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Home My WebLink About07-7636IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA GOLDEN LIVING CENTER -- WEST SHORE HEALTH AND REHABILITATION, Plaintiff, V. No. 01 - JY? 34, FORREST KNORR, Defendant. CIVIL ACTION - EQUITY NOTICE TO DEFEND Pursuant to PA RCP No. 1018.1 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, 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 17013 Telephone: (717) 249-3166 EN LA CORTE DE ALEGATOS COMiJN DEL CONDADO DE CUMBERLAND, PENNSYLVANIA GOLDEN LIVING CENTER -- WEST SHORE HEALTH AND REHABILITATION, Plaintiff, V. No. FORREST KNORR, Defendant. CIVIL ACTION - EQUITY AVISO PARA DEFENDER Conforme a PA RCP Num. 1018.1 USTED HA SIDO DEMANDADO/A EN CORTE. Si usted desea defenderse de las demandas que se presentan mas adelante en las siguientes paginas, debe tomar accion dentro de los proximos veiente (20) dias despues de la notification de esta Demanda y Aviso radicando personalmente o por medio de un abogado una comparecencia escrita y radicando en la Corte por escrito sus defensas de, y objeccionee a, las demandas presentadas aqui en contra suya. Se le advierte de que si usted falla de tomar accion como se describe anteriormente, el caso puede proceder sin usted y un fallo por cualquier suma de dinero reclamada en la demanda o cualquier otra reclamacion o remedio solicitado por el demandante puede ser dictado en contra suya por la Corte sin mas aviso adicional. Usted pued perder dinero o propiedad u otros derechos importantes para usted. USTED DEBE LLEVAR ESTE DOCUMENTO A SU ABOGADO INMEDIATAMENTE. SI USTED NO TIENE UN ABOGADO, LLAME O VAYA A LA SIGUIENTE OFICINA. ESTA OFICINA PUEDE PROVEERLE INFORMACION A CERCA DE COMO CONSEGUIR UN ABOGADO. SI USTED NO PUEDE PAGAR POR LOS SERVICIOS DE UN ABOGADO, ES POSIBLE QUE ESTA OFICINA LE PUEDA PROVEER INFORMACION SOBRE AGENCIAS QUE OFREZCAN SERVICIOS LEGALES SIN CARGO O BAJO COSTO A PERSONAS QUE CUALIFICAN. Cumberland County Bar Association 32 South Bedford Street Carlisle, PA 17013 Tel6fono: (717) 249-3166 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA GOLDEN LIVING CENTER -- WEST SHORE HEALTH AND REHABILITATION, Plaintiff, V. FORREST KNORR, Defendant. No. 07- 7G 36 CIVIL ACTION - EQUITY COMPLAINT AND NOW, COMES, Golden Living Center - West Shore Health and Rehabilitation ("Plaintiff"), by and through its attorneys, SCHUTJER BOGAR LLC, and files the following complaint against Forrest Knorr ("Defendant"), and in support thereof, states: 1. Plaintiff, a corporation licensed to do business in the Commonwealth of Pennsylvania, is a skilled nursing care provider with its principal offices located 770 Poplar Church Road, Camp Hill, Pennsylvania 17011. 2. Defendant is an adult individual who resides at 1182 Pottsville Street, Lykens, Pennsylvania 17048. 3. On or about May 23, 2007, Defendant made application for his wife's admission to Plaintiff's skilled nursing facility. 4. On or about May 23, 2007, Plaintiff and Defendant entered into a written Admission Agreement ("Agreement"), pursuant to which Plaintiff agreed to provide Defendant's wife with skilled nursing care and services in return for Defendant's promise to make timely payment for that skilled nursing care and services from his wife's resources, or, upon her becoming insolvent, to make timely and proper application for Medical Assistance benefits on her behalf and to provide all of the necessary documentation for an eligibility determination to be made with regard to her application for Medical Assistance benefits. A true and correct copy of the Admission Agreement is attached hereto as Exhibit "A." 5. Shortly after her admission to Plaintiff's skilled nursing facility, Defendant's wife allegedly became insolvent. As a result, an application for Medical Assistance benefits was subsequently filed on her behalf. 6. The application for Medical Assistance benefits was denied by the Cumberland County Assistance Office on July 18, 2007. A true and correct copy of the PA-162 is attached hereto as Exhibit "B." 7. An appeal of the July 18, 2007, denial of Medical Assistance benefits is currently pending before the Bureau of Hearing and Appeals of the Department of Public Welfare of the Commonwealth of Pennsylvania. 2 8. If the documentation requested by the Cumberland County Assistance Office is not provided by Defendant prior to or at the time of the hearing on the appeal, the application for Medical Assistance benefits will ultimately be denied, and any further appeal to the Commonwealth Court would be without merit. COUNT I - BREACH OF CONTRACT/SPECIFIC PERFORMANCE 9. Paragraphs 1 through 8 are incorporated by reference as though restated in full. 10. Plaintiff has provided skilled nursing care and services to Defendant's wife in accordance with the Agreement attached hereto as Exhibit "A." 11. Defendant has breached the Agreement, attached as Exhibit "A," by not providing the documentation requested by the Cumberland County Assistance Office for a determination to be made as to the eligibility of Defendant for Medical Assistance benefits. See Exhibit "A." 12. As a result of the failure of Defendant to abide by the terms and conditions of the Agreement, the application for Medical Assistance benefits filed for Defendant's wife has been denied. 13. The aforementioned breach of the Agreement with Plaintiff has caused and continues to cause irreparable harm to Plaintiff, as the appeal of the denial of Defendant's application for Medical Assistance benefits will be denied absent the necessary documentary evidence to establish her eligibility for benefits. 3 14. Upon information and belief, at all times material hereto, Defendant's wife has been financially unable to compensate Plaintiff for the care and services that it has rendered to her in accordance with the terms and conditions of the Agreement. 