Loading...
HomeMy WebLinkAbout01-6483KELLEY S. BETTON, Plaintiff Vo CONSUMERS LIFE INSURANCE COMPANY, Defendant : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : : NO. 01- &¥P3 CIVIL TERM : : CIVIL ACTION - LAW : 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 are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the court without further notice for any money claimed in the complaint or for any other claim or relief requested by the plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Bar Association Lawyer Referral Service 2 Liberty Avenue Carlisle, PA 17013 (717) 249-3166 KELLEY S. BETTON, Plaintiff CONSUMERS LIFE INSURANCE COMPANY, Defendant : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : : NO. 01-&q~ CIVIL TERM : : CIVIL ACTION - LAW : : COMPLAINT AND NOW, comes the Plaintiff, Kelley S. Betton, by her attorney, William A. Addams of the Law Office of Michael J. Hanft, and makes the following complaint: 1. The Plaintiff is Kelley S. Betton, an adult individual who resides at 70 West Big Spring Avenue, Newville, Cumberland County, Pennsylvania. 2. The Defendant is Consumers Life Insurance Company, a corporation authorized to conduct insurance business in the Commonwealth of Pennsylvania with its offices and principal place of business at 1200 Camp Hill By-Pass, Camp Hill, Cumberland County, Pennsylvania 17011. 3. The Defendant issued a certificate of life and disability insurance to the Plaintiff effective April 12, 1999 to April 27, 2004 to provide disability benefits of $346.35 a month. The "Customer Copy" is attached as Exhibit "A." 4. The Plaintiff became totally disabled as defined in the policy of insurance on December 4, 2000 and gave notice and proof of loss to the Defendant on March 9, 2001 as stated on the attached Exhibit "B." 5. The Defendant's claims agent, Life Of the South, denied the claim by letter dated April 25, 2001 attached as Exhibit "C" based on the claim being "caused by preexisting conditions as defined in the policy." 6. The Plaintiff's disability is not a result of a preexisting condition, which is defined in the policy as one which caused her "to be totally disabled at any time during the six (6) month period immediately preceding the Effective Date." 7. The Plaintiff has complied with all policy provisions. COUNT I - BREACH OF CONTRACT 8. The Plaintiff continued to be totally disabled as defined in the policy. 9. As a result of the Plaintiff's disability, the Defendant is liable to her in the mount of $346.35 a month beginning December 4, 2000 and ending no later than April 27, 2004. WHEREFORE, the Plaintiff demands judgment against the Defendant for an amount not in excess of $25,000, plus interest and costs of suit, an amount within the jurisdiction of arbitration under the local rules of court. COUNT II - BAD FAITH 10. The allegations of Paragraphs 1-9 are incorporated herein by reference. 11. The Plaintiff's attorney wrote the letter of May 30, 2001 attached as Exhibit "D" to the Defendant's claims agent requesting an explanation of its denial of the claim. 12. Neither the Plaintiff nor its agent has responded to this request. 13. There is no reasonable basis for the Defendant's denial of the claim. 14. By its unreasonable denial of the claim, the Defendant has acted in bad faith towards its insured. WHEREFORE, the Plaintiff demands judgment against the Defendant for an amount not in excess of $25,000, plus interest and costs of suit, an amount within the jurisdiction of arbitration under the local roles of court. LAW OFFICE OF MICHAEL J. HANFT Willian~ Pff'~ddams - Attorney I.D. No 06562 19 Brookwood Avenue, Suite 106 Carlisle, PA 17013 (717) 249-5373 VERIFICATION Kelley S. Betton hereby verifies that the facts set forth in the foregoing Complaint are true and correct to the best of her knowledge, infomiation and belief, and understands that false statements herein are made subject to the penalties of 18 Pa. C.S. §4904 relating to unswom falsifications Exhibit A Group Policy No. · ~i ~:. ~ Certificate No. ,, ;:' ' ,~ ._._'" -;.~-Z-r. · ~ .. ':,~ A Member of ~ ~nsu~m Fina~l G~p - ... - CONSUMERS LIFE INSURANCE COMPANY MAILING~DDR~SS: Re; BOX 26, CAMP HILL, PENNSYLVANIA 17001:0026 EXECUTIVE:;~FEICE'.. 1.2~ C~P Hill B~-Pa~,~ Camp Hill, Pennsyl~nia 17011 HOME OFFICE: 1209 Orange Strut, Wilmin~n, Dela~re 19801 ~EDuLE: . (Street) Address !71~ tCFSI' ~It~ Name Of Co-Debtor (also called you) (C~yl (Stare) I'{EI~UILLE, PA lYEql Debtor'S ' ' Co-Debtor's FULl LIN BRI"IK Second Second Lender ' Beneficiary '~ Beneficiary Debtor [ Co-Debtor d. [ Age (Zip) Month Day Year ~tzl- [ EXPIRATION DATE 2/ { ~1~ .Disal:,lity ,,. :J20 months LIFE'INSURANCE DOES NOT COVER ANY'PERSON WHO.W LL BE AGE 71 OR OLDER ON THE F~PII~'~ib"N~D,~T~'~F':~:~=I~GE. DISABILITY INSURANCE DOES NOT ~IVER ;ANY, PERSONWHO WILL-BE. AGE 66 OR OLDER ON ,THE ExPIRATIOI~ ~DATE OF COVERAGE. -- ' ' ' , ? ",, P, tL%~" .C .-, . v' . ,. - - ~ '? .... :;" . ........ IMPORTA~. NOTIOE'REGARDING EXCLUSION OF PRE-alS"rING OONDITION8 \\ BENEFJT]E~Y,OOR DISABILI.TY¢.RESULTSi,FRo~ A:CONDITION.WHICH CAUSED YOU.'.TO BE,~'~)ISAB~ED AT ANY TIME',DURING ,THE SIX(6)'MgNTH'~PERjoD~dMMEOIAT,E, LY'RREGEOING:THE: EFFE,,_O?~~..~r.._.~E' CERTIFICATE. Either Debtor;mav a0olv.for Sinale IJf~..or,Si"gleDisability. Both Debtors may app~/. ~J, kife.~and/or Joint .Disability.... Y_es, I~wa~:the insurance chec.k.~,b~-N, ow~ ;_ ::. ~.~ , . -- I/' ~- : CrO~lit' "e' e o ....... ~,:- .:- or. - ,.,O-J~,,eD! r,. ' DIe S , ~' , ," , ,~ · .r-,.~ .-- · , . , . ,' . .... , . ,¢ ; . ....... ~ . - ~' BE~Mb~D'~,~,~.,~~~%DEB~:~DIOfl:~DEBT~~~FE~ xx ~D/OR DI~BI~ ~OE: ~J~ ~J~)c~dh'~r~r (~ludlug b~ ~s~~ di~, acquired immune deflcien~ syndrome (AIDS) 0r ~l?~S.o[~%~te~pomplex (ARC). ~ I ~r~t ...... ~4S ...... .,,, .. nsured C~,Debtor Yes D NO Are :mu aOveiy,;empL~ ~~n~) ~ minimbm of thi~ (30) hours a ~ek on the Ef~tive Date sh~n above? TO BE COMPLETED BY DEBTOR AND/0'R Has any person prOposed for insurance consulted twelve (12) months for cancer (excluding basal c or AIDS related complex (ARC)? TO BE COMPLETED Are you Insured Debtor No or treated by a medical practitioner during the last acquired immune deficiency syndrome (AIDS) ~ Ihs~recl Co-;Debtor Yes [] ' ! Nc~ ' [] DISABILITY COVERAGE: a minimum of thirty (30) hours a week on the Effective Date shown above? [] Insured Co-Debtor Yes [] No [] Do Not Sign This 3lank Spaces Applicable To The Debtor Electing The Coverage And To The Coverage Being Elected ~pplication is void and will not be used in a contest if all blank spaces have not and dated the application and if the application has not been witnessed. I/We apply described above. I/We represent the above statements are correct and comPlete to the best of my/our knowledge. I/We understand that false answers to the above questions may serve to void my/our insurance coverage. A copy of this Application and Certificate of Insurance was given to me/us on this date. Signature of InSur~'d Debtor Age Date Signature of Insured Co-Debtor Age /~Agent or Employee of Policyholder CERTIFICATE OF CREDIT DISABILITY INSURANCE ELIGIBILITY~ RE~UtREMEN1~S: No disability insurance Will be provided.on' any,~Debtor who an~vered "yes" t° thf9 heath question on the Certl~cate. No d~sabd~ty insurance w~ll be prowded on any Debtor who wdl be age 6~r 61der on the E~P'~rabon Date or who answe[ed,?no" to the employment question on the Certificate. If within sixty (60) days after issue, we discover a Debtor is nOt elig[b!e fo~':'coverage, we will terminate coverage and refund an amount equal to all premiums received, as long as the Debtor-is not disabled and did not meet the Waiting Period as of the date of termination. If joint insurance was purchased, coverage will be terminated on the ineligible Debtor. The remaining DebtOr's coverage will continue under a single insurance Certificate. Within sixty (60) days after issue, a refund will be made in an amount equal to the difference between the premium paid for joint coverage and the premium payable for single coverage. WHAT YOU GET: We certify that if we have been paid the premium shown in the Schedule, you are insured for the coverage shown in the Schedule, subject to the terms of the Group Policy, numbered above, issued to the Policyholder by us. MAXIMUM BENEFITS: The maximum amount of insurance per Debtor may not exceed the maximum amounts shown in the' Schedule above. If wa discover that you paid premiums for any insurance in excess of these amounts, wa will cancel the excess coverage. Within sixty days a refund of excess premiums will be credited to your account providing, however, we shall be liable' for any claim arising prior to our notifying you. CC:379335-A&H (1) WHO GETS PAID: We will pay benefits to the Lender shown above. The payments shall be applied to reduce your indebtedness. WHAT WE WILL PAY SINGLE DISABILITY INSURANCE BENEFIT: We will pay a benefit if you file written proof that you became totally disabled while insured and continue to be totally disabled for more than the waiting period. Payment will be calculated from the day benefits commence. The daily benefit will be equal'to 1/30th of the Monthly Disability Benefit in the Schedule for each day of disability to be compensated. You are liable for the difference between the Monthly Total Disablility Benefit and your Total Monthly Payment. Payments will stop when you are no longer totally disabled or when benefits are paid to the date your insurance stops, (see WHEN INSURANCE STOPS-REFUNDS below) whichever comes first. The total number of Monthly Disability Benefits will not exceed the number of months in the term tess the number of Monthly Payments due at commencement of the indebtedness. JOINT DISABILITY INSURANCE BENEFIT: If you are insured for joint total disability insurance, we will pay a benefit if you or the Co-Debtor file written proof that you become totally disabled while insured and continue to be totally disabled for more than the waiting pedod. Payment will be calculated from the day benefits commence. The benefit will be equal to 1/30th of your Monthly Disability Benefit shown in the Schedule for each day of disability to be compensated. Payments will stop when you are no longer totally disabled or when benefits are paid to the date your insurance stops, (see WHEN INSURANCE STOPS-REFUNDS below) whichever comes first. The waiting period shall not apply to successive periods of disability resu tng from the same or related condition within thirty days. The simultaneous disabitity of you and the Co-Debtor will resuit in only ONE disability benefit being paid. In no instance will more than ONE disabilty benefit be paid under the.~ertificate. The benefit we pay will not exceed the amount of insurance that would be paid if single disability coverage were provided. If you ele. ct the joint disability coverage, the Debtor and the Co-Debtor each will be insured for one hundred percent of the disability payment. If coverage on the Debtor or Co-Debtor terminates for any of the reasons which follow, the other Debtor's coverage will be continued under a single disability certificate. The reasons for termination are: 1. coverage is contested; 2. coverage was issued in error to a Debtor who exceeded the eligibility age and who correctly stated his age in writing, and such coverage is terminated by us within sixty days from the Effective Date; 3. coverage was issued in error to a Debtor who did not meat the eligibility employment requirements and who correctly states his employment status in writing and such coverage is terminated by us within sixty days from the Effective Date; 4. suidde. "Total Disabili~ means that, due to injury or sickness you are totally disabled and unable to perform the duties of your occupation. After benefits have been paid for twelve (12) months, 'Total Disability" means you are unable to perform the duties of any occupation for which you are reasonably qualified by education, training or experience. You must be receiving regular medical treatment by a legally qualified physician. You will be required to give proof of continuing total disability on a monthly basis. WHAT WE WON'T PAY TOTAL DISABILITIES NOT COVERED: We won~ pay the dalm if your disability is a result of: 1. normal pregnancy, or -- ~.-~ ' ~ ~ '~ ~ '~: ~ 2.' intentiohally self-infiXed injury, or ' · -: ~ 3. illness, disease or physical condition which caused you to be totally disabled at any time during the six (6) month period immediately preceding the Effective Date, or 4. flight in 0on-scheduled aircraft. ACTIVELY AT WORK REQUIREMENT: To be eligible for disability insurance coverage, you must be actively at work at a full-time gainful occupation on the Effective Date. "Full-Time" means a regular work week of not less than thirty (30) hours. You will be considered to be actively at work if you are absent from work due s~l. ely to regular days off, holidays or paid vacation. WHEN N URANCE STOPS-REFUNDS: 'This insur ce stOps wheneve~.~e~r~ of the following occurs: · '1. 'tti'~ Expiration Date shown - ' ' 2. a repossession; 3. refinancing; . ? 4. you or your Co-Debtor's death; 5. your written request to the Policyholder for terminatiOn of the insurance; 6. prepayment of balance of loan agreement. If your total disability insurance stops before the end of the term, for any reason (including your death), we will refund the unearned total disability insurance premium as determined by the 'Rule of 78" refund formula. NO' refunds will be made if less than one dollar. If the Group Policy stops for any reason, insurance will continue subject to the terms of this Certificate. You may cancet the insurance at any time. Termination of this insurance for any reason will not affect the payment of benefits for the period prior to the date of termination. The insurance will not continue beyond the Expiration Date. .WHAT THE CONTRACT IS.AND HOW YOUR STATEMENTS AFFECT IT: The Group Policy, Certificate, and the Application for the Group Policy are the complete COntract of insUi'ancel If you completed an APl~licaiion foi' this insurance; "' ' ' a. all statements made by you in your Application are considered to have been made to the best or you knowledge and belief; b. no statement in your Application can be used to void this insurance or deny a claim unless the Application is Signed by you. CONTESTABLE PERIOD: This;Certificate shall be incontestable:after two (2).years from its Effective Date except for non-payment of premiums, and no statement made by any Debtor insured under the Certificate shall be used in contesting the validity of the insurance with respect to which such statement was made after such insurance had been in force prior to the contest for a period of two (2) years during such persons's lifetime, nor unless it is :contained in a written instrument signed by the Debtor and a copy was given to the Debtor. MISSTATEMENT OF AGE Th s nsurance may not be effective if you have reached the age limit (see ELIGIBILITY REQUIREMENTS). If during the contestable period, we discover that your age has been misstated and coverage would not have been issued at your correct age, we will terminate coverage and refund an amount equal to all premiums received. If joint insurance was purchased, coverage will be terminated on the Debtor who made the misstatement of age. The remaining Debtor's coverage will continue under a single insurance Certificate. A refund will be made in an amount equal to the difference between the premium paid for joint coverage and the premium payable for single coverage. If you have reached the age limit and COrrectly stated your age, within sixty (60) days from the Effective Date, we will terminate coverage and refund the premium paid as I~g as you have not become disabled and have not met the waiting period, as of the date of termination. -HOW'TO FILE A~TOTAL DISABILITY CLAIM NOTICE OF CLAIM: You mUst give us written notice of a total disability rialm within thirty (30) days after it starts, or as soon as you can. You may give the notice, or you may have someone do it for you. The notice should give your name and Certificate number as shown on the front page. Notice should ~ mailed-to us.at our Executive Office in Camp Hill Pennsylvania~ior given to the Policyholder. CLAIM FORl~l:.