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Home My WebLink About99-07120 .a 0 Cl `r PRAECIPE TO WITHDRAW CARDIOVASCULAR SURGICAL IN THE COURT OF COMMON PLEAS INSTITUTE CUMBERLAND COUNTY, PENNSYLVANIA VS DONALD E. PIPER DIANNA PIPER To Prothonotary: CIVIL ACTION - MONEY JUDGMENT No. 99-7120 Please WITHDRAW the action against DONALD E. PIPER, DIANNA PIPER. Date: July 27, 2004 Respectfully submitted, Gail Guida Souders Guida Law Offices, P.C. 111 Locust Street Harrisburg, PA 17101 717-236-6440 Identification #68740 Attorney for Plaintiff ?- I CV C3 C) A. N fL ?I J {Tj ? I L U o ti CARDIOVASCULAR SURGICAL IN THE COURT OF COMMON PLEAS INSTITUTE CUMBERLAND COUNTY, PENNSYLVA VS CIVIL ACTION - LAW DONALD E. PIPER 74.'?q, 171;1oC,?? T DIANNA PIPER NOTICE TO DEFEND You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this complaint and notice are served, by entering a written appearance personally or by attorney and filing in writing with the court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the court without further notice for any money claimed in the complaint or for any other claim or relief requested by the 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. Bar Association 2 Liberty Avenue Carlisle, PA 17013 717-249-3166 CARDIOVASCULAR SURGICAL IN THE COURT OF COMMON PLEAS INSTITUTE CUMBERLAND COUNTY, PENNSYLVANIA VS CIVIL ACTION - LAW n % DONALD E. PIPER 710 q9. 71,)o DIANNA PIPER l'Gn f 1 COM2' LAINT AND NOW, this 23 day of November 1999 comes Cardiovascular Sugical Institute, above-named plaintiff, by and through its attorney, Richard E. Guida, Esquire, and respectfully avers the following: 1. Plaintiff is a corporation having offices at 123 North 21st Street, Camp Hill, PA 17011. 2. Defendant Donald E. Piper is an adult individual residing at 210 Mill Street, Mt. Holly Springs, PA 17065. 3. Defendant Dianna Piper is an adult individual residing at 210 Mill Street, Mt. Holly Springs, PA 17065. 4. At the specific instance and request of Defendants, Plaintiff provided medical services to Defendants at the times, amounts, and the prices for these services are indicated in Plaintiff's Statement of Account, a true and correct copy of which is attached hereto, marked Exhibit A, and made part thereof. 5. The prices charged by Plaintiff were fair, reasonable, and market prices that prevailed at the times o£ the transactions 6. The prices charged by Plaintiff were the prices that Defendants agreed to pay. 7. Plaintiff avers that the balance due amounts to $11,775.00, which is below the limit for mandatory arbitration. 8. Although repeatedly requested to do so by Plaintiff, Defendants have willfully failed and refused to pay the aforesaid balance or any part thereof to Plaintiff. WHEREFORE, Plaintiff respectfully requests that judgment be entered in favor of Plaintiff and against Defendants in the amount of $11,775.00 with interest and costs. Respectfully submitted, /-,-I ? A? Richard E. Guida Guida Law Offices 503 North Front Street Harrisburg, PA 17101 717-236-6440 Identification #62405 Attorney for Plaintiff sA', DIOYASCUIGP. STIR 6I(hl 1X51. II apiaed St a ter.( III IZi NOUN/ 21sr SIMI •11(61(1'?dl 12(31(?d ]A COOP Nlll, PA 114!1 ]Uf97S-8908 Federal 10 : 23.2112943 Patient PIPF,R, 00"1410 F- P.rtlo- 22645 210 X111 ST Dub: 05(18(1941 4T HOLL'f SP8I46S, PA 17465 Age: 53 117(496.4796 top] oyer: Addresslielephonel: 77605 6varanlor Page: I (c) 3edic P. i0 pd: 111@911949 7:57 PA 0070359•6001 if SS Aut10: 161347512 P(PF•3, 0034(0 F SSn l5 F3t-26t7 710 hill S1 AT HOW SPRI36S, P3 11465 1111486•479 .......... ..... Posting Date ............. Patient .......... Nape ........ ........ (ode ..... -_............_.----....... Description ......--........... OlylSrc Charged ......... Open ........... Proeid(r ............ Place casel 61178199 PIPER, DONALD f 99754 INTTIAI INPATIENT (001IT-X601 1.611 2P5.0N 7PS.NN Cu II R1 I 01agP: 411.41 010HAR'1 ATHEROSCLEROSIS 07179199 TT( TPAHSfER TO COLIECIION Pr"d -M." 62/43(99 PIPER, OONIALO E 33S34 036-ARTFRIAL 61AFTS '( 2 1.44 7345.44 7345.44 CU Hill I 03agP: 414.111 CORONAPY ATHEP.OS(IFROSIS 41129197 TTC TRA4SFf,R TO COLLECT103 Prsnl -7345.44 117108199 PIPER, DONALD F 93503 PIA6fe(IIT OF SEAN 66N7 (AIL: 1.00 54a.P0 540.00 (u HHI I 0iag1) : 414.41 C0R01AR7 ATHE305CLF-ROSIS 07179199 TT( TRANSFEP. TO COLLECTION Pr',nl -540.00 42193199 PI90, DONALD 1• 33513 0436-YEU S All 6RFT; 911.8011S 6 1.44 1274.44 1214.66 Cu HRI I 03agP: 414.01 CORONARY ATHEROSCIFROSTS 41129199 TTC TRANSFER T6 COLLECTION Prial -1276.40 67108199 PIPIP, DONALD F 33534-AS A.S. PA C06; APT(RIAI 6PAf15 1.60 1565.00 1565.60 SN Hill I QUIP: 414.41 COR0NIA9'f ATNEROSCLE80S1S 07179(99 TTC TRANSFER TO C611FCT1DR Prsn) •1565,60 42143199 PIPER, 003ALO E 33513-Ai A.S. P4 CAW A.M E30US GRAFT 1.44 234.44 266.64 S3 HNE I 0iagP: 414.01 CORONARY ATHER05(IEROSIS 41129199 fh: TRANSFFR TO COLLF.0103 Pnnl -264.44 07175(99 PIPER, DONAID F 93931-76 RPM UPPER FYI. 1IN11f DlF(I1l I.01 130.110 130.60 (u ILIA 7 OiagP: 413.9 PERIPHERAL 9AWILAd DISEASE 07/29191 TT( TPANSUP, TO 011FCTIOH Pr,nl •130.00 43114199 PIPER, 00-1,110 £ 99434 RE91Eu 4E0 RECORDS 1.44 71.4.) 4.44 DH CSI Dia9P: 40.41 I'MPHEPAI PAS(UM.' OI5fh5l - lljli 99 111 PAYAPIT - THIRD PART'" Ins,ir -21.44 06174199 PIPER, D ONAID E sent sl alap(nt asking pt to forv;rd to att. FPbi": ?OS INC PHONE NO. : 7177022007 -Nov. 08 1999 04:32PM PG Nov-04-99 05:30P Guida Law Offices 236 9599 P.06 C-%RzxOVABCULAR BUAOICAL X'STITM VS DONALD E. PIPER DIAMM PIPER IN THE COURT OT comm plj= CUMSMU M COUNTY, PMSYLVANIA CIVIL ACTION - LAN V921preATICmi I VERXFT THAT THE 9TATEMTB MDE IN THIS COtdiLA WT ARE TREE AND CORRECT. I UNDERSTAND THAT THY STATEbiT8 HEREIB ARE WWZ SUBJECT TO THY PENALTIES OF 18 PA.C.9,A. 8ECTICW 4904 FZ"TINO} TO UNGWM FALSIFICATION TO AUTHORITIES. v 8ignat re S--e-&r,-[A V; 5 PrInti-d Name ue, I I reCl+b r- Title 9 7 Datm SHERIFF'S RETURN - REGULAR CASE NO: 1999-07120 P COUNTY4JOFLCUMBERLANDSYLVANIA: CARDIOVASCULAR SURG INSTITUTE VS. PIPER DONALD E ET AL BRIAN BARRICK , Sheriff or Deputy Sheriff of CUMBERLAND County, Pennsylvania, who being duly sworn according to law, says, the within COMPLAINT was served upon PIPER DIANNA the defendant, at 14:06 HOURS, on the 2nd day of December 1999 at 210 MILL MT HOLLY SPRINGS, PA 17065 CUMBERLAND County, Pennsylvania, by handing to DONALD E. PIPER (HUSBAND) a true and attested copy of the COMPLAINT together with NOTICE and at the same time directing His attention to the contents thereof. Sheriff's Costs: So answe Docketing 6.00 Service .00 Affidavit .00 Surcharge 8.00 omas ine, eri 0 GUIDA LAW OFFICES by epu l Sworn and subscribed.to before me this /J ? day of aj9 ?2tV9 A.D. C-1, a ?kuF? itQa?s rotnonocary SHERIFF'S RETURN - REGULAR CASE NO: 1999-07120 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND CARDIOVASCULAR SURG INSTITUTE VS. PIPER DONALD E ET AL BRIAN BARRICK , Sheriff or Deputy Sheriff of CUMBERLAND County, Pennsylvania, who being duly sworn according to law, says, the within COMPLAINT was served upon PIPER DONALD E the defendant, at 14:06 HOURS, on the 2nd day of December 1999 at 210 MILL ST MT HOLLY SPRINGS, PA 17011 CUMBERLAND County, Pennsylvania, by handing to DONALD E. PIPER a true and attested copy of the COMPLAINT together with NOTICE and at the same time directing His attention to the contents thereof. Sheriff's Costs: So answe s: Docketing 18.00 Service 3.72 Affidavit .00 ne, 5 eri Surcharge 8.00 A-omas i 212M/19990FFICE ,(A A 4 epu y eri f Sworn and subscribe to before me this Jy - day o A. D. ?F?on??o ary A CARDIOVASCULAR SURGICAL IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA INSTITUTE VS CIVIL ACTION - LAW DONALD E. PIPER 99-7120 CIVIL TERM DIANNA PIPER Donald and Dianna Piper TO: March 14, 2000 DATE OF NOTICE: IMPORTANT NOTICE YOU ARE IN DEFAULT BECAUSE YOU HAVE FAILED TO ENTER A PERSONAL AND WITHTTHEACOURTTAANEANSWER OLPLAINTIFF'S COMPLAINT.ILUNLESSRYOUNG ACT WITHIN TEN 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 NOTICE TO A LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE FOLLOWING OFFICE TO FIND OUT WHERE YOU CAN GET LEGAL HELP: Cumberland County Bar Association 2 Liberty Avenue Carlisle, PA 17013 717-249-3166 ?,,_ CARDIOVASCULAR SURGICAL IN THE COURT OF COMMON PLEAS INSTITUTE CUMBERLAND COUNTY, PENNSYLVANIA VS CIVIL ACTION - LAW DONALD E. PIPER DIANNA PIPER 99-7120 CIVIL TERM CERTIFICATE OF SERVICE I hereby certify that I am this 14th day of March 2000, serving the foregoing document upon the persons and in the manner indicated below: Service by first class U.S. Mail addressed as follows: Donald and Dianna Piper c/o Craig R. Shagin, Esquire PO Box 1225 Harrisburg, PA 17108-1225 Richard E. Guida N ? r ... r.0 :.1 C_] J C:1 J ...,,..,?.. ...