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HomeMy WebLinkAbout05-3028R. J. MARZELLA & ASSOCIATES, P.C. BY: Zachary D. Campbell, Esquire Pennsylvania Supreme Court I.D. No. 93177 3513 North Front Street Harrisburg, PA 17110 Telephone: (717) 234-7828 Attorneys for acsimilf: (717) 234-6883 Shannon Baker IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION- LAW SHANNON BAKER, 60 Fairway Drive Etters, Pennsylvania, 17201 n C Plaintiff Docket Noll?" -22a4e u i Civil Action V. AFLAC INSURANCE 10306 Regency Parkway Drive Omaha, Nebraska, 68114 MICHAEL PEACOCK 166 Main Street Chambersburg, Pennsylvania, 17201 Defendants JURY TRIAL DEMANDED NOTICE TO DEFEND 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 defense 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 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 2 Liberty Avenue Carlisle, Pennsylvania (717) 249-3166 NOTICIA Le han demandado a usted en la corte. Si usted guiere defenderse de estas demandas expuestas en las paginas siguintes, usted tiene viente (20) dias de plaza al partir de la fecha de la demanda y la nontificacion. Usted debe presentar una apariencia escrita o en persona o por abogado y archivar en la corte en forma escrita sus defensas o sus objectiones a las demandas en contra de su p esona. Sea avisado que si usted no se defiende, la corte tomara medidas y puede entrar una orden contra usted sin previo aviso o notification y por cualquier queja o alivio que es pedido en la peticion de demanda. Usted pueda perder dinero o sus propiedades o otros derechos importantes para usted. LLEVE ESTA DEMANDA A UN ABODAGO INMEDIATAMENTA. SI NO TIENE ABOGADO 0 SI NO TIENE EL DINERO SUFICIENTE DE PAGAR TAL SERVICIO, VAYA EN PERSONA 0 LLAME POR TELEFONO A LA LFICINA CUYA DIRECCION SE ENCUENTRA ESCRITA ABAJO PARA AVERIGUAR DONDE SE PEUDE CONSEGUIR ASISTENCIA LEGAL. Cumberland County Bar Association 2 Liberty Avenue Carlisle, Pennsylvania (717) 249-3166 Respectfully submitted, R. J. Marzella & Associates, P.C. By: Z ary . C pbell Attorney dentifcation No. 93177 Dated: 6 3 Zo?S R. J. MARZELLA & ASSOCIATES, P.C. BY: Zachary D. Campbell, Esquire Pennsylvania Supreme Court I.D. No. 93177 3513 North Front Street Harrisburg, PA 17110 Telephone: (717) 234-7828 Attorneys for Facsimile; (717) 234-6883 Shannon Baker IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION- LAW SHANNON BAKER, 60 Fairway Drive Etters, Pennsylvania, 17201 Plaintiff Docket No. nS- _?02P l=tu?L?4iLr.? Civil Action l v. AFLAC INSURANCE 10306 Regency Parkway Drive Omaha, Nebraska, 68114 MICHAEL PEACOCK 166 Main Street Chambersburg, Pennsylvania, 17201 Defendants JURY TRIAL DEMANDED COMPLAINT Parties Shannon Baker (hereinafter "Mrs. Baker"), the Plaintiff, at all relevant times hereto was an adult individual who maintained her residence at 60 Fairway Drive, Etters, Pennsylvania, York County, 17201. 2. American Family Life Assurance Company of Columbus (hereinafter "AFLAC"), the Defendant, is a disability insurance company that is duly incorporated in the state of Nebraska with an address for service of process at 10306 Regency Parkway Drive, Omaha, Nebraska, 68114. 3. Defendant AFIAC's registered agent is Frank J. Barret, who maintains his address at 10306 Regency Parkway Drive, Omaha, Nebraska, 68114. 4. Michael Peacock (hereinafter "Defendant Peacock") is a licensed insurance agent in the state of Pennsylvania who maintains a business address at 166 Main Street, Chambersburg, Pennsylvania, 17201. 5. At all relevant times herein, Defendant Peacock, was the agent, apparent agent, servant and/or employee of Defendant AFLAC and was acting within the course and scope of his employment when providing professional services to the Mrs. Baker. 6. At all relevant times herein, it is believed and therefore averred that Defendant Peacock made representations to Mrs. Baker based on his training and instruction given by Defendant AFLAC. 7. In March of 2004, Mrs. Baker was an employee of Lincare Holdings, located at 913 Kranzel Drive, Camp Hill, Pennsylvania, 17011. 8. In March of 2004, Mrs. Baker had maintained a policy for disability insurance through AIIState Insurance Company. 9. On or around March 18, 2004, Mrs. Baker met with Defendant Peacock, a licensed insurance agent, who was employed by Defendant AFLAC, at her employer's office. 10. The meeting occurred on the premises of Mrs. Baker's employer, Lincare Holdings, in Camp Hill, Cumberland County, Pennsylvania, 17011. 2 11. During this meeting, Defendant Peacock presented Mrs. Baker with several different insurance plans that were offered by Defendant AFLAC and were available for Mrs. Baker to purchase. 12. At the time, Mrs. Baker was interested in purchasing a disability insurance policy from Defendant Peacock, individually and/or as an agent, apparent agent, servant and/or employee of Defendant AFLAC. 13. Mrs. Baker had previously suffered from "bilateral renal calculus" or "kidney stones" and this condition had previously necessitated that she take extended time off work on different occasions. 14. For this reason, Mrs. Baker maintained the disability insurance policy through AllState Insurance to supplement her lost income, when she was unable to work because of her medical condition. 15. Mrs. Baker was however concerned that her medical condition would be classified as a pre-existing condition under the AFLAC policy and therefore, any new onset of "kidney stones" could possibly be excluded under the AFLAC policy. 16. Mrs. Baker was concerned because she had suffered from "kidney stones" since she was a teenager and had frequently had new occurrences of "kidney stones" throughout her life. 17. Because of this concern, Mrs. Baker questioned Defendant Peacock extensively regarding coverage under the AFLAC disability insurance policy. 18. Mrs. Baker was concerned that if she decided to cancel and/or not renew her current disability policy with AllState and purchased a new disability policy with Defendant AFLAC, she would not be covered by a policy for any new onset of "kidney stones." 19. Therefore, Mrs. Baker specifically questioned Defendant Peacock on whether the AFLAC disability insurance policy would cover losses caused by a new onset of "kidney stones" or whether "kidney stones" are considered a "pre-existing condition" under said policy and would be excluded from coverage. 20. In response to Mrs. Baker's question regarding coverage, based on his training, Defendant Peacock stated to Mrs. Baker that "kidney stones" are not considered a pre-existing condition and therefore losses that result from "kidney stones" are not excluded from coverage under the AFLAC disability insurance policy, even during the first 12 months of the policy. 21. Defendant Peacock stated under the AFLAC disability insurance policy that Mrs. Baker was interested in obtaining, in order to make a claim for losses that resulted from "kidney stones" under the AFLAC disability insurance policy, Mrs. Baker would only have to observe the thirty (30) day waiting period that would begin the day the policy went into effect. 22. Based on his training and instruction, Defendant Peacock specifically stated and misrepresented that each new onset of "kidney stones" was treated as a "new illness" and/or new diagnosis rather than a reoccurrence of a pre-existing condition. 23. Defendant Peacock specifically likened each occurrence of kidney stones to an absence caused by a "broken bone." 24. At no time did Defendant Peacock tell Mrs. Baker that any losses that resulted from "kidney stones" would be excluded from coverage under the AFLAC disability insurance policy. 25. At no time did Defendant Peacock confirm and/or attempt to confirm with his employer, Defendant AFLAC, that losses Mrs. Baker sustained as result of a new occurrence of "kidney stones" would or would not be covered. 26. Defendant Peacock simply misrepresented to Mrs. Baker that losses resulting from a new on-set of "kidney stones"' would be covered thirty (30) days after the AFLAC disability insurance policy became effective. 27. Defendant Peacock intentionally and/or recklessly misrepresented to Mrs. Baker that losses resulting from "kidney stones" would be covered under the AFLAC disability insurance policy with the intent of misleading Mrs. Baker into purchasing the policy based on his misrepresentation. 28. Based on Defendant Peacock's misrepresentation regarding coverage under the AFLAC disability insurance policy, Mrs. Baker justifiably relied on Defendant Peacock's statements and she purchased the policy. 29. Because of her justified reliance on Defendant Peacock's misrepresentations regarding coverage under the policy, Mrs. Baker allowed her disability insurance policy with AIIState Financial Company to lapse without renewing it. 30. Defendant Peacock convinced Mrs. Baker that she would save money on her premiums with the new AFLAC policy and but for the misrepresentation regarding kidney stones not being a "pre-existing condition", Mrs. Baker would never have allowed her current Short Term disability policy issued by Allstate to lapse. 31. in purchasing the policy, Mrs. Baker agreed to make bi-weekly payments for the policy premiums as consideration for the protection offered by the policy. 32. As of the execution of the policy, a contract was formed between Mrs. Baker and the Defendant AFLAC; the terms which are set forth in the policy that became effective on or about May 1, 2004. 33. The aforementioned AFLAC Short Term Disability Policy is attached hereto as "EXHIBIT "A". 34. The AFLAC Short Term Disability Policy, Policy Number PB294995, became effective on May 1, 2004 35. Defendant AFLAC began deducting the premiums owed by Mrs. Baker for the policy from her paycheck in bi-weekly installments beginning on May 1, 2004. 36. On or about July 1, 2004, Mrs. Baker was hospitalized because of a new onset of kidney stones. 37. Mrs. Baker was initially hospitalized for three days at Harrisburg Hospital for treatment of the kidney stones. 38. She was again hospitalized at the end of July 2004 and again in August 2004 for additional treatment of the kidney stones. 39. Because of these kidney stones, Mrs. Baker was forced to be absent from her employment from July 1, 2004 to September 21, 2004. 40. Since Mrs. Baker was unable to work because of her condition, she immediately began the process of submitting a claim for benefits under the AFLAC Short Term Disability Policy. 41. Although requested on several occassions, Mrs. Baker did not receive a copy of the disability policy she purchased from Defendant AFLAC until the middle July of 2004. 42. Mrs. Baker obtained "Continuing Disability Claim Forms" from Defendant AFLAC and she completed the forms as instructed. 43. In August, Mrs. Baker became aware that there could be a problem with her claim for benefits because of Defendant AFLAC's initial determination that kidney stones were a pre-existing condition under AFLAC's policy. 44. Mrs. Baker received a correspondence dated August 6, 2004 from the Claims Department ofAFLAC stating her claim had been denied because her "condition/diagnosis" was deemed to be a "pre-existing condition." 45. On or about August 11, 2004, Mrs. Baker immediately attempted to contact Defendant Peacock at his office in Chambersburg, Pennsylvania. 46. Mrs. Baker was told that Defendant Peacock was not in the office; however, a staff member who was familiar with Mrs. Baker's policy and medical history spoke with Mrs. Baker. 47. The staff member explained that she remembered Defendant Peacock selling the policy to Mrs. Baker and he had discussed her medical condition and that Defendant Peacock had said it was ok because every new onset of kidney stones is considered a new diagnosis and therefore not a pre-existing condition 30 days from the effective policy date. 48. The staff member stated that she would contact Defendant AFLAC's headquarters in attempt to assist Mrs. Baker. 49. At no time did Defendant Peacock contact Mrs. Baker in attempt to help with her claim for benefits under the policy that he had convinced her to purchase. 50. On or about August 23, 2004, Mrs. Baker received a correspondence from the Claims Department of Defendant AFLAC again stating that her claim for benefits had been denied. 51. Finally, Mrs. Baker received a correspondence dated September 1, 2004 from the Claims Department of Defendant AFLAC that outlined in detail why Mrs. Baker's claim for short-term disability benefits was denied. 52. Defendant AFLAC came to the determination that since Mrs. Baker had treated for a previous onset of kidney stones prior to the effective date of the policy, the policy would not cover any claims made for any new diagnoses of kidney stones within twelve months because it would be considered a pre-existing condition. 53. To date, Mrs. Baker has not received any benefits under the AFLAC Short Term Disability Policy for the claims she has submitted. 54. Furthermore, in all probability, Mrs. Baker will suffer a new onset of kidney stones within the next year. Under Defendant AFLAC's current interpretation of the policy, Mrs. Baker will not be able to receive benefits under the policy until May of 2005. 55. Because of Defendant Peacock's intentional and/or reckless misrepresentation regarding the benefits and restrictions in the AFLAC policy, Mrs. Baker suffered to her detriment and was unable to receive benefits under the policy she purchased from the Defendants. 56. Defendant AFLAC failed to prevent its employee and/or servant and/or agent, and/or apparent agent, Defendant Peacock, from making misrepresentations about the AFLAC Short Term Disability Policy that Mrs. Baker justifiably relied on in making her decision to purchase said Policy. 