15. Accordingly, only a decree of specific performance will adequately protect the interests of Plaintiff and provide it with the benefits and/or protections promised under the Agreement. WHEREFORE, Plaintiff respectfully requests that this Court enter a decree ordering specific performance of the Agreement by the parties. Respectfully submitted, SCHUTJER BOGAR LLC Dated:. 1A - 6161 By: Brad y A. Schutjer Attorney I.D. No. 75954 (717) 909-5921 Mariclare L. Hayes Attorney I.D. No. 201289 (717) 909-5922 417 Walnut Street, 4th Floor Harrisburg, PA 17101 Attorneys for Plaintiff 4 VERIFIC,A ON 'The undersigned hereby verifies that the statements of fact in the foregoing Complaint are true and correct to the best of my knowledge, idormation and belief. 1 understand that any false statements therein are subject to the penalties contained in 18 Pa. C S? § 4904, relating to unsworn falsification to authorities. Dated: 1 V 1? N Nursing Ho a Administrator EXHIBIT "A" RESIDENT-SPECIFIC INFORMATION XIM. Payer Sources - This Facility accepts the following types of payments: Private [`],Medicare [Q Medical Assistance [ ] Veterans Administration XXM ACKNOWLEDGEMENTS - By signing the Admission Agreement Signature Page, the Resident/Agent/Legal Representative acknowledges that he or she has been given and has read this Agreement in its entirety, and all addenda. The Resident also acknowledges that the following information was provided upon or before admission by the Facility. Initial the lines below (if not `na applicable, write N/A): z _ 1 _ A list of supplies and services that are included in the Facility's private monthly rate or that will be paid for by the Medical Assistance or Medicare programs and a list of supplies and services not included in the Facility's private monthly rate or paid for by the Medical Assistance or Medicare programs for which the Resident will be separately charged (1 _ 2. Information about the Facility's bed-hold procedures. r% N 3. A written explanation of how to apply for and use Medicare and Medical Assistance benefits and how to receive funds for previous payments covered by these benefits. ;?' 4. A statement explaining that the Resident may file a grievance with the appropriate State Agency about resident abuse, neglect, and/or misuse/theft of resident personal property in the Facility. 7 i f h i 1 5. es o t Cop e State Res dent Rights. --?-.6. A written explanation of the Facility's Rules and Regulations. ?7. Where applicable, if your condition warrants, you may be placed in the Facility's Medicare-Certified Distract Part Unit. At some point, circumstances may occur which will make residing in another unit more appropriate for you. In that case, the Facility will discuss such a transfer with you. Under law, you cannot be discharged from this Facility unless you agree or unless, following an appeal, it is determined that you may be involuntarily discharged or transferred 9 8. 1 do>( do not have an advance directive. z c 9. I have been informed, both orally and in writing, in a language I understand, of my rights and the rules and regulations governing my conduct and responsibilities during my stay at J the Facility. 10. 1 have been given a copy and had an opportunity to review the Facility's Notice of Privacy J Practices. XXIV, NOTICES - Notices shall be mailed to the address (es) indicated below. The Agent and/or Legal Representative are responsible for notifying the Facility in writing of any change of address. The Resident designates the following parson(s) to be notified when any legally required notices are provided to the Resident, Agent, and/or Legal Representative. Rev. 03113/03 White - Business Office Pink - Medical Records Yellow - Resident 11 A. Legal Representative And/Or Agent Name Fo"flr KNOAK Home Phone [q ][t ]ti ][s7[7][][$J[8]t?][8] Work Phone( ][ ][ 1111111111 ][ If ) 11 ix Nakilk if. le,Y106 w Street City State Zip B. Other Person To Be Notified Name RodN+r7 g1 jaR Home Phone (9)[I ]Cp['b][j][QXd[17][9] (I] Work Phone[l][I]M[?][Y][Z][3][5][3) , r AD 6 ip! ph a? SA X ? ? Street City State Zip XXV. MAIL - The Facility is authorized to handle the Resident's mail as follows: (Check one box only.) [ ] All mail given directly to the Resident [ ] Forward all of the Resident's mail to: W All mail read to the Resident [`j Give personal mail to the Resident; forward business roan to: iX a 7 re XXV1. RESIDENT'S PHYSICIAN A. NAME: bK. S-AADA B. SPECIALTY: C. ADDRESS- H z 0 U D. TELEPHONE: 9 6' 0 ?y L- o 7 R q -s XXVII. RESIDENT TRUST FUND AUTHORIZATION - A Resident Trust fund is an amount of money held by the Facility for the Resident's personal use. (Examples of use: To allow the resident to pay for room and board, beauty shop charges, cigarettes, postage stamps, or other similar expenses as desired by the Resident.) By signing below, the Resident authorizes the Facility to set up a trust fund in his/her name, The individual financial records shalt be available through quarterly statements, and on request, to the Resident or his/her Agent or Legal Representative. The Resident understands that all withdrawals Rev. 03/13/03 White - Business office Pink - Medical Records Yellow - Reaidcut 12 ADMISSION AGREEMENT SIGNATURE PAGE XXiX. PARTIES - The parties to this Agreement are: tv SA ng 6 tleelv -A --Jevogg (Name of Facility) (Name of Resident) io RA-ft -t A ' t (Name of Resident's Agent) (Name of Resident's Legal Representative) If the Legal Representative signs the Agreement, check the Type of Legal Representative (below), ] Conservator of Person (J Guardian Durable Power of Attorney [ ] Conservator of Estate for Health Care (DPAHC) ] Other, spe* Agent Acting Under General POA If you are signing this Agreement on behalf of the Resident, note your relationship to the Resident- My relationship to the Resident is ii! gago -1 ft On this day of M A 200 the above Parties agree to be bound by the provisions of this Agreement and agree that on the?day of 2011 the Resident shall be admitted to __MAy this Facility. C1iet A A of K rjaRF% Resident t Fly Po-l??y ? S+. Address , - - LN t f PA 1104t City, Statd, zip Witness if Resident Signed with a Mark Witness if Resident Signed with a Mark Legal Representative IIu po-Wiv . Il4 34. ?4 v awg Legal Representative's Address Rev. 03/13103 White - Business OT= PA. Dated ! 