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Home My WebLink About94-02000 j j J -:r ~ ) ~ \~ ~} ~\) \3\~ '~ ~ ~~ \. .t ~~ 10.< 0.... Z ~~ W...:I ...:1>< ... W 11.00 ... ...:I ., ZZ . ... .... c .., III OZ U c 0 '" ~~ . ... ~ 'C o '" c gj o . .... Cl U>< . 11. 0 ... .. w 1o.E< "" ::l < 8 ~ w '" a: 0 0?5 '" w ...:I . I:i E<o .... !2 <>< u ~ ~ ~ N . o~ Ii: oj a: 0 w" o:U < en I[ - 00 '" > E<o.. i ~ * ~ ~ .. < 0:& .. III II. 8 Z :&0 0 . l! Z II. f"I ; Ii W :'i .., ili~ we' w c I[ :c 0: ...:I 16 Z J: ~ .. ~ ~ ~l:l w i::~ I[ % on :; % m < W g .. :; III .. 1'1 z ~ ci :c w~ _ I[ a: I[ w "'U U ~o ... < 06 o m Z ... ... z Z % :& E<!2 0: 8 ! c 00... x (!) N U ::I: C"...._ t;: ~ ~ ..,>- ..c- ,-."~ 'J"' ~ ~-l _~..f _..:e~ - l...C-'(,,;., , ,:; '~?i ~ .,,< ~~ -..... ",.:.: d.,. 1 .:.. I..::) ~'. ';) > . . STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant CIVIL ACTION - LAW vs. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA /J /J_ ;.,j/ \.7l:e,., NO. 7V-07t'W t-U'1994 MICHAEL J. BARTELL, D.C., Plaintiff NOTICE You have been sued in court. If you wish to defend aqainst the claims set forth in the followinq paqes, you must take action within twenty (20) days after this Complaint and Notice are served, by enterinq a written appearance personally or by attorney and filinq in writinq with the court your defense or objections to the claims set forth aqainst you. You are warned that if you fail to do so, the case may proceed without you and judqment may be entered aqainst you by the court without further notice for any money claimed in the Complaint or for any other claim or relief requested by the Plaintiff. You may lose money or property or other riqhts 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 Court Administrator CUmberland County Courthouse 1 Courthouse Square CarliSle, PA 17013 (717) 240-6200 or 697-0371 vs. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. MICHAEL J. BARTELL, D.C., Plaintiff STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant COMPLAINT 1. Plaintiff is Michael J. Bartell, a doctor of chiropractic, who maintains his practice at 1001 South Market Street, Mechanicsburg, Cumberland County, Pennsylvania. 2. Defendant, State Farm Mutual Automobile Insurance Company, is a corporation engaged in the business of automobile insurance, which regularly conducts business in Cumberland County. Defendant maintains a place of business at 115 Limekiln Road, New CUmberland, Pennsylvania. That address is in Fairview Township, York Ccunty. 3. On a date prior to February 18, 1993, Defendant issued to Linda Smith, of Mechanicsburg, Pennsylvania, an automobile insurance policy which provided inter alia coverage for First Party Benefits in accordance with the Pennsylvania Motor Vehicle Financial Responsibility Law, 75 Pa.C.S. S 1702, et seq. Plaintiff does not presently have a copy of that policy. He believes that Defendant does have a copy in its possession. 4. Said insurance policy was in full force and effect on February 18, 1993, when Linda Smith was involved in a motor vehicle accident which caused her to suffer injuries which included acute cervical strain/sprain, acute thoracolumbar strain/sprain, sublupations at C1, C2, C3, C5, C6, L4, and L5, 1 .-.. ~<,.. ; 2 cervical arthrosis, and either caused or aggravated degenerative joint disease at L4 and L5. 5. Linda Smith began receiving treatment from plaintiff for those injuries on March 12, 1993. 6. Linda Smith also received treatment from other health care providers for injuries she suffered in the motor vehicle accident of February 18, 1993. 7. As is required by the Motor Vehicle Financial Responsibility LaW, Plaintiff submitted his bills for care of Ms. Smith's injuries to Defendant, accompanied by appropriate supporting documentation. 8. Defendant assigned claim number 38-6539-169 to Linda Smith's claim for First Party Benefits, and did pay a portion of the bills submitted by Plaintiff. 