HomeMy WebLinkAbout00-05506
Plaintiffs
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
:NO. 0(::)- S'S'Ot. ClU~l~€.R..fV)
BRUCE J. BISHOFF and BETTY J
BISHOFF,
v.
: CIVIL ACTION LAW
PENNSYLVANIA PROPERTY AND
CASUALTY INSURANCE GUARANTY : ACTION FOR DECLARATORY JUDGMENT
ASSOCIATION,
Defendants : 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 Complaint for
Declaratory Judgment is 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. IF YOU DO
NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE
OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP.
CUMBERLAND COUNTY BAR ASSOCIATION
2 LIBERTY AVENUE
CARLISLE, PA 17013
(717) 249-3166
(800)-990-9108
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NOTICIA
Le han demandado a usted en la corte. Si usted quiere defenderse de estas demandas
expuestas en las paginas siguientes, usted tiene viente (20) dias de plazo al partir de la fecha de la
demanda y la notificacion. Usted debe presentar una apariencia escrita 0 en persona 0 por
abogado y archivar en la corte en forma escrita sus persona. Sea avisado que si usted no se
defiende, la corte tomara medidas y puede entrar una orden contra usted sin previo aviso 0
notificacion y por cualquier quaja 0 alivio que es pedido en la peticion de demanda. Usted puede
perder dinero 0 sus propiedades 0 otros derechos importantes para usted.
LLEVE ESTA DEMANDA A UN ABODAGO INMEDIATAMENTE. SI NO TIENE
ABOGADO 0 SI NO TIENE EL DINERO SUFICIENTE DE P AGAR TAL SERVICIO,
V AYA EN PERSONA 0 LLAME POR TELEFONO A LA OFICINA CUY A
DIRECCION SE ENCUENTRA ESCRlT A ABAJO PARA A VERlGUAR DONDE SE
PUEDE CONSEGUlR ASISTENCIA LEGAL.
CUMBERLAND COUNTY BAR ASSOCIATION
2 LIBERTY AVENUE
CARLISLE, P A 17013
(717) 249-3166
(800)-990-9108
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Plaintiffs
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
; NO. (I-Q- 550C ~ t.u-
BRUCE 1. BISHOFF and BETTY J
BISHOFF,
v.
: CIVIL ACTION LAW
PENNSYLVANIA PROPERTY AND
CASUALTY INSURANCE GUARANTY : ACTION FOR DECLARATORY JUDGMENT
ASSOCIATION,
Defendants : JURY TRIAL DEMANDED
COMPLAINT FOR
DECLARATORY JUDGMENT
1. Plaintiffs are BRUCE J. BISHOFF and BETTY J. BISHOFF, who are adult individuals,
husband and wife, and who are residents of Cumberland County, Pennsylvania.
2. Defendant PENNSYLVANIA PROPERTY AND CASUALTY INSURANCE
GUARANTY ASSOCIATION (hereinafter PPCIGA) is an unincorporated association organized,
existing, and created under the laws of the CornmonwealthofPennsylvania, and specifically existing
pursuant to the provisions of 40 PS Section 991.180 1 et seq., with offices located at One Penn Center
Suburban Station, Suite 1620, 1617 JFK Boulevard, Philadelphia, Pennsylvania 19103.
3. This is an action for Declaratory Judgment pursuant to PA C.S.A. Section 7513 et seq.,
for the purpose of determining a question of actual controversy between the parties as hereinafter
more fully appears.
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4. All parties with an interest in this matter have been joined as parties in this Complaint.
5. On November 23, 1994, Plaintiffs filed a medical malpractice action against Physicians
Unlimited, P.C. t/d/b/a Apple-A-Day and Hugh T. Knight, M.D., in the Court of Common Pleas of
Cumberland County, Pennsylvania, at Number 94-6662 Civil Term.
6. The Defendants were insured by the PIC Insurance Group, Inc. (hereinafter PIC), which
undertook to defend their interests in that litigation.
7. On January 21, 1998, the Commonwealth Court issued an Order of Liquidation against
PIC finding that company insolvent and staying all proceedings pending in any Court of the
Commonwealth in which PIC was obligated to defend a party for a period of ninety (90) days.
8. Under the application provisions of Pennsylvania law, PPCIGA assumed the handling of
all covered claims on behalf of PIC pursuant to the provisions of 40 PS Section 991.1801 et seq..
9. At the conclusion of the discovery in the case, the matter was listed for trial by the
Plaintiffs for the trial term commencing July 10, 2000.
10. Prior to the commencement of the trial, the parties entered into a settlement of the dispute
for the nominal amount of One Hundred Ninety Five Thousand Dollars ($195,000.00).
11. PPCIGA has asserted the right to an offset for the medical expenses that were paid on
behalf of the Plaintiff Bruce J. Bishoff in the amount of One Hundred Thirty Eight Thousand Three
Hundred Six Dollars ($138,306.00). That offset is asserted under the provisions of 40 PS Section
991.18l7(a).
12. The parties entered into a Full and Final Release of their claims, which Release
specifically preserved the right of Plaintiffs to contest the offset claim by PPCIGA. A true copy of
that Release is attached hereto as Exhibit "A".