47 /f /S Resident's Social Security Number Resident's Telephone Number Date Date Date ooy$ 16$ 3(o 4(o3 -------------- -- Legal Representative's Social Security No. Legal Representative's Telephone Number Pink - Medical Records Yeflow - Resident z IN z a 15 Agent Agent's Address Facility Execudvc Dir or or Designee we s r SI-t ok e.. - "A In/ 4vr vq, Facility Name r7'7 0 PontW& L F T. it ty Address Date Agent's Social Security Number Agent's Telephone Number Date Note: The signatures above refer to the information contained on pages 1 through 16 of the Admission Agreement. w C ?> 4 l z h 7 O I? J R.cv 03/13/03 White - Business Office Pink - Medical Rocords Yellow - Resident 16 EXHIBIT "B" NOTICE TO APPLICANT - CUMBERLAND CAO _ 33 WESTMINSTER DRIVE ' PO BOX 599 BENEFIT CARLISLE, PA 17013-0599 ASSISTANCE After the first check which may be a special amount you will receive $ CHECK ? Twice a Month ? Once a Month ? in the Mail ? At the Bank * MEDICAL ? U You have a patient pay liability of $ ASSISTANCE for the period beginning and endin FOOD You will receive $ 9 ? Effective Date fc the month(s) of then you lop receive food stare STAMPS a month from to El In the Mail El At the Bank amount of S 0-/ Nl1R.SWG HOME ?/ Level ct care authormed L SERVICES s Y aB oPd to pay $ a month toward your tee. THE FOLLOWING PERSONS ARE INCLUDED NAME NAME 01 ('Ml .. If--- _..-- Mrs. Knorr was found not eligible for - ?'°"55Pa Code 178.1 R.. code 079 $11800.00+ " Lean cafe medical assistance because countable resources on 5/23/07 totaled $35822.44 (2004 truck valued at $23091.49 excess cash value of Shenandoah insurance policy + $11829 Roadway acct X)(9774). After deducting ft $23711.19 protected spousal share and $6000.00 standard disrega b + resources Mid Penn sect 25. R + $500.38 Mid Penn $2000:00 III by $4111.25. See the attached letter for ways to reduce or totaled$611 125. Resources exceed the protect rBSUUrCet3. Name of Persons Name Name TOTAL GROSS MONTHLY INCOME GROSS MONTHLY DEPENDENT CARE COSTS GROSS MEDICAL COSTS Electric Garbage/7'? Gas Utility installation off Other GROSS a UTILITY STANDARD' $ RENT/M GAGE $ TAXES $ INSURANCE COST ON HOME $ TOTAL SHELTER COST $ CRECORD NUMBER CAT CTR DIG DI.ST 0114822 PJN 00 )TAL GROSS MONTHLY INCOME $ ZOSS MONTHLY DEPENDENT CARE COSTS $ D MEDICAL ??1$TANCE Number of Persons Name Name TOTAL GROSS MONTHLY INCOME $ NET MONTHLY INCOMEME7 SEMI-ANNUAL INCOME $ INCOME LIMIT $ Marcia Mikos 7/18/07 717-240-2704 Workers Signature Date Telephone Number LEGAL HELP IS AVAILABLE AT Forrest Knorr 1182 Pottsville St Lykens, PA 17048 cc: Golden Living-WS, Pittsburgh <f you do not understand ow decision or trave any yuesdons contact your womer. CLIENT ; APPEAL COPY LEGAL SERVICES INC. 8 IRVINE ROW CARLISLE, PA 17013-0000 (717) 243-9400 0 CASE RECORD COPY FArFS 162 u07 O d -TI ?s» fTE(z? l.Y.? V-.2 -on C-) _ t= O _ OZ) S-" ?7 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA GOLDEN LIVING CENTER - WEST SHORE HEALTH AND REHABILITATION, Plaintiff, V. No. 07-7636 FORREST KNORR, Defendant. CIVIL ACTION - EQUITY GOLDEN LIVING CENTER - WEST SHORE HEALTH AND REHABILITATION'S PETITION FOR PRELIMINARY INJUNCTION AND NOW, COMES, Golden Living Center - West Shore Health and Rehabilitation ("Petitioner"), by and through its attorneys, SCHUTJER BOGAR LLC, and pursuant to the provisions of Pa. R.C.P. § 1531, makes the following petition for preliminary injunction and, in support thereof, avers: 1. On December 20, 2007, Petitioner filed a complaint ("Complaint") against Forrest Knorr ("Respondent") seeking specific performance of the written Admission Agreement into which Respondent entered upon the admission of his wife, Colleen Knorr ("Mrs. Knorr") to Petitioner's skilled nursing facility. 2. The Complaint sets forth a claim against Respondent relating to his breach of the Admission Agreement ("Agreement") he signed on behalf of Mrs. Knorr, by failing to secure Medical Assistance benefits on behalf of Mrs. Knorr by providing the necessary financial documentation to the Schuylkill County Assistance Office to qualify Mrs. Knorr for benefits, and Respondent continues to breach the Agreement with ORIGINAL Petitioner by refusing to properly pursue the appeal of the denial of the application for Medical Assistance benefits. See Complaint, Exhibit "A." 3. The very nature of the breach of the Agreement, i.e., Respondent's failure to secure Medical Assistance benefits in a timely manner, presents an issue of immediate and irreparable harm to Petitioner. 4. The requested injunction would restore the parties to the status quo as it existed immediately prior to Respondent's breach of the Agreement. 5. Greater injury would result from the denial of the requested injunction than from the granting of the same, as, without a decree ordering Respondent to perform his contractual duties, Petitioner will have no remedy by which to receive compensation for the skilled nursing care and services provided to Respondent's wife in accordance with the Agreement and Petitioner will lose the appeal of the denial of Respondent's wife's Medical Assistance application, for which there is no remedy. 6. Petitioner's right to relief is clear. See Complaint. 7. Petitioner lacks an adequate remedy at law, as upon information and belief, and to the extent of Petitioner's knowledge, the financial resources of Respondent's wife are not sufficient to compensate Petitioner for the skilled nursing care and services that it provided to her. 8. A bond in the amount of $100.00 should be adequate in the event that it is later determined that the issuance of the instant petition was in error. 