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HomeMy WebLinkAbout95-03881 -:9 Q) at . '~ ;J ~ '& J Q) - ]~ I , / / E F j - co ()o (Y) IN '1'111': COUll'!' OF COmlON PLE^S mUillUN..rJ COUNTY, PENNSYI.VMJlf, CIVIL ^CTION - L^W NO. SEIDLE HEfIORI^L 1I0SPIT^L, PL^INTH'[' V EDW^IlD L. REED and DEIlR^ D. REED, DEI'END^NTS COM P I, ^ I N T \ ~--. :: :. ',i r ~ " '".; ; ,.1l ,'/. '. ; " " :'" ;,u. . ;, t. _.__.___-_~_..__._ ARTHUR A. KUSIC ATIORNEY AT LAW 4201 CfllJMS M'LL ROAD 1'.0, IlOX 67015 HAI""SIlUI<G. PlWISYI.V..lI,' 17106.7015 (717) 5405610 ~ (, ,)0. :~\ ~ ." ,; - , '. A ~' ,~ ""'-.. '>. , "- K>'~ ~" \ '~ \ " \' ", , , ( ~ , IV n. ~. f...... ~~ ~... '\\ '\\. ~ ~..J \ '(,,; .~ '~ '-J ".' '"" SEIDLE MEMORIAL 1I0SPITAL, IN THE COURT OF COMMON PLEAS ~ COUNTY PENNSYLVANIA Plaintiff V, EDWARD L. REED and DEBRA D. RB~~endantS CIVIL ACTION - LAW NO. tj{ - .3g'~ / CUu/~~ NOTICE You have been sued in court, I f you W 1 sh to defend against the claims set forth in the following pages, you must take action within twenty (~O) days after this Complaint and Not1ce are served. by entering a written appearance personally or by attorney and filing in writ1ng with the court your defenses or obJectlons to the claims set forth against you. You are warned that if you fail to do so, the case may proceed without you and Judgment may be entered against YOU by the court w1thout further notice for any money claimed in the Compla1nt for any other cla1m or reI ief reQuested by the Pl a i nt iff. 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 CAt,1 GET LEGAL HELP, Respectful iy sllbmn.ted: LAWYER REFERRAL Cumberlanel Co. Court Admin. Fourth Floor One Courthouse Square Carlisle, PA 11013-3387 (111) 240-6200 ~~::IC' ESQUIRE 4201 CrumiM111 Road Post Off1ce Bo. 67015 Harn sb<olrg. PA q 112 (717) 540-5610 SUPREME COURT NO. 07207 ATTORNEy FOR PLAlllTIFF Dated: '\I,j (1\ SEIDLE MEMORIAL HOSPITAL, Plalnt1ff IN THE COURT OF COMMON PLEAS CcMBERUVDCOUNTY PENNSYLVANIA V. CIVIL ACTION - LAW EDWARD L. REED and DEBRA D. REED, Defendants NO, NOTICIA Le han demandado a usted en la corte, S1 usted quiere defenderse de estas demandas expuestas en las paginas siguientes, usted t 1 ene v 1 ente (20) di as de p 1 azo a 1 part i r presentar una apar1enC1a escrlta 0 en persona 0 por abogado y archivar en la corte en forma escrita sus defensas 0 sus objeciones alas demandas en contra de su persona. Sea avisado que S1 usted no se defiende, la corte tomara medidas y puede entrar una orden contra usted sin previa aviso 0 notlflcaclon y por cualqu1er queja 0 alivio que es pedldo ell la pe1.1C10n de demanda, Usted puede perder dinero 0 SUS proP1edades 0 otros derechos lmportantes para usted, LLEVE ESTA DEMANDA A UN ABOGADO INMEDIATAMENTE. 51 NO TIEtJE ABOGADO 0 SI NO TIEtjE EL DINERO SUFICIENTE DE PAGAR TAL SERVICIO, VAYA EN PERSONA 0 LLAME POR TELEFONO A LA OFICINA CUYA DIRECCION SE ENCUENTRA ESCRITA ABAJO PARA AVERIGUAR DONDE SU PUEDE CONSEGUIR ASISTENCIA LEGAL: LAWYER REFERRAL Cumberland Co. Court Admin. Fourth Floor One Courthouse Square Carlisle. PA 11013-3381 (111) 240-6200 Respectfully subml~ted: &;;~- 4201 Crums Mill Road Post Office Box 67015 ~arr'sbur9. PA 11112 (111) 540-5610 SuPREME COURT NO, 07207 ATTORNE~ FOR PLAINTIFF Dated )ftuh" - .........-~~.~~4- V. I I I I I I I I IN THE COURT OF COMMON PLEAS CUKBERLANDCOUNTY, PENNSYLVANIA CIVIL ACTION - LAW SEIDLE KEKORIAL HOSPITAL, plaintiff EDWARD L. REED and DEBRA D. REED, Defendants NO. c 0 M P L A I N T AND NOW comes plaintiff by and through its attorney, Arthur A. Kusic, Esquire, and respectfully represents the following: 1. plaintiff, SEIDLE MEMORIAL HOSPITAL, is a hospital facility organized and existing under the laws of the commonwealth of pennsylvania located at Filbert & Simpson streets, Mechanicsburg, Cumberland county, pennsylvania. adult married individuals residing at 119 Yorkshire Drive, Mechanicsburg, cumberland County, pennsylvania. 2. Defendants, EDWARD L. REED and DEBRA D. REED are " 3. On or about september 16, 1993 and from time to time through November 18, 1993, plaintiff, at the request of Defendant Edward L. Reed, did provide health care services to said Defendant. 4. plaintiff in good faith provided the necessary health care services to Defendant, Edward L. Reed, and thereafter billed Defendants for those services and expenses incurred. As evidence whereof, copies of the billing for services rendered to '.', ~ the Defendant, Edward L. Reed are attached hereto, made a part hereof and marked Exhibit "A". 5. Plaintiff's charges to the Defendants for services rendered to Defendant, Edward L. Reed are its usual and customary charges. 6. Plaintiff has made demands for payment of $1,439.00 upon Defendant, which demands remain unheeded. 7. Plaintiff avers that the amount due and owing does not exceed the jurisdictional amount requiring arbiitration referral by local rule. COUNT I. (Plaintiff v. Edward L. Reed) (Quantum Meruit) 8. Plaintiff incorporates herein by reference thereto the averments hereinabove set forth in paragraphs 1 through 6. 9. Plaintiff did render health care services Defendant with reasonable expectation that payment for services would be made by the party benefitted. 10. Should the Defendant not be required to pay for the balance due for the services rendered, Defendant would be unjustly enriched at Plaintiff's expense. to such 11. Plaintiff avers that the amount due and owing does not exceed the jurisdictional amount requiring arbiitration referral by local rule. WHEREFORE, plaintiff prays your Honorable Court to enter Judgment in its favor and against Defendant Edward L. Reed in the amount of $1,439.00 along with interest at the rate of 6% per annum and the costs of this proceeding. COUNT II. (Plaintiff v. Debra D. Reed) (Doctrine of Necessaries) 12. Plaintiff incorporates herein by reference thereto the averments hereinabove set forth in paragraphs 1 through 10. 13. Plaintiff believes and therefore avers that the health care services rendered, upon request, to Defendant Edward L. Reed, husband of Defendant Debra D. Reed, were necessary for his benefit and welfare. 14. Plaintiff believes and therefore avers that pursuant to the "doctrine of necessaries", Defendant Debra D. Reed, as spouse of the recipient of health care services, is liable to plaintiff for the balance due. 15. Should Defendant Debra D. Reed not be held liable to Plaintiff for payment of services rendered her husband, she would be unjustly enriched as the services were necessary to benefit the health and welfare of her spouse and their marital union. 16. Plaintiff has made demands for payment upon Defendant, which demands remain unheeded. 17. Plaintiff avers that the amount due and owing does not exceed the jurisdictional amount requiring arbitration referral by local rule. WHEREFORE, Plaintiff prays your Honorable Court to enter Judgment in its favor and against Defendant Debra D. Reed in the amount of $1,439.00 along with interest at the rate of 6% per annum and the costs of this proceeding. COUNT I II . (Plaintiff v. Debra D. Reed) (statute) 18. Plaintiff incorporates herein by reference thereto the averments hereinabove set forth in paragraphs 1 through 17. 19. Pursuant to 23 Pa. C.S.A. 4321, married persons are liable for the support of each other. -. 20. Pursuant to 23 Pa. C.S.A. 4102, where debts are contracted for necessaries by either spouse, a creditor may institute suit against the husband and wife for the price of the necessaries. 21. Plaintiff did render necessary health care services to Defendant Edward L. Reed with the reasonable expectation that such services be paid for by the persons benefitted, which in the instant case include said Defendant and his spouse, Defendant Debra D. Reed as a partner in the marital union. 22. Plaintiff has made demands for payment upon Defendant, which demands remain unheeded. 