HomeMy WebLinkAbout07-3392IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
GOLDEN VENTURES NATIONAL
SENIOR CARE, LLC d/b/a
d/b/a WEST SHORE HEALTH AND
REHABILITATION CENTER
770 Poplar Church Road
Camp Hill, PA 17011
Plaintiff,
CIVIL DIVISION
NO. CY7 - .3.3Q 2 ~ , ~ L~~
vs.
BETTY JOHNSON
West Shore Health and Rehab Center
770 Poplar Church Road
Camp Hill, PA 17011
Defendant.
PETITION FOR CONFIRMATION
OF ARBITRATION AWARD
PURSUANT TO PA RCP 1328
Filed on behalf of Plaintiff
West Shore Health & Rehab
Counsel of Record for this Party:
NATHAN T. CHASE, ESQUIRE
Pa. I.D. # 200295
DODSON, McCAFFREY & Assoc~~s
Suite 332 Building A
9800 McKnight Road
Pittsburgh, Pa. 15237
(412) 635-9314
Nathan Chase@dodsonmccai~rey.com
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
GOLDEN VENTURES NATIONAL
SENIOR CARE, LLC d/b/a
WEST SHORE HEALTH AND
REHABILIATION CENTER
CIVIL DIVISION
NO.
Plaintiff,
vs.
BETTY JOHNSON
Defendant.
NOTICE TO FILE ANSWER
A party to these proceedings has filed a motion to confirm an arbitration award. If you
oppose the motion, you are required to file an answer to the motion within thirty (30)
days from the date below setting forth your objections to the motion. If you fail to file an
answer, a money judgment based on the arbitration award may be entered against you
without further notice. 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, GO TO OR TELEPHONE THE OFFICE SET FORTH
BELOW THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT
HIRING A LAWYER.
IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE
TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY
OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO
FEE.
Cumberland County Bar Association
32 South Bedford Street
Carlisle, PA, 17103
717-249-3166
Toll Free (in PA) 1-800-990-9108
Date of maili g:
Gs~~,
Nathan T. Chase, Esq.
Attorney for Petitioner
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
GOLDEN VENTURES NATIONAL CIVIL DIVISION
SENIOR CARE, LLC d/b/a
WEST SHORE HEALTH AND NO. pq. 3 3 9oL
REHABILIATION CENTER
Plaintiff,
vs.
BETTY JOHNSON
Defendant.
PETITION FOR CONFIRMATION OF ARBITRATION AWARD PURSUANT
TO PA RCP 1328
1. Plaintiff, Golden National Senior Care, LLC d/b/a West Shore Health and
Rehabilitation Center, is a Pennsylvania registered business in good standing, being
engaged in the business of providing nursing home care and medical assistance and
having an address of 770 Poplar Church Road, Camp Hill, County of Cumberland,
Commonwealth of Pennsylvania.
2. Defendant, Betty Johnson, is an individual and a Pennsylvania Resident having her
current mailing address at Plaintiff's nursing home facility located at 770 Poplar Church
Road, Camp Hill, County of Cumberland, Commonwealth of Pennsylvania.
3. Defendant was admitted into Plaintiff's nursing home and healthcare facility on or
about September 6th of 2005 and she has remained at Claimant's facility until the present
date.
4. On or about September 6th of 2005, prior to Defendant's admission date Defendant, by
and through her then existing agent and power of attorney, agreed to and signed an
Arbitration Agreement, which bound both Plaintiff and Defendant to resolve any disputes
through an independent private arbitration. A true and correct copy of the Arbitration
Agreement is attached hereto, made a part hereof and is labeled as Exhibit "A".
5. During Defendant's stay at Plaintiff's facility, she has accrued an unpaid private pay
portion due to Plaintiff for services and items received of $31,192.37.
6. Defendant failed to pay the above stated amount following numerous attempts to
collect the same; Plaintiff subsequently filed a claim with the National Arbitration Forum
pursuant to the Arbitration Agreement.
7. Following proper service and notice via certified mail, signed return receipt, through
the United States Postal Service, hearings were held before the arbitrators on or about
June 1St of 2007 and the parties were given a full opportunity to present all testimony and
evidence they desired in support of their positions.