2 WHEREFORE, Petitioner respectfully requests that this Honorable Court immediately schedule a hearing on its request for injunctive relief, and thereafter issue a decree ordering the specific performance of the Agreement by and between the parties hereto. Dated: Respectfully submitted, SCHUTJER BOGAR LLC By: 4- A Bradt A. Schutjer Attorney I.D. No. 75954 (717) 909-5921 Mariclare L. Hayes Attorney I.D. No. 201289 (717) 909-5922 417 Walnut Street, 4th Floor Harrisburg, PA 17101 Attorneys for Petitioner 3 The undersigned hereby verifies that the statements of fact in the foregoing Petition for Prellanina y Injunction are true and correct to the best of my knowledge, information and belief. I understand that any false statements therein are subject to the penalties contained in 18 Pa. C. S. § 4904, relating to unsworn falsification to authorities. Dated: gi?y Fry, Executive DS or, Golden Living Center - west Shore CERTIFICATE OF SERVICE I hereby certify that a true and correct copy of the foregoing Petition for Preliminary Injunction was served via fist-class, United States mail, postage prepaid, upon the following: Forrest Knorr 1182 Pottsville Street Lykens, PA 17048 Dated: a a By: William Keslar, Paralegal *`? ?a C,^y ? --r_ ? ? + ;?,? t ;? cT i 4 ? + . i°i r` ;• .. 7 -i -?'? ; f t"i ;?.a .. C,,.? -.. ^-"' ,± :-G IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CASE NO.: 07-7636 Civil Term AFFIDAVIT OF SERVICE Golden Living Center-West SHore Health and Rehabilitation vs. Forrest Knorr Commonwealth of Pennsylvania County of Dauphin so. I, Chad Spotts, a competent adult, being duly sworn according to law, depose and say that at 7:36 PM on 01/08/2008, I served Forrest Knorr at 1182 Pottsville Street, Lykens, PA 17048 in the manner described below: ® Defendant(s) personally served. Adult family member with whom said Defendant(s) reside(s). Relationship is Adult in charge of Defendant(s) residence who refused to give name and/or relationship. Manager/Clerk of place of lodging in which Defendant(s) reside(s). Agent or person in charge of Defendant's office or usual place of business. ? Other: an officer of said Defendant's company. a true and correct copy of Notice to Defend, Complaint, Verification issued in the above captioned matter. Description: Sex: Male - Age: 58 - Skin: White - Hair: Black Sworn to and subscribed before me on this 7jLb day of _% k , 20g6. PUBLI - Height: 5'1011 - Wei 0 x Cha Spot Shinkowsk nvestigations 316 Fawn idge North Harrisburg, PA 17110 (800) 276-0202 Atty File#: 07-7636 - Our File# 2766 Law Firm: Schutjer Bogar LLC Address: 417 Walnut Street, 4th Floor, Harrisburg, PA, 17102 Telephone: (717) 909-5925 COMMONWEALTH OF PENNSYLVANIA Notarial Seal John F. Shinkowsky, Notary Public Susquehanna Twp., Dauphin Courtly My Commission Fires Sept. 28, 2010 Member, Pennsylvania Association of Notaries ?"t1-rte.-.' 'r ;P^'T> caq, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA GOLDEN LIVING CENTER - WEST SHORE HEALTH AND REHABILITATION, Plaintiff, V. No. 07-7636 FORREST KNORR, JAN 15 2008 'o Defendant. : CIVIL ACTION - EQUITY ORDER AND NOW, this ` day of 2008, a hearing in the above-captioned matter on Plaintiff's petition for the issuance of a preliminary injunction is scheduled for aka" 36 2008 at 47: 30 Q..m. in Court Room No. Cumberland County Courthouse, Carlisle, Pennsylvania. BY COUR : J• ORIGINAL v? 4t by 1 k l r1s.1`?1 tj -.Z1 d 91 PTVP 608Z 3HI -110 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA GOLDEN LIVING CENTER - WEST SHORE HEALTH AND REHABILITATION, Plaintiff, V. No. 07-7636 FORREST KNORR, Defendant. CIVIL ACTION - EQUITY GOLDEN LIVING CENTER - WEST SHORE HEALTH AND REHABILITATION'S PETITION FOR PRELIMINARY INJUNCTION AND NOW, COMES, Golden Living Center - West Shore Health and SAN 162008,6A' Rehabilitation ("Petitioner"), by and through its attorneys, SCHU'UER BOGAR LLC, and pursuant to the provisions of Pa. R.C.P. § 1531, makes the following petition for preliminary injunction and, in support thereof, avers: 1. On December 20, 2007, Petitioner filed a complaint ("Complaint") against Forrest Knorr ("Respondent") seeking specific performance of the written Admission Agreement into which Respondent entered upon the admission of his wife, Colleen Knorr ("Mrs. Knorr") to Petitioner's skilled nursing facility. 2. The Complaint sets forth a claim against Respondent relating to his breach of the Admission Agreement ("Agreement") he signed on behalf of Mrs. Knorr, by failing to secure Medical Assistance benefits on behalf of Mrs. Knorr by providing the necessary financial documentation to the Schuylkill County Assistance Office to qualify Mrs. Knorr for benefits, and Respondent continues to breach the Agreement with ORIGINAL 1. Petitioner by refusing to properly pursue the appeal of the denial of the application for Medical Assistance benefits. See Complaint, Exhibit "A." 3. The very nature of the breach of the Agreement, i.e., Respondent's failure to secure Medical Assistance benefits in a timely manner, presents an issue of immediate and irreparable harm to Petitioner. 4. The requested injunction would restore the parties to the status quo as it existed immediately prior to Respondent's breach of the Agreement. 5. Greater injury would result from the denial of the requested injunction than from the granting of the same, as, without a decree ordering Respondent to perform his contractual duties, Petitioner will have no remedy by which to receive compensation for the skilled nursing care and services provided to Respondent's wife in accordance with the Agreement and Petitioner will lose the appeal of the denial of Respondent's wife's Medical Assistance application, for which there is no remedy. 