9. In December, 1993, Defendant submitted Plaintiff's treatment records and bills for "Peer Review" pursuant to Defendant's arbitrary policy of peer reviewing all cases where treatment for neck and/or back injuries has continued for more than three months regardless of the facts of individual cases. 10. The peer review organization, selected by Defendant to review the claim, was consolidated Rehabilitation Company, an organization which is predisposed to disapprove continuing treatment of soft tissue neck and back injuries regardless of individual differences in the cases. 11. On or about January 28, 1994, Consolidated Rehabilitation Company reported to Defendant that it had determined that treatment Plaintiff had rendered to Linda smith after June 16, 1993, was not reasonable or necessary. 12. Defendant communicated consolidated Rehabilitation company's determination to Plaintiff on or about February 8, 19934, notifying Plaintiff that it was denying payment for treatment rendered to Linda smith after June 16, 1993. 13. On or about February 15, 1994, Plaintiff submitted a timely request for reconsideration of Consolidated Rehabilitation Company's determination, pursuant to the Motor Vehicle Financial Responsibility Law. 14. On or about March 14, 1994, Consolidated Rehabilitation Company summarily affirmed its earlier determination that treatment Plaintiff rendered to Linda Smith after June 16, 1993, was not reasonable or necessary. 15. The treatment which Plaintiff rendered to Linda Smith after June 16, 1993, was reasonable and necessary under the circumstances. 16. Defendant's actions with request to treatment rendered after June 16, 1993, have no reasonable foundation in light of the nature of Ms. Smith's injuries. 17. Plaintiff rendered treatment to Linda smith for her auto accident related injuries on August 13, 1993, August 17, 1993, and September 29, 1993. Prior to submitting the claims for services performed after June 16, 1993, for peer review, Defendant paid Plaintiff $238.95 for the care he rendered Ms. Smith on those occasions. 3 1993, December 16, 1993, and December 17, 1993. He billed 18. Defendant has demanded that Plaintiff reimburse it the sum of $400.00, which Defendant alleges to be the cost of reconsideration of the peer review decision. 19. Plaintiff rendered treatment to Linda 8mi th for her auto accident related injuries on November 19, 1993, November 22, Defendant a total of $450.00 for the care he rendered Ms. Smith on those occasions. Plaintiff has not been paid for those services. WHEREFORE, Plaintiff requests the Court to declare that Defendant is not entitled to reimbursement for bills it has already paid for treatment rendered to Linda smith after June 166, 1993, to declare that Plaintiff is not required to reimburse Defendant for the cost of the reconsideration, and to enter judgment against Defendant for damages not exceeding $25,000.00, interest at the rate of 12% per annum pursuant to 75 Pa.C.S.!i 1716, counsel fees pursuant to 75 Pa.C.S. !i 1716 and 1798 (a), costs of suit, and such additional relief as the Court deems appropriate. Respectfully submitted, GRIFFIE & ASSOCIATES ~ ....----....... ' '//- ~~l:' 7',/_ "~ Fred H. H t" Esquire Attorney for plaintiff 200 North Hanover Street Carlisle, PA 17013 (717) 243-5551 (800) 347-5552 4 AJ'J'IDAVIT I verify that any facts not of record set forth in the foregoing Answer and New Matter are true and correct to the best of my knowledge, information, and belief. I acknowledge that any false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unsworn falsification to authorities. Date ~ {{~/11?CJ 'I ( ?tiift.fl~l' D.C. . SHERIFF'S RETURN COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND In the Court of Common Pleas of Cumberland County, Pennsylvnaia NO.94-2000 Civil Term Complaint in Civil Action Law ' and Notice Michael J. Bartell, D.C. VS State Farm Mutual Automobile Insurance Company R. THOMAS KLINE, Sheriff, who being duly sworn according to law, says, that he made diligent search and inquiry for the within named defendant, to wit: State Farm Mutual Automobile Insurance Company but was unable to locate in his bailiwick. He therefore them deputized the sheriff of York County, Pennsylvania, to serve the within Complaint in Civil Action Law and Notice On May 02, 1994 , this office was in receipt of the attached return from York County, Pennsylvania. Sheriff's Costs: Docketing 14.00 Out of County 5.00 Surcharge 2.00 York County 29.44 50.44 Pd. by Atty. Sworn and subscribed to barB~~9~e So answers: ~ ./ - ,...