-" 1=sut.C6.:..Ai.:e.:c`.'iF?r,dt<`.'i 1 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CARDIVASCULAR SURGICAL CIVIL ACTION - LAW INSTITUTE, Plaintiff v. No. 99 - 7120 CIVIL TERM TRIAL BY JURY DEMANDED DONALD E. PIPER DIANA PIPER, Defendants To: Cardovascular Surgical Institute c/o Richard E. Guida 503 North Front Street Harrisburg, PA 17101 NOTICE TO PLEAD You are hereby notified to plead on behalf of Plaintiff to the New Matter within twenty (20) days after service hereof, or a default judgment may be entered against you. Respectfully, Shagin & Anstine LLC Crai R. Shagin Pa Supreme Court No. 32956 100 Pine Street, Suite 510 Harrisburg, PA 17101 717-221-1111 Attorneys for Defendants a IN 711E COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CARDIVASCULAR SURGICAL INSTITUTE, Plaintiff V. DONALD E. PIPER DIANA PIPER, Defendants CIVIL ACTION - LAW No. 99 - 7120 CIVIL TERM TRIAL BY JURY DEMANDED ANSWER AND NEW MATTER AND NOW, this 23 day of March 2000 comes Donald and Diana Piper, above named defendants, by and through their attorneys, Shagin & Anstine LLC, and respectively answers the averments of plaintiff as follows: I. Admitted. 2. Admitted. 3. Admitted 4. Admitted 5. Admitted 6. Admitted in part: denied in part. Defendants admit that they have been repeatedly W asked to pay the balance of their medical bill to plaintiff. Defendants admit further that they bave been unable to pay this bill. Defendants deny that they have refused to pay in so far as `refusal' means that their failure to pay is a volitional act suggesting that the defendants have the money necessary to pay such bills. By way of further answer, defendants aver that they are without the means to pay the medical bills that they owe and arc diligently seeking to enforce a contract of indemnity against the American National Life Insurance Company of Texas to obtain the fiords to pay plaintiff. NEW MATTER 7. Defendants had a contract of health insurance with the American National Life Insurance Company of Texas which commenced no later than December 28, 1998 and continued throughout the period in which plaintiff's services for defendant Donald Piper were rendered; 8. The American National Life Insurance Company of Texas has wilftdly refused to pay on its contract of insurance. Defendants have filed an action against The American National Life Insurance Company in the United States District Court for the Middle District of Pennsylvania, Civil Action No. L CV-99-2190 stating a claim against such company for, among other things, the bad faith denial of coverage of insurance and breach of contract. 9. Any and all sums owed by defendants to plaintiff should paid by the American National Life Insurance Company of Texas. 10. Defendants intend to join the American National Life Insurance Company of Texas in this action as a third party defendant. Respectfully submitted, Shagin & Anstine LLC C /1 Craig R Shagin, Pa. 32056 100 Pine Street, Suite 510 Harrisburg, PA. 17101 717-221- 1111 Attorney for Donald and Diana Piper VERIFICATION Donald E. Piper, Plaintiff, deposes and says, subject to the penalties of 18 Pa. C.S.A. § 4904 relating to unsworn falsification to authorities, that he has examined the foregoing Answer and New Matter and that the averments of fact set forth therein are true and correct upon his personal knowledge, information and belief. Date.. M X112 a CI - GYM Donald E. Piper IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CARDIVASCULAR SURGICAL CIVIL ACTION - LAW INSTITUTE, Plaintiff No. 99 - 7120 CIVIL TERM V. TRIAL BY JURY DEMANDED DONALD E. PIPER DIANA PIPER, Defendants CERTIFICATE SERVICE 1, Craig Shagin, certify that I am this 24"' day of March 2000, serving the foregoing document upon the persons and in the manner indicated below: Service by facsimile transmission and first class mail on: Cardiovascular Surgical Institute C/O Richard E. Guida Guida Law Offices 503 North Front Street Harrisburg, PA 17101 Crai R. Shagin °l ur. w0 s L-: C,j CO '1. CARDIOVASCULAR SURGICAL INSTITUTE VS DONALD E. PIPER DIANNA PIPER IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW 99-7120 PLAINTIFF'S ANSWER TO DEFENDANTS' NEW MATTER AND NOW, this 29 day of March 1999 comes Cardiovascular Sugical Institute, above-named plaintiff, by and through its attorney, Richard E. Guida, Esquire, and respectfully avers the following: 7. Neither admitted nor denied. 8. Neither admitted nor denied. 9. Neither admitted nor denied. 10. Admitted. WHEREFORE, Plaintiff respectfully requests that judgment be entered in favor of Plaintiff and against Defendants in the amount of $11,775.00 with interest and costs. Respectfully submitted, 1^-?F /yt? Richard E. Guida Guida Law Offices 503 North Front Street Harrisburg, PA 17101 717-236-6440 Identification #62405 Attorney for Plaintiff CARDIOVASCULAR SURGICAL INSTITUTE VS DONALD E. PIPER DIANNA PIPER IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW CERTIFICATE OF SERVICE On March 29, 2000, I served a copy of Plaintiff's Answer to Defendants' New Matter on the Defendants by sending a copy via First Class United States Mail to: Craig R. Shagin, Esquire 100 Pine Street, Suite 510 Harrisburg, PA 17101 Richard E. Guida r c o> >- LZ O •?n -„ c : - C ? CJ IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CARDIOVASCULAR SURGICAL INSTITUTE, Plaintiff V. DONALD E. PIPER DIANA PIPER, Defendants CIVIL ACTION - LAW No. 99 - 7120 CIVIL TERM TRIAL BY JURY DEMANDED ORDER ` 2000 inconsideration of defendants' AND NOW this day of MV(,( Motion for Leave to Join a Third Party Defendant it is hereby ORDERED that defendants' motion is GRANTED. By the Court: Date: -: I dbe ni,: 1; V 17 ca 3'3??5 IN T14E COURT OF COMMON PLEAS CUMBERLAND COUNTY. PENNSYLVANIA CARDIOVASCULAR SURGICAL INSTITUTE, Plaintiff V. DONALD E. PIPER DIANA PIPER. Defendants CIVIL ACTION - LAW No. 99 - 7120 CIVIL TERM TRIAL BY JURY DEMANDED MOTION FOR LEAVE TO JOIN A THIRD PARTY AND NOW COMES Defendants by and through their undersigned counsel SHAGIN &s ANSTINE LLC and respectfully moves this court for leave to join a third party as defendant. In support of this motion the Defendant avers as follows: 1. A Complaint was filed by Plaintiff on November 23. 1999 against defendants for nonpayment of medical bills incurred as a result of a heart attack suffered by Mr. Piper in January of 1999. 2. The defendant had a contract with the American National Life Insurance Company ofTesas (hereinafter "ANLIC" or "the Insurance Company") for an insurance policy which covered them for their medical bills resulting from the heart attack that was effective during the period in 4 which Mr. Piper incurred his medical expenses resulting from his heart attack. 'file Defendants have sued the Insurance Company for. among other things, the bad faith denial of coverage and breach of contract, in United States District Court for the Middle District of Pennsylvania. A true and correct copy of that complaint, without the attachments against. is attached hereto as Exhibit A. 4. Discovery is presently proceeding in this case and the matter is scheduled for trial on January 8. 2001. 5. An agreement had been reached between counsel for Cardiovascular Surgical Institute and counsel for the Pipers to delay the time for filing an answer in hopes that the matter against the Insurance Company would result in a prompt settlement. 6. Cardiovascular Surgical Institute is no longer willing to wait for an answer and thus the Pipers responded to the complaint by admitting all material facts but presenting as New Matter its intention to bring a third party action against the Insurance Company in this action. More than sixty (60) days has transpired since the serving of the Complaint and. therefore, the Pipers needs leave of Court, pursuant to Pennsylvania Rule of Civil Procedure 2253. to join ANLIC as an additional defendant. 8. The plaintiff is not opposed to this motion. WHEREFORE it is respectfully requested that this Court grant the defendants leave to join the American National Life Insurance Company of Texas as a third party defendant. Respectfully submitted, SHAGIN & ANSTINE LLC ?z Craig . Shagin, Esquire PA Id # 32956 Dory L. Sater. Esquire PA Id# 83783 100 Pine Street. Suite 510 Harrisburg, PA 17101 Attorneys for Defendants om i ?rnnm EXHIBIT A IN THE UNTIED STATES DISTRICT COURT MIDDLE DISTRICT OF PENNSYLVANIA :CV `. DONALD E. PIPER, Sr. and DIANA L. PIFER, plaintiffs Civil Action trn ?' "^UNG, FA vs. No. I)F1: 21 1999 AMERICAN NATIONAL LIFE MARY F. n'nr4on>=A, 0 INSURANCE COMPANY OF TEXAS r'er a Texas Corporadon Oaputy clerk TRIAL BY JURY DEMANDED Defendant COMPLAINT AND NOW COMES Plaintiffs DONALD E. PIPER and DIANA L. PIPER, by and through their undersigned counsel, SHAGIN & ANSTINE LLC and respectfully aver the following: 1. The Court has original jurisdiction pursuant to 28 U.S.C § 1331 Federal Question 1 Jurisdiction. This action arises in part under 18 U.S.C §1961 et seq. The Racketeering Influenced and Corrupt Organizations (RICO) Act. 2. Jurisdiction in this matter is also proper pursuant to 28 U.S.C. § 1332 Diversity of Citizenship Jurisdiction. The matter is between citizens of different states and the amount in controversy .exceeds the minimum requirement of $75,000. Complete diversity of citizenship exists between plaintiffs and defendant. Plaintiffs are adult individuals residing in and citizens of Pennsylvania and Defendant is a citizen of Texas with its principal place of business at One Galveston Plaza Galveston, Texas. 3. The Court may also exercise "pendant jurisdiction" over all claims stated here under state law. PARTIES 4. Plaintiffs, DONALD E. PIPER and DIANA L. PIPER (Mr. and Mrs. Piper or the Pipers), are adult individuals and citizens of the Commonwealth of Pennsylvania, residing at 210 Mill Street, Mt. Holly Springs, Cumberland County, Pennsylvania, 17065. 