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Home My WebLink About01-2217NOTICE TO DEFEND You have been sued in court. If you wish to defend against the claims set forth in the follo~vmg pages, you must take action within rwent), (20) days after this Complaint and Notice are sen'ed, by entering a written appearance personally or by attorney and filing in writing with the court, your defenses or ob}ections to the clain~s set forth against you. You are warned that if you fa/il to do so, the case may proceed without you and a judg~nent may be entered against you by the court without further notice, for any money claimed in the Complaint or for any other claim for relief requested by the Plaintiff. You may lose money or properS' or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LA~¥TER AT ONCE. IF YOU Df) NOT HAVE A LAWYE, R OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW 'FO FIND OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Lawyer Referral Service 1 Liberty Avenue Carlisle, Pennsylvania 17013 (717) NOTICI~A Le han demandado a usted en la corte. Si usted clmere defenderse de estas demandas expuestas en las paginas sigiuentes, usted tiene vemte (20) dias de plazo al partir de la fecha de la demanda y la ~otificacion. Usted debe presentar una apariencia escrita o en persona o pot abogado y archivar en h corm en forma escrita sus defensas o sus objeciones a las demandas en contra de su persona. Sea avisado que si usmd no se defiende, la corte tomara medidas y puede entrar una orden contra usted sm previo aviso o nodficacion y por cualqtder queja o alivio que es pedido en la peticion de demanda. [ sted puede perder dmero o sus propiedades o otros derechos importantes para usted. IJLEVE ESTA DEbIANDA A UN ABOGADO INMEDIATEMENTE. SI NO TIENE ABOGADO O SI NO TIENE El. DINERO SUFICIENTE DE PAGAR TAL SERVICIO, VAYA EN PERSONA O LLAME POR TELEFONO A 1~\ OFICINA CL~'A D}t~CCI()N SE ENCUEN'llLA ESCRITA ABAJO PARA AVERIGUAR DONDE SE PUEDE CONSEGUIR ASISTENCIA LEGAL. Cmnberland County Lawyer Referral Service 1 Liberty Avenue Carlisle, Pennsylvania 17013 (717) DEAN TEETER, Plaintiff APPLETON PAPERS, INC., Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION NO.: JURY 2'RIAL DEMANDED COMPLAINT 1. Plaintiff, Dean Teeter, is an individual who resides at 1605 Walnut Street, Camp Hill, Pennsylvania, 17011. 2. Appleton, Appleton Papers, Incorporated, (hereinafter "Appleton") is a corporation organized, operating and existing under the laws of the Commonwealth of Pennsylvania, which has its local place of business at 2850 Appleton Street, Mechanicsburg, Cumberland County', Pennsylvania 17055. 3. At all times relevant hereto, plaintiffwas employed in a second-hand operator's posit/on at Appleton's Mechanicsburg Pennsylvania plant. COUNTI WRONGFUL DISCHARGE 4. The allegations contained in paragraphs one (1) through three (3) of fids complaint are incorporated herein by reference as though fOly set forth. 5. On or about April 7, 1986, plaintiff became employed by Appleton. He held his current position as a second-hand operator position for approximately thirteen (13) years. 6. On or about March 3, 1999, plaintiff injured his left arm, elbow and band, while in the course of his employment. 7. As a result of the March 3, 1999 injury, plaintiff received surgical intervention on April 12, 1999, by Appleton's panel physician, Dr. Robert J. Maurer. 8. Plaintiff received a re-graphed nerve followed by eight (8) weeks of rehabilitative therapy prior to his return to work. 9. Appleton accepted plaintiff's accepted workers' compensation claim as a result of the March 3, 1999, injury. The period of accepted workers' compensation was March 3, 1999 through July 5, 1999. 10. On or about July 5, 1999, Dr. Maurer instructed plaindff to return to his preqn}ury work position. 11. Following his return to work, plaintiff began experiencing numbness, pain and aggravaton at the surgical point in }tis left arm. He reported these p~oblems to his supervisors. 12. On or about july 27, 1999, plaintiff obtained a second opinion from his own physician, Morton L. Rubin, M.D., F.A.C.S. Dr. Rubin is an orthopedist. 13. Dr. Rubin directed plaintiff not to return to the pre-injury work position. 14. D~. Rubin is of the opinion that plaintiff has sustained a repetitive work inju~. 15. Dr. Rubin approved plaintiff for work in any position not invol~;mg repetitive motion with plaintiff's left arm. 16. Appleton was advised of Dr. Rubin's instruction for plaintiff to remm to light duty ~vith no repetitive motion of his left arm. 17. Appleton refused to provide any light duty work for plaintiff. 18. On or about August 3, 1999, Appleton informed plaintiff that they would not be accepting his workers' compensation injury claim. 19. On or about August 5, 1999, plaintiff filed a Re'restatement Petition for workers' compensation benefits. 20. On or about August 18, 1999, Appleton filed an Answer to plaintiff's Reinstatement Petition. Once again, Appleton denied his requests. 21. Appleton has never offered plaintiff light duty work. 22. Plaintiff followed Appleton's procedures for medical leave and completed all requisite forms necessary for leave. 23. On or about October 25, 1999, Plaintiff's name appeared as hay:rog been terminated and was displayed at Appleton on the employee status bulletin board. (.See, Finishing Departmem Schedule 25 October 1999, attached hereto as Exhibit A). 24. Appleton fired plaintiff on November 2, 1999. 25. Plaintiff was on an accepted leave of absence on November 2, 1999. 26. Appleton knexv that plaintiff was on an accepted leave of absence when they fired plaintiff. (See, Request for Leave of Absence or Family/Medical Leave of Absence forms, attached hereto as Exhibit B.) 27. Appleton's human resources manager, James A~ Honafius, testified at a union grievance heanng and workers' compensation hearing that plaintiff was fn'ed while on an accepted leave of absence. (See, Notes of Testimony from Workers' Compensation Hearing on February 22, 2001, page 17, attached hereto as Exhibit C). 28. Plaintiff's termination by Appleton violates public policy, was in violation of Appleton's legal and ethical obligations and was intended to punish plaintiff for filing for workers' compensation. 29. The conduct of Appleton, acting through its agents, servants, workmen and/or employees, as set forth in this Complaint, amounts to a wrongful discharge of plaintiff. WHEREFORE, plaintiff demands judgment in his favor and against Appleton in an amount in excess of $25,000.00, plus interest, costs and attorney fees. COUNT Il VIOLATION OF THE AMERICANS WITH DISABILITIES ACT 31. Plaintiff incorporates by reference the allegations in paragraphs I through 30 as though set forth herein. 32. Plaintiff has exhausted his administrative remedies and been granted a Right to Sue letter from the Equal Employment Opportunities ComnZssion (EEOC). (See, Right to Sue letter, attached hereto as Exhibit D). 33. Plaintiff is mentally/physically disabled as defined by the ADA. 34. Plainfiffis a qualified individual with a disability within the meaning of the ADA. 35. Appleton discriminated against plaintiff because of the disability. 36. Appleton terminated plaintiff because of his work-related injury. 37. Appleton's termination of plaintiff is a disc£mninatory action prohibited by the ADA. 38. Appleton's discriminatory conduct as to plaintiff was taken with mahce with reckless indifference to the federally and state protected rights of plaintiff. 39. Appleton's termination of plaintiff's employment has caused, continues to cause and will cause plaintiff to suffer substantial damages for future pecuniary losses, mental anguish, loss of enjoyment of life, and other non pecunia~ losses. WHEREFORE, Plaintiff demands judgmcnt in his favor and against Appleton in an amount in excess of $25,000.00. This demand is for all ~vages lost since November 2, 1999, through the present, interest on all wages lost since November 2, 1999, to the present, furore pecuniary losses, mental anguish, loss of enjoyment of life, and other non-pecuniary' losses, and costs of this action, including expert witness fees and attorney's fees. COUNTIII VIOLATION OF THE FAMILY MEDICAL LEAVE ACT 40. Plaintiff incorporates by reference the allegations in paragraphs 1 through 39 as though set forth herein. 41. Appleton employed more than fifty (50) employees at the location where the plaintiff ~vorked. 42. Plaintiff worked in excess of 1,250 hours at Appleton's place of business in the twelve (12) months preceding his request for leave under the Family and Medical Leave Act, hereinafter referred to as "FMLA." 43. On September 8, 1999, Plaintiff requested leave under the FMLA, 29 U.S.C.A. 22612. Plaintiff was unable to perform the functions of his position due to his health condition. 44. On October 4, 1999, Plaintiff requested leave under the FMLA, 29 U.S.C.A. 22612. Plaintiff was unable to perform the functions of his position due to his health condition. 45. Appleton denied plaintiff's requests for leave under FMLA. 46. Appleton never requested nor required plaintiff to obtain certification issued by his health care provider, as penmtted pursuant to 29 U.S.C.A. 22612. 