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Home My WebLink About04-0550Brian J puhala, Esq. PA52677 Hait & Puhala, P.C. The Wellington 17 E High St STE 101 Carlisle, PA 17013-3047 (717) 249-4500/263-7444 249-2411 (fax) Attorney for Plaintiff MICHAEL McLEAN, Plaintiff TIM WILBUR MECHANICAL CONTRACTING, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND, PENNSYLVANIA Civil Action - Law PRAECIPE FOR ENTRY OF DEFAULT JUDGMENT PURSUANT TO SECTION 428 OF THE WORKERS' COMPENSATION ACT, 77 P.S. §921 Pursuant to section 428 of the Workers' Compensation Act, 77 P.S. 921, enter judgment against Defendant in the mnount of $30,000.00, plus continuing compensation as provided by the Workers' Compensation Act, as specified by section 406.1 of the Workers' Compensation Act, based upon the following: Michael McLean was an employee of Tim Wilbur Mechanical Contracting on or about October 16, 2002 when he sustained an injmy in the course of his employment. Mr. McLean filed a Claim Petition and a Penalty Petition pursuant to the Pennsylvania Workers' Compensation Act. Certified copies of those petitions are filed concurrently with this ?raecipe. During the litigation of the petitions, Claimant was made aware that Tim Wilbur Mechanical Contracting did not have workers' compensation insurance at the time of the alleged injury. A copy of the search from the Ratings Bureau is attached hereto showing no workers' compensation insurance carded by Tim Wilbur Mechanical Contracting from 7/8/02 through 5/2/03. 3. By operation of section 428 of the Workers' Compensation Act, Plaintiff is entitled to a protective judgment against Defendant for failing to carry workers compensation insurance at the time of his alleged work injury. Dated: Respectfully submitted, Hair& Puhala, P.C. Brian J Puhala PA52677 The Wellington 17 E High St STE 101 Carlisle PA 17013-3047 (717) 249-4500 AFFIDAVIT I verify that I have personal knowledge of all facts not of record set forth in the foregoing Praecipe, and that such facts are true and correct, to the best of my knowledge, information, and belief. I acknowledge that any false statements herein are made subject to the penalties of 18 Pa.C.S. 4904, relating to unsworn falsification to authorities. Brian J Puhala · Received BWG2003-04-28 · COMMO~IWEALTH OF PENNSYLVANIA DEPARTMENT OF LABORAND INDUSTRY BUREAU OF WORKERS' COMPENSATION 1171 B CAMERON STREET, ROOM 103 HARRISBURG, PA t7104-2501 ¢'OLL FREE) 800-482-2383 PETITION FOR PENALTIES Social Security Number: __1_90~._.6.0. -_9379 Date of Injunj: __t_0_/_-1-6_ L20_02 PA BWC Claim Number: (if K.o~) Employee MICHAEL __ _ MclEAN 26 Oak Ln Perry ~_ly~ _q82_ -=4~2_~_0_ __ Injury Lumbar Baok Injury Check ff Oc~.~patmnal Diseas~ Zl VS. TJM_WI_ LBU. R _M E~H_AN[~._AL_CONT _RAC:r_ IN G i 50_7_ _N_Y_a~_S.~t Stree~ 2 Cumberland ! (.7_1Z).7._6~-~ s_5_9 ........ PA_ 17055. Insurer or Third Party Administrator (if self4nsured) PLEASE ENTER MY APPEARANCE FOR PETITIONER: Attorney ..... Brian J Puhala ....... ~ Halt & Puhala PC The Wellington Suite 101 ............... Carlisle (717) 249-4500 ..... PA 17013 - 3047 526_ _"~7_ .......... Counsel for Respondent (if known) L--.) __'~ ...... NOTICE: This petition should be cleady completed (preferably ~ped) and original mailed to the Bureau at the address in the upper left corner. 686 297 uec~ee REV 9-02 (OVER) LI8C~.68.