~n;notice of a clam, you will be~ given forms for filing prool of loss, If ih. ese f.o. rms are not sent to you in fifteen (15) days, you wi meet the pro~f~f.'-J~ 'ru e,§e ow f ~,oL] g v~~us a Written statement about {h~:'clai~hi~:~!~OWs th~ date and ca~Jse~°f the tOtal aisability and it must be signed by a legally qualified physician. This statement must be sent within the. time limit shown in the proof of loss provision. LEGAL ACTIONS; Y~u~ can1 bring legal action to recover under this Certification for at leasL s xty (60) days after g~wng wntten Proof of loSS. You can'~ start such an action more than three (3) years after the date of proof of loSS is required., PROOF OF LOSSilYou must give us written proof of loss within ninety (90) days, or as~soo~aS you Can. In any case, proof must be furnished within twelve (12):months, except in the absence of legal capadty. Claims will be paid as soon as we get the proof of loss we need. .PHYSICAL EXAMINATION iWe have the right at our exPenm to have you examined; by a physician when and as often as we feel, is necessary during the appraiSal of a ~laim. CONFORMITY-WITH STATE-STATUTES: Any-part of thi; form 'in COnflict with the law of your-state as of the Effective Date is changed to ~:ompty with the law. Signed at the Exective Office in Camp Hill, Pennsylvania as of the Effective Date.. Exhibit B ,. ,. '. CREDIT DISABILITY CLAIM DCREDIT INSURANCE COMPN~YAmerican Repul)llc In~ran~ Coml~ny Ci~Ktit 168arance Proceseing Center 100 We~t Bay Steel I PO Box 441~0 Jidclorwi~, FL 3223t-4130 I _ _ _J~-888-2738 submits an application or files s claim containing any false, Incomplete, mleleading, or deceptive ~tatement ie guilty of en Ineumnce fraud. c~ Wnan did you o~ do you expect to ream to light work? When did you or do you expect to return to full time won~ DaM &Tlme I~up/Oo~uml, d? OAM nPM AveraGe hours worked Iq $ b~D Week [D"Year Have you ever bed this or m stmil~ condlJon before? film~ mhd eddml~ o~ Hol;~i~l I]I[No Have you ~,~.~ any wo~ other than your usual =f ~1 ¢loctom a'eattng your present dita~ll~/. the 2 yearl prioc to this k~n. your family phy~dan. AUTHORIZATION: Upon presentation of the original or m photooo~y of this signed mu~orizafion. I authorize any medical pro~___~oMI, ho~olt~l or other medical-care institution. InmJmnoe .upport org&niz, ition, pharmaoy, govemmentil igency, insurance oompiny, group policyholder, employer or bene~t ~ ~ministmtor to provide (my credit insurance company n~med m) or an ~geflt, attorney, · o~aumor reposing ~gency or Independent admistrator, adlng o~ Its behalf, info.nation conoeming advice, care or treatment provided the meed named below, including infon~ relating to mental il~. uae of drugs or uae of alcohol. I al/o authorize my employer, group policyholder o~ bef~ I~ edn~n;eb .~ur to ~-o~le my kllurlnce co~ny wl~ financial or empto~nt-rellted Inforr~. I un(lemtand that ~uoh Information wla be used by the k~urance company for the pu~e of evaluating my claim for Insuranoe benefits and that I or any authorized representative wi, receive · copy of this authorization upo~ request. This authorization Is valid from the date signed for the term of the policy. Date ~ Slg~ of Insured I ALL QUESTIONS MUST BE FULLY ANSWERED OR DELAY WILL RESULT/ Re-order~ 11-021898-00 J PATENT 1. HISTORY (,} WMn did ly,..~.~ Ilrat ii,Mr ~ ia:ideM ha~en? It yel. illel when end dei~.~ , . , ATTENDING PHYSICIAN's STATEMENT OF DISABILITY · The Ilatient I~ reepon~ll~le for the ¢omldeflon of.thl~ form without expen,e to the Company. DAI~ OF & I~OGRE~ I~=COVG~D 0 IMPI~OV~D 0 U~tW~OV~D ~ I~=I~OGRESSF. O 0 DAY ~9 MO. C~Y DAY lg MO. DAY__ 19 0 MUST BE COMPLETED BY CLAIM~ DEPARTMENT FmmDMe 'll~uDala I No. Deva I A.-,~_~ (ALL CLAIM~ SHOULD BE F, i:r~ TH~ THE CREDITOR) Exhibit C LIFE OF THE SOUTH. 04/25/01 KRTJ.Ry B~TION 70 W BIG SPRING AVE NEWVILLE PA 17241 RE: CONSUMERS LIFE INSURANCE COMPANY Insured: K~.I.I.Ky BETTON Certificate:0006450465 0 Claim: i05~3 We have received your claim and after careful consideration, we regret that we must decline benefits for the following reason: Claim was caused by preexisting conditions as defined in the policy We are sorry we cannot be of service at this time. If you have any questions concerning our decision or if you have additional information for our review, please send it by return mail along with a copy of this letter. c~erely, Customer Operations/Claims cc: FULTON BANK Cl 10583 DENX 1 O0 West Bay Street · PO Box 44130 · Jacksonville, FL 32231-4130 TEL (904) 350-9660 · TOLL FREE (800) 888-2738 · FAX (904) 350-9440 PREMIUM (904) 355-5878 CLAIMS Exhibit D  I,AW OFFICE OF MICHAEL J. HANFT ATTORNEYS & COUNSELLORS AT LAW MICHAEL ]. HANFT GREGORY H. KNIGHT RICHARD L. WEBBER. JR. May 30, 2001 OF COUNSEL WILLIAM A. ADDAM$ MICHAEL R. RUNDLE // Karen Gatlin, Customer Operations/Claims Life Of The South 100 West Bay Street P.O. Box 44130 Jacksonville, FL 32231-4130 Consumers Life Insurance Company. Insured: Kelley Betton Certificate: 0006450465 0 Claim No. 10583 Dear Ms. Gatlin: We have been retained by Kelley S. Betton regarding your denial of her claim as stated in the attached copy of your letter of April 25, 2001. Would you please explain how this claim was caused by preexisting conditions as defined in the policy. Ms. Betton has no recollection of being disabled during the six month period preceding the effective date of the policy. Thank you for your cooperation. Very truly yours, LAW OFFICE OF MICHAEL J. HANFT WAA/nunp Enclosure cc: Kelley S. Betton William A. Addams 19 BROOKWOOO AVENUE StlFrl! IO6 CABI.ISLI!, PA 17013-9142 717.249.5373 [AX 717.24'-).0457 WW\V. II^NFTI.^WI:IRM.C{)M SHERIFF'S RETURN · CASE NO: 2001-06483 P COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND BETTON KELLEY S VS. CONSUMERS LIFE INSURANCE CO CERTIFIED MAIL R. Thomas Kline , Sheriff of Cumberland County, Pennsylvania, who being duly sworn according to law served the within named DEFENDANT ,CONSUMERS LIFE INSUR3LNCE , COMPANY by United States Certified Mail postage prepaid, on the 30th day of November ,2001 at 0000:00 HOURS, at 100 WEST BAY STREET PO BOX 44130 JACKSONVILLE, FL 32231-4130 and attested copy of the attached COMPLAINT & NOTICE with receipt 12/03/2001 Additional , a true Together card was signed by V. PASCALE The returned on Comments: Sheriff's Costs: Docketing Service Cert Mail Surcharge 18.00 9.75 4.63 10.00 .00 42 .38 SO answers ~ ~- ~ R. Thomas K'line Sheriff of Cumberland County Paid by MICHAEL J H3LNFT Sworn and subscribed to before me this /3~ day of ~/ A.D. ~'r~t hGnb~ ary on 12/10/2001 · Complete items 1, 2, and 3. Also complete item 4 If Res~tcted Dellve~ is de~imd. · Print your name and address on the reveme so that we can return the card to you. · Attach this card to the back of the mallplece, or on the front if space permits. Life of the South 100 West Bay Street PO Box 44130 Jacksc~ville, FL 32231-4130 C. S~,atum [] Addressee I address different from item 1 ? nyee If YES, enter d®llve~ adclm~s be~)w: i'-I No 0001 8790 0963 civil 6483 civil PS Form 3811, July 1999 Dome~c Return Receipt KELLEY S. BETTON, Plaintiff CONSUMERS LIFE INSURANCE COMPANY, Defendant : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA NO. 01-6483 CIVIL TERM CIVIL ACTION LAW NOTICE TO PLEAD TO: Kelley S. Betton, Plaintiff and William A. Addams, her attorney You are hereby notified to file a written response to the within New Matter within 20 days from service hereof or a judgment may be entered against you. McNEES WALLACE & NURICK LLC · Mi~ha-el R Kelley ' I.D. No. 58854 100 Pine Street P.O, Box 1166 Hardsburg, PA 17108-1166 (717) 237-5322 Attorneys for Defendant Consumers Life Insurance Company KELLEY S. BETTON, Plaintiff CONSUMERS LIFE INSURANCE COMPANY, Defendant : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : : NO. 01-6483 CIVIL TERM : : CIVIL ACTION LAW : : DEFENDANT'S ANSWER TO COMPLAINT Upon information and belief, admitted. Denied as stated. Admitted in part and denied in part. It is admitted that Defendant issued a certificate of life and disability insurance to Plaintiff. The remaining averments of this paragraph are denied as they refer to Exhibit A, a writing which speaks for itself. 4. Admitted in part and denied in part. It is admitted that Defendant provided a letter in the form of Exhibit B. It is denied that that letter provided proof of total disability as defined in the policy. 5. Admitted in part and denied in part. It is admitted that Life of the South denied the claim. The remainder of this paragraph is denied as the allegations are based upon a writing which speaks for themselves. 6. Denied. 7. After reasonable investigation, Defendant is without knowledge or information sufficient to form a belief as to the truth of the allegations of this paragraph, and the same are therefore denied. 8-9. Denied. It is denied that Defendant breached any contract. 10-14. It is denied that Defendant engaged in any bad faith conduct. WHEREFORE, Defendant Consumers Life Insurance Company requests that judgment be entered in its favor and against Plaintiff Kelley S. Betton, and that it be awarded costs of suit. NEW MATTER 15. To the extent requested, Plaintiff is not entitled to a jury trial in this litigation. 16. Defendant Consumers Life Insurance Company's actions in this matter at all times were reasonable, and Defendant, at no time engaged in intentional, knowing, or grossly negligent conduct with respect to denial of any claims. McNEES WALLACE & NURICK LLC Dated: P.O. Box 1166 Harrisburg, PA 17108-1166 (717) 237-5322 Attorneys for Defendant Consumers Life Insurance Company -2- 05/24/02 10:13 F.42;2 · 0002 VERIFICATION Subject to the penalties of 18 Pa. C.S.A. §4904 relating to unswern falsification to authorities, I hereby certify that I am the Vice President and Chief Coml~llance Officer of Life of the South, and am authorized to execute this Verification on its behaE, and that the facts set forth in the foregoing Answer with New Maffer are true and Correct t~ the best of my knowledge, information and belief. Dated: CERTIFICATE OF SERVICE The undersigned hereby certifies that on this date a true and correct copy of the foregoing document was served by first-class mail, postage prepaid, upon all counsel of record. Dated: William A. Addams Law Office of Michael J. Hanft 19 Brookwood Avenue, Suite 106 Carlisle, PA 17013 Attorneys for Defendant Consumers Life Insurance Company KELLEY S. BETTON, Plaintiff V. CONSUMERS LIFE INSURANCE COMPANY, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 01-6483 CIVIL TERM PETITION FOR APPOINTMENT OF ARBITRATORS TO THE HONORABLE, THE JUDGES OF SAID COURT: that: Hanft & Knight, P.C., counsel for the Plaintiff in the above action, respectfully represents 1. The above-captioned action is at issue. 2. The claim of the plaintiff in the action is not greater than $25,000.00. The following attorneys are interested in the case as counsel or are otherwise disqualified to sit as arbitrators: Michael R. Kelley, Esquire, McNees, Wallace & Nurick, LLC, 100 Pine Street, Harrisburg, PA 17108. WHEREFORE, your petitioner prays your Honorable Court to appoint three (3) arbitrators to whom the case shall be submitted. Respectfully submitted Date: /ORDER OF COURT AND NOW,//~ff~ t~ ~ ,2002, in consideration of the foregoing peti, ti,on,/~_~,,R ?~/~[~..fl_J Esq., ~Z ~~sq., ~d ff~ ~ ~3 ~ J Esq. ~e appointed ~bi~atZ in the above-captioned action as p~ed f~ By ~e Co~, KELLEY S. BE'I'TON, Plaintiff CONSUMERS' LIFE INSURANCE COMPANY, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 01-6483 PRAECIPE FOR WITHDRAWAL OF APPEARANCE TO THE PROTHONOTARY: Please withdraw the appearance of the undersigned on behalf of Defendant Consumers' Life Insurance Company in the above-captioned case. RICE, BOOP & FINA Attorney I.D. No. 71711 106 Market Street Sunbury, PA 17801 Dated: CERTIFICATE OF SERVICI= The undersigned hereby certifies that on this date a true and correct copy of the foregoing document was served by first-class mail, postage prepaid, upon the following counsel of record. Dated: ~5/~///0 2-. William A. Addams Law Office of Michael J. Hanft 19 Brookwood Avenue, Suite 106 Carlisle, PA 17013 Michael R. Kelley Attorneys for Defendant Consumers Life Insurance Company VlNVA"L,t,$N N]8 KELLEY S. BETTON, Plaintiff CONSUMERS LIFE INSURANCE COMPANY, Defendant : IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 01-6483 CIVIL TERM CIVIL ACTION - LAW REPLY AND NOW, comes the Plaintiff, Kelley S. Betton, by her attomey, William A. Addams of Hanft & Knight, P.C., and makes the following Reply to the Defendant's Answer with New Matter: 15. The conclusion of law is denied. 16. The conclusion of law is denied. HANFT & KNIGHT, P.C. i liam A Addams - Attorney I.D. No. 06265 19 Brookwood Avenue, Suite 106 Carlisle, PA 17013 (717) 249-5373 F:\U~: Folder~Firm DOcs\WAAL2235. I ~eply.wpd _CERTIFICATE OF SERVICE AND NOW, this 12th day of August, 2002, I, Mary M. Price, an employee of Hanft & Knight, P.C., hereby certil~ that I have served the Plaintiff's Reply by mailing the same by United States mail, postage prepaid, to: Michael R. Kelley, Esquire McNees, Wallace & Nurick, LLC 100 Pine Street P.O. Box 1166 Harrisburg, PA 17108-1166 KELLEY S. BETTON, Plaintiff : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA , v. : NO. 01-6483 CIVIL TERM : : CIVIL ACTION LAW : Defendant : STIPULATION AND AGREEMENT CONSUMERS LIFE INSURANCE COMPANY, The Parties, by and through their respective counsel, hereby Stipulate and Agree to the following: 1. Plaintiff Kelley S. Betton amends her Complaint as follows: a. Plaintiff strikes Paragraph 4, which states, "The Plaintiff became totally disabled as defined in the policy of insurance on December 4, 2000 and gave notice and proof of loss to the Defendant on March 9, 2001 as stated on the attached Exhibit 'B."' (underlining added). b. Plaintiff substitutes the following allegations as Paragraph 4: "The Plaintiff became totally disabled as defined in the policy of insurance on December 4, 1999 and gave notice and proof of loss to the Defendant on March 9, 2001 as stated on the attached Exhibit 'B."' c. Plaintiff strikes Paragraph 9, which states, "As a result of the Plaintiff's disability, the Defendant is liable to her in the amount of $346.35 a month beginning December 4, 2000 and ending no later than April 27, 2004." (underlining added). d. Plaintiff substitutes the following allegations as Paragraph 9: "As a result of the Plaintiff's disability, the Defendant is liable to her in the amount of $346.35 a month beginning December 4, 1999 and ending no later than April 27, 2004." 2. In response to the Amended Complaint, Defendant adds Paragraph 17 to its New Matter, stating "Plaintiff failed to provide Defendant with reasonable notice of her claim, and Defendant has been prejudiced thereby," which is deemed denied by the Plaintiff. 3. 