57. Defendant AFLAC permitted and/or instructed its employee and/or servant and/or agent, and/or apparent agent, Defendant Peacock, to make misrepresentations regarding the interpretation and/or definition of clauses contained in the Policy that Mrs. Baker justifiably relied on. 58. Currently, Mrs. Baker has not received any benefits for the claims that she submitted under the policy in question and she is left with substantial damages because of herjustifiable reliance on Defendants' misrepresentations and a claim is made therefore. 59. Specifically, Mrs. Baker was forced live without income from July 1, 2004 to September 21, 2004 because she did not receive the benefits that she was entitled to under the AFLAC Short Term Disability Policy. 60. As a direct and proximate result of Defendants' misrepresentations outlined above, Mrs. Baker allowed an effective insurance policy to lapse and purchased a policy with the Defendants based on the intentional and/or reckless misrepresentation. 61. As a direct and proximate result of the foregoing, the Defendants are in violation of Title 73 P.S. § 201 et seq. (Pennsylvania's Unfair Trade Practices and Consumer Protection Law). COUNT]-FRAUD SHANNON BAKER V. MICHAEL PEACOCK 62. The allegations contained in Paragraphs 51 to 61 of Plaintiffs Complaint are incorporated herein by reference as if fully set forth. 63. Defendant Peacock is liable to the Plaintiff for the injuries and damages herein which were directly and proximately caused by his intentional and/or reckless misrepresentations with respect to Shannon Baker by: a) knowingly, and/or intentionally and/or recklessly misrepresenting that kidney stones are not a "pre-existing condition" under the AFLAC Short Term Disability Policy attached hereto; b) failing to contact and/or confirm with Defendant AFLAC that kidney stones are not a "pre-existing condition" under the AFLAC Short Term Disability Policy attached hereto; C) knowingly, and/or intentionally and/or recklessly misrepresenting material facts in an attempt to fraudulently induce Mrs. Baker to justifiably rely on the representations and purchase the AFLAC Short Term Disability Policy attached hereto in an attempt to increase profits; 10 d) knowingly and/or intentionally and/or recklessly providing Plaintiff with inaccurate information regarding the coverage provided in the AFLAC Short Term Disability Policy; e) knowingly, and/or intentionally and/or recklessly allowing Plaintiff to rely on the misrepresentation and taking no action to correct the misrepresentation; and 0 knowingly, and/or intentionally and/or recklessly providing Plaintiff with false and/or inaccurate information regarding Defendant AFIAC's interpretation of Plaintiffs medical condition being classified as a "pre-existing condition"; 64. The aforesaid intentional and/or reckless misrepresentation was made by the Defendants in an attempt to procure monetary gain. 65. As the intended result of the aforesaid fraud, Plaintiff justifiably relied upon the said misrepresentation, to her detriment. 66. In any event, such reliance was reasonably foreseeable given the nature of the disability policy in question and the medical condition that Plaintiff revealed to the Defendants. 67. Defendants acted willfully, knowingly, intentionally, and/or with reckless indifference when they committed these acts of fraud. 68. As a direct and proximate result of the said fraud, Plaintiff has sustained damages. 69. By virtue of the aforesaid fraud, Plaintiff is entitled to compensatory and punitive damages from Defendants. It WHEREFORE, Plaintiff demands judgment from Defendants in excess of $25,000.00 together with interest, costs and any relief that the court deems appropriate on each count. COUNT 11-FRAUD SHANNON BAKER V. AFIAC INSURANCE 70. The allegations contained in Paragraphs 55 to 61 of Plaintiffs Complaint are incorporated herein by reference as if fully set forth. 71. At all times hereto, Defendant Peacock was the agent, apparent agent, servant and/or employee of Defendant AFLAC and was acting within the course and scope of his employment when providing professional services to the Plaintiff. 72. Defendant AFLAC acting through its agents, apparent agents, servants, and/or employees is liable to the Plaintiffs for the injuries and damages alleged herein, which were directly and proximately caused by its willful, knowing, intentional, and reckless indifference to Plaintiff by: a) knowingly, and/or intentionally and/or recklessly misrepresenting that kidney stones are not a "pre-existing condition" under the AFLAC Short Term Disability Policy attached hereto; b) failing to contact and/or confirm and/or communicate with Defendant Peacock that kidney stones are or not a "pre-existing condition" under the AFLAC Short Term Disability Policy attached hereto; 12 C) knowingly, and/or intentionally and/or recklessly misrepresenting material facts in an attempt to fraudulently induce Mrs. Baker to justifiably rely on the representations and purchase the AFLAC Short Term Disability Policy attached hereto in an attempt to increase profits; d) knowingly and/or intentionally and/or recklessly providing Plaintiff with inaccurate information regarding the coverage provided in the AFLAC Short Term Disability Policy; e) knowingly, and/or intentionally and/or recklessly allowing Plaintiff to rely on the misrepresentation and taking no action to correct the misrepresentation; and f) knowingly, and/or intentionally and/or recklessly providing Plaintiff with false and/or inaccurate information regarding Defendant AFLAC's interpretation of Plaintiffs medical condition being classified as a "pre-existing condition" 73. The aforesaid intentional and/or reckless misrepresentation was made by the Defendants in an attempt to procure monetary gain. 74. As the intended result of the aforesaid fraud, Plaintiff justifiably relied upon the said misrepresentation, to her detriment. 75. In any event, such reliance was reasonably foreseeable given the nature of the disability policy in question and the medical condition that Plaintiff revealed to the Defendants 76. Defendants acted willfully, knowingly, intentionally, and/or with reckless indifference when they committed these acts of fraud. 13 77. As a direct and proximate result of the said fraud, Plaintiff has sustained damages. 78. By virtue of the aforesaid fraud, Plaintiff is entitled to compensatory and punitive damages from Defendants. WHEREFORE, Plaintiff demands judgment from Defendants in excess of $25,000.00 together with interest, costs and any relief that the court deems appropriate on each count. COUNT 111- VIOLATIONS OF PENNSYLVANIA CONSUMER PROTECTION LAW ("UTPCPL" ), 73 Pa.C.S. & 201-1 et sect. SHANNON BAKER V. MICHAEL PEACOCK 79. The allegations contained in Paragraphs 55 to 61 of Plaintiffs Complaint are incorporated herein by reference as if fully set forth. 80. Plaintiff and Defendants are "Person[s(" pursuant to 73 Pa.C.S. § 201-2. 81. The UTPCPL proscribes, inter alia, engaging in any "unfair or deceptive acts or practices" either at, prior to, or subsequent to a consumer transaction. 82. The actions of the Defendant, as outlined above, constitute unfair or deceptive acts and practices under the UTPCPL, by way of the following, inter alia: a) engaging in fraudulent or deceptive conduct which created a likelihood of confusion or of misunderstanding, 73 P.S. § 201-2(xxi); 14 b) causing a likelihood of confusion and/or misunderstanding as to the source, sponsorship, approval or certification of goods and services, 73 P.S. § 201-2(ii); C) representing that goods or services were of a particular standard, quality, or grade, or that goods are of a particular style or model, if they are of another, 73 P.S. § 201-2(vii); d) advertising goods or services with intent not to sell them as advertised, 73 P.S. § 201-2(ix); e) deceiving Plaintiff of her rights and/or benefits under the short-term disability policy; and 0 misrepresenting the characteristics and/or benefits of the short-term disability policy. 83. As a direct and proximate result of the said actions, Plaintiff has suffered financial and other harm. 84. By virtue of the violations of law as aforesaid, and pursuant to the UTPCPL, Plaintiff is entitled to an award of actual damages, treble damages, attorneys' fees and costs of suit. WHEREFORE, Plaintiff prays this Honorable Court enter judgment in her favor, and against Defendant, and Order the following relief: An Order declaring the Defendant violated the UTPCPL; ii) Actual damages as permitted by 73 P.S. §201-9.2(a); iii) Treble damages as permitted by 73 P.S. §201-9.2(a); 15 iv) An award of reasonably attorneys' fees and expenses, and costs of suit as permitted by 73 P.S. §201-9.2(a); V) Such additional relief that this Honorable Court deems just and proper under the circumstances. COUNT IV- VIOLATIONS OF PENNSYLVANIA CONSUMER PROTECTION LAW ("UTPCPL" ), 73 Pa.C.S. & 201-1 et seq. SHANNON BAKER V. AFLAC INSURANCE 85. The allegations contained in Paragraphs 55 to 61 of Plaintiffs Complaint are incorporated herein by reference as if fully set forth. 86. Plaintiff and Defendants are "Person[s]" pursuant to 73 Pa.C.S. § 201-2. 87. The UTPCPL proscribes, inter alia, engaging in any "unfair or deceptive acts or practices" either at, prior to, or subsequent to a consumer transaction. 88. The actions of the Defendant, as outlined above, constitute unfair or deceptive acts and practices under the UTPCPL, byway of the following, inter alia: a) engaging in fraudulent or deceptive conduct which created a likelihood of confusion or of misunderstanding, 73 P.S. § 201-2(xxi); b) causing a likelihood of confusion and/or misunderstanding as to the source, sponsorship, approval or certification of goods and services, 73 P.S. § 201-2(ii); 16 C) representing that goods or services were of a particular standard, quality, or grade, or that goods are of a particular style or model, if they are of another, 73 P.S. § 201-2(vii); d) advertising goods or services with intent not to sell them as advertised, 73 P.S. § 201-2(ix); e) deceiving Plaintiff of her rights and/or benefits under the short-term disability policy; and 0 misrepresenting the characteristics and/or benefits of the short-term disability policy. 89. As a direct and proximate result of the said actions, Plaintiff has suffered financial and other harm. 90. By virtue of the violations of law as aforesaid, and pursuant to the UTPCPL, Plaintiff is entitled to an award of actual damages, treble damages, attorneys' fees and costs of suit. WHEREFORE, Plaintiff prays this Honorable Court enter judgment in her favor, and against Defendant, and Order the following relief: An Order declaring the Defendant violated the UTPCPL; ii) Actual damages as permitted by 73 P.S. §201-9.2(a); iii) Treble damages as permitted by 73 P.S. §201-9.2(a); iv) An award of reasonably attorneys' fees and expenses, and costs of suit as permitted by 73 P.S. §201-9.2(a); 17 V) Such additional relief that this Honorable Court deems just and proper under the circumstances. Respectfully submitted, By: -L,) O chary . C mpbell, Esquire Supreme Court Identification No. 93177 Attorney for the Plaintiff Dated: 3 Zoo S 18 VERIFICATION I, Shannon Baker, do hereby swear and affirm that the facts and matters set forth in the foregoing document are true and correct to the best of our knowledge, information and belief. I understand that the statements made therein are made subject to the penalties of 18 Pa. C.S. § 4904 relating to unworn falsification to authorities. Dated: o S 1 v ?? ??,? ?? bbl -Y- Shannon Baker IAC. SHORT-TERM DISABILITY POLICY Non-Participating IMPORTANT: This policy pays benefits for Short-Term Disability due to Sickness or Off-the-Job Injury. Read it Carefully. In this policy, you the Insured, as shown in the Policy Schedule, will be referred to as "you," "your" or "yours." American Family Life Assurance Company of Columbus, a stock company, will be referred to as "we," "our," "us" or "AFLAC." N CONSIDERATION m We promise to insure you for the benefits described in this policy. We make this promise in d consideration of the application for this policy and the payment of the premium. YOUR RIGHT TO EXAMINE THIS POLICY If you are not satisfied for any reason, you may return the policy within 30 days after you receive it. Send it to: your associate (duly licensed agent); or to AFLAC Worldwide N Headquarters, 1932 Wynnton Road, Columbus, Georgia 31999. You will receive a full refund of all premiums paid, and your policy will be void from its Effective Date. IMPORTANT NOTICE: Please read your application attached to this policy. This policy is issued on the basis that the information shown on the application is correct and complete to the best of your knowledge and belief. Carefully check the application. Write to us within 30 days of the date you receive this policy if any information shown on it is not correct or complete. No associate (duly licensed agent) may change this policy or waive any of its provisions. W Is THIS POLICY IS GUARANTEED-RENEWABLE TO AGE 70 SUBJECT TO OUR RIGHT TO CHANGE PREMIUMS BY CLASS UPON ANY RENEWAL DATE. We guarantee you the right to renew this policy until the policy anniversary date following your 70th birthday by the payment of premiums at the rate in effect at the beginning of each term. We may change the established premium rate, but only if the rate is changed for all policies of this class. While this policy is in force, no change will be made in your class because of age or physical condition. "Class" means all policies of this form number and premium classification in your state that are then in force. If the established premium rate