23. Plaintiff avers that the amount due and owing does not exceed the jurisdictional amount requiring arbitration referral by local rule. WHEREFORE, Plaintiff prays your Honorable Court to enter Judgment in its favor and against Defendant Debra D. Reed in the amount of $1,439.00 along with interest at the rate of 6% per annum and the costs of this proceeding. COUNT IV. (plaintiff v. Edward L. Reed and Debra D. Reed) (Total) 24. Plaintiff incorporates herein by reference thereto the averments hereinabove set forth in paragraphs 1 through 23. 25. Plaintiff has made demands for payment upon Defendants for payment of the balance due of $1,439.00, which demand remains unheeded. WHEREFORE, Plaintiff prays you Honorable Court to enter Judgment in its favor and against Defendants Edward L. Reed and Debra D. Reed in the amount of $1,439.00 along with interest at the rate of 6% per annum and the costs of this proceeding. RESPECTFULLY SUBMITTED: ~" ~.. ~, ././~. /~ ;/' ._;~.-.,._ - '--'l.- Ar hur A. Kus~~ Esquire 4201 Crums MIll ad-- Post Office Box 11585 Harrisburg, PA 17108 (717) 540-5610 Supreme Court No. 07207 Attorney for the Plaintiff DATED: SEIDLE MEMORIAL HOSPITAL, I IN THE COURT OF COHMON PLEAS Plaintiff I CUMBERLAND COUNTY, PENNSYLVANIA . . V. . CIVIL ACTION - LAW . . . . EDWARD L. REED and . NO. . DEBRA D. REED, I Defendants I V E R I F I C A T I 0 N I, HARRY PARK the SUPERVISOR, OF , CREDIT & COLLECTION of SEIDLE MEMORIAL HOSPITAL verify that the statements made in the Complaint are true and correct and that I am authorized to make this Verification on behalf of SEIDLE MEMORIAL HOSPITAL. I understand that false statements herein are subject to the penalties of 18 Pat C. S. Section 4904, relating to unsworn falsification to authority. SEIDLE MEMOIRAL HOSPITAL BY:~~ DATE: 5/15/95 \ ~ Hxlt I HI'T "A" ':' FORM _2e.cA , ..... ~E C~ e.~ a __'~3 ct..r .. "._.m_ e ~1.''''3 FEfl:::: DISCH 6\ '64'9~ 00 '00 0104 OUTI' GARMANS lOL:';;: I BE\El="S AS3: ,"IS...A....:e :O.E~':'J: ,..'----r-------- Gl:la_~ ',:' ;;-, ... f . I I __J F;C I 5 . EDWARD L REED , L 1108 LAUREL AVE L T CAMP HILL PA 17011 0 L PlT.EII;T NuVBE~ I PATIE""T NAME 2t2609822 REED, EDWARD L CATE - -" '---CE"SCRiPTIO",.H 09,16 09 :16 09'20 09:20 09'22 09:22 09'23 09:23 09:23 09,28 09:28 09'30 09:30 10 '05 10,05 10:07 to,07 10 :08 10 '08 10: 12 10' 12 10: 12 to'12 10: 19 10: 19 10,21 10 :21 10'22 10:22 to'26 , to,26 10 '28 10 :28 to:29 54: 00 30: 00 30 00 26: 00 27' 00 26: 00 27' 00 , 30, 00 26: 00 30, 00 26: 00 30' 00 26: 00 ' 2700 26: 00 30: 00 26, 00 30: 00 26, 00 30: 00 26' 00 30: 00 26' 00 30: 00 26: 00 30, 00 26: 00 30' 00 26: 00 30' 00 , 26, 00 30' 00 26: 00 27' 00 , O~QO I TOTALS~' 'I .,__SELLAST._l'AGE ,.,___.__.___._._____,______, See Reverse Side If You Have Not Furnished Us Your Health Insurance Information and/or Forms KEEP THIS PORTION FOR I'OUR RECORDS DETACH AND RETURN TH'S PORTION VlITH PAYMENT P,,'!',;;...r 11;1.'''; 1..__.... -:.:,,:'50~;~.--+ AO"S~~'-SE:""CE I ''0-"""",, O-E , _ ._ . _______--1___ ' , I l. Q,SC..,,\RGE CATE ! 1--'- , INTERMED-PHY THERAPY MASSAGE MASSAGE HOT PACK STANDARD ULTRASOUND PHY THERP HOT PACK STANDARD EXERCISE-THERAPEUTIC MASSAGE HOT PACK STANDARD MASSAGE HOT PACK STANDARD MASSAGE HOT PACK STANDARD ULTRASOUND PHY THERP HOT PACK STANDARD MASSAGE HOT PACK STANDARD MASSAGE HOT PACK STANDARD MASSAGE HOT PACK STANDARD MASSAGE HOT PACK STANDARD MASSAGE HOT PACK STANDARD MASSAGE HOT PACK STANDARD MASSAGE HOT PACK STANDARD MASSAGE HOT PACK STANDARD MASSAGE HOT PACK STANDARD EXERCISE-THERAPEUTIC Ie: LATE C"ARoeS FOR SER',flCES RE'-'E=::: OtC:..iR. YOu Wi.... RECE.E ,:.,~ "',O"oA:. 6..1.1\0 PAT,p..r"o;:; MAKE CHECKS PAYABLE TO: 90 90 90 90 90 90 90 90 90 90 90 90 90 i 90 90 90 90 90 90 90 90 90 90 90 90 90 90 90 90 90 90 90 90 90 -l --.J SEIDLE MEMORIAL HOSPITAL P.O. BOX 2332 HARRISBURG, PA, t7105 717 - 782-3680 I.R.S. 23-1352215 1ST COVERAGE 2NO COVERAGE 3RD COVERAGE PATlE~ AUOU,..T 54, 00 30: 00 30, 00 26: 00 27' 00 26: 00 27' 00 , 30, 00 26: 00 30, 00 26: 00 30' 00 26: 00 27' 00 , 26, 00 3D; 00 26, 00 30: 00 26' 00 30: 00 26' 00 30: 00 26' 00 , 30, 00 26: 00 30, 00 26: 00 30' 00 26: 00 30' 00 , 26, 00 30' 00 , 26, 00 27: 00 AIJOU' T PAt.: " P:"T!Etr1'''S BIRTHDATE BLUE CROSS CONTRACT NO SUBSCRIBER GROUP NO IENCLOSE AUTHORIZATION I E.UE CROSS GROUP NO KEYSTONE HEALTH NO ____,___ ------- -------- --- MEDICARE PATIENTS: PLEASE COMPLETE QUEST'ONS BELOW AND SIGN ANY QUESTIONS CONTACT HOSP'TAL AT 795.6610 MEDICAL ASST, PATIENTS: YOU MUST BR'NG YOUR CARD WHICH RELATES TO THE DATE OF SERVICE TO SEIDLE MEMORIAL HOSP'TAL BUSINESS OFFICE, COMMERC'AL INS, FORWARD A SIGNED INSURANCE CLA'M FORM FOR PROCESSING CHAMPUS: RETURN COMPLETED AND SIGNED FORM ALONG W'TH COpy OF CARDS, EFFECTIVE DATE PART A HOSPITAL MEDICARE ... MEDICARE SECONDARY PAYOR .... COMPLETE;I 1. IS THE PATIENT OR PATIENT'S SPOUSE EMPLOYED7 PART B MEDICAL _YES _NO IF YES, COMPLETE A, ~ IS THE PATIENT ENTITLED TO MEDICARE ON THE BASIS OF END STAGE RENAL DISEASE? _ YES IF YES. COMPLETE C, IS THE PATIENT COVERED BY AN EMPLOYER GROUP PLAN? _ YES - NO IF YES, NAME OF GROUP PLAN: _NO _YES _NO IF YES. COMPLETE C, 2, DOES PATIENT HAVE RENAL DISEASE OR HAD A KIDNEY TRANSPLANT? @] _YES _NO _NO IS PATIENT ENTITLED TO MEDICARE SOLELY ON THE BASIS OF RENAL DISEASE? IS THE PATIENT COVERED BY AN EMPLOYER GROUP PLAN? _ YES 'F YES, NAME OF GROUP PLAN: HAS PATIENT COMPLETED THE TWELVE (12) MONTH COORDINAT'ON PERIOD? _ YES, STOP MEDICARE PRIMARY _ NO. SEE ABOVE GROUP INS, PLAN 3. ARE SERVICES RELATED TO OR DUE TO AN AUTO ACCIDENT OR OTHER LIABILITY INCIDENT? _ YES _ NO IF YES, COMPLETE B, @] WHAT TYPE OF ACCIDENT CAUSED THE ILLNESSIINJURY? _ AUTOMOBILE: INSURANCE COMPANY AND CLAIM NO, _ OTHER: SPECIFY WAS ANOTHER PARTY RESPONSIBLE FOR THIS ACCIDENT? _ YES NAME/ADDRESS OF RESPONSIBLE PARTY/LIABILITY INSURER: _NO 4. IS THIS ILLNESS OR INJURY WORK RELATED/BLACK LUNG? _YES _NO IF YES. EMPLOYER NAME AND ADDRESS AND TELEPHONE NO, 5. DOES THE PATIENT HAVE VA HEALTH BENEFITS THRU CARD ;llO.1174? YES NO 6. IS THE PATIENT A DISABLED MEDICARE BENEFICIARY UNDER AGE 65? _YES _ NO MEDICARE ASSIGNMENT FORM , REQUEST PAYMENT OF AUTHORIZED MEDICARE BENEFITS TO ME, OR ON MY BEHALF FOR At-N SERVICES FURNISHED TO ME BY OR IN SE'DLE HOSPITAL. INCLUDING PHYSICIAN SERVICES, I AUTHORIZE ANY HOLDER OF MEDICAL AND OTHER INFORMATION ABOUT ME TO MEDICARE AND ITS AGENTS At-N INFORMATION NEEDED TO DETERMINE THESE BENEFITS OR BENEFITS FOR RELATED SERVICE, SIGNED DATE ____.,_ - - - - - FOR,.. .25.... -'''::~flh' 8.....1",030;...:;: UISCI/ 'ot '04 '9.'\ OUTI', 8'~lr"'a PER :~ 00'00 GAR MANS 0104 PJ.~: u , , ROOM "'0 AOMITTEO OlSCI1AROED "I I.R.S. 23.1352215 212609822 IREED EDWARD l 1/ 109,16,93/11, 18,93/ PATIENT -_.--~ - .-- . '. 'oesCRIPTiO"" ---. ._-.-.... 'rOTAl CI1A.J:lQE ""'OUNT OArE 1 ST COVERAGE 2"'0 COVERAGE 3RO COVERAGE 10,29 HOT PACK STANDARD 90 26, 00 , , , 26, 00 11 ;01 EXERCISE-THERAPEUTIC 90 27: 00 , , , 27: 00 , . , 11 '01 I1ASSAGE 90 30, 00 , , , 30' 00 II :01 HOT PACK STANDARD 90 26: 00 , . , 26; 00 , , , 11 '02 I1ASSAGE 90 30' 00 , , , 30' 00 11 :02 HOT PACK STANDARD 90 26: 00 , , , 26: 00 , , , II '09 I1ASSAGE 90 30' 00 , , , 30' 00 , . , , , , 11,09 HOT PACK STANDARD 90 26, 00 , , , 26, 00 11: 10 EXERCISE-THERAPEUTIC 90 27: 00 . , , 27; 00 , , , 11'10 HOT PACK STANDARD 90 26. 00 , , , 26, 00 11:12 EXERCISE-THERAPEUTIC 90 27; 00 , , , 27: 00 , , , 11 '12 HOT PACK STANDARD 90 26' 00 , , , 26' 00 11 : 16 EXERCISE-THERAPEUTIC 90 27: 00 , , . 27; 00 , , . 11 '16 HOT PACK STANDARD 90 26' 00 . , , 26' 00 11 ; 18 4: 00 , , , , MISC-OTHER PHY THRPY 90 . , , 4, 00 11 :18 EXERCISE-THERAPEUTIC 90 27: 00 . , , 27; 00 , , , 11 ,18 HOT PACK STANDARD 90 26, 00 . , , 26, 00 , '-----_!..._- I------!...__ :.._----~-- ------~-- -----_!..._- , . , , , , TOTAL CHARGES 1439' 00 . , , 1439' 00 , , , ....._~.. , , , ........ ......... ....."... ........ , , . , , . , , , , , , , , , , , , , , , , , , , , . , , , , , . , , , , , . , , , , . , , , , , , , , , , , , , I , , , , , I , , , , , , , , , I , , , , , , , I , I , , , , I , , , I , , , I I I , , , , , , , . . , , , , . , , , , . , : , , . I ri= LATE CHARGES ~OR IEF:MCES TOTALS~ i . . , PATIENT PAY REN:lE.l:lEO O~CUR. YOu ~ll. , I 2 flE'..P,~.~_olSJ~?.t__.~~':'~~,.,~E :O.'E..A:i.~ __ ,^ ul=l~.,p '.:.. n:;. :::.. ...~ FiC I --] 5 . EDWARD l REED SEIDLE MEMORIAL HOSPITAL , L 1108 lAUREL AVE P.O. BOX 2332 L T CAMP HIll PA 17011 HARRISBURG, PA, 17105 0 L -! 717 - 782-3680 REeE .E AOO.110NAL BIWNG THIS AMOUNT '- ---.--------.......-.- ,. -.-.--...-..------.------------.-- See Reverse Side If You Have Not Furnished Us Your Health Insurance Information and/or Forms KEEP THIS PORTION FOR YOUR RECORDS DETACH AND RETURN THIS PORTION W'TH PAYMENT OAtl ...t~A' r~e:l~'O-5.i..E--I..--I Ao,...ss'o,.stR-~..CCT-~-j. A'ijQ~OUE-'1 --.--'-r----- --_.....---r- . _ , ,,! I I LOLc.OIt.&.5_'t_O, 91, 6.&, ~LL5---!_.1ItJ9~Oj MAKE CHECKS ~c,sc.i~"q',?,,"LI !_~O.~I;T.A'O . PAYABLE TO: SEIOlE MEMORIAL HOSPITAL l.lL'..l8.c9Li l _ -7!T-= 782-'3680 . , OAT, ~r1ojO \ ,--. , PATIENTS B'RTHDATE w B~UE CROSS GROUP NO , KEYSTONE HEA~TH NO ______,____ B~UE CROSS CONTRACT NO SUBSCR'BER GROUP NO _ .. IENC~OSE AUTHOR'ZATIONJ MED'CARE PATIENTS: P~EASE COMP~ETE QUESTIONS BE~OW AND SIGN ANY QUESTIONS CONTACT HOSPJTA~ AT 795.8810, MEDICAL ASST, PATIENTS: YOU MUST BRING YOUR CARD WHICH RELATES TO THE DATE OF SERVICE TO SEID~E MEMORIA~ HOSPITA~ BUSINESS OFFICE COMMERCIA~ INS, FORWARD A SIGNED INSURANCE CLA'M FORM FOR PROCESSING, CHAMPUS: RETURN COMP~ETED AND S'GNED FORM ALONG WITH COpy OF CARDS, MEDICARE MEDICARE SECONDARY PAVOR ~ COMP~ETE /1 EFFECTIVE DATE PART A HOSPITA~ PART B MEDICA~ 1, IS THE PATIENT OR PATIENT'S SPOUSE EMP~QYED? _YES _NQ IF YES, CQMP~ETE A, ~ IS THE PATIENT ENTITLED TO MEDICARE ON THE BASIS OF END STAGE RENAL DISEASE? _ YES IF YES, COMPLETE C, IS THE PATIENT COVERED BY AN EMPLOYER GROUP PLAN? _ YES _ NO IF YES, NAME OF GROUP PLAN: _NO 2. DOES PATIENT HAVE RENAL DISEASE OR HAD A KIDNEY TRANSPLANT? _YES _NO IF YES. COMPLETE C, @] IS PATIENT ENTITLED TO MEDICARE SOLELY ON THE BASIS OF RENA~ DISEASE? IS THE PATIENT COVERED BY AN EMPLOYER GROUP PLAN? _ YES IF YES, NAME OF GROUP PLAN: HAS PATIENT COMPLETED THE TWELVE (121 MONTH COORDINATION PERIOD? _ YES. STOP MEDICARE PRIMARY _ NO, SEE ABOVE GROUP INS, PLAN _YES _NO _NO 3, ARE SERVICES RELATED TO OR DUE TO AN AUTO ACCIDENT OR OTHER L'AB'LITY INCIDENT? _ YES _ NO IF YES, COMPLETE B. lID WHAT TYPE OF ACCIDENT CAUSED THE ILLNESSIINJURY? _ AUTOMOBILE: INSURANCE COMPANY AND CLAIM NO, _ OTHER: SPECIFY WAS ANOTHER PARTY RESPONSIBLE FOR THIS ACCIDENT? _ YES NAME/ADDRESS OF RESPONSIBLE PARTY/LIABILITY INSURER: _NO 4. IS THIS ILLNESS OR INJURY WORK RELATED/BLACK LUNG? _YES _NO IF YES. EMPLOYER NAME AND ADDRESS AND TELEPHONE NO, _ 5. DOES THE PATIENT HAVE VA HEALTH BENEFITS THRU CARD /110.1174? _ YES _NO 6. IS THE PATIENT A DISABLED MEDICARE BENEFICIARY UNDER AGE 65? _YES NO MEDICARE ASSIGNMENT FORM I REQUEST PAYMENT OF AUTHORIZED MEDICARE BENEFITS TO ME, OR ON MY BEHALF FOR ANY SERVICES FURNISHED TO ME BY OR 'N SEIDLE HOSPITAL, INCLUDING PHYSICIAN SERV'CES, I AUTHORIZE ANY HOLDER OF MEDICA~ AND OTHER INFORMATION ABOUT ME TO MEDICARE AND ITS AGENTS ANY INFORMATION NEEDED TO DETERMINE THESE BENEFITS OR BENEF'TS FOR RELATED SERVICE. S'GNED _ D~TE - -., -t---- ".:0::: ::)J: B '.~; 8.i.",::; :.:..~ llIS'CII"":"OI 'O~ 95 OUT!' . -----.---'--'- . GARI1ANS PAGE ,3 B....'I-.,::; ;:1:":: {){)'(jO (II O~ I BE"'E;:~S ASO'O ,---.---- ''''S~~:''''C~5_c~,.~~..J; J..:. In,: .. _ d_~~-:~~_~':: Fie I I 5 e EDWARD L REED SEIDLE MEMORIAL HOSPITAL I L 1108 LAUREL AVE P.O. BOX 2332 L T CAIIP HILL PA 17011 HARRISBURG, PA. 17105 0 L -1 717 - 782-3680 I PATIENT NUIolBER IREED. PATIENT NAME ir ROOM NO ADMITTED OlSCHARGeC I.R.S. 23-1352215 212609822 EDWARD L 109,16,93111,18,931 PATIENT CATE OESCAIPTlOf.! TOTAL. CHARGE 15T COVERAGE 2NO COVERAGE 3RD COVERAGE AMOUNT SOIlIAL SECUR ITY NO. - 182-46-55 4 , , , , , , BIIlTH ATE - 11/09/54 , , , , , , , , , , SEX - , , , , I I1AI\ IT A STATUS - 11 , , , , , , , , , , RACE - W , , , , , ATTEND NG DOCTOR - 97999 ALL OTI , I I D020133E , , ER , , , , DIAGNO IS - P 847.0 , , , , , PO~ICY HOLDER EMPLOYER - MONTGOI I , , , I ER Y WARD /999 , , , PO~ICY HOLDER - NOT ENTERED , , I , I , , , , I INSURA CE COVERAGE , , I , , CO. AIlE - SELF PAY : GR( P NO.: - I ONE )>OLICY NO.: - ? I , REASON FOR VISIT - PHY THERAPY , . , I I NOTE - CERVICAL STRAIN , , , , , , , . , 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 , , , 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 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 , I , , , I , , , , I , . Ii: IJ.TE CIoIARGES I='OR SERVICES TOTALS ~ I , , , PATIENT PAY RE~OE;:lEO OCCUR, you Wt~:' , , R= '~m A. ' I ... THI S AMOUNT _CE JcADO O~ L.Bu.~~ __"__., ___. _n___ ___._____'__'__""_'_ See Reverse Side If You Have Not Furnished Us Your Health Insurance Information and/or Forms KEEp THISP08TION FOR YOUR RECORDS DETACH AND RETURN THIS PORT'ON W'TH PAVMENT FI1~::':' :,y. I[O:-::':jj~::SS:.~;'~' ~' p:SCHARGE OATE SEIDLE MEMORIAL HOSPITAL L-1~1 ' AVOuM O..E "717''" 782-"3680' FORV.2t14A PAT'E"-T "00 I ? 1 ?,<;nQR?? RFFn MAKE CHECKS PAYABLE TO: PATIE"T S BIRn-mATE , BLUE CROSS GROUP NO KEVSTONE HEALTH NO ________,_ BLUE CROSS CONTR';:T rw SUBSCRIBEF GROUP NO IENClOSE AUTHORIZATION I MEDICARE PATIENTS: PLEASE COMPLETE OUESTlONS BELOW AND S'GN ANV OUEST'ONS CONTACT HOSPITAL AT 79S,eel0. MEDICAL ASST, PATIENTS: VOU MUST BR'NG VOUR CARD WH'CH RELATES TO THE DATE OF SERVICE TO SEIDLE MEMORIAL HOSPITAL BUS'NESS OFFICE, COMMERC'AL INS, FORWARD A SIGNED INSURANCE CLAIM FORM FOR PROCESSING, CHAMPUS RETURN COMPLETED AND SIGNED FORM ALONG WITH COpy OF CARDS, MEDICARE .... MEDICARE SECONDARV PAVOR ... COMPLETE;; 1. IS THE PATIENT OR PATIENT'S SPOUSE EMPLOVED? EFFECTIVE DATE PART A HOSPITAL PART B MEDICAL _VES _NO IF VES. COMPLETE A, ~ IS THE PATIENT ENTITLED TO MEDICARE ON THE BASIS OF END STAGE RENAL DISEASE? _ VES IF VES, COMPLETE C, IS THE PATIENT COVERED BV AN EMPlOVER GROUP PLAN? _ yeS _ NO IF VES, NAME OF GROUP PLAN: _NO 2, DOES PATIENT HAVE RENAL DISEASE OR HAD A KIDNEV TRANSPLAN7? _VES _NO IF VES. COMPLETE C, @] IS PATIENT ENTITLED TO MEDICARE SOlELV ON THE BASIS OF RENAL DISEASE? IS THE PATIENT COVERED BV AN EMPlOVER GROUP PLAN? _ VES IF VES, NAME OF GROUP PLAN' HAS PATIENT COMPLETED THE TWELVE 112) MONTH COORD'NAT'ON PERIOD? - VES, STOP MEDICARE PR'MARV _ NO, SEE ABOVE GROUP INS, PLAN _VES _NO _NO 3. ARE SERVICES RELATED TO OR DUE TO AN AUTO ACCIDENT OR OTHER "'ABI"ITY INCIDENT? - VES _ NO IF VES, COMPLETE B ~ WHAT TYPE OF ACCIDENT CAUSED THE ILLNESSIINJURV? - AUTOMOBILE: INSURANCE COMPANV AND CLA'M NO, _ OTHER: SPECIFY WAS ANOTHER PARTY RESPONSIBLE FOR THIS ACCIDENT? _ VES NAME/ADDRESS OF RESPONSIBLE PARTY/LIABILITY INSURER: _NO 4. IS THIS ILLNESS OR INJURV WORK RELATED/BLACK LUNG? _VES _NO IF VES, EMPLOVER NAME AND ADDRESS AND TELEPHONE NO, 5. DOES THE PATIENT HAVE VA HEALTH BENEFITS THRU CARD ;;10,1174? _ VES _ NO 6. IS THE PATIENT A DISABLED MEDICARE BENEFICIARV UNDERAGEeS? _VES _ NO MEDICARE ASSIGNMENT FORM I REOUEST PAVMENT OF AUTHORIZED MEDICARE BENEFITS TO ME, OR ON MV BEHALF FOR ANV SERVICES FURNISHED TO ME BV OR 'N SEIDLE HOSPITAL. INCLUDING PHYSICIAN SERVICES, I AUTHORIZE ANV HOLDER OF MEDICAL AND OTHER INFORMATION ABOUT ME TO MEDICARE AND ITS AGENTS ANV INFORMATION NEEDED TO DETERM'NE THESE BENEFITS OR BENEFITS FOR RELATED SERVICE, SIGNED .. --., -----_._~-~-_.~.._~-_.__..,-_.- ~._~.----_._---,._~-_._... DATE .-- --.. ._-~--_._.__._.._-- -.------.'-------.._..,.._.._.- _ __'u_n... .. . --_. - ~--,.._._---.,--- ~------ , ~. .., . ,., ~. ~a:......~ ,~ ", ,-..-~..:::-- . ~ I r,'l) too.:!'!.!!, . a....3"o4'" j ,,",- 9.{ qIJ-'1'-'- (). '/11, t(: ~/ .JIfO'f' . . --." ~ -- ~.~ "...~- r ~~"'~1- ~ 3-wt q( Cf...'1....... Q. f\,L r~. r ~ ~ ;" '--... q;~ ruuJ ~ !lJ.(J. 0 PHONE:' 117) 2l8al85 FAX: (717)231.4083 ; 111 ~ ~ 8'1"f&i HNfWB.RI. flBrIet\.VNM 1n01 ATTORNEYS Ar lAW COpy " . ~ ^ , ~_. 