~ The aforementioned Employee, or his/her Representative, Brian J Puhala believes that the aforementioned Insurer, TPA, or Self-insured Employer has violated the terms of the Workers' Compensation Act and/or Regulations in the processing or payment of compensation to the Employee(s) in that: (Specify, in detail, the nature of the alisged violation(s) and the Section of the Law/Regulation which applies. Attach an additional sheet, if necessary.) Employer failed to properly acknowledge the injury ~thin twen~-one days of the DOl. Furthermore, Employer asked Claimant to resign his position shortly after the injury date when it was apparant that Claimant was unable to continue working. 2. Further, the Employee requests that the Insurer, TPA, or Self-insured Employer be required to pay penalties in the total amount of $ __, which represents __ percentage of the compensation to which the Employee was entitled, but [] not paid which was [] paid late for the period from 1~0/ 16 / 2002 to PR/~E~_./_ENT [] illegally suspended WHEREFORE, the Employee requests that the Department of Labor and Industry require the Insurer, TPA, or Self-insured Employer to answer this PeffiJon within twecty(20) days ofeervice of this Petition on the adverse parties as provided for by Section 416 of the Workers' Compensation ,~t, and to schedule such hearings as are necessary to determine and grant the relief requested in the previously mentioned paragraphs. DATE OF THIS NOTICE: 04/._2_5_/;~003 Petitioner .M.j.c.h. ~_e.l , MqLean Any individual filing misleading or incomplete informedon knowingly and with intent to defraud is in violation of Section 1t02 of the Pennsylvania Workers' Compensation Act and may also be subject to criminal and civil penalties through Pennsylvania Act 165 of 1994. ~ecei~/~U' BWC 2003-04-28 -.ff. 0 document Index - <undefined> Class - CIMS DOCUMENT CLAIM NUMBER 2503223 USER ID msch~eff FORM CODE 686 I297-1 LAST NAME MCLEAN FIRST NAME MICHAEL DATE OF INJURY 10/1~/2G02 SCANNED TIMESTAMP 2003-04=28-00.00.00.000000 CURRENT BASKET TIMESTAMP 2003-05=01-08.~7.16.000000 SSN 190609379 BATCH ID 21190G87 · Rec-~ived BWC 2003-04-28 CLAIM PETITION FOR WORKERS' COMPENSATION / 190609379 10/16/2002 EMPLOYEE F~rst Name MICHAEL Last Name MoLEAN If Deceased - Dependent or Guardian First Name Last Name Aclclmss 26 Oak Ln Address City/Town Shermansdale County Perry Telephone 7175824290 State PA Zip 17090 VS E~EL.O_Y_E e Nome TIM WILBUR MECHANICAL CONTRACTING Address 507 N York St Address City/rowe Mechanicaburg State PA 7dp 17055 County Cumberland Telephone 7177668559 INSURER or THIRD PARTY ADMINISTRATOR (if se~f-insumd) _ Name Address Address cr~/Towa State Zip Telephone Bureau Code County Claim # FEIN t. Complete description of injury or illness including afl parts of body affectS. 0~u m seeking ~ com~ense~n Subsequent Inju ~/Fend fo~ to~a[ diseb~lrb* se a ~seult ora pm~oue pem~anent loss, o~ Joss ef use of one hand, o~e am1, one fo~ one leg e~ or~e eye, anti a subsequent InJue~ causing lOSS, er h3ss of use of;, enamor hand, am~ fo~t, ~eg or e.~ you must am ~utxnlt form LlBC.a7S.) Lumbar back injury. MONIH DAY YEAR 2. If occupational disease, give the Fast date of employment and/or last date of exposure MONTH DAY 3. Give date of injury or onset of disease 10/16/2002 YEAR 4. How did the injury or disease happen? On the date of injury, Claimant was unloading a toolbox offthe back ora truck and felt a pop in his lower back. He dropped the toolbox on the floor. 5. Did injury or disease occur on employer's premises? x Yes No Where? (Be specific.) 6. Notice of your injury or disease was sewed on your employer on following manner. Advised the aselstant manager, Tony. Tony told Claimant to go home. 7. What was your Job title at the time of Inju~ or disease? Plumber/Laborer L_ LleC-362 REV 4-02 (OVER) MONT~ DAY YE.