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13. Plaintiffs believe that PPCIGA is not entitled to claim the offset which it has asserted in
this case for the following reasons:
(A) PPCIGA cannot claim a credit for the medical expenses paid by the Central
Susquehanna Region School Employees' Health and Welfare Trust, since that
entity is not an insurance company, and the payments made by that entity
were not insurance payments paid under an insurance policy as contemplated
by 40 PS Section 991.1817(a); and
(B) The statutory provisions of Section 991.18l7(a) were added to the statute on
December 12, 1994, two (2) years after the occurrence of the incidents which
gave rise to the cause of action on behalf of Plaintiffs, and application of that
credit to the claims presented by the Plaintiffs are in the nature of an ex post
facto taking without due process oflaw; and
(C) The provisions of the enabling statute, 40 PS Section 991.1801 et seq., extend
only to property and casualty insurance companies, which insurers do not
include the Central Susquehanna Region Employees' Health and Welfare
Trust; and
(D) The provisions of Section 991.1817(a) constitute a denial of Plaintiffs
constitutional rights to access to the Court; and
(E) The provisions of Section 991.18l7(a) constitute a denial of Plaintiffs
constitutional rights to equal protection under the laws; and
(F) The offset provision of Section 991.18l7(a) is otherwise invalid as may be
revealed through continuing investigation and discovery
WHEREFORE, Plaintiffs request that:
(A) The Court enter a Declaratory Judgment holding the PPCIGA has no right to
claim a credit pursuant to the provisions of 40 PS Section 991.181 7 ( a) for the
medical expense benefits paid by the Central Susquehanna Region School
Employees' Health and Welfare Trust; and
(B) The Court enter a Declaratory Judgment that the Defendant PPCIGA is
obligated to remit to Plaintiffs the sum of One Hundred Thirty Eight
Thousand Three Hundred Six Dollars ($138,306.00), representing the amount
of the offset claimed by PPCIGA; and
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(C) The Court grant such other further relief as may be just and proper.
THONY ST
!.D. #25497
407 North F nt Street
P.O. Box 12027
Harrisburg, P A 17108-2027
(717) 232-0511
A- 7-00
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FULL AND FINAL RELEASE
FOR AND IN CONSIDERATION of the sum of One Hundred Ninety-Five
Thousand Dollars ($195,000.00) to be paid to the undersigned upon
receipt of this signed Release; the undersigned does fully release
and discharge Hugh T. Knight, M.D. and Physicians Unlimited, P.C.,
the Pennsylvania Property and Casualty Insurance Guaranty
Association and all other persons, associations and corporations
whether or not named herein, their heirs, executors,
administrators, successors, assigns and insurers, and their
respective agents, servants and employees, from any and all causes
of action, claims and demand of whatsoever kind on account of all
known, and unknown injuries, losses and damages allegedly sustained
by the undersigned and, specifically, from any claims, or joinders,
for sole liability, contribution, indenmity or otherwise as a
result of, arising from, ,or in any way connected with all medical
professional health care services rendered by the above Health Care
Provider(s), and on account of which legal action was instituted by
the undersigned in the Court of Common Pleas of Cumberland County,
Docket No. 94-6662. The undersigned do upderstand, and agree, that
the acceptance of said sum is in full accord and satisfaction of a
disputed claim and that the payment of said sum is not an admission
of liability by any party named herein. It is expressly understood
and agreed that this Release and settlement is intended to cover
and does cover not only all now known injuries, losses, damages,
but any further injuries, losses or damages which arise from, or
are related to the occurrence set forth in the legal action noted
above.
It is understood and agreed that the primary insurer for Hugh
T. Knight, M.D. and Physicians Unlimited, P.C. was PIC Insurance
Group, Inc., which has been declared insolvent by the Commonwealth
Court of Pennsylvania, and tha't the Pennsylvania Property and
Casualty Insurance Guaranty Association has assumed responsibility
for covered claims pursuant to 40 P.S. ~991.1801 et. seq. The
amount paid by the Pennsylvania Property and Casualty Insurance
Guaranty Association on any covered claim is subject to 40 P.S. ~
991.1817(a) Non-duplication of recoverv which states:
Any person having a claim under an insurance
policy shall be required to exhaust first his
right under such policy. For purposes of this
section, a claim under an insurance policy
shall include a claim under any kind of
insurance, whether it is a first-party or
third-party claim, and shall include, without
limitation, accident and. health insurance,
worker I s COmpensation, Blue cross and Blue
Shield and all other coverage except for
policies of an insolvent insurer. Any amount
payable on a. covered claim under this Act
shall be reduced by the amount of any recovery
under other insurance.
If it should be finally determined by the Court that the
offset provision of 40 P.S. ~ 991.1817 is invalid, the undersigned
reserves the right to seek full recovery $138,306.00, which was
taken as a set off, exclusively from the Pennsylvania Property and
Casualty Insurance Guaranty Association or from the Estate of PIC
Insurance Group, Inc. through the Statutory Liquidator of the
insolvent PIC Insurance Group, Inc.,. i.e., the Pennsylvania
Insurance Oepartment, Bureau of Liquidation Claims.
The undersigned hereby agree, on their behalf and on behalf of
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their heirs, executors, successors' and/or assigns, to ind~mnify and
save forever harmless the releasee named in this document from and
against any and all claims, demands or actions, known or unknown,
made against the Releases by any person or entity on account of, or
in any manner related to or arising from the legal action noted
above.
It is further understood and agreed, that this is the complete
release agreement, and that there are no written or oral
understandings, or agreements, directly, or indirectly connected
with this Release and settlement that are not incorporated herein.
This agreement shall be binding upon and inure to the successors,
assigns, heirs, executors, administrators, and legal
representatives of the respective parties hereto.
It is further understood and agreed and made part hereof, that
neither the undersigned nor our attorneys or other representatives,
will in any way publicize, in any news or communications media,
including but not limited to newspapers, magazines, radio or
television, the facts or terms and conditions of this settlement.
All parties to this agreement expressly agree to decline comment on
any aspect of this settlement to any me~er of the news media.
This paragraph is intended to become part of the consideration for
settlement of this claim.
In the event court approval is required for the settlement,
compromise or resolution of this claim, this settlement is
conditioned upon plaintiff undertaking any and all necessary action
to obtain same.
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If this settlement is ever determined by any court to' be
without effect because some necessary court approval was not
obtained, or if the released parties are subjected to further legal
action or claim which could not have been instituted or presented
had proper court approval been obtained'by plaintiff, then
plaintiff will indemnify the released parties for any future loss,
cost, or expense including but not limited to reasonable attorney's
fees for defending, litigating and settling any such claims or
action, and for any judgment resulting from any such action or
claim.