6. Petitioner's right to relief is clear. See Complaint. 7. Petitioner lacks an adequate remedy at law, as upon information and belief, and to the extent of Petitioner's knowledge, the financial resources of Respondent's wife are not sufficient to compensate Petitioner for the skilled nursing care and services that it provided to her. 8. A bond in the amount of $100.00 should be adequate in the event that it is later determined that the issuance of the instant petition was in error. 2 WHEREFORE, Petitioner respectfully requests that this Honorable Court immediately schedule a hearing on its request for injunctive relief, and thereafter issue a decree ordering the specific performance of the Agreement by and between the parties hereto. Respectfully submitted, SCHUTJER BOGAR LLC Dated: 1 114 1 6!2; By: ' Bradl A. Schutjer Attorney I.D. No. 75954 (717) 909-5921 Mariclare L. Hayes Attorney I.D. No. 201289 (717) 909-5922 417 Walnut Street, 4th Floor Harrisburg, PA 17101 Attorneys for Petitioner 3 aCATION The undersigned hereby verifies that the statement`s of fact in the foregoing Petition for Preliminary Injunction are true and correct to the best of my knowledge, information and belief. I understand that any false statements therein are subject to the penalties contained in 18 RL C. S. § 4904, relating to unsworn falsification to authorities. Dated: y Fry, Executive Di or, Golden Living Center - West Short CERTIFICATE OF SERVICE I hereby certify that a true and correct copy of the foregoing Petition for . . Preliminary Injunction was served via fist-class, United States mail, postage prepaid, upon the following: Forrest Knorr 1182 Pottsville Street Lykens, PA 17048 Dated: a a By: William Keslar, Paralegal ? ? C -r+ ?-" C-- .-? "T' -n ?? 3, ? s-+? ?.- S y '= ' , r { - t '? =? ?' ;y, C y ? = S C H U' T*J'E' RIBOGAR «C attorneys & consultants Email: wkeslar@schutjerbogar.com Direct Dial: (717) 909-8985 January 9, 2008 Curt Long, Prothonotary Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Re: Golden Living Center - West Shore Health and Rehabilitation v Forrest Knorr, Docket No. 07-7636 Dear Mr. Long: Enclosed for filing, please find an original and two (2) copies of a Petition for Preliminary Injunction and Brief in Support of Petition for Preliminary Injunction in the above-captioned matter. Kindly time-stamp one of each and return same in the self-addressed, stamped envelope that we provided. Additionally, we kindly request that you forward the additional copy of the Petition and Brief along with their proposed Orders to the Court Administrator so that a hearing can be scheduled. Please note that we have included a self-addressed, stamped envelope for the return of the Orders after execution. If you should have any questions, please do not hesitate to contact me at the number above. Thank you for your attention and assistance in this matter. Sincerely, SCHUTJER BOGAR LLC William Keslar Paralegal Enclosures cc: Forrest Knorr (via regular mail w/enc.) 305 N. Front Street, Suite 401, Harrisburg, PA 17101 • Fax (717) 909-5925 • www.schutjerbogar.com 7AN i 12008 ?? IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA GOLDEN LIVING CENTER - WEST SHORE HEALTH AND REHABILITATION, Plaintiff, V. No. 07-7636 FORREST KNORR, Defendant. CIVIL ACTION - EQUITY GOLDEN LIVING CENTER - WEST SHORE HEALTH AND REHABILITATION'S BRIEF IN SUPPORT OF ITS PETITION FOR PRELIMINARY INJUNCTION AND NOW, COMES, Golden Living Center - West Shore Health and Rehabilitation ("Petitioner"), by and through its attorneys, SCHUTJER BOGAR LLC, and files the within Brief in support of pursuant to petition for preliminary injunction pursuant to the provisions of Pa. R.C.P. § 1531: I. Summary of Argument Respondent's wife, Colleen Knorr, ("Mrs. Knorr"), was a resident of Petitioner's skilled nursing facility. On May 23, 2007, Respondent made application for his wife's admission to Petitioner's facility. Petitioner and Respondent entered into a written Admission Agreement ("Agreement"), which provided that Petitioner would provide skilled nursing care and services to Mrs. Knorr in exchange for the payment of a specific monetary fee from Mrs. Knorr's income or resources. Additionally, in the event that Mrs. Knorr became insolvent, Respondent promised to make application for Medical Assistance benefits "in a timely and proper manner" and provide all of the necessary ORIGINAL documentation for an eligibility determination to be made. See Exhibit "A" to Complaint. While a resident at Petitioner's facility, Mrs. Knorr allegedly became insolvent, and Petitioner requested that an application for Medical Assistance benefits be filed pursuant to the Agreement. Subsequently, an application for Medical Assistance benefits was filed and that application was denied on July 18, 2007. While Petitioner filed an appeal of that denial, which is currently pending before the Bureau of Hearings and Appeals of the Department of Public Welfare of the Commonwealth of Pennsylvania, if those documents needed by the Cumberland County Assistance Office ("CAO") are not provided prior to or at the time of the hearing, the application and appeal will ultimately be denied. If Respondent is not compelled to assist with the Medicaid application process, Petitioner will be left without a reasonable remedy to secure complete payment for the care and services that Petitioner provided to Mrs. Knorr. Consequently, an injunction is necessary to compel Respondent to produce the requisite records needed for a determination to be made as to the eligibility of Mrs. Knorr for Medical Assistance benefits. II. Question Presented Whether Petitioner Is Entitled To A Preliminary Injunction? Suggested Answer: Yes. 2 III. Factual Background On May 23, 2007, by and through her husband, Respondent, applied for admission to Petitioner's skilled nursing facility. Pursuant