changes, we will notify you in writing at your last known address at least 30 days before the change becomes effective. PRE-EXISTING CONDITIONS Disability caused by a Pre-existing Condition or re-injuries to a Pre-existing Condition will not be covered unless it begins more than 12 months after the Effective Date of coverage. A Pre-existing Condition is a Sickness or an Injury for which medical advice or treatment was recommended by a Physician or received from a Physician within the 12-month period before the Effective Date of coverage. American Family Life Assurance. Company of Columbus (AFLAC) Worldwide Headquarters: 1932 Wynnton Road, Columbus, Georgia 31999 Call toll-free 1-800-99-AFLAC (1-800-992-3522). ? Form A-57200-PA 1 A57200PA.1 INDEX Insured ....................................................................................................... Policy Schedule Definitions ....................................................................... ............................... Part 1 Limitations And Exclusions ...................................................................................... Part 2 Uniform Provisions ................................................................................................... Part 3 Benefits ..................................................................................................................... Part 4 Policy Schedule INSURED: Shannon C Baker TYPE OF COVERAGE: INDIVIDUAL ONLY POLICY NUMBER: PB294995 MODE OF PAYMENT: Bi-Weekly PREMIUM: $46.29 If deductions from your paycheck are made on a frequency other than the mode COVERAGE: CSDIOD MESSAGES: EFFECTIVE DATE: 05/01/04 CSDIOD SHORT TERM DISABILITY ELIMINATION PERIOD ACCIDENT: 0 DAYS SICKNESS: 7 DAYS BENEFIT PERIOD 24 MONTHS $46.29 MONTHLY BENEFIT PAYABLE: 17 UNITS = $1,700.0 Georgia, as of the policy effective date shown in the Policy Schedule. w Joey M. Loudermilk, Secretary Daniel P. Amos, President A572NDX 2 This policy is a contract between you and AFLAC. READ YOUR POLICY CAREFULLY. a rn N a ro g w 0 0 0 N Part 1 DEFINITIONS A. ADLs (Activities of Daily Living): activities used in measuring levels of personal functioning capacity. Normally, these activities are performed without Direct Personal Assistance, allowing personal independence in everyday living. The ADLs are: (1) Continence: Maintaining control of urination and bowel movements, including your ability to use ostomy supplies or other devices such as catheters; (2) Transferring: Moving between the bed and the chair, or the bed and a wheelchair; (3) Dressing: Putting on and taking off: all necessary items of clothing; and/or medically necessary braces and artificial limbs usually worn; (4) Toileting: Getting to and from the toilet, getting on and off the toilet, and performing associated personal hygiene; (5) Eating: Performing all major tasks of getting food into the body; and (6) Bathing: Getting into or out of the tub or shower and otherwise washing the parts of the body. B. BENEFIT PERIOD: the maximum number of days for which benefits can be paid for any one or Successive Periods of Disability. Each new Benefit Period is subject to a new Elimination Period. See the Policy Schedule for the Benefit Period you selected. For the purposes of this calculation, a month will be defined as 30 days for which benefits are paid. See definition of Successive Periods of Disability. C. DIRECT PERSONAL ASSISTANCE: requiring direct physical assistance from another party to help you perform an ADL, each and every time you perform that activity, due to an inability to perform the entire activity alone with the supports and mechanical aids that are normally available to you. D. EFFECTIVE DATE: the date shown in the Policy Schedule. The Effective Date of this policy is not the date you signed the application for coverage. E. ELIMINATION PERIOD: the number of consecutive days at the beginning of your period of total disability for which no benefits are payable. See the Policy Schedule for the Elimination Period you selected. Each new Benefit Period is subject to a new Elimination Period. F. FULL-TIME JOB: a job at which you work 30 or more hours per week for pay or benefits. Form A-57200-PA 3 A57200PA.1 4 G. IMMEDIATE FAMILY: anyone related to you in the following manner: your spouse; brother or sister (includes stepbrother and stepsister); children (includes stepchildren); parent(s) (includes stepparents); grandchildren; father-in-law or mother-in-law; and spouses, as applicable, of any of these. H. INJURY: accidental bodily injury or injuries for which benefits are provided, sustained by the covered person, which are the direct and independent cause of the loss and occur while coverage is in force. See the Limitations and Exclusions provision and Pre- existing Conditions for Injuries not covered by this policy. 1. ON-THE-JOB INJURY: an Injury which occurs while you are working at any job for pay or benefits. J. OFF-THE-JOB INJURY: an Injury which occurs while you are not working at any job for pay or benefits. K. PHYSICIAN: an individual who is legally qualified as a physician and licensed to practice medicine and who is operating within the scope of that license. The term "Physician" does not include: you or a member of your Immediate Family; or anyone who normally resides in your home or residence. L. SICKNESS- a sickness or disease of a covered person which is medically treated or diagnosed after the Effective Date of coverage and while coverage is in force. Illnesses, diseases or disorders that are medically treated or diagnosed within the 30-day period after the Effective Date will not be covered for 12 months from the Effective Date of coverage. See the Limitations and Exclusions provision and Pre-existing Conditions for Sicknesses not covered by this policy. M. SUCCESSIVE PERIODS OF DISABILITY: separate periods of disability, if due to the same or related condition and not separated by 180 days or more, will be considered a continuation of the prior disability. Separate periods of disability due to unrelated causes will be considered a continuation of the prior disability unless they are separated by your returning to work at a Full-Time Job for at least 1 (one) full day, during which you are performing the material and substantial duties of this job and are no longer qualified to receive disability benefits. N. TOTALLY DISABLED: your continuing inability to perform the material and substantial duties of your Full-Time Job. You also must be under the care and attendance of a Physician for your condition. Part 2 LIMITATIONS AND EXCLUSIONS We will not pay benefits for a disability that is caused by or occurs as a result of you: A. Giving birth within the first 10 months of the Effective Date of this policy as a result of a normal pregnancy (including caesarean). Complications of pregnancy will be covered to the same extent as a Sickness; B. Being intoxicated or under the influence of any narcotic unless administered on the advice of a Physician; C. Mountaineering using ropes and/or other equipment, parachuting or hang gliding; Form A-57200-PA 4 A57200PA.1 N m a m LL v 0 N 0 s s s s D. Committing or attempting to commit a felony or engaged in any illegal occupation; or being incarcerated in any type penal institution; E. Attempting suicide or intentionally self-inflicting bodily Injuries; F. Having cosmetic surgery or other elective procedures except as necessitated by a covered Sickness or Injury; or dental treatment except as a result of Injury; G. Loss sustained or expenses incurred while a member of the armed forces of any nation, or losses sustained or expenses incurred as a result of enemy action or act of war, whether declared or undeclared; H. Participating in any form of flight aviation other than as a fare-paying passenger in a fully licensed passenger-carrying aircraft; Participating in any legally scheduled speed contest; J. Being Totally Disabled while outside the territorial limits of the United States or, if outside the United States, the territorial limits of the place where your policy was issued; or K. Being Totally Disabled due to any of the following: bipolar affective disorder (manic depressive syndrome), delusional (paranoid) disorders, psychotic disorders, somatoform disorders (psychosomatic illness), eating disorders, schizophrenia, anxiety disorders or mental illness without demonstrable organic disease. This policy will pay, however, for covered disabilities resulting from Alzheimer's disease, or similar forms of senility or senile dementia (without a requirement of demonstrable organic disease), which made itself known while coverage is in force. Benefits will only be paid for one disability at a time even if the disability is caused by more than one Sickness, more than one Injury, or Sickness and Injury. Part 3 UNIFORM PROVISIONS A. ENTIRE CONTRACT; CHANGES: This policy together with the application, endorsements and additional benefits, if any, constitutes the entire contract of insurance. Any change in this policy shall not be valid until approved in writing by the secretary and president of AFLAC at our worldwide headquarters. Any such change must be noted on or attached hereto. No associate (duly licensed agent) has the authority to change this policy or to waive any of its provisions. B. TIME LIMIT ON CERTAIN DEFENSES: (1) After two years from the Effective Date of this policy, any misstatements, except fraudulent misstatements, made by you in the application shall not be used to void the policy or to deny a claim for disability commencing after the expiration of such two-year period. (2) Any claim for loss commencing after 12 months from the Effective Date of coverage shall not be reduced on the grounds that a physical condition, not excluded from coverage by name or specific description, had existed prior to the Effective Date of coverage. Coverage for Pre-Existing Conditions will not be reduced or denied after the policy has been in force 12 months. Form A-57200-PA 5 A57200PA.1 C. TERM: The term of this policy begins at 12:00 o'clock midnight, standard time, at the place where you reside on the Effective Date shown in the Policy Schedule. It ends at 12:00 o'clock midnight, at the same standard time, on the first renewal date. Each renewal term ends at 12:00 o'clock midnight, at the same standard time, on the next following renewal date. Renewal dates are determined by the mode of payment. The mode of payment for the original term of this policy is shown in the Policy Schedule. An annual premium will maintain this policy in force for 12 months, semiannual for six months, quarterly for three months and monthly for one month. If you fail to pay your premium by the end of the grace period, coverage under this policy will terminate. If you are receiving short-term disability benefits on the date coverage would otherwise terminate, coverage under this policy will be extended to the earlier of the date you are no longer Totally Disabled or to the end of the Benefit Period, whichever occurs first. D. MISSTATEMENT OF AGE: If your age has been misstated on the application, the benefits will be those the premium paid would have purchased at the correct age. We will refund all unearned premiums paid, less any benefits paid, if your misstated age at the time of application was outside the age limits for this policy. E. REINSTATEMENT: You may request reinstatement of your policy from your associate (duly licensed agent) or AFLAC. If your policy has lapsed for nonpayment of premium and we accept a later payment without requiring an application, your policy shall be reinstated. If we require a written application and provide you with a conditional receipt, your policy will be reinstated upon our approval of the application. If we do not notify you of our disapproval in writing within 45 days of the date of your application, your policy shall be deemed reinstated. The reinstated policy shall cover only loss resulting from accidental Injury that is medically treated or diagnosed and that takes place after the date of reinstatement and loss resulting from Sickness that is medically treated or diagnosed and that begins more than 10 days after the date of reinstatement. In all other respects, you and AFLAC shall have the same rights as provided under the policy immediately before the due date of the defaulted premium subject to any provisions added in connection with the reinstatement. Any premium accepted in connection with a reinstatement will not be applied to any period prior to the date of reinstatement. F. GRACE PERIOD: A grace period of 31 days will be granted for the payment of each premium falling due after the first premium. During the grace period, the policy shall continue in force. G. MISSTATEMENT OF OCCUPATION OR INCOME: If your occupation has been misstated, the benefits will be those that the premiums paid would have purchased for your correct occupation. If your income has been misstated, the benefit payable will be that which would have been allowed for your true income level and any overpayment of premium will be refunded. H. NOTICE OF CLAIM: Written notice of claim must be given within 60 days after a covered loss starts or as soon as reasonably possible. The notice can be given to us at AFLAC or to your associate (duly licensed agent). Notice should include your name and policy number. 