-~ / L,&~~t!/,--:'-rP' R. THOMAS KLINE, Sheriff this 5~ day of ~ 19 q" A.D. Q'1"; 0., hulr._ U'J~ I 1/ Prothonotary .b Th~ Court ci C~mmO;j ;: I =....-:: . -....- . C " ., ? I . OT :.Jr.~:"'-:;;:~1=n= \",,:;u,:;".y, . SMr:SY'/enl:: Michael J. Bartell, D.C. 'IS. State Farm Mutual Automobile Insurance Company :-fo. 94-?nnn ri"il ~ :~_ :O;ow, Apr il 20. 1994 ~9_ !. S~..z::: O~ C~G::::::?.!..A."fD COt.~':"!. ?_~ co h=-~ ~::u= C:: .r~.:i oi York ~u:ty :0 =--::1:: ':"ilt ',V:::, .., . \..:.,,,. .... .;.. - ...-..: :.t. t' '_-- :::s -:.:::u:::cn ...~ --....- .- -= ~.. -... :=.. " ?t":-d. r-~~~ sae..~ ~'t S=:::er.:ci C"u:tr. :3. .A. ~da.vit or - . :::e..--nc.e :O;ow, April 26 Complaint & Notice o'dea A: 'tL 1=-:= ~994 11:15 .. . .... . ... =~ ':"'l-.'" 'Jpoll . ~ ~ State Farm Mutual Automobile Insurance . CUIIII:JC1U'y ~; 115 Limekiln Rd., New Currberland, PA by ~C:q :0 John WillaNski, Supvr. 3. True and Attested c:pr ai ::e ~::t-.,I Comolaint & Notice ... md -..:. !cowu :0 ...J2bn Wi 11 o..1Sk i . ., :::.: ~:=t=:S ::~:::::t. So :L::SW=, ~~.~'~''lo..~~ Shc:5 of YORK CoW1~. ;0.. cosrs S:c:.~v"'ICZ ~aI.!AGE s 19-!J.1 . ..\: : wA ; J.7 -v- ---.-----.-- s r_ "--4 Telephone, FIx: 1717] 236.3200 171 n 236.6863 Attorney for Oefendant: STATE FARM INSUllANCE . . .' ~. ROI.f E. KROLL, ESQUIRE Pe. supreme Court 1.0. No. 47243 FOULKROO, REYNOLDS & HAVAS A Prof..llonal Corporation 101 Pine Street POlt Office Box 932 Herrllburg, pennaylvenle 17108.0932 MICHAELJ. BARTELL, D.C., Plaintiff : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA . . . . v. : NO. 94-2000 CIVIL TERM . . STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant . . . . : CIVIL ACTION - LAW : JURY TRIAL DEMANDED PRAECIPE TO ENTER APPEARANCE TO THE PROTHONOTARY OF CUMBERLAND COUNTY: Kindly enter my appearance as counsel for Defendant, State Farm Mutual Automobile Insurance company. FOULKROD, REYNOLDS & HAVAS A Professional corporation DATE:S'p6/1y By: Attorneys for Defendant, STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY "..."""""...-...,...,.~ . -." CERTIFICATE OF SERVICE I HEREBY CERTIFY that I have served a true and correct copy of the foregoing document upon all counsel and parties of record this .:Q<:, tt day o~'Q ,LA , 1994, by placing the , \ same in the United States First Class Hail, postage prepaid, at Harrisburg, Pennsylvania, addressed as follows: Fred H. Hait, Esquire 200 North Hanover Street Carlisle, Pennsylvania 17013 N.~ '&, f' ~),"(",\' Ha E. nlap " "", a; - - ,. >- ..;; ~.. "I,'": :~ (,)' ..,.,. - '.. o~-''':'; .. .. :c 0- f'> ~ N " - " ~ .' .' . -. 1 ROLF E. KROLL, ESQUIRE PI. Supr.... Court 1.0. No. 47243 FOULKROO, REYNOLDS & HAVAS A Prof..IIOl1lI Corporltlon 101 Pine Str..t POlt OfficI Box 932 Hlrrllburg, Pomoylvonll 17108.0932 Tlllphone: Fax: t71n 216.3200 t71n 216.686] MICHAELJ. BARTELL, D.C., Plaintiff v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant '....4_...>.- ., ..,,~>_,_" "-_ _ Attorney for Olfondont: STATE FARN INSURAIICE : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA . . . . : NO. 94-2000 CIVIL TERM : . . . . : CIVIL ACTION - LAW : JURY TRIAL DEMANDED NOTICE TO pr.1>.a.n TO: Michael J. Bartell, D.C. c/o Fred H. Hait, Esquire 200 North Hanover Street Carlisle, Pennsylvania 17013 You are hereby notified to file a written response to the enclosed New Matter within twenty (20) days from service hereof or a default judgment may be entered against you. OAT", 7/21 /'1{ By' FOULKROD, REYNOLDS & HAVAS A Prof ional Corporation Attorneys for Defendant, STATE FARM INSURANCE CO. ROLF E. KROLL, ESQUIRE PI. Suprema Court 1.0. No. 47243 