to the Agreement into which Respondent entered, Respondent promised to make prompt payment for the care and services rendered to Mrs. Knorr from his wife's resources. In addition, if Mrs. Knorr became insolvent, Respondent further agreed that he would secure Medicaid in a timely and proper manner, that she would cooperate with Petitioner by providing the necessary financial information, and that he would abide by Petitioner's policies and procedures. When Mrs. Knorr became insolvent, an application for Medical Assistance benefits was filed on her behalf, and that application was denied on July 18, 2007. While an appeal of the denial of the application for Medical Assistance benefits was filed, a hearing on the appeal will soon be scheduled on the matter. When scheduled, the main issue at the hearing will be whether the required financial documentation is available. If Respondent fails to provide the documents requested by the CAO prior to or at the time of the hearing scheduled on the aforementioned appeal, the appeal will be denied, and any further appeal to the Commonwealth Court would be without merit. IV. Ar ument An injunction is an extraordinary remedy, the issuance of which is solely within the trial court's discretion. Soja v. Factoryville Sportman's Club, 522 A.2d 1129,1131 (Pa. Super. 1987). The burden is on the party seeking the injunction to establish the following elements: 3 (1) [T]he injunction is necessary to prevent immediate and irreparable harm that cannot be adequately compensated by damages; (2) [G]reater injury would result from refusing an injunction than from granting it, and concomitantly, that issuance of an injunction will not substantially harm other interested parties in the proceedings; (3) [A] preliminary injunction will properly restore the parties to their status as it existed immediately prior to the alleged wrongful conduct; (4) [T]he activity it seeks to restrain is actionable [and] ... its right to relief is clear...; (5) [T]he injunction it seeks is reasonably suited to abate the existing activity; and (6) [A] preliminary injunction will not adversely affect the public interest. Warehime v. Warehime, 860 A.2d 41, 46-47 (Pa. 2004) (internal citations and quotations omitted). In addition, in order for Petitioner to comply with Pa. R.C.P. 1531(b) Petitioner avers that a bond in the amount of $100.00 should be adequate to protect Respondent in the event that it is later determined that the issuance of the instant petition was in error. A. Sufficient legal basis exists for this Court to issue an injunction, as Respondent has breached the Agreement with Petitioner. Respondent breached the Agreement into which he entered with Petitioner, the appropriate remedy for which, on the facts of this case, is an injunction requiring the specific performance of that Agreement between the parties. Petitioner provided care and services to Mrs. Knorr in accordance with the terms of the Agreement. However, Respondent has not abided by his promise to secure Medical Assistance benefits on Mrs. Knorr's behalf by providing the information that the Cumberland County 4 Assistance Office requires to qualify Mrs. Knorr for benefits. As will be shown, based on the application of the aforementioned legal factors to the facts before this Court, it is clear that Petitioner is entitled to the relief requested, and an injunction should be granted to order and to ensure that Respondent abides by the terms and conditions of the Agreement into which he entered with Petitioner. B. Petitioner is entitled to a preliminary injunction. 1. The breach of the Agreement by Respondent has caused immediate and irreparable harm to the interests of Petitioner for which a legal remedy is inadequate in this case. Respondent's breach of the Agreement with Petitioner, by refusing to provide the necessary documentation requested by the Cumberland County Assistance Office to qualify Mrs. Knorr for Medical Assistance benefits, presents an issue of immediate and irreparable harm to Petitioner. Mrs. Knorr has not, and apparently cannot, pay for the skilled nursing care that Petitioner provided to her, and Petitioner has incurred, without payment, significant costs in providing said care. Therefore, any legal remedy sought from the income and assets of Mrs. Knorr is inadequate. However, under the pending application for Medical Assistance benefits, if Mrs. Knorr is insolvent, she would qualify for Medical Assistance benefits, and Petitioner would receive payment for the care and services that it provided to her. But if Respondent fails to provide the financial documentation to determine whether Mrs. Knorr is eligible for benefits, the application will be finally denied and the ability to secure repayment from Medical Assistance for the services provided will be forever lost. Therefore, the continued failure of Respondent to 5 produce the documentation necessary to qualify Mrs. Knorr for Medicaid has caused and will cause irreparable harm to Petitioner. 2. Greater injury will result if the injunction is not granted The issuance of an injunction under the circumstances of this case is further appropriate because significant harm would result from the denial of the requested injunction than from the granting of the same. By denying the injunction, the Court would be allowing the appeal of the denial of the application of Mrs. Knorr for Medical Assistance benefits to fail. Once that appeal fails, all chance at reimbursement for the preceding and subsequent months of care rendered would be lost and any subsequent application would only provide coverage prospectively. Conversely, what harm would result to Respondent from the issuance of the injunction? Respondent contractually agreed to secure Medical Assistance benefits for his wife and to cooperate in that process of securing benefits. He has not abided by his contractual duties. The injunction would in fact benefit Respondent by allowing him to secure much needed Medical Assistance benefits for his wife, particularly since, upon information and belief, there are inadequate assets to fully compensate Petitioner for the care and services it has rendered to Mrs. Knorr in accordance with the terms and conditions of her admission. 