8. After a hearing and review of the claim, being on or about June 1St of 2007, the
National Arbitration Forum issued an Award for Plaintiff and against Defendant,
individually, for the amount of Thirty One Thousand One Hundred and Ninety Two
Dollars and Thirty Seven Cents ($31,192.37). A true and correct copy of the Arbitration
Award is attached hereto, made a part hereof and is labeled as Exhibit "B".
9. Since the award has been issued, Defendant has turned over her social security
payments to Plaintiff, resulting in Eight Thousand Two Hundred and Twenty Nine Dollar
and Fifty-Eight Hundredths ($8,229.58) being paid toward the past due balance.
10. The now current balance from the arbitration award less payments received is
Twenty Two Thousand Nine Hundred and Sixty Two Dollars and Seventy-Nine
Hundredths ($22,962.79).
11. Defendant has continually failed to pay portion of this remaining balance, contrary to
the arbitrators' award.
WHEREFORE, Plaintiff respectfully requests that this Honorable Court enter an
order in the form attached hereto confirming the award of the arbitrators and entering
judgment in favor of Plaintiff, West Shore Health and Rehabilitation Center and against
Defendant, Betty Johnson, in the amount of Twenty Two Thousand Nine Hundred and
Sixty Two Dollars and Seventy-Nine Hundredths ($22,962.79), being the amount of the
Arbitration Award less payments received.
Respectfully sub fitted,
Nathan T. Chase, Esq.
Dodson, McCaffrey & Associates
Attorneys for Plaintiff
West Shore Health and Rehab Center
~ I VERIFICATION
I ~A-~,
,the undersigned, being an attorney for West
Shore Health and Rehabilitation Center, verify that the statements and averments made in
the foregoing Petition for Confirmation of Arbitration Award are true and correct to the
best of my knowledge, information and belief. I understand that false statements herein
are made subject to the penalties of 18 Pa. C.S. Section 4907, relating to unsworn
falsification to authorities.
Date:
Nathan T. Chase, Esq.
Dodson, McCaffrey & Associates
Attorneys for Plaintiff
West Shore Health and Rehab Center
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
GOLDEN VENTURES NATIONAL
SENIOR CARE, LLC d/b/a
WEST SHORE HEALTH AND
REHABILIATION CENTER
Plaintiff,
CIVIL DIVISION
NO.
vs.
BETTY JOHNSON
Defendant.
PETITION FOR CONFIRMATION OF ARBITRATION AWARD
ORDER AND JUDGMENT OF COURT
AND NOW, this day of , 2007, upon consideration of the
foregoing Petition for Confirmation of Arbitration Award of Petitioner Golden
LivingCenter-Stroud, it is hereby ORDERED and DECREED:
1. The arbitration award, attached to the foregoing petition as Exhibit A,
issued by the National Arbitration Forum File Number FA
0612000859104, is hereby confirmed and shall be docketed by the
Prothonotary as a confirmed judgment;
2. The above petition is hereby granted and judgment is entered for the
Plaintiff, West Shore Health and Rehabilitation Center, and against
Defendant Betty Johnson, for the amount of Twenty Two Thousand Nine
Hundred and Sixty Two Dollars and Seventy-Nine Hundredths
($22,962.79), being the amount of the Arbitration Award less payments
received.
By:
J.