FOULKROO, REYNOLDS & HAVAS A Profe..lonal Corporltlon 101 Pine Strllt Poet OfficI 80x 932 Hlrrl.burg, Pennoylvlnll 17108.0932 TIlephone, Fax: l71n 236.3200 l71n 236,6863 Attorney for Olfendant: STATE FARN INSURANCE MICHAEL J. BARTELL, D.C., Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA v. NO. 94-2000 CIVIL TERM STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant CIVIL ACTION - LAW JURY TRIAL DEMANDED ANSWER WITH NEW HATTER TO PLAINTIFF' S COMPLAINT AND NOW, comes Defendant, State Farm Mutual Automobile Insurance Company, ("Defendant") by and through its counsel Foulkrod, Reynolds & Havas, a professional corporation to answer the Complaint of Plaintiff, Michael J. Bartell, D.C. ("Plaintiff") as follows: 1. Denied. After reasonable investigation State Farm Mutual Automobile Insurance Company is without knowledge or information sufficient to form a belief as to the truth of the averments of this paragraph of Plaintiff's Complaint and they are, therefore, denied. 2. Admitted. ~. 3. Admitted. 4. Admitted in part and denied in part. It is admitted that the state Farm Policy ("policy") was in full force and effect on February 18, 1993. It is specifically denied that the injuries at issue and the medical care and treatment Plaintiff's contend are associated therewith are reasonable, necessary and/or related to the motor vehicle accident and this allegation of Plaintiff's Complaint is therefore denied. S. Denied. After reasonable investigation State Farm Mutual Automobile Insurance Company is without knowledge or information sufficient to form a belief as to the truth of the averments of this paragraph of Plaintiff's Complaint and they are, therefore, denied. 6. Denied. After reasonable investigation state Farm Mutual Automobile Insurance Company is without knowledge or information sufficient to form a belief as to the truth of the averments of this paragraph of Plaintiff's Complaint and they are, therefore, denied. 7. Admitted in a part and denied in part. It is admitted that Plaintiff submitted various bills to state Farm. It is specifically denied that the bills submitted supported Plaintiff's claims in the instant case and strict proof to the contrary is demanded at trial. - 2 - 8. Admitted. 9. Admitted in part and denied in part. It is admitted that state Farm submitted the matter to a Peer Review. It is specifically denied that state Farm has policy of peer reviewing all cases for neck and back injuries where care is continued for more than three months. To the contrary, state Farm's decision to commence a Peer Review was based upon the totality of the circumstances of Plaintiff's care and treatment. 10. Denied. It is specifically denied that the Peer Review Organization is predisposed to disapprove continuing treatment. To the contrary, the Peer Review Organization is a Commonwealth approved Peer Review organization that has been properly screened by the Commonwealth of Pennsylvania to insure its impartiality. 11. Admitted. 12. Admitted. 13. Admitted in part and denied in part. It is admitted that on or about February 15, 1994, Plaintiff submitted a request for reconsideration. It is specifically denied that said request was timely or constituted a valid request for reconsideration and strict proof to the contrary is demanded at trial. 14. Denied as stated. state Farm requested and had performed a reconsideration which reconsideration confirmed that the treatment at issue was not reasonable, necessary nor related - 3 - to the motor vehicle accident in question. 15. Denied. The allegations contained in this paragraph of Plaintiff's Complaint constitute conclusions of law to which no further pleading is required and they are therefore, denied. By way of further answer, paragraphs 1 through 14 hereof are incorporated herein by reference as if set forth in full. 16. Denied. The allegations contained in this paragraph of Plaintiff's Complaint constitute conclusions of law to which no further pleading is required and they are therefore, denied. By way of further answer, paragraphs 1 through 14 hereof are incorporated herein by reference as if set forth in full. 17. Admitted. 