4. The Parties will complete discovery by March 31, 2003. The arbitration hearing currently scheduled for ~Nednesday, December 4, 2002, will be continued until April 2003, by which time discovery in this matter will be concluded. Willi~r~ A. ~d~ms Attorney I.D. No. 06562 Hanft & Knight, P.C. 19 Brookwood Avenue, Suite 106 Carlisle, PA 17013-9142 Phone: (717) 249-5373 Attorneys for Plaintiff Kelley S. Betton Michael R. Kelley ,/ Attorney I.D. No. ~8854~_ Charles T. Your~, Jr. Attorney I.D. No. 80680 McNees Wallace & Nurick LLC 100 Pine Street, P.O. Box 1166 Harrisburg, PA 17108-1166 Phone: (717) 237-5322 & -5397 Attorneys for Defendant Consumers' Life Insurance Company KELLEY S. BETTON Plaintiff VS, CONSUMERS LIFE INSURANCE COMPANY Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA No. 01 - 6483 Civil Term Civil Action - Law CERTIFICATE PREREQUISITE TO SERVICE OF SUBPOENAS PURSUANT TO RULE 4009.22 As a prerequisite to service of subpoenas for documents and things pursuant to Rule 4009.22, Defendant, Consumers Life Insurance Company certifies that: (1) A Notice of Intent to Serve Subpoenas with copies of the subpoenas attached thereto was mailed to plaintiff, Kelly S. Betton; (2) A copy of the Notice of Intent and the proposed subpoenas are attached to this Certificate; (3) Plaintiff has waived the 20 day waiting period. A copy of the signed Waiver is also attached to this Certificate; (4) The subpoenas which will be served are identical to the subpoenas which is attached to the Notice of Intent to Serve Subpoenas. Dated: McNEES~W~LLACE & NURIC,K LLC Delano ~1~ Lantz I.D. No. 214/01 Attorney Charles T. Young~v<J'r. ./ Attorney I.D. No. 80680 100 Pine Street Harrisburg, PA 17108 (717) 232-8000 KELLEY S. BETTON Plaintiff VS. CONSUMERS LIFE INSURANCE COMPANY Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA NO. 01-6483 Civil Term CIVIL ACTION - LAW NOTICE OF INTENT TO SERVE SUBPOENAS TO PRODUCE DOCUMENTS AND THINGS FOR DISCOVERY PURSUANT TO RULE 4009.21 TO: Kelley S. Betton and her attorney, William A. Adams, Esquire PLEASE TAKE NOTICE that Defendant, Consumers Life Insurance Company intends to serve subpoenas identical to the ones attached to this Notice. You have twenty (20) days from the date listed below in which to file of record and serve upon the undersigned any objection to the subpoenas. If no objection is made, the subpoenas will be served. McNEES,'VVALLACE & NURICK LLC Michael R. Kelley ~: Attorney I.D. No: 58854~.-~ Charles T. Young, Jr. Attorney I.D. No. 80680 100 Pine Street Harrisburg, PA 17108 (717) 232-8000 Attorneys for Consumers Life Insurance Company {A258914:) CC~TH OF p~INNSYLVANIA KELLEY S. BETTON Plaintiff CONSUMERS LIFE INSURANCE COMPANY Defendant File No. NO. 01-6483- Civil Term TO: SUBPOENA TO PRO[X.lCE ~NTS OR THINGS FOR DISOOVERYPURSUANTTORULE 4009.22 James B. Murphy, D.M.D./Oral Surgery Associates 918 Russell Drive, Lebanon, PA 17042 (Name of Person cc Entity) Within twenty (20) days after service of this subpoena, you are ordered by the court to produce the following doctn~ts or.things: Any and all records pertaining to Kelly S. Betton, Social SecuritM No. 206-50-9059, DOB: 8/20/71, Address: 70 West Big Spring Ave., Newville, PA The records should include but not be limited to any records regarding surgery she underwent : at McNees, Wallace & Nurick (Attn. Charles T. Young, Jr.)- .. approx. Oct. 1998~ 100 Pine Street, Harrisburg, PA 17101 (Address) Yo~ may deliver or mai] legible copies of the doctrnents or produce things requested by this subpoena, together with the certificate of co,~liance, to the party making this request at the address listed above. You have the right to seek in advance the reasonable cost of preparing the copies or producing the things sought. If you fail to'produce the doctments cc things required by this subpoena within twenty (20) days after lis service, the party serving this subpo~',amay seek a court ccder con~ellir:g you to comply with it. THIS SUBPOeNA WAS ISSI~SD AT THE REQO~ST O~ THE FOLLO~IN~ PERSON: NAMe: Charles T. YounK, Esq. ADfAqESS: McNees, Wallace & Nurick LLC ]00 Pine St.~ Harrisburm, PA 17108 YELEP~ONE: (717) 237-5397 SUPREP~OOURT ID # 80680 AI-IO~NEY FOR: Deft., Consumers Life Insurance Co. :)ATE: Seal of the Court BY ~ CX]URT: Prothc~qotary/Cl~k, Civil Oivision / '~ D~s~uty (Elf. 7/97) C~TH OF P~qNSYL~ KELLEY S. BETTON Plaintiff CONSUMERS LIFE INSURANCE COMPANY Defendant File No. NO. 01-6483- Civil Term SUSPOENATO PRCOUCE~NTS OR THINGS__ Attn: Jeanne Byler FOR DISOOVERY PURSUANT TO RUtE 4009.22 Bureau of Unemployment Compensation Benefit& Allowances Disclosure Office, Claims Information Center, 6th Floor TO: Dept. of Labor & Industry, 7th & Forster Street Harrisburg, PA 17120 (Name of Person o~ Entity) Within twenty (20) days afte~ service of this subpoena, yo~ are o~de~ed by the cotmt to m~x~Jce the followir~ docune~ts o~ things: ~.~_E~]J~Lllunemplo_vment compensation records' pertaining to Kelly S. Betton, SS# 206-50-9059, DOB: 8/20/1971, Address: 70 W. Big Spring Avenue, Newville, PA (Cumberland County). mt McNees, Wallace & Nurick LLC (Attn. Charles T. Young, Jr, Esquire), 100 Pine Street, Harrisburg (Address) PA 17108 You may deliver or mail legible copies of the o~nts or produce things requested by :his subpoena, tc~3ethe~ with the certificate of CoT~liance, to the party making this 'equest at the address listed above. You have the right to seek in advance the reasonable :ost of preparing the copies or producing the things sought. if you fail to produce the doct~r~nts .or things required by this sub;~en~ within twenty 20) days after its service, the party serving this subpo~',a may seek a court order ~ellir:g you to ccnl~ly with it. HIS SUSPOENAWAS ISSUED AT THE REQUEST O~ THE FOLLOWING PERSON: ~:.Charles T. Young, Esq. DORESS: McNees. Wallace & Nurick LLC 100 Pine St., Harrisburg, PA 17108 ELEPHONE: (717) 237-5397 1,3PREP~OO.,'RT I0 ~ 80680 T]ORNEY FOR: Deft., Consumers Life Insurance Co. Seal of the Court BY THE CO_~T: Proth~otary/~_f~erk, Civil Division (Eff. 7/97) CERTIFICATE OF SERVICE The undersigned hereby certifies that on this date a true and correct copy of the foregoing document was served by facsimile and U.S. first-class mail., postage prepaid, upon the following: William A. Addams Hanft & Knight, P.C. 19 Brookwood Avenue, Suite 106 Carlisle, PA 17013 ~' Kath~ ¥~)cum, Paralegal Dated: December 3 , 2002 KELLEY S. BETTON Plaintiff Vo CONSUMERS LIFE INSURANCE COMPANY Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA NO. 01-6483 Civil Term CIVIL ACTION - LAW WAIVER OF TWENTY DAY WAITING PERIOD I hereby acknowledge that I have received the Notice of Intent to Serve a Subpoenas to Produce Documents and Things For Discovery Pursuant to Rule 4009.21 (subpoenas directed to James Murphy, D.M.D./Oral Surgery Associates and the PA Bureau of Unemployment Compensation Benefits in the above- captioned matter, that I hereby waive the twenty day waiting period required by the above-referenced rule, and that I permit counsel wishing to serve the subpoenas to serve such subpoenas immediately. Date: William Adcr~rns, Esquire Attorney for Plaintiff {A258914:} CERTIFICATE OF SERVICE The undersigned hereby certifies that on this date a true and correct copy of the foregoing document was served by facsimile and U.S. first-class mail, postage prepaid, upon the following: William A. Addams Hanft & Knight, P.C. 19 Brookwood Avenue, Suite 106 Carlisle, PA 17013 aries T. YO!~~-) ~ Dated: December~'~ 2002 KELLEY S. BETTON Plaintiff VS. CONSUMERS LIFE INSURANCE COMPANY Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA No. 01 - 6483 Civil Term Civil Action - ]_,aw CERTIFICATE PREREQUISITE TO SERVICF OF SUBPOENA PURSUANT TO RULE 4009.:.~2 As a prerequisite to service of a subpoena for documents and things pursuant to Rule 4009.22, Defendant, Consumers Life Insurance Company certifies that: (1) A Notice of Intent to Serve Subpoena with copy of the subpoena attached thereto was mailed to plaintiff, Kelly S. Betton; (2) A copy of the Notice of Intent and the proposed subpoena is attached to this Certificate; (3) Plaintiff has waived the 20 day waiting period. A copy of the signed Waiver is also attached to this Certificate; (4) The subpoena which will be served is identical to the subpoena which is attached to the Notice of Intent to Serve Subpoena. Dated: McNEES,)N,~_LACE & NURICK LLC By Delano M. Lantz ~ Attorney I.D. No. 2_./~401 Charles T. YourS, Jr. Attorney I.D. No. 80680 100 Pine Street Harrisburg, PA 17108 (717) 2:32-8000 KELLEY S. BETTON Plaintiff VS. CONSUMERS LIFE INSURANCE COMPANY Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA NO. 01-6483 Civil Term CIVIL ACTION - LAW NOTICE OF INTENT TO SERVE SUBPOENA TO PRODUCE DOCUMEiNTS AND THINGS FOR DISCOVERY PURSUANT TO RULE 4009.21 TO: Kelley S. Betton and her attomey, William A. Adams, Esquire PLEASE TAKE NOTICE that Defendant, Consurners Life Insurance Company intends to serve a subpoena identical to the one attached to this Notice. You have twenty (20) days from the date listed below in which to file of record and serve upon the undersigned any objection to the subpoena. If no objection is made, the subpoena will be served. Dated: ~,/I 2, / cD 3 t McNEES,/V)/A/17.LACE.~& NURICK LLC Michael R. Kelley/ ~ Attorney I.D. N~./58854~ Charles T. young, Jr. Attorney I.D. No. 80680 100 Pine Street Harrisburg, PA 17108 (717) :;)32-8000 Attomeys for Consumers Life Insurance Company {A258914:} C~TH OF Pi~R~SYLVA~IA O0ONTY OF ~ KELLEY S. BETTON Plaintiff Ve CONSUMERS LIFE INSURANCE COMPANY Defendant File No. NO. 01-6483- Civil Term SUSIKENATO PR(KX, K~ DO3.1~ENTS OR THINGS - FOR~ISOOVERYPURSUANTTORULE 4009.22 Social SecurityAdmini~ra[zon 401 East Louther St. (Minerva Mills BIDE.) Carlisle, PA 17013 (Name of Person or Entity) Within twenty (20) days afte~ semvice of this subpoena, you a~eordered by the court to ~.~oduce the followim9 docunemts o~ things:.Any and ail records relative to Kelley S. Betton, DOB: 8/20/71~ SS: 206-50-9059, Address: 70 W. Big Sprt,5 Ave., Newvtll~pA. Th, records shoul.d any aoolications for disab, benefits a-d/or SSI~ Es~rtaining to disability benefits, d,,c~ anY. correspondence, tr~nmcriDts ~ng other at~JcNees. W~ll,ce & brick (Attn: Charles Xoaa~, 100 Pime Street, liarrisburg, PA 17101 (Address) You may deliver o~. mail legible copies of ~he doctn~m~s o~ p~oduce things requested by ~his subpoena, togethe~ wi~h the certificate of ccn~liance, to ~be pa~ty mak~m9 this request at the address lis~ed above. You have the right ~o seek in advanc~ ~he reasonable cost of pceoarim9 ~he copies oc ocoducim9 the thimgs sough~. if you fail to produce khe doctrnen~s oc things required by this subpoena within twenty (20} days afte~ ~s s~'vice, the pa~ty secvin9 this subpoe~'~ama¥ seek a cour~ ocder c~n~ellir;9 you to c~,~ly wi~h it. THIS SUBPOENA WAS ISSUED AT THE REQUEST(DF THE FOLLOWING PERSON: NAME:_Charles T. Young, Esq. ADORESS:--J~s. Wallace & Nurick 1~ P~ne SE.~ Rarrisburg, PA 17108 tELEPHONE: (717) 237-5397 SUPREI"~O3L~T ID ~ 80680 ~TIORNEY FOR: Deft., Consumers Life Insurance Co. )ATE: Seal of the Court 8Y THE COURT: Pr°th<x~otary/Cle~k,~'Civi 1 Division · /- ~Deputy - (Eff. CERTIFICATE OF SERVICE The undersigned hereby certifies that on this date a true and correct copy of the foregoing document was served by facsimile and U.S. first-class mail, postage prepaid, upon the following: William A. Addams Hanft & Knight, P.C. 19 Brookwood Avenue, Suite 106 Carlisle, PA 17013 -Chades T. Yo~, Jr. ~:~ Dated: February J2, 2003 CERTIFICATE OF SERVICE The undersigned hereby certifies that on this date a true and correct copy of the foregoing document was served by U.S. first-class mail, postage prepaid, upon the following: William A. Addams Hanft & Knight, P.C. 19 Brookwood Avenue, Suite 106 Carlisle, PA 17013 Charles T. Young, Jr. / / Dated: February',&, 2003 In _The Court of Common Pleas of Cumberland County, Penns.vlvania so. o~ ~ ~9~ c,~,~~ AWARD We do solemnly swear (or affirm) thac we will support, obey and defend The Constitution of the United States and the ConstituEion of chis Com..on- wealth and that we will discharge the duties of our office with fidelity. We, the undersigned arbitrators, having been duly appointed and sworn (or affirmed), make the following award: (Note: If dm.~ges for delay are awarded, They shall be separately stated.) Arbitrator, dissents. (Inser: name if applicable.) ~ ~ Date of Hear~ng:~ UO' Arbitrators' compensation to be paid upon app, eal: award was nra. ed uoon ~he docket and notice 2hereof given by mail to The parties or their aC:orneys. /~/ ~r~hono ~a~ / KELLEY S. BETTON IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CONSUMERS LIFE INSURANCE COMPANY NO. 01-6483 - Civil Term NOTICE OF 'APPEAL FROM AWARD OF BOARD OF ARBITRATORS TO THE PROTHONOTARY: Notice is given that CONSUMERS LIFE INSURANCE COMPANY from the award of the board of arbitrators entered in this case on APRIL 15~ 2003 A jury trial is demanded C). (Check box if a jury trial is demanded. wise jury trial is waived.) appeals Other I hereby certify that: 1. The compensation of the arbitrators has been paid, or (Strike out the inapplicable clause) Appellant or Attome~r A~%flant, C0NSm~S n~VE I~U~NCg C0MV~X NOTE: The demand for )u~ ~al on appeal from compulsory arbi~ation is governed by Rule 1007.1 (b), (b) No affidavit or verification is required. KELLEY S. BETTON, Plaintiff CONSUMERS LIFE INSURANCE COMPANY, Defendant : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : NO. 01-6483 CIVIL TERM : CIVIL ACTION LAW DEFENDANT'S MOTION TO STRIKE CASE FROM TRIAL LIST PURSUANT TO LOCAL RULE 213-2 Defendant Consumers Life Insurance Company ("Consumers Life"), by and through its attorneys McNees Wallace & Nurick LLC, hereby files this Motion to Strike the Case from the Trial List Pursuant to Local Rule 213-2. In support thereof, Consumers Life avers as follows: Procedural History 1. On May 5, 2003, Consumers Life appealed from the arbitrators' award in this case. 2. On or about July 7, 2003, Plaintiff's counsel filed a Praecipe listing this matter for trial without a jury. 3. By Order dated July 14, 2003, Judge Edward E. Guido directed that a pretrial conference be held in this matter on Wednesday, July 30, 2003. 4. Consumers Life objects to the listing of this case for trial and believes that the pretrial conference scheduled for July 30, 2003, is premature in that (1) discovery has not been completed, (2) all pretrial actions have not been taken, and (3) the case is not ready for trial in all respects. See Local Rule. 213-2. Accordingly, Consumers Life is filing this Motion to Strike the Case from the Trial List. The Facts Of The Case 5. Consumers Life issued Plaintiff Kelley S. Betton a Certificate of Insurance for credit life and disability insurance (the "Policy") in connection with the purchase of a motor vehicle. Plaintiff subsequently filed this action for breach of contract and statutory bad faith, based on the denial by Consumers Life of her claim. 6. The Policy contains an exclusion for pre-existing conditions, which is the primary basis of Consumers Life's defense. Specifically, the Policy excludes coverage for a claim if that claim resulted from a condition that caused the insured to be disabled from her occupation at any time during the 6-month period preceding the issuance of the Certificate. Discovery Is Incomplete And All Pretrial Actions Have Not Been Taken 7. This case is not ready for trial in that discovery is incomplete.~ Consumers Life intends to subpoena the records of Plaintiff's former employers to determine the dates of her absence from work. 8. This case is not ready for trial in that discovery is incomplete and/or a pretrial action has not been taken. Specifically, Consumers Life intends to take the videotaped deposition of Plaintiff's treating physician, James B. Murphy, D.M.D., and to depose and obtain records from Plaintiff's employers concerning her ability to perform her job duties. ~ By Stipulation and Agreement filed with the Court on November 26, 2002, Consumers Life agreed that discovery in this matter would be completed by March 31, 2003, so that the arbitration hearing could take place in April 2003. The Stipulation and Agreement was limited to the arbitration proceeding, and has no further application to this case, which is now proceeding to a trial. 