~R 10/16/2002 Jn the 362 1197-1 9. Did this problem cause you to stop working? x Yes No If Yes, give date. 10/2312002 10. Are you back to work with the same employer?. Yes x No If Yes, Regular Job Other Job t Give Title. 11. Are you working with another employer?. Yes x No tf Yes, give name and address of new employer:. 12. What were your wages at the time of injury? $ 8.00 XHour Day orWeek 13. if you have returned to work since your injury or illness, are you earning than you were at the time of injury? Current samings $ 14. I am seeldng payment for (check all that apply): More Same Less Hour Day X Loss of wages X Partial disabili~ from 10116/2002 to 10/23/2002 YEAR x Full disability from 10/2312002 to X Medical bills (give name of doctor/hospital, address, type of treatment and bill in space below). Non"nan Plank DC x Counsel fees to be paid bythe employer. 21 W Pomfret St Loss or loss of use of arm, hand, finger, leg, toot or toe. Carlisle PA 17013 Disfigurement (scars) of head, face, or neck. Cont~uad on a Separate Page orWesk Present Loss of sight. LOSS of hearing. 15. Other 16, Is there other pending litigation in this case? Yes x No If Yes, explain below: PLEASE ENTER MY APPEARANCE FOR PETITIONER: Attorney Name Briall J Puhala PA^tthmey ID Number 52677 Rrm N~e Hair & Puhala PC Add,ess The Wellington Suite 101 Address 17 E High St c~£re~'~n Carlisle Stete PA Te~=phene 7172494500 Zip Code 170133047 Date of PetYaon 04/25t2003 A c~py ef this petition has be.~n ~ast to the employer. Signature x Employee Attorney NOTICE: This Petition must be filled out as fully as possible. The original m~st be sent to the Bt~reau ef Workers' Compensation, 1171 Sooth Cameron Street, Room 103, Harrisburg, PA 17104~2501, A ¢op¥ muet be sent by y~u ~ the employer, toformetlon on the completisn ; of this form may be obtained by =ailing the Bureau of WoOers' Compensafion Helpline at 800~182-2383. Any ind,v[~ual filing m~eeding or incomplete information kaowingly and with intent to dcfratzd is in v~olet[on of Sect[on 1102 of the Pennsylvania Workem' Compensation ~y also bo subject to criminal end chnl peaalfles through Pennsylvania Act t65. LIBC-362 REV 4-Q2 Receiyed BWC 2003-04-28 MICHAEL I~Ic~_EAN Claimant, v. TIM WILBUR MECHANICAL CONTRACTING Defendant. S.S. No. 190609379 Date of Injury: 10/16/2002 Claim Petition for Workers' Compensation - Cont. Page 1 '3 14. Medical Bills Bdan Uniacke MD 5 Willow Mill Park Rd Mechanicsburg PA 17055 Received BWC 2003-04-28 · Received. BWC 2003-09-08 LTR-005 RE%; 09/0S/00 COMMONWF. ALTH OF Pt~'NSYLVANIA DEPARTMENT OF LABOR AND INDUSTRY BURF~AU OF WORKERS'COMP~NSAT/O~ 71%7834419 Circulation Date: 08/29/2003 CHARLES CLARK HARRISBURG JUDGES OFFICE EAST GATE CEi~TER 1010 NORTE SEVENTH STREET HARRISBURG PA 17102-1400 INTERIM/INTERLOCUTORY DECISION COVER LETTER Bureau Claim Number: 2503223 Insurer Claim Number: Pggtio~s: Claim-Pet Penalty-Pc! MICHAEL MCLEAN 26 OAK LN SHERMANS DALE, PA 17090 BRIAN J PUHALA, ESQ HAIT & PUHALA PC THE WELLINGTON STE 101 17 E HIGH ST CARLISLE, PA 17013 Us TIM WILBUR MECHANICAL CONTRACTING 507 N YORK ST MECHANICSBURG, PA 17055 COMMONWEALTH OF PENNSYLVANIA BWC LEGAL DIV 1171 S. CAMERON STREET ROOM 327 HARRISBURG, PA 17104-2501 Judge: Charlc~ Clark East Gate Ccntcr 1010 North Seventh Street Harrisburg, PA 17102-1400 DECISION Attached is an Intefim/Intarlocmory Order of the Judge. This Order does not constitute a final disposition of the P~dtion. A hearing on the merits of the Petition will be conducted at a time and place fixed by the Judge. This Interim/Interlocutory Order is not subject to appeal Page I of 2 ~R~ceived