0_- _ _~..... ....- ". . SBIDLB MIHORI~L HOSPITAL, plaintiff IN THB COURT or COMMON PLIAS CUMBBRLlUfD COUNTY, PBHNSYLVlUfIA v. BDWARD L. REED and DB BRA D. REBD, Detendants 110. 95-3881 v. HORRACE HAHN IIISURANCB CO., CIVIL ACTION - L~W and HBALTH AMBRIC~ or CENTRAL PEHNSYLVlUfIA, s JURY TRIAL DEKAHDED Additional Defs. s . NOTICE TO DEFEND You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this complaint and notice are served, by entering a written appearance personally or by attorney and filing in writing with the court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the court without further notice for any money claimed in the complaint or for any other claim or relief request 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 TELEPHOllE TilE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Court Administrator, Cumberland County Courthouse, 4th Floor 1 Courthouse Square Carlisle, PA 3-3387 Telephone No. (71 240-6200 01 Dated: ,-z.'..if(" ~1L- By: Ar ie . squire Atto ey for Plainti f 119 Locust st. HarriSburg, PA 11101 (717) 236-5985 \.. .' . i NOT I C I A Le han demandado a usted en la corte. si usted quiere defenderse de estas demandas expuestas en las paginas siguientes, usted tiene viente (20) dias do plazo al partir de la fecha de la demanda Y la notificacion. Usted debe presentar una apariencia escrita 0 en persona 0 por abogado Y archivar en la corte en forma escrita sus defensas 0 sus objeciones alas demandas en contra de sus persona. Sea avisado que si usted no se defiende, la corte tomara medidas Y puede entrar una orden contra usted sin previa aviso 0 notificacion Y por cualquier queja 0 alivio que es pedido en la peticion de demanda. Usted puede perder dinero 0 sus propiedades 0 otros derechos importantes para usted. LLEVE ESTA DEMANDA A UN ABODAGO INMEDIATAMENTE. SI NO TIENE ABOGADO 0 SI NO TIENE EL DINERO SUFICIENTE DE PAGER TAL SERVICIO, VAYA EN PERSONA 0 LLAME POR TELEFONO A LA OFICINA CUYA DIRECCION SE ENCUENTRA ESCRITA ABAJO PARA AVERIGUAR DONDE SE PUEDE .CONSEGUIR ASISTENCIA LEGAL. . Court Administrator, Cumberland county Courthouse, 4th Floor 1 Courthouse square carlisle, PA 17013-3387 Telephone No. (717) 240-6200 Dated: ,...1,,1-'11" By: Arc ie V. Diveglia, Attorney for plainti 119 Locust st. Harrisburg, PA (717) 236-5985 P.c. v. I IN THE COURT OF COKMON PLEAS I CUMBERLAND COUNTY, PEHHSYLVAHIA I I NO. 95-3881 I I CIVIL ACTION - LAW I JURY TRIAL DEMANDED I SEIDLE MEMORIAL HOSPITAL, Plaintiff BDWARD L. REED and DEBRA D. REED, Defendants AHSWER TO COMPLAINT AND NEW MATTER . AND NOW, this 27th day of September, 1995, come the D&fendants by and through their attorney, Archie V. Diveglia, and respectfully represent the following: 1. Admitted. 2. Admitted. J. Admitted. 4. Admitted. '5. The averments nor denied in that they and belief. in paragraph five can be neither admitted are out of the scope of their knowledge 6. Denied as stated. It is admitted that the demands for payment have been made, but Plaintiff has indicated to the Defendant that he has insurance coverage either through his auto insurance carrier or to his private health carrier and that either one or the other should pay such billing. 7. Admitted. COUNT 1 PLAINTIFF V. BDWARD L. RB~ 8. No answer needed. 9. The allegations are neither admitted nor denied in that it is unknown to the Defendant what was the expectation of the plaintiff in this matter. 10. The averments in paragraph ten denied. The averments in paragraph ten are conclusions of law to which no further response is required. 11. Admitted. . WHEREFORE, Defendants request Plaintiffs prayer for judgment .' be dismissed. COUNT 11 PLAINTIFF V. DEBRA REED 12. No answer needed. 13. Admitted. 14. Denied. The averments in paragraph 14 are denied as a conclusion of law for which no further response is needed. 15. Denied. The averments in paragraph 15 are denied as a conclusion of law for which no further response is needed. 16. Denied as stated. It is admitted that the demands for payment have been made but plaintiff has indicated to the Defendant that he has insurance coverage either through his auto insurance carrier or to his private health carrier and that either one or the other should pay such billing. 2 COUNT I PLAINTIFF V. BDWARD L. REED 8. No answer needed. 9. The allegations are neither admitted nor denied in that it is unknown to the Defendant what was the expectation of the plaintiff in this matter. 10. The averments in paragraph ten denied. The averments in paragraph ten are conclusions of law to which no further response is required. 11. Admitted. . WHEREFORE, Defendants request Plaintiffs prayer for judgment . be dismissed. COUYT II PLAINTIFF V. DEBRA REED 12. No answer needed. 13. Admitted. 14. Denied. The averments in paragraph 14 are denied as a conclusion of law for which no further response is needed. 15. Denied. The ~verments in paragraph 15 are denied as a conclusion of law for which no further response is needed. 16. Denied as stated. It is admitted that the demands for payment have been made but Plaintiff has indicated to the Defendant that he has insurance coverage either through his auto insurance carrier or to his private health carrier and that either one or the other should pay such billing. 2 17. ^dmlttad. WHEREFORE, the prayer for relief of the PlaintIffs should be dismissed. COUNT III ~XHrlrFS V. DEBRA REED lB. No answer required. 19. Denied as a conclusion of law to which no further response is needed. 20. Denied as a conclusion of law to which no further response is needed. ~ 21. Denied. Plaintiff has no knowledge as to the . expectation of the Defendant. 22. Denied as stated. It is admitted that the demands for payment have been made but Plaintiff has indicated to the Defendant that he has insurance coverage either through his auto insurance carrier or to his private health carrier and that either one or the other should pay such billing. 23. Admitted. WHEREFORE, Defendant moves the claims of Plaintiff be dismissed. COUNT IV ~NTIFF V. EDWARD RBED and DEBRA REED 24. No answer required. 25. Denied as stated. It is admitted that the demands for payment have been,made but Plaintiff has indicated to the Defendant that he has insurance coverage either through his auto 3 insurance carrier or to his private health carrIer and that either one or the other should pay such bllllng. WHEREFORE, Defendant moves this Honorable Court to dismiss all claims of the PlaIntiff. NEW HATTBR Tho avormnntA fram pnrnqraphA 1 through ~5 nro incorporatgd herein and made a part hereto. 26. The services rendered by the Plaintiff to the Defendant, Edward L. Reed, were believed by the Defendant to be . services related to problems he had relating to a heart attack in August of 1993. However, Plaintiffs' health care carriers indicated that it is of the opinion that the treatments and expenses were related to an automobile accident incurred by the Plaintiff on September 20, 1992 and has denied coverage on that basis. . 27. Plaintiff believes that his auto insurance company is on notice as to this pending claim by the Plaintiff, but that the auto insurance company has yet to render a decision as to payment. 28. Regardless as to whether the services rendered by the Plaintiff were related to the Defendant's heart attack or to the Defendant's automobile accident injuries, there is insurance coverage to provide payment and Plaintiff has filed a third party Complaint against each Defendant which is attached hereto. 4 WIIEREFORE, Dofondilnts movo this Honorable Court to dismIss the clilims of Plaintiff. Respectfully sUbmitted, 01VEGL1A and KAYLOR, P.C. DATEn: f!