HomeMy WebLinkAbout94-06681
J
&\i
..
.'~
,
J
J
-::r
5" ~:t
:x:: ;. .~
c., '. .,
..... ~ :.~:,~);_.',
(','1-.."\ - d." ,
:J ~ .'
f
"
f ~ 1!-
X
-I- ()
'J ':.) \;1
In 0
() '-'-) ~
':t-
ur \It-
. )ll ,l (.' r, ,j). ('11,{- J.'
'- )1 ~ I L. r j, IJIL W-H' d'Y\.J. !-1'L.J.oJ..WI!
,JM /1 /J/~""'6::Xl?t)
r,.,
'"
".. ,
o "t',
~ ~ -
--
I.;:)
::t- o-
cr- ':f-
r- -
cr-
-
"i.\ -:p
..j ~
u
f:) ~
~~~ I. . II ·
~ r.. ~ ~
::J
. E-t '. ~~n ~
N I~ ~ ~ . 1 ~
g~ ~~ '0 !, r
;Ii ~ ~ I . Q) ~~ 8 < I IN
~~ 8 ~~;i~ i
~[Jl
8 ~ ~ . :il 1I1!!11
~ i
: !~ ~I
[Jl ~
p.,
- "
-- ~
71<. l/U t,-- }-)-, (~~ I1LUJ....JA.I.(,
,,,-Ar ftj.;C fJ r '
JL~ I], (1'wG~7lb{J
J ,~
l~ ~ .
Z
~ 1::' .S ~I .~~'"
m ~~ a~ J Hi! I
;~ - J~ c
,Q
.~ ..... < ~ .~
;1 ~~ ,.t;!
(j ~ ,~ ,~~!~
.... ,:!j p; ~ !~~21N
CZ) ,;.j
'" tJ
'" ~ . Q)' fi..... ~
I ..... ~~ ..., OM I"""l
.. ~~ .;, UlAoC:OAo....
'"
~
. .
&~....-.'.." .'
U'I
CT'I :'-,_
_ ~r I ~
:I: I" .'
~ 1..1..
t.;".' .
l t) I: " ~ \ .
::r I ..'
M
..
~ ". .J
C'o..I ,._
D;: .... ~~
:C u
~
i ~~ i~. ..
..
[:J N
"
] ..
'"' ~ ~ ~ , 5 ~
~~~ ~~ ~ !iJ' 1'i ~ I ~j ~3
2f:i t [j~ t:l 8 ~ f ~
~~~ I~ j ~ . m ~ :~~;dl~
i~ ~ il!~
~ ~ ~81 Pi :n Q)CIl;~I= j
~ 'rl el e 0
8~ ~l . J! f ~ n
!!! ~
~ S PiP:: CIl ~
.gl ~
~ I(j ~~
- -.
SIlERIF"F"'S RETURN
CASE NO: 1994-06581 P
COMMONWEALTH OF" PENNSYLVANIA:
COUNTY OF" CUMBERLAND
MOTORISTS INSURANCE COMPANIES
VS.
PARKER W E TRANSPORT ET AL
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: -EARKER W E TRANSPORT
but was unable to locate
deputized the sheriff of
to serve the within
Them
in his bailiwick. He therE'forE'
PHILADELPHIA
WRIT OF" SUMMONS
County, PE'nnsylvania.
the attached return from
PHILADELPHIA
County,
receipt of
Pennsylvania.
On April
24th.
1995
this office was in
18.00
9.00
2.00
58.00
~97.00 STEPHANIE A. MURPHY
1-- 04/24/1995
-i~~' .orJ
Sworn and subscribed to before mE'
this .;JL ~ day of ~:P
19 'it A.D.
Sheriff's Costs:
Docketing
Out of County
Surcharge
PHILADELPHIA CO
So answers:
~L' /'
~'k" . /<
.,_' J . :....,'
..>1. ;0 c~~-;. -:~,.. .../ ..... ,. .r'
H. Ihomas Kline, Sheri:!:!
q". 9ro~ar^fn'
'H........... ".TU"N - .UMMON./~,,".r-anqT
/Jjt/p!u~ cPlu ,~:
/' '/.2
f--'- .3tJ../OO
COMMON PL.~AS NO.
c:.au~T"'-C01l1iL
VERSUS
It/.f'.,/$zit/L ~~~t.y',.[;r ;I
t~.zittt_ [' .;0:tk/L/ 7i7 /
. ~ ./. ).----; . /' [i2( Defendants
SERVED AND MADE KNOWN Tl!d:ft/tlt,c. 1;(,I/#,6't1 ;ftl&t/u, f Afdu;JZ 0 Defendant Company
/ I
by handing a true and attested copy of the within Summons/C_p18int, issued in the above captioned matter
on 1"- 7- ,19~ , ati:50 o'clock, A. M" E-s:t.T'.6>.S:V
at..:?J'.3:;J. ~dU",.L /&(k~ , in the County of Philadelphia,
State of Pennsylvania, t~ t1du.Lt:- ~J.'/ltJt2fL. _
tI
the aforesaid defendant, personally;
TERM, 11
NO.
o (II
0(2)
an adult member of the family of said defendant, with whom sald defendant resides, who stated that
his/her relatillnship to sald defendant is that of
Ji(3)
an adult person in charge of defendant's residence; the said adult person having refused, upon re-
quest, to give hi@ame and relationship to said defendant;
the manager/clerk of the place of lodging in which said defendant resides;
0(4)
0(5)
o (6) the
agent or person for the time being in charge of defendant's office or usual place of business,
and officer of said defendant Company;
So Answers,
JOHN D. CiRe:IIN. Sheriff
By' Vt&,
. t'" .
~;(f'/'J "7..-60
Deputy She,iff
12,38IRo,. 131117)
li''l'Th~'Court cT C.:mmO:1 Fl=::s or C:,;;",:;;-:"lt'l:nc c,:,:u:-;~'YI Panr:syl'lc:r:i:::
Motorists Insurance Companies as subrogee of John Ousley
VS.
W. E. Parker Transport
. :-fo. 94
.,6681 Civil
::-
:O;ow,
March 23
'9 95 T S"--::'''''''''::',,:;, 0_-:;' ,..--. G"""''' """ CO''''''''''''' ".. "'0
. -. - ---.. -....~ .,:)__~,J.J ....., _ _, ...~ _
==-..by ci..;:u= tb.: 5h::-=S 0/
Philadelphia
C~U:t7 :0 =:::-':,t.: =.is -,V:::,
... .,. . l.
=:.s =-~u:::::ct1 :~ -.,-- ~t :....: ....~u=t ::a
~...:k oi
:.::
?!.1!:=:.
.-(.......
-....
.". ,
,.
5l1...-..:f ot C::::i:er'...u:r1 C:u::ry, :':1.
Affidavit or Se:-ri~
:O;ow,
19
o':.!cc:::
,,,t 1=:-.-=
. ...
:.:e ':"1~...."
~F"a
.;
:y::u:c:i!:q:.a
.I.
cpr ex
-.
-
:::-:F-'"
.,
..
md -..:. lc:own :0
:.::.:: .::=:::.:s
, .
==:=t.
So :u:.ow=.
~ai
CoUArr. :~
=: :.=s
cyol
19_
CCST3
::..:..-<.'i1C
~m..z.-\G;::
.-\'" "7mA 'y7r
3
Swcr:: ;me! r.:bc-.:l:d 1:d=
..i..-___
s
,- "---..
OfFICt, ". ,
C1Ju":' '..
.1';, .
7~M('A )J-. Ifilil-
\. J r ~ I t '61 AL,tt-->>, N\4 ;..:U.' L uA' ,( ,
J.:P--lt (I, '/ fI tU v.-,.. j .
J .~
lIAR 23 B 3~ flH '95
~;.,' : ' I:,: !J:
['["1'" ' 'J
;",:, __ \/,!. IA
I U1
III I
C> -n ,
... <:tJ' I 1
~~ 1
~ I . I
uS g ,
m i~ I
~~ .S ~I .~~O\
I f~m~
'~ ~: ~~ J ~M~
I ~ 1 ,Q I '~
, I
tJ I l!! 0 I-<~ 1 & j~ 12
I ~~ 1 ~ ..:~ ~!::
..... l!~ , .\J !<
<Xl I
\D M~ , III I-<-a.~ 1
:l 1
\D 'I-< .g , '8 ~ 8 B.!. ,
I I ,
.,. ;,: I ~I -S.' ~ <Xl ,
0\ o U1 . ~~flN I
~ ~!~ I
~ ~ ~ ~ I I
1 ~ I Ill' :5 ~ N
1 I 4J.r: ..... ..-. I
1 I rJ)O.coP-.",""
, I
1
,>, ,-
h-; (,~ .I ..
j': .'
..
UJ~. .! -' .
(,).-"; ,
\" '
,I..;',. L._
~:: ,
)C:. \,:) :
ltl-: -- ,
~!' "' , id
j; , , .'.
,
'L In ..
(.) l, , (
g, :iJ
~ ~
~z ~ ~ ~- _
'a ~ ~...
~ ~o ~
g,~o ~~ ~
~!~ ~~ ~ .
~ ~l ~
~
~ - ~ri
P,jl~
~ ~
o
~i
~~
,~ -
'~~ ..
~1 r,
:~ J~I~~
'P.,t:) il .. ~ E ft
~~~~~~I~
.o:'~~~'" ~
j~i~U J
fJ ~ E
Ul
~
j
a
. ....
fA . ~
.
.. ;.
~
"',
.
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL DIVISION
MOTORISTS INSURANCE COMPANIES )
as subrogee of JOHN OUSLEY, )
)
Plaintiff, )
)
VS. )
)
W.E. PARKER TRANSPORT and )
WALTER E. PARKER, IV, )
)
Defendants. )
No, 94-6681
CIVIL ACTION
NOTICE TO DBPKND
You have been sued in court.
If you wish to defend
against the claims set forth in the following pages, you must take
action wi~hin twenty (20) days after this complaint and notice are
served, by entering a written appearance personally or by attorney
and filing in writing with the court your defenses or objectiolls 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.
HELP:
Court Administrator
Cumberland County Courthouse
CarliSle, PA 17013
(717) 240-6200
..
.A,
,
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL DIVISION
W,E. PARKER TRANSPORT and
WALTER E. PARKER, IV,
MOTORISTS INSURANCE COMPANIES )
as subrogee of JOHN OUSLEY, )
)
)
)
)
)
)
)
)
)
Plaintiff,
No, 94-6681
vs.
CIVIL ACTION
Defendants.
COMPLAINT
1. Plaintiff is Motorists Insurance Companies, a
corporation with a business address of 471 East Broad Street,
Columbus, Ohio 43215-3861.
2. Defendant is W.E. Parker Transport with a business
address of 2832 Neptune Road, Philadelphia, Philadelphia County,
Pennsylvania 19154.
3. Defendant is Walter E. Parker, IV, an individual
with a business address of 2832 Neptune Road, Philadelphia,
Philadelphia County, Pennsylvania 19154.
4. At all times material the Plaintiff's subrogor was
John Ousley, an individual who resides at 2788 Hazelton Court,
Cincinnati, Ohio 45251.
5. At all times material the Plaintiff's subrogor was
the owner and operator of a 1989 Lincoln Continental, Registration
Plate CTH388, Vehicle Identification Number 1LNCM9849XY639975,
which vehicle was insured by Motorists Insurance Companies under an
Ohio automobile insurance policy.
.
...
6. At all times material the Plaintiff's subrogor's
automobile insurance policy permitted subrogation of first party
medical payments.
7. At all times material, Pennsylvania Law recognized
and imposed a Foreign Compensation Statute allowing for subrogation
of first party medical payments.
8. At all times material the Defendant, Walter E.
Parker, IV, was the operator of a 1987 Freightliner Conventional
which vehicle was owned by the Defendant, W.E, Parker Transport,
and carried the Registration Plate of XL2SPM, Vehicle
Identification Number 1FUYYXYBSHH309124.
9. At all times material the Defendant, Walter E.
Parker, IV, was an agent, servant and/or employee of the Defendant,
W.E. Parker Transport.
10. On or about November 26, 1992 the Plaintiff's
subrogor, John Ousley, was proceeding in a eastward direction on
the Pennsylvania Turnpike, State Route 0076 in the right-hand lane
when the above-described vehicle owned by the Defendant, W. E.
Parker Transport and operated by the Defendant, Walter E. Parker,
IV, an agent, servant and/or employee of the Defendant, W.E. Parker
Transport, swerved from the left lane into the right lane of the
Pennsylvania Turnpike, State Route 0076 and struck and damaged the
Plaintiff's subrogor's vehicle.
11. The above-described collision was the direct and
proximate result of the negligence of the Defendants generally and
in the following particulars:
..
a. In failing to maintain a sharp
lookout of the road and the
condition of traffic surrounding
them;
b. In failing to observe and avoid
the Plaintiff's subrogor's vehicle;
c, In continuing to operate the
Defendant's vehicle toward the
Plaintiff's subrogor's vehicle
when the Defendant knew or should
have known that further operation
in that direction would result in a
collision;
d. In failing to maintain control of
his vehicle;
e. In changing lanes without the
clear right-of-way to do so.
12. As the direct and proximate result of the negligence
of the Defendants, the Plaintiff's subrogor suffered damage to his
vehicle in the amount of $4,609.34, an itemization of which is set
forth in the Estimate of Repair which is attached hereto, made a
part hereof and marked Exhibit "A".
13. At all times material the Plaintiff's subrogor, John
Ousley, was insured by the Plaintiff, Motorists Insurance
Companies, under an Ohio Automobile Insurance Policy allowing
subrogation of the first party medical benefits paid by the
Plaintiff.
14. As a direct and proximate result of the negligence
of the Defendants, the Plaintiff's subrogor, John Ousley, suffered
injuries which are or may be serious and permanent in nature,
including but not limited to contusions, lacerations, abrasions,
.
.
injuries to the bones, muscles, tissues and ligaments of the body
and shock and injuries to the nerves and nervous system as further
delineated in the documents attached as Exhibit "B".
15. As a result of the aforesaid negligence of the
Defendants, the Plaintiff's subrogor, John Ousley, made a claim
against his insurance policy with the Plaintiff, Motorists
Insurance Companies, for first party benefits.
16. By reason of the said collision and as a result of
the above claim, the plaintiff, Motorists Insurance Companies, paid
the total amount of $2,975.05 under the first party benefits
medical payments provision of the Plaintiff's subrogor's automobile
insurance policy.
17. Due to the nature and extent of the Plaintiff's
subrogor's injuries, the amount of $2,975.05 was a fair and
reasonable payment of the Plaintiff's subrogor's medical bills.
18. Having paid the aforesaid amounts totaling
$7,584,39, the Plaintiff, Motorists Insurance Companies, is
subrogated to the rights of its insured, John Ousley, and is
entitled to be indemnified by the tort-feasor, the Defendants, for
that amount.
WHEREFORE, Plaintiff demands judgment against the
Defendants individually, jointly and severally in the amount of
$7,584.39, plus costs.
PHILLIPS AND GALANTER, P.C.,
By
--------........------------. ,
..."'c.Ye......
MOTORISTS MUTUA~ INSURANce COMPANY 2437917 "~~.u
.
~-'_.
.,.... -"" "'.. ,
.&.\J'\JU ,
I.l~V'Vl\I~I,J IIIVIL..1L.-
(
I",. cc.
il. . fill' '..I. ......
.., '....1_"'.......
oeoc....243791 ~
Dato ...' Chodc
12/03/92
Com Iobnb..
3-066432
IIranch PClyM Code Deft 01 Lou
261 11/26/92
No... 01 FOR COLLISIO~I LOSG
P"l'..... OF' ABOVE DATE
$ ..'....43"14.136
.'
fey ..
urod
77~9~J6-44e~~7-07
JOHNNY"OUSL.EY
~ '....4394 COLLARS 84 CENTS
JOHNNY OUSLE'I
::788 HA;;:ELTON
CINCINNATI
dot
,
COURT
OH "~251
',><..:.~':?~(~\~::,'
., "
~ MAna..... UHIC
-.CItD
':!.;\'M riW CCj)"( . flcr NeO'~;J",C~
',213,,0'
-------
------.....----- ----------......--
MUG litO
i'OJ 22 '94 14'46
I>>iIBIT "A.