2 9. Following the close of discovery, Consumers Life intends to file a Motion for Summary Judgment on Plaintiff's claims. Plainti~s cause of action for breach of contract fails in that her credit disability claim falls within the Policy's exclusion for pre- existing conditions. In addition, Consumers Life did not act in bad faith, and Plaintiff has failed to present any evidence supporting her claim of statutory bad faith. WHEREFORE, the Defendant Consumers Life Insurance Company requests that the Court grant this Motion, strike the case from the Trial List, and Order that the case not be re-listed until discovery is complete and dispositive motions have been filed. McNEES WALLACE & NURICK LLC / Charles T. Young?Jr. Attorney I.D. No. 80680 100 Pine Street, P.O. Box 1166 Harrisburg, PA 17108-1166 Phone: (717) 237-5322 & -5397 Fax: (717) 237-5300 Attorneys for Defendant Consumers LifE; Insurance Company July ~1 , 2003 3 CERTIFICATE OF SERVICE The undersigned hereby certifies that on this date a true and correct copy of the foregoing document was served by U.S. first-class mail, postage prepai~l, upon the following: Dated: July ~,~ , 2003 William A. Addams Hanft & Knight, P.C. 19 Brookwood Avenue, Suite 106 Carlisle, PA 17013 Charles T. Young,~ KELLEY S. BETTON, Plaintiff CONSUMERS LIFE INSURANCE COMPANY, Defendant : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : : NO. 01-6483 CIVIL TERM : : CIVIL ACTION LAW : .- ORDER . _ ;~ AND NOW, this ~t~day of ~ ,2003, upon ~ ~"':.~/ cc.m.~!3:c c,;.,., ...,;ou,..,~idv~ mul. Juns nave been Tiled. BY TF : KELLEY S. BETTON, : Plaintiff : CONSUMERS LIFE INSURANCE : COMPANY, : Defendant : IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 01-6483 CIVIL TERM IN RE: PRETRIAL CONFERENCE A pretrial conference was held Wednesday, July 30, 2003, before the Honorable Edward E. Guido, Judge. Present for the Plaintiff was William A. Addams, Esquire, and present for the Defendant was Charles T. Young, Jr., Esquire. This is a breach of contract and bad faith claim. The parties indicate that the case may take anywhere from a half day to a day and a half to try, depending on stipulations. The Defendant wishes to engage in some additional discovery, and Plaintiff does not object, if we set certain deadlines and can get this case to trial in early December. Trial in this matter is scheduled commencing at 1:00 p.m. on Thursday, December 4, 2003. We have set aside all day Friday, December 5, 2003, for completion of this matter. The parties have agreed to the following deadlines: A. 2003. Ail discovery shall be complete by October 15, B. Ail dispositive motions, with briefs in support thereof, shall be filed by October 31, 2003. Any responses, with briefs in support thereof, shall be filed by November 10, 2003. We shall hold argument on any dispositive motions at 8:30 a.m. on Friday, November 14, 2003. Another pretrial conference shall be held on Tuesday, November 18, 2003, at 8:30 a.m. The parties are directed to forthwith check the availability of the necessary witnesses. No continuance of the trial date, except for a dire emergency, will be entertained unless made within 10 days of today's date. By the Court, Edward E. Guido, J. ~liam A. Addams, Esquire For the Plaintiff ~arles T. Young, Jr., Esquire For the Defendant Court Administrator srs KELLEY S. BE'FI'ON Plaintiff VS. CONSUMERS LIFE INSURANCE COMPANY Defendant IN ']HE COURT OF COMMON PLEAS OF CUIVBERLAND COUNTY, PENNSYLVANIA No. 01 -6483 Civil Term Civil Action - Law CERTIFICATE PREREQUISITE TO SERVICE OF SUBPOENAS PURSUANT TO RULE 4009.22 As a prerequisite to service of a subpoena for documents and things pursuant to Rule 4009.22, Defendant, Consumers Life Insurance Company certifies that: ¢) Notices of Intent to Serve Subpoenas with copies of the subpoenas attached thereto were mailed to plaintiff, Kelly S. Betton; (2) Copies of the Notices of Intent and the proposed subpoenas are attached to this Certificate; (3) Plaintiff has waived the 20 day waiting pedod as to the subpoenas directed to Alliance Funding and State Fan'n Insurance Company. Copies of the signed Waivers are attached to this Certificate; (4) The subpoenas which will be served are identical to the subpoenas attached to the Notices of Intent to Serve Subpoenas. Dated: J~cJG ~'I" t f ~OO '~ McNEF,,~S/~/AI/LACE & NURIQK LLC Michael R. Ke,;¢ ."' Attorney I.D. No. ~64~'~---2--~ Chades T. Youn~Jr. AEomey I.D. No. 80680 100 Pine Street, P.O. Box 1166 Ha~isburg, PA 17108 G17) 237-5397 KELLEY S. BETTON Plaintiff VS. CONSUMERS LIFE INSURANCE COMPANY Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA NO. 01-6483 Civil Term CIVIL ACTION - LAW NOTICE OF INTENT TO SERVE SUBPOENAS TO PRODUCE DOCUMENTS AND THINGS FOR DISCOVERY PURSUANT TO RULE 4009.21 TO: Kelley S. Betton and her attorney, William A. Adams, Esquire PLEASE TAKE NOTICE that Defendant, Consumers Life Insurance Company intends to serve subpoenas identical to the ones attached to this Notice. You have twenty (20) days from the date listed below in which to file of record and serve upon the undersigned any objection to the subpoenas. If no objection is made, the subpoenas may be served. Dated: McNEES,/~/A~ACE & NURICK LLC By .--"'-h '~ Michael R. Kelley ~/ - j Attorney I.D. No. 5~854 Charles T. Your~g', Jr. Attorney I.D. No. 80680 100 Pine Street Harrisburg, PA 17108 (717) 232-8000 Attorneys for Consumers Life Insurance Company {A258914:} ~TH OF P~qNSYLVAN/A KELLEY S. BETTON Plaintiff CONSUMERS LIFE INSURANCE COMPANY Defendant File No. NO. TO: SUBPOENA TO PROOUc~ DOCL~ENTS O~ ]~l FO~ D~SCOVERY_ ~3RSOANT TO K%"__E 4009.2? Alliance Funding, 4900 Ritter Road, Mechan%~sburg, PA 17055 (Name of Pe~so~ c~ Entity) 01-6483- Civil Term Within twemty (20) days afte~ service of this subpoena, y,mJ a~e ccde~ed by ~e ~rt to pr~uce the foll~ing ~ts ~ things: ~and all.lo.eat records for Kelle~. Bettom, SS~: 206-50-9059, ~B: 8/20/71, ~dress: 70 W. Big Spr~ Ave., Ne~lle, PA. ~e records ~clude all atte~ce records ~dicat~g dates of ~lo~nt, dates ~r~d ~d/o~ dates at ~ees, Wallace & Nurick ~C (Attn. ~rles Yo~g, Esq). 100 P~e St., ~isburg. PA 17101 (A~mess) - ~cludi~ sick ~d vacatiom ~d days on leave. Y~ ~y del~v~ ~ ~i] legible c~i~ of the ~nts or produce things ~e~est~ by this sUSa. t~eth~ with the c~tiflcate of ~liance, to the p~ty ~king this r~uest at the address listed ~ve. Y~ have the ri~t to seek in advice the reas~le cost of prepping the ~ies or pr~ucing the things sought. If Y~ fail ~ pr~uce the ~nts ~ things re~ired by this sub~ within tw~ty (20) days after fEs service, the P~ty servin~ this sub~r,a ~y seek a ~rt ~d~ ~ellir:g y~ to ~]y with it. ~IS ~ WAS IS~D AT ~E RE.ST ~ ~ F~L~I~ PER~I: ~:~harles T. young, EEq. _ ~ESS: McNee~ . 100 P1,~ St.. H~, PA 1~108 5LEP~E: (717) 237-5397 ~R~ ~T ID ~ 80680 ~N~ F~: Deft., Consumers Life Insurance Co. kTE: Seal of the Ccitt BY THE COURT: Pr°th°°°tary/C~/~-, Civl 1 Division (Elf. 7/97) ~TH OF PIiNNSYLVANIA COON'I~ OF CUMBERLAND KELLEY S. BETTON Plaintiff Vo CONSUMERS LIFE INSURANCE COMPANY Defendant File No. NO. 01-6483- Civil Term SUBPOENA TO PF~OUCE [~OJM~N~'S O~ I~ING~ F_O~ DISCOVERY F~RSUANTTo _Rt~_.E 400~.22 TO: John J. Zampelli, Jr., State Farm Insuranc~g~[, ]838 Spring Road, Carll.]e, PA 17013 (Name of Pe~som o~ Entity) Within tweoty (20) days after service of this subpoena, you are c~de~ed by the court to produce the fo]lowing doctm~ots o~ things: ~__~_~all documents pertaiikin~ to ~-lle~_~. Betton, SS~: 206-50-9059, DOB: 8/20/1971, address: ?0 W. Big Spring Ave, Ne~ville, PA am4 amy amd all documents pertainimg to her father, David Betton. at McNees, Wal/ace & NnrickLLC.(attm. Charles Yo.ng, Esq), 100 Pine St., ~arrish.rg, PA 17101 (Address) Yc~ may de]ive~ oc mai] ]esib]e cooie~ of the doctn~nts or Oroduce things requested by this subpoena, to~ethe~ with the certificate of ccrro]iamce, to the party making this request at the address listed above. You have the right to seek in advance the reasonable cost of ore0arin9 the copies or Oroducin9 the things sousht. If you fail to produce the doctrnents o~ things required by this subpoene within twenty (20) days after its s~'vice, the pa~ty servin9 this subpoer~a may seek a court o~de~ co~ellin~ you to comply with it. ]%lis SUBPOENA WAS ISSUED AT THE RE(iOES¥ OF TI~ FOELC~ING PERSC~;: qAi~:~harles T. YounK, Esq. ~DORESS: McNee~ LL~ |00 Pine Sr.. ~7108 FELEPHONE: (717) 237-5397 ~JPR~ C~T ID ~ 80680 %]-]C~qNEY FOR: Deft., Consumers Life Insurance Co. 'ATE: Seal of the Court BY THE COURT: Protbc~otary/~le~k, Civil Oivisio~ (Eff. ~/97) CERTIFICATE OF SERVICF The undersigned hereby certifies that on this date a true and correct copy of the foregoing document was served by facsimile and U.S. first-class mail, postage prepaid, upon the following: Dated: July ~J],~, 2003 William A. Addams Hanft & Knight, P.C. 19 Brookwood Avenue, Suite 106 Carlisle, PA 1701, 3 Ohanes KELLEY S. BETTON : Plaintiff : CONSUMERS LIFE INSURANCE : COMPANY Defendant : IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA NO. 01-6483 Civil Term CIVIL ACTION - LAW NOTICE OF INTENT TO SERVE SLTBPOENA TO PRODUCE DOCUMENTS AND THINGS FOR DISCOVERY PURSUANT TO RULE 4009.21 TO: Kelley S. Betton and her attorney, William A. Adams, Esquire PLEASE TAKE NOTICE that Defendant, Consumers Life Insurance Company intends to serve a subpoena identical to the one attached to this Notice. You have twenty (20) days from the date listed below in which to file of record and serve upon the undersigned any objection to the subpoena. If no objection is made, the subpoena will be served. Dated: By ~1/ Michael R. Ke~ '"'"- Attorney I.D//No. 58854,,,~ Chades 'r,2foung, Jr. Attorney I.D. No. 80680 100 Pine Street Harrisburg, PA 17108 (717) 232-8000 Attorneys for Consumers Life Insurance Company {A258914:} KELLEY S. BETTON Plaintiff VS. c~TH OF p~qNSYLVANIA COUNTY OF (~0MR~RLAND Fi le No. 01-6483- Civil Term CONSUMERS LIFE INSURANCE COMPANY : Defendant SU~PC~NATO P~ ~NT'~'~ig~.:;~;J, AI~S FOR DISCOVERY PURSUANT TO RULE 4009.22 FO: John J. Zampelli, Jr., State Farm Insurance Company, 1838 Spring Road, Carlisle, pA 17013 (Nan~ of Person or Entity) within twenty (20) days after service of this subpoena, you are ordered by the cou~t to ~roduce the following doctrnents or things: Any and all documents pertaining to disability tnsurar~l .olicies, life insurance policies, and/or credit insurance policies, which policies are either insure Kelley S. Betton, SS#: 206-50-9059, DOB: 8/20/71, address: 70 W. Big Spring Aveu~e~ McNees, Wallace & Nurick (Charles T. Young, Esq.), 100 Pine St., Harrisburg, PA mewville, (Address) 17101. Yc~ may deliver or. mail legible copies of the docunents or produce things requested by :his subpoena, tc~ethe~ with the certificate of ccrnpliance, to the party making this 'equest at the address listed above. You have the right ko seek in advamc~ the reasonable zost of preoaring the ©ooies or producing the things sought. If you fail to produce the doct~ents or things required by this subpoen~ within twenty ]20) days after its s~-vice, the party serving this subpo~',a may seek a court order ~5elling you to c~ly with it. ~lS SUbPOENA WAS ISSUED AT THE REC~J~ST OF ~ FOELONIN~ PERSON: IAblE: Charles T. Young, Esq. ~)ORESS: McNees, Wallace & Nurick LLC 100 Pine St., Harrisburg, PA 17101 ~LEPHONE: (717) 237-5397 ;U~REI'i2 O01o~T I0 . 80680 ~I-IC~RNEY FOR: Deft., Consumers Life Insurance Co. of the Court (Eff. 7/97) CERTIFICATE OF SERVICE The undersigned hereby certifies that on this date a true and correct copy of the foregoing document was served by facsimile and U.S. first-.class mail, postage prepaid, upon the following: Dated: July ~i, 2003 William A. Addams Hanft & Knight, P.C. 19 Brookwood Avenue, Suite 106 Carlisle, PA 17013 , T. You~/~Jr. -~- 07/3i/2003 15:33 717-2450457 HANFT&KNIGHT PC PAGE 02/02 I(~LLEYS, BETTON Plaintiff CONSUMXRS LIFE INSURANCI~ CON[PANY Dnfendnnt COURT OF COMMON P]~A~ CUM~EP~AND COUNTY: PA NO, 01-~489 Civil Term CIVIL ACTION- LAW W,~VER OF TWE~ DAY W~['I']i~ G I hereby acknowledge that 1 have received the Notice of Intent to Serve Subpoena to Produce Documents and Things For Dlscevery Pursuant fo Rule 4009.21 (subpoena directed to John Zampelli, agent for State Farm Insurance Company) In the -bore-captioned matter, that I hereby waive the twenty day welting peric~{ required by the above-referenced rule, and that I permit counsel ,,vlshin0 to serve the subpoena to serve such subpoena immediately. Dated: W]'lliam ~A'-dclame, Esquire Attorney for Plaintiff IN THE COURT OF COMMON ~PLEA~ CUb~BERLAND COUNTY, PA NO. 01-6485 Civil Term CIVIL ^CI~ON- LAW WA~R O~TWENTY DAy WAITING PERIOD I hereby acknowledge that I have received the Notice of Intent to Serve Subpoena to Produce Documents and Things For Discovery Pursuant to Rule 4009.21 (subpoena directed to AJliance Funding) in the above-~aptioned matter, that I hereby waive the twenty day waiting period required by the above-raferenoed rule, and '~hat I permit counsel wlehln0 to serve the subpoena to sen/e such subpoena immediately. Dated: ?- 3/' 0_3 William Addame, Esquire Attorney for Plaintiff CERTIFICATE OF SERVICE The undersigned hereby certifies that on this date a true and correct copy of the foregoing document was served by U.S. first-class mail, postage prepaid, upon the following: Dated: August I , 2003 William A. Addams Hanft & Knight, P.C. 19 Brookwood Avenue, Suite 106 Carlisle, PA 17013 Charle., T. '¢our~g,J~ J / KELLEY S. BETTOl~aintiff CONSUMERS LIFE COMPANY, DEFEND~ In accordance Defendant Consume attorneys McNees V~ Judgment. In suppo 1. On April 1; Insurance for credit purchase of a motor the Appendix, as Exl conditions. (Exhibit 2. On March "Claim"), which Con= Plaintiff's pre-existir (Appendix, Exhibits 3. For many suffered from TM J, ~ISURANCE ~fendant : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : NO. 01-6483 CIVIL TERM : CIVIL ACTION LAW iT'S MOTION FOR PARTIAL SUMMARY JUDGMENT vith Judge Edward Guido's Scheduling Order of July 30, 2003, · s Life Insurance Company ("ConsurTlers"), by and through its allace & Nurick LLC, hereby files this Motion for Partial Summary t thereof, Consumers avers as follows: 1999, Consumers issued Plaintiff Kelley S. Betton a Certificate of ~ and disability insurance (the "Policy") in connection with the vehicle. (A true and correct copy of the Certificate is included in libit "A.") The Policy contained an exclusion for pre-existing 'A," at p.1). ~), 2001, Plaintiff made a Credit Disability Claim on the Policy (the ;umers subsequently denied because the Claim resulted from condition, specifically temporomandibular joint problems ("TM J"). )"& "E.") ears before purchasing the Policy from Consumers, Plaintiff :emming from automobile accidents in 1986 and 1991. (Appendix, Exhibit "B," Dep. of Betton at 7-10). Plaintiff had six (6) different surgeries for her TMJ before making the Claim with Consumers. (Appendix, Exhibit "F.") 4. The Certifidate of Insurance issued by Consumers excludes coverage for claims if the claim re~ulted from a condition that caused the insured to be disabled from her occupation at an Certificate (in this ca,' Plaintiff's Claim is ex, TMJ. 5. The Certifi( YOUR CERTI EXCLUSION. YOUR DISAB YOU TO BE '[ MONTH PERI OF THE CER' COVERED" S (Exhibit "A," at p.1 ). 6. In the Cert sickness you are tot~ After benefits have unable to perform education, training o a legally qualified ph disability on a month 7. Due to the against Consumers, time during the 6-month period preceding the issuance of the .e between October 1998 and April lg99). (Exhibit "A," at p.1). ;luded from coverage based on Plaintiff's pre-existing condition of ;ate of Insurance provides as follows: --ICATE CONTAINS A PRE-EXISTING CONDITION YOU WILL NOT RECEIVE A DISABILITY BENEFIT IF LITY RESULTS FROM A CONDITION WHICH CAUSED OTALLY DISABLED AT ANY TIME r)URING THE SIX (6) OD IMMEDIATELY PRECEDING THE EFFECTIVE DATE r'IFICATE. REFER TO THE "TOTAL DISABILITIES NOT ECTION OF YOUR CERTIFICATE. ficate of Insurance, "Total Disability" ~means that, "due to injury or Ily disabled and unable to perform the duties of your occupation. 