5. Defendant, AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXAS (the Insurance Company) is an insurance company and citizen of Texas, with its principal place of business located at One Moody Plaza, Galveston, Texas 77550. 6. AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXAS is a wholly owned subsidiary of the AMERICAN NATIONAL INSURANCE COMPANY, with its principal place of businesslocated at One Moody Plaza, Galveston, Texas 77550. FACTS - 7. Mr. and Mrs. Piper were enrolled in a Blue Cross/Blue Shield Group Health Plan that 2 was fully paid until November 1, 1998. The Certificate of Coverage is attached as "Exhibit A." 8. On or about November 19, 1998 the Insurance Company, through its authorized agent, Mr. Dennis Shillen (the Insurance Agent), persuaded Mr. and Mrs. Piper to join the National Business Association, an incorporated trust of Mississippi, and to enroll in the Insurance Company's group health insurance provided to members of that association and their dependents. 9. The Insurance Company represented to Mr. and Mrs. Piper that they would be covered on or before December 28, 1998 and neglected to inform the Pipers that they were, as a matter of Pennsylvania Law, required to be covered as of November 19, 1998, the enrollment date. 10. Mr. Piper answered the questions put to him by the Insurance Agent who filled the application and had Mr. and Mrs. Piper sign the enrollment application at the completion of the interview. The application is attached as "Exhibit B." 11. The Insurance Company's agent then mailed this enrollment application through the United States mail to the Insurance Company's home office for processing. 12. During the twelve months preceding his enrollment Mr. Piper was treated for hypertension and was insured pursuant to a group health policy by Blue Cross/Blue Shield. 13. Mr. and Mrs. Piper made a full and accurate disclosure of his medical history including that Steven L. Hatleburg M.D. had treated him from March 1991 through November 1998 for hypertension. 14. The Insurance Agent advised W. Piper that because of his history of hypertension the Insurance Company would need to examine the medical records to determine if he would have to pay a higher premium 15. Blue Cross/Blue Shield is a "creditable" group health plan, as defined by the Pennsylvania Health Insurance Portability Act. 16. M. and Mrs. Piper were not first time enrollees in a group health insurance plan. 17. Mr. and Mrs. Piper had not allowed 63 days to lapse between November 1, 1998 the date his previous coverage under Blue Cross/Blue Shield terminated and November 19, 1998 the date of his Enrollment with the Insurance Company. 18. The aggregate of Mr. and Mrs. Piper's periods of creditable coverage well exceeded twelve months. 19. The lnsurance Company did not credit Mr. and Mrs. Piper's "creditable" coverage with Blue CrossBlue Shield to reduce any preexisting exclusion period. 20. Mr. and Mrs. Piper paid an initial premium of $448.00 ($100 of which was to join the National Business Association and $30 for the transfer of the medical records) representing the amount they would have to pay if the Insurance Company determined Mr. Piper was in a higher risk class because of his history of hypertension. 21. Mr. Piper and Mrs. Piper made repeated calls to the agent and the Insurance Company's customer service representatives starting in December 1998 and dontinuing through January 14, 1999 to determine if they were, in fact, covered and if not, the reason therefor. 22. On December 14, 1998, the Insurance Company sent Mr. and Mrs. Piper a letter through the United States Mail, stating, "Your application for health insurance has been received. In order to clarity the health history indicated on the application and determine your insurability. we have requested your medical records from: DR STEVEN LHATLEBERG. Although we anticipate a prompt response to our request you may want to contact the doctor's office to be certain the records have been submitted. Final action cannot be taken until 4 rye... the records are received" (emphasis added). This letter is attached as "Exhibit C." 23. Believing that he was not covered, but soon would be, Mr. Piper postponed visiting his doctor in December of 1998 when he experienced symptoms of weakness, tiredness, and "heartburn" 24. The Insurance Company and the Insurance Agent advised Mr. and Mrs. Piper that the reason for the delay in coverage was because of the neglect of his own doctor to forward the required medical records. 25. In fact, the Insurance Company failed to pay the required $30.00 charge to Dr. Hatleberg's office for the attending physician statement until sometime after December 23, 1998. 26. Although the costs of the charges for reproducing medical records and the attending physician's statement were included in the initial premium paid by the Pipers, upon discovering that the Insurance Company's failure to pay these costs was delaying his coverage as initially promised, W Piper offered to the Insurance Company to pay directly to Dr. Hatleberg these costs to expeditethe Insurance Company's placement of his and Mrs. Piper's coverage. 27. The Insurance Company told W. Piper in December not to pay these costs directly and assured him that they had already paid these costs when, in fact, it had not. 28. On January 15, 1999, Mr. Piper suffered a heart attack resulting in his receiving emergency medical treatment at the Carlisle Hospital, in Carlisle Pennsylvania. 29. On January 19, 1999, the Carlisle Hospital transferred W. Piper to Harrisburg Hospital where be subsequently underwent coronary bypass grafting surgery at Harrisburg HospitaL,in Harrisburg, Pennsylvania. 30. On January 31, 1999' Harrisburg Hospital discharged Mr. Piper. 31. On February 1, 1999, the Insurance Company finally approved Mr. and Mrs. Piper's application and issued, through the United States mail, a "Certificate of Coverage" which had the , COVERAGE IS PROVIDED UNDER THE GROUP POLICY FOR MEDICAL caption ENPENSES DESCRIBED IN THE GROUP POLICY AND THIS CERTIFICATE. A PREFERRED PROVIDER COMPONENT IS INCLUDED WITH THIS.COVERAGE." A true and correct copy of the Certificate of Insurance together with the attached exhibits is attached hereto as "Exhibit D." of coverage did not purport to exclude any coverage for any pre- The Certificate 32. medical condition and included the following statement: "PHIS INSURANCE COVERAGE IS BEING ISSUED IN A SPECIAL PREMIUM CLASS WITH RESPECT TO DONALD E PIPER DONALD PIPER'S PREMIUM HAS BEEN JgCREASED BY 25% DUE TO HYPERTENSION." See attached "Exhibit D." 33. The Insurance Company never sent Donald and Diana L. Piper a copy of the complete insurance policy, but only a Certificate of Coverage which stated, "The Group Policy is available for review during usual business hours at the office of the Group Policyholder." The the Group policyholder certificate of insurance further discloses that is the National Business Association, an incorporated trust, but does not give its address. See attached "Exhibit D." 34. The Pipers have incurred medical bills resulting from the medical care received by the Pipers between January 15, 1999 and January 31, 1999 all of which the Insurance Company has refused to-pay claiming their health insurance coverage began only, on February 1, 1999. 35. Mr. and Mrs. Piper have incurred medical bills for treatment after February 1, 1999, which the Insurance Company has refused to pay because the "condition manifested prior to the effective date." 36. Because of the Insurance Company's refusal to pay the medical bills submitted by W. and Mrs. Piper, the Pipers are unable to pay the very doctors, hospitals, nurses, ambulance services and other medical providers who saved Mr. Piper's life all ofwhich has caused them embarrassment, humiliation and loss of a worthy credit reputation and severe emotional distress. 37. Because of the Insurance Company's refusal to pay the medical bills submitted by Mr. and Mrs. Piper, the Pipers are now threatened with lawsuits, the costs of those lawsuits, interest accruing on the underlying bills and a substantial risk of loss of significant business assets that would prevent Mr. Piper from continuing in his trade. See Attached Complaint as 'Exhibit E." COUNT I - PIPER v. THE INSURANCE COMPANY BAD FAITH VIOLATION UNDER 42 P.S. & 8731 OF 40 P S § 1302 et seg THE PENNSYLVANIA HEALTH CARE INSURANCE PORTABILITY ACT - - 38. The averments of paragraphs 1 through 37 are incorporated herein by reference as though they were fully set forth at length. 39. The Pennsylvania Health Care Insurance Portability Act 40 P.S. §1302.1 et seq. adopting the United States Health Insurance Portability and Accountability Act, 29 U.S.C §§ 1181 and 1182 is applicable to the transaction between the Pipers and the Insurance Company. 40.1& and Mrs. Piper are members of the class of people the Pennsylvania Health Care Insurance Portability Act is intended to protect. 