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HomeMy WebLinkAbout14-2319 Supreme Co<� ennsylvania Con fCommo leas For Prothonotary Use Only: f , Ct i 1'. lei Sfie 't Cu erland�'�� / Docket No: t� County ) �' The information collected on this form is used solely for court administration purposes. This form does not supplement or replace the filing and service of pleadings or other papers as required by law or rules of court. Commencement of Action: Complaint ❑ Writ of Summons ® Petition S 0 Transfer from Another Jurisdiction 0 Declaration of Taking E C Lead Plaintiffs Name: Lead Defendant's Name: Mary Chambers Erie Insurance Exchange T Dollar Amount Requested: X; within arbitration limits I Are money damages requested? x Yes ®No (check one) Doutside arbitration limits O N Is this a Class Action Suit? Yes EM No Is this an MDJAppeal? 0 Yes x No i A Name of Plaintiff /Appellant's Attorney: 0 Check here if you have no attorney (are a Self- .Represented (Pro Se] Litigant) Nature of the Case Place an "X" to the left of the ONE case category that most accurately describes your PRIMARY CASE. If you are making more than one type of claim, check the one that you consider most important. TORT (do not include Mass Tort) CONTRACT (do not include Judgments) CIVIL APPEALS Intentional 0 Buyer Plaintiff Administrative Agencies f Malicious Prosecution 0 Debt Collection: Credit Card 0 Board of Assessment 0 Motor Vehicle 0 Debt Collection: Other ❑ Board of Elections 0 Nuisance 0 Dept. of Transportation 0 Premises Liability 3 Statutory Appeal: Other S 0 Product Liability (does not include { E mass tort) 0 Employment Dispute: Discrimination ® Slander/Libel/ Defamation 0 0 C 0 Other: Employment Dispute: Other Zoning Board � , 0 Other: I xl Other: MASS TORT PIP- wage loss y © Asbestos N 0 Tobacco 0 Toxic Tort - DES 0 Toxic Tort - Implant REAL PROPERTY MISCELLANEOUS 0 Toxic Waste 0 Other: 0 Ejectment 0 Common Law /Statutory Arbitration B 0 Eminent Domain /Condemnation 0 Declaratory Judgment 0 Ground Rent J Mandamus 0 Landlord/Tenant Dispute U Non - Domestic Relations 0 Mortgage Foreclosure: Residential Restraining Order PROFESSIONAL LIABLITY g g — Quo Warranto ® Mort a e Foreclosure: Commercial i 0 Dental 0 Partition Replevin 0 Legal 0 Quiet Title 0 Other: 0 Medical 0 Other: 0 Other Professional: Updated 1/1/2011 NOTICE Pennsylvania Rule of Civil Procedure 205.5. (Cover Sheet) provides, in part: Rule 205.5. Cover Sheet (a)(1) This rule shall apply to all actions governed by the rules of civil procedure except the following: (i) actions pursuant to the Protection from Abuse Act, Rules 1901 et seq. (ii) actions for support, Rules 1910.1 et seq. (iii) actions for custody, partial custody and visitation of minor children, Rules 1915.1 et seq. (iv) actions for divorce or annulment of marriage, Rules 1920.1 et seq. (v) actions in domestic relations generally, including paternity actions, Rules 1930.1 et seq. (vi) voluntary mediation in custody actions, Rules 1.940.1 et seq. (2) At the commencement of any action, the party initiating the action shall complete the cover sheet set forth in subdivision (e) and file it with the prothonotary. (b) The prothonotary shall not accept a filing commencing an action without a completed cover sheet. (c) The prothonotary shall assist a party appearing pro se in the completion of the form. (d) A judicial district which has implemented an electronic filing system pursuant to Rule 205.4 and has promulgated those procedures pursuant to Rule 239.9 shall be exempt from the provisions of this rule. (e) The Court Administrator of Pennsylvania, in conjunction with the Civil Procedural Rules Committee, shall design and publish the cover sheet. The latest version of the form shall be published on the website of the Administrative Office of Pennsylvania Courts at www.pacourts.us THIS IS AN ARBITRATION MATTER. ASSESSMENT OF DAMAGES HEARING CLEARFIELD & KOFSKY IS REQUIRED. By: Casey O. Srogoncik, Esquire Attorney for Plaintiff Identification No.: 204395 One Penn Center at Suburban Station 1617 JFK Boulevard, Suite 355 Philadelphia, PA 19103 (215) 563 -6333 MARY CHAMBERS COURT OF COMMON PLEAS 513 Quail Court CUMBERLAND COUN Mechanicsburg, PA 17055 it 1' V. NO. ERIE INSURANCE EXCHANGE 100 Erie Insurance Place s Erie, PA 16530 -7 0 COMPLAINT IN CIVIL ACTION NOTICE TO DEFEND 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 an 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 32 South Bedford Street Carlisle, PA 17013 (717) 249 -3166 C� L4 L41 V� " l GENERAL AVERMENTS 1. Plaintiff, Mary Chambers, is an adult individual who resides at the above - captioned address. 