1. CLAIM FORMS: When we receive a notice of claim, we will send you forms for filing proof of loss. If the forms are not given to you within 10 working days, you will meet the proof-of-loss requirements by giving us a written statement of the nature and extent of the loss within the time limit stated in the Proof of Loss provision. Form A-57200-PA 6 A57200PA.1 in m m N Ql a W U 0 0 0 N WE: J. PROOF OF LOSS: Written proof of loss must be furnished to AFLAC at our worldwide headquarters within 90 days after the date of such loss. Failure to furnish such proof within the time required shall not invalidate nor reduce any claim if it was not reasonably possible to give proof within such time. However, such proof must be furnished as soon as reasonably possible and in no event (except in the absence of legal capacity), later than one year from the time proof is otherwise required. K. TIME OF PAYMENT OF CLAIMS: All benefits payable under this policy will be paid immediately upon receipt of written proof of loss. L. PAYMENT OF CLAIMS: All benefits will be payable to you unless you assign them. Any accrued benefits unpaid at your death will be paid to your estate. M. LEGAL ACTIONS: Any legal action may not be brought to recover on this policy within 60 days after written proof of loss has been furnished in accordance with the requirements of this policy. Any such actions shall not be brought after six years from the time written proof of loss is required to be furnished. N. CONFORMITY WITH STATE STATUTES: Any provision of this policy that, on its Effective Date, is in conflict with the statutes of the state in which the insured resides on such date is hereby amended to conform to the minimum requirements of such statutes. 0. PHYSICAL EXAMINATIONS: At our expense, we shall have the right and opportunity to have you examined by a Physician or other appropriate duly licensed medical professional of our choice as often as it may be reasonably required during the pendency of a claim. P. ASSIGNMENT: We will not assume responsibility for determining the validity of an assignment of your benefits to a provider of services. No such assignment of benefits will be recognized until we have received notice of it at our worldwide headquarters. 0. OTHER INSURANCE WITH AFLAC: If you are covered under more than one AFLAC policy with disability benefits, only one AFLAC disability policy or rider chosen by you, your beneficiary or your estate, as the case may be, may remain in force. We will pay benefits for claims that may have been incurred since their respective Effective Dates. We will also return all premiums paid for the canceled policy or rider from the date of duplication, less any benefits paid under these policies or riders from such date. R. ILLEGAL OCCUPATION: AFLAC shall not be liable for any loss to which a contributory cause was the insured's commission or attempt to commit a felony, or to which a contributing cause was the insured being engaged in an illegal occupation. S. INTOXICANTS AND NARCOTICS: AFLAC shall not be liable for any loss sustained or contracted in consequence of the insured being intoxicated or under the influence of any narcotic, unless administered on the advice of a Physician. Part 4 BENEFITS We will pay the following benefits as applicable if your disability is caused by a covered Sickness or covered Off-the-Job Injury. Disability Benefit for Sickness and Off-the-Job Injury: Form A-57200-PA 7 A57200PA.1 A. Working Full-Time: While you are working at a Full-Time Job and while coverage is in force, we will insure you as follows: If your covered Sickness or covered Off-The-Job Injury causes you to become Totally Disabled within 90 days of your covered Sickness or covered Off-the-Job Injury, we will pay you one-thirtieth of the benefit shown in the Policy Schedule for each day you remain Totally Disabled. This benefit is payable up to the Benefit Period you selected and is subject to the Elimination Period, as shown in the Policy Schedule. Also see the Uniform Provision titled Term and the definitions of Benefit Period and Successive Periods of Disability. B. Not Working Full-Time: If you are not working at a Full-Time Job and while coverage is in force, we will insure you as follows: If you are unable to perform two or more ADLs (Activities of Daily Living) within 90 days due to a covered Sickness or covered Off-the-Job Injury, as certified by a Physician, and you require Direct Personal Assistance to perform such ADLs, we will pay you one-thirtieth of the benefit shown in the Policy Schedule for each day you can not perform such ADLs. This benefit is payable up to the Benefit Period you selected and is subject to the Elimination Period, as shown in the Policy Schedule. Also see the Uniform Provision titled Term and the definitions of Benefit Period and Successive Periods of Disability. Benefits will only be paid for one disability at a time even if the disability is caused by more than one Sickness, more than one Injury, or Sickness and Injury. We reserve the reasonable right to meet with you during the pendency of a claim or use an independent consultant and Physician's statement to determine whether you are Totally Disabled, or are unable to perform two or more ADLs and require Direct Personal Assistance. You must be under the care and attendance of a Physician for these benefits to be payable. Benefits will cease on the date of your death. IF YOU HAVE ANY OTHER DISABILITY POLICIES OR RIDERS IN FORCE WITH US, ONLY ONE DISABILITY BENEFIT WILL BE PAYABLE UNDER THIS POLICY. IMPORTANT: This policy pays benefits for Short-Term Disability due to Sickness or Off-the-Job Injury. Read it carefully. Form A-57200-PA 8 A57200PA.1 f , Application for Short-Term Disability Insurance (Form A-57200-PA) P11- 0 Application to American Family Life Assurance Company of Columbus (AFLAC) Worldwide Headquarters: Columbus, Georgia 31999 0t New ? Conversion Policy Number: PB294995 Please Print in Black Ink - To Be Completed by Applicant N W d N m a m cn U 0 M N N N Applicant's Name -BAKER SHANNON C DOB 10102/1972_ Sex _F Last First Mf Month/Oey/Vear Applicant's SS# _186-52-2401 Address _109 BLACKSMITH RD_ Street IN Post Office l3oz CAMP State PA ZIP 1701 Apt# Home Telephone (717)730-9411 Business Telephone ((800)284-2006 Best Time to Call 01 Name of Employer_LINCARE HOLDINGS Job Duties CENTER MANAGER/ SALES Occupation Code Occupation Class C (Completed by worldwide headquarters) (Completed by associate/agent) Type of Business-DURABLE MEDICAL EQUIPMENT Job Title CENTER MANAGER Industry Code C (Completed by associate/agent) TO BE COMPLETED BY AFLAC ASSOCIATE/AGENT PAYROLL MODES: Employee No. 186522401 ? 01 Weekly Pre-Tax ? Dept. No. IX 01 Biweekly ? 03 Quarterly After-Tax 0( Billable Premium $ 92.58 ? 01 Semimonthly ? 06 Semiannual Premium Collected $ _PR ? 01 Monthly ? 12 Annual Associate/Agent's No. AC159 Sit. Code 0 CHECK COVERAGE DESIRED: Class: ? A ? B N C Accident/Sickness 1 ? 0/30 Days` ? 30/30 Days' (• not available with 3-month Benefit Period) ? 60160 Days" ? 90/90 Days" ("not available with 3- or 6-month Benefit Period) Total # of Units: Premium: 0( Base Policy Form A-57200-PA): 17 92.58 D On-the-Job In'u Rider Form A-57250-PA): NOTE: Each unit is equal to $100 monthly. Total Premium: 92.58 TO BE COMPLETED BY APPLICANT 1. Do you have any of AFLAC's accident policies with disability benefits? It yes, please compiete the ? Yes 70 No Supplemental Notif ication section at the end of this application and be aware that you cannot have this policy without canceling those disability benefits with AFLAC. 1 Is the purchase of this coverage intended to replace any other disability insurance now in force? ? Yes 0t: No If yes, please read and sign the Replacement Notice provided by your associatelagent and provide ? Not policy number here: applicable 3. Do you have any other individual disability coverage in force with another company? ? Yes IX No If yes, please provide name of company, benefit amount and elimination period here: Form A-57205-PA 1 A57205PA.2 PLEASE COMPLETE QUESTION 4 IF APPLYING FOR MORE THAN $700 OF ANY ONE MONTHLY DISABILITY BENEFIT: _ 4. List vour annual income, without overtime (unless contractual), for your full-time job for the current year. Annual Income: $44000.00 1 understand that this information will be verified at the time of claim. 5. Do you work fewer than [30) hours per week in your primary (full-time) occupation with the employer ? Yes X No listed on the first page of the application? 6. Have you been charged with driving under the influence of alcohol or any narcotic within the last 12 ? Yes IX No months or been charged two or more times within the last five years? 7. Are you currently on leave or not working due to sickness, maternity or injury? ? Yes qQ No 8. Are there any material or substantial duties of your job that you are unable to perform due to ? Yes IXi No sickness, maternity or injury? 9. Is your current annual income less than [$12,000], without overtime (unless contractual), for your ? Yes X No primary occupation? 10. Has a member of the medical profession ever medically diagnosed you with or ever medically ? Yes XI No treated you for any of the following: • stroke or TIA • systemic lupus • heart valve replacement • chronic fatigue syndrome • vascular insufficiency (circulatory problems) • rheumatoid arthritis • insulin-dependent diabetes multiple sclerosis • emphysema Crohn's disease • chronic liver disease regional enteritislileitis • chronic hepatitis (other than Type A) diverticulosis • fibromyalgia ulcerative colitis 11. Have you ever been medically diagnosed with acquired immune deficiency syndrome (AIDS) by a O Yes IX No member of the medical profession or have you tested positive for HIV (human immunodeficiency virus)? 12. In the past five years, has a member of the medical profession medically diagnosed you with or O Yes XI No medically treated you for cancer (other than non-melanoma skin cancers)? 13. In the past 24 months, has surgery been performed for any of the following or has a member of the a Yes IX No medical profession medically diagnosed you with or medically treated you for any of the following; • heart attack • coronary bypass surgery • drug or alcohol abuse • congestive heart failure sciatica • kidney disease • angina • carpal tunnel syndrome (not including kidney stones) • coronary angioplasty (unless surgically corrected) 14. Within the last sic weeks, have you taken prescribed pain medication for injury, disease or disorder ? Yes XI No of the back, neck or joint(s)? It you answered "yes" to Question 5, additional underwriting may be required. If you answered "yes" to any one of Questions 6 through 14, a policy will not be issued; therefore, do not submit this application. 15. Have you received disability benefits or claimed workers' compensation in the last five years? 16. In the past 12 months, have you missed five consecutive days or 10 total days of work due to your sickness or injury (not related to pregnancy)? 17. In the past 12 months, have you been confined in a hospital as an inpatient (not including confinement due to, pregnancy)? 18. In the past 12 months, has a member of the medical profession medically diagnosed you with or medically treated you for any of the following: • chronic bronchitis • back, neck or joint injury or disorder • asthma • hypertension ? Yes A No ? Yes A No ? Yes X No ? Yes IX No you answered "yes" to anyone of Questions 15 through 18, you must complete Item 22 and provide details in Rem 23. Form A-57205-PA A57205PA.2 N m m a m N u_ U 0 0 0 cn N m 19, During the past 12 months, have you had any surgical procedure or have you been advised by a physician to have tests, treatment or surgery that has not yet been done? 20. During the past 24 months, for other than routine checkups, have you been medically treated for any other illness/injury or have you had any medical/surgical treatment other than those listed above? 21. Do you have any group disability income coverage in force? It yes, please list your monthly benefit amount(s)/percentage(s): and your elimination period: If you answered "yes" to any one of Questions 19 through 21, additional underwriting may be required. If you answered "yes" to any one of Questions 19 or 20 you must complete Item 22 and provide details in Item 23. 22, Within the last six weeks, have you been prescribed any medication by a physician or D Yes D No taken any prescription medication (not including prescription contraceptives)? If yes, please provide complete information below. name Your Physician's Name: Phone Number: If no regular physician, physician last seen Address Date last seen by physician: Reason for last visit: 23. (Details to Questions 15 - 20) ?YesONo D Yes D No D Yes D No Onset Surgery Performed? Name and Address of Physician Conditions mo r es no date and Hospital Question is Question 16 Question 17 Question 18 Question 19 Question 20 Form A-57205-PA 3 A57205PA.2 . • » APPLICANT'S STATEMENTS AND AGREEMENTS I understand that the Effective Date of the policy will be the date recorded in the Policy Schedule by AFLAC Worldwide Headquarters. I acknowledge receipt of, if applicable: ? Replacement Notice ? Guide to Health Insurance for People With Medicare IX Outline of Coverage ? Fair Credit Reporting Notice I understand that: (1) the policy of insurance I am now applying for will be issued based upon the written answers to the questions and information asked for in this application and any other pertinent information AFLAC may require for proper underwriting; (2) AFLAC is not bound by any statement made by me, or any associate/agent of AFLAC, unless written herein; (3) the associate)agent cannot change the provisions of the policy or waive any of its provisions either orally or in writing; (4) the policy together with this application and endorsements or riders, if any, is the entire contract of insurance; and (5) no change to the policy will be valid until approved by AFLAC's secretary and president and noted in or attached to the policy. 