47. Appleton denied plaintiff's exercise of rights provided under the FMLA. 48. Appleton discharged the plaintiff due to his repeated requests for leave under the 49. Appleton's £mng of plaintiff is in violation of the FMLA. WHEREFORE, Plaintiff demands judgment in his favor and against Appleton in an amount in excess of $25,000.00. This demand is for ail wages lost since November 2, 1999, through the present, interest on all wages lost since November 2, 1999, to thc present, liqt~idated damages in an amount equal to plaintiffs lost wages and interest thereon from November 2, 1999, to the present, and costs of this action, including expert witness fees and attorney's fees. COUNT 1V INTENTIONAL INFLICTION OF EMOTIONAL DISTRESS 50. Plaintiff incorporates by reference the allegations in paragraphs 1 through 49 as though set forth herein. 51. Appleton's conduct in firing plaintiff ~vhile on an accepted leave of absence and a work- related injury, was extreme and outrageous. 52. Appleton's conduct intentionally caused plaintiff emotional distress. 53. Appleton's conduct was with the reckless disregarded for causing plaintiff emotional distress. 54. Plaintiff has suffered severe or extreme emotional distress as a result of Appleton's conduct. 55. Appleton's conduct caused plaintiff's emotional distress. WHEREFORE, Plaintiff demands judgment in his favor and against Appleton in an amount in excess of $25,000.00 plus interest, costs and attorney's fees. COUNT V 56. Plaintiff incorporates by reference the allegations in paragraphs 1 through 55 as though set forth herein. 57. The conduct of Appleton, as more fully set forth above, was outrageous, intentional, malicious, willful and in blatant disregard for the rights of plaintiff. 58. As a result of said conduct, Appleton is liable to plaintiff for punitive damages. WHEREFORE, Plaintiff demands judg~nent in his favor and against Appleton in an amount in excess of $25,000.00 plus interest, costs and attorney's fees. CERTIFICATE OF SERVICE AND NOW, this 16th day of April, 2001, 1, Jason P. Kumlakis, Esquire, hereby ceftin, that I did serve a true and correct copy of the foregoing ENTRY OF APPEARANCE AND COMPLAINT ON BEHALF OF PLAINTIFF upon all counsel of record bv depositing, or causing to be deposited, same in the U.S. mail, postage prepaid, at Harrisburg, Pennsylvania, addressed as follows: By First-Class Mail: Robert J. Goduto, Esquire Duane, Moms & Heckscher, LLP 305 North Front Street, 5th Floor P.O. Box 1003 Harrisburg, PA 17108-5500 · Kumlaki~ DEAN TEbTFER, Plaintiff APPLETON PAPERS, INC., Appleton : IN THE COURT OF COMMON Pi. EAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : CIVIl. ACTION NO.: : JURY TRIAL DEMANDED ENTRY OF APPEARANCE Please enter the appearance of the undersigned as counsel for Plaintiff, Dean Teeter, in the above-captioned matter. Respectfully submitted, ABOM & KUTULAKIS 8 South Hanover Street, Suite 204 Carlisle, PA 17013 Attorney for Plaintiff Dated: CERTIFICATE OF SERVICE AND NOW, this 16th day of April, 2001, I, Jason P. Kumlakis, Esquire, hereby certify that I did serve a true and correct copy of the foregoing ENTRY OF APPEARANCE AND COMPLAINT ON BEHALF OF PLAINTIFF upon all counsel of record by the method listed below: Cumberland County Sheriff: Appleton Papers, Incorporated 2850 Appleton Street Mechanicsburg, PA 17055 First-Class Mail Robert J. Goduto, Esquire Duane, Morris & Heckscher, LLP 305 North Front Street, 5th Floor P.O. Box 1003 Harrisburg, PA 17108-5500 EXHI3IT A EXHIBIT Request for: Leave of Absence or Family/Medical Leave of Absence Name: ;(> :v ,.~/: , ~,~:. - Employee#: Date: ~ -/ ./ '-: ~ - Supervisor: .... / "- - Department: :- ,, ..~ - · ~ . ~ ' NO~. or YES If Yes, date original leave began: ---~/~..,/y., Extension: (circle one) , , ' I__j I hereby request L~'~e' of Absence: (i.e., non-FMLA leave, military leave, personal) Facts pertaininq to this leave: Request leave to start: I Projected return to work date: '~'~ My own serious illness, work-related injurT/illness My own serious illness, non work-related injury/illness __ Birth of a child or placement of a child for adoption/foster care Caring for a sick child, spouse or parent Medical or Informational Facts pertaining to this leave: I hereby request a Family/Medical Leave of Absence (FMLA) from work for the purpose Expected due date: Additional Employee Signature: Steward's Acknowledgement: (If applicable) Date of illness: Physician/Health Provider Statement attached Yes, or No includes need to care for ~ll fam . memuer _ Request leave to start: Projected return to work ate:-,~f/~ Date of the next doctor's appointment: ~.~ ,'~ ." ~../ Documentation'~'a~ill be provided on: Date: ~ .' , To: <' -. ........ - /::,.,,,? Employees on medica~ leave will provide an Appleton papers Inc Return to Work SI~P signed by thea doctor or personally provide documentation signed by their doctor to extend their ~eave on by 12:00 noon to (Date) (Name) Failure to personally provide documentation to extend this Leave of Absence or failure to return to work on [ne employee's first scheduled day of work will result in loss of seniority {employment) in accordance with Article 6.6E of the Labor Agreement Comments: Approved by (FMLA ONLY): Sunervisor: Department Manager: Human Resources: Note: Date: Date: Date: This Leave of Absence Request ~s not approved un~ all signa~re approvals are ob~Med by a# pa~les or ~ e~r deleggms. VVhite: Payroll [ Green: Medical . [ Canary -IR File , Pink: Deoadment Goldenrod: Employee Request for: Leave of Absence or Family/Medical Leave of Absence Name: '-~ : ,t., ...' * Employee #:-- ~ Date: ~ Department: , Supervisor: Extension: /circle one) NO or YES, If Yes, date original leave began: __l I hereby request Leave of Absence: (i.e., non-FMLA leave, military leave, personal) Facts pertaininq to this leave: Request leave to star[: I Projected return to wOrk date; __ I hereby request a Family/Medical Leave of Absence (FMLA) from work for the purpose __ My own serious illness, work-related injury/illness __ My own serious illness, non work-related injury/illness __ Bir[h of a child or placement of' a child for adoption/foster care Expected due date: __ Caring for a sick child, spouse or parent : Medical or Informational Facts pertaining to this leave: ! (If applicable) Date of illness: Physician/Health Provider Statement attached Yes or No ncludes need tocare for Request leave to start: Projected return to work date: Date ofthe next_,doctor's appointment: ~/ ?'? Documentatioriwas/will be provided on: Date: To: faml v memeer ! Employees on medical leave will provide an Appleton papers nc. Return to Work Slip signed by their doctor or personally provide documentation signed by their doctor to extend their leave on by 12:00 noon to (Date) --"' (Name) Failure to personally provide documentation to extend th~s Leave of Absence or failure to return ~o WOrK on [ne employee's first scheduled day of work will result in loss of seniority (employment) in accordance with Article 6~6E of the Labor A~reemen[, Additional Comments: Employee Signature: Steward's Acknowledgement: Date: Date: Approved by (FMLA 0 :~., . Supervisor: "' /! / ~', Date: Department Manager: i' , :: ,?,"-". 'f Date: Human Resources: -' Date: Note: This Leave of Absence Request is not approved until all signature approvals are obtained by all parties or their delegates, [White: Payroll [Green: Medical I Canan/: HR Fil~ Pink Department Goldenrod Employee Request for: Leave of Absence or Family/Medical Leave of Absence ~' / ' Employee #: Date: '~'~::'/-' Name: *' - ~' / ~ ' Department: ,, / ...... Supervisor: ~.~ Extension: (circle one) NO or ~YES 'i If Yes, date original leave~bb~an: __~ I hereby ~;equest Leave of Absence: (i.e., non-FMLA leave, m~h~ry leave, personal) Facts pertaining to this leave: ~Request leave to start: Projected return to worki~.date! l ~ I hereby request a Family/Medical Leave of Absence (FMLA) from work for the purpose .X~ . My own serious illness, work-related injury/illness My own serious illness, non work-related injury/illness Birth of a child or placement pt a child for adoption/foster care ~pected due date: !?:: Caring for a sick child, spouse or parent ¢~';:, Medical or Informational Facts pertaining to this leave: (If applicable) Date of illness: ' ':'-;'~ '~ ' Physician/Health Provider Statement attached Yes Or No nclbdes need to care for ill f,a, mdv memb Request leave to start: Projected return to work Date of the next doctor's appointment: Documentatiofl was/will be provided on: Date: -~/..~,'~ ~ / > To:....,';' '. ,' Emp oyees on medical leave will provide an Appleton papers Inc. R~n i-o Work Slip signed by their doctor or personally provide documentation signed by their doctor to e~(e~d their leave on, by 12:00 noon to (Date) (Name) Failure to personally provide documentation to extend this Leave of Absence or failure to return to work on the emolo/ee's first scheduled day of work will result in loss of seniority (employment) in accordance with Adicle 6 6E of the Labor Agreement Additional Comments: - . Employee Signature: !.~.~.,. ...~,~ - Date: " ~ ~ ~. ~ '/' ///.__,r~ ~'r- Steward's Acknowledgement: --:-;'.~/'~ · , ~--.:?~S:~")' Date: ?"~ Approved by (FMLA ONLY): Supervisor: Department Manager: ' ..... -~ Date: .~ Date: / '/ Human Resourc s,,..,..~.~.. _ .... ~-· . .... . ~"'*~: Date.- Note: ¢'~Thi$ Leave of Absenc~ Request is not approved dh~i~l signature approvals are obtained by all pa~ie~ or their del~ates, Name: Department: Extension: /circle one) Request for: Leave of Absence or Family/Medical Leave of Absence / Employee #: Date: ' Supervisor: ~ NO or YES If Yes, date original leavebegan~ __1 I hereby.request Leave of Absence: (i.e., non-FMLA leave, miiita-ry leave, personal) Facts pertaining"to th!s leave: Request leave to start: Projected return to work idate: ~' I hereby request a Family/Medical Leave of Absence (FMLA) from work for the purpose My own senous illness, work-related injury/illness My own senous illness, nQn w0r~-relate¢ injury/illn.es~ .