18. Denied as stated. state Farm requested, in accordance with the terms of the Pennsylvania Motor Vehicle Financial Responsibility Law, that Plaintiff reimburse state Farm for the costs associated with the reconsideration of the Peer Review decision, which reconsideration was favorable to state Farm. 19. Admitted in part and denied in part. It is admitted that Plaintiff has not been paid for certain services rendered. It is specifically denied that said services are reasonable, necessary or related to the motor vehicle accident and are therefore not compensable under the state Farm policy in Pennsylvania Law. - 4 - WHEREFORE, Defendant, state Farm Mutual Automobile Insurance company requests judgment in its favor and against Plaintiff, Michael J. Bartell, D.C., with costs of suit assessed to Plaintiff. NEW MATTER 1. The claims of Plaintiff are limited by the terms of the MVFRL, 75 Pa. C.S.A. 61701 ~~. as amended by Act 6, April 15, 1990 ("Act 6"). 2. The bills in dispute were incurred after the effective date of Act 6. 3. state Farm has paid $3,386.06 to various health care providers on behalf of Linda Smith. 4. Thereafter, based upon the totality of the circumstances including a lack of objective evidence of injury, state Farm sought professional assistance in assessing the reasonableness, necessity and relatedness of said injuries. 5. Therefore, State Farm submitted Plaintiff's matter to a Commonwealth approved Peer Review Organization established for the purpose evaluating treatment and health care services provided to an injured person. state Farm is required by the terms of MVFRL to contract with such Commonwealth approved peer review organizations for the purpose of assessing the - 5 - reasonableness, necessity and relatedness of treatment. 6. A Commonwealth approved peer review organization has opined that the medical expenses at issue were neither reasonable nor necessary under the terms of the policy under Pennsylvania Law. On the basis of the peer reviews dated January 28, 1994 and March 5, 1994 state Farm has denied payment. 7. Plaintiff has not and cannot sustain damages as a result of a diminished payment or non-payment of automobile accident related bills. ~ 75 Pa. Cons. stat. 11797(a). Since Plaintiff cannot sustain such damage, the lack standing to sue state Farm. 8. This Honorable Court lacks jurisdiction to entertain this matter as state Farm performed a peer review in accordance with the Pennsylvania Motor Vehicle Financial Responsibility Law. Accordingly, Plaintiff's claims are barred by the terms of 11797(b) (4) as Plaintiff has not exhausted his administrative remedies by requesting and paying for a reconsideration by the peer review organization. 9. The amounts in dispute in this case represent charges for excessive treatment which was neither reasonable nor necessary within the meaning of the insurance policy in question and/or the motor vehicle financial responsibility law. 10. The charges at issue in this case and for which - 6 - insurance coverage is claimed from state Farm are unreasonable and unnecessary and/or are for injuries and/or conditions unrelated to the accident in question. The nature and extent of injuries, damages and other losses alleged by Plaintiffs are denied. 11. Plaintiff's claims for insurance benefits are barred by lack of consideration. 12. Any application of a legal rule so as to broaden defendant's liability under the insurance policy in question is barred as a matter of equity. 13. Plaintiff's are not entitled to recover attorney's fees incurred in obtaining any insurance benefits which may ultimately may be paid by Defendant, since Defendant's, withholding or of said benefits was made in good faith and for reasonable cause. 14. Plaintiff has failed to state a claim in whole or in part upon which relief can be granted. 15. Plaintiffs claims are barred by the statute of limitations. 