It is further understood that the undersigned releasing
parties will payor otherwise discharge, or reach an agreement to
discharge, and will be fully and completely responsible for any and
all liens, charges, fees, costs, interest and other sums which may
exist against the settlement under common law, statute or
otherwise, including but not limited to any liens, subrogation
liens or claims by any insurance carrier or governmental agency
which may have paid any bills, costs or expenses on behalf of the
undersigned, and the undersigned further agrees to defend and
indemnify the released parties, the pennsyl vania Property and
Casualty Insurance Guaranty Association, and defense counsel for
any claims, legal actions or administrative actions brought against
any released party, the Pennsylvania Property and Casualty
Insurance Guaranty Association and defense counsel for payment or
discharge.
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THE UNDERSIGNED HEREBY' DECLARES that the terms .of this
settlement have been completely read; and that they either have
discussed the terms of this settlement with legal counsel of their
choice, or voluntarily chose not to seek the advice of legal
counsel and said terms are fully understood and voluntarily
accepted for the purpose of making a full and final compromise
adjustment and settlement of any and all claims on account of the
injuries and damages above-mentioned, and for the express purpose
of precluding forever any further or additional suits arising out
of the aforesaid claims.
IN WITNESS WHEREOF, and intending to be legally bound, I have
hereunto set my hand and seal this
19
day of J V c. <.( ,2000.
CAUTION - READ BEFORE SIGNING
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Social Security Number
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Betty J /," Btshoff r ;'
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Federal Tax ID Form
Due to Section 604(t) of the Federal TilXpayer Relief Act of 1997 the Fund is required to
obtain a Federal Tax ill Number for the plaintiff counsel who is to be named on the Fund's
settlement check. Please fill in the correct blanks below:
Plaintiff counsel to be na~ed on check: A N ?-t+ON '( ;;71; F II No rJ
Plaintiff counsel Federal Tax ID #:
1..5 - loSv 79Z21
Or
Firm name to be named on check:
Firm Federal Tax ID #:
If the firm ID is used, then the Fund's settlement check can only be made out to the Firm,
while if the plaintiff counsel name is used, then the Fund's settlement check can only be made
out to the individual attorney.
Please complete this form and return with the executed release by August 31, 1999 . We
must have this information to process the invoice for payment. If you have any questions, please
do not hesitate to contact Joyce E. Helfrich or Jacqueline Haynes at (215) 560-5160.
Thank you for your cooperation.
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VERIFICATION
The undersigned hereby verifies that the facts averred in the foregoing Complaint For
Declaratory Judgment are true and correct to the best of his knowledge, information and belief.
This Yerification is made subject to the penalties of 18 Pa C.S.A. Section 4904 relating to
unsworn falsification to authorities.
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VERIFICATION
The undersigned hereby verifies that the facts averred in the foregoing Complaint for
Declaratory Judgment are true and correct to the best of her knowledge, information and belief.
This Verification is made subject to the penalties of 18 Pa C.S.A. Section 4904 relating to
unsworn falsification to authorities.
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BETTY J. If!HOFF
DATE:
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BRUCE 1. BISHOFF and BETTY J
BISHOFF,
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
Plaintiffs
: NO. 00-5506 Civil Term
v.
: CIVIL ACTION LAW
PENNSYL VANIA PROPERTY AND
CASUALTY INSURANCE GUARANTY : ACTION FOR DECLARATORY JUDGMENT
ASSOCIATION,
Defendants : JURY TRIAL DEMANDED
PRAECIPE TO REINSTATE COMPLAINT
TO THE PROTHONOTARY:
Mark the Complaint in the above captioned matter reiinstated, and deliver a copy of that
Complaint to the Sherifffor service.
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SHERIFF'S RETURN - OUT OF COUNTY
CASE NO: 2000-05506 P
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
BISHOFF BRUCE J ET AL
VS
PA PROPERTY AND CASUALTY INS
R. Thomas Kline
, Sheriff or Deputy Sheriff who being
duly sworn according to law, says, that he made a diligent search and
and inquiry for the within named DEFENDANT
, to wit:
PENNSYLVANIA PROPERTY AND
CASUALTY INSURANCE GUARANTY
but was unable to locate Them
in his bailiwick. He therefore
deputized the sheriff of PHILADELPHIA
County, Pennsylvania, to
serve the within COMPLAINT & NOTICE
On December 14th, 2000 , this office was in receipt of the
attached return from PHILADELPHIA
Sheriff's Costs:
Docketing
Out of County
Surcharge
DEP. PHILA CO
18.00
9.00
10.00
116.00
.00
153.00
12/14/2000
ANTHONY STEFANON
S~~_~
~O;;;-afKline
Sheriff of Cumberland County
Sworn and subscribed to before me
this l,f~
day of l11.en~.L. /
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SHERIFF'S RETURN - SUMMONS/COMPLAINT
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COMMON PLEAS NO.
~nll"ITV "-Q\J-RT
VERSUS
~t/ TERM, ~ ~
NO. ";;0 -60276'
o Defendant
SERVED AND MADE KNOWN TO 4- ~? r'-~ ~ndant Company
by handing a true and attested copy of the within Summons/Complaint, issued in the above captioned matter
on //- /7 :rg-20100 ,at j()f D~lock, ft M~.S.T.
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, in the County of Philadelphia,
State of Pennsylvania, to
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o (1) the aforesaid defendant, personally;
o (2) an adult member of the family of said defendant, with whom said defendant resides, who stated that
his/her relationship to said defendant is that of
o (3) an adult person in charge of defendant's residence.; the said adult person having refused, upon re-
quest, to give his/her name and relationship to said defendant;
o (4) the manager/clerk of the place of lodging in which said defendant resides;
~ agent or person for the time being in charge of defendant's office or usual place of business.
o (6) the
and officer of said defendant Company;
So Answers,
.JOHN D. GREEN, Sheriff
By: !J~~~
~ 6eputy Sheriff
12-38 (Rev. 12Al7)
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. l'h Tbe Court of Common Pleas of Cumberland County, Pennsylvania
Bruce J. Bishoff, et. al.