6142258407
'1,',
PAGe. 39
I',' .' E'" . 1'8"'.. E'" C' OP' ,'. .,
f.. .. : . . . ',' . .. : . . '. . . t.
.. . .1,.' If ,,' I'. . ... . .
.. I ..' .' ". ',' " . . ,',
. .f. '. 0' . . ",' . . .' .... . 00 .
. '" . " I' . . .. of '.' .
..:LL. .: .. .... . .L. : :., .... y
. IllEGIBLE COpy
ILLE IBLE
C p
IllEGIBLE COpy
I,.t': t': E.....' '1"8""'t': E..'.. C" 'O'P" ....'
.. . '.1,,'. ,,' ',' ..... . .... ...'y"
. I . ..' . . . . " . . . .
. '" . . ..
. .'. '. .' I' ',' . . ....':. . Of .
., " . ~. I' . . .. .' .
. t' I II' . 'I' ..... I' . ,,' I.' .. . .' '. .'. '.
'. I .... .......' . .'. ., I ........ '. ... . .
:.m't~!h~I'}Jt~f1,f~'J.~.~} ~".~
:~r;At::*~~~"i~~$:~:~.,,:";~);,.~t:r~1&~::;,,:~.!\~~~:r~", ,A1.-a -~ '~~ ' '
~~,l)(l:J ""~I-F.lml::U"I~HIJ'H~l~l:.~. .~~,~~ L r' F:.!(lY:t6U".... . -",;1',22 I rl: .~.~~...T.~} . .
.;t:~..;.110:1:.~.':':.l~I"..:NIJE:'4If:.H(jN,.[.~..~~t~~r\...; I.T Rr.:FIHTSH:'~' . J.i...~.:-(~-.. ....,...:~'i:~t:;.-:f1J:i~ .,~
"r:.":i"t~' 1)1 . tll.~11J 1~"':NUt:.}l' L~W< .;'...~~'. :L/W EDU'l'l~():J~~!I" . j:.r... ~: :'llt~..r.,~!~'-"~"~~"~/.~l 1:;"
'.E' 'l~J MLIIU,IIH.~L'UPIHl..Ii'" xc' loT, E9')YI60J9~~- '. ''''i':,''(lh''.'6U'''''~'l?'' " ;\',"
:-l::J..~\ 1 If ... ....Ul'lMti PI.' A'rE:;~~'EHU~W ~;~\I'~,';~ L. T EOO,(l~(J'ftiA.' ~. f'~~-".;...I".'~:1 (t,.ll.~~::f~i:I~"~ :,,!i'
" . . '.' ....f ,..... I' . .... ~,. .". "',.'" ~'<l;I1 ---t",.
.I::U .91) 1.IHtrl:::1.. .FRUN~.... .\.' .: .:.-. . LT. l..IKtL 'KtHU.).6... ~!,LI!Y' . H}q...OO~.;..;,.t!~..-,:::~--...:;.:I..~', .
. N'~ '1'/11 '~U!iPEWHaN Al..IUN,"'~'r..: nutJTl. .1..AlIl~f(f~'t."~:.~J;... <...:.,~;:_'l.-.n.~.....;il'1~.~1~O.:2:mN
.X" \tJ~ III ~ILI.MI,IHUUEi "'1 .;,,;.: LT REI'AlfU~I~[mt..~\.1-.~.... :~.~':-, 'l:.'.!f.)"'f,,\j\;t.::J.O.li;:l~.~
~~'!'~~~S . tlILLt\t( .HtNOl::',.~;~ .,. . ~j.. ~:' . L'r RV-F I~I~tl,t"'~~.~~.",...,. .'~~j::','~'..:~J:h :tJt.~,~.::u~~~~
~" ~~I r\LU'J.lmCKE~ ~AHElo LT E'80Y~410P'?~,1!{ ". . ","o~",la '..... ,,!I,.,',.J.1.:\:.~M
E::U :1/)1 rJI}Il~ t'S';;fF:HUL'f I FR r L T L. I t<~ I KIN.O; i.' ~~lI~i~r.T't..:~ ~Ill).. ~tl~~t ~'f':5:~. :.' \;'~:;1::~~1
I... ~III IllIlIH 8HF.LL .FRONT LT Ii~Fl'H!;iU.:-.t}.-.}J'!":i.:;":"~ .'.:. ...,;.t.!...~, ~;:~!:~. :!'.6~I.l).~~
,ti'. '~1; 01 \I/qlRI~,FRT IlllOR UUUY 'loT R ~ l' ,...;i..!\\:1~>i. ',..;", :,,~,.:,_....".;<'i'i'(,' ,~~'\.';',~
~::,~.~~ OJ I1LUU,FR-r 'UR' LU~ ~ . L.T F.OU't~"'I(JU;~Alh.t~,'n<: i'..~..t,I,67'~"~4-;r;~.J'" .4':1."'.cr'(l
.~. .24'1 11tRROrt OUTER"R/C 1.T R ~t ~~7':r.J~~.;...'n,"''''!''.:.:...:;..,;~.."..;...:.:;.t4''~,''::'('1-'~';'r1'
. _ '.".~.J 'L J. "".. .,. \. ': 4..'4..- ",. <\4 . ..t :,......;.
. .L '.. :':4'" MJ ~kuk ,UUTEk H/C L. T HI::J.4INI SH :':::''!,.!,~:~h l.~ '.:,"'::'~:':f'-'-: .~ \' Gt"'::~ ~..::.I['.J.'I ~ r4 ":..
lo ',',.,~'J tll",)L' fooT UR U"R loT RE~I"15H"....,...:r....,~. f .........,'l. -;"; .,I..!.,r~:-,.-t.tlo" _..: ~
., r.. :, r ,--- Il I..... ;.}:-....~. .. - '4 ',.' ". '. . ....4......1 .,.
L.'" :/:10 HIIWE.FHT.UR L.IJH L.r REF(Nl!;i~,~~~~~':~:;;""f::~f~~' ~:':::.,:'~:.}~\~~:J'~"~>'
E . :.!1:5 HMIllL.e: .FRT. UR UTk L.T R 6. I'f ~;~~~......":.. ~I~':;'~"~ " . * ..:....:;..:',::.a~12...1.::''':4-~
I.. :':~~, HMWt.E ....ij.r UN [I ft-! L. r HEF lIH5H';."'~--;~:';~:~.) ';':;~':..~:\:.,}. _ ~'.f'''':.. ')~\:J ..4 t.~
C ~ti'l PtlL..H~ lIUUH..OTH LT R~Pf'\lfV(\~~~-.j;' "..i~:.~......:.t"~:~: . ~ 1 ~.~~.7.0~.\":'~',:\
;..,'L'.,'.:!HV "NL.Ht<< lIUUR UTk' L.T 1lt::f"IlHS.....:...;..:. )"'" 'l':.:t'..' .'..:. .','2.1 "I.:/~
:E" :'!'jY 'JI '1L.LIIJ.}t~ UH LUH L.T EtlO'f::"::::;~~7~U;-: :;- ~ll..~:t '. ,I ~":l1j.i~::.:i
rr :189 tlMtEL...UUAkT~H L.T F::OY~'I~i'(141"':.; "....474..90 :."..-r'"l',J.'''
.L '6:.!t PMIl;:L. .uUrtRTEn LT RE:FUlt3H ~.~-~~.~~..': ...'" ..:.:~.~\.. ';' _. ~~43:'1 :...~.-:t'
....1::' 'o:n ~"'I~fL. CJuIlrnEk (t'\T UI:-:LrlL. T SECl'rO'UPAlrr.1A~ ~ti~l.:: _..:~.~." ,,1 ':'. ~IU .9' '1:1'.: ~
"E :!6~ III '"~OIJ.LlTI1 LOUER L./F' EUU'(~":~I}O'J7UH .) . '~~~.'~:J'.j . .'~":~~~'1 ~1~~~~'::
. c: 40\ ~ILUU.(,nk UHL OPNU L.T E9(IV~":!916~"\A.'.:',1. ::w.~u "'_ ..:....:1 .1";'~~:..
"r :'jOY ~AI~EL. . Hl::r1H DIJI.lY nE:p~ J R/Ala IU~> ~ ~t. : ~.. ., ." ......~. ";::.1. O..1!.~~
.L., ~IJY "AUii.L. .Hl::t'H BUUY HEF1UIHH "~'I'';';''~: .. . . . .'.,:, ; 1'.:;;''''1:\.\'
Ell :;3:.J . TA ~L.L.'HP t\SSY L. T L. I KE. KIUU: l.: QlI,\L.1,.y .. .'/:; :1)\'. +::')' :. ~.:~';r:~,.ll o{:~~',
.h t.l/13..0 L.:(JV~H.Hk UUM.,EH EUOY17K8:J~(\'.:,,,;\'.' ".: .~:'6..'1,." .::;'1f'O.1!:S.~
l.. :;:Jlj 1~IlV~lf IRR BUH~ER REFltU'Ht '..~~'A~'.' " ~ '; .' " :._ ":,~'2t.~-\4.;;~4
. r.:. ~.J;,1:f 411 l..;IH)~,IH:;f\H.IM"AL:T E.DO'fli'CU:JOA';;: ".. ,5~.tlO .' ;.'';.110 1':!i'~
:';'"1.' 'HOl l.;1.r.I'R COAT '_.;~. Rr:FHH~H . i\t .. .':'::. ";'~. j'.;~;:. ..' .... ~ ".2.~.4~::*
'~N' .f10h NII~TIJHlllJrlNU. /'lLlUlL L.,.'HlOH }'; .~,.... .......,0.00.. '.. :,~,,,~"10";1.,, .
.-.L......110o PtN51.ftIJJ~!.i-p"rUTl::U RF.FIIHSH 1'"" ..-. .,' .'::':.",',:,,:\:-! .";:' '.::.".:~.1.;k"".~:~
.' ":. ~". ..IIL.L POST . ,.,.,. . SU lJL E'T .. ";.., ~ '. :,' . ~f? . 0.0* ...:i._...: ,~.:.;'.~~:.~~~.. ~
", I' ..J.... ..,;..l,-l;~. "';"0\"'..'1~~~.
~.~:~.:' ;'.:1"'0 t......ii!i :~,./ /. ~:... . ,.,";":f~;~ .~~~~;;/:',.';. '~~~~'?'i~~:!~1~~~(~,~~~":I\~
_,.....,;~,..:::.I..:..... .. ..:......,..~....... .',,"'/"-. ~.:'..,:".. 1'.f.....:fl..~..;..!1-.~i"I,~.'.~-
'~-., " ". ...:.,c'" . '.. :"--r ....::, .....'.-.'s.!"r..t....lfbIoo..~;r.,;.....J,.;..... . ,0'\
.~, . I . "I~:. 11~ HSf\GF. ;:.:~~;'-. ~:'.: . ..~... :;: ~:i.': , :':' i::'::.~ ~!f":i\.,.~t.':!.:r~.~!.~t1i.. .
..,', " ..:....,J..:;.-;.;:.:.. . -,,~~ ....'..L~.,..~.:'.:c. /!;:;.. ';", ..;:,,\,........,~."::'^...~~ '
,'.:.''-c,.,'.".,.,~,,:...r~.~l~.:,".".:.:....~..' .... ,.., , '. _'~ , ... ....... ..~".'......-'j.H~-...."f.:~ ,;
'~ . (1J t:ALL U~AI..~H FOR EX'ACl ~nHT . .kEqUTRE:D :...: _ ';.'.' :"~.:~:~ ;::~:::.;.!..~..,.:~r:.:.;:"' .-"
... '. 1)7 :HRUG1 URAl. PART Al:i tUENTtFI'::O \J't J-\:A.R. : ::I,~..7..!..'~}fir .:::~;t~~$~..c-. :.~'f~':::~ ~
"" "'If) IIXI" HI:.AHClIEU tJur NtH COH"AREU .....1 .... :.',.'. .... :,' ::":_"'i...:,,r.-,!t. ..t'.,..;:--j:, "_"~.;'_\ ~t
\;":~':''-'''' _ . ..'" . .. u
'. .1>','.,".~ .~...'.\T",.-"i/'''';~'.: .....
_.... . '. .' t-.;;Jj')..'I1. .J""!"i...ti'1.U\ .
"\'FTtIAI. ';nl.t:IJI.(lTTOtl!i 60 ~HTHll:i'i i," .. . ~"~:' .f..,.:"""t:~,,'--rA'''.'' ~'r;.~
f .. .., :":.' ""1 ~6'~O'U""""""" ~~",:,:,'t!: 1
:..'J:"::'. Itll'J1IH "MH~ .',.-' ...... ~ -. . . \.':"':. _,OJ, 1.. l':':;':'~''''.~:;''l?' .
."'1.:jA IJTIl~" f'nAT!3 .~' ~ ..'... "':;.,',. .... i..;:,.~:'<'.t7.fJ:hOO::il-~~'.t~
~\!..:'.~.'llnHltlJ" :.:. '. '.,.".':.;.",,:.-. .', . :'.;:~ .....:~:'.'.l'....:.;'t..~: ;':;'"to!I'I~.~,.;r.-:19:1';7.u~..r:.~~~':.~
.\rlt.,...... _ ,. I..... ...... 1.1>'. ..... ",t. ... ...... '- ,..., I . .... 'r'. -. , ',.,
. "'~r;:l~)lHI14r 1'I~'l:::Ii~t\l.'''''''''. ...... . . 1 ~:\....:".... ~ ......:,;...'t.'.!. I.~ ....., 21,)0 ~C"'lIt.... ...\1:;..
~~.,. ....TIi. "..' ,"' ..~:tJ. f.' .... ..1':' .,....\ . :........,... .;~. . ..~'~.':::~.'~JIIl4'!...U..''\:;. ......"'}~
tn I:'AH..... TU rHL....{. ,....11.,. .,..:)"~." ,. _ . ........~..'. .....,:.,:'";I.:,:'.:'\;.I:'jl.r,..- 'tL"',~~ .oJ If.'_
.. ./ IT^X Ut-l Io'At'r:J ,..HA1'EH'1(\L. :.., '~~._;'.~.'.t.'\';'I..,:,~'li'~~I~OO ~~ .. 1.":12 \\:.
u._';..p ;J...'~"fl~"'''~..~,~,!:t;t["H'''!tnlVlLO::-
!....,...I_..,.-. _11'''' ....~.;1....~ "\. .~~~u,
WAJ.E.~.~'~i;_Hlc;Pl.~CE,'.It~~_"','1!ii:!,~ l.w. w~
:!6.00-~.ll!l:!1:.~'~1. ,
~'t.1.; "~.'~','~:~;"'I!~t~.:'~~~~;;'~ ,
~ '''.''-'''~ .
_...~.-
MOT
'~~~:;;A~;-;;;:;~~:;-;-'::;;~' ---O::24'382SS;-j
Cat. 01 ChodI
12/11/92
00im ~.
:l!-i:Jla....33
IIaldI
ala1
ray.. Code
0... of Lou
U 126192
.,.
......
77:!:!jI-,)b-4..a:5:7-t)7
JOHNNV*OUSLEV
Notunt .,
1'aynwI.
FOR VEHICLE REP~rRS
~y
*.0.*\4 DOLLARS 48 CZNTS
S .........\...49
.
lodIt
If
JOHNNV QUGLEY
a7sa HA,ELTON COURT
~trJCINNATt OH"O:2:5 \
.... ~"'./W;',\...:.:.. '.
.,'. .' '., '.' .....
:~. .:~ '.' ~ ":':: ". ...
v
,., "I' ,~l~~ ,~:~~\# ','.)T NC':Ci!NU!
42139
IAlrKaMtO MAftOIUI. ~
_CltICl
M.SSQ 1M
....-----..-
.---------------
IOJ 22 '94 14146
'.a...
61~407
~.40
'I . ----..~c;'r llYTl1OMf"'\)rrICE-.~-'---
\ '
,
'\
.'
.'
{
"
.
",.
.
~"AMIA '1'\MNNt& ~~.IQN AUntCIUDD ..vie. QAAA~ .
. SAC I"c.
11113 H8r\'tIllUrQ PIke. c.rtlall, PA 17'013
.. (T171 2A3411O '. .........