3. The requested injunction would restore the parties to the status uo. The issuance of the injunction will put the parties back into the position in which they existed at the time of the admission of Mrs. Knorr to Petitioner's skilled nursing 6 facility. Simply put, Respondent is contractually obligated to timely apply for Medical Assistance benefits on behalf of his wife and to cooperate in the application and appeal process by providing the financial documentation necessary to secure benefits for his wife. Petitioner has provided Mrs. Knorr with skilled nursing care and services, but Respondent has failed to fulfill his contractual duties. In short, the injunction would require Respondent to perform his contractual duties and restore the parties to the status quo. 4. Petitioner's right to relief is clear. As set forth in the Complaint against Respondent, Petitioner's right to relief could not be clearer. The injunction seeks to abate the ongoing breach of the Agreement effectuated by Respondent's refusal to produce documentation to establish the eligibility of Mrs. Knorr for Medicaid and his refusal to cooperate in the process to secure those benefits. The contract is clear that Respondent would secure Medical Assistance benefits for his wife. He has no excuse for withholding the required records or for not cooperating with the process. 5. The in is suited to abate the harm and protect the Petitioner's interests. An injunction that simply requires Respondent to provide the records is reasonably limited and abates the harm. Determining Respondent's compliance with an injunction of such limited scope will not be a significant burden to this Court because it is merely a question of whether Respondent turns over those records or 7 whether he continues to withhold them, thereby perpetuating an ongoing harm to Petitioner's interests. 6. Granting this injunction is in the public interest. Petitioner requests this injunction to hold Respondent to his contractual obligations. It is in the public interest to both encourage a party to fulfill his duties under a contract into which he has entered willingly and voluntarily and to ensure that those institutions that provide skilled nursing care for its residents are fully compensated. Accordingly, it is unlikely that Respondent would be able to articulate a valid reason why the injunction should not be granted, for such a remedy clearly is not only within Petitioner's and Respondent's interests, but also in the interests of the public. 8 . 1 V. Conclusion: Based on the above, Petitioner respectfully requests that this Court issue a decree ordering Respondent to complete the application process for Medical Assistance benefits filed for Mrs. Knorr, including providing the requisite financial records needed by the CAO to determine her eligibility for benefits. Respectfully submitted, SCHUTJER BOGAR LLC Dated: By: Bradle A. Schutjer Attorney I.D. No. 75954 (717) 909-5921 Mariclare L. Hayes Attorney I.D. No. 201289 (717) 909-5922 417 Walnut Street, 4th Floor Harrisburg, PA 17101 Attorneys for Petitioner 9 CERTIFICATE OF SERVICE I hereby certify that a true and correct copy of the foregoing Brief in Support of Petition for Preliminary Injunction was served via fist-class, United States mail, postage prepaid, upon the following: Forrest Knorr 1182 Pottsville Street Lykens, PA 17048 Dated: 4 ? 0 8 By: William Keslar, Paralegal I . -0. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA GOLDEN LIVING CENTER - WEST SHORE HEALTH AND REHABILITATION, Plaintiff, V. FORREST KNORR, Defendant No. 07-7636 CIVIL ACTION - EQUITY PRAECIPE TO WITHDRAW PETITION FOR PRELIMINARY INJUNCTION TO THE PROTHONOTARY: Kindly mark the Petition for Preliminary Injunction, filed in the above- captioned matter on January 11, 2008, as withdrawn. Consequently, the Preliminary Injunction hearing scheduled for January 30, 2008 at 9:30 a.m. is no longer necessary. Respectfully submitted, SCHUTJER BOGAR LLC Dated: G kma By: Cha ick O. Bog Attorney I.D. 83755 (717) 909-5920 Maria Macus-Bryan Attorney I.D. 90947 (717) 909-8640 417 Walnut Street, 40, Floor Harrisburg, PA 17101 Attorneys for Plaintiff CERTIFICATE OF SERVICE I hereby certify that a true and correct copy of the foregoing Praecipe to Withdraw Petition for Preliminary Injunction was served via overnight delivery, upon the following: Christian S. Daghir, Esquire ETZWEILER AND ASSOCIATES 105 North Front Street Harrisburg, PA 17101 (Attorney for Defendant) Dated: i a By: O&UIVAI, L&J?IL#03 Catherine Klobucar, Paralegal IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA GOLDEN LIVING CENTER - WEST SHORE HEALTH AND REHABILITATION, Petitioner, V. No. 07-7636 FORREST KNORR, : Respondent. CIVIL ACTION - EQUITY ORDER AND NOW, this Q J /09"' day of a-!r? i , 2008, in consideration of the parties' Stipulated Agreement, it is hereby ORDERED AND DECREED that: 1. Within fifteen (15) days of the date of this Order, Forrest Knorr shall take any and all actions needed and provide any and all records within his possession that are required by the Cumberland County Assistance Office for the pending application to determine Colleen Knorr 's eligibility for Medical Assistance benefits and diligently work to secure any and all other documents necessary to obtain benefits on Colleen Knorr`s behalf. 