9en paid for twelve (12) months, 'Total Disability' means you are duties of any occupation for which you are reasonably qualified by experience. You must be receiving regular medical treatment by tsician. You will be required to give [)roof of continuing total , basis." (Exhibit "A," at p.3; underlining added). lenial of the Claim by Consumers, Plaintiff brought this action asserting counts for breach of contract and statutory bad faith under 42 Pa.C.S.A. § 8371. For the reasons discussed below, Consumers is entitled to summary judgment on Plaintiff's bad faith claim. 8. Plaintiff ha,' (See Appendix, Exhil April 12, 1999. Plain immediately precedir exclusion is applicab 9. Plaintiff ha. surgery on October; the duties of her oct Claim falls squarely, 10. Plaintiff's work for 1 month foil Act Form, which stat 11. Under PE prove, by clear and basis for denying be disregarded its lack 699 A.2d 751,754 ( 649 A.2d 680, 688 I 12. There is Plaintiff ultimately p~ admitted that she had surgery for her TMJ on October 26, 1998. ~it "B," Betton Dep. at 34-35). Plaintiff applied for insurance on :iff's surgery therefore occurred during the 6-month period g the issuance of the Certificate, and the pre-existing condition e. admitted that she was off of work for 2 to 3 weeks following her 3, 1998. (Betton Dep. at 36). Because she was unable to perform )ation, Plaintiff was "totally disabled" under the Policy, and the ithin the Policy's exclusion for pre-existing conditions. surgeon, Dr. James Murphy, estimated that she would be unable to )wing the TMJ surgery. He completed a Family and Medical Leave ~d this opinion. (Appendix, Exhibit "C.") nnsylvania law, in order to recover for bad faith, a plaintiff must .,onvincin.q evidence, that (1) his insurer did not have a reasonable ~efits under the policy and (2) the insurer knew or recklessly )f reasonable basis in denying the claim. MGA Ins. Co. v. Bakos, ~a. Super. 1997); Terletskv v. Prudential Prop. and Cas. Ins. Co., ~a. Super. 1994). lo evidence that Consumers acted in bad faith. Even assuming 9vails on the breach of contract claim (which is denied), Consumers 3 acted reasonably in its handling of PlaintifFs Claim, and it possessed a reasonable basis for denying PlaintifFs Claim based on the Policy's exclusion for pre-existing conditions. 13. This CourlF does not need to decide the breach of contract claim in order to grant summary judgment in favor of Consumers on the bad faith claim. The bad faith claim is separate an( 14. Even putt of subjective bad fait nothing more than in based on the results 15. Plaintiff c~ Summary judgment = Plaintiff on the bad VVHEREFOF Court grant its Motio distinct. ng aside the merits of the contract claim itself, there is no evidence on the part of Consumers. The record shows that Consumers did estigate its suspicions regarding PlaintifFs Claim and take action f that investigation. lnot possibly prove bad faith by clear and convincing evidence. ;hould therefore be granted in favor of Consumers and against ~ith count. !, Defendant Consumers Life Insurance Company requests that the 1 for Partial Summary Judgment, and enter summary judgment 4 against Plaintiff Kelley S. Betton and in favor of Consumers on the bad faith claim contained in Count II of the Complaint. October ~0, 2003 McNEES WALLACE & NURICK LLC 100 Pine Street, P.O. Box 1166 Harrisburg, PA 17108-1166 Phone: (717) 237-5322 & -5397 Fax: (717) 237-5300 Attorneys for Defendant Consumers Life Insurance Company 5 CERTIFICATE OF SERVICE The undersigled hereby certifies that on this date a true and correct copy of the foregoing documentWas served by U.S. first-class mail, postage prepaid, upon the following: William A. Addams Hanft & Knight, P.C. 19 Brookwood Avenue, Suite 106 Carlisle, PA 17013 -Char~'~ '¢. Youn~/Jr. Dated: October 3'C 2003 KELLEY S. BETTON, Plaintiff V. CONSUMERS LIFE INSURANCE COMPANY, Defendant 1N THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 01-6483 CIVIL TERM CIVIL ACTION - LAW PLAINTIFF'S ANSWER TO DEFEND&NT'S MOTION FOR PARTIAL SUMMARY JUDGMENT AND NOW, c6mes the Plaintiff, Kelley S. Betton, by her attorney, William A. Addams of Hanft & Knight, P.C., and makes the following answer to the Defendant's motion for partial summary judgment. 1. Admitted. 2. Admitted. 3. Admitted. 4. Denied as stated. However, the exclusion is quoted in Paragraph 5. 5. Admitted. 6. Denied as stated. "Total disability" is defined as being "totally disabled and unable to perform the duties 0f your occupation." (Emphasis added). 7. The conclusion of law is denied. 8. Admitted. 9. Denied~ Ms. Betton testified that she may have been off work two or three weeks. She did not remember. She never applied for any disability benefits at that time. (Depo. P. 36-37). She also testified that during that time she worked between six and twelve hours at Dutrey's Shoes. (Id. at 63). This was confirmed by John Dutrey at the arbitration, hearing, and it is expected that he will so testify at trial. 10. Denied pending Dr. Murphy's deposition. 11. The conclusion of law is denied. 12. Denielt. The claim was submitted on March 9, 2001. The insurance company requested medical verification of Ms. Betton's disability and then denied the claim by letter of April 25,2001 because the clfiim "was causedbypreexistingconditions."(Defendant'sExhibitE). There was no reasonable bas~s for the denial at that time. After suit was filed the carrier went on a fishing expedition through discovery to support its denial. 13. The corlclusion of law is denied. 14. The answer to Paragraph 12 is incorporated herein by reference. 15. Denied. The Plaintiff intends to issue notices to attend trial and call the claims personnel who handle~ this matter to prove what they knew and when they knew it. WHEREFORI~, the Plaintiff requests that the motion for partial summary judgment be denied. HANFT & KNIGHT, P.C. Wflli~h~A~--Addams Attorney I.D. No. 06265 19 Brookwood Avenue, Suite 106 Carlisle, PA 17013 (717) 249-5373 Attorney fbr Plaintiff CERTIFICATE OF SERVICE AND NOW, this 6th day of November, 2003, I, William A. Addams hereby certify that I have served a copy of the Plaintiff's Answer to Defendant's Motion for Partial Summary Judgment by hand delikery to: CharlesiT. Young, Jr. Esquire McNee$, Wallace & Nurick LLC P.O. Bdx 1166 HarrisbUrg, PA 17108-1166 KELLEY S. BETTON, : Plaintiff : CONSUMERS LIFE INSURANCE : COMPANY, : Defendant : IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA 01-6483 CRIMINAL TERM CIVIL ACTION - LAW ORDER OF COURT AND NOW, this 14th day of November, 2003, after argument on Defendant's motion for summary judgment, we will defer the decision thereon to give the Plaintiffs the opportunity to depose the claims adjusters and supervisors involved in the decision to deny the claim. The deposition may be by telephone. Defendant is directed to make the adjusters and supervisors available during the week of November 17, 2003, at a time that is mutually convenient to both parties. The Plaintiffs may file a motion for production of documents by close of business today, by fax, requesting items they need to prepare for the depositions. If there is any objection, the Defendant's counsel may schedule a conference call with this Court and we will handle it in that manner. November 18, November 26, The pretrial conference scheduled for Tuesday, 2003, at 8:30 a.m., will be continued to Wednesday, 2003, at 8:30 a.m. Plaintiff is directed to file those portions of the deposition and documents that support his position in opposition to the motion of summary judgment not later than Monday, November 24, 2003. A brief or memo in support of his position shall accompany said filing. -- GSido, J. Edward E. ~illiam A. Addams, Esquire Attorney for Plaintiff v'Charles T. Young, Jr., Esquire Attorney for Defendant srs KELLEY S. BETTON, Plaintiff : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : NO. 01-6483 CIVIL TERM CONSUMERS LIFE iNSURANCE COMPANY, Defendant : CIVIL ACTION LAW DEFENDANT'S RESPONSES TO PLAINTIFF'S REQUEST FOR PRODUCTION OF DOCUMENTS TO: KELLEY S. BETTON, Plaintiff, and WILLIAM A. ADDAMS, ESQUIRE, her attorney PLEASE TAKE NOTICE that Defendant, Consumers Life Insurance Company, by it's undersigned attorneys and pursuant to the Pennsylvania Rules of Civil Procedure, hereby serves the following Responses to Plaintiff's Request for Production of Documents. I.D. No. 58854 ~/ 100 Pice Street P.O. Box 1166 Harrisburg, PA 17108-1166 (717) 237-.5322 Attorneys for Defendant Consumers Life Insurance Company Dated: 1. All statements, signed statements, transcripts of recorded statements or interviews, recorded statements, if not transcribed, taken of any parties, persons, or witnesses as part of an investigation in the possession of Defendant, Defendant's attorney, insurers, or anyone else acting on behalf of Defendant. RESPONSE None, 2. All expert opinions, reports, summaries, or other writings of experts in the possession, custody or control of Defendant, or its attorneys or insurers, which relate to the subject matter of this litigation and the incident in question. RESPONSE None at this time. Defendant reserves the right to supplement this response. 3. All documents prepared by Defendant, or by any insurers, representatives, agents or anyone acting on behalf of Defendant except its attorneys, during an investigation of any aspect of the incident in question. Such documents shall include any documents made or prepared up through the present time, with the exclusion of the mental impressions, conclusions or opinions respecting the value or merit of a claim or defense, or respecting strategy or tactics. (NOTE: As referred to therein, "documents" includes written, printed, typed, recorded, or graphic matter, however produced or reproduced, including correspondence, telegrams, other written communications, data processing storage units, tapes, contracts, agreements, notes, memoranda, analyses, projections, indices, work papers, studies, -2- reports, surveys, diaries, calendars, films, photographs, diagrams, drawings, minutes of meetings or any other writing (including copies of the foregoing, regardless of whether the parties to whom this request is addressed is now in the possession, custody or control of the original) now in the possession, custody or control of Defendant, its former or present counsel, agents employees, officers, insurers, or any other person acting on Defendant's behalf.) RESPONSE All non-privileged documents from the claim file are enclosed. 4. If not otherwise covered by the above Requests, the complete claims/investigation/subrogation file(s) of any insurer dealing with the incident in question, with the exclusion of the mental impressions, conclusions, or opinions, respecting the value or merit of a claim or defense, or respecting strategy or tactics. RESPONSE See Response No. 3. 5. All documents in the possession, custody or control of Defendant, Defendant's counsel, insurers, or anyone else acting on Defendant's behalf, dealing any way with the injuries, damages and losses sustained by Plaintiff, other than those documents supplied by Plaintiff's counsel. This should include, but not be limited to, all medical bills, medical records, medical reports, correspondence, and all other bills and documents relating to medical treatment, hospitalization, medication, appliances, lost wages, etc. RESPONSE See Response No. 3. -3- VERIFICATION Subject to the penalties of 18 Pa. C.S.A. §4904 relating to unsworn falsification to authorities, I hereby certify that I am the Assistant Vice President and Senior Compliance Officer of Life of the South, and am authorized to execute this Verification on its behalf, and that the facts set forth in the foregoing Responses to Request for Production of Documents are true and correct to the best of my knowledge, information and belief. Craig S ~'lart Dated: CERTIFICATE OF SERVICE The undersigned hereby certifies that on this date a true and correct copy of the foregoing document was served by first-class mail, postage prepaid, upon all counsel of record. William A. Addams, Esquire LAW OFFICE OF MICHAEL J. HANFT 19 Brookwood Avenue, Suite 1,06 Carlisle, PA 17013 Michael R. Kelley Attorneys for Defendant Consumers Life Insurance Company Dated: -4- Claim Master File Displai~ $CRN0~ U~er :"AFISER Company..: C1 CONSUMERS LIFE INSURANCE COMPAN~ Account..: ~006802 YORK VOLKSWAGEN INC Claim No.: D~~oan: Member: Name ..... : ~ KELLEY Form: Cert: Time: 14:21:37 Date: ~ 00006802 '0'0'~65 000 Sex ...... : M Age: 027 028 D.O.B.: o8201971 I.D.#: 206509059 Lit'~l Coy Typ De~c. Cov--~--xp-~te Coy. ~e Cov. Term Claim Benefit Amoun--~ 201 2 R14 4/12/2004 4/12/1999 060 346.35 ~ D~yl~r-~-TRemaining Amount ~Max Pymts~ Cheuks---~dlTotal pa~-~-~l~aid 27 52.27 18,103.71 052 000 .00 .00 Creator : 0000001366 000 Fu~ON ~]~K Injury : 524. DENTOFACIAL ANOMALIES, INCLUDIN~ MALOCCLUSION Occupation : OW OFFICE WORK/CT.~RICAL Status : O OPEN CLAIM Perm Disabled: _ Disposition: ~EW NEW CLMNO PAY~m~TS MADE Estb Date IInc--~-Date IRept Date ~Open Date IClose Dare,Denied Date~Lst Paid Dt 3/19/2001 12/04/1999 3/19/2001 3/19/2001 ~-~te~Status Date~Cert Can Dt~Expenses Paid ~User----~--~"~iner~Payee cd 3/19/2OOl .oo ! Comment: Assoc. Ret: 00010583 Micr#: Enter-Next Scm F3-Exit F4-Payments F5-~rrors F6-Act~ons ~'15=Keys SOME FUNCTIONS UNAVAILABLE TO YOU vOLKSWAGEN 3475 EAST MARKET STREE~T P.O. BOX 3514 YORK, PENNSYLVANIA '17402-0514 Credit insurance Processing Center 1{30 West Bay Street / PO Box 44t 30 Jadrsonville, FI_ 32251-4150 1-800-888-2738 CREDIT DISABILITY CLAIM [] Continuing Claim [~] Flea1 CREDIT INSURANCE COMPANY [] Arnedcan Republic Insurance Company [~-aler Name; ,j, City ~ State I ~a~ng [] Eliminatton . ~ I mos @ I ElY,s ~No OYes ~No Loan No. 5. Name of Creditor Payee A~e~,~ 6. Mail Check To The Attention Ot~ L~O.~ ~ No. & Street City State Zip Te~l~..~ No. Is a copy of the insurance CettJficate m~osed? ~ Not? and complete to ~he best of my knowledge and belief ~.~._.~L' ~) ~ Any pemon who, Intent to defraud or knowing that he/she is facilitating a fraud against an Insurer, submits an application or files a claim containing any false, incomplete, misleading, or deceptive statement is guilty of an insurance fraud. Full Name 1 Telephone rl~ ~q Social Security No. Date of Birth c~y our job. Wben did you or do you expect to return to light work? W'nen did you or do you expect to tatum to full time work? State Zip Code Average hours worked Base Pay Date & Time InjuP/Occurred? O AM I Were you injured at work? CIpM I OYes ~ No W~nere? Have you ever had this or a similar condition before? I~'Yes ~ No When? Describe how, when, where and why this injury incurred. Were you hospital confined? Name and address of Hospital performed any work other than your usual occupation? 0 Yes ~No If "yes", give nature of work and dates worked. Are you receiving or entitled to receive any other disability benefits? ~Yes I~No Source and amount ~nd addresses of all doctors treating your present disability. of all doctors seen in the 2 years pdor to this loan. I address of your family physician. AUTHORIZATION: Upon presentation of the original or a photocopy of this signed authorization, I authorize any medical professional, hospital or other medical-care institution, insurance support organization, pharmacy, governmental agency, insurance company, group policyholder, employer or benefit plan administrator to provide (my credit insurance company named above) or an agent, attorney, consumer reporting agency or independent administrator, acting on its behalf, information concerning advice, care or treatment provided the Insured named below, including information relating to mental illness, use of drugs or use of alcohol. I also authorize my employer, group policyholder or benefit plan administrator to provide my insurance company with financial or employment-related information. I understand that such information will be used by the insurance company for the purpose~ of evaluating my claim for insurance benefits and that I or any authorized representative will receive a copy of this authorization upon request. This authorization is valid from the date signed for the term of the policy. Date {e-order# 11-021898-00 Signat~ of Insured I ALL QUESTIONS MUST BE FULLY ANSWERED OR DELAY WILL RESULT ATTENDING PHYSICIAN'S STATEMENT OF DISABILITY The patient is responsible for the completion of this form without axpense to the Company. DATE OF JNAMEOF ' ,, /~ , . (a) V~en did symptoms first appear or accident happen? MO. DAY MO ~'1 nAY 2. PRESENT CONDITION (a) Subjentive Symptoms ~/~[.