HAM" " \ ("ril I (......~,- DJ>,_/ J "1.:J
0( .".-.0" :..-c.-~. c=r. r .. ,..., .u..' C\
AOOIII!SS;
PHONG" 'Y c;, ,'>,- Cl "" ~ q.S'-'"
~OCAT10N OF VlHICl.Ii; 5) YI I.c.-n
TlIolI AECI!IVI!O' TIIAI COMPl.I!TeIl'
Y!AA '1< '1 I ""'Kl!/IAOO~COlCR (i....t'~,I_ -;., 'V~f1-\ t I {</".,I""F'\,'
L1ce.sE.CTW- ~~ ~~!I SERIAl.' .. :
IlAT 111IK5 CAll8 II'ROZ I!!HO ITl~ I~GTS kOClC lOUT I'\JII. .
START III!l.T OVEIIM!!AT loliSC. TROUBl.I
ACCIO!NTIRECOVERY WHEEL LIFl' . I AOLLBAC:< IDOLLIES IW'NCH
3ERVIC! P!IlI'OIWEDITOWED TO: ~-A "I 1='-'<-
M'L~GI SERVICa TlMI I!XTRA UNIT
PlNI5I' PI NiSI' PIN IS"
START STAAT STAIIT
TOT.... TOTAl , TOTAl
PAVMEI<T' MACI BY (CI1ECK ONEl: INS, CO, ( I INDIVIDUAL ( I
NAMI!IADCAESS:
PO~IC'1 " I INS. cu.,... I: I CHECK r. I
NAME OF \40TCR C1.UB' CLUI"
M!I.IBI!RSHIP r. !XPIAE;
PICK UP~IRVICa CH'i' .. MIU!AG" .. .'-' .. @noo'
TOTAL )J,\()UHT CHAAGI!D TO MOTOR CLUB: t
CESCllIPTlON 0fI WOAK J'flII'ORIAED
ON 'niB ROAD - IN THI! SHOP
TOWIPIC:<-UP CHARGE I :II "'/ I ........ I I I
-111.'" JUI. /' I I
!.ABCII CHAAGI! /' I I
/I. .....~......... a~,;;; 'OU / I I
riP I/jt.i-'~ .J-' / I I I I
'/ I r I I
~'-)::JO -~ I
TOTA~ ON IIOAD 1-4r7 ..... "'"' ,. ,c I (Q c:"..
I ....UY AImlDRIZI! 'niE AlIOVI RePAIR WORK TO I ---- 1."-
el CONULONQ WITH'IliENICI!SSAR'r MAT1!RIAL.AHO ' /' " . (' 1"1' \ I ,
HERI!IIY GllAHT YOU ANDlOR YOUR E/oIPl.OYEIS.'
I'INotIllION TO :~TI! 'Ilia CAR. TRUce. OR ;" I 'If\..\ \0.. , l.- n' \
VllltlCU HIJIlI!IN Ol\llallllEU ON STREETS. HIGHWAYS 1"1 -, al-
011 1!LS&WHIJIlI-1'Qll"THI PURPOS! OP TiSTlNG , '"'\ \I :ill .A'
ANOIOII 11I8P'l!C'T10N. A MECHANIC'S LElN IS HEREBV
ACllHOWUlDGID ON A&ovI CAR, TRUCX OR VeilCUl, ,-".
TO SICURI! '!Hi AIllOUHT lll' REPAIR HERI!TO. Sl'OAAG ys~1
IT IS UNOERSTOOO 'THAT 'ni1S COMPANY ASSlJIID
NO RIlllPONSlIILITY FOR LOSS OllllAMAGa BY '!HI!PT PNl1'S I
OR PIlla TO VEHICLl!3 PI..lCm 'MT11 'niE\J FOR BU8LA!'
STOIIAGf. !ALa OR WAlAS. SUBTOTAL I
AImlDRIZl!D BY: >'- TAX I
.... -CO. I '-'(.)
AliCllIVUl 8T: TOWING ClWlGES I
- TOTAL CUll I I
IINOlca_BeA 8210- N~ ~ 1 \)3-5
.." . lIAIUf c:::M'f I ~'oAlGUIRc:o.. ......,c.CCPI' ~lfl ~ ....4A,COI"I ,
,
.
G
~'.
IOJ 22 ''34 14147
61~4117
PI'G:. 42
'.
PWoSII
DO NOT
ST~Pl&
IN 1111S
AllI!A
,
1136
MOTORISTS INSURANCE
11250 REED HARTMANN HGWY.
P.O. BOX 42434
CINCINNATI OH
HEALTH
45242-0434
SU
im.",. IN RANCE CLAIM FORM ..,..n-; I
1....QIC.lIlC ~ ~ OWtIlI'YA ~K.&H ~tu., <mtlD"l lL~llo.HUM'(Jll ~~"RlMrJ t
i-on-"Cl,-.....OIY......n._.'" .11."..... -n ,.., 3-06643a
... -....11ooMf~,..."- ......-.. J, J'''lJIHr: DlITfH CAfC Ulf . 'loo&lo".....':I_,~'-,....-.."'-__
..."", '"'vrm."" ... ' 00 ,.,. .n ~i1 OUSLEY JOI~N
05 12 44. .
L '''TWIn AGOIIUI v-. .s-I ....,\I~rA&L.4I1OH1,...fO~(O , INll.l"IO'I AOOIIl1IlH&. ~"I
a7ee HAZEL TON CT '"'O-CJ...c::J 0'. CJ 27ee HAZELTON CT
<>" I UAf1~C'1Afili.tTIIA'~ I~ I ". z
CtNT! o -0-1 XI '''0 CINT! OH 0
i
"'"C""" I rCU,ttQ14 Ift'CflIH..... c;.a.1 Vl'l;QOC I '1I.U~'flCl,uot ......('CG..
4~c:~1 (3d e:S1-4513 .......O...-'--::i:-....n 45231 ( 513 e:S1-4:!:13
'-.. ;'-'-I.l.' 0
~ 1I,.s'AriiHrl"QHgmQlotAt~r~ 11.1HIUIlw....-_y... ;J"-~N\J/loI'UI I'
"QThUlIH:lUAIO'IHo\.\Ct~""" ,.......... ~"\IM
nlJ!'lLl::V .TnHN 0
..
.. ant,. "--.0'1 ~ ICY DIIt 0"0"" ""l!WI_" III "1.1,", 0..........." lCUMINT CIA 'Q~Sl .. .lIIUillialQAf1 011 IUUM .n ~
O'U 0'" ,.. loa. .,., .0 'D
: : ..
.. OnoUllMlUlWrI OA11 OII"'nt !
.'" .. AUro A(C1OCH" t\ACI,_ LIW\O'tI"'I,......Q"~rw4 g
'WllI . 00 i 'tV I.rt .n o.u 0...
L...-.J
"UotlI'\""CHIIH.....CO"4CJ~.-.... c. 01Mlt 1oCC1J~"'" ..IHIUNoHC'&I"VoIf"""', o,...~ - ,.
o.u 0... MOTORtSTS INSURANCE ~
...
""".~l"\AHIWI'O"'''OONl'''H''''''. 1a.&.~flV"o'ro'Ol'l\.OCAl.~' 4..S~''''''''''lOJl<C1tI1c.-.\"*.....,.. 1l'\AH' ..
n", 0"" ..
ATTORNEY D. c:. SCHULTZ """,~I.""-"""_,,,,,
IIIIAa ucc 0' '0". ."Olt. COW\.&TlHQ I SKlMUtQ 'HIJ ~AIf. 12. .HSUNC'S ~ lWntOAIUD fll!MQ..... ~I\IA' I ,..NIt...
12. 'Al'!IHn QfI AUTW3nlZEQ PIRCOH'S ~T\JA. I iIUlJIlrlII I'" ,...... of My -.lCaI .. 'IIW 1'1.."......... ~ frI._ItMel.... 11I'1/IN""9N1 ."'ICUIl.'.....-tCf
".......I.Ol':IOMI~a..m.I....IN.... D~OI~".,...I'-"'.ta""....OI'O"'..IIt't_.lCCtOtS Mft"Ct. GtfCHlCt MIt-.
--SorlmATURE ON FILE 1;:/11/~~ SIGNATURE ON FILE
......" e'T1! 'JIOHfD . .~.. .,
I..G4f'c#C"'~ ~ IUIolDS(,",IM'101Mt~R f lL - '''IIN' ~AC WAO ""'-W 0" r;:1I",~ IlL....;. IL OA,.."nv.rtIrU... TO WOIlllCIHC:U"'blfOCC'Jrlncw ,&
... . ?O . .,., :KlURYf"-~ . ON.m=T""T1 "..... OD . .,., '1'0" ww i DO i .,. TO - i aD: .,."
11 ~:a!2 :92 ~E4frMNCY lUll" , ,
".,..... ~ "<<'UWtllll"tf'lIC:loWifQ"CTktA<GOwca It""'''''NW'''''O''''''I''IWrIG~'I'~ IL 11O~I'AUtAnaHQ.t,'u "IlJI,IW ,a ~r ~1A"tCU I
~..... i co: 'tV TO !,AM i DO ; .,."
"_IDIQlllww.I.V.. ZOo ounlJl v.a, I~-- I
D-.O,,:,,-L I
~l.~OIl""T1JI'IIC'IU.Ht..", 1~"'.INLATlII";'I.Uc;.A. ralrl":" I"LlNlO ..
~ u'I4DICAIO ,,,JI'....._.. I
co", Of\IQIoI.t.lo."U.HO.
, I e4~:.Sl .1.-,_ 1 ,
u.,1IlIOPI ~U1ltONAT1OH,.",..lrt ,
.
I,L--, .1.-, i
-
.. . . : 0 , . . ' . , , , , Z
o.~ 0. MJNCI /,"=" 1\"1 ~~~~~..:;ru~ I ~""""'" I 0"'1 '""'I 1Il1lrJIIVID JOA 10
':' T. C"T~ ,'- UOOl_.. CCOI . OW\OU CA J-, 0tQ ... """"UII 15
... - .... "" .,., s...c.t!tI'l'al ..... -
2 i t.,i .,31 , I t 1 ,1""213 I i , t 4~.Q1~ I I~
, ! 0
I ; I I I , I I I I~
I , , , ,
. ..
i I i : I I . I I I I~
I , ,
... - :>
I I I I ..
i , : : I ..
. , , 0
I I I I ... z
, i i I i ..
. I , a
;;
i I i i I I i I I I 1:
, ii:
. , ,
"'_''''0_" .... "" U.'UlOfT"loWX.Cl.lN'~ K"~-Il_. u. TOfl"OWlQI . ",J:a.AMOLIHT~~ Jla.~OUI
fl1t....n.N........
'.._"''''"........ I II y I ....,... _ .. , ., YU ... · 4':;. I ~ . At!: 'M
II.~~:.=~~~-.~ :11...-.. ""O~Q1..ACaJrr_.,... """Q~WVIC "~~~lSlm.11 "'INC.
(1c-..CNlIA............."'-_ "etOtND (If _1tIM --."/rat
................--......,...,.f F.B. WINSTON & c. D. FOX M. D.
ORAN aas~ BANNING ROAD
DANIEL FOX MD CINCINNATI ~~..4523" Q...J
1-- ~, .~ .- 31-01"........1'0 .,
IoV'NOW'D rr AIM CClUfIrQ, ON IoMDICIo\ SI!IR'tCI: .....
WtCI"'I~
PlEAsa Pf{INT OR TYP6
-aNIllICII"'I"
~0VlCfI0'"
,,-
---
i'CV 22 '94 14:42
~.
6142258407
PI=G:.JB
l_........~......._ ..... ..
'.' I'
AY *......4~ DOL.LARS 00 cENTS' i
. 'NORTHWEST ORTHOPAEDICS, 'I
"., INC.
If 2ea~ BANNING ROAD
'CINCI~T1 \"OH 4~a39 ;
"
'.
.......~au.I .
-"""
CUlM F1Lil copy. NOT NEGO'AAWi
"",:1 .;:.
.-------------...----' ,".
..
....
.
!OJ 22 '94 14'43
,"
'..0
. ,.~,
.,.".......\
.........".
,....., .-. '.',~' -. .....
614~407
..
....
PI'G:. J2
Pl!AS.
DONOT . I
!T ..'PUl
IN i1iIS
MEA
I.
,
.. 01'hlllt WCIUflto 11'0\.1'" ~ Q~U" HWI8lUI
Ill.Jn..ulIMlUllCA'SO""IQlIIMTH m
... I 00 I .,., Iwll,11
.. ~~Oylft'j -... U" I.-.Wi[
!lWJNID
II. wAn ell CU""'Tt ~ /UJrfUl ,"'-.......... 0"
_ ~ Dj)'"" IHNA..I..........' 0"
11 ~7 ~a' ~C'fILW'l
I', -...0' ~~QIIlQTloM foOWlCI
It. I~"'''''V'O ~ L.aC.i4- u.&
u.
113&
MOTORISTS INSURANCE
il~~0 REED HARTMANN HG~Y.
P.O. BOX 42434
CINCINNATI OH 43242-0434
.. ~Q'YNvm (C~lleHfO" I"l'II't1OUJt
D'11
I AII<l
.......-
I "'" L-..J
,.,.." "'" HEALTH INSURANCE CLAIM FORM _. rrr .j;
I.WIDCAN WIDCAlQ CKAWuI ~.. ~~IIUIrf_:f'~ 0'ntVl... lNl\lllCA.,lo."",...". ~"Or.IW""lrDtl1 !
h.......lI,.......,,,r-1Is-..w.r-'1tv..,,.",--,...'ISN..a, -- -I (WIt r'X1 rlQ 3-066it3ia . ,
'd~;~~~;c;N;"~--- '~:r~~"'i~' .~'~rT1 .~;~.~~..~;-..._-- :
.to I_.~ ..'..r...ldllCLAfJO......ro\lllSU~ ....\lAW,....O"I:J.I"Ie.,.....
27BB HAZELTON CT ...n1-~_r! 27BB HAZELTON CT '.
~"'INTt '_'""llA;;/'":2]'_Gi -D ';;'INTI r"~H ~
1JIe:0l1 11'1S.UttOHI1"""'"".......~ Z.'C::OOI Ttl.UttQelCl'''~ C
45239 1(51;;) Bea-4S13 '-11 ~r~::'::"-r! 45"=3<) ( ~q B~1-4~13 ~
..-.., waloWol l~"'_ ........-......-. .~""'UliHrc.;,Ql<lJInQIIIAliiL..r'OIOl 11.'HIii\i"'O'IIOlwC'l' .,"'." !
c
~
...
3
c
'"
c
..
::
..
!:
c
..
~ .UTO .ccOtN"
C!J'"
.. aTl1e1t 4CCOEn"
0,,, [71...
"iMIUI\lHCI~MAMlWI~1WIII 11011. AIlCI\vlDfoOALCCA"IJU
NO OT~~R COVeRAG~ ,ON FILg ... L__.
Q.lO IAC:X OJ 101IIllIIDQlI.I COWllT1NG "SUI"INQ THIS Fa.....
II. '.T1INT'S QIIl .4U~ flllUON"S SkUrUT\PtI I ..--.u. ll'le ........ tit ..., "'-Dir... " ~"..w ;,.1Iwlft1l_
-......,....... CII..,..,., I...,..,... ,..--., 'JO'lf-.... ~ IIlI\M .....,. C:, 1.'11."""....... UiUOI.
~'lmATURE ON FILE 12/11/9Z
_ DATI
lit. ~ ',nrh' "'I.I KAQ....".. ell JIW"""'ll..I"MUL
CN'~1T:l4f1 ...... i 00 ; Tf'
1'ra.I-a..-'UlQII"U~~''''ac","
It. ~OII"'~'O~'U.HI:"QIIlI"lUlW'I~"IIEU' I.UQA. JOUiWa"lifu.-1
,.1722,~ 2.l--._
, ',LAA1......1
:. I.
,
. c
-.....
. .
.,., s.....s.,.....
o...lQaOIl'~CI
\1M ~ _ 'JU ~
I - ,
;",.,.1
" 1
I
I
I
· :: :: t,
1L 1lDUW, r~ur.h~ 1"UM tw
~~",::a<).:~J~t0& L.JITl
-. nJ" d'.....,~ 0_ S\.l1'ltl1iA
INCLUOINa. OICllIU QIIlI CM.0VtNU
...... _IN.....--....._
.............--.IIMI'""'--I
!
ORAN DANiEL FOX MD
4/30/93
-
,,,.
I~... ""' c:ca..c:.. OMutDCAl.llJtYCa....