~ . ~ _ . Birth of a child or placemen( of a child for adoption/foster care Expected due date: Caring for a s~ck child spouse or oarent Medical 3r Informational Facts pertaining to this leave: (If applicable', Date of illness: Physician/Health Provider Statement attached Yes or No ncludes need to care for ill family memDerl Request leave to start: -//.' "/ ~ / -':'?¢ Projected return to work date: Date of the next doctor's appointment: Documentation was/will De provided on: Date: To: ?- . Employees on medical leave will provide an Appleton papers Inc. Re!u~,to Work Slip signed by their doctor or personally provide documentation signed by their doctor to extend the!.r leave On by 12:00 noon to (Date) ~ (Name) Failure to oersona ~y prowdedocumentat~on to extend this Leave of Absence or failure to return [o work on me employee's first scheduled day o~work will result in loss of seniority (employment in accoraance with Article 6.6E of the Labor Agreement Additidnal Co~mments: ,, ;: * Employee S gnature: .-. ~ ~-~-~" Date:' ' Steward's Acknowledgement: Date: Approved by (FMLA ONLY): Supervisor: Date: Department Manager: Date: ... ' · % ' Date: " " H Re -'-- , uman sources: · - -.~', "" ' ' -' '~" Note: This Leave of Absende Request is not approved until all signature approvals are obtained by all parties or their delegates I /Vhite: P~ay. ro~ I Green: Medica ' Canary HR File P~nk Oeoartment Goldenrod: Employee Request for: Leave of Absence or Family/Medical Leave of Absence Name: / /? ~':¢, {~"~ 'L<~-'t- Employee #: /~-"¢:, ate: , Department: Supervisor: .~ / Extension: (circle one) NO or YES If Yes, date original leave~,begar~: ...r/' ] I.hereby request Leave of Absence: (i.e., non-FMLA leave, mt ~taWeave, personal) Facts perta, i~ina to-this leave: Request leave to start'~ I Projected return to worl~i~iate: ~(~ I hereby request a Family/Medica! Leave of Absence (FMLA} from work for the purpose Myt}wn serious illness, work-related injury/illness M . '¢'own 'sene"' '.~ s "lli~l essf ~* ' n"ad' '"~'~:'~*____.. __'wr~rk-m. ~'~'c¢"m Jury/'" "111 ness- ' ' '~ ~I' 'r ~ ~ ' ~' Birth of a child or placement of a child for adoption/foster care .Expeoted due date · Caring for a sick child, spouse or parent Medical or Informational Facts pertaining to this leave: (If apphcable) Date of Ilness: _. . . -: ~hysician/Health Provider Statement attached Yes el¢ NO ncluaes need to care for ill familv memeer Request leave to start',. >/t/ ~ / ~' ~' ' ,~ ,- ~/~,.~ .~'-P~ojected return to work date'. ¢;/~."-;, Date of the next doctors appo ntment i~'i~/'*,;"~/' .. ~'~'~ /' ' / Documentation was/will be orovided on: Date! ~//~'/~/'~//~' To: ~....J'Z... Emoloyees on medica leave will 0rovide an Appleton papers Inc Re~.t6 WorR SI/p signed Dy their doctor or perso~qally provi(;le.4do~..cumentation signed by their doctor to e~{~,dihe rJeave 0n ~// ~ ~:~ /Y~ by12:00 noon to · . (Date) (Name) { Failure to personally provide documentation to extend this Leave of Absence or failur,¢ to return to ¢, Ork on tne employee's first scheduled day of work will result in loss of seniority (employment) in accordance wit~i~Je.r .¢ ,6..~E./~lhe. Labar Agreement}- Additional Comments: . .- : ..'~!,~ '~. ,. · Erh'ployee Signature: / Steward's Acknowledgement: Approved by (FMLA ONLY): Supervisor: Department Manager: Human Resources: Date:; · ate~r: Date: Note: This Leave of Absence Request is not approved until ail signature approve s are ob a ned by all par~ies or their delegafes. I White; Payroll Green Medical Canary HR File Pink DePartment Goldenroc Em~}loyee Name: ~ J~ De partment: Extension: (circle one) Request for: Leave of Absence or Family/Medical Leave of Absence i '~-- Supervisor: ~ NO or YES If Yes, date original leave began: ___I I hereby request Leave of Absence: (i.e., non-FMLA leave, military leave, personal) Facts pertaining to this leave: Request leave to start: Projected return to work date: x I hereby request a Family/Medical Leave of Absence (FMLA) from work for the purpose ~: My own serious illness, work-related injury/illness __ My own serious illness, non work-related injury/illness i ~ ~, ',," ., __ Birth of a child or placement of a child for adoption/foster care Expected dUe'date:. __ Caring for a sick child, spouse or parent · Medical or Informational Facts pertaining to this leave: ' i " (If applicab'lb) Date of illness: Physician/Health Provider Statement attached Yes Or NO (includes need to care for ill family member) ReqUest leave to start: : ~ ! ~ ~ I Projected return to work dat,9: Date of the next dqctor's appointment: ;,t~ } ~ f `~ ' ' ' '~'~ ..... - ' ¢-, Documentatlon,'Was/wlll be provided on O~tte: t Employees on medical leave will provide an Appletor) papers Inc. Return to Work Slip signed by their doctor or personally provide documentation signe, d by'their doctor to extend their leave on by 12:00 noon to (Date) (Name) Failure to personally provide documentation to extend this Leave of Absence or failure to return to work on the employee's first scheduled day of work will result in loss of seniority (employment)in accordance with Article 6.6E of the Labor Agreement Additional Comments: Employee Signature: ~.~ -~ ~ -~ Steward's Acknowledgement: !, " Approved by (FMLA ONLY): Supervisor: ~ ~ ,..~ ~ Date: Department Manager: ¢ ~ *.-~-.~-. , / '.-~- ~..'.-~ .,' ~*, - Date: Human Resources'. .:'' / : , ~, / ~-' /( ,- ;' ,;.-'~ ,-~ ~ Date: Note: This Leave of Absence Request is not approved-until, all signature approvals are obtained by al part es or their de egates. I White: Payroll Green: Medical I Can~/: HR File I Pink: Department j Goldenrod: Employee Request for: Leave of Absence or Family/Medical Leave of Absence '-' '- Supervisor: Extension: (circle one) NO or yEs If Yes, date original leave began: ;: ..~ ':~ __1 I hereby request Leave of Absence: (i.e,, non-FMLA leave, military leave, personal) Facts pertaining to this leave: Request leave to start: Projected return to work date: I hereby request a Family!MedicaLL.~_a. ve of Absence (FMLA) from work for the purpose ~ My own serious illness, .work-related inju~/illness My own serious illness, ~'~'-~)~;~-RT(~l-~(~'d injury/illness Birth of a child or placement af a child for adoption/foster care Ex pected due date: Caring for a sick child, spouse or parent Medical or Informational Facts pertaining to this leave: (If applicable) Date of illness: Physician/Health Provider Statement attached Yes or No ncluees need to care for ill Request leave to start: Projected return Date of the next doctor's appointment: :;, ~,. ,¢: 'F Documentation was/will be provided on: Date: ? /~; ./~/ To: Employees on medical leave will provide an Appleton papers nc Return to Work Slip signed Dy their doctor or personally provide documentation signed by their doctor to extend their leave on r~ ~ 5'' ~1 by 12:00 noon to (Date) (Name) Failure to personally provide documentation to extend this Leave of Absence or failure to return to WOrK on me emo~oyee's first scheduled day of work will result in loss of seniority (employment) in accordance wttl~ Article 6.6E of the Labor Agreement Additional Comments: Employee Signature: ~ ~:~,~.~ ~ o~waru'~ ~c~now~eogemenc Approved by (FMLA ONLY): Supervisor: Department Manager: ~ .... Date: Date: Human Resources: Date: Note: This Leave of Absence Request is not approved unt a signature approva s are ob ained by al parbes or their delegates. I White: Payroll I Green: Medical ]Canary: HR File I Pink Department GoldenrorJ Employee Request for: Leave of Absence or Family/Medical Leave of Absence Name: ~"~" ,~- Department: /_.:)- Extension: (circle one) NO or', YES . Employee#: ,2 ? Date: :?" · ¢ / Supervisor: __. ~,, : · If Yes, date original leave began: __j I hereby request Leave of Absence: (i.e., non-FMLA leave, military leave, personal) Facts pertaininq to this leave: Request leave to start: Projected return to work date: ~. I hereby request a Family/Medical Leave of Absence (FMLA) from work for the purpose __ My own serious illness, work-related injury/illness ."4' My own serious illness, non work-related injury/illness Birth of a child or placement o¢ a child for adoption/foster care Expected due date: Caring for a sick child, spouse or parent Medical or Informational Facts pertaining to this leave: (If applicable) Date of illness: Physician/Health Provider Statement attached Request leave to start: Date of the next d~.q~ctor's appointment: Dbcumentatior~.f;~a~will be provided on: Date: Yes or No ~ncludes need to care for ¢11 faro v member I Projected return to work date:/-;~ Employees on medical leave will provide an Appleton papers Inc. Return to Work Slip signed by [he~r doctor or personally provide documentation signed by their doctor to extend their, leave on by 12:00 noon to (Date) (Name) Failure to personally prowde documentation te extend this Leave of Absence or failure to re[urn to wort( on t~e emDrc~ee s first scheduled day of work will result in loss of seniority (employment) in accor~]ance with Article 6.6E of the Labor Agreemem Additional Comments: Employee Signature: Steward's Acknowledgement: Approved by (FMLA ONLY): Supervisor: Date: Department Manager: Date: Human Resources; Date: Note: This Leave of Absence Request is not approved until all signature approvals are obtained by all parhe$ or their delegates. I ,White: Payroll I Green: Medical I Canary: HR File I Pink' Deoarzmen[ J Goldenrod: Employee Leave of Absence or F~:umf!