41. The Pennsylvania Health Care Insurance Portability Act adopting §1181 of the Federal act provides that no health insurer may impose a waiting period or preexisting condition exclusion except on an individual who is a first time enrollee or failed to obtain new group health insurance before the expiration of 63 days since the prior health insurance terminated.' 42. The Pennsylvania Health Care Insurance Portability Act, adopting § 1181 of the Federal Act, alsoprovides that the period of a preexisting exclusion is limited to twelve months and is reduced by the aggregate of the periods of creditable coverage as of the enrollment date. 43. The Pennsylvania Health Care Insurance Portability Act, adopting section 1182 of the Federal Act, provides that a health insurer providing group health insurance may not establish rules for eligibility of any individual to enroll under the terms of the plan based on health status, medical condition, or medical history. 44. The Insurance Company violated the Pennsylvania Health Care Insurance Portability Act by deliberately and willfully creating a "waiting period" from November 19, 1998 to February 1, 1999 for Mr. Piper based upon his prior treatments for hypertension and by delaying the effective date of coverage until after Mr. Piper's heart attack and bypass surgery ho spitalization. 45. The Insurance Company violated the Pennsylvania Health Care Insurance Portability -Act, by deliberately and willfully imposing a preexisting exclusion period in excess of twelve months on insurance coverage for Mr. and Mrs. Piper by not crediting his previous "creditable" health insurance to reduce that twelve month exclusion period based upon his prior treatments for hypertension. 46. The Insurance Company violated the Pennsylvania Health Care insurance portability Act by establishing rules for eligibility for individuals to enroll under the terms of the plan based on health status, medical condition, or medical history. 47. The Insurance company knew or should have known that the Pennsylvania Health Care Insurance Portability and Accountability Act regulated Group Health Insurance in Pennsylvania. 48. The Insurance Company's several violations of the Pennsylvania Health Care Insurance Portability and Accountability Act constitute wilful bad faith. 49. The Insurance Company's statements concerning the effective date of coverage are misrepresentations made for the purpose of deceiving the Pipers into thinking that that' would not be covered until later "approved" by the insurance company, but such approval would be prompt so as to induce tie Pipers to allow their insurance policy with glue Cross/Blue Shield to lapse. 50. The Insurance Company made statements to the Pipers that misrepresented the benefits, conditions, and terms of their group health insurance policy. 51. The Pennsylvania Unfair Insurance Practices Act 40 P.S. § 1171.1 et seq, declares unlawful any unfair or deceptive acts in the business of insurance. 52. The Unfair Insurance Practices Act does not provide a private cause of action, but any violations of the Act may support a bad faith claim. 53. The Insurance Company knew that Donald Piper was treated for hypertension for seven years prior to his enrolling for the Insurance Company's Group Health Insurance Plan. .54. The Insurance Company knew or should have known that Donald and Diana L. Piper were insured under a "creditable" group health insurance policy for at least twelve (12) months preceding November 1, 1998. 55. The Insurance Company knew that less than sixty-three (63) days elapsed between the day coverage under the Blue Cross/Blue Shield Group Health Insurance Policy terminated until the day Donald and Diana L. Piper enrolled in the Insurance Company's Group Health Plan. 56. The Insurance Company knew or should have known that it had no legal basis to deny group insurance coverage to Donald and Diana L. Piper after the Insurance Company received its initial payment.- 57. The Insurance Company knew or should have known that it had no legal basis to deny group health insurance coverage to Donald and Diana L. Piper based on Donald Piper's pre- existing health condition. 58. The Insurance Company has refused to pay medical claims incurred after February 1, 1999 on the grounds that the claims arose from a preexisting condition. 59. The Insurance Company knew or should have known that denying medical claims for Donald Piper based on his preexisting medical condition for which he was paying an additional prennum above its regular rates was in violation of the contractual terms as evidenced by its own group health insurance policy certificate. 60. The Insurance Company knew or should have known that denying medical claims on or after February 1, 1999 for Donald Piper based on his preexisting medical condition for which he was previously insured under a creditable group health insurance policy for at least twelve (12) months preceding November 1, 1998 was in violation of State Law. 61. The Insurance Company's refusal to insure Donald and Diana L. Piper pending review of medical records constituted a waiting period which could not form the basis of a denial 10 B_.-____ I i of coverage was a breach of its fiduciary duty to insure and constitutes wilful bad faith conduct by the Insurance Company. 62. The Insurance Company's knowing refusal to insure Mr. Piper for his heart attack and subsequent medical care from November 19, 1998 until January 31, 1999 constituted an imposition of a waiting period in violation of State law and constitutes wilful bad faith conduct by the Insurance Company. - .. .__...__?_,_... 63. The Insurance Company's refusal to insure W. Piper for his heart attack and subsequent medical care from February 1, 1999 until he terminated his relationship with the Insurance Company constituted an imposition of a pre-existing exclusion period in excess of the twelve months prescribed by law and constitutes wilful bad faith conduct. 64. The Bad Faith Statute, 42 Pa. C.S.A § 8371, provides that in an action arising under :an insurance policy, if the insurer has acted in bad faith the court may award interest in the amount of the prime rate of interest plus 3%, punitive damages, and court costs and attorneys fees. 65. The Insurance Company's bad faith violations of the Pennsylvania Health Care Insurance Portability Act and the Bad Faith Statute entitle the Pipers to receive all the statutory remedies under the Bad Faith Statute. WHEREFORE, Plaintiffs Donald E. Piper and Diana L. Piper demand judgment against Defendant The American National Life Insurance Company of Texas and pray this Honorable Court provide relief and damages as follows: a. That ibis Court award Donald E. Piper and Diana L. Piper compensatory and consequential damages which resulted and continue to result from the Insurance Company's bad it faith violation of the Commonwealth of Pennsylvania Health Care Insurance Portability Act including, but not limited to, all medical expenses, less the applicable deductibles, that Donald and Diana L. Piper incurred on or after November 19, 1998, including all those expenses related to the treatment of Donald Piper following his heart attack on January 15, 1999, including, but not limited to, transport, surgery, subsequent hospitalization, physical therapy and medications; and b. Interest in the amount of the prime rate plus 3%; an c. Costs of litigation, including reasonable attorney's fees, in seeking to have the Insurance Company. pay under its contract of insurance, d. The interest, penalties, and any cost charged, including reasonable attorneys' fees, charged by the medical providers for late payment for their services; d. Punitive damages in excess of $1,000,000.00; and e. Such other and further relief as this Court deems appropriate COUNT II PIPER v. THE INSURANCE COMPANY FRAUD AND DECEIT 66. The averments of paragraphs 38 through 65 are incorporated herein by reference as though they were fully set forth at length- 67. The hnsurance Agent, by and through and on behalf of the Insurance Company convinced the Pipers that, if they switched to their insurance company, they would be covered sometime between mid-December 1998 and December 28, 1998. I 12 68. The Insurance Company expected or should have.reasonably expected Mr. and Mrs. Piper to rely on the representations regarding the effective date of coverage. 69. The Insurance Company knowingly represented that coverage would start no later than the end of December 1998, to Mr. and Mrs. Piper, as an inducement to gain their business. 70 The Insurance Company later advised that coverage would begin promptly even when it knew or should have known that it bad not yet paid a fee for the transfer of medical -- records that if claimed were requured to determine insurability. 71. The Insurance Company intended to induce the Pipers not to pay directly to Dr. Hatelburg another $30 for the record transfer in reliance on their representation that they had already paid the fee when, in fact, they had not. 72. Mr. and Mrs. Piper believed in and reasonably relied upon the insurance Company's promise for the date of coverage and in accordance with such reliance, permitted his existing coverage to lapse. 73. Abseat the representations of the Insurance Company, Mr. and Mrs. Piper would have reinstated coverage through Blue Cross/Blue Shield. 