BWC 2003-09-08 Emulovee Witnesses & Exhibits: Michael McLean C-01 Pay Stubs C-02 Fcc Agreement C-03 Letter dated 7/30/2003 Emolover Witnesses & Exhibits: None Hearings: 9/23/2003 13:00:00 7/9/2003 13:00:00 Held MICHAEL MCLEAN ~ 2503223 21 Page 2 of 2 Re~ived. BWC 2003-09-08 ~' · MICHAEL MCLEAN Bureau Claim #2503223 Claim/Penalty Page 1 of 2 RECORD: This matter arose on April 25, 2003 when Michael McLean, hereinafter called the claimant, filed a claim petition. A hearing was held in this matter on July 9, 2003. The employer appeared and indicated that they had filed an answer to the petition with the Department of Labor and Industry. This Judge has found that the answer allegedly filed by the employer, Tim Wilbur Mechanical Contractors, is unavailable to this Judge, therefore, the motion for relief under the Yellow Freight ease filed by the claimant is granted. Accordingly, this Judge issues the following order: INTERLOCUTORY ORDER: AND NOW, to wit, on this 29th day of August, 2003, the claimant's motion under the Yellow Freight case is hereby granted. This claimant's claim petition is deemed to be admitted as there was no answer filed according to the Act. Section 416 of the Pennsylvania Workers' Compensation Act, as amended, provides: "Within 15 days after a copy of any claim petition or other petition has been served upon an adverse party, he may file with the department or its referee an answer in the form prescribed by the department. Every fact alleged in the claim petition, not specifically denied by an answer filed by any adverse party, shall be deemed to be admitted by him. But the failure of any party to deny a fact alleged in any other petition shall not preclude the referee before whom the petition is heard from requiring, of his own motion, proof of said fact. Ifa party fails to file an answer and/or fails to appear in person or by counsel at the heating without adequate excuse, the referee hearing the petition shall decide the matter on the basis of the petition and evidence presented." As there is no evidence in this record available to this Workers' Compensation Judge that the employer, as the adverse party, has filed an Received BWC 2003-09-08 MICHAEL MCLEAN Bureau Claim #2503223 Claim/Penalty Page 2 of 2 answer to the petition, the claim petition is deemed admitted and this Judge supports this with this final order: On this 29th day of August, 2003, the clam petition filed herein is hereby deemed to be admitted, subject to proof as provided in Section 416 of the Act. There is no evidence that the adverse party, the employer, filed an answer in this case. Under the Yellow Freight series of cases, this petition, therefore, is deemed admitted. A further hearing will be scheduled and held to allow the claimant to offer into evidence testimony and documentary evidence in support of his claim petition as to the extent established by the Yellow Freight case. CFC/bem August 29, 2003 Charles F. Clark Workers' Compensation Judge OBC-a75 REV 6-01 Han-isburg, PA 1710~ BUREAU OF WORKERS' COMPENSATION January 29, 2004 www. dli.state.pa.us The foregoing is hereby certified to be a true and and correct copy of the Record in the case of Michael McLean v. Tim Wilbur Mechanical Contracting, S.S. #190-60-9379. D/I 10/16/02 as full, entire, and complete as the same remains on file in the Bureau of Workers' Compensation of the Department of Labor and Industry. Certified this 2 9 t h day of January 2004 Cblef Claims Management Division ATTEST: I hereby certify that Nathaniel M. Holmes , who signed the foregoing, was at the time of signing, Chief, Claims