. #19222
Attorney for Plaintiff
The language of the foregoing document is that of counsel and not necessarily my
own; however, I have read the foregoing document and to the extent that it is based upon information
that I have given to counsel, it is tree and correct to the best of my knowledge, information, and
belief; to the extent that the coment of the foregoing document is that of counsel, I have relied upon
counsel in making this verification.
I understand that any false statements herein are made subject to the penalties of 18
Pa.C.S.A. §4904, relating to unsworn falsification to authorities.
~)~orey R. ~,ees
COREy R. LEES (Keiter)
Plaintiff
NATIONWIDE INSURANCE
COMPANY,
Defendant
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
:
: No. 98-7326
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
CERTIFICATE OF SERVIC~
I hereby certify that I have this day served a tree and correct copy of the attached
Plaintiffs Reply to Defendant's New Matter and Counterclaim by first class mail, postage prepaid,
addressed to the following person:
Girard E. Rickards, Esq.
214 Senate Avenue
Suite 503
Camp Hill, PA 17011
Date:
ROBERT F. CLARAVAL, ESQ.
By_ ~'"1 k,~-.., C,[ ~_.J
DENISE I. WILLIAMS, Secretary
COREY R. LEES (Keiter)
Plaintiff
VS.
NATIONWIDE INSURANCE
COMPANY,
Defendant
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
98-7326 CIVIL
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
ORDER
AND NOW, this ~o ~ day of March, 2001, a brief argument on the within discovery
motion is set for Thursday, April 26, 2001, at 1:30 p.m. in Courtroom Number 4, Cumberland
County Courthouse, Carlisle, PA.
BY THECOURT,
Robert F. Claraval, Esquire
For the Plaintiff
Girard E. Rickards, Esquire
For the Defendant
:rim
COREY R. LEES (Keiter)
Plaintiff
NATIONWIDE INSURANCE
COMPANY,
Defendant
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
No. 98-7326
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
ORDER
AND NOW this
conference is set for
day of
,2001 at
., 2001, a discovery
.m. in Chambers.
BY THE COURT:
JUDGE
COREY R. LEES (Keiter)
Plaintiff
NATIONWIDE INSURANCE
COMPANY,
Defendant
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
No. 98-7326
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
PLAINTIFF'S MOTION FOR A DISCOVERY CONFERENCE PURSUANT
TO CUMBERLAND COUNTY LOCAL RULE 206-1 and 206-2
AND LOCAL RULE 4001-1
1. The Plaintiff in this case Dr. Corey R. Lees is a chiropractor who provided
care for his client Barbara Keiter. Ms. Keiter was injured in a motor vehicle accident which occurred
on November 29, 1997. Pursuant to the Motor Vehicle Financial Responsibility Law, Dr. Lees was
required to send his bills for his care to Nationwide, Ms. Keiter's carrier.
2. Nationwide paid some of Dr. Lees bills but then refused to pay others on the
basis of a peer review performed by Dr. Jess Armine. Several discovery disputes have now arisen
in this litigation and although counsel has conferred on the matter, they are unable to resolve the
issues. The first issue concerns a subpoena which Dr. Lees through counsel intends to issue to Dr.
Armine. That proposed subpoena was supplied to defense counsel. Nationwide through counsel
objects to the subpoena. The second issue is Nationwide's objections to certain categories contained
in Dr. Lees' request for production of documents. The third issue concerns the interrogatories to
Nationwide filed by Dr. Lees' counsel which as of the date of the filing of this motion are overdue.
It is assumed that by the time the conference occurs that there will be answers but likely with
objections. In addition, Plaintiff's counsel has prepared a subpoena to be issued to the peer review
organization in this case, Claims Review Associates. It is anticipated that defense counsel will also
object to that subpoena and therefore an Order from this Honorable Court scheduling a discovery
conference is requested.
3. Counsel for the Plaintiff Dr. Corey Lees is Robert F. Claraval, P.O. Box
11965, Harrisburg, PA 17108-1965. (717) 233-4780. Counsel for the Defendant Nationwide is
Girard E. Rickards, Esq., 214 Senate Avenue, Suite 503, Camp Hill, PA 17011. (717) 731-0988.
4. The Honorable Judge Kevin Hess previously issued a Discovery Order in this
case regarding Plaintiff's Answers to Defendant's Interrogatories.
WHEREFORE, the parties respectfully request that this Honorable Court schedule
a discovery conference to review these matters and to issue an appropriate Order.