1 understand that coverage is not provided for a sickness or an injury for which medical advice or treatment was medically recommended by a Physician or received from a Physician within the 12-month period before the COMPLETE IF YOU ARE REPLACING/TERMINATING EXISTING AFLAC DISABILITY COVERAGE. 1, , am applying for AFLAC's short-term disability policy. I currently have disability benefits under AFLAC accident/disability policy number , t understand that I must cancel existing AFLAC disability coverage in order to purchase this short-term disability policy. cancel: ? The disability riders attached to my accident policy; but keep my accident policy in force. ? Cancel my entire accident policy (with Disability Benefits) number . I understand that I will be terminating benefits provided for in my current accident policy that are not provided for ih the new short-term Form A-57205-PA A57205PA.2 •I m a N m a m LL U 0 0 m N AUTHORIZATION TO OBTAIN INFORMATION I authorize the following to give information (defined below) to American Family Life Assurance Company of Columbus (AFLAC) or any person or group acting on their part: any medical professional, any medical care institution, insurer, reinsurer, government agency, consumer reporting agency or employer. Information means facts of a medical nature in regard to my physical or mental condition, employment, other insurance coverage, or any other nonmedical facts. I understand that this information will be used by AFLAC to determine eligibility for insurance and may be used to evaluate a claim for benefits during the time it is valid. I agree that this authorization is valid for 21/2 years from the date signed. 1 know that I have a right to receive a copy of this authorization upon request. I agree that a copy of this authorization is as valid as the original. understand that the premium amount listed on this application represents the premium amount that my employer will remit to AFLAC on my behalf; and 1 further understand that this amount, because of my employer's billing/payroll practices, may differ from the amount being deducted from my paycheck or the premium amount quoted to me by my associate/agent. Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent act, which is a crime and subjects such person to criminal and civil penalties. 1 have read, or had read to me, the completed application and realize that policy issuance is based upon statements and answers provided herein and any other pertinent information AFLAC may require for proper underwriting. The answers are complete and true to the best of my knowledge and belief. and Dated at CAMP City and State Signature r? s- s- a= 1= E- Beneficiary (your estate unless otherwise indicated) _TYSON L on _03/1812004 Date I certify that: I personally saw the applicant when the application was written, and each question was asked of the applicant and answered as recorded. All answers above are correct to the best of my knowledge. Associate/Agent's Signature ;.e Licensed Associate/Agent Form A-57205-PA MAKE CHECK OR MONEY ORDER PAYABLE TO AFLAC. FOR INFORMATION, CALL TOLL-FREE 1-800-99-AFLAC (1-800-992-3522). 0311812004 Date A57205PA.2 American Family Life Assurance Company of Columbus (AFLAC) Worldwide Headquarters: Columbus, Georgia 31999 STATEMENT OF UNDERSTANDING AND AGREEMENT I, the undersigned, understand and agree that the: (check all that apply) BAKER SHANNON C ? Cancer ? Hospital Intensive Care ? Hospital Indemnity ? Accident D0 Short Tenn Disability ? Life ? Specified Health Event ? Dental ? Payroll Long-Term Care ? Hospital Confinement Sickness Indemnity policy (policies) that I am applying for will not be effective until 0510112004 , K issued. No benefits will be due me or any family members, ff applicable, and AFLAC will not be liable for any claims for loss incurred prior to the effective date of the policy (policies) listed above. tE?0311812004 Signature of Applicant Date Form A-13072 A13072.14 L in }? V Fh U'! w ?h s? ?t? R. J. MARZELLA & ASSOCIATES, P.C. BY: Zachary D. Campbell, Esquire Pennsylvania Supreme Court I.D. No. 93177 3513 North Front Street Harrisburg, PA 17110 Telephone: (717) 234-7828 Attorneys for Facsimile: (717) 234-6883 Shannon Baker IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION- LAW SHANNON BAKER, 60 Fairway Drive Etters, Pennsylvania, 17201 Plaintiff Docket No. 05-3028 Civil Term Civil Action V. AFLAC INSURANCE 10306 Regency Parkway Drive Omaha, Nebraska, 68114 MICHAEL PEACOCK 3027 Crottlestown Road Chambersburg, Pennsylvania, 17201 Defendants JURY TRIAL DEMANDED PRAECIPE TO REINSTATE COMPLAINT TO THE PROTHONOTARY, CUMBERLAND COUNTY: Please reinstate the Complaint in the above-captioned action and direct the Sheriff of Cumberland County to deputize and direct the Franklin County Sheriff to make service upon the Defendant listed below. MICHAEL PEACOCK 3027 Crottlestown Road Chambersburg, Pennsylvania, 17201 R. J. MARZELLA & ASSOCIATES, P.C. Respectfully submitted, By: Z ary D. mpbel , Esquire Supreme Court Identification No. 93177 Attorney for the Plaintiff Dated: -)////05 . ^ r-- c -'? ' til 4 . T r. mom- r c;r N _ z McNEES WALLACE & NURICK LLC Kandice Giurintano I.D. No. 86345 Davin J. Chwastyk I.D. No. 91852 100 Pine Street, P.O. Box 1166 Harrisburg, PA 17108-1166 Telephone: (717) 232-8000 Fax: (717) 237-5300 Attorneys for Defendant AFLAC Insurance SHANNON BAKER, 60 Fairway Drive Etters, PA 17201, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA Docket No. 05-3028 Civil Term V. AFLAC INSURANCE 10306 Regency parkway Drive Omaha, NE 58114 MICHAEL PEACOCK 166 Main Street Chambersburg, PA 17201, Civil Action Defendants JURY TRIAL DEMANDED NOTICE TO PLEAD TO: Shannon Baker, Plaintiff, and her attorney Zachary D. Campbell, Esquire 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. I.D. No. 86345 Devin J. Chwastyk I.D. No. 91852 100 Pine Street P.O. Box 1166 Harrisburg, PA 17108-1166 (717)232-8000 Attorneys for Defendant Dated: 71%410S AFLAC Insurance McNEES WALLACE & NURICK LLC Kandice Giurintano I.D. No. 86345 Devin J. Chwastyk I.D. No. 91852 100 Pine Street, P.O. Box 1166 Harrisburg, PA 17108-1166 Telephone: (717) 232-8000 Fax? (717) 237-5300 Attorneys for Defendant AFLAC Insurance SHANNON BAKER, 60 Fairway Drive Etters, PA 17201, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA Docket No. 05-3028 Civil Term V. AFLAC INSURANCE 10306 Regency parkway Drive Omaha, NE 58114 MICHAEL PEACOCK 166 Main Street Chambersburg, PA 17201, Defendants Civil Action JURY TRIAL DEMANDED ANSWER WITH NEW MATTER OF DEFENDANT AFLAC INSURANCE Defendant AFLAC Insurance ("AFLAC"), by and through its counsel McNees Wallace & Nurick LLC, files the following Answer with New Matter to Plaintiff Shannon Baker's ("Baker") Complaint: Parties 1. Denied. After reasonable investigation, AFL-AC is without knowledge or information sufficient to form a belief as to the truth of paragraph 1, and the same is therefore denied. 2. Admitted. By way of further answer, AFLAC is misnamed in the caption of this action. There is no such entity as "AFLAC Insurance." Further, while the Nebraska address listed in the Complaint is the address of AFLAC's registered agent in Nebraska, AFLAC's corporate address is 1932 Wynnton Road, Columbus, GA 31999. 3. Admitted. 4. Denied. After reasonable investigation, AFLAC is without knowledge or information sufficient to form a belief as to the truth of paragraph 4, and the same is therefore denied. By way of further answer, AFLAC's records indicate a business address for Defendant Michael Peacock ("Peacock") of 3027 Crottlestown Road, Chambersburg, PA 17201. Peacock is no longer listed as an agent authorized to sell AFLAC insurance. 5. Denied. The averments of Paragraph 5 that "Defendant Peacock, was the agent, apparent agent, servant and/or employee of Defendant AFLAC" and "was acting within the course and scope of his employment when providing professional services to the [sic.] Mrs. Baker' state conclusions of law to which no responsive pleading is required, and the same are therefore denied. By way of further answer, Peacock worked as an independent contractor selling AFLAC insurance. 6. Denied. After reasonable investigation, AFLAC is without knowledge or information sufficient to form a belief as to the truth of paragraph 6, and the same is therefore denied. 7. Admitted upon information and belief. By way of further answer, Baker worked as an agent selling AFLAC insurance from January 1999 through September 1999. 8. Admitted upon information and belief. However, by way of further answer, when Baker completed her application for AFLAC insurance she checked "No" to the 2 question "Is the purchase of this coverage intended to replace any other disability insurance now in force?" See Complaint at Exhibit "A," p. 9. 9. Admitted in part and denied in part. It is admitted that "on or around March 18, 2004, Mrs. Baker met with Defendant Peacock" at Baker's employer's office. It is denied that Peacock was employed by AFLAC. By way of further answer, Peacock worked as an independent contractor selling AFLAC insurance. 10. Admitted. 11. Denied. Upon information and belief, Peacock presented Baker with various offered insurance plans during a February 9, 2004 visit to Baker's place of employment. Baker then contacted Peacock in March 2004 to inform him she was interested in an AFLAC Short-Term Disability Policy (the "Policy"). During the March 18, 2004 meeting, Baker completed the necessary applications for the Policy. 12. Admitted in part and denied in part. It is admitted that "Mrs. Baker was interested in purchasing a disability insurance policy." The averment of paragraph 12 that Defendant Peacock was "an agent, apparent agent, servant and/or employee of Defendant AFLAC" states a conclusion of law to which no responsive pleading is required, and the same is therefore denied. 13. Admitted upon information and belief. 14. Denied. After reasonable investigation, AFLAC is without knowledge or information sufficient to form a belief as to the truth of paragraph 14, and the same is therefore denied. 3 15. Denied. After reasonable investigation, AFLAC is without knowledge or information sufficient to form a belief as to the truth of paragraph 15, and the same is therefore denied. 16. Denied. After reasonable investigation, AFLAC is without knowledge or information sufficient to form a belief as to the truth of paragraph 16, and the same is therefore denied. 17. Denied. After reasonable investigation, AFL.AC is without knowledge or information sufficient to form a belief as to the truth of paragraph 17, and the same is therefore denied. 18. Denied. After reasonable investigation, AFL.AC is without knowledge or information sufficient to form a belief as to the truth of paragraph 18, and the same is therefore denied. 19. Denied. After reasonable investigation, AFL.AC is without knowledge or information sufficient to form a belief as to the truth of paragraph 19, and the same is therefore denied. 20. Denied. After reasonable investigation, AFLAC is without knowledge or information sufficient to form a belief as to the truth of paragraph 20, and the same is therefore denied. 21. Denied. After reasonable investigation, AFLAC is without knowledge or information sufficient to form a belief as to the truth of paragraph 21, and the same is therefore denied. By way of further answer, under the Policy, disability caused by a pre- existing condition is not covered unless it begins more than 12 months after the 4 effective date of coverage. This information is clear from the face of the Policy, and Baker knew or should have known this information before: enrolling in the Policy. 22. Denied. After reasonable investigation, AFLAC is without knowledge or information sufficient to form a belief as to the truth of paragraph 22, and the same is therefore denied. 23. Denied. After reasonable investigation, AFLAC is without knowledge or information sufficient to form a belief as to the truth of paragraph 23, and the same is therefore denied. 24. Denied. After reasonable investigation, AFLAC is without knowledge or information sufficient to form a belief as to the truth of paragraph 24, and the same is therefore denied. By way of further answer, AFLAC provided Baker with documentation regarding the terms of the Policy prior to Baker enrolling in the Policy. That documentation explained that under the Policy, disability caused by a pre-existing condition is not covered unless it begins more than 12 months after the effective date of coverage, and Baker knew or should have known this information before enrolling in the Policy. 25. Denied. After reasonable investigation, AFLAC is without knowledge or information sufficient to form a belief as to the truth of the averment that Defendant Peacock did not confirm or attempt to confirm whether kidney stones would or would not be covered, and the same is therefore denied. It is denied that Peacock was employed by AFLAC. By way of further answer, Peacock worked as an independent contractor selling AFLAC insurance. 5 26. Denied. After reasonable investigation, AFLAC is without knowledge or information sufficient to form a belief as to the truth of paragraph 26, and the same is therefore denied. 27. Denied. After reasonable investigation, AFLAC is without knowledge or information sufficient to form a belief as to the truth of paragraph 27, and the same is therefore denied. 