~tH(~gic:d , '~" ~ o, ' ' ' __Name: ~.L&.~L. kZ&L ~tcL..... ' .... ".-~ /~./"/'/ ' ~ j I hereby request Leave of Absence: h.e., [tof~.Fl*¢lLA le;~ve, mHdary leave, personal) ~F:acts pe. rtmmn~to'=' this heave My own serious illness, work-related injury/illn?.st- My own serious illness, rlon work-related injuwgll'~ess Birth of a child or placement of a child for adoption/':oster care E×pected due date: Ca~ing for a sick child, spouse or parent _?~.~d_i¢_al L~c!n_[o_r!n_Atj_o_na_JkF_a.cts pertaining.'K,, th~s_lq~;r. _e.; ~.~_¢_-applicat_,le) Date of illness: ......................................................... Phvsician/Healjh Provider Statement attached Yes O¢' ~O .~nch]de~, need tO care ior ill fami!y rnember) Date ot the next ~tor's appo,ntment: /~--~--~ ~ _ ~ Doc,.,nentation~as)will be provided on: Date: /O /~l/,~ (¢ To: .%, ~, Employees on medical leave will provide an Appleton papers Inc Return to Work SLip s~gned by the doctor or peFsonalty provide documentation signed by their doctor to extend their leave on by 12:00 noon to (Date) tNamm Failure to personally provide documentation to extend this Leave of Absence or faiiure tc tatum to work on the employee's fir sch~uled day of work wilf result in loss of seniority (employment: in accomance ~,~,:1~ Artcir~ 5 GE of the Labor Agreement ~ddifional Common~: Employee Signature: ~ ~i ...... ' .................................. Steward's Acknowledgement: ....................................... [) ate: Approved by (F~LA ONLY): Dep~lment Manager: ............................................... Date' ~ Human Resources: Date: ] Whqe: Pa'/ro'J FGreen: Medical Canary: HR f'~k. ! r.:rp Ch~paHment Goldenrod' Employee EXHIBIT C COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF LABOR AND INDUSTRY Bureau of Workers' Compensation In the Matter of: Dean Teeter, Claimant VS. ~ppleton Papers, Incorporated, Defendant Pages 1 through 36 Claim No. 2051428 Penalty/Reinstate Hearing Room A Harrisburg Judges Office East Gate Center 1010 North Seventh Street Harrisburg, Pennsylvania Thursday, February 22, 2001 BEFORE: Met, pursuant to notice, at 2:30 p.m. KARL H. PECKMAiNN, Judge APPEARANCES: JASON P. KUTULAKIS, Esquire 8 South Hanover Street Carlisle, Pennsylvania 17013 (For the Claimant) ROBERT J. GODUTO, Esquire Fifth Floor 305 North Front Street P. O. Box 1003 Harrisburg, Pennsylvania (For the Defendant) 17108-1003 (717) 761-7150 Commonwealth Reporting Company, Inc. 700 Lisburn Road Camp Hill, Pennsylvania 1701l 1-800 334-1063 5 6 ? 8 9 10 11 12 13 16 19 20 21 2! 24 25 17 1 the decision not to come to work. 2 BY MR. KUTULAKIS: 3 Q Under the union regulations, is an accepted leave of 4 absence defined? A Yes, it is. Q Okay. Was he on an accepted leave of absence under those regulations? A Based on -- based on the union contract, yes. MR. KUTULAKIS: Nothing further, Your Honor. JLrDGE PECKMANN: Anything else? MR. GODUTO: Yes. CROSS-EXAMINATION BY MR. GODUTO: Q Mr. Honafius, in terms of the documentation that was submitted by Mr. Teeter for a requested leave, when were the last time those documents were completely filled out to continue the leave? A The leave of absence form was filled out completely on July the 26th, and that leave was signed off by his supervisor, department manager, and human resources. Q What's required internally -- first of all, what's required to have an approved leave? A Ah, to get the approved leave of absence, the employee must present medical documentation that they have a disability or are unable to perform their job, and they EXHIBIT D F~OC E. orm 161 -B (10/96) U.S. EQUAt, EMPLOYMENT OPPORTUNITY COMMISSION NOTICE OF RIGHT TO SUE (ISSUED ON REQUEST) To Dean A. Teeter From: Equa~ Employment Opportunity Commission 1605 Walnut Street Philadelphia District Office Camp Hill, PA 17011-3971 The Bourse 21 S. Fiffi~ Street, Suite 400 Philadelphia, PA 19106-2515 [ I On behalf of person(s) aggrieved who~e tdennty is CO NFID£NTIA£ (29 CFR ~ 1601. Charge No. EEOC Representative 170A 10385 Stanford Lamb, Investigator NOTICE TO THE PERSON AGGRIEVED: Telephone No. 215-440-2617 (See also the additional information attached to this form.) Title VII of the Civil Rights Act of 1964 and/or the Americans with Disabilities Act (ADA): This is your Notice of Right to Sue, issued under Titl Vll and/or the ADA based on the above-numbered charge. It has been issued at your request. Your lawsuit under Title VII or the ADA must be file in federal or state court WITHIN 90 DAYS of your receipt of thts Notice. Otherwise, your right to sue based on this charge will be lost. (The time limit for filing suit based on a state claim may be different.) [ X ] More than 180 days have passed since the filing of this charge. [ ] Less than 180 days have passed since the filing of this charge, but I have determined that it is unlikely that the EEOC will be abl to complete its administrative processing within 180 days from the filing of the charge. [ X ] The EEoC is terminating its processing of this charge. [ ] The EEOC will continue to process this charge. ,~ge Discrimination in Employment Act (ADEA): You may sue under the ADEA at any time from 60 days after the charge was filed until 90 days after you receive notice that we have completed action on the charge. In this regard, the paragraph marked below applies to your case: [ ] The EEOC is closing your case. Therefore, your lawsuit under the ADEA must be filed in federal or state court WITHIN 90 DAYS of your receipt of this Notice. Otherwise, your right to sue based on the above-numbered charge will be lost. I The EEOC is continuing its handling of your ADEA case. However, if60 days have passed since the filing of your charge, you may file suit in federal or state court under the ADEA at this time. Equal Pay Act (EPA): You already have the right to sue under the EPA (filing an EEOC charge is not required.) EPA suits must be brought in federal or state court within 2 years (3 years for willful violations) of the alleged EPA underpayment. This means that backpay due for any violations that occurred more than 2 years (3 years} before you file suit may not be collectible. If you file suit based on this charge, please send a copy of your court complaint to this office. F~nclosure(s) Information Sheet cc: Appleton Papers, Inc. On behalf of the Conl~i~ipn Marie M. Tomasso, District Director Jason P. Kutulakis, Esquire (for Charging Party) (Date Mailed) ;SHERIFF'S RETURN CASE NO: 2001-02217 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND TEETER DEA~N VS APPLETON PAPERS INC - REGULAR GERALD N. WORTHINGTON Sheriff Cumberland County, Pennsylvania, who being says, the within COMPLAINT & NOTICE APPLETON PAPERS INC DEFENDANT , at 1425:00 HOURS, on the at 2850 APPLETON STREET ME__CHANICSBURG, PA 17055 JA24ES HONAFIUS, HUMA~N RESOURCE MANAGER a true and attested copy of COMPLAINT & NOTICE or Deputy Sheriff of duly sworn according to law, was served upon the 18th day of April , 2001 by handing to together with and at the same time directing His attention to ~he contents thereof. Sheriff's Costs: Docketing Service Affidavit Surcharge 18 00 8 68 00 10 0O 00 36 68 Sworn and Subscribed to before SO Answers: R. Thomas Kli~e 04/ 9/2001 ABOM & KUTULAKIS Deputy ~eriff DEAN TEETER, APPLETON PAPERS INC., Plaintiff Defendant : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : CASE NO.: 01-2217 Civil TO: NOTICE OF FILING OF NOTICE OF REMOVAL OF ACTION TO THE UNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA THE PROTHONOTARY OF THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA --and-- COUNSEL OF RECORD In compliance with 28 U.S.C. § 1446(d), you are hereby notified of the filing of a Notice of Removal of this action to the United States District Court for the Middle District of Pennsylvania. A copy of the Notice of Removal is attached as Exhibit 1. Respectfully submitted, DUANE, MORRIS & HECKSCHER LLP Goduto, Esqtfire C~ Attorney ID No. 55769 Jennifer L. Murphy, Esquire Attorney ID No. 76432 305 North Front Street, 5th Floor P.O. Box 1003 Harrisburg, PA 17108-1003 Attorneys for Defendant, Appleton Papers Inc. DEAN TEETER, APPLETON PAPERS INC., IN THE UNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA Plaintiff : : CASE NO.: Defendant NOTICE OF REMOVAL Defendant Appleton Papers Inc. ("Appleton"), by and through its counsel, Duane, Moms & Heckscher LLP, hereby files this Notice of Removal of this action to this Court and states as follows: l. Appleton is a named Defendant in a civil action in the Court of Common Pleas of Cumberland County, Pennsylvania, docketed as Dean Teeter v. Appleton Papers, Inc., No. 01- 2217 Civil (the "State Court Action"). 2. The Complaint in the State Court Action was filed with the Prothonotary of the Court of Common Pleas of Cumberland County, Pennsylvania on April 16, 2001. 3. Appleton was served with PlaintiffTeeter's Complaint on April 18, 2001. 4. In Count 1I of his Complaint, Plaintiff Teeter asserts a claim under the Americans With Disabilities Act, 42 U.S.C. § 12000 et seq., a federal statute. 5. In Count III of his Complaint, Plaintiff Teeter asserts a claim under the Family and Medical Leave Act, 29 U.S.C. § 2601 et seq., a federal statute. 6. This Court has subject matter jurisdiction over this action pursuant to 28 U.S.C. § 1331 because it arises out of the Constitution, laws or treaties of the United States. Accordingly, this action can be removed by this Court by Notice pursuant to 28 U.S.C. §1441(b). 