-'-
NO\) 22 '94 14'44
'L--.
o
~au"a.. u-c... Clll'W~ I
ll_~"'_ I
,.__ 1 .-..._-
"',,"'..,. I '
.
""""'so
coo.
1 2
I ;
.1.---
,..---L.~__..
J :
I
I
- , .,
!
1L~"'lf.Hr'~JIQ.
K"'~~"
,'......._ -....
57396- ~ L2 ... "r'1i...
..,..",.. ~ .1(10..... 0lII' '''''''N~ IIIW'lCU vtW-
~1'__Il'tlI""-.""
!'LEASE PIfINT OR TYPe
... iIf-Slllll!D.s OA'. a' IlIA,"
.... ' aD ' ,.,
, .
, ,
.n
'0
'r!
. ~C'f'UI'1"""" 0" 5' JooOQl,. ,........, .
II. '1&SlJJII.v.ct ""... --"'!;1Il ~llIQWl.t.1oI '-II
MOTORISTS INSURANCE
..Ill ThM.I.uc;n.V' .......'14 tlN.Ar......".'
0,11 r-lHO "....,_......c.---......... j
l~ l~"m.s 0" AUrnolllru:J 'lI'SOU':; ~11JII' I iMlUlOll.
'1.,-,.III.....bIIlIt_.."-~~......I.
---
SIGNATURE ON FIL~
!IQN!D
II. DATU"lnOtr UMoUU TO WOIlIe IN CUIl"DtT OCQ.Mt.t.hCN
MO.loI"'loI;Q~I"' r=....~C10;'f"t
II ..o;..trAUlAflON o..-TU"ILolftD TQ G:""""";&IIv<u
MQ,y..... I 00 ; Y't l'Q "... ; OD! W
zo. OUr.l!O' LAt1 I '*MU
n,,, nl... I
I
.
U. ..,lIlUlCAlU "UUOWfS)lOH
ceo. 0..... AU. NQ.
I
U....IOA ~U'l<MllAnON""""1IA
. ,
. ,
, ,
.
'z
~~=" Is
I~
I~
..
l::l
Ill:
::l
I"
,li
I I~
: , I~
u TOrA&,QiAAQI Iu..&~r': ~~ou. I
· 4~001, :' ..~.00
~fllle5'1'''I3Rl'l'l~-S''mC.
F.B. ~INSTDN & ~.D. FOX M.D.
22B3 BANNING ROAD
CINCINNATI OH 4~Z3~
- 31-11192330& 1._
'-
I::I~I o.J I co.
,
4S.00
11
I
G
.
llOliIrotlCll'_..
l'OfIIIWo-rJlr.l_
~
1QIIIt,,"IMI
'~.,
G1422584117
PRGE.33
,}f1t'.i"":lI:J'(f IlY:ItOtItEOfI'ICf :11-22-94 1::1:::1-1: Alorottl.:!/.) blUI\JAI.~ ,~d l i"~_ ,
,: I . '~~~;~W~,.k~~XL. li~~~N~~ '~II~y 24~-:- ~=~"~~~4'A'2S1'~~:~
_ ., . "\"...,, ,I ""!;l~T"'.'.I"~. . .... ,It
. . ,.' 0" .' . :. ..:. ,-,
f ," " . , .':,.
0... .. CbocIc ~ " - 0a0n tunbor Itcroch .... Codo 0... .. '-
. i.
O~/04/'3 3~06~43a eel 31-0'2330~ Sl/a6/9B
"
....
'..
. 'I,'
..,-
.uood
77e'~06-442~~-o7
JOHNNV*OUSl..EV
No.... .,
Paynww
FOR HEDICA~'PAVHENT9 CLAIH'
OF JOHN OUSLEY
0~/14/Cjl3
"
IY
....*4~ DOLLARS 00 CENTS
..
S ***"*4~.OO
.
...
~
NORTHWEST ORTHOPAEDICS,
. INC.
229~ 9ANNING ROAD
CINCINNATI OH 4~239
;~~~(~~
''ill ~MPl.. 1J:u....~ 1!f;
CLAIM FIl! COPY. NC?'T NEGOT1A!U! '. 44 I (10
u
'"'uo .'"
--....
-....
-------------...----------
------
-...
.
!OJ 22 ''34 14144
',:.-,
Gl422Sa4ll7
Pl'G:.34
.........
Pt..E.-\se
DO NOT ..
srolPlJ!
IN~IS
AIII!A
~lviVft.I.'lI.'l .\I~I~.Il..-
1136
MOTORISTS INSURANCE
11250 REED HARTMANN HGWY.
P.O. BOX lta"3"
CINCINNATI OH 4~242-0434
HEALTH INSURANCE CLAIM FORM
. ", ~IT'T" ~ I
I.~ WII:lIl:.I.O au""" QWMI'.'A ~\of.uH_~l.ItO_QTWU ''''''SUAID''II,O:..'''''/roI1I1II ~~.~ll 11
--,..........I'I~"n(f.....'UMn,VAn.ttr-1..!UH.Q 11 IGM I "I '~04 ~,3-0664~2 .... t
~~~;~~~;="'----- ~:~~NT:{;vr:~~rl 4~~~~~~,,-~,,,,,__ '. I
..~~nwtrS"OOM.II~.~ "l'..MHf-Nl.A~fOItl&UAiD"'~ I' ~'g'I.oa"'III_."''' I
2788 HAZEl.TON CT ...rxl_- ..I-'-D i::7Sa HAZEl.TON CT .t.
"''' IlTAr. .. ,,,ntHf :T4l\J1 .. IYrT 1'1..... :z
~T"'TT 01-; -0 -I AI -D CINTI OH !!
ilI'c;~ II l-.....-.~ I~cat& I 1wQ.U Q t(
..S251 I (51.::l 851-..513 ~r-;::;;::I:::::II 4:'J2~1 (~q 851-..5J.3 I
t.Q'"I:\IJ4UN.Q.'fUoMIlW.........~4~~__1 " . .li..i;-'~rllH1'S~HOlnCoH...l".to IU II. 1M3UlleD 1'CUC'tQltOUltC"""ra,."....... ~
~~~O"r\MI~"IMA"" . ,.....~"lr.t.lf'lll~'r.lIt~SI "IHSUoIlIO'IOAflClltlA," UJl I~..:
D'D G}NO Y"; DO :.,., "n .r! :
..~AC::OIH" I'l.AClr""" .. ........I.MoUI'olI Ie
[2]'" 0" L--.J <
... Q1loUI ACQOIHT?
D'" [!]...
IN.Il'SU"lOl'OIt~\,l~
w~'1
UI"I&""1SC. vrl'I'..c.
;U-~~-~'4
13:3~ ;
,- ~. '-'" .,'"
-rn_
.. ~fMftlHtU"'O"C"
.... I :xl I Y'f J",r!
"~fllK'",,.....Uttll4.:ioUU.._t
""
.~
..~I,,",,"MMt' Q"~MlIJIOAM'
ATTORNEY D.C. SCHUl.TZ
"I.aO IAOC 0' '0"" DUO.. COWl\I'fUG . 'IQHWO 04'- (11I0.....
IZ.,...n!Hr1 011 AU~ PIRSOHS ~ru"ll """""Id 1M ,...... oW."., ---,.,.,.,..,~..-
......,.. I. .......,"" ...... I ....,...... ,.,,-.. CI 00----'1"'''.' fCPl" .. "'YW'" 0110 ,,,. OIlff"'O UCH'lI
~tnATURE ON FILE 03/11/':l3
'"""'.
I. 0A1'ICPCUMI14n ~ I.WQSIIl:nt_.-.tl>>
~ :_~ :..- T'" INAUIlTI.-.-.OIt
1, ~c:... ~2 ,..QMAM:"tf\Ul1
" ,.....g'...VVlllINQ,.,.,.UQAMC"O'..I"SQUNC~
04"
IlL II ,.ntHr lU.I ~Q cu.lI Oil m&.UlIl.UlUI.
I ON',",I1'O"1't .....::10. ,"t
, ,
!,ra.,.o.ItWolMIIIOIIIII...llli11a1'1G'''''''_ -
'''H""iIO''Oftl.OCA&.",''
II ~llS QIIt No\lUMi'OJ ww ell IMJIJIIrt 1"!1.A1'1 rre.tt I.U ellt. TO jiG N I UH61
,.~,,~
.L.--,_
.l-,
'" .
04IU~1 e. :lUN1C1
"" ":" ..... ~ 2 ..,..,
m";1b.~Q'"
..1.-..
o
'~~~,;::~':rut: I
e~iI'I!' ...oOl""!1II
C\..~'" I '
I I r: ,
.
"""""'.
eo,.
I ~"'I "'"
..:.....:..
I" ,
I I
I
.
I ,
I i
.-'-.
I ;
.. ,....
I i
.. 1__..
i , i
,
, ; i
,
..-.........
i .
, ,
; ; ;
, .
; ; ;
L.i.,
.1.Lf'IINHrs","OUHrNQ. K"~"~"'"
r,.......~~UOoI
~7...al- ~ LZ TO' I <I..
K.~. ......o.t,Q(HIIQI Q' ,.tGII.iiV -.-1 MIMc:U "11II1
~lIf....._,-..1fkoII
,
U.'~T"'.',a.MlMIIJI . LksN fIN
":1-""""""0'" nm
, 1oIGM.t.n-.0II,.,.IIICUoItMW~'.1II
~DIGNUOlltCNDIHlW.I
\'1__.,......_...__,......
...................... .....,
ORRN DANIEl. FOX MD
S/26/':13
....., ....""
~.,.-~C)IIIlooItClICA4S"'~f..
-,-
PLEASH PRINT OR TYP/!
tQJ 22 '94 14'44
.' '.
.......,..... ",,~...~,.~, 1'.""_' ...
. .~ - ~. .. ....
..: _'~" .. I
~
&.IIfS~Il..Nt'_Oft~"""'~'
MOTORISTS INSURANCE
..
"
II
..
..
...
.. " fI1lM ~u """""'" IIHU.T """'"
n"ll riND u....'_"IMt-............
1,J.IMlUAIO.S OR .LUT'HOIUUQ "'KMCN"t SIOH"TUAI I IUI__
1l.,....af~tlIflMItt'."..,,,,.....,....~.MIC...,1If
feNlCM tII...,e..a "'".
SIGNATURE ON FILE
'!CHID
...
I
.
... OATIl ,1I'IDlf ~HA&L.I TO we""lN C~MrHT OCCUI'At1OI
""" . CD . 't't "... . CD . .,.,
,aow~ I ro!!
... ..o""".t.UUona.. D,"'II ""u.lm TO ~lHr ~~u
'-' . aD . .,., ~ . CD' 'f'I
~ !' TO! ~
U,CUfSJOlv.I' S~I
rJ.u CXJ.. I
D.""QIC.I.IO"'SUIolAUlOH
coo.
,I.
-'
CWQINAI" IV. MQ.
n..AlQR""",1 --
. , . , . I" I C 'z
'...I....!:! I I ........ "'" I~
.- I). --.. ,YO eel \.CCol..~,..
\.Nfl ,..., Ii
..~.0l/J1 11 I I
Q
I I I I!
..
I r- .1 ::
...
...
:>
I ..
'"
Q
I ~
a
;:;
1 I I ~
it
:A.tQ'llIo~ 1~"""lJ\IH"".o >>r.~&DU&
I 4::2. 001. ! I 4& 0QJ
'~"JIa~ft'I'I'lDl"l'\ ow- '......C.
F.B. WINSTON & 0.0. FOX M.D.
Z26~ BANNING ROAD
CINCINNATI OH 4523':l U
_. 31-0':122306 ~__
/laJIIe t<f"'...
~QIlIIIIIOo''''
,....
---
:,.
61422Sll407
ProC. 3S
....
Il T : I1ONI;; Off I U:.
;1l-22-~
(
W.H
u.\JIVI\,I.JLJ ...'" 11...\1..-
r
. .
.' \
. .'
. .
:;I"OR'l'S THI:RAt-'V. I Nt:..
11~4 WEST KEMPE~ RD.
CINCINNATI, OH 4:\241)
Tml~1 (a13) a~1-37eo
O"'t<31 U;":-l.,."'f:.('
f'ilQO
KAI,EN QUeL,,'"
1:::8:: WEST OAL13RA Il'H RUAD C'll
CINCINNATI, OH 4:l~31
r~~i~nt "Umber: 1U41
Aml''ll.lnt r:i1,......: t, .tHFJ.IICJ
Do:. ta 01 lU1St ",tats,",," ~ I ')1'-';:';-'13
Il:1.t..1l Qs!!t:r-inf:il.:.1ll
AmQunt.
Cr.T Cod" ~"l!,JJl.!.:. R"rn~inlnr:3
97011,1 1 'I ..:1(, n.on
9,014 , f;1 . I )I~I lB. ell)
9 7 J.'''4-~: r.~1'1 . .:11'. ~O.('IO
973:" :Zt-l.oa 28..,0
'T"') 41) :('.00 ;Zl).OO
97010 I.~.OO Ij.Of>
97014 I.a,oo 10.00
q71J.1)-~:: 11). t:'tJ ~O.I)O
971::7 4-:l2 :!O.t:;O :ZO.OO
9,.'30-':: l'~,OO 14.1)(,1
901:,2,) !.l~.C')t:1 1.1:.00
971:za la.UO ,18.QO
97014 loB .(11' 16.00
~7110-~:t 21). .)C~ ZO.OfJ
9712'1- tH.J.')I'\ '10.00
~
3~~
O.!.-C4-'i'3 HOT P1o:SiHEAi rHr''fI:j-i'I(~I.
Oi~gnQ~i.: 64T,I
',1.l-'J4-'/:'; E.STIM.-Ur.IArT, t-l::lM!N,
01~qno"i~1 04;.1
Ol-04-9~ MA6~AG~ l-I~ MIN
D1~gnoB1~1 847.!
1)~-c)4-9: KINETIC EX .16-10 M1N
olagnos1s1 ~41.1
1:-~1-?: BRIEF EVAL.~~TD.!' l~MIN
D1aQnoais: A~7.~
1:-31-:;::: HOT PKS/HEAr THF'V..:5'-MIN.
D1agnosisI 847.L
1:-~1-9: E.STIM.-UNAr-f.l-l:iiHN.
Diagnosi31 847.1
1:2-:::1-9::: THEI\AFEIJTIC EX .1-1~MIN
D1.gno9~s: 847.1
12-::.1.-9:: MASSAGE I-lS I'IIN
Dlagnos1s: 847;1
12-31-9::: KINETIC eX.1-l3MIN
Di3gnos1s1 847.!
1~-30-9::: COMP .E\JAL.NE\~ 46-60 ;1 [N
1:-:1)-9: ULTRAGOUND l-L5 Mm.
1:-.~O-92 E..::iTIM.-UNArr. I-,LSM.U~.
l:::-30-92 rHG:RAPEurIC ex. 1-1:11-1 IN
1::-30-9:;: MASSAGE 1';'-:;0 i1iiu
"
.
c....
t>OJ 22 '94 14:41
":",
61422SB407
PIlGi:. 2S
. -....-:-: .... ",-
.... - ...~....'.-.~
. .....~.
;.1;,.,.,
I
I
i,
l'..,JI '. '~"'J;"'"
'" ~llJllJl\l.)I.) ...I.ILrlL- ':::..~{I"~.;.,.
MOTORIST;li~sUR~NCE W ":~'\;~,~-
112:5121 REED HARTMANN HGW.". ' '\,,~~ ,
P. O. BOX 42434 > ,:.\ ',,'
CINCINNATI OH 4:5242-121434 ,.:/;iF~
HEALTH INSURANce CLAIM FORM " "
~~ Oll4tJ1 '.....I\lIlWSIO'JrU.lIiA gtrQA~"l1'DIlt
,."" "-,II ,"" 3-1ll&&432 '~':',\; 1
io,..nu. II ',"!At c.n ""~lO"HA".I~~"""-,,,,-, ':
"'13" ''alii "'4:'5 ~ n 'I'" OUSLEY JOHN - . ' ~
'.''''1 U ~f0IH1U1l.0 ,,,It "AO \HI.~
...n.....' 2788 HAZEL TON CT
II II I..,...n~" Ai Q "
OH -0 -0 c"O CINTt OH
I T'lLU'MOHlI~"'':'.. ~..... IINCl.lJO coo
(:5q 8:'51-4:513 - 4:sa3'3 ( :51'; 8:51-4:513
IWII"_. "",....\oIIOlge~... 1Cl,!J.."f Illkll.lMO'r~v"dJQ~tI;,&HU....l
's.oo' BY:1lO6IE Ofl'lCE .--------
oWu
DlJ NOT .'