VS.
FA Property & Casualty Insurance
Guaranty Association
No. 20-5506 Civil
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10/23/00
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, 2() 0 I/) , I, SHERIFF OF CillvlBERLAND COUNTY, P A, do
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Now,
. hereby deputize the Sheriff of PhiJ,loelPhia
County to execute this Writ, this
d'epU1li!ion being madf;atther~~uest and risk of the Plaintiff.
_'uuu_'U . rPt?A#l"'~~#
Sheriff of Cumberland County, P A
Affidavit of Service
Now
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o'clock
M. served the
within
upon
at
by handing to
copy of the original
a
and made Imown to
the contents thereof
So answers,
Sheriff of
County, PA
Sworn and subscribed before
me this_day of ,20_
COSTS
SERVICE
MILEAGE
AFFIDA VIT
$
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BRUCE BISHOFF and BETTY J.
BISHOFF
COURT OF COMMON PLEAS
CUMBERLAND COUNTY,
PENNSYL VANIA
v.
No. 00-5506
PENNSYLVANIA PROPERTY AND
CASUALTY INSURANCE
GUARANTY ASSOCIATION
Civil Action Law
ENTRY OF APPEARANCE
TO THE PROTHONOTARY:
Kindly enter our appearance on behalf of defendant, the Pennsylvania Property and
Casualty Insurance Guaranty Association, in the above-captioned matter.
BRITT, HANKINS, SCHAIBLE & MOUGHAN
BY: X-d~
Lise Lu~orsky, Esquire
Attorney LD. No. 22099
Two Penn Center Plaza, Suite 515
1500 John F. Kennedy Boulevard
Philadelphia, PA 19102-1888
(215) 569-6918
Attorneys for Defendant
Dated:December 19. 2000
JURY TRIAL DEMANDED
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BRUCE BISHOFF and BETTY J.
BISHOFF
: COURT OF COMMON PLEAS
CUMBERLAND COUNTY,
PENNSYL VANIA
v.
No. 00-5506
PENNSYL VANIA PROPERTY AND
CASUALTY INSURANCE
GUARANTY ASSOCIATION
Civil Action Law
CERTIFICATE OF SERVICE
I certify that a copy of Defendant, the Pennsylvania Property and <rasualty
Insurance Guaranty Association's, Entry of Appearance was mailed this day to the below-
listed counsel:
Anthony Stefanon, Esquire
407 North Front Street
P.O. Box 12027
Harrisburg, P A 17108-2027
(717) 232-0511
Attorney for Plaintiffs
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Lise Lubarsky, Esquire !
Attorney LD. No.: 22099 .
BRITT, HANKINS, SCHAIBLE & MOUGHAN
Two Penn Center Plaza, Suite 515
1500 John F. Kennedy Boulevard
Philadelphia, PA 19102-1888
(215) 569-6918
Dated: December 19.2000
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BRUCE BISHOFF and BETTY 1.
BISHOFF
COURT OF COMMON PLEAS
CUMBERLAND COUNTY,
PENNSYLVANIA
v.
No. 00-5506
PENNSYLVANIA PROPERTY AND
CASUALTY INSURANCE
GUARANTY ASSOCIATION
Civil Action Law
CERTIFICATE OF SERVICE
I certify that a copy of the Answer and New Matter of the Pennsylvania Property
and Casualty Insurance Guaranty Association was mailed, this date, by fIrst class mail, as
follows:
Anthony Stefanon, Esquire
407 North Front Street
P.O. Box 12027
Harrisburg, P A 17108-2027
(717) 232-0511
Attorney for Plaintiffs
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Lise Luborsky, Esquire
Attorney LD. No.: 22099
BRITT, HANKINS, SCHAIBLE & MOUGHAN
Two Penn Center Plaza, Suite 515
1500 John F. Kennedy Boulevard
Philadelphia, PA 19102-1888
(215) 569-6918
Attomeys for Defendant,
The Pennsylvania Property and Casualty
Insurance Guaranty Association
Dated:December 19.2000
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NOTICE TO PLEAD
To: Plaintiffs
You are hereby noticed to plead to the within New
Matter within twenty (20) days of service hereof
or a judgment may be entered against you.
&/~!rei ~t-e~
Attorneys for De endant
BRUCE BISHOFF and BETTY J.
BISHOFF
COURT OF COMMON PLEAS
CUMBERLAND COUNTY,
PENNSYLVANIA
v.
No. 00-5506
PENNSYL VANIA PROPERTY AND
CASUALTY INSURANCE
GUARANTY ASSOCIATION
Civil Action Law
ANSWER AND NEW MATTER OF THE PENNSYL VANIA PROPERTY
AND CASUALTY INSURANCE GUARANTY ASSOCIATION
1. After reasonable investigation, the Pennsylvania Property and Casualty
Insurance Guaranty Association (the "Association") is without knowledge or information
sufficient to form a belief as to the truth of the averments of paragraph 1. The averments
are therefore deemed denied.
2 - 7. Admitted.
8. The averments of paragraph 8 are conclusions oflaw to which no answer is
required. Further, the Association assumed the handling of covered claims pursuant to
the provisions ofthe Pennsylvania Property and Casualty Insurance Guaranty Association
Act, 40 P.S. SS 991.1801 et seq. (the "Act"), as required by the Act, not "on behalf of
PIC."
9. The Association admits only that at the conclusion of discovery, the matter
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was listed for trial during the week of July 10, 2000. After reasonable investigation, the
Association is without knowledge or information sufficient to form a belief as to the truth
of the remaining avennents of paragraph 9. The averments are therefore deemed denied.