74. Mr. and Mrs. Piper have suffered damages as a result of the insurance Company's actions including but not limited to Mr. Piper's heart attack and the medical expenses incurred from his heart attack. WHEREFORE, Plaintiffs Donald E. Piper and Diana L. Piper demand judgment against Defendant The American National Life Insurance Company of Texas and prays this Honorable Court as follows: a. That this Court award Donald E. Piper and Diana L. Piper compensatory and 13 consequential damages which resulted and continue to result from the Insurance Company's bad faith denial of claims including, but not limited to, all medical expenses, less the applicable deductibles, that Donald and Diana L. Piper incurred on or after November 30, 1998, including all those expenses related to the treatment of Donald Piper following his heart attack on January 15, 1999, including, but not limited to, transport, surgery, subsequent hospitalization, physical therapy and medications; and b. Interest; and - c. Costs of litigation, including reasonable attorney's fees, in seeking to have the Insurance Company pay under its contract of insurance, d. The interest, penalties, and any cost charged, including reasonable attorneys' fees, charged by the medical providers for late payment for their services; d. Punitive damages in excess of $1,000,000; and e. Such other aad further relief as this Court deems appropriate. COUNT III - PIPER v. THE INSURANCE COMPANY VIOLATION OF THE RACKETEER INFLUENCED AND CORRUPT ORGANIZATIONS (RICO) ACT 18 U S C SECTION 1962 (a) 75. The averments of paragraphs 66 through 74 are incorporated herein by reference as though they were fully set forth at length. Predicate Acts Interference with Commerce 76. The Insurance Company is in the business of selling and providing group health insurance throughout the United States in the stream of interstate commerce. 77. The Insurance Company imposes preexisting condition exclusions in excess of twelve months or denies health coverage to applicants for its group health insurance in violation of The Pennsylvania Health Care Insurance Portability Act. 78. The violations of the Pennsylvania Health Care Insurance Portability Act among the many states where the hrsuiance Company does business interferes with commerce and violates 18 U.S.C. Section 1951. 79. The violations of the Health Care Insurance Portability Act and the interference with commerce amount to "racketeering activity" as defined by 18 U.S.C. Section 1961. Mail Fraud 80. The Insurance Company conducts a substantial portion of their business through mailed correspondence. 81. The Insurance Company sent letters regarding their application and policy to Mr. Piper and Mrs. Piper through the United States Postal Service. r_ 82. The letters contained information and statements that were designed to lead the Pipers to believe that coverage under the plan was conditional upon a review of medical records. 83. Coverage was in fact not conditional upon review of Mr. Piper's medical records and was required by the Pennsylvania Health Care Insurance Portability Act. 84. The Insurance Company accepted the Pipers money and continued through a series of letters and correspondence through the mail to create the appearance of conditional coverage. 85. This activity amounts to a fraud perpetrated on the Pipers through the United States 15 i postal service. 86. Using the mail to perpetrate a fraud on an individual is a violation of 18 U.S.C. Section 1341 the Mail Fraud Act. Pattern of Racketeering Activity 87. Upon information and belief this racketeering activity is and has been conducted by the Insurance Company on a continuous basis. 88. The enrollment form Slled out by the Pipers was a standard pre-printed form, suggesting that it had been used by other people. 89. The Pipers disclosed that they were previously covered by a group health plan on questions 11 (a) and (b) on the form. 90. On December 14, 1998 the Pipers received a form letter suggesting that their insurability was in doubt because of Mr. Piper's pre-existing medical condition. 91. There exists a substantial likelihood that the racketeering activity will continue indefinitely into the future as even after a demand for payment by Plaintiff's previous counsel Costopoulos, Foster, & Fields, the Insurance Company refused to cover the insured, thus demonstrating its refusal to abide by the law. 92. There exists a substantial likelihood that the racketeering activity will continue indefinitely into the future as even after the effective date of coverage, the Insurance Company refused to cover the insured thus demonstrating its refusal to abide by the law. 93. The racketeering activity is part of a series of predicated acts engaged in as a,part of a regular way of doing business. 94. On information and belief the Insurance Company has engaged in such racketeering 16 activities in the past and continue presently to engage in these activities involving similarly situated individuals. 95. The 'racketeering activity" of interfering with commerce and mail fraud illustrates a "pattem of racketeering activity" as envisioned by the RICO Act that the Insurance Company was aware of over'an extended period of time, involving many similarly situated individuals and similar fact situations. '?' 96. The patt em of racket'erinp activity is engaged in for the purpose of gaining premium payments from individuals without having to pay benefits. 97. Multiplied by the number of individuals this racketeering activity has affected the Insurance Company have gained a significant monetary benefit through this "pattern of racketeering activity." 98. The money collected through the "pattern of racketeering activity" is used by the Insurance Company in the operation'ofits enterprise. Init rv from the Predicate Acts 99. The Insurance Company's interference with commerce created an injury to Mr. and Mrs. Piper by not providing them insurance benefits as required by law. 100. The Insurance Company's fraud through the mail injured the Pipers by taking their money in satisfaction of the insurance premium and not providing coverage for three months. 101. The Insurance Company has through the mail injured the Pipers by deceiving them into believing that they had no rights to coverage when, in fact, by law the Insurance Company was required to cover them. 102. The predicate ads of mail fraud and interference with commerce created a real and 17 substantial injury to Mr. and Mrs. Piper. Iniury from the Racketeering Activity 103. On information and belief the Insurance Company engaged in a "pattern of racketeering activity" to obtain premium payments from the Pipers and other individuals similarly situated and deny them coverage. 104. These premium payments were used by the Insurance Company in the operation of ?the enterprise ofgroup healfhinsurance'? 105. The use of these fiords allowed the Insurance Company to continue to engage in the "pattem of racketeering activity" and accept Mr. and Mrs. Piper's premium payment while not providing them coverage under the group health plan as required by law. 106. In late 199g and early 1999, as a result of the racketeering activity, Mr. and Mrs. Piper's group health coverage was delayed in violation of the Pennsylvania Health Care Insurance Portability Act. 107. As a result of the "racketeering activity," the Insurance Company's taking Mr. and Mrs. Piper's money and not providing them coverage, Mr. Piper neglected his medical care and experienced added stress all of which contributed to his suffering a heart attack in January. 1999. 108. Mr. and Mrs. Piper suffered an injury from the use of the money obtained through the racketeering activity in f rtherance of the insurance business. 109. The Insurance Company violated the Racketeering Influenced and Corrupt Organizations Act by obtaining premium payments from applicants for group health insurance through a pattem or racketeering activity,and using such premium payments in the operati on of their insurance company. is WHEREFORE, Plaintiff Donald E. Piper demands judgment against Defendant The Insurance Company, and prays this Honorable Court as follows: A. That this Court award Donald E. Piper and Diana L. Piper compensatory and -. --- - - - .......... consequential damages for damages which flowed from the Insurance Company's bad faith violation of the State Health Insurance and Portability Act and the Racketeering and Corrupt Organizations Act (RICO) including, but not limited to, all medical expenses related to Donald N `0`?---Piper'i heart attack on January 15-,10991 including, but not limited to, transport, surgery, subsequent hospitalization, physical therapy and medications; and b. Interest; and c. Costs of litigation, including reasonable attorney's fees; and d. Punitive damages in excess of $1,000,000.00; and. e. Such other and further relief as this Court deems appropriate; and f. Treble Damages. COUNT IV PIPER v. THE INSURANCE COMPANY BREACH OF CONTRACT 110. The averments of paragraphs 75 through 109 are incorporated herein by reference as though they were frilly set forth at length. 111. 'h& and Mrs. Piper relied on the representations, written and oral, of the Insurance Company and its agent at the time of their application as to the effective date of coverage. 