-7,1-fr By: Arc e V. 0 veg a, . re Attorney 1.0./17140 119 Locust street Harrisburg, penns Iv nia 17101 (717) 236-5985 . . Attorney for Defendants 5 ~ VERIFICATION The foregoing Answer to Complaint and New Matter is based upon information which has been gathered by our counsel in the preparation of the lawsuit. The language of the Answer to Complaint and New Matter is that of counsel and not our own. We have read the Answer to Complaint and New Matter and to the extent that it is based upon information which we have given to our counsel, it is true and correct to the best of our knowledge, information and belief. To the extent that the content is that . of counsel, we have relied upon counsel in making this verification. This statement and verification are made subject to the penalties of Pa.C.S. Section 4904 relating to unsworn falsification to authorities, which provides that if we make knowingly false averments, we may be subject to criminal penalties. Dated: C!j;;.1/~ ~'cf!k~ ED ARD L. REED ~1\~u~ ORAD. REED - " . . ORU[N I iO 15J.i1 . AJ ell_UAL 'lIf til'l'~a M~. HIBB[RO 6V",I."".. 'He. Pl 'ALUM", CA TO 'UOHOlU CALL fOll' Hlt NOU HIBBENe ICAI UN Iltoo, 1'8 IIl40 IUfu" , fDiIt A . .--.- ~~--=--~ ..~- .~~ ~- ''':':.~-;.~ \ SBIDLB MEMORIAL HOSPITAL, plaintiff III THB COURT OJ' COMMON PLOS CUMBBRLAHD COUNTY, PEIflfSYLVAIIIA v. BOWARD L. REBD and DBBRA D. RBED, D.fendants NO. 95-3881 v. HORRACB MAIfIf INSURAlfCB CO., and HEALTH AMERICA OJ' CENTRAL PBHNSYLVAIIIA, Additional Defs. CIVIL ACTION - LAW JURY TRIAL DEMANDBD .' NOTICE TO DEFEND . You have been sued in court, If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this complaint and notice are served, by entering a written appearance personally or by attorney and filing in writing with the court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the court without further notice for any money claimed in the complaint or for any other claim or relief request 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 TilE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Court Administrator, Cumberland county Courthouse, 4th Floor 1 Courthouse square carlisle, PA 3-3387 Telephone No. (71 240-6200 Dated: '.2,1..,\....... By: Ar ie squire Atto ey for Plainti f 119 Locust st. Harrisburg, PA 17('101 (717) 236-5985 NOT I C I A Le han demandado a usted en la corte. si usted quiere detenderse de estas demandas expuestas en las paginas siguientes, usted tiene viente (20) dias do plazo al partir de 1a fecha de la demanda y la notiticacion. Usted de be presentar una apariencia escrita 0 en persona 0 por abogado y archivar en la corte en forma escrita sus defensas 0 sus objeciones alas demandas en contra de sus persona. Sea avisado que si usted no se detiende, la corte tomara medidas y puede entrar una orden contra usted sin previo aviso 0 notificacion y por cualquier queja 0 alivio que es pedido en la peticion de demanda. Usted puede perder dinero 0 sus propiedades 0 otros derechos importantes para usted. LLEVE ESTA DEMANDA A UN ABODAGO INMEDIATAMENTE. SI NO TIENE ABOGADO 0 SI NO TIENE EL DINERO SUFICIENTE DE PAGER TAL SERVICIO, VAYA EN PERSONA 0 LLAME POR TELEFONO A LA OFICINA CUYA DIRECCION IE ENCUENTRA ESCRITA ABAJO PARA AVERIGUAR DONDE SE PUEDE CONSEGUIR ASISTENCIA LEGAL. . Court Administrator, Cumberland County Courthouse, 4th Floor 1 Courthouse Square Carlisle, PA 17013-3387 Telephone No. (717) 240-6200 Dated: ,..-z,1..qJ' By: t, SBIDLI MBMORIAL HOSPITAL, Plaintiff IN THB COURT OF COMMON PLBAS CUMBIRLAMD COUNTY, PIHHSYLVAHIA v. IDWARD L. RBBD and DBBRA D. RIBD, Detendants NO. 95-38e1 v. HORRACB KAHN INSURANCe CO., .and HEALTH AMIRICA OF ceNTRAL PIHHSYLVlUlIA, . AddItIonal Dets. CIVIL ACTION - LAW JURY TRIAL DBMAHDeD COMPLAINT OF DIFIHDAHTS BOWARD L. RBBD MID DeBRA D. RBBD AGAINST ADDITIONAL DIPeHDAHTS HORACB KAHN INSURANCI COMPMlY MID BBALTB AMeRICA OF CBNTRAL PA. Defendants, Edward L. Reed and Debra D. Reed, hereby file the within Complaint against additional Defendants, Horace Mann Insurance company and Health America of Central Pennsylvania, and . aver in support as follows: 1. This action was instituted by the filing of a complaint by the Plaintiff against the Defendants, a true and correct copy of Plaintiffs' Complaint is attached hereto and marked Exhibit A. 2. Defendants have filed their Answer to the Complaint which is attached as Exhibit B. 3. Additional Defendant, Horace Mann Insurance company is an insurance company licensed to transact insurance in the Commonwealth of pennsylvania and Is located at 9841 Broken Land ....--.. ~ . ..... Parkway, suite 303, columbia, Maryland 21046. 4. Additional Defendant, Health America of Central pennsylvania is a business corporation licensed to transact health insurance coverage in the Commonwealth of PennsylvanIa and has an address located at 2601 Market Place street, Harrisburg, PA 17110-9339. 5. For purposes of this Additional Defendant complaint only and without admission or adoption, the averments or paragraphs 1 - 23 of Plaintiffs' Complaint are Incorporated by .reference as if fully set forth at length herein. . COUNT I eDWARD L. REED AMD DEBRA D. ReeD V. HORACE MANN INSURMlCB COKPMlY 6. The averments of paragraph 1 - 5 of this complaint are incorporated herein by reference as if fully set forth at length herein. 7. Plaintiff Edward Reed was an insured under an insurance policy of the Defendant for injuries arising out of a motor . vehicle accident including that of 9/20/92. 8. That the Defendant Edward L. Reed did all steps necessary and filed all paper work required and placed the additional Defendant, Horace Mann Insurance company on notice of such claim. 9. That the additional Defendant, Horace Mann Insurance company did, in fact, make medical expense and other payments under said polIcy. 2 10. It is averred that the additional Defendant, Horace Mann Insurance Company, has notice as to the billing of the Plaintiff, Seidle MemorIal Hospital, but has not yet made a decision as to payment of the same. 11. Although Defendant, Edward L. Reed, does not possess medical reports indicating that the treatment for which the billing to the Seidle Memorial Hospital was incurred was causally related to the motor vehicle accident, he has been advised by his health insurance carrier that their medical representative had ~ndicated that it is causally related to the motor vehicle a~cident and proof will be supplied to the Defendant Horace Mann Insurance Company, If that Is the case. WHEREFORE, Defendant, Edward L. Reed, avers that additional Defendant, Horace Mann Insurance company is liable to Plaintiff as third party beneficiary to the contractual agreement between the Defendant Edward L. Reed and additional Defendant Horace Mann . Insurance Company. COUNT II IDWARD L. ReED V. HeALTH AMeRICA OF CeNTRAL peNNSYLVANIA 12. The Defendant, Health America of central Pennsylvania, is the HMO for Edward and Debra Reed. 13. The claim of the Plaintiff, Seidle Memorial Hospital, was presented to Defendant Health America of Central Pennsylvania as early as November of 1994 but it has failed to send to Defendant Edward L. Reed a written notice as to reasons for 3 denial of the claim. 14. The Defendant, Edward L. Reed, has only oral advisement from representatives of the additional Defendant that the claim has not been paid because It is believed to be related to the motor vehicle accident of September 20, 1992 and not the heart attack of August 1993. 15. It is averred that the addItional Defendant, Health America of Central Pennsylvania does not have a medical basis for saId denIed. . 16. It is averred that the additional Defendant, Health America of Central Pennsylvania does not have a physician's report so indicating the basis of the denial of the claim. 17. The addItional Defendant, Health America of central Pennsylvania, has a duty under the contract with the Defendant to pay for such billing and its failure to pay is a breach of its agreement with the Defendant. . 