EXHIBIT A
ARBITRATION AGREEMENT
RESIDENT AND FACILITY ARBITRATION AGREEMENT
(NOT A CONDITION OF ADMISSION -READ CAREFULLY)
This Arbitration Agreement is executed by ~~si 5/~D,eE
~*aLr/~ ~- ~~~~I/3 (the "Facility")
and 1~t l~j~ r~ ~~ ~~~SP~/1 ("Restdent" or "Resident's Authorized Representative"
hereafter collectively referred to as "Resident") in conjunction with an agreement for admission and for
the provision of nursing facility services (the "Admission Agreement") by Facility to Resident, The
parties to this Arbitration Agreement acknowledge and agree that upon execution, this Arbitration
Agreement becomes part of the Admission Agreement, and that the Admission Agreement evidences a
transaction involving interstate commerce governed by the Federal Arbitration Act. It is understood and
agreed by Facility and Resident that any and all claims, disputes, and controversies (hereafter collectively
referred to as a "claim" or collectively as "claims") arising out of, or in connection with, or relating in any
way to the Admission Agreement or any service or health care provided by the Facility to the Resident
shall be resolved exclusively by binding arbitration to be conducted at a place agreed upon by the Parties,
or in the absence of such an agreement, at the Facility, in accordance with the National Arbitration Forum
Code of Procedure, which is hereby incorporated into this Agreement\ 1, and not by a lawsuit or resort to
court process. This agreement shall be governed by and interpreted under the Federal Arbitration Act, 9
U.S.C. Sections 1-16.
This agreement to arbitrate includes, but is not limited to, any claim for payment, nonpayment, or refund
for services rendered to the Resident by the Facility, violations of any right granted to the Resident by law
or by the Admission Agreement, breach of contract, fraud or misrepresentation, negligence, gross
negligence, malpractice, or claims based on any departure from accepted medical or health care or safety
standards, as well as any and all claims for equitable relief or claims based on contract, tort, statute,
warranty, or any alleged breach, default, negligence, wantonness, fraud, misrepresentation, suppression of
fact, or inducement. However, this agreement shall not limit the Resident's right to file a grievance or
complaint with the Facility or any appropriate government agency from requesting an inspection from
such an agency, or from seeking review under 42 C.F.R. section 431.200 et seq. of a decision to transfer
or discharge the Resident.
The parties agree that damages awarded, if any, in an arbitration conducted pursuant to this Arbitration
Agreement shall be determined in accordance with the provisions of the state or federal law applicable to
a comparable civil action, including any prerequisites to, credit against, or limitations on, such damages.
Any award of the arbitrator(s) may be entered as a judgment in any court having jurisdiction. In the event
a court having jurisdiction finds any portion of this agreement unenforceable, that portion shall not be
effective and the remainder of the agreement shall remain effective.
It is the intention of tl~e parties to this Arbitration Agreement that it shall inure to the benefit of and bind
the parties, their successors, and assigns, including without limitat;on the agents, employees and servants
of the Facility, and all persons whose claim is derived through or on behalf of the Resident, including any
parent, spouse, sibling, child, guardian, executor, legal representative, administrator, or heir of the
Resident. The parties further intend that this agreement is to survive the lives or existence of the parties
hereto.
11 Inf'onnation about the National Arbitration Forum, including a complete copy of the Code of Procedure, can be obtained from
the Forum at 800-474-2371, by fax at 6S I -604-6778 or toll-free fax at 866-743-4517, or on the Internet at http;//www.arb_
forum. com.
Rev. OS/13/03
z
0
c~
White -Business Office Pink -Medical Records Yellow -Resident
All claims based in whole or part on the same incident, transaction, or related course of care or ser~~~ices
provided by the Facility to the Resident shall be arbitrated in one proceeding, A claim shall be waived
and forever barred if it arose and should reasonably have been discovered prior to the date upon which
notice of arbitration is given to the Facility or received by the Resident and such claim is not presented in
the arbitration proceeding.
THE PARTIES UNDERSTAND AND AGREE THAT THIS CONTRACT CONTAINS A BINDING
ARBITRATION PROVISION WHICH MAY BE ENFORCED BY THE PARTIES, AND THAT BY
ENTERING INTO THIS ARBITRATION AGREEMENT, THE PARTIES ARE GNING UP AND
WAIVING THEIIt CONSTITUTIONAL RIGHT TO HAVE ANY CLAIM DECIDED IN A COURT
OF LAW BEFORE A JUDGE AND A JURY, AS WELL AS ANY APPEAL FROM A DECISION
OR AWARD OF DAMAGES.
The Resident understands that (1) he/she has the right to seek legal counsel concerning this Arbitration
Agreement, (2) that execution of this Arbitration Agreement is not a precondition to admission or to the
furnishing of services to the Resident by the Facility, and (3) this Arbitration Agreement may be rescinded
by written notice to the Facility from the Resident within thirty days of signature. If not rescinded within
thirty days, this Arbitration Agreement shall remain in effect for all subsequent stays at the Facility, even
if the Resident is discharged from and readmitted to the Facility.