Management Division, Bureau of Workers' Compensation, and ns such, was the legal custodian of the above-described records. IN TESTIMONY WHEREOF, I have hereunto set my hand and caused the seal of the Department of Labor and Industry to be affixed on this 29th dayof January , 2004 Seal of thc Department of Labor and Industry Bureau of Workers' Compensation 1171 South Cameron Street, Room 103 Harrisburg, PA 17104-2501 800-482-2383 717-772.4447 wv, w.dll.state.pa.us/bwc 7/31/2003 BRIAN J. PUHALA, ESQUIRE HAlT & PUHALA. P.C. THE WELLINGTON 17 E. HIGH STREET - SUITE 101 CARLISLE, PA 17013-3047 Dear BRIAN J. PUHALA, ESGUIRE: This is in response to your inquiry for workers' compensation coverage for: TIM WILBUR MECHANICAL CONTRACTING 507 N. YORK STREET MECHANICBBURG, PA =---- COVERAGE DATE(S): OCTOBER 16, 2002 A search of the files, which have currently been made available to the Bureau of Workers' Compensation by the Pennsylvania Compensation Rating Bureau, discloses that the above employer:. XX 1) Was carrying Pennsylvanfa workers' compensation coverage with: NORGUARD INSURANCE COMPANY under policy number: TIWC308316 effective date: 03-09-02 TO 03-09-03 CANCELED 07-07-02. STATE WORKERS INSURANCE FUND under policy number: 0489751)91031 effective date: 054)3-03 TO 05.034)4. under policy number: effective date: . 2) Failed to disclose Pennsylvania workers' compensation coverage for the date(s) in question. 3) No record of this employer. 4) Date Records Checked 07131t03. 5) Other. PLEASE NOTE: The Bureau of Winkers' Compensation is providing this information as a courtesy to the inquirer. The actual source ofthe information provided ia the Pennsylvania Compensation Rating Bureau. The Bureau of Workers' Compensation neither creates nor maintains the files searched and ia not responsible for Inaccurate information. Claims Information Help Line IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION PRAECIPE FOR WRIT OF EXECUTION MICHAEL McLEAN, Plaintiff TIM WILBUR MECHANICAL CONTRACTING, /~ ~,,~,~=~ v,~ ~ ~ Defendant ( ) Confessed Judgment ( ) Other File No. 04-550 Amount Due: $30,000 Interest: $$8.21/day from 6~4~04 until paid ; Atty's Comm: $ TOTHEPROTHONOTARYFOTHESAIDCOURT: ~ ~ ° "'7// ~,/~¢. ~ .~: Z..Cf, The undersigned hereby certifies that the below does not arise out of a retail installment sale, contract, o~-- account based on a confession of judgment, but if it does, it is based on the appropriate original proceeding filed pursuant to Act 7 of 1966 as amended; and for real property pursuant to Act 6 of 1974 as amended. Issue writ of execution in the above matter to the Sheriff of Cumberland County, for debt, interest and costs, upon the following described property of the defendant(s) All property of Defendant located at its place of business at 507 N York St, Mechanicsburg, PA 17055, and any place where it is doing business. PRAECIPE FOR ATTACHMENT EXECUTION Issue writ of attachment to the Sheriff of Cumberland County, for debt, interest and costs as above, directing attachment against the above-named garnishee(s) for the following property 9if real estate, supply six copies of the description; supply four copies of lengthy personalty list) N/A And all other property of the defendant(s) in the possession, custody or control of the said garnishee(s). [] (Indicate) Index this writ against the garnishee(s) as a lis pendens against real estate of the defendant(s) described in the attached exhibit. Date: July 16, 2004 By: Brian J Puhala Esq PA 52677 The Wellington 17 E High St STE 101 Carlisle PA 17013-3047 (717) 249-4500 WRIT OF EXECUTION and/or