7. This Notice is being filed within thirty (30) days after Defendant Appleton received a copy of Plaintiff Teeter's initial pleading setting forth the claims for relief upon which Plaintiff Teeter's action is based. 8. This action was commenced within the judicial district and division of the United States District Court for the Middle District of Pennsylvania. 28 U.S.C. §1441(a). 9. Copies of all process, pleadings, and orders served upon Appleton in the State Court Action are attached hereto as Exhibit A. 10. Promptly after the filing of this Notice of Removal, Appleton shall give written notice of the removal to the Plaintiff through his attorney of record in the State Court Action and to the Prothonotary of the Court of Common Pleas of Cumberland County, Pennsylvania, as required by 28 U.S.C. § 1446(d). WHEREFORE, Defendant Appleton Papers Inc. respectfully requests that the above- described action pending in the Court of Common Pleas for Cumberland County be removed to this Court. Respectfully submitted, DUANE, MORRIS & HECKSCHER LLP 0,.ttrmey ID No. 41296 ,/~,/ Robert J. Goduto, Esquire ""' Attorney ID No. 55769 Jennifer L. Murphy, Esquire Attorney ID No. 76432 305 North Front Street, 5th Floor P.O. Box 1003 Harrisburg, PA 17108-1003 Attorneys for Defendant, Appleton Papers Inc. BG\74786.1 NOTICE TO DEFEND_ You have been sued in court. If you wish to defend agakxst d~e claims set forth in the following pages, you must take acdon xvitl~ txventy (20) days after tkis Complaint and Notice are setwed, by entedng a xvritten appearance personally or by attorney and filing in xvri~g with the court, yo~ defenses or objections to d~e clans set forth against you. You aze warned that if you fail to do so, the case may proceed wid~out you and a judgment may be entered against you by the cot~ ~vithout further nodce, for an), money cl:&ned in the Complaint o]~ for any other claim for relief requested by the Plaintiff. You nmy lose money or property or other fights important to you. YOU SHOULD TAKE TFIIS PAPER TO YOUR LAWYER AT ONCE. II;' 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. Cnmberland County Lawyer Referral Service 1 Liberty Avenue Carlisle, Pennsylvania 17013 (717) ' RUE COPY FROM RECORD m Te,~ire, ony',vnereot I h~ro unto set my ,-,nd t~'~ ~,~, o~ Sal~ Cou~ at Cadl~ NOTICIA Le han demandado a usted en L~ corte. Si usted quSere defenderse de estas demandas expuestas en Ns paginas sigiuentes, usted fiene veinte (20) dias de plazo al parfir dc la fecha de la demanda y h nofificacion. Usted debe presentar una apariencLq escrita o en persona o pot abogado y arch/var en la corte en forma escrita sus defensas o sus ob}eciones a las demandas en contra de su persona. Sea avisado que si usted no se defiende, la corte tomara medidas y puede cntrar una orden contra usted sin prego aviso o notificacion y pot cualquier queja o alivio que es pedido en Ia peficion de demanda. Usted puede perder dinero o sus propiedades o otros derechos importantes para usted. LLEVE ESTA DEMANDA A UN ABOGADO INMEDIATEMENTE. SI NO TIENE ABOGADO O SI NO TIENE EL DINERO SUFICIENTE DE PAGAR TAL SERVICIO, VAYA EN PERSONA O LLAME POR TELEFONO A LA OFICINA CUYA DIRECCION SE ENCUENTRA ESCRITA ABAJO PARA AVERIGUAR DONDE SE PUEDE CONSEGUIR ASISTENCIA LEGAL. Cumberland County Lawyer Referral Service 1 Liberty Avenue Carlisle, Pennsylvania 17013 (717) DEAN TEETER, Plaintiff APPLETON PAPERS, INC., Defendant IN THE COURT OF COMMON PLEAS OF CUMBEILLAND COUNTY, PENNSYLVANIA JURY TRIAL DEMANDED COMPLAINT 1. Plaintiff, Dean Teeter, is an individual who resides at 1605 Walnut Street, Camp Hill, Pennsylvania, 17011. 2. Appleton, Appleton Papers, Incorporated, (hereinafter "Appleton") is a corporation organized, operating and existing under the laws of the Conunonwealth of Pennsylvania, which has its local place of business at 2850 Appleton Street, Mechanicsburg, Cumberland County, Pennsylvania 17055. 3. At all times relevant hereto, plaintiff was employed in a second-hand operator's position at Appleton's Mechanicsburg, Pennsylvania plant. COUNTI WRONGFUL DISCHARGE 4. The allegations contained in paragraphs one (1) through three (3) of this complaint are incorporated herein by reference as though fully set forth. 5. On or about April 7, 1986, plaintiff became employed by Appleton. He held his current position as a second-hand operator position for approximately thirteen (13) years. 6. On or about March 3, 1999, plaintiff injured his left arm, elbow and hand, while in the course of his employment. 7. As a result of the March 3, 1999 injury, plaintiff received surgical intervention on April 12, 1999, by Appleton's panel physician, Dr. Robert J. Maurer. 8. Plaintiff received a re-graphed nerve followed by eight (8) weeks of rehabilitative therapy prior to his return to work. 9. Appleton accepted plaintifPs accepted workers' compensation cl,im as a result of the March 3, 1999, injury. The period of accepted workers' compensation was March 3, 1999 through July 5, 1999. 10. On or about July 5, 1995), Dr. Ma~er instructed plaintiff to return to his pre-injury xvork position. 11. Following t~is return to xvork, plaintiff began experiencing numbness, pain and aggravation at the surgical point in his left arm. He reported these problems to t~is supervisors. 12. On or about Jtfly 27, 1999, plaintiff obtained a second opinion from his oxvn physician, Morton L. Rubin, M.D., F.A.C.S. Dr. Rubin is an orthopedist. 13. Dr. Rubin dkected plaintiff not to return to the pre-injury work position. 14. Dr. Rubin is of the opinion that plaindff has sustained a repetitive work injury. 15. Dr. Rubin approved plaintiff for work in any position not involving repetitive motion xvith plainfifPs left arm. 16. Appleton was advised of Dr. Rubin's instruction for plaintiff to return to hght duty with no repetitive motion of his left arm. 17. Appleton refused to provide any light duty work for plaintiff. 18. On or about August 3, 1999, Appleton informed plaintiff that they would not be accepting his workers' compensation injury claim. 19. On or about August 5, 1999, plaintiff filed a Reinstatement Petition for workers' compensation benefits. 20. On or about August 18, 1999, Appleton filed an Answer to plaintiff's Reinstatement Petition. Once again, Appleton derfied his requests. 21. Appleton has never offered plaintiff light duty work. 22. Plaintiff followed Appleton's procedures for medical leave and completed all requisite forms necessary for leave. 23. On or about October 25, 1999, Plaintiff's name appeared as having been terminated and was displayed at Appleton on the employee status bulletin boa. rd. (See, Finishing DepatUnent Schedule 25 October 1999, attached hereto as Ex}fibit A). 24. Appleton fired plaintiff on November 2, 1999. 25. Plaintiff was on an accepted leave of absence on November 2, 1999. 26. Appleton knexv that plaintiff was on an accepted leave of absence when they fired plaintiff. (See, Request for Leave of Absence or Family/Medical Leave of Absence forms, attached hereto as Exhibit B.) 27. Appleton's human resources manager, James A. Honafius, testified at a union grievance hearing and workers' compensation hearing that plaintiff was fired while on an accepted leave of absence. (See, Notes of TesOmony fi:om Workers' Compensation Heating on February 22, 2001, page 17, attached hereto as Exhibit (2). 28. PlainfiWs termination by Appleton violates public policy, was in violation of Appleton's legal and ethical obligations and xvas intended to punish plaintiff for filing for workers' compensation. 29. The conduct of Appleton, acting through its agents, servants, workmen and/or employees, as set forth hi this Complaint, amounts to a xvrongful discharge of plaintiff. WHEREFORE, plaintiff demands judgment in his favor and against Appleton in an amount in excess of $25,000.00, plus interest, costs and attorney fees. COUNTII VIOLATION OF THE AMERICANS WITH DISABILITIES ACT 31. Plaintiff incorporates by reference the allegations in paragraphs 1 through 30 as though set forth herein. 32. Plaintiff has exhausted his administrative remedies and been granted a Right to Sue letter from the Equal Employment Opportunities Commission (EEOC). (See, Right to Sue letter, attached hereto as Exhibit D). 33. Plaintiff is mentally/physically disabled as defined by the ADA. 34. Plaintiff is a quahfied individual with a disability within the meaning of the ADA. 35. Appleton discriminated against plaintiff because of the disability. 36. Appleton terminated plaintiff because of his work-related injury. 37. Appleton's termination of plaintiff is a discriminatory action prohibited by the ADA. 38. Appleton's discriminatory conduct as to plaintiff was taken with malice with reckless indifference to the federally and state protected rights of plaintiff. 39. Appleton's termination of plaintifi's employment has caused, continues to cause and will cause plaintiff to suffer substantial damages for future pecuniary losses, mental anguish, loss of enjoyment of life, and other non-pecuniary losses. WHEKEFORE, Plaindff demands judgment in his favor and against Appleton in an amount in excess of $25,000.00. Tiffs demand is for all wages lost since November 2, 1999, through the present, interest on all xvages lost since November 2, 1999, to the present, future pecuniary losses, mental anguish, loss of enjoyment of life, and other non-pecuniary losses, and costs of this action, including expert witness fees and attorney's fees. COUNTIII VIOLATION OF THE FAMILY MEDICAL LEAVE ACT 40. Plzintiffincorporates by reference the allegations in paragraphs 1 through 39 as though set forth herein. 