18. That the failure of the additional Defendant, Health America of Central PennsylvanIa, to either payor supply written notices as to the reason of its failure to pay the billing of the seid1e Memorial Hospital is contrary to the Unfair Insurance Practice Act of the Commonwealth of Pennsylvania and it is an act of bad faith entitling PlaintIff for punitIve damages. WHEREFORE, Plaintiff demands judgment against the additional Defendant, Health America of Central PennsylvanIa, for the billing to the Seid1e Memorial Hospital, counsel fees, costs and 4 punitive damages to a sum in excess of the arbitration limits of the Court of Common Pleas of Cumberland County. Respectfully submitted, DIVEGLIA and KAYLOR, P.C. DATED: '-z~~~ .- By: Arch V. Diveg1 a,: Attorney 1.0.#17140 119 Locust street: , Harrisburg, Penn 1v nia 17101 (717) 236-5985 . Attorney for Defendant 5 VERIFI.CATION The foregoing complaint is based upon information which has been gathered by our counsel in the preparation of the lawsuit. The language of the complaint is that of counsel and not our own. We have read the complaint and to the extent that it is based upon information which we have given to our counsel, it is true and correct to the best of our knowledge, information and belief. To the extent that the content is that of counsel, we have relied upon counsel in making this verification. This statement and verification are made subject to the penalties of Pa.C.S. Section . 4904 relating to unsworn falsification to authorities, which provides that if we make knowingly false averments, we may be subject to criminal penalties. . Dated: cr(-z,1(fJ 'DM~~ EDWARD L. REED- ~o~ 1'\ Q.u.d BRA D. REED . CERTI~ICATB OF SERVICE AND NOW, this 27th day of September, 1995, I, Bethany A. King, for Archie V. Diveglia, Esquire, hereby certify that a copy of the foregoing Answer to Complaint and New Matter was served by depositing the same in the United states Mail located in Harrisburg, PA, postage prepaid, addressed to the following: Arthur A. Kusic, Esquire 4201 Crums Mill Road P.O. Box 67015 Harrlsburg, PA 17112 . Bethany A.,Kt Archie V. D glia, Esqui DIVEGLIA , KAYLOR, P.C. <./'> .on .0 r.J -, ., - ,-" L;\ ..., ~ ..;; <J' . PHONe: (Ili) 23&lI9ll5 FAX: (717)231-4003 0~~~ ~(f , ~ ATIllRNEYs AT lAW COpy . "' LOC%8T 8IREE1' lfA. U ...AQ. flBH!M..vNM 1ncn o. - .~ ':",l."' . ~ J" . ~.- .~-- ..-.-.-.- ." .~ I I I I I I I I I I I HORRACe KAHN INSURANCe CO., I and HIALTH MeRICA OF ceNTRAL I PENNSYLVANIA, I Additional Defs. I IN THE COURT OF COMMON PLBAS CUMBIRLAND COUNTY, PENNSYLVANIA SEIDLe MEMORIAL HOSPITAL, plaintiU v. EDWARD L. REED and DEBRA D. ReID, Defendants NO. 95-3881 v. CIVIL ACTION - LAW JURY TRIAL DEMANDeD . NOTICE TO DEFEND Vou hnva baan Quad in court. X~ you wiah to do fond aqain.t the claims set forth in the following pages, you must take action within twenty (20) days after this complaint and notice are served, by entering a written appearance personally or by attorney and filing in writing with the court your defenses or objections to the claims set forth against you. YoU are warned that If you fail to do so the case may proceed without you and a judgment may be entered agaInst you by the court without further notice for any money claImed in the complaInt or for any other claim or relief request 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 !lOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE TilE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Court Administrator, Cumberland county courthouse, 4th Floor 1 Courthouse Square carlisle, PA 3-3387 Telephone No. (71 240-6200 Dated: 1.Z,1..lf('" squire f Plt- By: Ar ie Atto ey for Pia inti 119 Locust st. Harrisburg, PA (717) 236-5985 17101 l NOT I C I A Le han demandado a usted en 1a corte. si usted quiere defenderse de estas demandas expuestas en las paginas siguientes, usted tiene viente (20) dias do plazo al partir de 1a fecha de la demanda y la notificacion. Usted debe presentar una apariencia escrita 0 en persona 0 por abogado y archivar en 1a corte en forma escrita sus defensas 0 sus objeciones alas demandas en contra da aus paraonn. Son aviaado qua ai uatad no .a dafianda. la corte tomara medidas y puede entrar una orden contra usted sin previo aviso 0 notificacion Y por cualquier queja 0 alivio que es pedido en la peticion de demanda. Usted puede perder dinero 0 sus propiedades 0 otros derechos importantes para usted. LLEVE ESTA DEMANDA A UN ABODAGO INMEDIATAMENTE. SI NO TIENE ABOGADO 0 SI NO TIENE EL DINERO SUFICIENTE DE PAGER TAL SERVICIO, VAYA EN PERSONA 0 LLAME POR TELEFONO A LA OFICINA CUYA DIRECCION SE ENCUENTRA ESCRITA ABAJO PARA AVERIGUAR DONDE SE PUEDE . CONSEGUIR ASISTENCIA LEGAL. . Court Administrator, cumberland County Courthouse, 4th Floor 1 Courthouse square Carlisle, PA 17013-3387 Telephone No. (717) 240-6200 Dated: ,..-z,1-'1J P.c. By: Arc ie V. Diveg1ia, Attorney for Pia inti 119 Locust st. Harrisburg, PA (717) 236-5985 SBIDLB MBMORIAL HOSPITAL, Plaintiff I IN THI COURT OF COMMON PLIA. I CUMBBRL~ND COUNTY, PINN8YLVANIA I BDWARD L. RBBD and DBBRA D. RBBD, Detendant. NO. 95-3881 v. v. HORRAce KAHN INSURMlCe CO., and HIALTH AMBRICA OF CeNTRAL .PBHHSYLVANIA, . AdditIonal Deta. CIVIL ACTION - LAW JURY TRIAL DBKANDID P9".LAZNT or DB~anDAHT. ID.~Q L. RI.~a DBBRA D. RIID AOAJ~ST ADDITIONAL DBF~AKiI-HQBAQI MANN INSURMlCB COMPANY MID HEALTH ~ OF CI.IIlBAL PA. Defendants, Edward L. Rced and Debra D. Reed, hereby fIle the within Complaint against additional Dofondllnta, lIorace Mllnn Insurance Company and IIcnlth Amorica of Ccntral Pennsylvania, and . aver in support as follows: 1. This action was instituted by tho fllinq or 1\ Complaint by the Plaintiff against the Defendants, n true nnd correct copy of Plaintiffs' Complaint is attached hcreto nnd mnrked Exhibit A. 2. Defendants havc Ciled their Answer to the Complaint which is attached as Exhibit B. 3. Additional Dcfcndnnt, Horace Mann lnsurnnce Compllny is an insurance company liccnsed to transllct insurance in the Commonwealth of Pennsylvanla and is located lit 9841 Broken Lnnd Parkway, suite 303, Columbia, Harylanu 21046. 4. Additional Defendant, Health America of Central Pennsylvania is a business corporation licensed to transact health insurance coverage in the Commonwealth of Pennsylvania and has an address located at 2601 Market Place street, Harrisburg, ~ PA 17110-9339. 5. For purposes of this Additional Defendant Complaint only and without admission or adoption, the averments of paragraphs 1 - 23 of Plaintiffs' Complaint are incorporated by ..reference as if fully set forth at length herein. . COUNT I EDWARD L. ReED AND DEBRA D. REED V. HORACE MANN INSURANCE COMPANY 6. The averments of paragraph 1 - 5 of this Complaint are incorporated herein by reference as if fully set forth at length herein. 7. Plaintiff Edward Reed was an insured under an insurance policy of the Defendant for injuries arising out of a motor . vehicle accident inclUding that of 9/20/92. 8. That the Defendant Edward L. Reed did all steps necessary and filed all paper work required and placed the additional Defendant, Horace Mann Insurance Company on notice of such claim. 9. That the additional Defendant, Horace Mann Insurance Company did, in fact, make medical expense and other payments under said policy. 2 10. It is averred that the additional Defondant, Ilorace Mann Insurance Company, has notice as to the bi II in(J or the Plaintiff, Seidle Memorial lIospital, but has not yet made ft decision as to payment of the same. 11. Although Defendant, Edward L. Reed, does not possess medical reports Indicating that the treatment for which the billing to the Seidle Memorial lIospital wns Incurred was causally related to the motor vehicle accident, he hfts been ndvised by his health insurance carrier that their medical reprenontntlve had .indicated that it is causally related to the motor vehicle aocident and proof will be supplied to the Defendnnt lIorace Mann Insurance Company, if that is the case. WHEREFORE, Oerendant, EllwIlrd L. R."d, av.r. thllt Ilddition..l Defendant, Horace Mann Insurance Company Is liable to Plaintiff as third party beneficiary to the contrnctual agreement between the Defendant Edward L. Reed and additiona I ()efendnnt lIorace Mann Insdrance Company. COUNT II EDWARD L. REED v. HEAL.TIL\IU:RICA O~H'l'8A~.LV1\HIA 1'-. The Defendant, lIenlth Americll of Central Pennsylvania, is the HMO for Edward and Debra Reed. 13. The claim or tho Plaintiff, Soldle Memorial Hospital, was presented to Derendnnt lIonlth America of Central Pennsylvania as early as Novembor of 1994 but It has failed to send to Defendant Edward L. Ileed n written notice as to reasons for 3 denial of the claim. 