ATTACHMENT COMMONWEALTH OF PENNSYLVANIA) NO 04-550 Civil COUNTY OF CUMBERLAND) CIVIL ACTION - LAW TO THE SHERIFF OF CUMBERLAND COUNTY: To satisfy the debt, ~nterest and costs due MICHAEL MCLEAN Plaintiff (s) From TIM WILBUR MECHANICAL CONTRACTING, 507 N YORK ST, MECHANICSBURG, PA 17055 (1) You are directed to levy upon the property of the defendant (s)and to sell ALL PROPERTY OF DEFENDANT LOCATED AT ITS PLACE OF BUSINESS AT 507 N YORK ST, MECHANICSBURG, PA 17055, AND ANY PLACE WHERE IT IS DOING BUSINESS. (2) You are also directed to attach the property of the defendant(s) not levied upon in the possession of GARNISHEE(S) as follows: and to notify the garnishee(s) that: (a) an attachment has been issued; (b) the garnishee(s) is enjoined from paying any debt to or for the account of the defendant (s) and from delivering any property of the defendant (s) or otherwise disposing thereof; (3) If property of the defendant(s) not levied upon an subject to attachment is found in the possession of anyone other than a named garnishee, you are directed to notify him/her that he/she has been added as a garnishee and is enjoined as above stated. Amount Due $30,000.00 Interest $8.21/DAY FROM 6/4/04 UNTIL PAID Atty's Corem % Arty Paid $37.00 Plaintiff Paid Date: 7/16/04 (Seal) REQUESTING PARTY: Name BRIAN J PUItALA, ESQ L.L.$ 0.50 Due Prothy $1.00 Other Costs CURTIS R. LONG Prothonotary fi' Address: THE WELLINGTON 17 E HIGH ST STE 101 CARLISLE, PA 17013 Attorney for: PLAINTIFF Telephone: (717) 249-4500 Supreme Court ID No. 52677 WRIT OF EXECUTION and/or ATTACHMENT COMMONWEALTH OF PENNSYLVANIA) NO 04-550 Civil COUNTY OF CUMBERLAND) CIVIL ACTION - LAW TO THE SHERIFF OF CUMBERLAND COUNTY: To satisfy the debt, interest and costs due MICHAEL MCLEAN Plaintiff (s) From TIM WILBUR MECHANICAL CONTRACTING, 507 N 'YORK ST, MECHANICSBURG, PA 17055 (1) You are directed to levy upon the property of the defendant (s)and to sell ALL PROPERTY OF DEFENDANT LOCATED AT ITS PLACE OF BUSINESS AT 507 N YORK ST, MECH~NICSBURG, PA 17055, ~ND ANY PLACE WHERE IT IS DOING BUSINESS. (2) You are also directed to attach the property of the defendant(s) not tevied upon in the possession of GARNISHEE(S) as follows: and to notify the gamishee(s) that: (a) an attachment has been issued; (b). the garnishee(s) is enjoined from paying any debt to or for the account of the defendant (s) and from delivering any property of the defendant (s) or otherwise disposing thereof; (3) If property of the defendant(s) not levied upon an subject to attaclmaent is found in the possession of anyone other than a named garnishee, you are directed to notify hirn/~er that he/she has been added as a gamishee and is enjoined as above stated. Amount Due $30,000.00 Interest $8.21/DAY FROM 6/4/04 UNTIL PAID Atty's Comm % Atty Paid $37.00 Plaintiff Paid Date: 7/16/04 (Seal) REQUESTING PARTY: Name BRIAN J PUHALA, ESQ L.L.$ 0.50 Due Prothy $1.00 Other Costs CURTIS R. LONG Prothonotary BY:~~''~ Deputy Address: THE WELLINGTON 17 E HIGH ST STE 101 CARLISLE, PA 17013 Attorney for: PLAINTIFF Telephone: (717) 249-4500 Supreme Court ID No. 52677 R. Thomas Kline, Sheriff, who being duly sworn according to law, states this writ is returned STAYED. Sheriff's Costs: Docketing 18.00 Poundage .94 Advertising Law Library .50 Prothonotary 1.00 Mileage 7.40 Surcharge 20.00 Levy Certified Mail Post Pone Sale Garnishee TOTAL $ 47.84 Advance Costs: 150.00 SherifFs Costs: 47.84 $102.16 Refunded to Atty on 09/13/04 Sworn and Subscribed to before me This ,~3~.axtay of~ :004 · Prothonotary So Answers; R. Thomas Kline, Sheriff By'Claudia A. Brewbaker