41. Appleton employed more than fifty (50) employees at the location where the plaintiff worked. 42. Plaintiff worked in excess of 1,250 hours at Appleton's place of business in the twelve (12) months preceding his request for leave under the Family and Medical Leave Act, hereinafter referred to as "FMLA." 43. On September 8, 1999, Plaintiff requested leave under the F~, 29 U.S.C.A. §2612. Plaintiff was unable to perform the functions of his position due to his health condition. 44. On October 4, 1999, Plaintiff requested leave under the FMLA, 29 U.S.C.A. 92612. Plaintiff was unable to perform the functions of his position due to his health condition. 45. Appleton denied plaintiff's requests for leave under FMLA. 46. Appleton never requested nor requited plaintiff to obtain certification issued by his health care provider, as permitted pursuant to 29 U.S.C.A. 92612. 47. Appleton denied plaintiff's exercise of rights provided under the FMLA. 48. Appleton discharged the plaintiff due to his repeated requests for leave under the FMLA. 49. Appleton's firing of plaintiff is in violation of the FIr[LA. WHEREFORE, Plaintiff demands judgment in his favor and against Appleton in an amount in excess of $25,000.00. This demand is for all wages lost since November 2, 1999, through the present, interest on all wages lost since November 2, 1999, to the present, liqtfidated damages Lq an amount equal to plaintiff's lost xvages and interest thereon from November 2, 1999, to the present, and costs of this action, including expert xvimess fees and attorney's fees. COUNT W INTENTIONAL INFLICTION OF EMOTIONAL DISTRESS 50. Plaintiff incorporates by reference the allegations in paragraphs 1 through 49 as though set forth herein. 51. Appleton's conduct in firing plaintiff while on an accepted leave of absence and a work- related injury, was extreme and outrageous. 52. Appleton's conduct intentionally caused plaintiff emotional distress. 53. Appleton's condU'ct was with the reckless disregarded for causing plaLqfiff emotional distress. 54. Plaintiff has suffered severe or extreme emotional distress as a result of Appleton's conduct. 55. Appleton's conduct caused plaintiff's emotional distress. WHEREFORE, Plaintiff demands judgment in his favor and against Appleton Lq an amount in excess of $25,000.00 plus interest, costs and attorney's fees. gOUNTV 56. Plaintiffincorporates by referencetheallegafionsinparagraphs 1 through 55 asthougb set forthherein. 57. The conduct of Appleton, as more fully set forth above, was outrageous, intentional, malicious, willful and Lq blatant disregard for the rights of phintiff. 58. As a result of said conduct, Appleton is liable to plaintiff for ptmitive damages. WHEREFORE, Plaintiff demands judgment in his favor and against Appleton in an amount in excess of $25,000.00 plus interest; costs and attorney's fees. CERTIFICATE OF SERVICE AND NOW, this 16t~ day o~' April, 2001, I, Jason P. Kutulakis, Esquire, hereby certify that I did serve a mae and correct copy of the foregoing ENTRY OF APPEARANCE AND COMPLAINT ON BEHALF OF PLAINTIFF upon all counsel of record by depositing, or causing to be deposited, same in the U.S. mail, postage prepaid, at Harrisburg, Pennsylvania, addressed as follows: By First-Class Mail: Robert J. Goduto, Esquire Duane, Morris & Heckscher, LLP 305 North Front Street, 5~h Floor P.O. Box 1003 Hardsburg, PA 17108-5500 DF~AN TEETER, Plaintiff APPLETON PAPERS, INC., Appleton IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION NO.: JURY TRIAL DEMANDED ENTRY OF APPEARANCE Please enter the appearance of the undersigned as counsel for Plaintiff, Dean Teeter , in the above-capfionedma~er. Respectfully submitted, ABOM & KUTULAKIS J tTrn yK . . 0 sn 8 South Hanover Stxeet, Suite 204 Carlisle, PA 17013 Attorney for plaintiff Dated: CERTIFICATE OF SERVICE AND NOW, this 16m day of April, 2001, I, Jason P. Kutulakis, Esquire, hereby certify' that I did ser~,e a true and correct copy of the foregoing ENTRY OF APPEARANCE AND COMPLAINT ON BEHALF OF PLAINTIFF upon all counsel of record by the method listed below: Cumbedand County Sheriff: Appleton Papers, Incorporated 2850 Appleton Street Mechanicsburg, PA 17055 First-Class Mail Robert J. Goduto, Esquire E)uane, Morris & Heckscher, L.LP 305 North Front Street, 5th Floor P.O. Box 1003 Harrisburg, PA 17108-5500 EXHIBIT LB Request for: Leave of Absence or Family/Medical Leave of Absence Name: Department: --~ / ~4 .~-" ~-xtension: m~rce one ,/ NO" or YES I I hereby request L~-~;~'of Absence: (i.e., non-FMLA leave, militaw leave, personal) Facts oe~a~mnq to this ~eave: _ Employee #: Date: ,"- / ,~// Supervisor: _~ - ~,,' -, ,, '-, If Yes dat~'orig~nal leave began: Request leave [o start Projected return to work date: ,. - ' . , '_~, I hereby request a Family/Medical Leave of Absence (FMLA)from~vor~ f0~: the p'urP'~se . ~ My own serious illness, work-rel~ated injury/illness _- ~ :....: ,,?x.i~(~?:..~..,~ ~_,~-.i_.-:, .~ .:: ::,-..- My own seriou~ illness, non W~rk-rel~t~d injuW/il.ln'ess . '.,~ BlAh of a Child or 3iaceme~{ of a chi'10 f0r'adspt~on)foster ~a~e ~ Caring for a s~c~ child, spouse or parent .. '. - · Medical or Informational Fac~ Dertainino to this leave Physician/Health Provide¢ Statement a~ached-~.Yes', or No , ~clud~'h~ i~'~'[~ fo~'il:l'f~i ~'~b~r~ Request leave to sta~. ~'. ': ~ -.' ;r Pr°jected.retg~.~'r~.'~da~.~/?¢:t:~¢:7~'~ Date of the next ¢octor's appointment: ~ :/~4, *-~/*~ ',:'"'L' ".. Documentattop wa~HI be prowded on:. Date.':' ~'/.~ J,?,7 · ', , To.;;,~ Employees on medical leave will provide an Appleton papers Inc. Return to'WOr~ ~SI~ ~ig'~'~d ~y'theiF doctor or persohally pro~ide documentation s nned ~V the r doct0~ t0:~'~hB'(h:~J~'. ~ ¢~:~"~:;~?}¢~2 ~',/~-':. ( adure to personally prowde documentation to e~end th~s Leave of Absence o[ fadure to return schedu ed day of work w~l result m Iq~s of semon¢ (employment) m accordance w Approved by (FMLA' ONLY): Supervisor: Department Manager: ~. ;-i /i:,, -'- ~/ .' Human Resources. ~,- ,,., .... . , Ngfe: -- Th~s~eave~fAbsenceRequest~sn~ta~vedunb7a~gnatureap~va~sare~bta¢nedbya~pa~es~the~deegatesT~-~ ~.~te,.Payroll , Greenr:Mg~jca.,~j:7,..~,~,:~-C.ana~ HRF e , Pmk. Depa~meo~. Req L~est for: Leave of Absence; or Family/Medical Leave of Absence Name: i~,(J ,, -.. ~' ,~,~' ~.. ~ Employee #:~--:~-.'.' / Date: '~ . Department: ;- Superviso¢: : :- Extension: :~rcle one NO or YES If Yes date original leave be§an:-t-.. I hereby request Leave of Absence: (i.e., non-FMLA leave t~ilit~'~le'a~'e, personal) Facts pertaining to this leave: Request leave to start Projected return to wotk dat~;.~: ,.': .-...' -, i hereby request a Family/Medical Leave of Absence (FMLAi from work for the purpose My own serious illness, work-related injury/illness - - - My own serious illness, non work-relate8 injury/ill~ess Birth of a child or p~acement of a child for aaopbon~foster care Caring for a sick cn~a spouse er parent . -..~ Medical or Informational Facts aertaining to th~s leave: -"-' _"'~ applicable) Date of illness: / ~ ~* .......... ' lan/Health Provider :'" ':":'"" ' "'~ Physic Statement attached Yes or No (~ncludes need to care for Request leave to start: I Projected return to work date ;, ¢~¢~: :7t Date of the neW.doctor's appointment: -~,~ ~,/- ?'Y, :: .-.-.,',~:', ,?-~..'.:':. :' :.',i:-':. i~'.~'/~ '.~ J'! :": Do~umentati0~will be provided on: Date: -.~?, ~.' .~.,:./..;./-~>:T6:,.-.:.'~z'¢~,.~',.~,:>~:'~-"'~::,..,.,:~,~'~;'?, ',. ~' .~-~,~ Employees on medical leave will prowde an Appleton papers tnc R~tu~:td.Wo~ Sfi~'~io~od bY the'ir:' doctor or persona y prov de documentat on s ...... gned by the r doctor tde~nd'.the r' e~ve"On. ~ ..~::". ,~¢..,?~';:;-:'.h?: ~,.,,,: ' (Date) -. ~ - . , .,' (Na~e) ' ~,:". ~,:_-.. :. ,--: ;-;.- .../: ;~. ~ailure [o personally :rowae aocument~tio~'to ~nd ~ C~ve 0f'ASsefi~or f~l~ (b'~(urd to'~b~ o~ t~e ~b~e~'s sg)ed~le~ day of work wilt result in loss of seniqfi~ (emoloYment) in a~o(d~nde ~i[~.~i~. :~_- ~ ._ __. ~,.: . _~'~6~ bf.(he:Labbr"~'F~m~t;:?. Additional Commen~: , ' ........ ' ........................ Employee Signature: ~ ~:, t~., ~ ..... . . .... . Steward's Acknowledgement: '- , ' .... ' '~ ...... "'- ~' "?"~¢¢;9 ~>.. ..... Date~ ...... ..... ~'"'_ Supe~,sor: / ,¢ ./ ¢'~- ': :: - Date:' De a~mentMana er , '~ ~ ~?,~4 ., '.,-~- Human Resources' ~ ¢~ - ~ ' :-'~ ....~ p-~2,-, x --- '¢' -'- ~ · ¢ -- -, ~ -, ~,-~_~Date, Note. ,~ ,. Thf~ ~¢~v9 of Abse~ce Request Is not appmved un~l all s~gnatum appmvals a~ obtained by all pa~es or ~eir del~ates ~[te~-Pavro ' ,-,- ;r~ ~ Crc&n: Medi~ ) Canaw: HR File I Pink: ~p~.~nt ~ :,t"I .... ~ , ~- F,~:?-'..',: Request for: Leave of Absence or Family/Medical Leave of Absence Department: /,~._ , ......... Extension: (c~rc~e one NO or ~,YES ..! pi Em oyee#: Date: Supervisor: - :';' If Yes date orlgin~-leavd~b~a'n: ~1 hereby request Leave of Absence: (i.e., non-FMLA leave,~'~'fl]'~'l~aVe~'r~nal) Facts pertainino to th~s Reques~ leave to star~: , Projected return to wotk';dat~.. ~,.7::,:-:-?~: ::. -~ :' ' ~ I hereby request a Family/Medical Leave of Absence (FMLA} from work for the purpose My own serious dness, work-related injury/illness My own serious illness, non work-related injury/illness Birth of a child or placement of a child for adoption/foster care -~..,;~p'ected d~eda-te: ::' Caring for a sick child, seouse or parent - Medical or Informational Facts oertaining to this leave: df applicable) Date of illness: '~ t Physician/Health Provider Statement attached Yes or No fi~'~]~d~'~e8 to: 8a'r~ fS~¢i[(fa~nilv member_L Request leave to sta~: ~ ~rolecte~ return to work date: :~/).