112. Absent such representat ions, The Pipers would not have become the Insurance 19 Company's customers and would not have paid any premium to the Insurance Company. 113. Because of the representations, Mr. and Mrs. Piper reasonably expected that coverage would start in mid-to4ate December of 1998. 114. Mr. and Mrs. Piper had no expectation that they would be without coverage for more than two months after they paid a premium that included the increase for his risk category. 115. The existence of the Insurance Company' s promise of the date of coverage is in-^dioaby the agent wn`tteistatemenf in the Special Instructions box on the face of the application form. 116. The Insurance Company should have reasonably expected Mr. and Mrs. Piper to rely on thew promise because a longer wait for coverage was a significant disincentive to switching to their group health plan. 117. A valid contract for health insurance was formed by the Pipers and the Insurance Company upon Mr. and Mrs. Piper's signing the enrollment application. 118. Mr. and Mrs. Piper acted in accordance with tlieir reasonable expectations and switched insurance companies, paying an increased premium to the Insurance Company. 119. Mr. and Mrs. Piper detrimentally relied upon the Insurance Company's promise for the date of coverage by permitting their existing health insurance coverage to lapse and delaying his doctor visits and medical treatments for his hypertension 120. The Insurance Company acted in bad faith and breached the contract by not complying with State law by delaying coverage from November 19, 1998 (the date the Pipers signed the enrollment application) until February 1, 1999 when the Insurance Company finally issued the certificate of coverage. 20 I 121. The Insurance Company acted in bad faith and breached the contract after February 1, 1999 when it refused benefits to the Pipers based upon a pre-existing condition exclusion that they knew or should have known was not legally justified under State law. 122. The Insurance Company acted in bad faith and breached the contract when it established rules for eligibility based on the Mr. Piper's health status, medical condition, and medical history in violation of State law. -? 123 `Thel'ipers EiV0 sl ffered damages as 'a result of the Imrance Company's actions including, but not limited to, his heart attack and medical expenses for the treatment of his heart attack and the ongoing physical and emotional effects of his heart attack. 124. The Insurance Company has had the benefit of Mr. and Mrs. Piper's premium payment since November, 1998 without paying any amount towards the claim for W. Piper's heart attack in January 1999. 125. The Insurance Company receives .a pecuniary benefit when it receives a premium but subsequently does not pay benefits. 126. Multiplied throughout the class of persons similarly situated, delays, in approval of applicants with pre-existing conditions, produce huge and significant pecuniary benefit to the insurance Company. 127. on information and belief, the insurance Company was, and is, aware of these pecuniary benefits. 128. The Insurance Company deliberately, willfully, and intentionally sought to avail itself of the pecuniary benefits associated with delayed approval. 129. The Insurance Company did actually receive pecuniary benefit from the delay in the ' 21 .11 approval of Mr. and Mrs. Piper's coverage and refusing to cover his heart attack related expenses. 130. The Insurance Company has been and continues to be unjustly enriched at Mr. and Mrs. Piper's expense through the receipt and control of monies paid as a premium for insurance coverage but for which no service has been rendered. 131. Mr. and Mrs. Piper have suffered damages as a result of the Insurance Company's actrons mcluding, but not limited to Mr. Piper's heart attack and the medical expenses incurred from his heart attack. WHEREFORE, Plaintiffs Donald E. Piper and Diana L. Piper demand judgment against the Insurance Company, and prays this Honorable court as follows: a. That this court equitably enforce the Pipers contract of insurance and award Donald E. Piper and Diana L. Piper compensatory damages which flowed from his reasonable expectations, including, but not limited to, all medical expenses related to Donald Piper's heart attack and bypass surgery on January 15, 1999, including, but not limited to, transport, surgery, subsequent hospitalization, physical therapy and medications; and b. Interest; and c. Costs of litigation, including reasonable attorney's fees; and d. Such other and further relief as this Court deems appropriate, r.. COUNT V THE PIPERS VS THE YNSURAN E ONZANY NEGLIGENCE 132. The averments of paragraphs 110 through 131 are incorporated herein by reference as though they were fully set forth at length. 133. Alternatively the Pipers believe and therefore aver that the Insurance Company owed a duty to the Pipers to exercise due-diligence in the processing of their insurance application. 134. The Pennsylvania Health Care Insurance Portability Act imposes a duty on the Insurance Company to expedite the enrollment and application process for individuals who are switching their group health plan. 135. The Insurance Company violated the Pennsylvania Health Care Insurance Portability Act by failing to expedite the enrollment and application process when it recklessly delayed The Piper's enrollment application from November 19, 1998 until February 1, 1999. 136. The Insurance Company breached its duty by failing to properly handle the application by delaying over two months the payment of $30.00 to Dr. Hatelburg for the transfer of medical records. 137, The Insurance Company also breached their duty by failing to complete the application process in a timely manner. 138. The breach substantially contributed and was the proximate cause of I%&. Piper suffering a heart attack in January of 1999. 139. The breach of the Insurance Company caused Nk. Piper to delay obtaining medical treatments in anticipation of group health coverage by the Insurance Company when he began 23 feeling symptoms of fatigue, weakness, and "heartbum." 14o. The delay in obtaining medical treatment resulted in a failure of Mr. Piper or any of Mr. Piper's doctors to detect that Mr. Piper was displaying early symptoms of a heart attack. 141. But for the breach of the Insurance Company Mr. Piper would have received medical treatment for his symptoms and his heart condition would have been diagnosed. 142. The Pipers suffered damages as a result of the breach including but not limited to the heart attack, costs arising out of the heart attack including but not limited to the medical expenses, mental anguish and pain and suffering and the ongoing physical and emotional effects of his heart attack WHEREFORE, Plaintiffs Donald E. Piper and Diana L. Piper demand judgment against the insurance Company, and prays this Honorable Court as follows: a. That this Court award Donald E. Piper and Diana L. Piper compensatory damages which flowed from the Insurance Company's negligence including, but not limited to, all medical expenses related to Donald Piper's heart attack on January 15, 1999, including, but not limited to, transport, surgery, subsequent hospitalization, physical therapy and medications; and b. Interest; and C, Costs of litigation, including reasonable attorney's fees; and d. Compensation for pas and future mental anguish, pain and suffering. E Such other and further relief as this Court deems appropriate. 24 COUNT VI - PIEPER v THE INS rm a rv E COMPANY INTENTIONAL R LICTION OF EMOTIONAL DISTRESS 143. The averments of paragraphs 132 through 142 are incorporated herein by reference as though they were fully set forth at length 144. The Insurance Company was aware that Mr. Piper was being treated for ._..,._ , hypertension because NFPiper disclosed this fact on his enrollment application. 145. Hypertension is a condition that requires continuous monitoring and frequent medical treatment such as doctor visits, which are normally covered by group health insurance. 146. The Insurance Company knowingly, willfully, and intentionally delayed approving Mr. and Mrs. Piper's group health insurance, by the use of an unlawful administrative procedure. 147. The Insurance Company's actions of delaying coverage under the group health insurance caused Mr. Piper to delay seeking medical treatments when he began feeling symptoms of fatigue, weakness, and "heartburn." 148. The Insurance Company's conduct of illegally delaying group health insurance coverage while knowing that Mr. Piper was in a delicate condition having been treated for hypertension was extreme and outrageous. 149. The rising amciety Mr. Piper experienced throughout late December and early January as a result of the Insurance Company's extreme and outrageous conduct contributed to W. Piper having a heart attack on January 15, 1999. 