10. Admitted in part; denied in part. The Association admits only that the
parties settled the case before trial for the gross amount of $195,000, subject to the offset
provision of the Act, 40 P.S. ~ 991.l8l7(a), under the terms ofa release, a copy of which
is attached as Exhibit "A" to the Complaint. The Association denies that the settlement
was for a nominal sum. On the contrary, the settlement was for the amount agreed by the
parties to conclude all claims.
11. Denied as stated. On the contrary, the Association asserted that the gross
amount payable on the covered claim, $195,000, must be reduced by the amount of any
recovery under other insurance, including payment of medical expenses, pursuant to the
offset provision of the Act, 40 P.S. ~ 991.l817(a).
12. Admitted in part; denied in part. The Association admits only that plaintiffs
executed the Release, a copy of which is attached as Exhibit "A" to the Complaint. The
remaining averments of paragraph 12 are denied, in that the Release speaks for itself.
13. Denied. On the contrary, the Association is not obligated to pay more than
the $56,693.22 it has already paid, because the $195,000 gross settlement amount is offset
by the recovery of $138,306.78 under other insurance, pursuant to the offset provision of
the Act, 40 P.S. ~ 991.l8l7(a).
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(a) Denied as stated. On the contrary, the Association incorporates by
reference paragraph 11 ofthis answer. As further answer, plaintiffs have not shown that
the $138,306.78 was paid by the Central Susquehanna Region School Employees' Health
and Welfare Trust and not through insurance. After reasonable investigation, the
Association is without knowledge or information sufficient to form a belief as to the truth
of those averments of subparagraph l3(A). The averments are therefore deemed denied.
(b) Denied. On the contrary, the entire Pennsylvania Property and
Casualty Insurance Guaranty Association Act was enacted as a whole on December 12,
1994, was effective February 10, 1995, and is expressly applicable to all insurer
insolvencies occurring after its effective date, including the PIC insolvency which
occurred three years after its effective date. The former statute was repealed in its
entirety effective February 10, 1995, three years before the PIC insolvency. Further,
plaintiffs had no claim against the Association until after the PIC insolvency, and the
Association did not take anything from plaintiffs. The remaining averments of
subparagraph 13(B) are conclusions oflaw to which no answer is required.
(c) The averments of subparagraph 13(e) are conclusions oflaw to
which no answer is required. Further, recoveries under health insurance are expressly
made an offset under the Act, at 40 P.S. II 991.l817(a).
(d)-(f) The averments of subparagraphs 13 (D) through 13(F) are
conclusions of law to which no answer is required.
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WHEREFORE, the Association demands judgment in its favor, together with costs
of suit and attorney's fees, and a judgment declaring that the Association is not obligated
to pay the more than the $56,693.22 it has already paid, because the $195,000 gross
settlement lllIlount is offset by the recovery of $138,306.78 under other insurance,
pursuant to the offset provision of the Act, 40 P.S. S 991.18l7(a).
NEW MATTER
14. The Association is an unincorporated association created under the Act.
15. The Association obtains its funds for payment of covered claims by
assessing its members, which are the licensed insurance carriers writing property and
casualty insurance in Pennsylvania. 40 P.S. S 991.1802,40 P.S. S 991.1803(b)(3), 40
P.S. S 991.1808.
16. The present Pennsylvania policyholders of solvent Pennsylvania insurers
bear costs of assessments under the Act, which provides:
The rates and premiums charged by a member insurer for policies
to which this article applies shall appropriately reflect
assessments paid to the association by the member insurer less
any amounts returned to the member insurer by the association.
40 P.S. S 991.1810.
17. Assessments are divided into two accounts, (1) automobile and (2) all other
insurance to which the Article applies. 40 P.S. S 991.1808(a).
18. Pennsylvania policyholders under homeowners' policies and all other non-
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automobile property and casualty insurance policies ultimately bear costs of assessments
the Association makes as a result of the PIC insolvency.
19. The Act limits the amount the Association may assess in any year to 2% of
the net direct written premiums in Pennsylvania for the preceding calendar year on the
kinds of insurance in an account, in this case, the "other" account, which includes all non-
automobile property and casualty insurance policies. 40 P.S. ~ 991.1808(d), 40 P.S. ~
991.1802 (definition of "net direct written premiums").
20. To handle and pay covered claims under PIC policies, policies issued by
another insolvent medical malpractice insurer, P.LE. Mutual Insurance Company
("P.LE.), and other insolvent insurers, the Association has assessed the maximum amount
it is entitled to assess for the "other" account in 1998, 1999 and 2000.
21. The statutory limitations on the Association's obligations are mandatory,
and are essential to conserve the Association's limited funds.
22. The Act provides, at 40 P.S. ~ 991.1817(a):
Any person having a claim under an insurance policy shall be
required to exhaust first his right under such policy. For purposes
of this section, a claim under an insurance policy shall include
a claim under any kind of insurance, whether it is a first-party or
third-party claim, and shall include, without limitation, accident
and health insurance, worker's compensation, Blue Cross and
Blue Shield and all other coverages except for policies of an
insolvent insurer. Any amount payable on a covered claim
under this act shall be reduced by the amount of any recovery
under other insurance. (emphasis supplied).
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23. Under the above offset provision of the Act, the amount of recovery under
other insurance offsets the $195,000 gross settlement amount.
24. In the medical malpractice action, plaintiffs had recovered $138,306.78 for
medical expenses.
25. Plaintiffs' claim for medical expenses in the underlying medical
malpractice case was covered under the PIC policy providing medical malpractice
coverage to Hugh T. Knight, M.D.
26. Plaintiffs' medical malpractice action against Dr. Knight was settled more
than two years after the PIC insolvency.
27. A copy of the Order of the Commonwealth Court of Pennsylvania of
January 21, 1998, declaring PIC insolvent and placing it in liquidation, is attached as
Exhibit "A."
28. At the time of the settlement of the medical malpractice case against Dr.
Knight, in July, 2000, PIC was in liquidation and did not participate in the settlement.