~./ Date of the ne~d~tor's appointment: -.. ~ o:~- .~}~ ,:-,~.- ;.:.,~?. ,' ' . Documentat~ was~will be provided 6n:- Date: ~5:'/~i ¢ ~ ~ -: T0~ '-: J~5~:4;,'L~-~,~',., Employees on medical leave will provide an Appleto~ papers Inc. R~d:,~o~-s~ip'~Si~'n~ doctor or personally provide documentation signed by t~eir doctor tC"~'~i~(~:~:'~,~'~?,~¢~;'~ - ' by 12.00 noonto .... : - - - -- - . (Date) ....... (Name) -., , , Failure to pembn~l~y proWde docu~entatiofi io e~end this Leave of Absence or failure to return' t6 work on }h~ ~m~ oyee s sche~u~e~ ~ay of work witl result in ~oss of semod~ (employment) m accordance w~th.~de ~ Off of ~e kabor Aflreement: _, : - ;....' ..;.~ _;,: Additional Commen~: . ....... ~ ~¢~+~,,,. t ~4~,,~ ,.: ~ ~,, ,¢ ;¢~.~ ,~-.-,..:~ .,. ¢.., · ~ / . .'.' ' .' U d :~',' Employee Signature: /~-. ./,~-/. , Date. ~ ~t ¢ / -. Supe~isor: .- - _~, ~. . - -' ---,"- - ~-~ Date. .:~: . . . Human Resources' ~,~ ~ ' %~D t · ;:;~% s-¢¢~ ....... . -, .,' Nofe..~. ~ Leave ~bsence ~equest ts not approved d~l all s gnatu~ epp~vals a~ ob~ ned by all pa~es or their delegates"; ~lte. Pay~(~%:~., ,¢,~;-,~-Green: Medial "' Canaw: HR File - ' Pink: Depa~ent . , Goldenrod: Employee Request for: Leave of Absence or Family/Medical Leave of Absence Name: .. ~ , Employee #: Date: Department: - - Supervisor: -~, ....... Extension: c~rcle one NO or YES "Yes date original eave'b~an:<.:~ I I'he~'eby ~request Leave of Absence: ti,e., non-FMLA eave m li[~iry leave, personal) _Facts pertaimnq-'to this leave Re est leave to s~ar~ ~----.. Pro ected return to workLdate::;-',?~ ,' ~,Z I hereby request a Family/Medical Leave of Absence (FMLA)'from work for the purpose '_ . My own serious illness work-related ir jury/illness My own serious lilt, ess non work~-re ated injufT/ Iness , .' ' .... Birth of a child or placement of a child for adoption/foster care ::;,.E~pe~;ted. due date: .-: Canng for a s~ck child SDOUSe or parent Medical or informational Facts oertainina to this leave: flf applicable) Date of illness: ..... ¢,, ....... -,~--,:*. ~' . ,-,. -, Physi~'ian/Health Provider Statement attached Yes or No nc udes need to care for far~ildmkmber'_ Re'q~§t I~av, e to sta~:" .:~-//-~ ¢'- ~ Projected ~e~urn'to ~ork ~ate:-~' (,--:?:?, Date of the next do tor s appo ntment ....... . ....... · .......... . ...... : ._ - Documentat on was/~ be prov ded on Date ~: ~7, f~/c/ . ,To,.~ ~,~<~ ~-,,~.~t-.. ~ ~.> :~,~. ..... ' .,~ < ,~ ~, ,, ..~--.-7q%< .., ........ , ~.- . f...., ~ ,: ?¢%~ ~;~?~r&~,~,~:'~:~,~?~-<~, ,~. :~. , .. Employees on medical leave will ~rovide an Appleton papecs Inc. '~}~¢~¢,~b,}~'S(i~?iOned b~ their': doctor or persbnally provide dOcumentation signed by their docto~ t~,&'~{$~8~{h~i~ i~'h~ ~n .... .~,~,.- .... , by 12.00 noon to ...... - . . .~,..--.-.,~: - (Name) ,.., FailUre to perso~l[y prowde'documentation to e~end th~s Leave of Absence or fadure to return to work on the e~p[oyee's first scheduled day ~work w~[I result ~n loss of semon~ (employment) ~n accordance w~th A~tcle 6,6E of the. Labor ~greemenL ....... ~ ~ ....... ~ .... . .... ~ ~ - ~ ~ _~ ...... ~ ~ ......... :~ ~ (. ................... ~ ~¢,-" ~-~ ..... Date,? ~[ . ~f ,: ,_: Steward's A nowle~ement: '}~ ' 'x ...... ~;,:~,.,~.Date.-.,. . Depa~ment Manager: - ';,~ ,-[ .' 71 ~;~,,-'~'~.'~,'.~ '. _~,?.:' ,~,-. :,.~:-~-~¢Date:¢,.:,:¢~:%~[~'~?: Depa~me~t ,-' ' Goldenrod- Empoyee , ,.~'. ~tet4;~ ::,, :,r:.~, Green: Medi~ Canaw: HR File I Pink: '¢~,".",'" , : ' . . . Request for: : Leave of Absence or Famity/Medical Leave of AbS'ence ' ¢-z.,L - ~--. Employee ~:. ate: Department: Extension: NO or YES l___J tJ.~ereby request Leave of Absence: (i.e.. non-FMLA leave, Facts pdrta~mnq to,'th~s leave: Rea Jesu leave to startS' S u p erv is o r: ;,,.¢¢~ ?._. If Yes date Projected return to wor[~date ;:,':,:'.- :._ ~ ,'?:-'.~' - 1 hereby request a Family/Medical Leave of Absence (FMLA) from work for the purpos~ ,.M.y ~wn serious dlness..., work-related.~..._. ,~.-~,~;~ .~r~juryfdness~ ' '. ".,' My o~n senous ~llhess, nu~or~ztei~dd ~n u~fdlness - BIdh of a child or placement of a chdd for adopbon/foster care,, .%~EeotCd :due datd:.;~'t~.?~;- , -~ - Car~-~ for a s ck ch d spouse (r parent Medical or Informational Facts ~e~aining to this leave: - .... ,.. (If applicable'} Date of illness: ' '" ; ~ sician/Health Provider Statement ~ach~8, Yes o~ equest leave to'sta~: ~//Ff,~.~. ected retumto work d:~:u' '"' Date of the'nex~ doctor's appointment: ~.r' ~ocumentation was/Will be provided on:~ DatO~ Employees 0n medica iea'~e Will'pr0vidd"an ~ppleton papers doctor or per~opallTprovi~umentation sigded by their doctor ~/ /-~ '/Y~ by i2:00 noon [o Failure to personall~ provide'dodument~bon to'~e~d ~his L~ave of Absence or f~lu It in foss o i6ri~ (emplsy scheduled day of w~rk will resu f sen ment) Add tonal Co~en~' ~ ~ ..... ~ ~',--~*.~'-.,~-, ~.---~ , ~ '~..:. Er~ployee Signature: tewai'd wledgement! ': - Ackci0 ': ' · by (FMLA ONLY) Approved ~upervlsor: ~ .- ~ ..: . ,: ..,..-; -..:',,.~ -;,***'.::..; . :~ ,,.,-.: , , ,-;.j/?~.~-:4;? _..',,-~.,." . Human Resources .... · -~ '-.,, ~, l'i~t ~,- ~t~-¢~ :~ffn, Med,cal Canal: HR File .... ~,:.~ ,-,:. !~:t~,,w~-- Name: ~' ) ~. Lf,,v~ Department: Extension: clrcte one Request for: Leave of Absence or Family/Medical Leave of Absence -f' ¢;.'(-J 4Jt,,;¢ Em_pJoyee #:?' ¢)-/ Date: I --,~- Supervisor: - NO or YES lyes dateorig~'~a eav~began: ] i hereby request Leave of Absence: (i,e., non-FMLA leave, military leave, p~rsonal) Facts oertainino to this leave: F~eouest leave to start: P~-0jecte~J return to work Ua'te: 5~ _ I hereby request a Family/Medical Le-~ive of Absence {FMLA) from work for the purpose ~ My own sertous dlness work~re!,ated ~njuryhllness; ~ ' ' ' /;' B An of a ch d or p ace ,ment'of a ch .d for adopt on/foster care ' E~(pecti~d Car ng for a s ck ch d, spouse or parent ' _ . ¢ .. - :: Medical or Informational Facts [~ertainir~Q'to this leave: ' ' ...... applicable) Date of diness: - PhysiciAn/Health ProvlderStatemehtattached Yes or No >- . /includes need to care for ill familv mem[}er _._ .. . -, . P.rojectgd return to wo?k da__t§-.". -~- , . Em~byee;'' ~h med(g~l :leave ~ili' p:rb¢i0e'.~n'A~l~tg~-~G&dem' fn~. R~ibm' iO 'w~SIf~ig~ea bY their doctor or personally provide documedt~tion:sign~fl by thek doctor to 'e~end their, leave Failure to personally provide documentation to eAend th~s Eeave of Absence or failure to return to WGrk 8n the employee s first sche'd'ufed day of Work Will result in loss of seniod~ (employment) in accordance with ~dicle 6.6E of the Labo~ A~reemeht:- Approved by (FMLAONLY): ' '"' ': %:>' ".---. .' Note ,'. This Leach-of A%s~nce Requ~t ~s n~t aCpm¢e'~b~>(al) s~gnat~"b~p~vals am ob~i~ by all pa~es or ~elr dbJeg~'tes. - :'' Request for: Leave of Absence or Family/Medical Leave of Absence Name: ~..-,.~¢c.,q., 7- ,~ Employee#:':**-~:--'-; Date: ~/¢c(~.-,? Department: ~" - ,..~. ~ ... ;.~.: --- Supervisor: Extension: clrcteone NO or~.~YES'~ ' Yes date ongina lea?e began '2 ::,'~ --::" --~-~ereby request Leave of Absence: (i.e.. non-FMLA leave, military leave, pers'ona[) Facts oertainino to [nls leave ReQues[ leave to s~ar~: Projected -eturn to work date: -~[-I hereby request a Family/MedicaLLeave of Absence (FMLA) from work for the purpose ~-'~ My own serious i ness,:~ork-re ated nju~/illness ,~,~' own senous illness non worU-re~*e'~,, ,~, ,~ ,~,z,Wu~'/l~lness .... Bi~h of a child or olacement of a child for adc~tion/foster care :. Expected due date:-: Caring for a sick child spouse or parent Medical or Informational Facts Detraining to this leave: ' Phvsician/Hea~th Provider Statement a~ached Yes or No ddcludes~eedtdcareforillfamiv~e~ber~ Req Jest leave to sta~: Projected,retorh t9 work Date of tne ne~ doctor s appointment.- ..... ~ ~ - , , ..... ...,~, · ... ~- ..... , .?~.. .......... Documentahon was/wdl be prowded on._ Date. . ~ , ~ 7 / Employees on medical leave wdl prowde an Appleton papers Inc. Retum'to Wo~ Sflp ~gned doctor or personally prowde documentat on s gned by the r doctor to , _ ~ .~ c~ by 12.00 noon to f Date) ., ' · .: (Name)' -?':'~-.-'::-:.'~-,~,~: Failure to personally prowde documentation to e~end th~s Leave of Absence or fadur~ to return scheduled day of work will result in 10ss of seniori~ (employment) in ~ccordan~ 0it6'~Ai~l¢6.¢~ ~f th&' Additional Commen~: Employee Signature: ff~,~ ~ ~/ ' "- . Approved by (FM~ ONLY): k~')~ % - ' " Supe~isor: ¢-- ~ t~¢~ ,' ....Date: ' ' k "l ~- Depa~ment Manager: ~ --;:;:;'- D'at~:: Human Resources . . I ~ite: Payroll' .' I Green: Medi~l [ Canaw: HR File - Pin~:: ~¢'~k~4'~(t.~=;'-)'[ Goldenrod: Name: - - -z, Request for: Leave of Absence or Family/Medical Leave of Absence c?/ ,u; / ~" ~-," ~ Emplo3(ee #:./.",?~2 ~ Date: Department: /'.;~.-_- Extension: cffcie one NO or', YES _, buperwsor: -..~ . ' f Yes date ong~qa leave oegan: __1 I hereby request Leave of Absence: (i,e., non-FMLA leave, military leave, personal) Facts pertaininq to this leave_ Reauest leave to s[a[~: Projected return to woik dat~:. - ,- .- _~_ I hereby request a Family/Medical Leave of Absence (FMLA) from work for the purpose My own seri3us Illness work-related ~njury/ill_ness ' ': ' ~ My own senous illness, non work-related injury/illness ..'