The undersigned certifies that he/she has read this Arbitration Agreement and that it has been fully
explained to him/her, that he/she understands its contents, and has received a copy of the provision and
that he/she is the Resident, or a person duly authorized by the Resident or otherwise to execute this
agreement and accept its terms.
Date
Signature:
(Resident)
ci
c~
c~
Witness: I
If the resident is unable to consent or sign this provision because of physical disability or mental
incompetence or is a minor and an authorized representative is signing this provision, complete the
following:
z
Relationship to Resided(. ~`'~'~~ `~ ` ~
(Authorized representative)
Witness; r~-~
For Facility:
Rev. OS/] 3/03
White -Business Office Pink -Medical Records Yellow -Resident
Date: ~ ~ .f
Authorized Representative Signature: ~
Print Name and Title: ~ " " ~' '
/~
x
a
z
i~
z
z
;~ o
i
Rev. 03/13/03
I
White - i
Business (~ff,~A n:..i. ~ ~_„ , „
•
EXHIBIT B
ARBITRATION AWARD
~~
~ ~ •
T= e NATIONAL ARBITRATION
~ FORUM
Golden Gate National Senior Care, LLC f/k/a Beverly Enterprises, PA -Inc., d/b/a West Shore Health & Rehab
770 Poplar Church Road
Camp Hill, PA 17011
CLAIMANT(S), AWARD
Betty Johnson
770 West Shore and Rehab Center
Camp Hill, PA 17011
RE: Golden Gate National Senior Care, LLC f/k/a Beverly Enterprises, PA -Inc., d/b/a
West Shore Health & Rehab v Betty Johnson
File Number: FA0612000859104
RESPONDENT(S).
The undersigned Arbitrator in this case FINDS and CONCLUDES:
Case Summary
1. The Claimant has filed a Claim with the National Arbitration Forum.
2. After Proof of Service of the Claim was filed with the Forum, where no Response has been filed, the Forum mailed to Respondent a
Second Notice of Arbitration.
3. The Respondent has not filed a Response with the Forum and served it on the Claimant.
4. An arbitration hearing notice was duly delivered to the Parties as required by the Forum Rules.
5. The Arbitrator conducted a Hearing ir- this case in accordance with the Forum Rules.
6. The Parties have had the opportunity to present all evidence and information to the Arbitrator.
7. The Arbitrator has reviewed all evidence submitted in this case.
Decision
1. The Arbitrator knows of no conflict of interests that exist.
2. This matter involves interstate commerce and the Federal Arbitration Act governs this arbitration.
3. The Claim was properly served on tht; Respondent by Claimant in accordance with Rule 6, including a Notice of Arbitration.
4. On or before 12/19/2006 the Parties entered into a valid, written agreement to arbitrate their dispute.
5. The Parties' Arbitration Agreement is valid and enforceable and governs all the issues in dispute.
6. This matter is arbitrable under the terms of the Parties' Arbitration Agreement and the law.
7. The matter has proceeded in accord with the applicable Forum Code of Procedure Rules.
8. The evidence submitted supports the issuance of this Award.
9. The applicable substantive law;supports the issuance of this Award.
Therefore, the Arbitrator ISSUES:
An Award in favor of the Claimant, for a total amount of $31,192.37.
Entered and Affirmed in the State of Pennsylvania
Peter L. Michaelson, Esq.
Arbitrator
ACKNOWLEDGEMENT AND CERTIFICATE
OF SERVICE
This Award was duly entered Forum hereby certifies that
pursuant to the Parties' 1~in~A,~r nt, a copy of this Award
was sent by first class it po e p id to a Parties at the above
referenced addre ses, r their Repres tativ~s, on this date.
r
Date: 05/31/2007 Hu~a~l - `[t~
^ .~.