~ (D) Obje~ve Findings Include results of curm~t X-rays, EKG's or [] F~sp~al Cc~'med? [] (c) Is Pa~e~t DIAGNOSIS (Please k. tc~ude the lCD Code) . EXTENT OF DISABILITY (a) Is Pa'~mt now totally disabled? (b) If no, when was patient able t~ go te wo~k? "~,,'~ MO.__ c) If yes, when do you think Patient will be able ~, Approximate date MO. ?. CARDIAC Of appmp~ata) (e) Furx~oeal Ca.db/(American Heart'Ass'n) (b) B~3nd Pros,sum FOR ANY OCCUPATION FOR REGULA~ OCCUPATION Yes~ No [3 Ye~ No E3 DAY 19__ MO.__ DAY DAY -- 19 MO.__ DAY__ Yes ~No O CLASS 1 (No LimltalJo~) CLASS 3 (Marked ~flon) 0 0 CLASS 2 (Slight [.imtte~on) ~3 ~ 4 (Con.ere Umaat~,) [3 I STREET ADORESS ~ CI~ O~ TOWN SI'A~ ZIP . ~' ,i.l=91pteyee,$N.me .~ . TJgbtltleend~t~ties :~ . -,~o-- THOu?~W~Orkedweekly 2. Da EmoIov ' Date last worked ] La~asL~eekwo~. _Date. I$ this claim one that may be covered by V~3rkefs ~'11 emp~yed? I VVas he la'~l off? t~ ~f.~;~.~/a~leave of ~ aye, ~.o I aye, [3No I dtowork? I It not resumed to work do yqu expect employee ta ~11 4. VVhen dtd employee become totally disab e , , ~q~ When did empk)yee retum to full Ume work? ~,.~ ~'t ~.~%~L~'t ~hen? I5. Employefs name and mailing address (If self employed, give name and To the be~t of my knowledge and belief all of the answe~ given by the MUST BE COMPLETED BY CLAIMS DEPARTMENT (ALL CLAIMS SHOULD BE FILED THROUGH THE CREDITOR) Exam. LIFE OF THE SOUTH 03/20/01 MS.F~.TJ~ S.BETTON 70 W.BIG SPRING AVE. NEWVILLE PA 17241 FILE COPY CONSUMERS LIFE INSURANCE COMPANY Insured: KELLEY BETTON Certificate: 0006450465 0 Claim: 10583 We are unable to process the enclosed claim without the following information: PLEASE HAVE YOUR ATTENDING PHYSICAN PROVIDE US WITH YOUR SPECIFIC DATE OF DISABILITY We will give this claim our i~nediate attention as soon as this information is received. If you have any questions regarding the information needed, please contact our Customer Service Representatives at 1-800-888-2738. Sincerely, Karen Gatlin Customer Operations/Claims C1 10583 UND1 100 West Bay Street · PO Box 44130 · Jacksonville, FL 32231-4130 TEL {904) 350-9660 · TOLL FREE (800) 888-2738 · FAX (904) 350-9440 PREMIUM (904) 355-5878 CLAIMS LIFE OF THE SOUTH, 03/20/01 FII.~. COPY KFI.I,RY BETTON 70 W BIG SPRING AVE NEWVILLE PA 17241 CONSUMERS LIFE INSURANCE COMPANY Certificate: 0006450465 0 Claim: 10583 Source(s): DR.BOWER We have reviewed the claim form submitted and based on our finding we have requested additional information from the source(s) listed above. Please contact the source(s) to see that our request is answered. Pending receipt of all information and approval of payment, it is importan~ that you keep payments current to avoid any additional late 6harges being added to your account, as late charges are not covered. Please notify your Lending Institution that you have presented a claim under your policy. Once this information is reviewed, you will receive 'written notification of your eligibility for benefits. Sincerely, Karen Gatlin Customer Operations/Claims cc: FULTON BANK C1 10583 MEDINS 100 West Bay Street · PO Box 44130 · Jacksonville, FL 32231-4130 wet (904) 350-9660 · TOLt FREE (800) 888-2738 · FAX (904) 350-9440 PREMIUM (904) 355-5878 CLAIMS LIFE OF THE SOUTH 03/20/01 DR.DOUGLAS BOWER 220 WILSON STREET #109 CARLISLE PA 17013 FILE COPY RE: CONSUMERS LIFE INSURANCE COMPANY Insured: KET.T~Y BETTON Certificate: 0006450465 0 Claim: 10583 Information: MEDICAL KECORDS For the period: 4/12/98-4/12/99 206509059 Dear Records Custodian: To properly consider this claim, we need the info~mation requested above for the period noted. An authorization to release information is attached. Please respond within 10 days so that we may proc,mss the claim in a timely manner. Attach your bill for services to a copy of this letter and return for prompt payment. If prepayment is required or if the bill will exceed $20.00, it must be pre-approved. Please contact us at 1-800-888-2738. Sincerely, Karen Gatlin Customer Operations/Claims C1 10583 MEDDR 100 West Bay Street · PO Box 44130 · Jacksonville, FL 32231-4130 TEL (904) 350-9660 · TOLL FREE {800) 888-2738 · FAX (904) 350-9440 PREMIUM (904) 355-5878 CLAIMS LIFE OF THE SOUTH. 03/20/01 DR.DOUGLAS BOWER 220 WILSON STREET #109 CARLISLE PA 17013 RE: CONSU~fERS LIFE INSURANCE COMPANY Insured: K~.TJ.EY BETTON Certificate: 0006450465 0 Claim: 10583 Information: MEDICAL RECORDS For the period: 4/12/98-4/12/99 206509059 Dear Records Custodian: To properly consider this claim, we need the information requested above for the period noted. An authorization to release information is attached. Please respond within 10 days so that we may process the claim in a timely manner. Attach your bill for services to s copy of this letter and return for prompt payment. If prepayment is required or if the bill will exceed $20.00, it must be pre-approved. Please contact us at 1-800-888.-2738. Sincerely, Karen Gat!in Customer Operations/Claims ITHORIZATION: Upon presentation of the original or a photocopy of this signed authorization, I authorize any medical professional, hospital or other ~dicel-care institution, insurance support organization, pharmacy, governmental agency, insurance company, group policyholder, employer or benef'~ administrator to provide (my credit insurance company named above) or an agent, attorney, ~umer reporting agency or independent adminiatrator, acting on its behaff, information concerning advice, cam or treatment provided the Insured ~ed below, incJuding information relating to mental illness, use of drugs or use of alcohol. I also authorize my employer group po cyholder or benefit ~dministrator to provide my nsurance company with financial or employment-related information. ~erstand that such information will be used by the insurance company for the purpose, of eva uat ng my claim for insurance benefits and that I or any !rized representative will receive a copy of this authorization upon request. This authorization is valid from the date signed for the term of the policy. Date ! 11-021898-00 Signat~'~ of Ins=red I ALL QUESTIONS MUST BE FULLY ANSWERED OR DELAY WILL RESULT · '--~-" 350-9440~REM~UM (904) 355-5878 CLAIMS TEL (904) 350-9660 · TOLL FREE (800) 888-2738 ~.F^X (904) 7172499332 MASLANDASSO INC PAGE ~9IASLAND ASSOCIATES, INC. ~¥TE~dV,-iL Y[ED ~ CfNE MEDICAL ARTS BUILDING DAVID $. ND, St. aND. M.D. 220 WiLSoN S~E~r, CaRLISLe, PA 17013 i~,Sgv S. R~NK;N, M.D., F.A,C.C. (7i7) 249-1929 TEaRy A. ROetSON. D.O. 81 Jasv. pH F. B~,~.£L M.D. FUNK P. CaS'r~N,,,. M.D. Pltlup A. Nel~R£~. D.O. Douol~,s J. B0W~. M.D, ~A'm 3- ~ o - o I . 'TO: 22DSU~r~.C Co. ~'f~ oF ~ coa~ PATIENT NAME: RETR/EVAL FEE $15.39 P^OSS ~ sl.o~ s/~ ,45' PAGES ~..77 $ PAGES ~ .26 $ TOTAL CHARGE PLEASE FORWARD CHECK FOR THE ABOVE AMOUNT AND WE WILL MAIL COPIES E~4~,fEDIATELY. ' - YOU. SINCERELY, OAYLE M. GUTSHALL OFFICE MA.N~G~,. ~]001 04/03/01 10:14 FAX *** TX REPORT *** TRANSMISSION OK TX/RX NO CONNECTION TEL SUBADDRESS CONNECTION ID ST. TIME USAGE T PGS. SENT RESULT 2003 04/03 10:10 04'01 2 OK 17172499332 Claims(904)355-5878 Premiums (904)350-9440 Collateral (904)350-9715 Administration (904) 354-4525 LIFE OF THE SOUTH If there are any problems in recelyiqg this tr~mmission please Company Number of pages LIFE OF TH E SOUTH Claims(904)355-5878 Premiums (904)350-9440 Collateral (904)350-9715 Administration (904) 354-4525 If there are any problems in receivinm tlhis tr~mmission please Fax to Number ~-~ Company H Comp any C Number of pages I O0 West Bay Street · PO Box 44130 · Jacksonville, F L 32231-4130 (904) 350-9660 · rOLL FREI (800) 888-2738 · ~:^X (904) 350-9440 PREM~U~.~ (904) 355-5878 ClL^~MS 04/03/2001 1~: 18 717249933~ " 03/3~/2~! ZS:§el 7~7249~332 M~SL~ND~SS~ [NC I~4~I. AND ASSOCIATES, ~N'C. PA~E OL TOTAl, Fr--,~E FORWARD CH~CK FOR TIlE ABOVI~ AMOLtNT AND ~ 'v~'z ~ COF~S EvI~r~!ATELY. · · T~ YOU. 04/03/2001 12:18 7172499332 M~SL~ND~S$O INC PAGE 82 LIFE OF THE SOUTH Claims(9043355-SB78 Collate~&l (90~3350-97t5 Administr&tion (904) I00 wes~ 8,'ny Street · PO Box 44130 · lac:kwik, Fl, 33231.4110 ?[~. {9041 :)SO-~f~,O · rCY, L fB~ (Boe} L,6lus?3e · K.,x ,'e04l 350..~1140 ~al~r,..~,, (go4l 3ss-~oTll 84/83/2881 12:18 7172499332 M~$LAND~$SO INC PAGE MASLAND Assoc , s, INc. INTERNAL MEDICINE 220 Wli.sot~ S'mErt, CAIUlSLE, PA 17013 (717) 249-1929 T~REY A. ROBUON. D.O. P.tu~, A. NSm~RZ% D.O. DOUOLA$ J. BO'#~R, M.D. FAX TRANSMITTAL COVER SHEET Fax No. 717-249-9332 DATE: ~ -- ~ TIME: TOTAL NL~4BER OF PAGES INCL%'DING COVER SREET: IF YOU DO N0~ RECEIVE ALL PAGES AS INDICATED, PLEASE CALL HESSAGE: 'The documents accompanying =his transmission .Dontain confidential information belonging to the sender :hat is legally privileged. The information is in~ended only for the usa of =he individual or entity named above. If you are not the in=ended recipient, you are hereby notified that any disclosure, copying, distribu:ion, or the taking of any action in reliance on the contents of this telecopied information is stric:ly prohibited. If you have received this =elecopy in error, please notify us by telephone to arrange for return of the original documents to us. Thank you for your cooperation. SIGNATURE OF PERSON SENDING FAX: NOTE: Pleaen photocopy f~xed mater~al onto regular pa~er before includins in your permanent ~eeord. Thermal fax paper is highly acidic, meaning it csn decay :o the point of illeEibillty ~n only :~o years. In addition, the aci~ in the thermal paper can migra:e to other 4ooumen:s and destroy them. 04/03/2001 12:i0 7172499332 MASLANDASSO INC PAGE 03 / LIFE OF THE SOU qq. o3/2o/oi DR.~UGI~S BO~ 220 WILSON $%~ #10g C~IST.~. PA 17013 CONSCrM~RS LIFE INSURANCE COMPANY Insured: ~u3.ay B~'l-i~N Certi£icate: 0006~50A65 0 Claim: 10583 Information: ~DICAL RECORDS ~er the period: 4/12/98-4/12/99 206509059 Dear Records Custodian: To properly consider this claim, we need :he information requested above for the period noted. An authorization to release information is a:taehed, Pie·se respond %r/thin 10 days so ~hat we may process the claim in a timely Attach your bill for services to s co~y of ~his ls'~ter and ret~---n for prompt payment. I~ prepayment is required or i~ the bili will exceed $20.00, it ~u~t be pre-approved. Please con, act us at 1-800-888-2'738. Sincerely, ICaren ~arlin Customer Operations/Cla~ ITHORIZATION: Upon preoentation of the original or · photocopy of this signed authorization, I authorize any medlcal professional, hospital or other dical..care instilu§on, insurance auppo~ orgen~tion, pharmacy, governmental agency, Insurance company, group policyholder, employer or benefit admOnish'·mr to provide_ (my credit insuranCe company named above) or an agent. ·~tomey, numar rapturing agency or independent administrator, a~ng on I~ behalf, information conCerning advice, care or treatment provided the Insured ~1 below, including information rol~fin§ lo mental lilfle~$, use of drugs or use of alcohol. I lisa authodrM my omploye~, group pollcyholder or becefit ndministralor to provide my insurance company with financial or emp~o,/men~,.rololed I~formatkm. leratand I. hat auoh ininn'nafio~ will be used by the intiuranns Company for the purpose of tivaluoting my claim f~ insurance ~enelfts and that I or any treed represent·tOY· will receive a copy of this authorization upofl rm:luest This nuthor~o§on Is valid from the date signed for th· term of the potty"y, Date "~ ) Slgnst~ of In~ured ' 11-o21898-00 I ALL QuEsTIONS I~IUST BI: FULLY ANSWERED OR DELAY WILL RESULT J .'~'b.~L~?,~ Oe~coMnea? 0 Ho,J~Co,~A~d? O P, oq)~l~ 0 . PROGRESS RECC)VEREO 0 IUHIO~EO O (&) h'Pa~~ YES ~.~ NO 0 UNIk~PROVGD 0 ~ 0 ' · ' *. Telephone Inquiry Account Name Person Calling Telephone # Account # Claim Policy Disposition of Inquiry Responded to Caller By [] Telephone [] Letter Date Summarize Handling of Inquiry and its Disposition, #06-021520-01 CLM 10 co~,~ .~ co. 4~97 Date Person Handling Inquiry LIFE OF THE SOUTIH, 04/25/01 KELLEY BETTON 70 W BIG SPRING AVE NEWVILLE PA 17241 FILE COPY RE: CONSUMERS LIFE INSURANCE COMPANY Insured: KELLEY BETTON Certificate: 0006450465 0 Claim: 10583 We have received your claim and after careful consideration, we regret that we must decline benefits for the following reason: Claim was caused by preexisting conditions as defined in the policy We are sorry we cannot be of service at this time. If you have any questions concerning our decision or if you have additional infor~tion for our review, please send it by return mail along with a copy of this letter. Sincerely, Karen Gatlin Customer Operations/Claims cc: FULTON BANK C1 105~ DENX 100 West Bay Street · PO Box 44130 · )acksonvi[le, FL 32231-4130 7EL (904) 350-9660 · TOtE FREE (800) 888-2738 · FAX (904) 350-9440 PREMIUM (904) 355-5878 CLAIMS 021823 01 LIFE OF THE SOUTH. 04/25/01 ~.T .~.¥ Bml-ION ?0 W BIG SPRING AVE NEWVI l,r.~- PA 17241 CONSUMERS LIF8 INSURANCE CONI~ANY Insured: KELLEY B=l-lON Certiftcate:0006450465 0 .... Claim: -t0583 We have received your claim and after careful consideration, we rester that we must decline benefits for the followin$ reason: Claim was caused by preexisting conditions as defined in the policy We are sorry we cannot be of service at this time. If you have any questions concerning our decision or ii you have additional information for our review. please send it by return mail along with a copy of this letter. c~erely. Karen Ga~I n Customer Operations/Claims cc: Fo'LTONBANK 10583 DENX 100 West Bay Street · PO Box 44130 · Jacksonville, FL 32231-4130 TEL (~04) 350-~0 ' TOLL FREli (800) B88-2738 · FAX (904) 350-9440 PREMIU~d (eJO4) 355o51~7~ CLAIM5 21823-01 MICHAEL ]. HANET GREGORY H. KNIGHT RICHARD L. WEBBER, JR. LAW OFFICE (DF MICHAEL J. HANFT ATTORNEYS & COUNSELLORS AT LAW Or _CQ~NSeL_ May 30, 200I WluL~A~ A. ADDA~s MICHAEL R. RUNDLE Karen Gatlin, Customer Operations/Claims Life Of The South 100 West Bay Street P.O. Box 44130 Jacksonville, FL 32231-4130 JuN 0 i Consumers Life Insurance Company Insured: Kelley Betton Certificate: 0006450465 0 Claim No. 10583 Dear Ms. Gatlin: We have been retained by Kelley S. Betton regarding your denial of her claim as stated in the attached copy of your letter of April 25, 2001. Would you please explain how this claim was caused by preexisting conditions as defined in the policy. Ms. Betton has no recollection of being disabled during the six month period preceding the effective date of the policy. Thank you for your cooperation. Very truly yours, LAW OFFICE OF MICHAEL J. HANFT William A. Addams Enclosure cc: Kelley S. Betton 19 BROOKW'OOD AVENUE SUITE 106 CARLISLE, PA 17013 9142 717.249.5373 FAX 717.24%O457 W~,'VW. HANF] LAVVFIRM.C{DM MASLAND ASSOCIATES PATIENT NAME: URINALYSIS DocToR: DATE Fecal - Occult Blood Date Results Date Results Date Results Date Result Trich-Candida/Wet Preps Date Results Date Results OMMENTS/OTHER LABS: kEDiC.~,L A~d'S 't,ZO v;'ILSO."l .., RE,.[ )ecimen ID~ : ,pe: PATIENT JBC: 9. 1 K/uL .YM: 2.5 27.0 %L liD: 0.4 4.2 %M tAN: 6.3 68.8 %G IBC: 4.22 M/uL IGB: 13. 1 g/dL ICT: 38.8 % ICV: 92. fL ~CH: 31.0 pg '~HC: 33.8 g/dL ~DW: 13.8 % CELL-DYN 1600 ~PEClMEN DATA REPORT 4 Mar 27 WBC RBC 1998 Operator I.D.: Sequence ~$ : ' iS~ 2~ 2~0 -- 5~ lee l~e 4.84 s 6.63 s 'LT: 221. K/uL PLT MID cells may include nocytes, eosinophils, less frequently occurring al~d rare cells correlating to basophils, blasts and other precursor white cells. :,ec~- i men i~D~ : 5 ,pe: PATIENT )BC: 7.2 K/uL _YM: 3. 