29. The Pennsylvania Property and Casualty Insurance Guaranty Association
Act does not preclude plaintiffs from making a claim in the PIC liquidation for the
$138,306.78 amount of the offset. See Exhibit "A."
30. On July 31, 2000, the Association paid plaintiffs $56,693.22, as a result of
reducing the $195,000 gross settlement amount by $138,306.78.
31. The entity that paid the $138,306.78 in medical expenses had contractual
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obligations to plaintiffs.
32. Plaintiffs have not shown compliance with the requirement to exhaust other
insurance, by failing to show how the $138,306.78 was paid.
WHEREFORE, the Association demands judgment in its favor, together with costs
of suit and attorney's fees, and a judgment declaring that the Association is not obligated
to pay the more than the $56,693.22 it has already paid, because the $195,000 gross
settlement amount is offset by the recovery of$138,306.78 under other insurance,
pursuant to the offset provision of the Act, 40 P.S. S 991.l8l7(a).
BRITT, HANKINS, SCHAIBLE & MaUGHAN
BY:
~ .-2tJ/W~k -------
Lise Luborsky {:l
Attorney LD. No. 22099
Two Penn Center Plaza, Suite 515
1500 John F. Kennedy Boulevard
Philadelphia, PA 19102-1888
(215) 569-6918
Attorneys for Defendant
Dated:_~.I'1 / :ZOO 0
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VERIFICATION
Stephen F. Perrone hereby states that he is the Claims Manager of Defendant in
this action and verifies that the statements made in the foregoing Answer and New Matter
of the Pennsylvania Property and Casualty Insurance Guaranty Association 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. S
4904 relating to unsworn falsification to authorities.
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Stephen F. Perrone
Claims Manager,
Pennsylvania Property and Casualty
Insurance Guaranty Association
Dated: ,'4- It 'i J 0 D
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IN THE COMMONWEALTH COURT OF PENNSYLV ANlA
M. Diane Koken, Insurance Commissioner
of the Commonwealth of Pennsylvania :
.
.
Plaintiff
.
.
.
.
v.
.
.
'l'lC Insurance Group, Inc.
Defendant
.
.
Docket NO.L\L\-!-O 1998
ORDER OF LIQUIDATION
Plaintiff, the Insurance Commissioner of the Commonwealth of Pennsylvania,
having filed a Petition for Review (In the Nature of a Petition For Liquidation) ("Petition") in
accordance with the Insurance Department Act of/921, Act of May 17, 1921, P.L. 789, l!li amended,
40 P.S. ~S221.1-221.63, the Court hereby fmds that it is in the best interest of Defend~t, its
policyholders and creditors, and of the public, that Defendant be placed into Liquidation in
accordance with the provisions of Article V of the Insurance Department Act, ID.!IIDl; and that
sufficient grounds exist for the entry ofan Order of Liquidation including, without limitation, the
fact that Defendant is insolvent and that on January IS, 1998, Defendant consented to the entry of
an Order of Liquidation.
.
NOW, THEREFORE, it is ordered, adjudged and decreed:
1. The Petition of the Insurance Commissioner of the Commonwealth of
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Pennsylvania ("Commis'sioner") for the entry of an Order of Liquidation, fmdings ofinsolvency and
agreement to liquidation is granted.
2. M. Diane Koken, Insurance Commissioner of the. Commonwealth of
Pennsylvania is, and her successors in office are, hereby appointed Liquidator of Defendant and are
directed immediately to take possession of its property, ,business. and affairs as Hquidator, to
liquidate the business and affairs of the company pursuant to the provisions of Article V of the
Insurance Department Act (40 P.S. ~~221.1-221.63), and to take such action as the nature of this
cause and the interest of the policyholders, creditors,. stockholders, or the public may;require.
ASSETS OF THE ESTATE
3. The Insurance Commissioner is vested as Liquidator with title to all
property, assets, contracts and rights of action of Defendant, wherever located, as of the date of the
filing of the Petition for Liquidation.
,
4. All banks, brokerage houses, or other companies or persons having in their
possession assets which are, or may be the property of Defendant, be and are hereby ordered to
deliver the possession of the same immediately to the Liquidator, and are further ordered not to
disburse the same without the written consent of or unless directed in writing by the LiqUidator, and
such persons and entities, and all other persons and entities, are enjoined from disposing of or
destroying any records pertaining to any business transactions between Defendant and banks,
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brokerage houses or other persons or companies having done business with Defendant or having in
their possession assets which are or were the property of Defendant.
.
5. All agents, brokers or other persons having sold policies of insurance and/or
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collected premiums on behalf of the Defendant shall account for' and pay all premiums and
c:JITunissions unearned due to policies canceled by this Order, orin the nonnal course of business,
owed to Defendant directly to the Liquidator within 30 days of demand by the Liquidator or appear
before this Court to show good cause, if any they may have, as to why they should not be required
to account to the Liquidator or be held in contempt ofCourtfor:violation:oftheprovisions of this
Order. No agent, broker, or other person shall use premium moneys owed to Defendant for refund
of unearned premium or any purpose other than payment to the Liquidator. The Liquidator shall
serve this Order on all agents, brokers or others in accordaru:e with 40 P .S. . S22l.24 which shall
constitute notice of its injunctive provisions.
6. All attorneys employed or retained by Defendant as of this date shall, within
thirty (30) days notice of this Order, report to the Liquidator on the name, company claim number
and status of each file they are handling on behalf of the Defendant. Said report shall also include
an accounting of any funds received from or on behalf of the Defendant.
7. Any premium tinance company which has entered into a contract to finance
for a policy which has been issued by the Defendant shall pay the premium owed to the Defendant
directly to the Liquidator.
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8. Upon request by' the Liquidator, any company providing telephone services
to the Defendant shall provide a reference of calls from the. number presently assigned to the
Defendant to any such. number designed by the Liquidator or perform any other changes necessary
to the conduct of the receivership.