Date:
RespecJ~ully.submitted,
BY ~ C~'~
ROBERT F. CLARAVAL
P.O. Box 11965
Harrisburg, PA 17108-1965
(717) 233-4780
Supreme Court I.D. #19222
Attorney for Plaintiff
COREY R. LEES (Keiter)
Plaintiff
NATIONWIDE INSURANCE
COMPANY,
Defendant
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
No. 98-7326
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
CERTIFICATE OF SERVICE
I hereby certify that I have this day served a tree and correct copy of the attached
Plaintiff's Motion for a Discovery Conference Pursuant to Cumberland County Local Rule 206-1
and 246-2 and Local Rule 4001-1 by first class mail, postage prepaid, addressed to the following
person:
Girard E. Rickards, Esq.
214 Senate Avenue
Suite 503
Camp Hill, PA 17011
Date:
ROBERT F. CLARAVAL, ESQ.
DENISE I. WILLIAMS, Secretary
COREY R. LEES
Plaintiff
VS.
NATIONWIDE INSURANCE
COMPANy,
Defendant
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
98-7326 CIVIL
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
IN RE'OBJECTIONS OF DEFENDANT NATIONWIDE INSURANCE COMPANy
ORDER
AND NOW, this ~' ~ day of May, 2001, following argument thereon, the
objections of defendant, Nationwide Insurance Company, to a subpoena to produce documents or
things addressed to Jess P. Armine, D.C., are DENIED and the defendant is directed to respond.
BY THE COURT,
Robert F. Claraval, Esquire
For the Plaintiff
Girard E. Rickards, Esquire
For the Defendant
:rim
. Hess, J.
CU pF_..N, NS%'4AN~r,
COREY R. LEES (Keiter)
Plaintiff
NATIONWIDE iNSURANCE
COMPANY,
Defendant
: 1N THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
:
No. 98-7326
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
RULE TO SHOW CAUSE
AND NOW, this 2 ~t day of ~t~ ,2001, upon
consideration
of Plaintiff's Petition for Rule to Show Cause why sanctions should not be entered, a Rule is hereby
issued upon Dr. Jess Annine that within ~/,.~ days he show cause if any he has why sanctions
as requested by Plaintiff should not be issued.
Service shall be made by Plaintiff on Dr. Armine by certified and reuglar mail and
on Nationwide's counsel by regular mail.
BY THE COURT:
JUDGE
COREY R. LEES (Keiter)
Plaintiff
NATIONWIDE INSURANCE
COMPANY,
Defendant
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
No. 98-7326
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
PLAINTIFF'S PETITION FOR RULE TO SHOW CAUSE
W}IY SANCTIONS SHOULD NOT BE ENTERED
1. On May 2, 2001 the Honorable Judge Kevin A. Hess issued an Order denying
the objections of Nationwide Insurance Company with respect to the Plaintiff's Subpoena to be
issued to Jess P. Armine, D.C. A copy of that Order is attached as Exhibit A.
2. Pursuant to that Order, Plaintiff's counsel served the Subpoena upon Dr.
Annine by certified mail, return receipt requested, and regular U.S. mail on May 16, 2001. As'of
this date PlaintiWs counsel has not received the return receipt back from the post office indicating
either delivery to Dr. Armine or Dr. Armine's refusal of that delivery.
3. As of the date of this Motion which is June 14, 2001 Dr. Armine has not
responded in any way to the Court Ordered Subpoena.
4. It is the practice of Dr. Armine to refuse to cooperate with Orders issued by
Judges of the Courts of Common Pleas with respect to similar Subpoenas. For example, in the case
of Dr. David B. Smith v. State Farm, No. 5085 S 1998, Judge Todd Hoover of the Court of Common
Pleas of Dauphin County ordered Dr. Armine to comply with the Subpoena. No response was
forthcoming and Dr. Armine was precluded from testifying in that case. A copy of Judge Hoover's
Order is attached hereto as Exhibit B.
5. Judge Hoover's Order fines Dr. Armine the sum of $150 for willful contempt
and precludes from testifying at the arbitration or trial of the action.
6. A similar Order is requested to be issued by this Court given Dr. Armine's
refusal to comply with the Order issued by Judge Hess and given Dr. Armine's proven course of
conduct in refusing to comply with Court Orders.
WHEREFORE, the Plaintiffrespectfully request that this Honorable Court issue a
Rule to Show Cause why monetary sanctions should not be entered against Dr. Armine in the
amount of $150 and why he should not be precluded from testifying at the arbitration or trial of this
action. A proposed Rule is attached.
Date:
Respectfully submitted,
P.O. Box 11965
Harrisburg, PA 17108-1965
(717) 233-4780
Supreme Court I.D. #19222
Attorney for Plaintiff
COREY R. LEES (Keiter)
Plaintiff
NATIONWIDE INSURANCE
COMPANY,
Defendant
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
No. 98-7326
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
CERTIFICATE OF SERVICE
I hereby certify that I have this day served a true and correct copy of the attached
Plaintiff's Petition for Rule to Show Cause Why Sanctions Should Not Be Entered by first class
mail, postage prepaid, addressed to the following persons:
Girard E. Rickards, Esq.