28. Denied. The averment of paragraph 28 that "Mrs. Baker justifiably relied on Defendant Peacock's statements" states a conclusion of law to which no responsive pleading is required, and the same is therefore denied. To the extent a responsive pleading is required, after reasonable investigation, AFLAC is without knowledge or information sufficient to form a belief as to the truth of paragraph 28, and the same is therefore denied. By way of further answer, AFLAC provided Baker with documentation regarding the terms of the Policy prior to Baker enrolling in the Policy. That documentation explained that under the Policy, disability caused by a pre-existing condition is not covered unless it begins more than 12 months after the effective date of coverage, and Baker knew or should have known this information before enrolling in the Policy. 29. Denied. The averment of paragraph 29 that Mrs. Baker justifiably relied on Defendant Peacock's statements states a conclusion of law to which no responsive pleading is required, and the same is therefore denied. To the extent a responsive pleading is required, after reasonable investigation, AFLAC is without knowledge or information sufficient to form a belief as to the truth of paragraph 29, and the same is therefore denied. By way of further answer, AFLAC provided Baker with documentation 6 regarding the terms of the Policy prior to Baker enrolling in the Policy. That documentation explained that under the Policy, disability caused by a pre-existing condition is not covered unless it begins more than 12 months after the effective date of coverage, and Baker knew or should have known this information before enrolling in the Policy. 30. Denied. After reasonable investigation, AFLAC is without knowledge or information sufficient to form a belief as to the truth of paragraph 30, and the same is therefore denied. By way of further answer, AFLAC provided Baker with documentation regarding the terms of the Policy prior to Baker enrolling in the Policy. That documentation explained that under the Policy, disability caused by a pre-existing condition is not covered unless it begins more than 12 months after the effective date of coverage, and Baker knew or should have known this information before enrolling in the Policy. 31. Admitted. 32. Admitted. 33. Admitted. 34. Admitted. 35. Denied. AFLAC did not deduct any premiums from Baker's paycheck. By way of further answer, Baker's employer deducted the amount of her premium from her paychecks and remitted that amount to AFLAC. 36. Admitted upon information and belief. 37. Admitted upon information and belief. 38. Admitted upon information and belief. 7 39. Denied. After reasonable investigation, AFLAC is without knowledge or information sufficient to form a belief as to the truth of paragraph 39, and the same is therefore denied. 40. Admitted in part and denied in part. It is admitted that Baker began the process of submitting a claim for benefits under the AFLAC Short Term Disability Policy. AFLAC lacks knowledge or information sufficient to form a belief as to the characterization that Baker began the process "immediately," and the same is therefore denied. 41. Denied. After reasonable investigation, AFLAC is without knowledge or information sufficient to form a belief as to the truth of paragraph 41, and the same is therefore denied. 42. Denied. Upon information and belief, Baker obtained and completed a "Sickness Claim Form," rather than "Continuing Disability Claim Forms." 43. Admitted. 44. Admitted in part and denied in part. It is admitted that Baker received correspondence from the Claims Department of AFLAC. 'That correspondence is a document that speaks for itself and any characterization of its contents is denied. 45. Admitted upon information and belief. 46. Admitted in part and denied in part. It is admitted that Baker was told that Peacock was not in the office. It is admitted that a staff member spoke with Baker. It is denied that the staff member was familiar with Baker's policy and medical history. By way of further answer, upon information and belief, Baker :spoke with Stacy Plourde, an 8 office administrator, and Heidi DeShong, District Sales Coordinator, neither of whom were familiar with Baker's policy or medical history. 47. Denied. After reasonable investigation, AFLAC is without knowledge or information sufficient to form a belief as to the truth of paragraph 47, and the same is therefore denied. 48. Denied. Upon information and belief, Heidi DeShong told Baker that she would contact AFLAC to find out why the claim had been denied, but did not say that she would attempt to assist Baker. Upon information and belief, Baker told DeShong that AFLAC had requested Baker's medical records, and that there was no need for DeShong to contact AFLAC. 49. Denied. Upon information and belief, Peacock returned a telephone call from Baker on August 20, 2004 to find out if he could assist her. After Baker explained the situation, Peacock informed her that he would investigate the situation. That same day, Peacock received Baker's complaint to the Pennsylvania Department of Insurance, and elected not to contact Baker until he had fulfilled his responsibilities to respond to that complaint. Upon information and belief, on August 24, 2004, Peacock returned a telephone call from Baker to explain that he had not contacted her because she had filed a complaint with the Department of Insurance. Peacock attempted to explain that the limits of the Policy with regard to pre-existing conditions, and told Baker that he had not represented to her that kidney stones were not treated as a pre-existing condition. 50. Admitted in part and denied in part. It is admitted that Baker received correspondence from the Claims Department of AFLAC. That correspondence is a document that speaks for itself and any characterization of its contents is denied. 9 51. Admitted in part and denied in part. It is admitted that Baker received correspondence from the Claims Department of AFLAC. That correspondence is a document that speaks for itself and any characterization of its contents is denied. 52. Admitted. By way of further answer, AFLAC; determined that Baker's claim was based on the same occurrence of kidney stones for which she was being treated prior to the effective date of the Policy. AFLAC does not consider kidney stones to be a pre-existing condition if they are a new onset of stones, unrelated to any occurrence of kidney stones prior to the effective date of the Policy. Upon information and belief, Baker was already undergoing treatment for the same set of kidney stones that formed the basis for her claim when she applied for the Policy. 53. Admitted. 54. Admitted in part and denied in part. After reasonable investigation, AFLAC is without knowledge or information sufficient to form a belief as to the truth of the averment that "in all probability, Mrs. Baker will suffer a new onset of kidney stones within the next year," and the same is therefore denied. Further, it is denied that Baker will not be able to receive benefits under the policy until May of 2005. Baker is entitled to benefits for any covered disability arising during her policy term. If Baker suffered a new onset of kidney stones, unrelated to her pre-existing condition, that disability would be payable according to the terms and conditions of the Policy. 55. Denied. It is denied that Peacock made intentional or reckless misrepresentations regarding the benefits and restrictions of the Policy. It is denied that any misrepresentations were the reason why Baker was unable to receive benefits 10 under the Policy, and it is denied that Baker suffered to her detriment due to any misrepresentations. 56. Denied. It is denied that Peacock made misrepresentations regarding the Policy. It is denied that AFLAC failed to prevent Peacock from making misrepresentations regarding the Policy. The averment that Baker "justifiably relied" on Peacock's misrepresentations states a conclusion of law to which no responsive pleading is required. To the extent that a responsive pleading is required, it is denied that Baker's reliance was justified. AFLAC provided Baker with documentation regarding the terms of the Policy prior to Baker enrolling in the Policy. That documentation explained that under the Policy, disability caused by a pre-existing condition is not covered unless it begins more than 12 months after the effective date of coverage, and Baker knew or should have known this information before enrolling in the Policy. The averment that Peacock was an "employee and/or servant and/or agent and/or apparent agent" of AFLAC states a conclusion of law to which no responsive pleading is required, and the same is therefore denied. By way of further answer, Peacock worked as an independent contractor selling AFLAC insurance. 57. Denied. It is denied that Peacock made misrepresentations regarding the Policy. It is denied that AFLAC permitted and/or instructed Peacock to make misrepresentations regarding the Policy. The averment that Baker "justifiably relied" on Peacock's misrepresentations states a conclusion of law to which no responsive pleading is required. To the extent that a responsive pleading is required, it is denied that Baker's reliance was justified. AFLAC provided Baker with documentation regarding the terms of the Policy prior to Baker enrolling in the Policy. That 11 documentation explained that under the Policy, disability caused by a pre-existing condition is not covered unless it begins more than 12 months after the effective date of coverage, and Baker knew or should have known this information before enrolling in the Policy. The averment that Peacock was an "employee and/or servant and/or agent and/or apparent agent" of AFLAC states a conclusion of law to which no responsive pleading is required, and the same is therefore denied. By way of further answer, Peacock worked as an independent contractor selling AFLAC insurance. 58. Admitted in part and denied in part. It is admitted that Baker has not received any benefits for the claim that she submitted under the policy in question. It is denied that Mrs. Baker is left with substantial damages because of Defendants' misrepresentations, as this averment states a conclusion of law to which no responsive pleading is required. To the extent that a responsive pleading is required, Baker has been denied coverage due to the lawful provisions of the Policy, which she knew or should have known when enrolling in the Policy. It is denied that Baker justifiably relied on Defendants' misrepresentations. AFLAC provided Baker with documentation regarding the terms of the Policy prior to Baker enrolling in the Policy. That documentation explained that under the Policy, disability caused by a pre-existing condition is not covered unless it begins more than 12 months after the effective date of coverage, and Baker knew or should have known this information before enrolling in the Policy. 59. Denied. It is denied that Baker was entitled to any income under the Policy. It is denied that AFLAC's denial of benefits under the Policy to Baker forced Baker to live without income for any period. After reasonable investigation, AFLAC is 12 without knowledge or information sufficient to form a belief as to the averment that Baker lived without income from July 1, 2004 to September 21, 2004, and the same is therefore denied. 60. Denied. It is denied that Defendants' made any misrepresentations. It is denied that Baker took any action based on Defendants' alleged misrepresentations. After reasonable investigation, AFLAC is without knowledge or information sufficient to form a belief as to the averment that Baker allowed an effective insurance policy to lapse, and the same is therefore denied. 61. Denied. Paragraph 61 states a conclusion of law to which no responsive pleading is required. To the extent that a responsive pleading is required, paragraph 61 is denied. COUNTI-FRAUD SHANNON BAKER V. MICHAEL PEACOCK 62. Paragraphs 1 through 61, above, are incorporated herein by reference. 63-69. Paragraphs 63 through 69 are directed to Peacock, and not directed at AFLAC, and therefore no responsive pleading is required. To the extent that a responsive pleading is required, the averments of paragraphs 63 through 69 are denied. WHEREFORE, Defendant AFLAC Insurance demands judgment in its favor and against Plaintiff Shannon Baker, along with costs and such other relief the Court deems appropriate. 13 COUNTI-FRAUD SHANNON BAKER V. AFLAC INSURANCE 70. Paragraphs 1 through 61, above, are incorporated by reference. 71. Denied. Paragraph 71 states a conclusion of law to which no responsive pleading is required, and the same is therefore denied. By way of further answer, Peacock worked as an independent contractor selling AFLAC insurance. 