9. Any entity furnishing water, electric; sewage;,garbage'or,.trash.removal
services to the Defendant shall maintain such service and transfer any such accounts to the
Liquidator as of the date of this Order unless instructed to the contrary by the Liquidator.
10. Any data processing service whichhas.custody,or controLof;any data
processing information and records including but not limited to source documents, data processing
cards, input tapes, all types o~ storage information, master tapes or any other recorded information
relating to Defendant, shall transfer custody and control of such records to the Liquidator and
continue to provide necessary data processing services to the Liquidator unless instructed to the
contrary by the Liquidator.
11. The United States Postal Service is requested to provide any information
sought regarding Defendant and to handle future deliveries of PIC's mail as directed by the
Liquidator.
.
12. The Defendant, its directors, officers, trustees, employees, attorneys,
brokers, agents, policyholders, creditors, and any and all other persons are enjoined from: (1) the
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transaction of further'busiii"ess, (2) the transfer of property, (3) any interference with Plaintiff in
liquidating the Defendant's business and affairs, (4) any waste of the Defendant's assets or property,
(5) the dissipation and transferof bank accounts and negotiable instruments, (6) the institution or
further prosecution of any actions in law or equity, (7),the.;obtainingofpreferences, judgments,
attachments, garnishments, or liens against the Defendant and its assets; property and policyholders,
(8) the levy of execution process against Defendant andits assets;prop.erty;.andpolicyholders,.(9)
the negotiation or execution of any agreement of sale or deed conveying personal or real property
for nonpayment of taxes or assessments or for any other purpose, (10) Withholding from Plaintiff or
removing, concealing, or destroying books, accounts,documents,'or,other,'records,relating to
Defendant's business, and (II) the taking of any other action which might lessen the value of
Defendant's assets or property, prejudice the rights and interests of policyholders and creditors, or
interfere in the administration of the proceeding.
13. Defendant, its officers, directors, trustees, employees, consultants,
contractors, agents and attorneys are hereby ordered and enjoined to surrender peacefully the
premises where Defendant conducts its business, and to deliver all keys thereto, and to any safe
deposit boxes, and to advise the Liquidator, her agents and attorneys, of the combinations of any safe
or safekeeping devices of Defendant or any password or authorization code or access code required
for access to data processing equipment.
.
14. Defendant, its officers, directors, trustees, employees, consultants,
contractors, agents and attorneys are hereby ordered and enjoined to deliver peacefully and surrender
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to the Plaintiff, her agents and attorneys, all and. singular, all of the assets, bookS, records; files,
credit cards, or other property of the Defendant in its possession or control and to otherwise advise
and cooperate with the Plaintiff in identifying and locating. any of the Defendan~'s assets.
. IS. The rights and liabilities of Defendant and ofits creditors, policyholders,
trustees, shareholders, members and all other persons interested'jn,'.this..estate are:determined in
accordance with Article V of the Insurance Department Act of 1921,Act of May 19, 1921, P.L. 789,
~ amended, 40 P.S. ~~221.l-221.63, as of the date of the filing of this Order of Liquidation.
. 16. Except for contracts of insurance or reinsurance;'all executory contracts to
which Defendant was a party are hereby canceled and will stand canceled unless specifically adopted
by the Liquidator within thirty (30) days of the date of this Order. Any cancellation under this
provision shall not be treated as an anticipatory breach of such contracts.
NOTICE AND PROCEDURE FOR FILING CLAIMS
17. The Liquidator shall give notice by first-class mail to all persons
(including but not limited to individuals, aggregations ofindividuals, partnerships, corporations,
associations, estates, trusts, and governmental units, to include all other entities not named),
which may have claims against Defend.imt, contingent or otherwise, as revealed by its books and
records, and shall advise such persons to present and file with the Liquidator, proper proofs of
claim, in the form hereafter set forth. Said notice by the Liquidator to claimants shall specify
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that one year from the liquidation order's date at 5:00 PM EST to be the last day for the filing of
such proofs of claim with the Liquidator at the offices designed in such notice.
18. The Liquidator shall notify all other persons who have, or may have a
claim or claims against Defendant, by causing a notice to<<bepublishedina'newspaper of general
ci:rculationwhere t4e Defendant has its principal place ofbusiness,'such,notice shall: (a) specify
the last day for the filing of claims; (b) shall advise all persons ofthe procedure by which all
such persons may present their claims to the Liquidator; (c) shall advise all such persons of the
Liquidator's office wherein they may present their claim; and (d) shalladvise,all,sucltpersons of
their right to present their claim or claims to the Liquidator.
19. Any and all persons, firms; corporations otherwise having or claiming
to have any accounts, debts, claims or demands against Defendant, contingent or otherwise, or
'.
claiming any right, title or interest in any funds or property in the possession of the Liquidator
be, and they hereby are, ordered and required to file with the Liquidator at her offices designated
in the above-described notice, or on or before 5 :00 PM EST one year from the liquidation order's
date a properly completed proof of claim, subject to the late filing provisions of the Insurance
Department Act, ~ 40 P.S. ~221.37, or be thereafter barred as claimants against any assets in
the hands of the Liquidator.
.
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20. No person having or claiming to have any claim or claims against
Defendant shall participate in any distribution of the assets of Defendant unless such claims are
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filed or presented in accordance with and within the time limits established by this Order, subject
to the provisions for the late filing of claims contained in the Insurance Department Act, ~
40 P.S. ~221.37.
. 21. ,Noaction at law or equity shall be, brought against the Defendant or
. Liquidator; whethedn.this Commonwealth orelsewhere,'nor$halLany such:existing action be
. maintained or further presented after issuance of this Order. 'AU-actions.currently;pending
against the Defendant in the.courts of the Commonwealth of Pennsylvania or elsewhere are
hereby stayed. ,AU actions against the Defendant or Liquidator shall be submitted and considered
as claims in this liquidation proceeding.