5TAPl!
IN ThiS
AAI!A
--.~;. ...,....-~:...
; 1l.22.5~ :
"""
1,-
...-,.
I"..,..... a...
-- ..
""""....
OU8Ll':V HEL.EN R
,~
,-
a7e8 HAZELTON CT
"
CINTI
4SaJ'3
.. ON
o.
~Q
WfUIIIIErIKAJf;TORGf'Ql...-~U"
.. III...,. QTIoIOlf1 lCUII"(Nr c. ~~"
..12 1H1Ul O'llU C ....f'H
D'"
la. AUlO <::lllHn
0'"
C.Gn1tR.CClCIHn
.... , uo I '"
I-
...
.~
D..
IlVatS....
r:JNO~
0'" UNO
lQt.o\Uur.r.O' Al.Cc.&I.We
"Al"\QT'''t
Q
.
"IN ""-"M""""'OII',-oaAw,."....
NO OTHER COVERAGE ON FILE
"IJ,.O lACa 0' ~"flt 1IP0Jt1 COWM.ITlNCI .. SM1H1HO nlll FOAM.
II. 'AntJol"'S Oil .l.UT'ttOI'1ZID Ot4AIQforS S)QNAruAlI IlIlI'M.. .w ....... )# ....., ~M 01 ortlH WW___
~I."""'IMJ_,I...~~.. .........,.........."""IlI"YMl1 Cllalll'OIftY'ooI'IO~01'
-~ATURE ON FILl:: lZ/11/9E:
1taHlO _
i '4. DAl1:11CtlMlNTl ~ UHIUIA<<.---.Ol'
~ ~O':"J.. W,""WI""_IC-"
I 11' Z7 : 9c:: ,.tow.cl'!~
I. ..,.,......,...'ItONfOA IA~
OATI
1'''I'...nl'''TIol.lS'''~!.I''I:''alUl""..u..''D',
'OIVI"'n'OAft .101" i CD ; rr
It.. .OJ. MI.....etA CI' Ill' MIIfG """1;1...
1 I'Q ..CD w
1.
OAMo\NMCPIWtUlCA~"" IIllLA' IfeU. U.iOlll'TOlttWWlrWil}
',1 72~~
1.~.J
II , . , 0 ,
.. 110 Wl't 1,z1.!J
"- r.
.. .. ... '"
1 8 931 I 1 11
I
1\-,_
.\-.
,
.. .. U,Q"~l.I~U
,ea.... u--. c-
~~. loIOC"U
r
I """"'SlS
. COOl
1)'213
1 ;2
.
~. ~",'~ ',+,: ~,
. ,
" ,
u,1I1OIJUr&. .uLo.~
....
ORAN DANIEL FOX MD
Iu\2S/9J
~~ '" ,u....,COUICI, 0fI~ UIMcC n.
'tIIIoCI'..,........
Pf..EAS1! PRINT OR TYPI!
/'OJ Z2 '94 1.1141
~oNI\i'" "0.1 0 ""'"
..... , 00 I "
. , ,
D,~YIIUH"'''' II
u.
.,-
.
l.."""
L 1Mi\l".&ftCllI\,aH 'f.....e CII ""00"...... ......e
MOTORISTS INSURANCE
'-I::
" IoIIIQfI1." I<IIN.'" 'u.I'I' ~..,.,
IX""n...
",..................-.-......
13,IHIUAlO'S Oil AUnrcRIUD 'UlSOH'! !Km\MI I .~. j
~""'-., --'I'M ~_~ .1". lI.....fI9NlI Oflotw..... ........1..
.lIAteMoa.cr......*-
SIGNATURE ON FILE
_..
II CArts ,,,no., UN4lll r:)wo;nc III CURNHTcx:'....,r.cH
"'0'" W DO; '1"1' ro .. i GO 1 ll',
,.. toOV'ITAUlA "OA' II
IoIU'QQ'W
.-au , l
aa.OUI"SlOI~T
o C"WNlUfl' ~'f<IJ
.... I 00 ' 'tV
TO 1 ~
."""""
~
ONOtIMl IIU ,..g,
=. III11UO""'UTt1OAIUnnrt""IW.."
'4 If I I , J I C z
IU.'''I.~'I I lalRVlDlCII 0
I CIiAlWW \l;~l'= o..a COD ~ uti =
I I I ~
45.12l121 1 a
..
: ..... Ii
I ~
..-1,.. I~
I I~
a.rUI~Q4.t.-o. IU,AWOWd"'Q :3O.~CU I
4 .illi2/. . 4~.00
~..t1fm!I01:II'lEtflt.':;"fi.lC.
F.B. WIN6TON & 0.0. FOX M.D.
aa8S BANNING ROAD C/
CINCINNATI OH 4~Z3'3
- 31-1ll92330& 1_
.., .-
.LJ
,
,
,
IIIQM.IIIC"Ao'1l1I
o\OlIW\n<'".
"..
--..
.',
6142258407
PAGa.27
~
..
~
a:
Ii!
:!
:il
a:
::I
..
3i
~
~
ffi
!:
~
..
,.
61OrVltl.)/S 61urL,Il.-
1136
MOTORISTS INSURANCE
11250 REED HARTMANN HGWV.
P.O. BOX Ita434
CINCINNATI OH 432'12-0434
nTl..". HEALTH INSURANCE CLAIM FORM
1.1iIICDlCNII "'o.c.ua CHAWUS cw""""'. _::.f~~AAN :?1.IroIIIe Q'nt", 1"~(O'tlo.HUM&III
i_r-;_.,i_"....r-] "',......, '1 '""w"" n rssm I~ ,"" 3-066432
a. r...nlHrlllWo6&lW.,..... '~".-. ~~IIII""I .. ".'_1 :"11"'" ".U1 so 4, oHS4.!AlCfI"""""............ ,.,.............-..
OUSLEY JOHN./ '"'05 ''l.ci! '44.rxJ .r-] OUSLEY JOHN
~... _r'MlUAUII_.~ ..'''fllNrn'LAflCH.....,..tQIHSUlleo "1UJI;IQ'Sol4O"&WitH&.iMwlI
278a HAZELToN CT ,..., ~'-I I=:{I'-li a7aa HAZELTON CT
em /IiATI .. 'AfltH, UAr\l1 ClN , .r."
CINTI Of ....0 -0 .....0 CINTI I OH
U""" I ""'''''''',._w''':-. "'Coot 'oa.,.,.....C4011
43251 1(313 a~I-4:!13 "'-r-; :::=n::::'-:--i 45231 I (:a~ 831-4313'
"\JOII" >HC\o#l.a'I'M....I~*-.. "'"'~ ..........,1 10 llli'.nlHrSQHOl~"'wl'Q.'c: II.iHiUI',gS~-:'t' OIIOU"OIt'!l:ANW&I~
'",.
.)c,;i',"DT:llIJtllt: orr I~
I'IZASI .
DO NOT o'
ST~Pt.8
:N 1'l1IS
AREA
.~
" '.' :....... _.>_.L.......~.----,~. 1,'
, :f1-22.:'s"4-':--13:32 :
"
OUSLEY JOHfll
. C~ IHlUAIO'C-,OUG't O. ~1.iI' IolW8fiA
.. OM\.QVt.CH" rc:~".INr o. "'1'tO.l11
a.,JOt"'IHQ.IA':;;10ATIO.~0t
,... I 00 I rt 1..11
.. ~OYl/n IIN.64II Q" 6Q00Ql. ""..e
CJ ...
D. Auro ACClJlwn
0....
..01).,,, .lCO:.IJ'H"
D,a 0""
10r.J. ~nifWi.D ~ l.Q("..U.I.ur
,..
,r-]
--
0""
"-'<I,_
D"" '---J
.. """""""IMAH NooWI QIIl"~ HAUl
ATTORNEY D. c.
SCHULTZ
MAD lACK 0' '0"'" BD'CRt c:aWUTlNG. S,,"NO 11tIJ 'aNI.
la. ""n~ OR ,wn.oAI,UD JillSON', SIOHAru_1f I .1IINftu 1M 'tIaaa. 01 tIItV "'.a.c" II OI"-t on'Clt"'11101t
"....." 1.1 ~.,,". ClIMI. I &II01iIqUiI. PI,"'IN llfgoor---.rlltfMlllI..""IO"'t,...w,.Utt'IIf1.....lCC.IOII
~.St~ATURE ON FILE 12/11/92
-..
14. 00\11 01 CUM(NT. ~ lUJ'lI!SS I"'''''''''' CA
1"1' :.... :,C; ""......-.CA
.~b -. ~1i.JM't
".~. QII "'UtIIM<<a _nu... ~ OllotlllCUlW;l
OArn ....
IILI1I."fIe1l'kAS fU,Q SA"'IOA S1"",Il.UIw,
Qlvli'iH1I UoIoIIII ..,; 00 : n'
, ,
I U"'I,.",~c'.ItUC.l"IINQ~'WQo
II. NIIII'VCD l'O" lQC.&L ~
~I. ~QAN.l",,'"I CI~C"AA.IWt lNUI'jfl.Yi ~ llOll. roI1'UlZ'IIY LJHit-
I,' 8~~:..0
Ll.--,_
:.l.--,
... .
.!-,
,
1'~l.lUM"" :;,....,-.;u. u" 5UI""UCS-,
1e......~C-- __
e,,",c ":"'" - , .:......,...."
. :
":'1 ':l'1
.,., f_.r-..
~reoilQJIslJI'\IlCl
,,&I ~ .... .... or;
1 . a '93 /,
/,
,
,
""""'...
00..
11
1
1
;
f--'
;
.
:
.
, ,
;
.
I
L
I
I
,
,
lI....n-.Hr.S~'NO. v~U":uo~rR".''Or"'f"''
,,-,",,,,, 1M'"
57401- 5 L2 ... ""
:I&. -...........u AUQllasCil_nc-1.I1'Y Yf'!:!1M SIil\\lICU~1IIl
~fDl"_~~.,......
.. .U~ rA. 10. HUWIIR iIH....
31-.a9a3306 I Ir A-I
.I, ,~~I~U~CJt'ClPIN4..1
11....,""'.._.......,..._
....".... ...-..... ....--1
ORAN DANIEl..
-
FOX MD
l.,',;;519
~D ..,........ CCl.>>Q. at t.IItlIll:M. SERYa...
'M<JI'..........
PLEASE p/fI,vr OR I'YPI!
N:lU 22 '94 14142
.......
.
00
.,'t:t
....hJ.' J\
.:..:.....,,>
....;~:..
"..,.., "
'..urn-.
lI'lCM'IICC.A&M"l1'l[Wtt !
., "'''''',. ...~O~...
... . OD . 'v
. . I I
, ,
It. liW\QU....3,........ 0" 1CHOO... /'UoM1
~
j
~
Q
'"
~
..
;5
Q
Z
0(
!i
'"
;::
..
...
,wr-;
In
-r-]
C.1H$""""hCI"-.AH""",,& OJ'~""",
MOTORIST6 INSURANCE,
.. 'I ntt'" ~f'ttA Hl.4I..rw l&httfnt..Uf'
~'!I I I NO ".....I_~.................... I
'3.INSlffllO':!: OR "UTWOJ:lI~ ~SOH'S "CHAnms I ..lAMrt
~.......'w......... ...... ~ .....UI'I..."..OI'IJ'1ICIIIlIu ruoc:u.rar
t-.n ~ecII b.....
SIGNRTURE ON FIL~
..
~
"OHm
IL OA'" '.lrTIHtU--.. TOWCliI'IC 1,'1 Ci.llNIQfrClCC1.>1.lncH
'''ONPoWjOO;1Y ra.......iOO;YT
'I. ttOUlTAU.ZA'n6HIJ..ru"'""'f&1J
MloMU&.I ; 00 i ,y
~OUT3lO'\.A4I'
D,u~",,1
12. ~.',".C\.lQ P,Ul.IlMIU;ON
... I eM.IoW., A". HO.
ro"'jOOjlY
"- .....
I
~jlillllO..~~tAliQ...H\lIIIIU\
,
I
.1 .." ~ " 's
QAY'I~D" "lIJU\lfDIOIlI 1_..
u~;~I~ ~ lOC.U.U,",
I I Ii
, I I I ~
I I I ~
"
I I !
I I I~
..
I .I if
tI.rDT.....a~ _13.l111OloN',)AtQ 1"~0U8 I
I 4~. illlllJ, :. 45.0el
-!~'. C;-;
F.B. WINSTON & 0.0. FOX M.D.
a2S5 BANNING RORD
CINCINNATI OH 45~39 ~
...., 31-0ge330& I~.
I ClWlCU
,
45.0'
I
I
I
~
..
JlO.'Mt<;I..... II....
I'nMIm.c..,.. i 1IQllII-...
'.'.
. I'
, .
"
('
..... "
~tI' w.'.;,,,^,' VI ~ 1\.4:. -"-~'";:.."~"~7i:r:'i~~fn"~'ull
'.
!l1"OR Ta THEfiAPY. we.
1191 W~ST KEMPER MD.
CINCINNATI. OH 45:24,)
T"lFlI (::ll:n 851-5'713')
~:Af':EN OUSt..EV
,~:::a:l W;;:ST GAI_SI':AITH ',L'rIO r., L I
CINCINNATI. OH ~~~~1
~~ J)'W=L~P"'l
a~-l~"'~~ ~R (EF ~'J(.'j .t=s t I~. 1-1~"N (N
Oi..1ql1o.ia: :-:4/.1.
ll::-1:l-93 HOT F'KS/HFAT 1'I4F....D-MIN.
O~~qnOyl~' a47.1
O:-l:l-q! ~.GT'M,'UNATr. L-L~MJN.
Oi~a"n~I~, A47.L
O:-1~-9: THERAPEUTIC ~:(.1~-30MIN
Diaqnos~~, 847.1
0:-15-93 JINETIC ~X.1-L~ M[N
Diagnosis; O~7.l
0:-1)1-93 SR IF.F ~\/AI. ."Si't..1-1:5mN
Oi~qnos~s' 647.1
1):;:-.)j,-''?3 HOT FK3/HER; rHI'Vl:5-11IN,
D~dqnQ$l~; 6~1.1
0:;:-':<1-93 COl.D I":(S/!C::; i'Hf"Y l~MIN,
O~AqnOS1~: a~7.1
0:-<)1-93 e. STIM. -UN~HT , J,- J.:;r'llN.
DiaQnosis: 847.1
0:;:-01-9~ THERAPeUTIC e^.1-1~MIN
O~~QnOS15. 047.l
0:-01-93 KINFT!C EX.1-1~ MIN
OiaQnlJu",,,, .'3'17..1
t)1-:<;-93 ElRIEF EVAl..ES~'B. :-l.~M[N
OiaQnO~L5l ~41.L
01-=';-9::; HOT r>KSmCi~ r 1'1110': ~~l-i'll rJ.
Di~Q"05iu: A47.1
01-29-93 E.STIM,-UNAr1.i-l~MIN.
Diag"cs~~, 8~7.1
Ol-'Z;'-9::' eRIEF EIJAL.'l!;T9.1-1SMIN
01~;nQ9~51 84~.1
01-:7-9::; HOT P"~iH~:~r.. TI4P';1~-M1N.
Oi..lyn-::}5i3: 8",7..t
l.1.L-~7-93 E.HTIM.-UN;.n T. !...15NIi~..
OiGgnc~ia: R4~.1
01-22-.y:;, &Rl~f' FiV';L.r;STi::.1"1:;MlN
Oi~qnc~lS: ~I~/.t
()1-:::-9,3 HI)" r-'1::3/11~'';'" IH?Yl:-.~l!tN..
01a~n~~13: ~4'.~
t:lt..::::z-\.f:'; E.:-:rr:"':.":JNi;1'-: ..~-.~:nH".
OJ.....qnc;; \..1 l1",,';r. t.
H:lV 22 '94 14'40
l"-'JIIJI\I.)I.,a ..._ i....u.. .
r
D~t~l 0",'-1'1-\1'::;
~~tl~f,t I,uinb~r: .l~~1
:~liIUl..U I ~ dl.l~.......: t ~ J :i~ .. "0
Jja~Q of l<l$t iiC..tQmQnt, 01-:a9-9~
.:.