14. The Defendant, Edward L. Reed, has only oral advisement from representatives of the additional Defendant that the claim has not been paid because it is believed to be related to the motor vehicle accident of September 20, 1992 and not the heart attack of August 1993. 15. It is averred that the additional Defendant, Health America of Central Pennsylvania does not have a medical basis for said denied. . 16. It is averred that the additional Defendant, Health ~merica of Central Pennsylvania does not have a physician's report so indicating the basis of the denial of the claim. 17. The additional Defendant, Health America of central pennsylvania, has a duty under the contract with the Defendant to pay for such billing and its failure to pay is a breach of its agreement with the Defendant. 18. That the failure of the additional Defendant, Health America of Central Pennsylvania, to either payor supply written notices as to the reason of its failure to pay the billing of the Seid1e Memorial Hospital is contrary to the Unfair Insurance practice Act of the Commonwealth of Pennsylvania and it is an act of bad faith entitling plaintiff for punitive damages. WHEREFORE, plaintiff demands judgment against the additional Defendant, Health AmerIca of Central Pennsylvania, for the billing to the Seidle Memorial Hospital, counsel fees, costs and 4 punitive damages to a sum in excess of the arbitration limits of the Court of Common Pleas of Cumberland county. Respectfully submitted, DIVEGI.IA and KAYLOR, P.C. DATED: 'f - Z-r.Jf J--' By: Arch V. Divegl a,/ Attorney 1.0.#17140 119 Locust street' Harrisburg, Penn ~lv (717) 236-5985 17101 . . Attorney for Defendant 5 _.. ~RIFICATIQti The foregoing complaint is based upon information which has been gathered by our counsel in the preparation of the lawsuit. The language of the Complaint is that of counsel and not our own. We have read the complaint and to the extent that it is based upon information which we have given to our counsel, it is true and correct to the best of our knowledge, information and belief. To the extent that the content is that of counsel, we have relied upon counsel in making this verification. This statement and verification are made subject to the penalties of Pa.C.S. section . 4904 relating to unsworn falsifIcation to authorities, which . provides that if we make knowingly false averments, we may be subject to criminal penalties. Dated: cr('2-1(<;j 'tMtI-ut ~ EDWARD L. REED- ~Q~1\QuA BRA D. REED ..:......, ~A . . ORDER I ;;rO.15U . AiJ. LEOAL fiLE .YSTU'.. allll'ERO &Va'UII, IHe:" P[fALUMA, e" TO H[OROER CA.LL TOLL rRrE 1l00-8188E"0 leA, 0" '800, 35.82"0 lunA, -- , ~ . \ - -,..:....-.-~,...~-~..;... "..::':':"'_-::-:", H1-~lnl.I': MI-:MORI^I, 1I0SPI'r^", III lifE COUIlT OF COMMON PLEM, l1M1UJUlllfl COUIHY PENt~SYLVANIA PlaIntiff v, CIVIL ACTION - LAW ~DWARD L. REED and UEDRA D. REED. d n Defen ant I~O. 1),5- 3'i{~ I CL;,e;! \..7J~I" NOTICE You have been sued in court. If you wifih to uefpnd against the claIms set forth in the following pages, you must take action within twenty (20) days after this Complaint and Notice are aaryeu. by antar 1"9 ,., w,. i Lt..,n appea'~l1l1c'" 11e,-eul1n 11 V or Uv at..torney and filing In wrItIng with the court your defenses or objectIons to the claims set forth against you. You are warned that if YOll fail to do so, the case may proceed without you and jUdgment may be entered against YOU by the court without further notice for any money clll1med in the ComplaInt for any other claIm or relIef reQuest.ed by the Plaintiff. You may lose money or propert.v or other rights importnnL to you. YOU SHOULD lAKE THIS PAPER 10 YOUR LAWYEIl AT OI~CE. IF YOU on NOT HAVE A I AWYEIl OR CANNOT AFFORO ONF, an TO nR TGLFPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CM' GET LEGAL HELP. LAWYI:R REFEIIIlAL ,Cumberland Co. Court Admin. Fourth Floor One CO\lrthousc ficlunrr Carllnle. PA 17013-3387 (717) 240-6200 lleSIJecLful iy sllbml1.Led: ~ ~~-1R'A fUSIC, <1201 Cr'wr,s'M .11 Post OffIce 80' Harrlsh.Ir<1, PA (717) f.4(1-5610 5UPRCI-lE COUIlT 110. 07207 ATTOIlNE'r' FOR PLAIIITIFJ ESfJU I RE RoarJ C,7015 1] 112 Dated:illll T~UE COpy FROM RECORD In TeSlrmony wl",rccr, I here Ul1lo sol my h~nd IIrKI the seal of said Court at C~rlislc. Pa. TIri. cJ.J.'51 d f /2 .I . . ..:.... ay o. ;;r;:fr.......' I'.i!:: ...........~1K.~...r. ~~. ..iJf1....... ,; rrolhonotary n..~rOI,"~ ~H~"'()nl^l. 1I0fiPI'I'^I" /I~ lllF. COURl OF COMMOIl PLEIIS cnIlH:IWwlCOUfHY PENIlSYLVIINIII PIa In\. 1 f f V. ~OWIIRO L. R~~O ~n~ IJ~IIRII O. R~r.IJ, (lefnne!an\. n CIVIL IICTlOll - LIIW llO . NOTICIII .. L'J hall demanLlado a usted en 1 a corte. 51 usted QU i ere defenderse de es\.as demandas expuestas en 1as pnginas siguientes. usted tlene Vlente (20) dins de plazo a1 partir presentar una aparlenCla escrlta 0 en persona 0 por abogado y archlVar en 1a corte en forma escrita sus defensas 0 sus objeciones alas demandns en contra de su persona. Sea aVlsado Que 51 usted no se defiende. la corte tomara medldns y puede entrar una orden contra usted sin previa aVlS0 0 notlflcaclon y por cualQuier Queja 0 a1ivio Que es ped i do en 1 a pet. 1 c lCHl de deOlanda. Usted Duede perder d i nero 0 SUS proPledades " otros derechos lmportantes para usted. . LLEVE EST A DEMIINDA A UN ABOGIIDO INHEDIIITIIHEIlTE. 51 NO TlEIIE IIBOGIIDO 0 51 NO TIEtlE EL DINERO SUFICIEtlTE DE PIIGAR TilL SERVICIO, VIIYII EN PERSONA 0 LLAME POI' TELEFONO II LII OFICINII CUYII DIRECCION SE ENCUEIlTRII ESCRITA IIBAJO PIIRII AVERIGUIIR DONDE SU PUEDE COIlSEGUIR ASISTENCIII LEGAL: J.IIW'{ER RP.FERRIIJ. Cumbcrlnnd Co. Courl IIdmln. '~'ourtb Floor One CO'lrthouR~ Squnr~ Cnrlislc, PII 17013-33R7 (717) 240-6200 Respectfully submitted: ~--:v II~R II. I<USIC. SOUY-RE ~ 4201 (rums 1.1111 Road Post ('ffice Box 67015 4arrlsburg, I'll 17112 (717) 540-5610 SUPREME COUPT NO. 07207 IITTORNEY FOR PLIIINTIFF lJated: Ji" /'-1\' BEIDLE HEHORIlIL 1I0BPITlIL, PlaintHt IN TilE COURT OF COHHON PLElIS CUHDERLlIND COUNTY, PENNBYLVlINIlI I I I V. CIVIh lICTION - LAW EDWlIRD L. REED and DEDRlI D. REED, Defendants NO. : . . . . C 0 M P L A I N T AND NOW comes Plaintiff by ilnd through its attorney, Arthur A. Kusic, Esquire, and respectfully represents the following: . 1. Plaintiff, SEIDLE MEMORIAL HOSPITAl" is a hospital . facility orgilnized and existing under the lilws of the Commonwealth of Pennsylvania Filbert simpson streets, located at (, Mechanicsburg, Cumberlilnd county, Pennsylvilnia. 2. Defendilnts, EDWARD L. REED and DEBRA D. REED are adult married individuals residing ilt 119 Yorkshire Drive, Mqchanicsburg, Cumberland county, pennsylvilnia. 3. On or about September l6, 1993 and from time to time through November 18, 1993, Plaintiff, ilt the request of Defendilnt Edward L. Reed, did provide health care services to said Defendant. 4. Plaintiff in good faith provided the necessary health care services to Defendant, Edwat-d L. Reed, and thereafter billed Defendants for those services ilnd expenses incurred. As evidence whereo~, copies of the billi.ng for services rendered to tho Dofenclllnt, ~;dw.'rd I.. Heed lire illtllched herelo, made 11 pllrt hereof and marked Exhibit "A". 5. Plaintiff's charges to the Defcndllnls for services rendcrml to Defendilnt, Edward I" Rerd lire its UGulIl and customary chnrgeG. 6. Plaintiff has made demands [or payment of $1,439.00 upon Defendant, which demands remain unheeded. 