150. Mr. Piper has suffered and will continue to suffer damages as a result of the Insurance Company's extreme and outrageous conduct including, but not limited to his heart 1. rt 25 attack and the medical expenses resulting from his heart attack and ongoing physical and emotional effects of his heart attack. WHEREFORE, Plaintiff Donald E. Piper and Diana L. Piper demand judgment against Defendant the Insurance Company, and prays this Honorable Court as follows: a. That this Court award Donald E. Piper and Diana L. Piper compensatory which flowed from the Intentional Infliction of Emotional Distress including, but not limited to, past and future para`and ;offering and all medical ;;penises related to Donald Piper's heart attack on January 15, '. 1999, including, but not limited to, transport, surgery, subsequent hospitalization, physical therapy and medications; and b. Interest; and c. Costs of litigation, including reasonable attorney's fees; and d. Punitive damages in excess of $1,000,000.00; and e. Such other and further relief as this Court deems appropriate. COUNT VII - PIPER v. THE INSURANCE COMPANY NEGLIGENT INFLICTION OF EMOTIONAL DISTRESS 151. The averments of paragraphs 143 through 150 are incorporated herein by reference as though they were fully set forth at length. 152. The Insurance Company owed a duty to the Pipers to exercise due diligence in the. . processing of their insurance application. 153. The Insurance Company breached its duty to use due diligence in processing Mr. Pipers application, in that the Insurance Company allowed the request for records to proceed at i 26 exceptionally slow pace, allowed administrative procedures and error to further delay the process, and did so while holding a first month premium that had the rate increase already included for someone with a history of hypertension. 154. The Insurance Company failed to exercise due diligence and instead demonstrated callous indifference to Mr. Piper's plight. 155. W. Piper has suffered and will continue to suffer severe physical manifestations of -`" the emotional distress as a result of the Insurance Company's negligence. 156. The rising anxiety b& Piper experienced throughout late December and early January as a result of the insurance Company's negligence contributed to W. Piper having a heart attack on January 15, 1999. 157. The Insurance Company's negligence was the proximate and direct cause of anxiety that W. Piper experienced in January 1999 and contributed to Mr. Piper's heart attack. 158. Mr. Piper has suffered damages as a result of the Insurance Company's actions including, but not limited to, the medical expenses for and subsequent to his heart attack of January 15, 1999. WHEREFORE, Plaintiff Donald E. Piper and Diana L. Piper demand judgment against the defendant Insurance Company, and prays this Honorable Court as follows: a. That this Court award Donald E. Piper Diana L. Piper compensatory and consequential damages for damages which flowed from the Insurance Company's negligence including, but not limited to, past and future pain and suffering and all medical expenses related to Donald Piper's heart attack on January 15, 1999, including, but not'limited to, transport surgery, subsequent hospitalization, physical therapy and medications; and 27 b. Interest; and c. Costs of litigation, including reasonable attorney's fees; and d. Punitive damages in excess of $1,000,000.00; and e. Such other and further relief as this Court deems appropriate COUNT VIII - THE PIPERS V. THE INSURANCE COMPANY VIOLATION OF THE PENNSYLVANIA UNFAII2 TRADE PRACTICES ACT 73 PA & 201-2 ET SEO. 159. The averments of paragraphs 151 through 158 are incorporated herein by reference as though they were fully set forth at length. 160. The Pipers purchased the group health insurance policy and the services related to the group health policy primarily for personal and family use. 161. The Insurance Company engaged in conduct that led the Pipers to believe that their insurance coverage was conditioned on a determination of Mr. Piper's insurability because of his history of hypertension. 162. When the Insurance Company finally did issue the policy, a "Certificate of Coverage" was sent to the Pipers which did not by its own terms exclude coverage based on Mr. Piper's pre-existing condition of hypertension. 163. The Certificate of Insurance states that the coverage was issued at a "special premium class" based on Mr. Piper's history of hypertension thereby creating an understanding on the part of Mr. Piper that he would be covered for his hypertension. 28 164. The Insurance Company never provided a copy of the actual insurance policy to the Pipers. 165. The Insurance Company never intended to cover the Pipers for any of the health care costs that manifested from Mr. Piper's hypertension. 166. The Insurance Company purported to sell group health insurance policies that were in conformity with the laws of the Commonwealth of Pennsylvania where it was engaged in the business of selling group health insurance policies. 167. The Insurance Company did not sell group health insurance policies that were in conformity with the laws of the Commonwealth of Pennsylvania. 168. The selling of group health insurance policies that were not in conformity with the law constitutes fraudulent unfair, and deceptive conduct. 169. The unfair and deceptive conduct confused and mislead the Pipers into believing that they were purchasing a group health policy that was in conformity with the laws of Pennsylvania. 170. The delaying of insurance coverage in violation of the Pennsylvania Health Care Insurance Portability Act, issuing of the Certificate of Coverage that failed to exclude Mr. Piper's coverage for his Hypertension while charging him an additional premium for such coverage constitute fraudulent, unfair, and deceptive conduct. 171. This fraudulent and deceptive conduct confused and mislead the Pipers because the Pipers believed that W. Piper insured for medical conditions resulting from his hyperteasion based upon the terms of the Certificate of Coverage. •172. The Pennsylvania Unfair Trade Practices Act 73 P.S. 201-2 et seq. is applicable to the transaction between the Pipers and the Insurance Company. 29 173. ThePipers are members of the class of individuals intended to be protected by the Pennsylvania Unfair Trade Practices Act. 174. The Pennsylvania Unfair Trade Practices Act declares unlawful any unfair or deceptive acts orconduct in the conduct of any trade or commerce that create a likelihood of confusion or misunderstanding when individuals purchase services or goods primarily for personal family or household purposes. 175. The Insurance Company's fraudulent conduct of delaying insurance coverage, issuing an deceptive Certificate, and failing to provide a copy of the insurance policy created confusion and misunderstanding on the part of the Pipers. 176. Thefraudulent conduct of the Insurance Company caused damages to the pipers including but notlimited to the his heart attack, any medical costs that arose from his heart attack; and loss of premiums paid to the Insurance Company plus interest. R'HEREEORE, Plaintiff Donald E. Piper and Diana L. Piper demand judgment against the defendant Insurance Company, and prays this Honorable Court as follows: a. That this Court award Donald E. Piper Diana L. Piper damages which flowed from the Insurance Company's fraudulent, unfair, and deceptive conduct including, but not limited to all medical expenses related to Donald Piper's heart attack on January 15, 1999, including, but not limited to, transport, surgery, subsequent hospitalization, physical therapy and medications; and b. Interest; and c. Costs of litigation, including reasonable attorney's fees; and d: Punitive damages in excess of $1,000,000.00; and e. Such other and further relief as this Court deems appropriate i 30 £ TrebleDanwes as allowed by the Unfair Trade Practices Act. Dory L. Sater, Esquire PA S.Ct. Id #83783 Shagin & Anstine LLC 100 Pine Street, Suite 510 Harrisburg, PA 17101 (717) 221-1111 Attorneys for Plaintiff of Counsel Fell & Spalding 2230 Land Title Building 100 South Broad Street Philadelphia, PA 19110 DATE: 12,1 z t 9 5 31 Res ecMy submitted, raig Shagin, squire Pa S. . Id #32951 and; P IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY. PENNSYLVANIA CARDIVASCULAR SURGICAL CIVIL ACTION - LAW INSTITUTE, Plaintiff No. 99 - 7120 CIVIL TERM V. TRIAL BY JURY DEMANDED DONALD E. PIPER DIANA PIPER, Defendants CERTIFICATE SERVICE I, Craig Shagin. certify that I am this 24'h day of March 2000, serving the foregoing document upon the persons and in the manner indicated below: Service by first class mail on: Cardiovascular Surgical Institute C/O Richard E. Guida Guida Law Offices 503 North Front Street Harrisburg, PA 17101 0 Craig . Shagin ti ` r( u A 4, CARDIOVASCULAR SURGICAL INSTITUTE, Plaintiff V. DONALD E. PIPER DIANA PIPER, Defendants and Third-Party Plaintiff : V. AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXAS Third-Party Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA : CIVIL ACTION - LAW : No. 99 - 7120 CIVIL TERM TRIAL BY JURY 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 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 arc 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 moncy claimed by 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 Court Administrator Cumberland County Courthouse South Hanover Street, Fourth Floor Carlisle, PA 17013 IL DATE: t-/ - 1!1 - 0 C> Craig R. Shagin, Esquire PA Id. # 32056 100 Pine Street, Suite 510 Harrisburg, PA. 17101 717- 221- 1111 Attorney for Tile Pipers CARDIOVASCULAR SURGICAL : IN THE COURT OF COMMON PLEAS INSTITUTE, : CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff : CIVIL ACTION - LAW No. 99 - 7120 CIVIL TERM V. TRIAL BY JURY DEMANDED DONALD E. PIPER DIANA PIPER, Defendants and Third-Party Plaintiff V. AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXAS Third-Party Defendant THIRD-PARTY COMPLAINT I. Plaintiff, CARDIOVASCULAR SURGICAL INSTITUTE, has filed against defendants, DONALD E. PIPER and DIANA PIPER, a complaint, a copy of which is attached as Exhibit "A". 