2. Defendant, Erie Insurance Exchange (hereinafter referred to as "Erie ") is a business corporation engaged in the insurance business throughout the Commonwealth of Pennsylvania and at all times material hereto, maintained an office located at the above - captioned address. 3. At all times material hereto, Defendants acted or failed to act by and through their agents, servants, workmen and /or employees who were then and there acting within the scope of their authority and course of their employment with Defendants, in furtherance of Defendants' businesses and on behalf of Defendants. 4. On or about May 2, 2011, at or near the intersection of Hilton Avenue and Oakland Road, Dover Township, York, Pennsylvania, Plaintiff Mary Chambers, was involved in an accident arising from the maintenance and use of a motor vehicle that resulted in bodily injuries and a loss of wages. 5. Defendant insured Plaintiff's vehicle. 6. Such insurance would include wage loss benefits. 7. Under the terms of this policy, Defendant was responsible for providing Plaintiff with first party benefits including but not limited to wage loss benefits pursuant to the Pennsylvania Motor Vehicle Financial Responsibility Law, 75 P.S. §1791, 1792 et seq. 8. Despite requests by the Plaintiff to pay for certain and necessary wage loss, said defendant has refused to do so. -2- 9. As a result of the foregoing, Plaintiff, Mary Chambers, has been obliged to expend various sums of money, incur various expenses and suffered severe economic hardship and financial burdens. COUNT PLAINTIFF MARY CHAMBERS v. DEFENDANT ERIE 10. Plaintiff, Mary Chambers, incorporates by reference hereto all of the allegations contained in the General Averments, as if they were set forth at length herein. 11. As a result of the foregoing, Plaintiff, Mary Chambers, suffered economic hardship and financial strain which may continue. 12. Most recently, Defendant has refused to pay plaintiff for wage loss benefits which are included in defendant's policy issued to Plaintiff, Mary Chambers. A copy of the declaration page is attached as Exhibit "A ". 13. As a result of all the foregoing Plaintiff, Mary Chambers, was required to hire the services of an attorney to recover wage loss benefits due to plaintiff. WHEREFORE, Plaintiff, Mary Chambers, demands judgment against the Defendant, for damages, in an amount not in excess of the arbitration limits, plus interest and costs. CLEARFIE OFSKY BY: EY O. SROGONCIK, ESQUIRE ttorney for Plaintiff, Mary Chambers -3- i .. .' Y L' PM{..tSL..I ION 1. LAP L. hereby verify that 1 am the in the attached i 1'�f v , and that the facts set forth herein are true and correct to the best of my knowledge, information and belief. I understand that Use statements made herein are subject to the penalties.of the 18 PA C.S_ §4904, relating to unswom falsification to authorities. NAME ADDRESS '51 _ r 6`1 DATE CLEARFIELD & KOFSKY `' ` faOPJ!� lEt BY: CASEY O. SROGONCIK, Esq ir�o HAV _5 pH 2: 00 Attorney for Plaintiff Identification Number: 44449 1617 John F. Kennedy Boulevard, SiiitKORL AND COUNTY Philadelphia, PA 19103 PENNSYLVANIA 215-563-6333 MARY CHAMBERS v. ERIE INSURANCE EXCHANGE : COURT OF COMMON PLEAS : CUMBERLAND COUNTY : NO: 14-2319 - CIVIL PRAECIPE TO REINSTATE COMPLAINT TO THE PROTHONOTARY: Kindly reinstate the Civil Action Complaint for an additional thirty (30) days in the above -captioned matter. DATE: 05.02.2014 BY: CASE O. SROGONCIK, Esquire Attorney for Plaintiff CLEARFIELD & KOFSKY avvA. Wispci a Ck.