~... '::---,'.:.. ~.. :..:q.. ~.. c.. Bir~h of a child or Dlacement of a child for adoption/foster care ExPe'cte.ddue_.dat. e:" --' Caring for a S~CK child spouse or parent Medical or Informational Facts pe[taining tothis leave: ' : (IfapDlicable~ Date of illness: ................~ .. .~. Physician/Health Provider Statement attached Yes or No cnc[ud~ne~d . Request leave to start: Projected return to ~,e nex,~k,or .... :,,~:..,., ,....~-..:-. Documentatio~will be provided on: Dae: C~ ~,.[;-~ , ::.~TO~:~./~:~:,~-(~.~'..:.~,:,:~.;~/ . , , . -...'~/,~,.~ Employees on medtcal leave wd~ provide an Appleton papers Inc. ~e~,(~:,~:~r~.:,~[tp~A~gn.~ doctor or persona y arov de Oocumentat on s ~ned by the r dodot to~on~}~[ by 12:00 nqon to ~: -.-,:~,:- (Date) _ (Name) -,. Failure to personally 3rovide documentation to e~end this Leave of Absence or failure t0 retQm to work scheduled day of work w~fl result ~n loss of's~.mon~ (employment) m accordan~ w~th A~le 6.6E of the Eab6~ ACr~6me0t:~.~'~., Additional Commen ~: : Employee Signature: .~ · . :.... ~te:~-,':- ' ' ~ ~ .-~ ~ ~ . . .;~.~,~:xd.,~.,..~,';-.~.:-~.~; .~,.~ ..~ -_,.,: steward's Ack6owledgement:- ~ '~ -/~ . .-.-/~% ~.~:'., by (FMLA ONLY): ~'-'~'~' : '"'~-'~¢':':'~":~':'~'~":":'~:' A pproved Supe~isor: Date:.'-' , t~ . "': .' DepaAment Note: This Leave of Absence Req~es~ is not ~pproved un~l all signature approvals are obtained by all ~b~es-o~ ~ir'delegates,'~ ~, {.~ te Payroll ' Green: Medica' ., { Caoa'~' HR File '.-( Pink: be~a~q~[:~:::::~.'." Leave of Absence or Fatnii.yl'lrt!'i~dical Le~'a~ o'¢ Absence -' ~/ . ~ ,. ;, ,- .... . ~,/, f ' . ........................ 0 .................. ,'-' ...... ' ...... 7 .... ........ hereby request Leave of Absence: {i.e., non .FMLA leave, md,i;.,ry I,.ave, perso,al) ~acts~e~ainin~o this leave: Requesf' leave to sla~t ..... My own serious illness, work-related injury/illness _~/...=_ My own serious illness, non work~related injuw/illness Birth of a child or placement of a child for adoption/::'oster (.'.are Expected due dale: ___J Caring for a sick child, spouse or parent Medical or Informational Facts .pertaining__tc2 th__is. Jlr:~8,,_..'_e; ........................................... _(J_'~p~lica_[~e) Date of illness: __P_h~v~sicia. n_~Health Provider Statement attached Yes_ ~E__NO_. ...... _~.l~_h~¢_~;~L<(l_to~_c_~r_{~ fobill fan'd!y member) Request lea~e' to start: I Projected reium to work date~. ,// /¢,¢ Date of the next dr~tor's appointment: /¢2.-~--~ Y _ /~ ~/i ~ Doc,. mentation~'~s?~will be provided on'. Date'. ~2_./_d~/,H~Z~_~¢_¢_ To'._.~ ~.¢¢~_~.~__ Employees on medical leave will provide an Appleton papers In(. ~i'elurn to Work Slip signed by the doctor or personally provide documentation signed by their doctor to extend ti~eir leave on _ by 12:00 noon to (Date) ' {Name) Failure to personally provide documentation to extend this Leave of Absence or failure lc return to work on the employee's fin scheduled day of work will result in loss of seniority (employment) iii accordance wid-, Article 6 6E of the Labor Agreement. IAdditional Comments: Employee Signature: Steward's Acknowledgement: Approved by (FMLA ONLY): Supervisor: Oepad. ment I~lanager: .......................... [)ate' Human Resources: Date: Note: T~is L~ave c.r Absence Request is not approved unfil all signatl~re a,oprova~2 are ob~aim~d b~, ah' ~a~ies or their dOegares. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF LABOR AND INDUSTRY Bureau of Workers' Compensation In the Matter of: Dean Teeter, Claimant VS. Appleton Papers, Incorporated, Defendant Claim No. 2051428 Penalty/Reinstate Pages 1 through 36 Hearing Room A Harrisburg Judges Office East Gate Center 1010 North Seventh Street Harrisburg, Pennsylvania Thursday, February 22, 2001 BEFORE: Met, pursuant to notice, KARL H. PECKMANN, Judge at 2:30 p.m. APPEARANCES: JASON P. KUTULAKIS, Esquire 8 South Hanover Street Carlisle, Pennsylvania 17013 (For the Claimant) ROBERT J. GODUTO, Esquire Fifth Floor 305 North Front Street P. O. Box 1003 Harrisburg, Pennsylvania (For the Defendant) 17108-1003 Commonwealth Reporting Company, Inc. 700 Lisburn Road Camp Hill, Pennsylvania 17011 (717) 761-7150 1-800-334-1063 ! 5 6 ? $ 10 13 14 15 16 17 19 -~0 2~ ~4 .% 17 the decision not. to come to work. BY MR. KUTULAKIS: Q Under the union regulations, is an accepted leave of absence defined? A Yes, it is. Q Okay. Was he on an accepted leave of absence under those regulations? A Based on -- based on the union contract, yes. MR. KUTULAKIS: Nothing further, Your Honor. JUDGE PECKMANN: Anything else? MR. GODUT0: Yes. CROSS-EXAMINATION BY MR. GODUTO: Mr. Honafius, in terms of the documentation that was submitted by Mr. Teeter for a requested leave, when were the last time those documents were completely filled out to continue the leave? A The leave of absence form was filled out completely on July the 26th, and that leave was signed off by his supervisor, department manager, and human resources. Q What's required internally -- first of all, what's required to have an approved leave? A Ah, to get the approved leave of absence, the employee must. present medical documentation that they have a disability or are unable to perform their job, and they EXHIBIT D EEOC Form 161-B (10/96) U.S. EQUAl. EMPLOYMENT OPPORTUNITY COMMISSION INrOTICE OF RIGHT TO SUE (ISSUED ON REQUEST) To:Dean A. Teeter 1605 Walnut Street Camp Hill, PA 17011-3971 From: Equal Employment Opportunity Commission Philadelphia District Office The Bourse 21 S. Fifth S~-eet, Suite 400 Philadelphia, PA 19106-2515 [ I On behalf of person($) aggrieved whose identity is CONFIDENTIAL (29 CFR.~ 1601.7(a)) Charge No. 170A10385 NOTICE TO THE PEP. SON AGGRIEVED: EEOC Represents five Stanford Lamb, Investigator Telephone No. 215440-2617 (See also the additional information attached to this forrr Title VII of the Civil Rights Act of 1964 and/or the Americans with Disabilities Act (ADA): This is your Notice of Right to Sue, issued under Ti VII and/or the ADA based on the above-numbered charge. It has been issued at your request. Your lawsuit under Title VII or the ADA must be file in federal or state court WITHIN 90 DAYS of your receipt of this Notice. Otherwise, your right to sue based on this charge will be lost. (The time limit for filing suit based on a State claim may be different.) [ X ] More than 180 days have passed since the filing of this charge. [ ] Less than 180 days have passed since the filing of this charge, but I have determined that it is unlikely that the EEOC will be ab to complete'its administrative processing within 180 days from the filing of the charge. [ X ] The EE6~ is terminat~g its processing of this charge. [ ] The EEQ~ ~/il[ continue to process this charge. ~ge Discriminatinu in Employment Act (ADEA): You may sue under the ADEA at any time from 60 days afier the charge was filed until 90 days afier you receive notice that we have completed action on the charge. In this regard, the paragraph marked below applies to your ease: [ ] The EEOC is closing your case. Therefore, your lawsuit under the ADEA must be filed in federal or state court WITHIN 90 DAYS of your receipt of this Notice. Otherwise, your right to sue based on the above-numbered charge will be lost. The EEOC is continuing its handling ofyour ADEA case. However, if60 days have passed since the filing of your charge, you may file suit in federal or state court under the ADEA at this time, Equal Pay Act (EPA): You already have the right to sue under the EPA (filing an EEOC charge is not required.) EPA suits must be brought in federal or state court within 2 years (3 years for willful violations) of the alleged EPA underpayment. This means that backpay due for any violations that occurred more than 2 'years (3 years) before you file suit may not be collecfible. fyou file suit based on this charge, please send a copy of your court complaint to this office. ;nclosure(s) Information Sheet c: Appleton Papers, On behalf of the Congli&sion Marie M. Tom~sso, District Director Jason P. Kumlakis, Esquire (for Charging PaCeff) (Date Mailed) CERTIFICATE OF SERVICE I, Jennifer L. Murphy, Esquire, or~e of the attorneys for Defendant Appleton Papers Inc., hereby certify that I have served the foregoing document upon Counsel of record this date by depositing a true and correct copy of the same in the United States mail, first-class postage prepaid, addressed as follows: Jason P. Kutulakis, Esquire ABOM & KUTULAKIS 8 South Hanover Street, Suite 204 Carlisle, PA 17013 Date: May 3, 2001 DUANE, MORRIS & HECKSCHER LLP CERTIFICATE OF SERVICE I, Jennifer L. Murphy, Esquire, one of the attorneys for Defendant Appleton Papers Inc., hereby certify that I have served the foregoing document upon Counsel of record this date by depositing a true and correct copy of the same in the United States mail, first-class postage prepaid, addressed as follows: Jason P. Kutulakis, Esquire ABOM & KUTULAKIS 8 South Hanover Street, Suite 204 Carlisle, PA 17013 Date: May 3, 2001 DUANE, MORRIS & HECKSCHER LLP BY~~~r~l~hy~' '~~ Curtis R. Long Prothonotary Renee K. Simpson Deputy Prothonotary <umberlanl~ (~ottntp John E. Slike Solicitor Court of Common Pleas Cumberland County, Pennsylvania Docket THE UNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA Please acknowledge receipt of this case by signing and dating this document. Please send this back to: PROTHONOTARY OFFICE CUMBERLAND COUNTY COURTHOUSE ONE COURTHOUSE SQUARE CARLISLE, PA 17013 Attn: Becky Record received: Date: (signature & title) One Courthouse Square · Carlisle, Pennsylvania 17013 · (717) 240-6195 · Fax (717) 240-6573