" 'r
"
Amount i
t;EI G.i'-!~!l Mlnf']11p ..~ "".....l" [,-1St
'11)1:"':'(1 ::0.. 1:ltJ ~I)."')
9~'IHO 1::.00 n.!)!)
'7"Oi" 16.00 111. 00
9711ll .ltl,lJO 4r..,--0
'Y7~:C-:5.~ 1/~.l10 1 <1.1",1
9ut141.l =,) .1)1) ~O.C'.:
Y'/Ol.C, 13.'JO l::.'."U
9:0iO 1':. ')0 l~ .r.~')
971)[:1- 10..(:0 lr3.rii
971.l1)-~,:2 21'. "1) :O.~'O
l:"7~:ru-'~~.; l'''' .OG L:~ . :~..J
'11.11.)40 2(1.C'J(.l ~o .f,ij~,
C;:7'J tf~' 13.(.Il' J..";~ . r:',
9;('14 lS.(If) la.(",
'ilOO.le; :::0.00 2CJ.",'"
9/';1\(; 1~. (II) 1. ,..
.;.. .
1~:rO.1.4 1U.0(,.' 1=. .n',
'1VU4C) 20.00 .:.!t~. tj'~1
1"/11 !.e) 13.00 ~':;.":1
'.r/f,'J * li?UIJ ~::. C,HI
~ 6
..
G1422Sll407
fll:lGZ. 22
_" ..... ."vtoW.~v,. 1\0-
AR~i;L~,HOSP1TAL
244 PARKER STREET
CMILISLE, PA
,
~,~I.Al""" ,.
.
. 17013
~ , l
co ..
M
CT
-
MEO-5URG SUPPlLES
EMEilGENCY ROOM
TOTAL CHARGES
"
',' I
....".
_MOTOR HUTUAI.
.
.
---'-
-OUSLEY, JOHN
.
.
.. .... ra~OfCI'
AP 1 GENEP.AL ELECTRIC
"~.....o
-'-
MULTIPLE CONTUSIONS NEC
.1. .............--.......... ~
L-
.--
I I
,
.--
I I
.
..
FC 75 PIT
ACCOUNT , 591834-7
us.Q HCl'A.I451 PAVER COPY
I'OJ 22 '94 14:39
...,...,.,...
-
. .
.tt~h,.o.
.. . .. ~, .. ..,
45239
u., ...._., ~IQ"""""""" .. M
270 1 7 ~95
450 1 3 3 ~10
001 1 41105
, '
.
...1.....
M \ 01
n'..........'...I..
--
u,~.
I" wi. ...---"
41 ~O 5
.. ..
.U.'........OIIIC OJ....
..
nIIOl'\IiU,.tJilC,Il
CINCINNATt, OH
... ""'"
.
.-...._~
.
'.'
~
-
r-
,~
_n'_'_
0.:00
4l~1
M
I
.
I"
a.'C
.-..
...,-
12111./92
=~_,...x
.."",,," """I ~""..,....,....PIt""'''''''''''''-'' 10 '_'....._... -01....,.....
.
"_11',
61422S8407
Pl'1CiE. 17
:1
.
..-.....-'4-"-;J"*~-r ...
"''''1\11\1,)1,) ."'-110..",-
"
!'RGE ' " I
.
.(
('
NORTHWEST ORTHOPAEDICS INC.
~.a. WINSTON & 0.0. 'FOX M.D.
2~a~ BANNING ROAD
CINCINNATI OH 4:239
1:51:U e.al-':I300
FEDERA~ 1.0. 31-0~23306
A
NOT!: AUPAVMfNT5 ^ND Cl<AIICCSIlOSTlr
AFTER T~EA90VEC~OSlN(l DATI'NIU
APPiJ\R ON THI HI" 'TA'.M.HT,
r
I
KAREN OUSl.EY
138~ WEST GAl.aRAITH C-11
ctNTI OH 4~a31
AMOUNT eNCL~&O
L ~
J
PlEASE OETACH ANO RETURN TliIS STUB WITli VCUR PAVMIiNTTO INSURE PJlQpSilCAEOIT
A , PAmm', Jo,Z, "l,;"'{jo,,;;;-aae:\';DESCtIW.ON PROCEDURE ICDA ..MOUHT
I......,.... ,'/'1''1\, ....,.
PREVIOUS BAU1NCe: ."''''
lZ1 111 a KAREN NEW PT EXTENDED VISIT ':1'32'/)4 847'. a~0. 't..,
1:::1111 C: KAREN XRAV/C SPINE/AP/l.AT ,....,40 847. e.~.0\l
lallll 2 2 KAREN XRAY/THORAC SPINE/Z 7207'0 847. 7~. ~I/l
12/111 2 Z KAREN PAYMENT BY CASH 100 SiD. ~I\l-
, I'ASTOUE .
.00
1:11I DAYS. OVIiR
.00
.00
.00
340.00
OV&II '" DA VS
oveR so OA VS
oveR ~a DAYS
ClJRRENT
PAY THIS AMOUNT
,
~ ORAN URNlt:.L. r-u~ 1'111)
41 L~ tl.JUrt "C.~"'UI'l;J.a~'-J.1 T II"J .::11.:'::' ,j'H'
YOUR ATTORNEY RECEIVES THIS BIl.~ ~~D
PAYMENT IS MADE AT 'rIME or- Se:TT~E1'ENi.
wi:-: WI~~ 61:: HAPPV TO ANS\.lER eNV OIJE';il QN:
~~GARDING YOUR BILL BETWEEN 10:0~-:,~~=~
MON--F'R [. AT aa 1-~3l/l0. 6 ILLIN(; Oc:p,;:;,.,.,,=:~.r
& O. O. FO~ M. D.
ROAD
u
-............--.. ...... .-....-,.,
I'OJ 22 .~4 14:39
'~'.
6142:S8407
Pl'IOC:. 19
"., .........,.,._" '".". ... ~
~.. -"----'".'.-...-':''''' f . . I I( ..11.) 1'4'" I..U..-
.._....-'_.~ -... - '- ...-.---
~';'~1'9~8T~ ifurUAl' iNSUR~' co,.,PAN\I';~;;'10999';" ,"::.;'~:::;.' ,:,,:
,/. ,:JJ ' '.., , '.
., ..)~,I \."
e:,~
'3~_
~
r.M.Cod
. :31-re3o"OO
, , .
",."j '.'
0... of !au ;,',
U/C!6/9i! .,
:>Icy.
...w
77~9-o6-442~7-07
JOHNNV.OUSLEY
No... 01
""-'"
'0. .
"
FOR MEDICAL PAVMENTS CLAIM
OF I<AREN OUSLEY
12/~O/q2 - 02/1~/93
I
I
I
,.,
*-11:0::8 fJOU.ARS 0') CENTS
SPORTS THERAPY INC
1194 WEST KEMPER RD
CINCINNATI OH 4~240
s .......11:8.1)0
I
Ildor
If
"
, ,
---
-ClOD... ' ......,..,
. , ", , , .. ,
--------------------------------
~.~~-.~ /.~~...i:.~~
ffi""~ "J':'f """;""11 /";"G,..t:~_J
. .... . '.-
')I:""YA.j l. '''!~'~'.'~1 ,
4" I.J9
ClAIM i'lL! CCPY . Nor NKlOTWlLf
c...-
4~;
/QJ 22 '94 14'39
,',
614~4El7
f'I:lUC:.21
::..;,....,.. , .,......---" ., " .
.:.:......
..........'.,-
.
......,. ul,'nvrc.vrr i,-~
-ilT=22:<;H"Y
~i~a .
,\iIJIVI\I.)I.:l ..il,.llooU..-.
.,.
11:::...
MIJTORISTS INSURANCE
11~~<) REED HARTNANN HOWV.
P.". 61)X 42434
CINCINNATI QH 4~Z4~-0434
HEALTH INSURANce CLAIM FORM
PLIASI
CQ NOT '
!TAP!.! ,
IN ThiS
:.I\A~ .
.
"".
I.~.
rh(>" filii
C/1ou" ....r." OTHm l.l/oIu'>"IO'llIII.~I" ~'~...u".rr.v1117
_Un.M.~N llLAlUHQ . . ,
!,v..en...,r1 ....."~"" I '''I,tVtf CjJ:/CI 3-l'~."4~'~ ._....__ ~
I ~ '....To,:'.:"': ~I'nt 101"":,;;, .. ""\111111:" ,,.......L.tIt........ I" ......,. ,~~ ._. '_,'
....'w'.,., r-v1 " t
I ~ v QHN f), ":I 440'" v -, 1~II~f FV . ".H."~I I
'."""""",,"",- -, ".In' ""'inCH".. r"""'_IO f' ......,.. ooCIOI...... :,-, 'I'
'~7S:~ HAlFl TiJr~. <<T , ", "-'Q-n ~;::iS HAZE:L T')N. O::T ,_ "
CIT'I' E11"" '''"ntHrUM". \,ar, ,,',..
. I-
,'rill'!" n ..",Cl .....1 'l1 -0 '~INTt I I.~i
U~. - 1~'lN;""NdCM;, - .;;.of"l,;r..- Im"'t<"Cj'~L.;i'Af~.l!.5l" ,_
. 0>
4"~"1 0 ("l~\ "'PI-4~1~ r,-r :~"'-I~'''"''''O "........1 ("1') --I '~l' ,q
-..JL..J l w...."U ,~~ ,:-,.~ t _---I :;10_ 'h_ ,..--..... . . ..--, __, <( 'e:
"..;r"'~llo'sH.4""~r;_.""'IH__._......... 'o.ll,1Anw"!iI~....wnCNni~iCDr.:):" "'''s''''U!.J'~i'QUI;.,~.,~"..:,,:v""... .....-.....:.. i1
nl"" r:v 1,"4N _ _ Ie
.."'............:i ,O'.:;J, ""..cuo........ ........,...'''"'''11.....'..-....., 7,';,"".16'....,.......,. ,:. Ii
,.... . ';0 ' ..v ,-:
:! ..If f ,., 11,__
II. (.I.IIW,,,,A'.S H.i1l1C1I ~"';Ufo. ,..~.. -
--.
~H"'SUI'tD.SQA"'C,5iAfI.f
D." r.xi...
. .l.uro "C::OCUM pt,;,ClfSu..1
I x.J'" , I.. L--I
Ic.o;nl(tRM:':'Q;"U1 _
Dm 1-",,1"
I lOt. ne.l;lVlO' iCl1 Lo;~.. ",'Wf
C.oIo.liA""";II~..I.""."'Il.;."I'I'\OC.'."'H."C
'IX
.... . ~ ~ n J",n 1Ir-i
~7,f,W\.oJlur'NotoM'(,.A~0&,,w."i'-'
~M>>INMI.""'rftOQ.'\AMI'f.wi:
:r:
.:;
1;;
MOTIJR f:;T8 tN:.;IJ~ ~I'\II:I;" I;:
...j, r..,iliI .uoul'\OlI,A ...._~(.. n"II'lr _...,,1 1-1
, ,a.
c:iJflS r J~ ',,_......._'. o""lf:....J..1_i... 'I
11.IlSUA1:'S Oil Aur..cl'.ttc .'en1c....' ;~~"....:;u.1 .I.~~
1J~,'7\'^I.I"'lOItJ.l.......,.IIII1'.".."'.."""J.,_,..."'"too..__ '
IiNV'tt1GUC:.UU:,_ : f
S (GNATLIRE ')N ,: rLI:' I
ATTnRNEV n.l:. Sr.HIJLTZ
MAi ucx C1 'CA,. IUClA. COWU;T1MQ,\ SIl1HIHG TtilS 'OA....
II. ,."nEtI" c.. "lJTWOAtl!O '!A!ClfS SIQHATUIlI , ~WIlIUI'lU "'. I':..", f'If lit., ,1'tC!UI J, ;"U1iH ,n'~",I""'''
1'tU...,., I."..... "'" ClMft.1 j"~" p.aym~1 01 go.--........1It unt' '0,.,.".., 0111 III' .;1M,.,."" ~::.nl'
--:.ftt~AT1JRE' ON F!LE
'MlHl!D
I" OATI01 c:..M"'f'
tal. 00 . .,.,
" "f,. 51"
",MAM
1 ~Il t 10';:
aAT;
!la....o
..
~ II.WUslr.....-.ICII
IltJUAY'--.....I)..
"'fQNANC'l' r\J\llll'l
"....-=-0" ar",'I." ~iiCI
I II, ""ITJ!Ni' ".I.: I '.AI) ,,,,,'~,11 "UIIoM 'LJ "',,,,
CNq~O.T' WoI' co . tV
, ,
11~lo.~f"o;nuw.,...;,."1'~_
III. ;MQ '.\JIQ.\T;..'U.iU: ~:#O\l... ....~I"...._l.:~::"....,....
'1M Ci)' n "'l,!:o ,.,
'.110101 I I :'0 .
''- ""'sl"lfAUl.A:rQ~" ~""c.t iI'll"":~ t.') '......11.1 ;&,.. '......
MOIolIolM I tQ I -.. ...,) .~ , ,: ; t,
..
I:
,
-..11
,
I'MUI""'IOI'CRL.ClCIo&;Ula
19l;ut~'wr:~,
1- If" rY'i'~ I
':.1 "~Cll"...,~ pu.......S!JQH
,~C
OIllGiH"~ ~(r t.1l
tCr.laG.:;
I,
. .._---! I
Ij
:1
---- !.
...
""n.u.'l,;IIlU,/'l~S CIt lH.lU"'t, l"nArllTI:UJi"..a..Cl\.I 10 lie.. UIS'L..'ftJ
,
.
!
~.1 o'IloIQ.ot.lul)oU...U'IQH,.u....,.
I, , 84(, ,.J2
lL.._._
LI_.
.
.,Al"s>> CJI &.lIMe.
l,It.I':':''Nuu'~
d
, . Ie,
,,..,,..' ''Ii'll4j
.. M,
,., s.... ~'I
, I, t ,
, l' "4
I
, I
.
CW\HQSIS
"'..
I ;
u "ANH':~.:H' 'ec:""::':~'tr;
...".,......-'.I-~I
:57401-~ 1 '" '~\I..!l.l""
il.,.,.wt:u..oIDOlI .Oll'........wII'V"'-'"~ '\I '.,.",,11.
1l1HalHl&iJ,.'..-.'...I_,......
I~~~ h,;O,." I I ~
~CL= .,... I :ca
'~oL"1l1 ,1' ",
toLQj~' 1 I
i I I
: I I a
~. -.- - ,- '~,'u 'i
'I i~
I :a:
.:a. l;n""~"'J' '.:I .we...,." '.'0 ;0 ,~:: OU411
I ~a:nl ,11"1 1.1 -_.1._ 1 ':';(1 ~.t)fL.;
'!ll;,.'~'"' ."''''''''..I\:..oI\.'w....,~.,,:;. "
V"'IQot1wE,:, I (fH I HI.I...(",Eij If:'''---;, 1.1'.1.. '
F.Ci. WtNS,I)i\l e. 0.0. I~IJX ,1.C'. j,
~::8~ BANNING F;(!AiJ I
';INCINNAT I (iH ~;;:~3~ "
.."~ " 1 -..l'loi..,.~..,,',c. t...... .
1 CltAACtI
. -
... ~~,~...; .::" 12
~...'" =-
..... .-.......-,2
'"
'0
1"-
,=
Ia:
..
I~
...
-~
'",
I 1~i. t ic"'t
t
Il.
r
..,; .. '9."
,
, ,
, ,
! ;
; ;
, ,
,
,
o
----,
,
'..
ORAN DANtF.L F'1X MO
1- '''''''~'O'''
~ 1Il'.\MA c:a..ca. "" "-*:.14 lMY\CII ....
MIa.....__
PU'J,SE PRINT OR I"YP!:
....ifl..l~r.l.....
"""""",,",I~
,'....
"Ot''''''''''.
".
t-O.J 22 ''34 14: 38
614~8ae7
PQt::' ,...
'~cnl Dr:~ 'Oto't"ICE
P~I! .
ocrhQr.. .
STAPI.!!
INrI'"S
}REA '
.. .~----
--r~~~; lJ'~D;
--.......-:'... ..~..'..,
I'.' "I. ..',...:..tM;.;;c
. .., .....i"~
11"6 ~ ,. ...., ".',~;~'l'!