72. Denied. Paragraph 72 states a conclusion of law to which no responsive pleading is required, and the same is therefore denied. B,y way of further answer: a) Denied. AFLAC did not misrepresent that kidney stones are not a pre-existing condition under the Policy. Rather, AFLAC provided Baker with documentation regarding the terms of the Policy prior to Baker enrolling in the Policy. That documentation explained that under the Policy, disability caused by a pre-existing condition is not covered unless it begins more than 12 months after the effective date of coverage, and Baker knew or should have known this information before enrolling in the Policy. b) Denied. AFLAC communicates the terms and conditions of its policies to its insurance agents. By way of further answer, the averments of paragraph 72(b), even if proven, would not state a claim for fraud. c) Denied. AFLAC did not knowingly, intentionally or recklessly misrepresent facts in an attempt to fraudulently induce Baker to justifiably rely on the representations and purchase the Policy. Rather, AFLAC provided Baker with documentation regarding the terms of the Policy prior to Baker enrolling in the Policy. That documentation explained that under the Policy, disability caused 14 by a pre-existing condition is not covered unless it begins more than 12 months after the effective date of coverage, and Baker knew or should have known this information before enrolling in the Policy. d) Denied. AFLAC did not knowingly, intentionally or recklessly provide Baker with inaccurate information regarding the coverage provided under the Policy. Rather, AFLAC provided Baker with documentation regarding the terms of the Policy prior to Baker enrolling in the Policy. That documentation explained that under the Policy, disability caused by a pre-existing condition is not covered unless it begins more than 12 months after the effective date of coverage, and Baker knew or should have known this information before enrolling in the Policy. e) Denied. AFLAC did not knowingly, intentionally or recklessly allow Baker to rely on any misrepresentation and took action to correct Baker's apparent misunderstanding of the Policy promptly upon learning of the misunderstanding. f) Denied. AFLAC did not knowingly, intentionally or recklessly provide Baker with false or inaccurate information regarding AFLAC's interpretation of Baker's medical condition being classified as a pre-existing condition. Rather, AFLAC provided Baker with documentation regarding the terms of the Policy prior to Baker enrolling in the Policy. That documentation explained that under the Policy, disability caused by a pre-existing condition is not covered unless it begins more than 12 months after the effective date of 15 coverage, and Baker knew or should have known this information before enrolling in the Policy. 73. Denied. AFLAC did not make any intentional or reckless misrepresentation, and did not make any misrepresentation in an attempt to procure monetary gain. AFLAC provided insurance services to Baker under a lawful contract, and accurately represented the terms of that contract to Baker at all times. 74. Denied. It is denied that there was any fraud or misrepresentation, or that there was any intended result beyond providing Baker with insurance services in conformance with the Policy. The averment of paragraph 74 that Baker "justifiably relied" on the alleged misrepresentation, "to her detriment," states a conclusion of law to which no responsive pleading is required, and the same is therefore denied. 75. Denied. The averment of paragraph 75 that Baker's reliance was reasonably foreseeable states a conclusion of law to which no responsive pleading is required, and the same is therefore denied. By way of further answer, AFLAC provided Baker with documentation regarding the terms of the Policy prior to Baker enrolling in the Policy. That documentation explained that under the Policy, disability caused by a pre-existing condition is not covered unless it begins more than 12 months after the effective date of coverage, and Baker knew or should have known this information before enrolling in the Policy. 76. Denied. It is denied that AFLAC committed any acts of fraud. 77. Denied. It is denied that AFLAC committed any acts of fraud, and it is denied that Baker sustained any damages as a result of AFLAC's conduct. The averment that Baker sustained damages "As a direct and proximate result of the said 16 fraud" states a conclusion of law to which no responsive pleading is required, and the same is therefore denied. 78. Denied. It is denied that AFLAC committed any acts of fraud, and it is denied that Plaintiff is entitled to any damages. WHEREFORE, Defendant AFLAC Insurance demands judgment in its favor and against Plaintiff Shannon Baker, along with costs and such other relief the Court deems appropriate. SHANNON BAKER V. MICHAEL PEACOCK 79. Paragraphs 1 through 61, above, are incorporated herein by reference. 80-84. Paragraphs 80 through 84 are directed at Peacock and are not directed at AFLAC, and therefore no responsive pleading is required, To the extent that a responsive pleading is required the averments of paragraphs 80 through 84 are denied. WHEREFORE, Defendant AFLAC Insurance demands judgment in its favor and against Plaintiff Shannon Baker, along with costs and such other relief the Court deems appropriate. 17 COUNT III - VIOLATIONS OF PENNSYLVANIA CONSUMER PROTECTION LAW ("UTPCPL") 73 Pa.C.S. 5201-1 et seg. SHANNON BAKER V. AFLAC INSURANCE 85. Paragraphs 1 through 61, above, are incorporated herein by reference. 86. Admitted. 87. Admitted. 88. Denied. The averments of paragraph 88 state a conclusion of law to which no responsive pleading is required. To the extent such a response is required, the same are denied. By way of further answer: a) AFLAC did not engage in fraudulent or deceptive conduct. b) AFLAC did not cause any such likelihood of confusion or misunderstanding. c) AFLAC made no such representations. d) AFLAC did not advertise goods or services with intent not to sell them as advertised. e) AFLAC did not deceive Plaintiff as to her rights or benefits under the Policy. Rather, AFLAC provided Baker with documentation regarding the terms of the Policy prior to Baker enrolling in the Policy. That documentation explained that under the Policy, disability caused by a pre-existing condition is not covered unless it begins more than 12 months after the effective date of coverage, and Baker knew or should have known this information before enrolling in the Policy. 18 f) AFLAC did not misrepresent the characteristics or benefits of the Policy. Rather, AFLAC provided Baker with documentation regarding the terms of the Policy prior to Baker enrolling in the Policy. That documentation explained that under the Policy, disability caused by a pre-existing condition is not covered unless it begins more than 12 months after the effective date of coverage, and Baker knew or should have known this information before enrolling in the Policy. 89. Denied. Paragraph 89 states a conclusion of law to which no responsive pleading is required. To the extent that a response is required, the averment that Baker suffered harm "As a direct and proximate result of AFLAC s actions states a conclusion of law to which no responsive pleading is required, and such averment is therefore denied. Further, it is denied that Baker suffered financial and other harm as a result of any actions of AFLAC. 90. Denied. Paragraph 90 states a conclusion of law to which no responsive pleading is required. To the extent that a response is required, it is denied that Baker is entitled to actual damages, treble damages, attorney's fees and/or costs of suit. WHEREFORE, Defendant AFLAC Insurance demands judgment in its favor and against Plaintiff Shannon Baker, along with costs and such other relief the Court deems appropriate. NEW MATTER 91. The averments of paragraphs 1 through 61, above, are incorporated by reference. 92. Baker has failed to state claims upon which relief can be granted. 19 93. Baker's claims are barred, in whole or in part, by applicable statutes of limitations. 94. Baker's claims are barred, in whole or in part, because Baker failed to mitigate her damages. 95. AFLAC's actions are not the proximate cause of the damages alleged by Baker. 96. The damages allegedly suffered by Baker were caused, in whole or in part, by Baker's own actions or failure to act. 97. The damages allegedly suffered by Baker were caused, in whole or in part, by actions of third persons. 98. From January 1999 through September 1999, Baker worked as an agent selling AFLAC insurance. 99. Through her experience working as an agent for AFLAC insurance, Baker was familiar with the terms of AFLAC's insurance policies, including the provisions regarding pre-existing conditions. 100. AFLAC provided Baker with documentation regarding the terms of the Policy prior to Baker enrolling in the Policy, which explained that under the Policy, disability caused by a pre-existing condition is not covered unless it begins more than 12 months after the effective date of coverage. 101. Baker completed and signed the Application for the Policy, attached to the Complaint as pages 1 through 6 of Exhibit A. 102. The Application included Baker's agreement to the following: I understand that:... (2) AFLAC is not bound by any statement made by me, or any associate/agent of AFLAC, unless written herein; (3) the associate/agent 20 cannot change the provisions of the policy or waive: any of its provisions either orally or in writing ... I understand that coverage is not provided for a sickness or an injury for which medical advice or treatment was medically recommended by a Physician or received from a Physician within the 12-month period before the Effective Date of coverage. See Complaint at Exhibit A, pp. 12-13. 103. Baker knew or should have known that her kidney stones were a pre- existing condition under the Policy. 104. The falsity of any alleged misrepresentations made by Defendants would have been patently obvious to Baker had she made a cursory examination of the Policy, Application and other documentation provided to Baker by AFLAC. 105. Baker's reliance on any alleged misrepresentations made by Defendants was not justifiable. 106. Baker waived and released her claims for fraudulent misrepresentation by signing the Application, with its agreement that oral statements by AFLAC's agents are not binding and that agents cannot change or waive policy provisions. 21 WHEREFORE, Defendant AFLAC Insurance demands judgment in its favor and against Plaintiff Shannon Baker, along with costs and such other relief the Court deems appropriate. MCNEES WALLAQE-4 NURUCK LLC By e? Ka ice Giurintano I.D. No. 86345 Devin J. Chwastyk I.D. No. 91852 100 Pine Street P.O. Box 1166 Harrisburg, PA 17108-1166 (717) 232-8000 Attorneys for Defendant AFL.AC Insurance Dated: -7I26go5 22 JUL-25-05 14:11 FROM-AFLAC LEGAL DEPARTLENT 706-596-3EI77 T-069 P.003/003 F-632 VERIFICATION Subject to the penalties of 18 Pa. C.S.A. §4904 relating to unswom falsification to authorities, I hereby certify I am authorized to make this verification on behalf of AFLAC Insurance and that the facts set forth in the foregoing Answer with New Matter are true and correct to the best of my knowledge, or information and belief. Thomas P. McKenna Dated: ??Ov, tt CERTIFICATE OF SERVICE: I hereby certify that a true copy of the foregoing document was this day served upon the following via first class mail, postage prepaid: Zachary D. Campbell, Esquire R.J. Marzella & Associates, P.C. 3513 North Front Street Harrisburg, PA 17110 Date: '712610S T r' .. 'CI Yl7 -ii C'O R. J. MARZELLA & ASSOCIATES, P.C. BY: Zachary D. Campbell, Esquire Pennsylvania Supreme Court I.D. No. 93177 3513 North Front Street Harrisburg, PA 17110 Telephone: (717) 234-7828 Attorneys for Facsimile: (717) 234-6883 Shannon Baker IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION- LAW SHANNON BAKER, Plaintiff Docket No. 05-3028 Civil Term Civil Action V. AFLAC INSURANCE, and MICHAEL PEACOCK, Defendants JURY TRIAL DEMANDED PLAINTIFF'S RESPONSE TO DEFENDANT'S NEW MATTER 91. No response is required for the allegation stated herein. 92. The allegation herein states a conclusion of law to which no response is necessary. To the extent that a response may be required, it is specifically denied that Plaintiff has failed to state claims upon which relief may be granted. 93. The allegation herein states a conclusion of law to which no response is necessary. To the extent that a response may be required, it is specifically denied that Plaintiffs claims are barred, in whole or in part, by applicable statutes of limitations. 94. The allegation herein states a conclusion of law to which no response is necessary. To the extent that a response may be required, it is specifically denied that Plaintiffs claims are barred, in whole or in part, because Plaintiff failed to mitigate her damages. 95. The allegation herein states a conclusion of law to which no response is necessary. To the extent that a response may be required, it is specifically denied that AFLAC's actions are not the proximate cause of the damages alleged by Plaintiff. 96. The allegation herein states a conclusion of law to which no response is necessary. To the extent that a response may be required, it is specifically denied that the damages suffered by Plaintiff were caused, in whole or in part, by Plaintiffs own actions or failure to act. 97. The allegation herein states a conclusion of Ilaw to which no response is necessary. To the extent that a response may be required, it is specifically denied that the damages allegedly suffered by Plaintiff were caused, in whole or in part, by actions of third persons. 98. Admitted in part. It is admitted that Plaintiff worked for AFLAC insurance. However, it is specifically denied that Plaintiff worked as an agent selling AFLAC insurance from January 1999 through September 1999. 99. Denied. This allegation is denied to the extent that Defendant purports to know Plaintiffs subjective knowledge without any proof thereof and it is specifically denied that Plaintiff was familiar with the terms ofAFLAC's insurance policies, including the provisions regarding pre-existing conditions. 100. Admitted in part. Although Plaintiff was provided with documentation regarding the terms ofAFLAC's insurance policies, including pre-existing conditions, it is specifically denied that Plaintiff was provided a copy of the actual Policy prior to enrolling in the Defendant's insurance policy. 101. Admitted in part. It is specifically denied that the Plaintiff completed the Application for the Policy attached to Plaintifrs Complaint. Defendant Michael Peacock completed the Application for the Plaintiff on his computer, never provided a hard copy of the Application for the Plaintiff to sign and merely had the Plaintiff endorse the Application created on his computer. 