0 41. 7 %[- liD: 0.2 2.4 %M tAN: 4.0 55.9 iBC: ~.98 M/uL tGB: 12.7 g/dL tCT: 36.2 % 1CV: 91. fL 1CH: 31.9 pg ;HI]: 35. 1 g/dL iDW: 14.0 % WBC RBC 1600 SPECIMEN DATA REPORT Jan 15 19'.49 12: = Operator' I·!}. : Sequence :!$ : 664 5~ .... t~0 iS~---- 200 ii...P.,2 s 6. 4.9 s 'L't': 200. K/ul- PLT MID cells may include less frequently occurring and rare cells cor~-elating to nocytes, eosinophils, basophil, s, blasts and other precu~sor white cells. Car~l~Hospital and Health Se~ces Dept, of Pathology 246 Parker St., Carlisle, PA 170~ 3-g3I 0 CliniCal Laboratory Report William J poska, Admin: Director Duckkyu Chang, M.D:, Pathologist BETTON, KELLEY S. ADDE~-DUM OUTPATIENT I~EPORT DOB:08/20/1971 AGE 27 YRS F (002)023502 206-50-9059 (717) 776-3683 70 W BIG SPRING AVE DR ROBISON, TERRY A. (attending phy: ROBISON, TERRY A. ) PRINTED 10DEC98 TIME 2346 A/~MITTED 08DEC98 PAGE 1 CULTURE, URINE Source: URINE-UNK. COLLECTION TYPE Collected: 08DEC98 0001 ............... FINAL REPORT ............... 10DEC98 0719 >100.000 CFU/ML ESCHERICHIA COLI ............... SENSITIVITY TESTING ............... E COLI AMPICILLIN 2 S CEFAZOLIN <=8 S CIPROFLOXACIN <=0.5 $ GENTAMICIN <=C.5 S NITROFURANTOIN <=32 S / PIPERACILLIN <=8 S f'"~' TRIMETH/SULFA <=10 S ***susceptibility-InterpretiveData~* PiDeracillin susceptibility may 'b~ Used uo predict susceptibility ~icarcilIin. Accession: 98-342-0433 Received: 08DEC98 1400 Started: 08DEC98 1445 BETTON, KELLEY S. PAGE 1 Date Name: Masland Associates Chemistry Doctor: Comments Date Hematology Ferritin To: Oouglas J, Bo~r, N.O. From: Carlisle Hospital 12-$-9B l:~Bpm p. I of ! BETTON, KELLEY S. PAIN CLNC / / MRt~ 023502 DATE: 12/08/98 The patient is a 2B-year-old female with TMJ who presents for follow-up. The patient is approximately six weeks status post her last TMJ surgery. The patient states things are going well. She is able to open her mouth more than before. She still com- plains of some pain although it is not as severe as it had been. She is currently taking MS Contin 30 mg in the morning and 15 mg at night. We are going to start to taper her of? her narcotics. I have instructed her to take 30 mg in the morning and to discon- tinue the dose at nighttime. She will do this for approximately tan days and then begin taking 15 m9 of MS Contin in the morn~qg. I will follow-up with her in approxzmately three weeks. I told her if she has any problems, to please call the Pain Clinic. She is also going to continue taking her Zoloft. She no longer takes Neurontin. OJC/bks D: 12/0B/1998 - 07:56 am T: 12/0B/199B c Dr. Douglas J. Bower Ox: Proc: Pt. ~: FC: CC: Daniel J. Chess, M.D, 'HECE]V~D C:V,.,~ & T~U. O~ BETTON, KELLEY S. PA]iN CLNC MR~ 023502 12/0B/1998 08/20/1971 Chess, Daniel J. M.D. Page 1 of 1 CARLISLE HOSPITAL FOLLOW-UP NOTE From: Carlisle Hospital 12-30-90 9:23am p. [ o? I BETTON, KELLEY S. PAIN CLNC / 023502 DATE: 12/30/98 Kelly Betton is a 2G-year-old female with TMJ who presents for fallow-up. The patient ia doing well status post her TMJ sur- gery. She ia currently taking one MS Contin 15 mg in the morn- in~. She aays that slowly her pain appears to be resolving. At thss point she does not feel that she can discontinue the MS Contin because of the pain. Will continue her on the MS Contin 15 mg q day for approximately six more weeks. I will follow-up with her at that time. OJC/bpm D: 12/30/1990 - 09:07 am T: 12/30/1990' c Douglas J. BoWer, M.D. Daniel J. Chess, M.D. Dx Proc Pt~ FC CC BE'FTON, KELLEY S. PAIN CLNC MRt 023502 12/30/199B 08/20/1971 Daniel J. Chess, M.D. Page 1 of 1 CARLISLE HOSPITAL PAIN CLINIC - FOLLOW-UP NOTE :'Carlisle Hospital DEPARTMENT OF RADIOLOGY and Health Services 246 Parker Street · P.O, Box 310 · Carlisle, Pennsylvania 17013-0310 · (717) 249-1212 CARLISLE IMAGING ASSOCIATES, P.C. BETTON, KELLEY S. 27Y 70 W. BIG SPRING AVE NEWVILLE, PA 17241 01/15/1999 X-RAY #71743 MED. REC. #023502 DR. ROBISON, T. NON-CONTRAST MRI OF THE BRAIN This study was requested for evaluation of chronic headaches and chronic TMJ symptoms. Extracranial soft tissue structures, including the visualized paranasal sinus, orbital, facial and upper cervical spinal cord structures are grossly unremarkable in appearance. Sagittal images not adequately depict the temporomandibular joints on this exam. do Intracranially, the pituitary and suprasellar cistern regions are within normal limits, although the superior aspect of the pituitary gland is mildly convex. This can be related to normal hormonal variation in a patient of reproductive age range. The adjacent brain stem, including the 2nd, 5th and 7th and 8th nerve complexes, is normal. Cerebellar and cerebral hemispheric structures show symmetric development, and symmetry of cisterns, sulci and ventricles. Flow voids in the expected distribution of the anterior, middle and posterior cerebral arterial circulations suggest vascular patency. There is no evidence of hemorrhage, mass effect or intercompartmental shift or herniation. No pathologic extra-axial fluid collections are iden%ified. IMPRESSION: Normal study. RAND J. CUTHBERTSON, M.D. RJC/je T: 01/16/1999 03:53 pm 'HECED/ED STAMP' DATE RCVD .... DATE CHART/PHYSiCiAN 2-It-99 p. 1o?I BETTON, KELLEY S. PAIN CLNC / / MR~t 023502 DATE: 02/11/99 The patient is a 27-year-old female with TMJ who presents for follow-up. She continues to take MS Contin 15 mga day. She states that this keeps her pain under control. She saw her oral surgeon 2 days ago who was happy with her ability to open her mouth. She states that this week has been particularly bad in terms of the pain in her jaw. I instructed her to continue to take the MS Contin as needed and I will follow-up with her in approximately two months, DJC/nw D: 02/11/1999 - 0B:04 am T: 02/11/1999 c Douglas J. Bower, M.D. Ox Proc Pt ~ FC CC Oaniel J. Chess, M.D. BETTON, KELLEY S. PAIN CLNC MR~ 023502 02/11/1999 0B/20/1971 Daniel J. Chess, M,O. Page 1 of 1 CARLISLE HOSPITAL PAIN CLINIC OFFICE NOTE BETTON, KELLEY $. / / PAIN CLNC MR~ 823582 OATE: 04/14/99 The patient is a 28-year-old female with TMJ who presents for a follow up. She reports unfortunately that after her most recent jaw surgery she still has pain which appears to be unchanged. She is going to continue takin9 the MS Contin 15 mg b.i.d, as well as zoloft. I also gave her a prescription for celebrex to take 100 m9 b.i.d, for the next 1-2 weeks. She will follow up in the Pain Clinic in approximately 3 months. DJC/dem 0: 04/14/1999 - 08:12 am T: 04/14/1999 c: Oou91as J. Dower, Dx FC CO Daniel J. Chees, APR ~ O^T~. R _ ; DATE REVIEWF-D SE~ ~'>ROGRES.3 NOTE9 ~R ~NS~L~ONS BEITON, KELLEY S. PAIN CLNC MR~ 023502 04/14/1999 08/20/1971 Daniel J. Chess, M.D. Page 1 of 1 CARLISLE HOSPITAL FOLLOW UP NOTE )ATE AP ~L ~ 'EMp ULSE UI WT ~L Pi: TEMt~ PULS PUl NAME: ~_~ 1998 3 0 1998 1998 no/ Kelley is a patient of Dr. Bowers who states that for the past couple days, she has had some pressure in her pelvic area and it has felt hard as a rock. She currently is taking narcotics for TMJ dysfunction and has intermittent constipatic She also recently was treated in April for UTI. She relates some urinary frequency without burning. She states that she is taking birth control pills and there is no way she could be pregnant. P~E: Reveals an alert and oriented and very pleasant lady in no acute distress. Lungs clear. Heart regular. Abdomen soft with positive bowel sounds. She has some suprapubic tenderness to deep palpation. Speculum exam of the vagina reveals no significant discharges. Cervix looked normal. No blood coming from the cervix. No discharges coming from the cervix. Adnexal exam reveals no masses that: I can appreciate bilaterally. No suprapubic masses. Rectal continued: JE FOR TETANUS '28/9 TEMP =ULS~ *UI Kelley Betton ~ continued: exam revealed no intra-rectal masses and she was heme negative. The assessment is pelvic discomfort - not clear of etiology. She could have an early UTI. This could also be complicated by intermittent constipation although no stool was appreciated in the rectal ampulla. The plan will be 3 days of Cipro 500mg BID x3 days for possible simple UTI, Senekot S 2 QD for regular BM's in face of taking narcotics. She will followup with Dr. Bower in a week to see how she is doing and make sure nothing else such as a pelvic ultrasound needs to be done. As long as she is doing well, that's what we'll do. She'll call if she does no~ get better or should acutely worsen in any way. TAR/pjd T: 6/3/98 Patient comes in today for followup. Please see Dr. ~bison's last note. Since last being seen, she has felt better. Hasn't really had much of a response to the Senokot S yet. The antib~ seemed to clear up her urinary symptoms. She has fairly signif constipation. TAkes Metamucil. Still only has a bowel movemen every 4-5 days. TAkes Ex-lax as needed. Pe: Abdomen entirely benign. IMPRESSION: 1. Possible recent UTI, now resolved. 2. Chronic constipation. 3. Chronic pain on narcotics secondary to TMJ. PLAN: 1. Continue current regimen. Continue Senokot for time being to see if it has a chance to give her some improvement. If not improving down the line, may wish to send her to the Pain Clinic, Carlisle Hospital. She is going to a Pain Clinic at Allentown at this point. Continue Senekot S. Take a laxative if she hasn't had a bowel movement every 4 days. Call if problems. Otherwi~ routine followup when due. DJB/pj d T: 6/15/98 ~tics .cant NAME: ',9 1998 Patient comes in today for evaluatio~ of probably poison ivy. She was out weeding last Tuesday. Over the weekend, she started breaking out. PE: She has characteristic erythematous papules and ves~l~s~ streaked pattern consistent with thus dermatitis. IMPRESSION: 1. Poison ivy,. PLAN: 1. Prednisone burst and taper. 2. Wash all of her clothing including her garden gloves and shoes. 3. Follow up if her symptoms do not improve with therapy. Otherwise, routine follow up when due. DJB?bw T: 7/7/98 z//o-- See Consultation. 1998' Kelly had T~J surgery done on ~onday. After the surgery, she noticed some right calf pain. She states that th:ts pain radiates up into her upper thigh and dowm into her leg. There are some areas of tenderness but she denies fever, redness, swelling or warmth. PE: Right and left leg are symmetrical to appearance. No obvious areas of edema or erythema. Both lower legs are equal in temperature. Homan's sign is negative. Some mild tenderness to palpation om the right lower posterior calf. Peripheral pulses are present and equal bilaterally. IMPRESSION: Musculoskeletal leg pain. PLAN: 1. Ibuprofen 400mg every 6-8 hours as needed for pain. 2. Apply heat to the areas where it hurts. con~inued: ,I. DAT'e BL PR TEMP PULSi PUl Kelly Betton B.continued: Gentle stretching exercises Co keep those muscles limber. She will call i~ned£ately if she develops any eryChema, any swellin$ in that area, fever or increased pain or PEN. Kelly has a long history of headaches that are related to misraines and TM$ disfunotion. Since she had TMJ surgery several months ago~ she has had a headache. In =he ~ast several days the headache has gotten worse and has become very bothersome to her because up the back of her head and into her forehead s~e denies blurring of vision ,or other neurological symptoms. She has Eaken Fiorina]. with some relief but when the Fiortnal wears off the headache comes back. She also complains of some photosensitivity. She states that h~r migraines are not the classic migra~nes Continued: NAME: Kelly Betton Continued: where she gets an aura or other neuro symptoms but she states that this is similar to other headaches that she has had. PE: Pupils equal, round, reactive to light. Normal extraocul movements. Normal fingertip to nose movements. No posterior, anterior cervical, or supraclavicula~ lymphadenopathy- There is some tenderness to palpation in the posterior neck area where the muscles feel somewhat tight. IMPRESSION: Headaches in a headache pro~e patient. PLAN: 1. A trial of Midrin 1 or 2 every 4 to 6 hours. No to exceed 8 capsules per day for headache. She will call in the next 48 hours if her headaches have not been somewhat alleviated or if they seem to get worse or if she develops any other symptoms. Difficult case. Kelly is a 27-year old lady who recently underwent surgery in October, TMJ arthroplasty of which she has had about six procedures now, following an accident, I guess in her late teens. She suffered some TMJ injury and has had probl with that and chronic headaches since then. Has been diagnosed as having mitral valve prolapse interestingly enough, and also has been diagnosed with migraines and has seen various and sund doctors for her chronic headache complaints, over the years. Continued ns 7y NAME: Kelley Betton 9 Continued Currently she is taking birth control pills, Ventolin, MiS ContH S-Gesic (?) PEN, Zoloft 50mg a day, Aerobid for her asthma, and uses Imatrix PRN. She abuses tobacco and smokes a half pac~ of cigarettes a day, she also drinks a lot of caffeine, she dri~ 3 or 4 Mountain Dews a day which has a ton of caffeine in it an( coffee as well. She works, I guess, as a mortgage adjuster and _ives alone and apparently has a dog. She doesn't exercise too much and it sounds like she is getting about 5 to 6 at the most hours of sleep a night. She states that since her TMJ surgery ~, October she has had a chronic daily headache. When she describfld her headache she points to her frontal area and also in her occipital area, although she is still tender in her TMJ areas bilaterally to palpation. There is no warmth, redness, heat or swelling. Her ear canals are clear and do not look particularly abnormal. Her TM's are intact and do not look infected. Her pupils are equal and reactive to light and extraocular muscles are intact. Her hare examination reveals just some clear non- )urulent looking rhinorrhea bilaterally. Her oropharyngeal examination is unremarkable. She has a bite block in her lower dentition. She opens her mouth only partially, I guess, because of the TMJ dysfunction and she is able to stick her tongue out and there is no deviation of her tongue, one way or the other. It is midline, she has no facial asymmetry. Her neck is supple and actually her range of motion of her neck seems to be pretty good to side bending rotation, forward and backward flexion. Her lungs are clear and her heart is regular. I can auscult th~ audible murmur of her mitral valve prolapse. I cannot~app~eciat any mitral regurgitat&on. Her abdomen is soft, with positive bowel sounds and most specifically I can't appreciate any splenomegaly or hepatomegaly. She moves all of her extremities ~nd she has equal adn brisk symmetrical deep tendon reflexes. Her biceps muscle strenght is good and she is able to flex her p against my resistance of my hand. ASSESSMENT: Headaches, I believe multi-factorial. I 'believe headaches are obviously related to her TMJ dysfunction and her subsequent surgery. She probably has some arthritis im there. She has headaches from migraines, she has headaches possibly birth control pills, she may have headaches because of Barlow's syndrome as it relates to her mitral valve prolapse although she really doesn't have any palpatations or strong history consiste~ with palpatations, etc. Frankly, I believe her very complex he~ picture isexacerbated by overlying depression and anxiety. PLAN: I told Kelly that by far and away the thing that is goin~ to get her headaches better is going to be lots of little things, and one of the most important things is her starting to take. be~ zer care of herself. She needs to exercise, she needs to eat well, she needs to sleep well and get at least 7 or 8-hours of sleep J a night. In addition to that, she needs to stop smoking cigarettes because I told her that