~ ...~~
Mr:lTojR ISTS tN:>URANO: , ~:!!
117:50 REF.D HARTMANN HC,WV. ~ ';:'j"
P.,), f,j':O:< 414;)4 '.'
':tNCINNATt OH 4:3:l42-0434 "~\i;~
HEALTH INSURANCE CLAI ORM ....;-T'1
,\:\.111./1\1 oJ I,) ,\iL I\..ll.. .
.
!
"""
I.~ "'0.:..0 ou,..-vl, ~4 ~~I'\.M ~\r..o OThlA., I'O'VI'(~"Il).H1iM_''1 1'<:..rnoc.,a..w",u'~111
........." ,........,."rl(.1.w..."SMI:-1fl"'1...., 1~..,t\II II/11M 1711'" ;1-(J,l;.~432 . ..
:,.,.r , ....~1\.."-.,..,..~'........7 .1.1'''n..~I'..Il...'''.....UI SIX ..'M4U."IQ'.......ll.~W...... AuH&oM'''____., '3.,
"""o,p',., ,--. rl
()II~1 t;:v HF,l.F.N R , '~9 ',","1. 4!i'. "~ O"'::,l.F.Y. '("'I-'N
"....l\CHrIAOQ~I-."'-t ,II "",w".tnflAhd;;;:::;i'I)IHIAJ,lUI I '~IIR:.4wQ~UI"-' lIl'-J
:.:'7~:3 HA7.ELTON r::.T I '"'L..XI.-~I I~..J ;:78:~ ~A7.S:I..i')N_-,=T
cm I :TMl I- ..,"It~, ""'1"'" !.oN I fhfC I.
r-:!Ni ,.11-' -0 .,"M[f] ~..u CINT! '~H ,
MC..O ~kC"i"_"~"_ ;;.00"," ~':""'."'L'-.n.', '--1:
4..~,--- ("1-) .;,cC'1 4"1~ .,.,......I-I-....t_I~"Mn.~ .,~.~........ ,( I.'~~.I--) ,,-\ '-1- I'
...'A..."":' oJ .:. '...' - .,1 .,;) , 1 '11_ ,.._ i.. r ...1......;... I'. ..~ J';" -.....,.J (
· ...........nl!ll.........'............_ .....-... 1"'IP",;mc;;~(.o.......It.ro" I" ",..;'0<.'''''<.'<''0' .t"".,.". -'!~
","I'MUlI~~'''OIJCYCH.ino\'!''"U.'''L' I' .~'I,"IC;lJIUI'H'on""em."J:.il ,..","WOU'C6'1t:'...1I' . t-. ;4
..... I :D ' ,.. ..
o....! r::K]NU . . I I '1~" '; ",
lHltU"ID'IQ.A'U\JIII4l'101 -, ~'-.. .. I _--;!
Will' ~ \tITU.w:ClCll4n "VCtl~.l..tl a.i,'n'''t lul.tf\~n~.:.IIC:l.'l~ t;
'1-' u-:... I I.., '---oJ --....:;
I. O'14il'.II "'~c~" . '''~\;tU'''c& ~..H m.w<<.;II .Ai.......... H4'~'
I L !''', CiJ"o i1':'Tl1R ISiS rN:::IJ;;..i'Ii:J:: ,;
4-. ,.... ".i CM""""'. -. I'''' ...."". 'en "",.." - .... .....,. ............... ...."" ,";,,,, . _ ~
NO iJTHF.R COVERAOl;; ')l'I ;::'ILE , 1"7;'" ["I"" ""."..""._.._:..._,.~ Ii
RUG IAQC a' 'Olli. "'0,.. caurumNC" $IOHu.Q rHII 'DR.... I ::"I"~l,.Q5: ': C" -UJ1.ot:Pt:IO ,1'!.!o:", 1: : .:.:.. r,u I ....""..t 'I
1'1. '..nvn-s OA ~IZI!D 'PION'S S1QHAY\I/l.11 ,.."""',, .". ........ .,.., ....ClIUI or ~II'" ""t"I9l"~" U'-""llflNol;Mh''''.' ''''''''''''1'''')1''10';'''''''''' .,...,.,.......", '
'ltl""", 10 '''''''''" CotMn I61UI~:tCll"""'" OI00'0__IDMtlVI """'11t"'\"IIIO/IOI~.,."WI'l' '-"1"" UIYO(H """''l'. .U_
-:'nlm'ATIJRE 'IN FILE 121 II I'?l';: J s rC'NATIJRF; (1/1 ,::: ,,;:'
,I
~IQHla . ':"". 'I(\NlI:J .l.
,t"j).t,flOICUMIHT'
..... ' 00 . 'tV
" ~7 1:1..,
u ""(
I
..
.... ~ 00 ! ,l' Iwr--,
. .".....~yQ'\.li _11II' CJI SCho~ /UM4II
..
""
=<."
1':\ "'''''''tHrH'''~'''s"u'o'':a,''u~Ii.I''US.
crv.. ""'" DATI ..... i nQ ; ,.
1..1r..IO....~I"OI...~~I,..,'~:cu...
11.__,_
/1...:....' .Ult)lr\"......\.' "1",,:-.,,,, :..,\&(-,." ~.;:..,.,...
'oo4W- I C".Q;" r, 10&4,;0."
" "oUlf~'flCH(..'n.ft..H1Hi~5,1o"''''' .""".a..
"'eM"" i ~ ; .,., ~a \At ::3 ..w
i3.~...':tlO(I..~~' . I 1'.....(..:1'" ..
--, ,U rvl... I
u.1_teICloQ~"
ccc: :~:H.......,....
l:.1:~4:'.. 1
. .
G4rw&&O'SlMIIQI
fIl.. r.
~""IQI'l"l.lnlO"':";'IlOH~....'.
-l[
Ii
'"I!
,
,
I
,ll.lIWOMJ;&e 0
'OfIIWII"O""'~~"'ll4l1ft.A"lTtM'l UClA. IO"tt.,~,d'f~1
1.1 i?'2....!
,
.
Ii
.~ I .. , I Z
1.).I.;';'I"tDfl I I "ftU,,"_' 1':11 9
vf.~ 'M:'I~:C':II ~O:~\\,jU I';
2::~,~"11 ;~
~'ILM /, t' ,- I I __.,___ I~
7~i ""'1 I I I '~i
I I, I ,iQ_~
m"" la
,;,;
I I I ~_J
.u f~"" CH4-'C; III ....lo()....t ''''10 ~ tJ4L.ulC: Jw.. I
· ~,:), ~ on f ~ t ~ :.) :.01:-
1<I1~':"~l.I~'" . ~i'''''''J'''':" '':''.
1,1 f:.~ 1 IJh I r1U&- ~t:.U ~ I,..':" . rt..,.
~.8, WINSTON' a.o. FOX H.D.
2:83 l.'lANN'[NQ A,jAD
C!NCINNATT I:'H 4~:;;::s'ii
~"~t_l'lo)"'''''':tl''\,l, 1-:....
'en..'OCI"IWl
'cr..~,,~
1/
~
~
""
OIAC1<<]SIS
c::;:ar
I OO....IOItS
."
,-:)..,
..,
,...,
'"..,
4rJ
,
I
'-.
L
..,
~-1~~t1
.
t.:)",
..,
.
i
za tA.lo.~ SIN' Iu/f
" - ...,.,~,'''' [ II
I. Il",,.n,.,..,~~~~......
=~-:=~~
""'IIOI.........__....~,
I'FlAN DANIF.:L FOX NO
,.."
....,
1~1Q ~ AMA COUNcI.CIM-.. ..--.....
\IIItoCIw...... -................_
PI.J!ASE PRINT OR TYPE
.
t'$*
1OalI....1Vll
i'(lV 22 '94 14'38
::,'.
6142258407
_.........::;: ..
.leI'.IlT:I1ONI::'''Ol'flu:: :U-22-IH: lJ'~I. ~IVI"I\'~I~ ~i~I~,u..- .:t;.'..,'t".
------------- T- ...-... '. .. _;\ I
~~'~l'~T' i.SJ"'.~At~:INsu~~~.. COMPANY a4~Eu.~~ ,-::..,=~..;.-" ':' l' o.eiX?2"'4' ':'~8"i6'"~Mi
." \. .... '..' l"'.. , . \. ,t .;J i)U......
'f" ' .,....,..,..,;;.
.... . ,.. . . '.." .::.e
. , .
c-..i~ Oaimlllmbor "-h PGyMCad. Oa....,~' :.iii
1e/i!E!/<i2 3-066432 261 23-22:l<i396 11/260/ge .
. .~.,
01-
-
77:l9-o6-442~:l7-o7
JOHNNY*OUSl.EY
No".. 0'
PCll'mOnt
FOR HEDICAL PAYMENTS CLAIM
OF JOHN OUSl.EY
*
-+9b DOl.l.ARS 00 CENTS
RWC EMERGENCY PHYSICIANS
117 N. HANOVER STREET
CARl. ISl.E PA 17013
f:_ ....-:"'.::... "~'_._.i .
"r;. -"'"'~ ,/ ", /'..... ,_~ : #>"':
tltA ~ /.'......_..../,,',.t.."'~..r '.r
',,-'4 ._..,.... . "_'
t~ ~~. "..~ ~;.. '~:~'-=,:. !..:',:'
:,(.:;z:..::6.::..!:.~~;:.:::,
S ......960.00 :,
--...-
_01<<1
C1..AJM FILe Copy. Nor ~GOTl"'OLG
10;:1:196
----.. ---- --.-
-UOI""
---.-----........
/>OJ 22 '94 14'37
'~'.
'...,.- .-: -- .~. ". .-....................~ ...,-...... -
614::>~~...,
. :.-.:
, ~.
.-.,.....: -:
., ~"':'
..'::1..
IMARY
','.'''lot..
." .
.~:;.. '.:.':.
.. " ~..
,! ~ 001/ 001 ~??90 HOTR M~
.-,..,.... 'I~"- \"- -. '.. ., . I
.-~..L... ....,;:1...:. t,.....: . .... '. ,. .,,;
.-.-...--
_.:1
.o;~_":04
, ,
"....:....
...., "\0"
$.. .~.
'. ".l'~ ..
...........1..
:"I'""""1'~~1
~I~""..'
J. '".."1 'X
_...;..t.
SANE
-"-'-- --
.:
,~,~~l
1
.j
~L~Y;" JO~~ /"-,....
-;'~~~:'. ",..!,
~7ae HAZELTON CT
----: .
-,
--...--
~ 1~ 44
x
SAME
'-"'--:":"7,
-
.... .
- --
x
'1'-'"
-....--
.'
CINCINNATI
OH
.-X
-~_.
..
. ,
'-'
.~ :'.' ':.' J \ ."
~a3-a~1-4:513
'-'
'.
4=239
'--
,
1'-~
... . .
".--
". . ,"1' .."':1'
'-:;.
!..,..-
'--n-' ,
. .j. ".
'---"'-
.. 1'." .,
::---:.'t.t
~---.:~-'''''
x.
.,
"'-'.'---
:..,
'.'
'.' ';1.
..._--.....
I....
.' ~
x
..1'
"
.
--:.-';"":". .":--
'--
..
.. .
'--'-:"".
. .'
;.
'X
......
--....
10.1 .0;
.~---
. '
~
NONE 0/00/00
... -.i'1=..:1,'~i''!";;;;rm::ii':::;,t'''l,\;;;L.1 .~::a.'.i:'~,'7i."i~"
"-.;'.'::,-" ....:':::.....:. ..~.;:..."1' ...~... .-'.. :. 411." ../ .
I ;.. .. 'i . ~ . . - .. M . _ .oj ~. . . . to .~:... .. . ,'" . ..
. ~ ~
,>.t-~~. ~I:_..~;.~
.t '.
~-~.
.. .. ., ...
.1 '..
. ~. .
." ,; SIGNATURE ON FILE
I \.:. ...~.... . ,,..,, I'" ...;~... ..... ",l"':":" ~.
I J.' .. .."'.'
" ....~ t. .. . :.'
~ ~.;~:;r:~i;..,.. "'H'!..,a ::1"~
., J '..: .' ...' .
......:.. .- :',1
": SIGNATURE ON Ftl.S:
.-------- -..-.-
:.: ~.~ II; ':"'.. .. ... . .' :", .
MICHAEL S l.IPI~E MD.
"'''!,':;1;\~~1''-
'. ",.', Q: ~ ': 'l1~S"" ':'1 . .... ,
.. --- --...
~-~l.:';....,..:..,
.:~ ..~,.: ;.
~.7....~-:--:'~.- ;......
--00:-- ....
.. ..
'-~"t.11
7:"':~i-:"'-~ I.;
.h :r
-. --:-r-
, ....' ,'l. ,.
:, 'X
---... --"-
,'t'- : '.'.
924.8
-..,--.
.. V71.4
---r.--r_..
-.
" I. I'
"
11 26 9~ 11
---.... -. .....-
..
,
.~:....
'-.~: ;;,.~"'"':":r:
.. '. .. .
....~..~.:.:.........:.~.:.!.:~.
'.','., .1 I
.. ---:-:-:;--
. '..
.....
26 92 :!:! 01
--'..--.
9~~a3'
1
::!
9609 ---~
'--.' .._-- ........
,.--.-. '---' --- .......---
....--
'-"
'-" ..
---.- . '-'-- :-.. '--
.--.-.
..--.
--. ..-....
23-2:l::i9396
. ------ -....-. -..
" ,
c
- '.
I,
"'-'--.
'x :591G347/01 12
..... - ....' -.-. . ..-....- '-"-' - ..---
I. . '..... .... :. ..
'" CAflL."iSLE HOSPITAL CAf/LISL
MICHAEL S. LIPPE M.D ~4Q PARKER STREET
1~03/?::! CARLISLE. PA 17013
9600
00
?40<
,--
- .......
RWC EHERCENCY FHY~ICIANS
11 7 N. HANOVER ST. 717-:W]-?1:
C.~~ISLE. PA 17013
~U:!3-~5'73'.
., '--.--
. .......
IOJ 22 "34 14'37
'1"
6142258437
~.12
(
.. ' ' ',., .. '. .:;;.:_:.:_:.:.....:....:..!'r=22~~"i"-1~'''r::-~..~' ~iVI"l\IJ1~ ,0,1.'1..\1.. " ..;~;1'i."'!11':9
.x:a'I"DI'.n\l\'lU::fJrrl~ ' .... , o6,Q, " ......sr. iJi."
~., I '. . ....,..c.a........ ro- f,':.f J.~lI'" 'l-2'4"" .. ......
~l. ,~I~TF.~\~~~,It.\BlJR,ANcE,.r;:D"'Pf\Ny,~3a649 ......:-:~:....~':, \':':t.....'~~ ' '3861:tt
~ ~I...~".~l ""''i,:t'..' . . ',,': . ~ ..,: ~ . I ".'J" ~H
... . -. ~ '\00 . , . "'.
" .. "
Date otCMd< Cairn N.onbw Brandl ~ Code Date 01 Lc.n ~.
12/22/92 3-060432 261 23-2298422 11/e6/'12 .
", .'
.:
77l59-06-442~-o7 '
JOHNNY*OUBLEY"
No,," of
Poymon'
FOR MEDICAL PAYMENTS
CLAIM OF JOHN OUSLEY
tq-
I! ...!
I
I
I
****23l5 DOLLARS 00 CENTS
CARLI8LE COMMUNITY AMBUL
P.O. SOX 496
CARLISLE PA 17013
s
......?3:l.00
!or
:.~;,'/:J ,,-j-;;; 1/.'.?).',:r-'7);
I~':"t.~~."... :,v'~r-:.",:.~~
','.",.. /.P;' . '/:f:',/ ':'/- "1
..,r.. __.-.,
. .. '..,..r.: 't! t .'.....,. .:,.-::.'
",,",.:._.-.:-_.-':~_... .J
ClAIM File copy. ,,",or NEOOTll<SLE
42136
UCDMO~I'"
0""'- """
..ua"",
, -
-------------' ,._-~._--------------
I'OJ 22 "34 14136
614":6<107
f'~.c:l9
.
'~'.