102. Denied as stated. The statement contained in Paragraph 102 of Defendant AFLAC's New Matter is taken out of context. Although the language listed in paragraph 102 of Defendant AFLAC's New Matter is contained in the Policy, it is specifically denied that such language binds the Plaintiff in anyway. 103. Denied. It is specifically denied that Plaintiff knew or should have known that her kidney stones were a pre-existing condition under the Policy. 104. Denied. It is specifically denied that the falsity of the alleged misrepresentations made by Defendants would have been patently obvious to Plaintiff had she made a cursory examination of the Policy, application, or other documentation provided by Defendant AFLAC. 105. The allegation herein states a conclusion of law to which no response is necessary. To the extent that a response may be required, iit is specifically denied that Plaintiffs reliance on the misrepresentations made by Defendants was not justifiable. 106. The allegation herein states a conclusion of law to which no response is necessary. To the extent that a response may be required, it specifically denied that Plaintiff waived and/or released her claims for fraudulent misrepresentations by signing the Application. R. J. MARZELLA & ASSOCIATES, P.C. Respectfully submitted, By, Uryn ipb e , Esquire SuIdentification No. 93177 Attorney for the Plaintiff Dated: d 9 aS CERTIFICATE OF SERVICE 1, Tammy L. McNamee, hereby certify that a true and correct copy of the foregoing document was served upon all counsel of record this Th day of August 2005, by depositing said copy in the United States Mail at Harrisburg, Pennsylvania, postage prepaid, first-class delivery, and addressed as follows: KANDICE GIURINTANo MCNEES WALLACE & NURICK, LLC 100 PINE STREET P.O. Box 1166 HARRISBURG, PA 17108 A77ORNEYFORf1FL4C R. J. MARZELLA & ASSOCIATES, P.C. BY: TAMMY I.. MCNAMEE n P m rr ` y L _ ? W R. J. MAIZZELLA & ASSOCIATES, P.C. BY: Zachary D. Campbell, Esquire Pennsylvania Supreme Court I.D. No. 93177 3513 North Front Street Harrisburg, PA 17110 Telephone: (717) 2347828 Attorneys for Facsimile. (717) 2346883 Shannon Baker IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION- LAW SHANNON BAKER, Plaintiff Docket No. 05$02$ Civil Term Civil Action V. AFLAC INSURANCE, and MICHAEL PEACOCK, Defendants JURY TRIAL DEMANDED STIPULATION OF COUNSEL IT IS HEREBY STIPULATED AND AGREED by and between counsel for all parties that the caption of this civil action shall be amended as set forth below: 1. American Family Life Assurance Company of Columbus shall be substituted in the place of AFLAC INSURANCE as the name of the Defendant. 2. The caption of Docket Number 05-3028 Civil Term shall be listed as follows: IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION- LAW SHANNON BAKER, Plaintiff Docket No. 05-3028 Civil Term Civil Action V. AMERICAN FAMILY LIFE ASSURANCE COMPANY OF COLUMBUS and MICHAEL PEACOCK, Defendants JURY TRIAL DEMANDED R. J. MARZELLA & ASSOCIATES, P.C. Dated: 8 ?1 S By: 7?ox Z ary mpbell, squire Supre u Identification No, 93177 R. J. Marzella & Associates, P.C. 3513 North Front St. Harrisburg, PA 17110 McNees Wallac" Nurick. LLC (Dated: $I??OS By. Supreme Court IdentiAcaton No. 91852 100 Pine Street P.O. Box 1166 Harrisburg, PA 17108-1166 2 At;G 3 1 2005 BUJ BY:- CERTIFICATE OF SERVICE 1, Tammy L. McNamee, hereby certify that a true and correct copy of the foregoing document was served upon all counsel of record this 1' day of September 2005, by depositing said copy in the United States Mail at Harrisburg, Pennsylvania, postage prepaid, first-class delivery, and addressed as follows: DEVIN J. CHWASTYK, ESQ. MCNEES WALLACE & NURICK, LLC 100 PINE STREET P.O. Box 1166 HARRISBURG, PA 17108 AMORNEYFOeAFL9C R. J. MARZELLA & ASSOCIATES, P.C. TAMMY L. MCNAMEE ?.> c-, ? ? c:? ,,.. -?? ?„ _i _?, ,? ?: n ?:. _?,?. z ,; - ;;; F?? - _ =ti ,. } R. J. MARZELLA & ASSOCIATES, P.C. BY: Zachary D. Campbell, Esquire Pennsylvania Supreme Court I.D. No. 93177 3513 North Front Street Harrisburg, Pennsylvania 17110-1438 Telephone: (717) 234-7828 Attorneys for Facsimile: 17171 234-6883 Shannon Baker IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION- LAW SHANNON BAKER, PLAINTIFF DOCKET No.: 05-3028 CIVIL TERM V. AMERICAN FAMILY LIFE ASSURANCE COMPANY OF COLUMBUS AND MICHAEL PEACOCK, DEFENDANTS JURY TRIAL DEMANDED PRAECIPE FOR JUDGMENT OF DEFAULT PURSUANT TO Pa.R.C.P. 1037(b) TO THE PROTHONOTARY OF CUMBERLAND COUNTY: Please enter a judgment by default against the Defendant, Michael Peacock. The undersigned hereby certifies that a written notice of intention to file this Praecipe was mailed after the failure to plead to a Complaint and at least ten days prior to the date of the filing of this Praecipe to the Defendant, who was unrepresented by counsel. A copy of the Notice is attached hereto, as required by Pa.R.C.P. 237.1(a)(3). Respectfully submitted, R. J. MARZELLA & ASSOCIATES, P.C. $y' Q?-er7-' ARY . CA PBELL, ESQUIRE ID No. 7 ATTORNEY FOR THE PLAINTIFF, SHANNON BAKER Dated: ?. /9. OS R. J. MARZELLA & ASSOCIATES, P.C. BY: Zachary D. Campbell, Esquire Pennsylvania Supreme Court I.D. No. 93177 3513 North Front Street Harrisburg, Pennsylvania 17110-1438 Telephone: (717) 234-7828 Attorneys for Facsimile: (717) 234-6883 Shannon Baker IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION- LAW SHANNON BAKER, PLAINTIFF V. AMERICAN FAMILY LIFE ASSURANCE COMPANY OF COLUMBUS AND MICHAEL PEACOCK, DEFENDANTS DOCKET No. 05-3028 Civil Term Civil Action JURY TRIAL DEMANDED IMPORTANT NOTICE OF INTENTION TO ENTER DEFAULT JUDGMENT PURSUANT TO Pa.R.C.P. 237.1(a)(2) TO: MICHAEL PEACOCK 3027 Crottlestown Road Chambersburg, Pennsylvania, 17201 DATE OF NOTICE: September 7, 2005 IMPORTANT NOTICE YOU ARE IN DEFAULT BECAUSE YOU HAVE FAILED TO ENTER A WRITTEN APPEARANCE PERSONALLY OR BY ATTORNEY AND FILE IN WRITING WITH THE COURT YOUR DEFENSES OR OBJECTIONS TO THE CLAIMS SET FORTH AGAINST YOU. UNLESS YOU ACT WITHIN TEN DAYS FROM THE DATE OF THIS NOTICE, A JUDGMENT MAY BE ENTERED AGAINST YOU WITHOUT A HEARING AND YOU MAY LOSE YOUR PROPERTY OR OTHER IMPORTANT RIGHTS. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH THE INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD. TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. Cumberland County Bar Association 2 Liberty Avenue Carlisle, Pennsylvania 717-249-3166 AV1SO IMPORTANTE FECHA DEL AVISO: 7, September 2005 USTED ESTA EN REBELDIA PORQUE HA FALLADO DE REGISTRAR COMPARECENCIA ESCRITA POR S1 MISMO 0 A TRAVES DE UN ABOGADO Y SOMETER CON LA CORTE SUS DEFENSAS U OB,JECCIONES A LOS CARGOS QUE SE HAN PRESENTADO CONTRA USTED A MENOS QUE USTED ACUTE DENTRO DE DIEZ DIAS DE HABER RECIBIDO ESTE AVISO, LA CORTE PUEDE TOMAR DERECHOS A UNA VISTA Y USTED PUEDE PERDER SU PROPIEDAD U OTROS DERECHOS IMPORTANTES. USTED DEBE LLEVAR ESTE DOCUMENTO A SU ABOGADO INMEDIATAMENTE. SI USTED NO T1ENE UN ABOGADO, LLAME 0 VAYA A LA SIGUIENTE OFICINA. ESTA OFICINA PUEDE PORVEERLE INFORMACION A CERCA DE COMO CONSEGUIR UN ABOGADO. SI USTED NO PUEDE PAGAR POR LOS SERVICIOS DE UN ABOGADO, ES POSIBLE QUE ESTA OFICINA LE PUEDE PROVEER INFORMACION SOBRE AGENCIAS QUE OFREZCAN SERVICIOS LEGALES SIN CARGO 0 BA,JO COSTO A PERSONAS QUE CALIFICAN. Cumberland County Bar Association 2 Liberty Avenue Carlisle, Pennsylvania Telefono: 717-249-3166 Respectfully submitted, Dated: ?S R. J. MARZELLA & ASSOCES, P.C. By: D.'.AN PBELL, ESQUIRE ID 1118-93-T77 ATTORNEY FOR THE PLAINTIFF, SHANNON BAKER CERTIFICATE OF SERVICE 1, Tammy L. McNamee, hereby certify that a true and correct copy of the foregoing document was served upon all counsel of record this 19' day of September 2005, by depositing said copy in the United States Mail at Harrisburg, Pennsylvania, postage prepaid, first-class delivery, and addressed as follows: DEVIN J. CHWASTYK, ESQ. MCNEES WALLACE & NURICK, LLC 100 PINE STREET P.O. Box 1166 HARRISBURG, PA 17108 A7TORNEYFOR AFLAC R. J. MARZELLA & ASSOCIATES, P.C. (:?f BY: TAMMY L. MCNAMEE ?`' !"i V ?,, ...._ ?` (?? ???^??.... V 4 ^? X3 .- l _t? - ??? „`?- ?-,? c.a :-? r _ t .? ?" ' o,.? :.? _ -rr ?? ; ? r?? -r `: e' _.-F- Sri ? t Cfr' ? .,- _. [}j SHERIFF'S RETURN - OUT OF COUNTY CASE NO: 2005-03028 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND BAKER SHANNON VS AFLAC INSURANCE ET AL R. Thomas Kline , Sheriff or Deputy Sheriff who being duly sworn according to law, says, that he made a diligent search and and inquiry for the within named DEFENDANT to wit: PEACOCK MICHAEL but was unable to locate Him deputized the sheriff of FRANKLIN in his bailiwick. He therefore County, Pennsylvania, to serve the within COMPLAINT & NOTICE On August 25th , 2005 , this office was in receipt of the attached return from FRANKLIN Sheriff's Costs: So answers_:, Docketing 18.00 Out of County 9.00 yc - Surcharge 10.00 R. Thomas Klin -- Sep Franklin Co 31.20 Sheriff of Cumberland County .00 68.20 08/25/2005 RJ MARZELLA & ASSOCIATES Sworn and subscribed to before mel this day of IBC Y SUS A.D. P not ry SHERIFF'S RETURN - OUT OF COUNTY CASE NO: 2005-03028 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND BAKER SHANNON VS AFLAC INSURANCE ET AL R. Thomas Kline , Sheriff or Deputy Sheriff who being duly sworn according to law, says, that he made a diligent search and and inquiry for the within named DEFENDANT PEACOCK MICHAEL but was unable to locate Him deputized the sheriff of FRANKLIN serve the within COMPLAINT & NOTICE County, Pennsylvania, to On August 25th , 2005 , this office was in receipt of the attached return from FRANKLIN Sheriff's Costs: So answers : Docketing 6.00 Out of County 9.00 Surcharge 10.00 R. Thomas Kline Dep Franklin Cc 26.20 Sheriff of Cumberland County .00 51.20 08/25/2005 R J MARZELLA & ASSOCIATES Sworn and subscribed to before me this L?- day of 1 L a cr(,S? A.D. to wit: in his bailiwick. He therefore Prot4oa?rtaryv In The Court of Common Pleas of Cumberland County, Pennsylvania Shannon Baker VS. AFLAC Insurance et al SERVE: Michael PEacock No. 05-3028 civil Now, June 14, 2005 , I, SHERIFF OF CUMBERLAND COUNTY, PA, do hereby deputize the Sheriff of Frank] +n County to execute this Writ, this deputation being made at the request and risk of the Plaintiff. -?0-001111 4 ? Sheriff of Cumberland County, PA Affidavit of Service Now, within upon at by handing to a and made known to Sworn and subscribed before me this day of 20 20 , at o'clock M. served the copy of the original So answers, Sheriff of the contents thereof. COSTS SERVICE _ MILEAGE _ AFFIDAVIT County, PA SHERIFF'S RETURN - NOT FOUND CASE NO: 2005-00127 T COMMONTWEALTH OF PENNSYLVANIA COUNTY OF FRANKLIN SHANNON BAKER VS AFLAC INSURANCE ROBERT WOLLYUNG , Sheriff , who being duly sworn according to law, says, that he made a diligent search and inquiry for the within named DEFENDANT to wit: PEACOCK MICHAEL but was unable to locate Him in his bailiwick. He therefore returns the COMPLAINT AND NOTICE NOT FOUND , as to the within named DEFENDANT PEACOCK MICHAEL 166 MAIN STREET CHAMBERSBURG. PA 17201 DEF NO LONGER EMPLOYED AT ADDRESS RETURN PER ATTORNEY Sheriff's Costs: Docketing .00 Service .00 Affidavit .00 Surcharge .00 .00 .00 So answers: RrSERT WOLLY G ROBERT WOLLYUNG, She 'ff CUMBERLAND COUNTY SHERIFF 06/21/2005 Sworn and subscribed to before me this day of !C/l? A.D. Notary Nmaid Jed Richard D. McCriy, NQWy N& Chambaebms Bmo,FtmWibCb Wy .. My Cmntisaim Expims In. 29,2W In The Court of Common Pleas of Cumberland County, Pennsylvania Shannon Baker VS. AFLAC Insurance et al SERVE: Michael Peacock No. 05-3028 civil Now July 15, 2005 , I, SHERIFF OF CUMBERLAND COUNTY, PA, do hereby deputize the Sheriff of Franklin County to execute this Writ, this deputation being made at the request and risk of the Plaintiff. Sheriff of Cumberland County, PA Affidavit of Service Now, A i c q u s? i 20 a S, at o'clock P M. served the within C e nl pja i n t upon ?lt I CA a ?/ P2a e a oL/y?s?,_ ?aY ?a1 at Tf dr+kli? ?`v?cK{y S?7ei {{?s e?f? u 1S -Z by handing to /(;I , a 4dt, m a 4ru •e a a 111ea.l,kcopy of the original d-e -n# la , -- r and made known to `r1., . Sworn and c?ubscribed before me this day of u s Notarial aw Richard D. McCarty, Notary Pup Chambersbarg 13m Fraakht, Cat My CommissimEspites.fat. 29,: the contents thereof. So answers, ?y Sheriff of County, PA 4 4.e.f /1/,- 64.1 COSTS SERVICE $ 20 d S MILEAGE AFFIDAVIT S a 1, . aU R. J. MARZELLA & ASSOCIATES, P.C. BY: Zachary D. Campbell, Esquire Pennsylvania Supreme Court I.D. No. 93177 3513 North Front Street Harrisburg, PA 17110 Telephone: (717) 234-7828 Attorneys for Facsimile: (7171 234-6883 Shannon Baker IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION- LAW SHANNON BAKER, Plaintiff Docket No. 05-3028 Civil Term Civil Action V. AFLAC INSURANCE, and MICHAEL PEACOCK, Defendants JURY TRIAL DEMANDED PRAECIPE TO DISCONTINUE TO THE PROTHONOTARY, CUMBERLAND COUNTY: Please discontinue the above action against AFLAC INSURANCE ONLY. R. J. MARZELLA & ASSOCIATES, P.C. Respectfully submitted, By: cha A Campbell, Esquire Supr ourt Identification No. 93177 Attorney for the Plaintiff Dated: l? S o , 'V CERTIFICATE OF SERVICE 1, Dennis C. Dougherty, hereby certify that a true and correct copy of the foregoing document was served upon all counsel of record this 5ch day of October 2007, by depositing said copy in the United States Mail at Harrisburg, Pennsylvania, postage prepaid, first-class delivery, and addressed as follows: Kandice Giurintano, Esquire McNees Wallace & Nurick, LLC 100 Pine Street P.O. Box 1166 Harrisburg, PA 17108 Attorney for Defendant AFLAC BY: ? ?v ? C? ? o ? ?? t.? ; -?-? ? S? ? ? _ -? m ? ? ? -?. W O . -? r. '"? J ? --C