there is tons of different carcigonens in tobacco and chemicals that could certainly be making a bad situation worse. In addition to that she needs to wean down slTly ache L pi: 'ULS ~elley Betton Continued on her caffeine, not dropping it too quickly because she will get a rebound headache from the caffeine withdrawal, but lly needs to get off of that as this can lower migraine threshold. In addition to that, she may need to stop birth control ]pills, we didn't advise that yet today, but that may also be something that we will reco~nend for this lady, and that is stopping her birth control pills. She may need an adjustment in her Zoloft as well. She has never had an x-ray of her brain as far as I c~ tell looking through the chart. She has had x-rays of her TMJ joints, and I think its not unreasonable at some point just to clear the air and pick up an MRI of her brain as well as her sinuses to make sure there is no contributing sinus disease for this very complex headache picture. I am going to set her up for that today since she is just fresh postop, I think its not unreasonable either to make sure she doesn't have any evidence of infection, although that is not appreciated today. }~ am to do a facial x-ray before the M_RI is done. We are going to start some Dtculsid for her headaches 750mg bid. I told her that eventually if she tolerates it she can :go up to two twice a day. She will continue her MS Contin with the hopes it may be weaning off of that and again, part of the ball has to be in her court. She has to start taking better care of here ~lf and with that she needs to make some lifestyle modifications. She is going to follow up with Dr. Bower in about 7 to 14-days .t see how she is tolerating this change. He can decide whether he wants to take her off birth control pills and try alternative contraception, assuming that the birth control pills cc, uld be a contributing to her complex headache picture. Go over the with her, see what her CBC and Diff and SED rate look like and basically go from there. This is how we approached Kelly. TAR/gay T: 1/15/99 Patient comes in today for followup from TAR's visit:, please see previous note. She notes that she's been having these headaches ever since her TMJ surgery in November. They seem to radiate up from the cervical spine across the top to above the eyes. She has a history of migraines. She continued: ~9 Kelley Betton Continued 2. Duratuss G bid. 3. May use Sudafed along with the Duratuss G for added deconge 4. Push fluids. Frequent saline nasal sprays and Tylenol or Advil as needed for fever or pain. Also gave her a few more Esgic Plus samples since she states that she is out of her Fiorinal. She will call if she is not feeling better in the next week or so, develops new symptoms, or PRN. MMM/gav T: 2/24/99 0 9 ]999 Kelly is here today for an exacerbation of a chronic headache. She has had a headache now for the past 4-days. This headache is the same as all the others, is associated with her TMJ~ In the past these headaches have been controlled with Fiorinal or Midrin along with her regular MS Contin. She denies blurring of vision or any other unusual symptoms. She states that the headaches are intermittent but they usually last several, days when she gets them. A&P: Kelly is awake, alert and oriented expressing herself coh I gave her the choice on this - ~Fiorinol or Midrin - whichever she seems to think worked better for the headaches. She has an appt on Saturday with an Osteopath in Virginia who does some manipulations for her. I suggested that she in the meantime call Dr. Bower, who is her regular Physician and try to see if we can't get her on some path towards improvement rather than just maintenance. We are going to go with the Midrin at this point, one or two every 4 to 6-hours as needed. No more than 8 per da~ with a couple of refills and she will follow-up PRN. T: 3/16/99 :ently. I,A¥-Zl-Z662 09:33 FROI~LIFE OF THE SOUTH 904-350-1069 I~ASLAND ASSOCIATES, ][NC. INTERNAL MEDICINE T-316 p.o14/Oi4 ~-GZZ MEOtCAL Aa~s'Bu~Lo~N~ 220 W~ON S~,E~.T. CARUSCE. PA 17013 (7:L7) 249-1929 Fax (717) 24%9332 ' D^wo :5. M~,NO. M.D. L~RR¥ :5. R~sr~N. M.D, F.A.C.C. T~RRY A. Roe~so~L D.O. April 2, 2002 DOt.,CLaS $. Bow~.~, M.D, RE: Kelley Betton 70 W Big Spring Avenue Newville, PA 17011 To Whom It May Concern: This is to verify that patient Kelley Betton is currently disabled secondary to chron/c temporo- mandibular joint pain and resultant severe depression. Lf further details are needed please do not hesitate to call us. Thsnk you for your consideration. Sincerely, Douglas J. Bower, M.D. DJB/bw T: 4/4/02 ~Y-Z1-2OOZ 09:32 FRO~LIFE OF THE sOUTH I--I_A_NFT & K.I'qlGHT, ?.C. ATTOKIqEY/ ~a. COUNSELLORS AT LAW 904-350-1~69 April 9, 2002 T-316 MICPI^EL ). Craig Hart, Assistant Vice President Life Of The South 100 West Bay Street P.O. Box 44130 Jacksonville, FL 32231-4130 Consumers life Insurance Company Insured: Kelley Betton Certificate: 0006450465 0 Claim No. 10583 Dear Mr. Hart: At your request, I am enclosing the report of August 29, 2000 from Stephen D. Blood, D.O. stating that Kelley Bctton is ,,sble to work and that he do~s not "see any good prognosis for this patient." Also enclosed is tho lcttar of April 2, 2002 fi, om her family physician, Douglas J. Bower, M.D. verifying that Ms. Bettonis still disabled. In addition, Ms. Beton was found eligible to r~celve Social Securi~ Disability Insurance benefits in a decision dated July 26, 2001, I u'ust this resolves any issues regarding disability, and look forward to your reply. Very u-uly yours, HANFT & IGNIGHT, P.C. Will/am A, Addar~ WAA]mmp Enclosures cc: Kelley Bet-ton k~Y-ZI-ZOOZ ~9:33 FRO~LiFE OF THE $OUT~ 604-35~-1069 T-3T$ OSTEOPATHIC FAMILY PHYSICIANS, LTD. Stephen D. Blood, D.O., F.A.C.G,P., F.AJLO. August 29, 2000 T. Bowman, Disability Claims, Adjudicator Bureau of Disability Determirmtion Department of Labor and Industry 1171 South Cameron Street, Room 200 Harrisburg, ?ennsylvania 11711104-2594 Re: Kelly S. Betton SS#: 206-50-9059 DOB: 8-20-71 ~]L~ APR15200Z L~ Dear IV[r. Bowman: Ms. Kelly Bet'ton has been a patient of mine since October 16, 1987. At that time the patient was a passenger in a car that was struck on her side of the ear which caused injury to her head, neck, back, jaw end chest. The accident occurred 12-12- 86. The patient had been receiving physical therapy, had been seen by an orthopaedic surgeon and a dentist and was taldng anti-inflammatory medication. Although the patient did improve with treatment to the cervical spine the patient's TM/problems continued to give her pain end dysfunction. On January 26, 1991, the patient was involved in another automobile accident at which time her head went into the windshield. She broke the dashboard with her chest. She had a cerebral conc~ssion, strain/sprain to the neck, a constant headache, right shoulder strain, and an aggravation of her temporomandibular joint. The pation.t has been treated on a regular basis, since then and has received f'~e- surgerms to her temporomandibular joint--mostly on the left side. Her surgeries include: l) Left temporomandibular joint surgery - 3-11-87; 2) Arthroplasty bilaterally - 12-22--87; 3) Microsurgery with laser bilateral fixation o£the disk - 11-22-93; 122S MARTHA CUSTI~ [~RIVE. SUIT~ C"? ALEX~.NDfilA. VIRCH NIA 22302-20'35 TELEPHONE 703 908-6760 FAX 703 998-~[389 McNees Wallace & Nurick,Lc attorneys at law CHARLES YOUNG DIRECT DIAL; (717) 237-5397 E-MAIL ADDRESS: CYOUNG~MWN.COM November 17, 2003 William A. Addams, Esquire Hanft & Knight, P.C. 19 Brookwood Avenue, Suite 106 Carlisle, PA 17013 FEDERAL EXPRESS RE: Kelley S. Betton v. Consumers Life Insurance Company Cumberland County No. 01-6483 Dear Mr. Addams: In response to your recent document request, please find enclosed documents Bate- stamped CONS 0321-0329. Sincerely, CY/mca Enclosures McNEES yVALLACi & N,/~RICK LLC RO. Box 1166 · 100 PINE STREET · HARRISBURG, PA 17108-1166 ° TEL: 717.232.8000 ° FAX: 717.237.5300 · WWW. MWN.COM HAZLETON, PA · STATE COLLEGE, PA · COLUMBUS, OH · WASHINGTON, DC Company..: C1 ConsU.m¢~ Li£e ~neu~anae Comp~-'~ __ ~orm: 00006802 A¢counn..: 0--~006802 ¥OR'~ ¥OLKSW&G]~T INC Cert~ 0006450465 000 Claim No.: 00010583 Lo~057-2601081089 Meraber: ,- · KELLEY EETTON Name ..... ~ M Ace' 0__27 02~ D.O.B.: 08201971 I.u.~: 206~09059 Life 0--1 Sex ..... ' CoY TlrP '~e~o.~Cov E~ Da~e Coy. E~f. Date Cov. TeZ~% Clai~ '~e~ef~t Alnou~at 201 2 R14 %/12/2004 4/12/1999 060 346.35 Due DayIR'T--i~Remaining Amoun~ IMax pymtsl Checks ~dlTotal Paid To Dt[Trm Paid 27 52.27 18~103.71 052 000 .00 .00 Cred-~or :0000001366 000 FULl'ON BANK Injury : ~24. ' DENTOFACIAL ANOMALIES, INCLUDIN~ MALOCCLUSION Occupation ; OW O~FICE WORK/CLERICAL Status : C CLOSED CLAIM Perm Disabled; _ CLOSED Disnosition: CLS Est~ Date lined Date [Rept Date ]Open Da~e IClose Date']'Denied Date'lLst Paid DI, 3/19/2001 12/04/1999 3/19/2001 7/03/2002 ~/03/200% 4/25/2001 11/03/2003 CONS0321 sCRN01 Account Number: 1)00068a~ Cergificate Number.-: D~A450465 200 Claim Number..: ~0Q1~8% Associated Reference: ~0%o~83 Ref No~e Description 001 CORRESPO~CE IsS~D - LETTER CODE: ~ ~IM ~'~'U~D FO~ CO~LE~R CODE: ~DDR ~O~ESPo~ENCE ISSUED - L~X~m C0R~po~ENCE ISSUED - LET'&~R CODE: ~DINS INS~ED NOTICE OF REQD INFOR MEDINS ~DDR 003 005 007 009 011 INSuK~D NOTICE O~ REQD INFOR DENY THE CLAIM FOR PRE-X DU~ TO THE INSURED TX ON SEVERAL OCCASSION FROM 12/17/98, 1/15/~,2/11/'J ~,3/9/99 FOR TMJ TnR CONDITION SHE IS FILING FOR. GAVE THE FILE TO TnB EX~MIN~R TO DENY FOR PRE'X. DENX 015 CORRESPONDENCE ISSUED - L~'zTER CODE: ENtered 3/20/2001 3/20/2001 3/20/2001 3/20/2001 3/20/2001 3/20/2001 4/04/2001 4/04/2001 4/04/2001 4/04/2001 4/25/2001 4/25/2001 4/25/2001 4/25/2001 4/25/2001 <---Enter Reference No. Enter~Proeess F12~Prevlous F21=Filter/All User I.D. KGATLIN KGATLIN KGATLIN KGATLIN KGATLIN KGATLIN VEEDWARDS VEEDWARDS VEEDWARDS VEEDWARDS SHMCMILLAN SHMCMILLAN SHMCMILLJtN SHMCMILLAN KGATLIN CONS0322 SCRN01 Account Number: claim Number..: Certificate Number.,: Associated Reference: User I.D. Ref Note Description DENIAL BASED ON PROVISION DENX 4/25/2001 KGATLIN <---Enter Reference No. ~Cer=Process F12=Previous F21~Filter/All CONS0323 Number- 00010583 claim Datel~try User Entry 7/03/2002 SCOLLINS 7/03/2002 SCOLLINS 7/03/2002 SCOLLINS 7/03/2002 SCOLLINS 7/03/2002 SCOLLINS 7/03/2002 SCOLLINS 7/03/2002 SCOLLINS 7/03/2002 SCOLLINS 4/16/2002 CHA/~T 12/04/2001 TEMP2 12/04/2001 TEMP2 ~/08/200I SBMCMI~U Decending By Entry Date LasU Name: EETTON Activity Description STATUS CHANGE FROM: OPEN TO CLOSED HAINT DiSPosITION CHA~GE FROM: OPN TO CLS STATUS CHANGE FROM: CLOSED TO OPEN ~4AI~'i' DISPOSITION C~N~E FROM: CLS TO OPN STATUS ~aI~GE FROM: DE~D TO CLOSED MAIR'r DISFOSIT~0N CHAN~E PROM: DEN TO CLS REFER TO SEQ ~ 000001 ~EFER TO SEQ ~ 000001 THRU;60'/.00/0000 CHK#'=00198607 6 210.00 ~ISC. COMMENTS FILE ~v~ TO CHART BY WSTATAN FROM FILEROOM MN MISC. COMMENTS ROLL-UP ROLL-DOWN Fixed Comment: , F4-Select Aotlon Fd~Display Notes FS=Add Notes Fll-A1t View F12-Previous CONS0324 Number- 00010583 Claim DatelE~try User Entry 6/08/2001 SHMCMI~L 6/0&/2001 AFISER 6/04/2001 AFISER 6/04/2001 AFISER 4/25/2001 K~ATLIN 4/25/2001 K~ATLIN 4/25/2001 KGATLIN 4/25/2001 KGATLIN &/2~/2001 K~ATLIN 4/25/2001 S~CMILL 4/25/2001 S~CMILL 4/16/2001 AFISER Decending By Entry Date Last Name: EETTON Activity Description RESPONSE SENT TO THE ATTY. RECEIq~D MISCELLANEOUS MAIL: ~ETTER FROM LAW OFFICE REQUESTING SOMEONE TO EXPLA IN WHY ChAIM WAS DENIED sENT: DF/TX C DENIAL BASED ON PROVISION STAT~S C~N~E FROM: OPEN TO DENIED DiSpOSiTION CHA/~E FROM: OPN TO DEN REVIEWED~ SENT DENX TO INSURED RE~ER TO ~EQ ~ 000001 REVIEWED: RECEIVED MISC~nLANEOUS ~AILt ROLL-UP ROLL-DOWN Fixed Comment: F4-$elect Action FL=Display Notes Fg=Add Notes F11-A1t View F12-Previous CONS0325 claim Number: 00010583 Entry DatelEntry User 4/16/2001 AFISER %/16/2001 AFISER 4/16/2001 4/04/200~ 4/04/200~ 4/04/2001 4/04/2001 4/04/200~ 4/04/2001 3/30/200~ 3/30/2001 3/3o/2oo~ KGATLIN KOATLIN KGATLIN VEEDWARD V~EDWA~D BCABLER BO. ABLER Decending By Entry Date Last Name: BETTON Autivity Desoription APg RECEIVED MEDICAL RECORDS~ FROM DR.DOUGLAS BOWER TH~:00/00/0000 CHK#:0~1~7245 6 30.84 ~ME~,ICAL RECORDS CK MAILED TO: DR.BOWER RECEIVED MiSCELL;~NEOUS MAIL: COPY OF OUR RE~EST FOR M~DICAL RECORDS TO DR. BOWER TELEPHONE CALL FROM~ ~RS O~FICE CALLED TO GIVE T~ ~oU~T FOR MEDICAL ~ECORDS $~0.84. Tn~¥ WILL pAX %'~ REQUEST OVER. ROLL-UP ROLL'DOWN Fixed Comment: F4-selec~ Action F5=Di~play N~te~ Fg=Add N°t~s F~i-Alt View F12-Previous CONS0326 Number' 00010583 claim DatelE~try User Entry 3/20/2001 KGATLIN 3/20/2001 KGATLIN 3/20/2001 KGATLIN 3/20/2001 KGATLIN 3/20/2001 KGATLIN 3/20/2001 KC~ATLIN 3/20/2001 K~ATLIN 3/20/2001 K~ATLIN 3/20/2001 KGATLIN 3/20/2001 KGATLIN 3/20/2001 K~ATLIN 3/20/2001 KGATLIN Decendin~ By Entry Date Last Name: ~ETTON Activity Description oPZN IN pROCeSS _ _ ~.KELL¥ S.BETTON --- - SENT: ~31TD1 C ,gLA~ RET~RI~ FOR COMPLETION _ O~-~N ~N pROCESS ~ - -- SENT: MEbINS~C NOTICK OF ~EgUESTE~ I~O ~p~ IN PROCESS ~: ~DDR C REQ~T ~D~ RECO~S __ -- ~VIEW~: ~ ~ ~o ~..o~ , -- ' ROLL-UP ROLL-DOWN Fixed comment: ~ .' - p9~A~N¢~e~ Fi~A1t ~ew--F12-Previous F4-Selec~ ActiOn F5=DxspIaY Notes cONS0327 Deoe~ding By E~try Date Number' 00010583 Last Name: BETTON claim Date lE~try User I Activity Description 3/19/2001 AFIS~R REPT: 03/19/2001 STAT: OPN INCD: 12/04/1999 ROLL-DOWI~ Fixed comment: F4-Select Action FS=Displa~ Notes Fg~A~d Notes Fll-Alt View F12-Previous CONS0328 Account Name Responded to Cal~er~ ,, ~ By [] Telephone L~ Letter ,. _ Date Person Calling. Telephone ~_ Account #. Policy #~,.--- "~ Summarize Handling of Inquiry and its Disposition. CLM lO pefsorI H&ridliRg Ir~tuifY CONS0329 KELLEY S. BETTON, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. CONSUMERS LIFE INSURANCE : COMPANY, : CIVIL ACTION q LAW Defendant : NO. 01-6483 CIVIL TERM IN RE: MOTION FOR SUM/~_AR~ JUDGMENT ORDER OF COURT AND NOW, this 26th day of November, 2003, after a review of the parties' briefs and having had argument thereon, the Defendant,s Motion for Partial Summary Judgment is DENIED. By the Court, Edward E. Guido, J. William A. Addams, Esquire For the Plaintiff Charles T. Young, Jr., Esquire For the Defendant :lfh KELLEY S. BETTON, Plaintiff V. CONSUMERS LIFE INSURANCE COMPANY, Defendant IN RE: : CIVIL ACTION - LAW : NO. 01-6493 CIVIL TERM PRETRIAL CONFERENCE IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORDER OF COURT A pretrial conference was held Wednesday, November 26, 2003, before the Honorable Edward E. Guido, Judge. Present for the Plaintiff was William A. Addams, Esquire, and present for the Defendant was Charles T. Young, Jr., Esquire. This trial is scheduled for Thursday, December 4, 2003, at 1:00 p.m. and will continue into December 5, if necessary. This is a claim on a disability insurance policy in which the Defendant denied the clai~ based upon a pre-existing condition that resulted in total disability under the policy. The parties have agreed that if Ms. Gatlin's testimony is needed, she may testify by phone. The parties have further agreed that her testimony is only relevant as to the bad faith component of Plaintiff's claim. We have an outstanding motion for partial summary judgment on the bad faith claim. We will enter an order by the end of today so that the parties have guidance on that matter. By the Court, Edward E. Guido, J. William A. Addams, Esquire For the Plaintiff ~ ~J~ I~.~ Charles T. Young, Jr., Esquire~ For the Defendant : lfh KELLEY S. BETTON, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA : NO. 01-6483 CIVIL TERM CONSUMERS LIFE INSURANCE COMPANY, Defendant CIVIL ACTION - LAW PRAECIPE Sir: Please mark this action settled and discontinued. HANFT & KNIGHT, P.C. To: Curtis R. Long, Prothonotary Date: December 19, 2003 By: 'Willia~ ~.fA-~dams Attorney I.]2). No. 06265 19 Brookwood Avenue, Suite 106 Carlisle, PA 17013 (717) 249-5373