~ •~ ~
"_ a O
, ( t~~ ..
n
1
~
~ fi~
-
''ww
~ YJ
W ~ V
~ ~s
't~
'~ '~ J ~
p~
~D (
~
V /
~
L\ ~ ~ C~,S
a. : ~'}
a~ ~ Cam? •' ("'t'i
N "~
SHERIFF'S RETURN - REGULAR
CASE NO: 2007-03392 P
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
GOLDEN VENTURES NATIONAL SENIO
VS
JOHNSON BETTY
SHAWN HARRISON
Sheriff or Deputy Sheriff of
Cumberland County,Pennsylvania, who being duly sworn according to law,
says, the within PETITION FOR CONFIRMATION was served upon
JOHNSON BETTY
RESPONDANT
the
at 1505:00 HOURS, on the 12th day of June 2007
at WEST SHORE HEALTH & REHAB CTR 770 POPLAR CHURCH ROAD
CAMP HILL, PA 17011 by handing to
BETTY JOHNSON, WITNESSED BY BEVERLY FRY. EXEC DIRECTOR
a true and attested copy of PETITION FOR CONFIRMATION together with
OF ARBITRATION AWARD PURSUANT TO
PA RCP 1328
and at the same time directing Her attention to the contents thereof.
Sheriff's Costs:
Docketing 18.00
Service 14.40
Affidavit .00
Surcharge 10.00
.00
L~lp~07 ~, 42 .40
Sworn and Subscibed to
before me this day
of ,
So Answers:
~'` ~ ~a
R. Thomas Kline
06/13/2007
DODSON MCCAF Y & ASSOCIATES
By:
Deputy Sheriff
A.D.
w
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
GOLDEN VENTURES NATIONAL CIVIL DIVISION
SENIOR CARE, LLC d/b/a
d/b/a WEST SHORE HEALTH AND NO.07 - 3392
REHABILITATION CENTER
770 Poplar Church Road
Camp Hill, PA 17011
Plaintiff,
ys. PRAECIPE FOR JUDGMENT FOR
FAILURE TO ANSWER PETITION FOR
CONFIRMATION OF ARBITRATION
AWARD PURSUANT TO PA RCP 1328(e)
BETTY JOHNSON
West Shore Health and Rehab Center
770 Poplar Church Road
Camp Hill, PA 17011
Defendant.
Filed on behalf of Plaintiff
West Shore Health & Rehab
Counsel of Record for this Party:
NATHAN T. CHASE, ESQUIRE
Pa. I.D. # 200295
DODSON, MCCAFFREY & ASSOCIATES
Suite 332 Building A
9800 McKnight Road
Pittsburgh, Pa. 15237
(412) 635-9314
Nathan Chase@dpdsonmccaffrey.com
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
GOLDEN VENTURES NATIONAL CIVII, DIVISION
SENIOR CARE, LLC d/b/a
WEST SHORE HEALTH AND NO. 07 - 3392
REHABILITATION CENTER
Plaintiff,
vs.
BETTY JOHNSON
Defendant.
PRAECIPE FOR JUDGMENT FOR FAILURE TO ANSWER PETITION FOR
CONFIRMATION OF ARBITRATION AWARD PURSUANT TO PA RCP 1328(e)
To the Prothonotary:
Please enter judgment on the award of arbitrators filed in the above captioned matter as
Defendant has failed to answer within 30 days after having been served by the Sheriff of
Cumberland County on June 12a' of 2007 as required by PA RCP 1328(e) and assess damages in
favor of the plaintiff and against Defendant as follows:
Total Amount Due from Award /Petition
B
Y
Nathan T. Chase, Esq.
Attorney for Plaintiff,
Damages Assessed as Above:
$ 22,962.79
s Date: 3 O
othonot
~'
~ a
~
%
~
.~- .
C~ ~~5 ~--
~
tp - oa ~ i~~ '~ -
i
6 x~ c
. ~' ..
~
.
.
~ ~
?
cx
_ ^'
~ ~
-..„~
"rt ~"~
` i J. ,
t ,,"mow. ~~•.j
..
~
,.
-f j
~
s
~,t-~
G J {'
°("71 ~i
.
f
.. (')
;~.
J
Y ~ f`~ } ;
~.
"'~y ~_. ~ ~t 1
~~