'; :; :':"'''~'':'::'''.~:'~'-:'''''''''''''''\J;.-:-;:;-
r : ~ . 'CUM8ERL.AND-GOOOWILL FIRE & RESCUE CO,
' CARLISLE COMMUNITY AMBULANCE
p,O, sox 498
CARLIS~ PA 17013
(717) 249-0012 FAX (717) 243-5482
TAX 10. 23-2298422
"'''"''~.i "'a-~; ..... ,
C>. .... ...
';)-:--:1 . --r.\l1 '.;1\ f ,J I oJ
".I'-.h.
, .
INVOICE /I (, g:!:!\J5~7
BILL TO:
DATE: C,t :2/1) ~/~:! ')
.;CHH .JUSt!::"!
~:::77 HA:!!:, CC.ijR:
:=~Nr;INNAT:. :)H ~5~39-
PATIENT: JOHN i)!1::!.Z'e /
RIffiJRN TOP PCRTlCN WITH PAYMENT
ACCOUNT' 4:::8:~~:
TFlIP It 92:0527
DATE OF SERVICE: 1 ~ ''':.? l'l:2
PATIENT PICXED UP: ?A 1'tl;:ll?':~::=:
PATIENT TAKEN TO: Crt::.!.: ,oLE !:OS?!TAi:.
OESCi'lIPTION OF ILLNESSIlNJURY
~AS i..mmm i~ .lB !l!!m.1CY StillmON. COULD om !! ~OViD aT mm:m.
~ :0 jUiO ACCIJAi.
at.:; ';AltVIC~ l:iiAac~ AOO':'O
i-l:U:A.:::=: AOO:O
1.7:.00
4,00
1
15
l75.(\C
~v .''':IJ
COMMems:
SUBTOTAL
.woUNT
PAID
:".J':. .1.:
I).I.\I}
MAI<E CH!CI<S PAVA81.1! TO: '
CAAUSUl COMMUNITY ....aU!..UiCe
P,o. aox... . CJ.RUSUi, FA 17013 '(717) Z'!klOIZ
THANK 'YOU
TOTAL
...oj:...'I.'
-
"CU 22 '94 141:J6
....
Gl~22a4Q7
~.11il
~ ,
VERIFICATION IN LIEU OF AFFIDAVIT
STEPHANIE A. MURPHY, ESQUIRE, says that she is attorney
for the plaintiff, that she is authorized to make this statement
and that the facts contained in the within COMPLAINT are true and
correct to the best of her information, knowledge and belief.
This statement is made subject
to the penalties of 18 Pa. e.s.
Section 4904 relating to unsworn
falsification to authorities.
PHILLIPS AND GALANTER, P.C.,
,-
f
~
,f: --
j". -,
Ill! I :.~
(' J 0"
j. ('; . . '_I':
17'"" I '. L)'~
l.,); ~..;
/.,' .
I:;
L~ ~
r.) j
~ ~ : : ;; ro..)
, ,- ~ ..
r~j!j
:''..1(1..
., :)
:.J
~~~ h _ ~I ! , .
] t z ~
~ ..
. f ql!!
~. fl i~
~I~ ~~ ~ 2~ i ~ ~ ~ ~ ~ =
~~
~ ~ m~ ~ ~i ~ og J.~~~dli
~,~ 0 Il< r.
8 ~ ~ P::1l< ~~ Up!1l
~r<i
. ~~
~ ~~ ~ ~~
~ fl U)1ll III
"" :il :3:~ ~
" .
-, .
...
.
~
..
>- 0 ~ i ~
( -~;:
j' ~ Lu
UJ~'! (.~ .< i~l~
(),-
c'
J...- " ~I I
dr II.
8' ,. ;~1 ~I~
r( r- , ,
<'I I ;.:~
[;':',.' (,:-- '<I - g
{" l\.}
L' . C'__ { ~
.... ,n
U
." "
i3
.
'..
- ~
.... ('~1
(:.-~
i .'~ Cj
..
UJ~.: ~ .~ ~ i I
0"-
, <'
[to 11._
<..-")1. . , :~i ~IU
l,' ' -:'0
L.' "2
'.t.l'-- ('I
,
ii: ~' . I" . ~ 'U
, ' . " t_~ 1
{,- Ld
U.
1<- 1(') :_5 I : ~
0 I,. <.J
{
5
..
..
'.. ~
'.. .-
r": c . ~
j-.., .... . ,
IJt'; -' " ~ i ~
--
("c":~ (- u_ ,
1" ',' ~ 'B
~:: ;
VJ
'" -- ,.j ~ I a I
-I:"'. (
'.. ....
c' 0,
"'. ..... I~~
,
,.. ,., r;.)
l) ~; I
(
. ,
6. Denied. After reasonable investigation, answering Defendants
are without knowledge or information sufficient to form a belief as to
the truth or veracity of the allegations contained in paragraph 6 of
Plaintiff's Complaint and the same are denied and strict proof thereof
is demanded.
7. Denied. The allegations set forth in paragraph 7 of
Plaintiff's Complaint constitute a conclusion of law to which no response
is required. To the extent a response is required, it is averred that
Pennsylvania's Motor Vehicle Financial Responsibility Law (75 Pa.C.S.A.
S 1701 et seq.) precludes subrogation of first party medical payments.
8. Admi tted.
9. Admitted.
10. Admitted in part and denied in part. It is admitted that on
or about November 26, 1992, the Plaintiff's subrogor, John Ousley was
proceeding in an eastward direction on the Pennsylvania Turnpike, State
Route 0076 in the r.ight-hand land. It is further admitted that a vehicle
owned by Defendant W.E. Parker Transport and operated by Defendant W.E.
Parker, IV, an agent, servant and/or employee of the Defendant, W.E.
Parker, was traveling on the Pennsylvania Turnpike, State Route 0076.
It is denied that Defendant's vehicle swerved from the lefthand land into
the right-hand lane and struck and damaged the Plaintiff's subrogor's
vehicle and strict proof to the contrary is hereby demanded. It is
averred that at all times relevant, Defendants acted carefully, lawfully,
properly and prudently with due care under the circumstances.
2
11. Denied. It is denied that the above-described collision was
the direct and proximate result of the negligence of the Defendants
generally and in the following particulars:
a.
In failing to maintain a sharp lookout of the
road and the condition of traffic surrounding
them;
b.
In failing to observe and avoid the
Plaintiff's subrogor's vehicle;
c.
In continuing to operate the Defendant's
vehicle to~ard the Plaintiff's subrogor's
vehicle when the Defendant knew or should
have known that further operation in that
direction would result in a collision;
d.
In failing to maintain control of his
vehicle;
e.
In changing lanes without the clear right-of-
way to do so.
On the contrary, it is averred that at all times relevant,
Defendants acted carefully, lawfully, properly and prudently with due
care under the circumstances and strict proof to the contrary is hereby
demanded.
12. Denied. It is denied that the Defendants were negligent and
that the negligence of the Defendants was the direct and proximate result
of damages which the Plaintiff claims.
The remaining allegations of
paragraph 12 of Plaintiff's Complaint are denied in that after reasonable
investigation, answering Defendants are without knowledge or information
sufficient to form a belief as to the truth or veracity of the
allegations and the same are denied and strict proof thereof is demanded.
3
13. DeniBd. After reasonable investigation, answering Defendants
are without knowledge or information sufficient to form a belief as to
the truth or veracity of the allegations contained in paragraph 13 of
Plaintiff's Complaint and the same are denied and strict proof thereof
is demanded.
14. Denied. It is denied that the Defendants were nBgligent and
that the negligence of the Defendants was the direct and proximate result
of damages which the Plaintiff claims. The remaining allegations of
paragraph 14 of Plaintiff's Complaint are denied in that after reasonable
investigation, answering Defendants are without knowledge or information
sufficient to form a belief as to the truth or veracity of the
allegations and the same are denied and strict proof thereof is demanded.
15. Denied. It is denied that the Defendants were negligent. The
remaining allegations of paragraph 15 of Plaintiff's Complaint are denied
in that after reasonable investigation, answering Defendants are without
knowledge or information sufficient to form a belief as to the truth or
veracity of the allegations and the same are denied and strict proof
thereof is demanded.
16. Denied. After reasonable investigation, answering Defendants
are without knOWledge or information sufficient to form a belief as to
the truth or veracity of the allegations contained in paragraph 16 of
Plaintiff's Complaint and the s~me are denied and strict proof thereof
is demanded.
17. Denied. After reasonable investigation, answering Defendants
are without knowledge or information sufficient to form a belief as to
4
the truth or veracity of the allegations contained in paragraph 17 of
Plaintiff's Complaint and the same are denied and strict proof thereof
is demanded.
18. Denied. The allegations set forth in paragraph 18 of
Plaintiff's Complaint constitute a conclusion of law to which no response
is required. To the extent a response is required, it is denied that
Defendants are liable to the Plaintiff, Motorists Insurance Companies,
for indemnification in the amount claimed.
WHEREFORE, Defendants demand judgment in their favor and against the
plaintiff, together with costs of suit.
By way o~ further an.wer, D.~.ndanc. a..erc the following
NEW HATTER
19. Paragraphs 1-18 hereof are incorporated hAre in by reference as
fully as though set forth at length.
20. Plaintiff's Complaint fails to state a cause of action upon
which relief can be granted.
21. Plaintiff's Complaint may be barred by applicable statutes of
limitation.
22. Plai01:iff's claims are governed by the Pennsylvania Motor
Vehicle Financial Responsibility Law (75 Pa.c.S.A. 5 1702 et seq.).
23. Plaintiff is not entitled to assert its subrogation claim for
first party medical benefits paid to its subrogor.
24. At all times relevant, Defendants acted carefully, lawfully,
properly, and prudently with due care under the circumstances and the
5
I
. ~
-.. c'> ~ . ~
t'; c ~ ~q
C", (:':'J 1111
\II ~
<,J ~_- ,. "
l~
'7, . ~ i I
\. ,I \ - C' .;
(L.. ~ -- "
....' [ : : ~
\. ,
~.\,l
f.. .. ; ..
" .:.; ...._) (
l..' ~ G.
.
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
vs.
I civil Action - Law
I
i
I
I NO. I 94-6691
I
I
I
I
MOTORISTS INSURANCE COMPANIES
as Subrogee of JOHN OUSLEY,
Plaintiff,
W.E. PARKER TRANSPORT and
WALTER E. PARKER, IV,
Defendants.
PRAECIPE TO SUBSTITUTION OF VERIFICATIONS
TO THE PROTHONOTARY OF CUMBERLAND COUNTY:
Please substitute the attached Verifications for W.E. Parker
Transport and Walter E. Parker, IV for my verification attached to
the Answer and New Matter of Defendants' filed in response to
Plaintiff's Complaint.
,
GRIFFITH, STRICKLER, LERMAN,
OLYMOS & CALKINS
(~~,( A
BY: v j\
ROBERT A. LERMAN, E QUIRE
Attorney for Defendants
Supreme Court I.D. No. 07490
110 South Northern Way
York, PA 17402
Telephone No. (717) 757-7602
jsh/1J3S
VERIFICATION
I verify that the foregoing facts are true, upon my personal
knowledge or information and belief. This verification is made sUbject
to the penalties of 18 Pa.c.S. S 4904, relating to unsworn falsification
to authorities.
Walter E. Parker, IV
c' ,
(..
..
','
, ,
I::
I
(
,
,
, ,
,
f'-<
o
~ ~~,
~ ~t3
z ~ ~ fj 8 ,,,
9.~~ ~
etj[g ~~ ~
~,,~ gj"" ~
~~~ :i ~ .
~ ~~ ~
~ 2~
.
'~
C;! ~ i
8i:< ~
J~' ~
:>J ~
~~
r.bl
~S!
~
""
'~I ~
~ z ~
liS' 0 ...
"-l P ~ ~ ~ ~
, ~jp ~
it:' ~ ~ B g il
~. ~ 8 I! ~ ~ I ;
~ ~ ~ ~ .
. ~ ~ ,,~ ~
.0:1 ; ~ H S
,~ ~ ~ G ~ a
~ f E
.2J Po.
[J)
.,..
~
~
~
!:!
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL DIVISION
MOTORISTS INSURANCE COMPANIES )
as subrogee of JOHN OUSLEY, )
)
)
)
)
)
)
)
)
)
Plaintiff,
NO. 94-6681
CIVIL ACTION
vs.
W.E. PARKER TRANSPORT and
WALTER E. PARKER, IV,
Defendant.
REPLY TO NEW MATTER
AND NOW, COMES the Plaintiff, Motorists Insurance
Companies, by and through its attorney, Stephanie A. Murphy of
PHILLIPS I< GALANTER, P.C. and in support of its Reply to New
Matter, aver as follows:
19. Paragraph 19 of the Defendants' New Matter requires
no answer by the Plaintiff.
However, the Plaintiff hereby
incorporates each and every allegation of its Complaint as though
fully set forth at length herein.
20. Denied as a legal conclusion to which no responsive
pleading is required.
To the extent a responsive pleading' is
required, after reasonable investigation the Plaintiff is without
knowledge and/or information sufficient to form a belief as to the
truth of the allegations contained in Paragraph 20 of the
Defendants' New Matter and the same are therefore denied with
strict proof thereof demanded at time of trial.
21, Denied as a legal conclusion to which no responsive
pleading is required,
To the extent a responsive pleading ill
required, after reasonable investigation the Plaintiff is unable to
.
ascertain the factual basis for the Defendants' allegation that the
Plaintiff's Complaint may be barred by the applicable statute of
limitations. To the contrary, the Plaintiff hereby believes and
avers that its cause of action was filed within the applicable
statute of limitations. As such, all allegations contained in
Paragraph 21 of the Defendants' New Matter are denied with strict
proof thereof demanded at time of trial.
22. Denied as a legal conclusion to which no responaive
pleading is required, To the extent a responsive pleading is
required, after reasonable investigation the Plaintiff is unable to
ascertain the factual basis for the Defendants' allegation that its
claims are governed by the Pennsylvania Motor Vehicle Financial
Responsibility Law and the same are therefore denied with strict
proof thereof demanded at time of trial,
23. Denied as a legal conclusion to which no responsive
pleading is required. To the extent a responsive pleading is
required, after reasonable investigation the Plaintiff is unable to
ascertain the factual basis for the Defendants' allegation that the
Plaintiff is not entitled to assert a subrogation claim for first
party medical benefits paid to its subrogor. As such, said
allegation is denied with strict proof thereof demanded at time of
trial.
24, Denied as a legal conclusion to which no responsive
pleading is required, To the extent a responsive pleading is
required, after reasonable investigation the Plaintiff is unable to
ascertain the factual basis for the Defendants' allegations that
the Defendants acted in a careful, lawful, proper and prudent
I'.'
, '
"
"
,
,.
,,'
~
~
~
?!
r<. m
~ ~
~~e5 s~ - ] .
r.8~ ~1~~, ~ ~ M
~~~ ~~ ti ~ ~ ~
~~~ ~~ ~ ~~ ~ ~
~~5 ~~ ~ . ~~ ;
~ ~ ~ ~ p;~
~ ~~ ~~
::J~
8 ~_,
iQ)1 ~
, N
~ ..
- ~~H ~
.[r.:l ~ ~ E n
~s~d~l~
.~~~.~ J
";Ul~~~:z!
lal<ul
fl~ P-
Ul
:;";0
~:-<
~~
l161';j
~>.:l~
Cfl ~......
f'. ><
':1 ,;J
~g
3~
"'~
;;. ....
~
,
~ c,V()(t'j b
N t:.
':-,
iyls
J.
(Ja .. tltv
C.j{t\-ptt-t1l(S, (Ie..
Aqll_ &ft.f/ (I'uit..t
-
((tl-w:; put
-(' I. (J (.
VERIPICATION IN LIEU OP APFIDAVIT
SHELLEY HUMPHRIES
, says that she is
aqenc
of the plaintiff corporation . that ahe
is authorized to make this stacement and that the facts contained
in the within RBPLY TO NEW MATTBR are true and correct to the best
of her information, knowledge and belief.
This sl:ateme~ is made this
,3fY of 'JJJu f , 1996
subject to t penalties of 18
Pa. C.S. Section 4904 relating to
unsworn falsification to authorities.
MOTORISTS INSURANCE COMPANIBS
By tM~ttIlF~e/J
.lIhelle Hump~ ies
,
~
MVJOl1n Ousley
v.
W.E. Parker Transport ana
\'lalter 1:;. Parker
SAM,ma1 (Hep.ly to N.Matter)
3jlBj!J6
APR 0 S 1996'