214 Senate Avenue
Suite 503
Camp Hill, PA 17011
Dr. Jess P. Armine
2710 Township Line Road
Upper Darby, PA 19082
Date:
ROBERT F. CLARAVAL, ESQ.
DENISE I. WILLIAMS, Secretary
COREY R. LEES
Plaintiff
VS.
NATIONWIDE INSURANCE
COMPANY,
Defendant
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
98-7326 CIVIL
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
IN RE: OBJECTIONS OF DEFENDANT, NATIONWIDE INSURANCE COMPANY
ORDER
AND NOW, this It ~ day of May, 2001, following argument thereon, the
objections of defendant, Nationwide Insurance Company, to a subpoena to prot!uce documents or
things addressed to Jess P. Armine, D.C., are DENIED and the defendant is directed to respond.
BY THECOURT,
Robert F. Claraval, Esquire
For the Plaintiff
. K~vJ~H~ess' J~' ~
Girard E. Rickards, Esquire
For the Defendant
:rim
DR. DAVID B. SMITH,
(Magaro),
Plaintiff
Vo
STATE FARM INSURANCE
COMPANY,
Defendant
: IN THE COURT OF COMMON PLEAS OF
: DAUPHIN COUNTY, PENNSYLVANIA
: CIVIL ACTION-LAW
: NO. 5085 S 1998
JURY TRIAL DEMANDE[~-.
ORDER
of Plaintiff's Motion for Contempt and Sanctions, it is here by ORDERED that Dr. Jess Annine pay
the stun orS150 within ~ days~this Order as a sanction for his willful contempt
in refusing to comply with this Court's Orders of October 6, 2000 and December 20, 2000.
action.
Further, Dr. Armine is precluded from testifying at the arbitration or trial of this
BY THE COURT:
-JAN 2.G 2001
r
t.~t the foregoing i'.~ ~
true and correct copy~of I~ origina
COREY R. LEES, D.C. (Keiter)
Plaintiff
Nationwide Insurance Ccmlpany
Defendan%
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 98-7326 CIVIL
RULE 1312-1. The Petition for Appointment of Arbitrators Shall be substantially in the following form:
PETITION FOR APPOINTMENT OF ARBITRATORS
TO THE HONORABLE, THE JUDGES OF SAID COURT:
Robert F. Claraval , counsel fgr the plaintiff/defendant in the above action (or actions),
respectfully represents that:
1. The above-captioned action (or actions) is (a~e) at issue.
2. Theclaimoftheplaintiffintheactionis$ 25,000 (approx.) .
The counterclaim of the defendant in the action is $290.40
The following attorneys are interested in the case(s) as counsel or are otherwise disqualified to sit as arbitrators: __
Robert F. Claraxral, Esq. (atty for Plain%iff) Girard Rickards, Esq. (arty for Defendant)
foregoing petition,
Esq., and ('~./--/-..F,~gc~F~,...~
actions) a~rayed/for.
WHEREFORE, your petitioner prays your Honorable Court to appoint three (3) arbitrators to whom the case shall be
submitted.
ORDER OF COURT
AND NOW, ~-/~ /~ , tx)~'~O/, in consideration of the
/~~ Esq., ~ /.~J~"~
//.~(~'~_ .-~q., am appointed arbitrators in the above captionex~ction-- (or
By the~
P.J.
V1NVA"IX~',~N'.'.~d
AJ_NNO0
,,, ~ ~' :,~ ', '", l~t :~t Hcl tl 130 I0
Date Entered
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF LABOR AND INDUSTRY
to the use of the
UNEMPLOYMENT COMPENSATION FUND*
Vo
VIRGINIA B. RUSSELL
PO BOX 42
SHERMAlgS DALE, PA 17090
: Docket No. 2801 CIV 1982
: (REV. 01-17-1997)
: Original Amount Due: $1,995.00
: Plus additional interest,
: fees and costs.
SUGGESTION OF NONPAYMENT AIgD AVERMENT OF DEFAULT
A/gD NOW, October 15, 2001, the Commonwealth of Pennsylvania, Department
of Labor and Industry to the use of the Unemployment Compensation Fund,
Plaintiff-Claimant herein, suggests of record that the above claim is still
due and owing to the Claimant, and avers that the above-named Defendant is
still in default for nonpayment thereof. The Prothonotary is directed to
enter this suggestion and averment on the proper docket of said claim, and
also to index it in the judgment index for the purpose of continuing the lien
of said claim.
*10th Floor
L&I Bldg
Harrisburg, PA 17121
S~a~ F: Creegan ~/
Deputy Chief Counsel
for Employment Security
Account NO.: 192-34-6328
L.O. No.: 0996
Date: 10/15/01
Revival Filing Fees: $9.00