2. Defendants had a contract of health insurance with the American National Life Insurance Company of Texas. 3. The contract commenced no later than December 28, 1998 and continued throughout the period in which plaintiffs services for defendant Donald Piper were rendered. 4. The contract for health insurance was entered into for the purposes of providing health insurance coverage to the defendants. 5. The American National Life Insurance Company of Texas has wilfully refused to pay on its contract of insurance. -ar_ 6. Any and all sums owed by defendants to plaintiff should paid by the American National Life Insurance Company of Texas. WHEREFORE, the third-party plaintiffs DONALD E. PIPER and DIANA PIPER, demand judgment against third-party defendant, AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXAS for all sums recovered by plaintiff form third-party plaintiff as defendant. Respectfully Submitted., SHAGIN & ANSTINE LLC (? 0 y Craig . Shagin, Esquire PA Id. # 32056 100 Pine Street, Suite 510 DATE: 4 - iW - Oy Harrisburg, PA. 17101 717-221- 1111 Attorney for The Pipers CARDIOVASCULAR SURGICAL INSTITUTE, Plaintiff V. DONALD E. PIPER DIANA PIPER, : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW : No. 99 - 7120 CIVIL TERM TRIAL BY JURY DEMANDED Defendants and Third-Party Plaintiff V. AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXAS Third-Party Defendant CERTIFICATE SERVICE 1, Craig R. Shagin, certify that on t`1 of Apra 12000, I caused a true and correct copy of defendant's THIRD-PARTY COMPLAINT to be served on the persons indicated below: Via Certified Mail Cardiovascular Surgical Institute C/O Richard E. Guida Guida Law Offices 503 North Front Street Harrisburg, PA 17101 and; Via Hand Delivery American National Life Insurance Company of Texas C/O Jonathan Rudd McNees Wallace & Nurick 100 Pine Street Harrisburg, PA 17101 DATED: D t-( - I% I - 0 0 ..._..-•1...., ? - _ _ n; ui i._ i. =. .{ u.'? •' ? r, .._ LI _ .?? ._ ail ? ?-? 'S ?- C1 U i I ?I I ?l 7 I s i t D E N U 7 o yz: Z N o i , m a + .7 , Q U ¢ O 1 m N o O N i w F ¢ i 2 N ? ' 2 ? a i r ,. t t I ? I \ i 1 1 i tr I 1 --i t Iv. i I Y U_ Z m O La w m ?- W m u m a u - (L ?QV) 4 J W X 0 ¢ J 2 3 a a m ? mn m L o - I m a W = W Z U f All v, l C dz F iz - wF-N _ ?.!.- " 7 N F d . b G Q F N C7 .? .•. y, rn Vl d - t?C?m W 'd _ u cn cl: 4!. j i r i i Y U ? Z m 0 W N n N U W V F d 4 N X O 0 -1 J W Z m a m 3 0 . N 0 0. m N Q W = W Z U f 1 1 tl 1 1 • ? j yy ' F p• to u .. z o U - _ t w ? w F 1 5_ Q?? oz 1 f' i 1 '. r 1 r, r y I f ?. I CARDIOVASCULAR SURGICAL INSTITUTE INSTITUTE, Plaintiff V. DONALD E. PIPER DIANA PIPER, Defendants and Third Party Plaintiff V. AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXAS, Third Party Defendant IN THE. COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW No. 99 - 7120 TRIAL BY JURY DEMANDED ORDER AND NOW, this day of , 2000, it is hereby ordered that Third Party Defendant American National Life Insurance Company of Texas, Preliminary Objections to the Third Party Complaint are SUSTAINED, and the Third Party Complaint is dismissed with prejudice. CARDIOVASCULAR SURGICAL INSTITUTE INSTITUTE, Plaintiff V. DONALD E. PIPER DIANA PIPER, Defendants and Third Party Plaintiff V. AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXAS, Third Party Defendant ORDER AND NOW, this day of : IN THE. COURT OF COMMON PLEAS : CUMBERLAND COUNTY, : PENNSYLVANIA CIVIL ACTION - LAW No. 99 - 7120 TRIAL BY JURY DEMANDED , 2000, it is hereby ordered that Third Party Defendant American National Life Insurance Company of Texas' Preliminary Objections to the Third Party Complaint are SUSTAINED, and the Third Party Complaint is dismissed with prejudice. ,1 • CARDIOVASCULAR SURGICAL INSTITUTE INSTITUTE, Plaintiff V. DONALD E. PIPER DIANA PIPER, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA : CIVIL ACTION - LAW No. 99 - 7120 Defendants and Third Party Plaintiff TRIAL BY JURY DEMANDED V. AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXAS, Third Party Defendant AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXAS'S PRELIMINARY OBJECTIONS TO THIRD PARTY COMPLAINT AND NOW comes, Third Party Defendant American National Life Insurance Company of Texas (hereinafter "ANTEX") by and through its attorneys, McNees, Wallace and Nurick, and makes the following preliminary objections to the third party complaint I. PRELIMINARY OBJECTION PURSUANT TO PENNSYLVANIA RULE OF CIVIL PROCEDURE 1028(a) (2) 1. In the Third Party Complaint, Defendants and Third Party Plaintiffs Donald E. Piper and Diana Piper ("Pipers") claim that they had a contract of health insurance with ANTEX which covers the claims asserted by the Plaintiff against the Pipers. The Pipers claim that the contract commenced no later than December 28, 1998 and continued throughout the period in which Plaintiff's services were rendered. 2. The Pipers have failed to attach a copy of the contract which they claim requires ANTEX to provide benefits to the Pipers. 3, ANTEX preliminarily objects to the third party complaint pursuant to Pa.R.Civ.P. 1028(a) (2) for failure of the pleading to conform to law or rule of court by failing to comply with Pa.R.Civ.P. 1019(h), which requires the attachment of any contract which forms the basis of the pleader's cause of action. WHEREFORE, the Pipers' Third Party Complaint should be dismissed for failure to conform to law or rule of court. II. PRELIMINARY OBJECTION BASED ON PA.R.CIV.P. 1028(a) (6) 4. On December 21, 1999 the Pipers filed a lawsuit against ANTEX in the United States District Court for the Middle District of Pennsylvania, No. 99-2190. The complaint filed by the Pipers against ANTEX in the federal court action involves the same issues as the Pipers are raising in their third party complaint. Specifically, the Pipers are seeking health insurance benefits so that they can pay the health care provides who performed services for them, including Plaintiff in this action. 5. ANTEX preliminarily objections to the Third Party Complaint on F77 ZR' •.. .. WHEREFORE, the Pipers' Third Party Complaint should be dismissed based on the pendency of a prior action. Respectfully submitted, McNEES, WALLACE &?NjUR?I?CK/ / Jonathan H. Rudd, Es Attorney I.D. No. 56880 100 Pine Street P.O. Box 1166 Harrisburg, PA 17108-1166 (717) 237-5405 Attorneys for Third-Party Defendant Date: 4.. ~.L -3- CERTIFICATE OF SERVICE pp I, Jonathan H. Rudd, Esquire, hereby certify that on this V l _ day of May, 2000, a true and correct copy of the foregoing document was served by first-class, United States mail, postage prepaid, upon the following: Richard E. Guida, Esq. GUIDA LAW OFFICES 503 North Front Street Harrisburg, PA 17101 BY HAND DELIVERY Craig R. Shagin, Esq. SHAGIN & ANSTINE, LLC 100 Pine Street, Suite 510 P.O. Box 1225 Harrisburg, PA 17108-1225 CARDIOVASCULAR SURGICAL INSTITUTE IN THE COURT OF COMMON PLEAS INSTITUTE, CUMBERLAND COUNTY, Plaintiff PENNSYLVANIA V. DONALD E. PIPER DIANA PIPER, Defendants and Third Party Plaintiff V. AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXAS, Third Party Defendant CIVIL ACTION - LAW No. 99 - 7120 TRIAL BY JURY DEMANDED PRAECIPE FOR ENTRY OF APPEARANCE TO THE PROTHONOTARY: Please enter my appearance on behalf of Third-Party Defendant American National Life Insurance Company of Texas, in the above matter. McNEES, WALLACE & NURICK oJo P athan H. Rudd, Esquire I No. 56880 . 00 Pine Street .O. Box 1166 Harrisburg, PA 17108 (717) 237-5405 Dated: May 1j , 2000 I. . . . , _ CERTIFICATE OF SERVICE I, Jonathan H. Rudd, Esquire, hereby certify that on this l day of May, 2000, a true and correct copy of the foregoing document was served by first-class, United States mail, postage prepaid, upon the following: Richard E. Guida, Esq. GUIDA LAW OFFICES 503 North Front Street Harrisburg, PA 17101 BY HAND DELIVERY Craig R. Shagin, Esq. SHAGIN & ANSTINE, LLC 100 Pine Street, Suite 510 P.O. Box 1225 Harrisburg, PA 17108-1225 H. CARDIOVASCULAR SURGICAL INSTITUTE Plaintiff VS DONALD E. PIPER DIANNA PIPER Defendants IN THE COURT OF COMMONN LEAS IA CUMBERLAND COUNTY, CIVIL ACTION - LAW 99-7120 pRAECIPE FOR SUBSTITUION OF COUNSEL TO THE PROTHONOTARY: Please WITHDRAW the appearance of RICHARD E. GUIDA, Esquire and ENTER the appearance of GAIL GUIDA SOUDERS, Esquire on behalf of CARDIOVASCULAR SURGICAL INSTITUTE, Plaintiff. Respectfully submitted, Richard E. Guide 503 North Front Street Harrisburg, PA 17101 717-236-6440 Attorney ID #62405 Gail Guida Souders 503 North Front Street Harrisburg, PA 17101 717-236-6440 Attorney ID #68740 ?, ?; = < ,