1 VINVAIAGMA-d sS o Nd ! E Nfr am AHVIO H.iOdd 3Hi 3O 3012a0-OMd IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA GOLDEN LIVING CENTER - WEST SHORE HEALTH AND REHABILITATION, Petitioner, V. No. 07-7636 FORREST KNORR, Respondent. CIVIL ACTION - EQUITY RETURN OF SERVICE I HEREBY CERTIFY THAT: I, Catherine Klobucar, served the annexed Order upon the following: Christian S. Daghir, esquire ETZWELER AND ASSOCIATES 105 N. Front Street Harrisburg, PA 17101 Service was made via first-class, United States mail, certified, return receipt requested, on February 5, 2008. A copy of the receipt evidencing service is attached hereto. I declare under penalty of perjury under the laws of the United States of America that the foregoing information contained in the Return of Service is true and correct. Date d: By: Catherine Klobucar SCHUTJER BOGAR LLC 417 Walnut Street, 41h Floor Harrisburg, PA 17101 ¦ Complete items 1, 2, and 3. Also complete a S re item 4 N Restricted Delivery is desired. ? Agent ¦ Print your name and address on the reverse ??- ? Addressee so that we can return the card to you. 13 Received Name) C. Date of Delivery ¦ Attach this card to the back of the mailpiece, u \ , ?.?- or on the front if space permits. h Cyr I 1. Article Addressed to. D. Is delivery address different from item 1? ? Yes It YES, enter delivery address below: ? No CGnr ?s?ha??Ddgh?r,?? 1 N . ??ro ri SJf-42Q ?--A ko ? r ? Sb ?un`rY'f Or 1 Type ?rcl T Mall ? Express Mail ? Registered ? Return Receipt for Merchandise ? Insured Mail ? C.O.D. 4. Restricted Delivery? {Extra Fee) ? Yes 2. Article Number 7007 0710 0000 8338 5591 (transfer horn service fabo Ps Form 3811, February 2004 Domestic Return Receipt 102595-02401-1540 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA GOLDEN LIVING CENTER - WEST SHORE HEALTH AND REHABILITATION, Petitioner, V. No- 07-7636 FORREST KNORR, Respondent- CIVIL ACTION - EQUITY ORDER AND NOW, this day of - 2008, in consideration of the parties` Stipulated Agreement, it is hereby ORDERED AND DECREED that: 1. Within fifteen (15) days of the date of this Order, Forrest Knorr shall take any and all actions needed and provide any and all records within his possession that are required by the Cumberland County Assistance Office for the pending application to determine Colleen Knorr's eligibility for Medical Assistance benefits and diligently work to secure any and all other documents necessary to obtain benefits on Colleen Knorr's behalf. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA GOLDEN LIVING CENTER - WEST SHORE HEALTH AND REHABILITATION, Petitioner, V. No. 07-7636 FORREST KNORR, Respondent. CIVIL ACTION - EQUITY STIPULATED AGREEMENT Golden Living Center - West Shore Health and Rehabilitation ("Petitioner') and Forrest Knorr ("Respondent") stipulate and agree to the following: On December 20, 2007, Petitioner filed a Complaint against Respondent, the spouse of one of Petitioner's residents, Colleen Knorr ("spouse"). 2_ The Complaint sets forth a single claim against Respondent based on his failure to specifically perform the terms of the Admission Agreement ("Agreement") entered into with Petitioner. See Complaint Exhibit "A." Specifically, the Complaint alleges that Respondent failed to assist his spouse in the application for Medical Assistance by failing to provide the verification of reduced resources needed by the Cumberland County Assistance Office. 3. An appeal of the denial of Medical Assistance benefits for Mrs. Knorr was filed on November 8, 2007, and is currently pending before the Cumberland County Assistance Office of the Department of Public Welfare. 4. The parties agree to the entry of an Order directing Respondent to provide any and all records within his possession and take any actions as required by the Cumberland County Assistance Office to determine the eligibility of Mrs. Knorr for Medical Assistance benefits within fifteen (15) days of the date of the Order and to diligently work to secure any and all other documents necessary to obtain benefits on Mrs. Knorr's behalf. That Order is attached as Exhibit "A." 7. Petitioner agrees to withdraw, without prejudice, its Petition for a Preliminary Injunction. Respectfully submitted, Dated: Dated: 22 f D By: Mari are L. Hayes Attorney for Petitioner By: Forrest Knorr 2 EXHIBIT "A" IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA GOLDEN LIVING CENTER - WEST SHORE HEALTH AND REHABILITATION, Petitioner, v_ FORREST KNORR, Respondent ORDER AND NOW, this day of No. 07-7636 CIVIL ACTION - EQUITY 2008, in consideration of the parties` Stipulated Agreement, it is hereby ORDERED AND DECREED that: 1. Within fifteen (15) days of the date of this Order, Forrest Knorr shall take any and all actions needed and provide any and all records within his possession that are required by the Cumberland County Assistance Office for the pending application to determine Colleen Knorr's eligibility for Medical Assistance benefits and diligently work to secure any and all other documents necessary to obtain benefits on Colleen Knorr's behalf. BY THE COURT C) t? sue' of . J rrs IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA GOLDEN LIVING CENTER - WEST SHORE HEALTH AND REHABILITATION, Plaintiff, V. FORREST KNORR, Defendant. No. 07-7636 CIVIL ACTION - EQUITY PRAECIPE TO SETTLE. DISCONTINUE. AND END TO THE PROTHONOTARY: Kindly mark the above-captioned matter as Settled, Discontinued, and Ended without prejudice. Respectfully submitted, SCHUTJER BOGAR LLC Dated:17 ByJBdley A. Schutjer Attorney I.D. No. 75954 (717) 909-5921 Maria G. Macus-Bryan Attorney I.D. No. 90947 (717) 909-8640 417 Walnut Street, 4th Floor Harrisburg, PA 17101 Attorneys for Plaintiff CERTIFICATE OF SERVICE I hereby certify that a true and correct copy of the foregoing Praecipe to Settle, Discontinue, and End was served via fist-class, United States mail, postage prepaid, upon the following: Christian S. Daghir, Esquire ETZWEILER AND ASSOCIATES 105 N. Front Street Harrisburg, PA 17101 (Attorneys for Defendant) Dated: D G??5- By: Christy A. Long, Paralegal CQ ..{