22" All actions or proceedings pending in the courts of this Commonwealth
. or elsewhere in which theDefendant is obligated to defend a party are hereby, stayed for a period
of ninety (90) days under Section 1819 of the Pennsylvania Property and Casualty Insurance
Guaranty Association Act, Article XVIII of the Insurance Company Law, added 1994, Dec 12,
P.L. 1005, No. 137 (40 P.S. ~991.l819).
23. No judgment or order against an insured or the insurer entered after the
date of filing of the Petition for Liquidation, and no judgment or order against an insured or
Defendant entered at any time by default or by collusion need be considered as evidence of
liability or quantum of damages, by th~ Liquidator.
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24. No action or proceeding in the nature of an attachment, garnishment, or
execution shall be commenced'or .maintained in this Commonwealth or.elsewhere.against the
Defendant, Liquidator, or their assets.
25. Any action in which the Defendant is obligated to defend a party, which is
on trial before a jury as of the date of this order, shall be allowed:to proceedtothejssuance ofa
verdict. Following the issuance of said verdict, all further proceedings are stayed.
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P.I.
DATED: Ianuary21,1998
.
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BRUCE J. BISHOFF and BETTY 1.
BISHOFF,
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
Plaintiffs
: No. 00-5506 Civil Term
v.
: CIVIL ACTION - LAW
PENNSYLVANIA PROPERTY AND
CASUALTY INSURANCE GUARANTY : ACTION FOR DECLARATORY JUDGMENT
ASSOCIATION
Defendants : JURY TRIAL DEMANDED
PLAINTIFFS' REPLY TO NEW MATTER
OF DEFENDANT
14. - 22. Denied. The averments of these paragraphs are conclusions oflaw not requiring
answer by Plaintiffs. To the extent that the averments may be construed as averments offact, after
reasonable investigation, Plaintiffs are without knowledge or information sufficient to form a belief
as to the truth of these averments, and proof thereof is demanded if relevant. To the extent that the
averments recite the provisions ofPeru'1sylvania Statutes, those statutes are a matter of public record,
and speak for themselves.
23. Denied. To the contrary PPCIGA is not entitled to a "offset" under the circumstances
of the present case for the reasons set forth in Plaintiffs' Complaint.
24. Denied. To the contrary, Plaintiffs have only recovered the sum of$56,693.22 on their
medical malpractice claim. They have yet to recover the sum of $138,306.78, which is the amount
in dispute in this matter.
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25. Denied. To the contrary, Plaintiff cl,aimed illedical expenses as an element of damage
in the medical malpractice case against Hugh T. Knight, M.D. Dr. Knight was insured under a PIC
policy, and the Defendant PPCIGA has assumed responsibility for the claims against PIC pursuant
to the provisions of 40 PS Section 991.1801 et seq.
26. Admitted.
27. Admitted.
28. Denied. To the contrary, pursuantto the provisions of 40 PS. Section 991.1801 et. seq.,
PPCIGA is obligated to pay the covered claims existing prior to the determination of the insolvency
of PIC, and PPCIGA has the power and duty to be deemed the insurer to the extent ofits obligation
on the covered claims, and has all the rights, duties, and obligations of the insolvent insurer with
regard to those claims.
29. Denied. The averments of this paragraph are conclusions of law not requiring answer
by Plaintiff. To the extent that an answer is required, under the provisions of PS Section 991.180 I
et. seq., it is the obligation ofPPCIGA to pay the $138,306.78, as a covered claim for the insolvent
insurer.
30. Denied. To the contrary, PPCIGA paid the sum of $56,693.22, leaving a balance due
and owing to Plaintiff in the sum of $138,306.78.
31. Admitted.
32. Denied. To the contrary, Plaintiffs have provided documentation to PPCIGA
establishing that the medical expenses were paid not by insurance, but by the Central Susquehanna
Region School Employees Health & Welfare Trust, which is not an insurance company.
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WHEREFORE, Plaintiffs demand judgment in accordance with the prayer for release set
forth in their Complaint.
DATE:-12- 2-7 -?>O
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VERIFICATION
The undersigned hereby verifies that the facts averred in the foregoing PLAINTIFFS'
ANSWER TO NEW MATTER OF DEFENDANT are true and correct to the best of his
knowledge, information and belief.
This Verification is made subject tot he penalties of 18 Pa. C.S.A. Section 4904 relating to
unsworn falsification to authorities.
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DATE: I '1";J3 J[j:)
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VERIFICATION
The lLtldersignt'.d hereby verifies that the-facts averred in the foregoing PLAINTIFFS'
REPLY TO NEW MATTER OF DEFENDANT are true and correct to the best of her knowledge,
information, and belief.
This Verification is made subject to the penalties of 18 Pa. C.S.A. Section 4904 relating to
unsworn falsification to authorities.
-&~ Q. -S~
BET Y 1. BISHOFF
DATE:
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CERTIFICATE OF SERVICE
The undersigned hereby. certifies that, on the date below he served a true copy of
PLAINTIFFS' REPLY TO NEW MATTER OF DEFENDANT, on each of the persons listed
below, at the addresses set forth, by First Class United States Mail:
LISE LUBORSKY
BRITT, HANKINS, SCHAIBLE & MOUGHAN
SUITE 515
TWO PENN CENTER PLAZA
1500 JFK BLVD
PHILADELPHIA, PA 19102-1888
By:
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ORIGINAL
BRUCE J. BISHOFF and
BETTY 1. BISHOFF, Plaintiffs
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
VS.
: No. 00-5506 Civil Term
PENNSYLVANIA PROPERTY AND
CASUALTY INSURANCE GUARANTY
ASSOCIATION,
: CIVIL ACTION - LAW
Defendants
: ACTION FOR DECLARATORY JUDGMENT
: JURY TRIAL DEMANDED
PRAECIPE FOR SETTLEMENT AND DISCONTINUANCE
TO THE PROTHONOTARY:
Mark the above-captioned matter settled, discontinued, and ended.
By:
DATE: Z ~ 'l7 -0/
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