16. Plaintiff has not pled any claims in respect to Plaintiff, Michael J. Bartell, D.C. Therefore, Plaintiff, Michael J. Bartell, D.C., has failed to state a claim for which relief can be granted. WHEREFORE, state Farm Mutual Automobile Insurance Company - 7 - ,. l/;,r demands judgment in its favor and against Plaintiff with costs of suit assessed to Plaintiff. Respectfully submitted, FOULKROD, REYNOIDS & HAVAS A Professional Corporation By: ROLF ,~ , Attorneys for Defendant, STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY DATED: 7/}! / ~( - 8 - - -- '""0-_'_, _,,": ~'tr "-..t,...~-:-,. ._, 1... ~,:~ ..;._~".~~,...,_.- VERIFICATION I, JOHN WILKOWSKI, hereby acknowledge that I am the CLAm SUPERVISOR of STATE FARK MUTUAL AUTOMOBILE INSURANCE COMPANY, the Defendant in this action; that I have read the foregoing pleading; and that the facts stated therein are true and correct to the best of my knowledge, information and belief. I understand that any false etatements herein are made subject to penalties of 18 Pa.C.S.A. Section 4904, relating to unsworn falsification to authorities. DATE: By: JoL~'-41tHt JOHN ,LKOWSKI f'.iJltIn <;U~~"('i'ftle) . CERTIFICATE OF SERVICE I HEREBY CERTIFY that I have served a true and correct copy of the foregoing document upon all counsel and parties of record this :i1~1 day of ~(JLLI ' 1994, by placing the same in the United states ;I1st Class Mail, postage prepaid, at Harrisburg, Pennsylvania, addressed as follows: Fred H. Hait, Esquire 200 North Hanover Street Carlisle, Pennsylvania 17013 , ~ :z: ..". 1/"1 ... ~>- .r'" ...z WU;"'")4f ': :c c..' i- ~oc..>.." 1"'%0> I"'")I-z-..l 0:"..'(>. ~....-: -JV') '''0.:...0:::7': ::'I'Jlu:.t! '__'~W ;-:"Xn.. ...~ .:> - en . - - ....., ....., .... :::0. -, . d!; - ~.. "'.. ;!:r. Wn4":')"~ U:.l:~'r U:CU.i. ~.... :1:0:'- h1-J":.-J , ('. "",,'>.. "."': _.1"'\ ,!'-'.C';~ , ...,lH2: . ,;:'D~ ;-.. x: 4..~ "" lie o ... -::r N u => .... to.. 0<: 0.... Z VlO<: '" ~ .. ~ 0<:> '" c: ~ CU...:l .... .... III ! w 0 ...:1>< ... lXl 'tl !( w ti "'Vl . c: 0 c: It ~ .. M Z U .... :E Cl U ~ III w ZZ ~ . III 0 '" 0 It <( OCU 0'" E-< Cl 0 It !:: .. :E'" CU '" ::> 0 ~ W ... III Q, :E E-< . 0<: I. III ~ <( g z g 0 . ...:I . * Q, < u>< ...:I ...:I ...:1>< c( z c o.i w ~ ::J E-< .... CU E3~ w :I .. ID to..z > E-< ij ~ z .. :; X on 0::> .... a: . E-<'" It X on III It It 0 U 0<: III ::>:E 0 .. :; ... E-<U lXl > :EO i w ~ It It 0 ID a: 0 u ii: 0 6 z I ::>0 0 . ~tJ ... z ! c oz 0 .., 8 X U:5 '" II: u I ...:I ~~ cua: .,. cu C) N :CCU '" :Ii E-olXl E-<::> :E . u O<:Ul z::> 0 .... E-<Z ....u Z :E Vl.... . . . .. . , , . vs. : IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 94-2000 CIVIL TERM MICHAEL J. BARTELL, D.C., plaintiff . . STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant . . CIVIL ACTION - LAW JURY TRIAL DEMANDED REPLY TO NEW MATTER 1. The allegations of Paragraph 1 are conclusions of law which require no response. 2. Admitted. 3. Admitted in part and denied in part. Plaintiff admits being paid for some of the services he has provided to Linda smith. After reasonable investigation, Plaintiff lacks knowledge or information sufficient to form a response with respect to the allegations as to what, if anything, Defendant may have paid to other health care providers. Such allegations are therefore denied, and proof thereof, if relevant, will be demanded at trial. 4. Admitted in part and denied in part. Plaintiff admits that Defendant sought Plaintiff peer lacks review. After reasonable investigation, knowledge or information sufficient to form a response to the remaining allegations of Paragraph 4. Such allegations are therefore denied, and proof thereof, if relevant, will be demanded at trial. 5. Admitted in part and denied in part. Plaintiff admits that Defendant submitted Plaintiff's bills for care rendered to Linda Smith to a Peer Review Organization. Plaintiff denies that the MVFRL requires Defendant to submit bills to Peer Review 1 Organizations. The remaining allegations of Paragraph 5 are conclusions of law which require no response. 