--# 4ur� 72* 3os�8� SHERIFF'S OFFICE OF CUMBERLAND COUNTY Ronny RAnderson ;-C Lj if L Sheriff t E K'rROIHO 1 ��M�ttr cat ;atarai,+�F.��x� Jody S Smith 2,014 MAY —2 PM 3: 07 Chief Deputy Richard W Stewart CUMBERLAND COUNTY Solicitor PENNSYLVANIA Mary Chambers Case Number vs. 2014-2319 Erie Insurance Exchange SHERIFF'S RETURN OF SERVICE 04/16/2014 Sheriff Ronny R Anderson, being duly sworn according to law, states he made diligent search and inquiry for the within named Defendant to wit: Erie Insurance Exchange, but was unable to locate the Defendant in the Sheriffs bailiwick. The Sheriff therefore deputizes the Sheriff of Erie, Pennsylvania to serve the within Complaint& Notice according to law. 04/23/2014 01:25 PM -The requested Complaint&Notice served by the Sheriff of Erie County upon Jodi Cole, Supervisor, who accepted for Erie Insurance Exchange, at 100 Erie Insurance Exchange, Erie, PA 16530. John T. Loomis, Sheriff, Return of Service attached to and made part of the within record. SHERIFF COST: $37.00 SO ANSWERS, April 30, 2014 RbNW R ANDERSON, SHERIFF SHERIFF'S OFFICE OF ERIE COUNTY JOHN T. LOOMIS JEFFREY GUILD Sheriff Captain JON HABURSKY WILLIAM FENTON Chief Deputy PRIDE Lieutenant MARY CHAMBERS Case Number vs. 2014-02319M ERIE INSURANCE EXCHANGE (et al.) SHERIFF'S RETURN OF SERVICE 04/23/2014 01:25 PM-DEPUTY MIKE CANNAVINO, BEING DULY SWORN ACCORDING TO LAW, SERVED THE REQUESTED COMPLAINT& NOTICE BY HANDING A TRUE COPY TO A PERSON REPRESENTING THEMSELVES TO BE JODI COLE, SUPERVISOR, WHO ACCEPTED AS"ADULT PERSON IN CHARGE"FOR ERIE INSURANCE EXCHANGE AT 100 ERIE INSURANCE PLACE, ERIE, PA 16530. 0. H-Lj MIKE CANNAVINO, DEPUTY SHERIFF COST: $68.00 SO ANSWERS, i April 25, 2014 J N T. LO IS, SHERIF WEALTH OF nWQn,,�&UINA NOTARIAL SEAL BARBARA D.TURNER,Notary Public City of Erie,Erie County Cornmission Eores Apri 7,2015 -- ---- --- - -- - - --- --- -- ---- - --- -- -- ... ..- - -- --- ---- ----- NOTARY Affirmed and subscribed to befpre me this, p( day of )NALD A=CLEARFIEID&AS OCIATES, P.C., 1617 JOHN F. KENNEDY BLVD, SUBURBAN STATION SUITE 355, PHILAL ("') 'ele,.,,h ;Fw Ronny R Anderson Sheriff Jody S Smith Chief Deputy Richard W Stewart Solicitor SHERIFF'S OFFICE OF CUMBERLAND COUNTY GFFiCE S,F Th"e $wFFIr -Eo, o^ ;c .- THEF'RQTHONOl'i 2014 MAY 20 PM 3: 1 �. CUMBERLAND COUNTY PENNSYLVANIA Mary Chambers vs. Erie Insurance Exchange Case Number 2014-2319 SHERIFF'S RETURN OF SERVICE 05/06/2014 Sheriff Ronny R Anderson, being duly sworn according to law, states he made diligent search and inquiry for the within named Defendant to wit: Erie Insurance Exchange, but was unable to locate the Defendant in the Sheriffs bailiwick. The Sheriff therefore deputizes the Sheriff of Erie, Pennsylvania to serve the within Complaint & Notice according to law. 05/09/2014 01:10 PM - The requested Complaint & Notice served by the Sheriff of Erie County upon Jodi Cole, Supervisor, who accepted for Erie Insurance Exchange, at 100 Erie Insurance Exchange, Erie, PA 16530. John T. Loomis, Sheriff, Return of Service attached to and made part of the within record. SHERIFF COST: $37.00 SO ANSWERS, May 16, 2014 RONNY R ANDERSON, SHERIFF (c) CountySuite Sheriff, Teleosoft, 100. SHERIFF'S OFFICE OF ERIE COUNTY JOHN T. LOOMIS JEFFREY GUILD Sheriff Captain JON HABURSKY WILLIAM FENTON Chief Deputy , s,Lieutenant MARY CHAMBERS vs. ERIE INSURANCE EXCHANGE (et al.) Case Number 2014-02319M SHERIFF'S RETURN OF SERVICE 05/09/2014 01:10 PM - DEPUTY MIKE CANNAVINO, BEING DULY SWORN ACCORDING TO LAW, SERVED THE REQUESTED COMPLAINT & NOTICE BY HANDING A TRUE COPY TO A PERSON REPRESENTING THEMSELVES TO BE JODI COLE, SUPERVISOR, WHO ACCEPTED AS "ADULT PERSON IN CHARGE" FOR ERIE INSURANCE EXCHANGE AT 100 ERIE INSURANCE PLACE, ERIE, PA 16530. MIKE CANNAVINO, DEPUTY SHERIFF COST: $68.00 SO ANSWERS, May 13, 2014 1-4, Qv/ ,6„.D JO N T. LOO s IS, SHERIFF NOTARY Affirmed ccand subscribed to before me this /L/��day of 007 )NALD A CLEARFIELD & ASSOC ATES, _P.C., 1617 JOHN F. KENNEDY BLVD, SUBURBAN STATION SUITE 355, PHILAL (c) CountySuite ;3herfF, Teieosoft. Inc. NOTARIAL SEAL BARBARA D, TURNER, Notary P City of Erie, Erie County Commission 7, 2016