6. Admitted in part and denied in part. Plaintiff admits that a Peer Review Organization has issued an opinion that the medical expenses in question were not reasonable or necessary, and that Defendant has relied upon that opinion in denying payment. Plaintiff denies any and all allegations of the validity of the Peer Review Organization's opinions. To the contrary, all treatment at issue was both reasonable and medically necessary. 7. Denied as stated. Plaintiff will be damaged if he is denied payment for reasonable and necessary treatment that he has rendered to Linda Smith. The remaining allegations of Paragraph 7 are conclusions of law which require no response. 8. The allegations of Paragraph 8 are conclusions of law which require no response. 9. Denied as stated. The charges in generated by treatment that was both reasonable question were and medically necessary. 10. Denied as stated. The treatment which resulted in the charges at issue were caused by the motor vehicle accident of 2/18/93, and were both reasonable and medically necessary. 11. The allegations of paragraphs 11 are conclusions of law which require no response. 12. The allegations of paragraphs 12 are conclusions of law which require no response. 2 13. The allegations of paragraphs 13 are conclusions of law which require no response. 14. The allegations of paragraphs 14 are conclusions of law which require no response. 15. Denied as stated. The claims at issue arise out of a motor vehicle accident which occurred on 2/18/93. This action was initiated on 4/19/94. The applicable statute of limitations, found in 75 Pa.C.S. S1721(a), is four years from the date of the accident, if first party benefits have been paid, or, where, as here, first party benefits have been paid, four years from the date of the last payment. Therefore, the allegations of paragraph 15 are frivolous on their face. 16. The allegations of paragraph 16 are conclusions of law which require no response. Respectfully submitted, GRIFFIE & ASSOCIATES Attorneys for Plaintiff ~} ~-- / ',' ' // Fred H. ait, Esquire 200 North Hanover Street Carlisle, PA 17013 (717) 243-5551 3 AFFIDAVIT I verify that any facts not of record set forth in the foregoing Reply to New Matter are true and correct to the best of my knowledge, information, and belief. I acknowledge that ... any false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unsworn falsification to authorities. Dat. J1 J,6;h Iffl ii _ '-~ ... _.l1l~Jib~.~~.~~IJ4~-ll.~.---_.----. Plaintiff In die Court of COII\IIIGn Plaa of Cumbcrlaad CoUllty, Pcaasyl\-mi& ---------------------------------------------- VI. Nil, __...'!.1=All~_Q_r..lllll_:l:smll Civil. i9.__.__ _P..!{\ l.ti.y'I}B.l'LtI.lLTYliw..Mmr:IQJU.I&--- INSURANCE CO., _____~_lYl~_1l~T~Q~_..;_~6~___________.._ -----.----.----------------------------------- Defendant .-------. -- .__._~ . . ~.- -. ------.---.----------. ----------------------...-------.----------------------------------------.------.----------------- .- .-- -------------------------------------.-- ._---------------- --... ~ ...----------------------- ..__._____.._________________.~~~_~C1J:~Q_~JJiC~t~Ult____.___..________________________ please mark this action discontinued and satisfied. ----------------.------------------------------------------------------.------------------------- ..----------------------------..-----------------.--------------------------.-------.------------- ~----------------------~--_._-_._-------------------------_..----------------.-------------- ..----------------------..- -------------------------- ..-----------....----... ~--------------- To __I-.i!.'!i!_~!J~.!;~1~~___._.____.__ Prothonotary ) , ., " \. -- ~:.; -, ~ .' .., No. ____._________ Tel'U1. 19______ ----------------------------------------- 5 ['IT '9~ DEe uo ,'(: ,,C) ,. 'II. ----------------------------------------- PR...ECIPE F"ued ___________________________ 19______ __________________________________, .~tty. ----------------------------------------- " \, r . --