7. plaintiff avers that the amount due and owing does not exceed the jurisdictional amount requiring arbiitration referral by local rule. . . COUNT I. (plaintiff v. Edward L. Heed) (Quantum Meruit) 8. Plaintiff incorporates herein by reference thereto the averments hereinabove set forth in paragraphs 1 through 6. 9. plaintiff did render henlth care services to Defendant with rellsonable expectation that payment for such services would be mnde by the party benefitted. 10. Should the Defendant not be required to pay for the bnlance due for the services rendered, Defendant would be unjustly enriched at Plaintiff's expense. 11. Plaintiff avera that tI", amount due and owing doC'a not exceed the juriadictional amount ,:equiring arbl itration refcrral by local rule. WHEREFORE, plaintiff prays your Honorable court to enter Judgment in its favor and against Defendant Edward L. Reed in the amount of $1,439.00 along with interest at the rate of 6% per annum and the costs of this proceeding. . . COUNT II. (plalntiCf v. Debra D. need) (Doctrinc of Necessaries) 12. Plaintiff incorporates herein by reference thereto the averments hereinabove set forth in paragraphs 1 through 10. 13. PlaintiC f believes and therefore avers that the health care services rendered, upon request, to Defendant Edward L. Reed, husband of Defendant Debra D. nC'cd, were necessary for his benefit and welfare. 14. plaintiff believes and therefore avers that pursuant to the "doctrine of necessaries", Defl:'ndant Debra D. Reed, as spouse of the recipient of heal th cnre services, is liable to Plaintiff for the bnlance due. ~;;.! 15. Should Defendant Debra D. Heod not be held 11l1hl" to Pl 11 inti ff for payment of servicCls rendered hor hushand, she would be unjustly enriched as the services were necessary to benefit the health and welfare of her spouse and their marital union. 16. Plaintiff has made demands for payment upon Defendant, which demands remain unheeded. . l7. Plaintiff avers that the amount due and owing does not exceed the jurisdictional amount requi ring arbi tration referra 1 . by locill rule. WIIEHEFOHE, Plaintiff prays your 1I0norable Court to enter Judgment in its favor arid against Defendant Debra D. Reed in the amount of $1,439.00 along with interest at the rate of 6% per annum and the costs of this proceeding. COUNT II!. (Plaintiff v. Debra D. Reed) (statute) 18. Plaintiff incorporates herein by reference thereto the averments hereinabove set forth in paragraphs 1 through l7. 19. Pursuant to 23 Pa. C.S.^. 4321, married persons are liable [or the support of each other. . 20. Pursllant to 23 Pa. C.r..^. 4102, whon' debts are contracted for necesGilrios by either npouse, il creditor may institute suit against the husband and wife for the price of the necessaries. 21. Plaintiff did render necessary hQillth care services to Defendant Edward I.. Ilr>ml with the "r>ilnonilhle <'Xpr>ctiltlon that such services be paid for by the persons benefitted, which in the instant case include said Defendant and his spouse, Defendant Debra D. Reed as a partner in the marital union. 22. plaintiff has made demands [or payment upon Defendant, which demands remain unheeded. 23. Plaintiff avers that the amount due and owing docs not exceed the jurisdictional amount requiring arbitration referral by local rule. WHEREFORE, Plaintiff prays your Honorable court to enter Judgment in its favor and against Defendant Debra D. Reed in the amount of $1,439.00 along with interest at the rate of 6% per annum and the costs of this proceeding. COUNT IV. (plaintiff v. Edward L. Reed and Debra D. Reed) (Total) 24. Plaintiff In<:orporatco hprf'ln by reference thereto the avermentn hereinabovo [;at forth in pnt'nqrnpbn 1 lht'ouCJh 23. 25. plaintlff IInS made demnndn for pnyment upon Defendants for pnyment of the balance due of $1,439.00, which demand remains unheeded. WHEIlEI'ORE, plaintiff prays you Honorable Court to enter Judgment in its favor and against Defendants Edward L. Reed and Debra D. Reed in the amount of $l,439.00 along with interest at the rate of 6% per annum and the costs of this proceeding. . RESPEC'l'I'U1,LY SUBMl'l"rElJ: ...'.., .' ---- ~ . r"....h "<'C/; / /-.~----- p~ C/r .-,:- Ar~hur A. . Kusic - Esquire 4201 Crums ~ill Dad- Post Office Box l1585 Harrisburg, PA 17108 (717) 540-5610 supreme Court No. 07207 Attorney for the Plaintiff DATED: IlEIDLE MEMORII\L HOnPITI\L, Plaintiff I IN Tilt: COIIRT OF COMMON PLEI\Il CUMnt:RLI\ND COUNTY, PENNSYLVI\NII\ . . v. I : CIVIL I\CTION - LI\W EDWI\RD L. RF.F.D And DEBRI\ D. REED, Dofondants . . NO. Y_E_8J_LL9.J\_1'._I-9_ti 1, IIARRY "ARK , the SUrf.RVI SOR, OF CRWIT & COI.Lf.CTlON of SEIDLE MEMORIAL HOSPITAl, verify that . the statements made in the Complaint arc true and correct and that .1 am authorized to make this Verification on behalf of SEIDLE MEMOIUAI, HOSPITAL. 1 understand that [alse statements herein arc subject to the penalties of 18 Pa. C. S. section 4904, relating to unsworn falsification to authority. SEIDLE MEMO] RAL HOSPI'l'A!, .y' dz4:;. DATE: 5/15/95 , I. f i I I . . " B>:IJJlIl'r "1\" " TOTALS ~ ' , l .5EE LAS PAGE, .. See Reverse Side If You Have Not Furnished Us Your Health Insurance Information and/or Forms . ~EEP T H!S PORTION FOR YOLlR RECORDS DETACH AND RETURN THIS PORTION WlHi PAYMENT .,,,,,,. """II-._:.\l~'in ii'~' '"V,~O" ,,{,.ie; " _. I. I.. (Jl!iOtAf1i.\[ DAlE , . I 1. - 'f r ~ " i IlISrlt 01111' , rl,,'.-l:'t" I': I',", n 'l !"~ 01 'III, ',,~ 1I!1'1I11! III III, ! lit '.~' '!: .'if}::: It;!;1 ,111.1. T '. 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REW D..:n or 8CMlMIQfi .- ,-- ---_._--- .-.. ---.------ 09,16 INTER/lED-I'IIY TIIERAPY 90 09:16 /lASSAGE 90 09'20 /lASSAGF. 90 09:20 IIDT PACK STANDARD 90 09 '22 UI.TRASDlINlJ PIIY TIlERI' 90 09:22 1I0T PACK STANDARD 90 09:23 EXERCISF.-TIIERAI'EUTIC 90 09.23 /lA5SAGE 90 Q.9:23 1I0T PACK STANDARD 90 09,28 /lASSAGE 90 09+28 1I0T PACK STANDARD 90 09'30 /lASSAGF. 90 09:30 1I0T PIICK STANllARD 90 10'05 UI.TRASOUNll Pity TilERI' 90 10:05 IIDT rACK STANDARD 90 10'07 /lASSAGF. 90 10:07 1I0T PACK STANDARD 90 10:08 /lASSAGE 90 10'08 1I0T I'IICK STANDARD 90 10:12 /lASSAGF. 90 10' 12 1I0T PACK STANDARD 90 10:12 /lASSAGE 90 10' 12' 1I0T rACK STANlJARD 90 , 10.19 /lIlSSAGF. 90 10: 19 1I0T rACK STANDARD 90 10'21 ~ASSAGF. 90 10:21 1I0T PACK STANDARD 90 10'22 /lASSIIGF. 90 10:22 1I0T PACK STANDARD 90 10'26 /lASSAGE 90 , 10,26 1I0T PACK STANllARD 90 10:28 /lASSAGF. 90 10,28 1I0T PACK STANDARD 90 10 :29 EXF.RCISf.-TIIF.RArEUTlC 90 lOJ29 SSAGE-____ ._u.90. Ir lATE CHlnoES rOl1 SUl'J'!:E5 1<[00\lEAEO OCCIJot YOU'-u. "ECEI."E AOOTIONAL Blll'",Q 1'''hENI NO r' or,,) . ~~,.I& MilKE CliECKS PIIYIIBLE TO: ';AIlIlANS n..:"i I'(;..~ f I,' Slmll.F. 1lF./llllIl AI. 111151' ITA!. I'. O. nox 2332 IIARRI5nURG, PA. 17105 717 - 782-3680 1~~~EO~-19{:"~:':~~311~~~':~~1 I.R.S. 23013,.. :..,o2./."T".~1.~.- I totAL CHARoi- .'SrCOvt:nAOE;. -2N.O COVi"MOE. .--"nrico;"{n.\(j{ _ ~ ~ ..,-...-- -----t-.. ---t'. --I 54, 00 ' 54. 00 30: 00 : 30: 00 31l' 00 ' 30' 00 ~oo : ~oo 27' 00 ' 27' 00 ~oo ~oo 27' 00 27' Oil , ' 30, 00 30. 00 ~oo ~oo moo moo 26: 00 26: 00 I 30' 00 30' Oil I ~oo ~OO 27' 00 27' 00 ~oo ~OO ~: ~~ ~oo ~OO ~oo ~OO ~oo ~OO woo WOO 30~ 00 30~ 00 26: 00 26: 00 30. 00 30. 00 26: 00 26: Oil moo moo 26: DO 26: IlII I moo moo ~oo ~OO 30' 00 30' 00 ~OO ~OO ~OO ~oo ~OO ~OO 27' 00 27' 00 , " _ .-30,.00_ ___., .._ _I .L._. , Fe Av5.iOj; llJl . AVOU.~T """:1 (P"" .;, ~A /"'''.;'.''; I;, , 1I,r) I"i II ~' 1111'1111 I 111 '111, 2 See Reverse Side If You Have Not Furnished Us Your Health Insurance Information and/or Forms .. _ KEEP THIS PORTION FOR YOUR RECORDS DETACH AND RETURN THIS PORTION WITH PAYMEIIT 1f:.'.';NG oil, --.., I , , ..01101, ,95 III ~,i" II (lUll'. 111'111, {II, ',0"""';-- (;AIl/IMI!; I'A',. ;..... "r",;\ I'i~;~.nt.... r -\'.ffif.~,~ ,. f), ,('" '.:~ I SEIIlI.f: HE/Will AI. 11051'1 TAL I'. O. BOX 2332 IIAIlIlISBIIIlG. PA. 17105 717 - 782-3680 , r I- s n T 0 L_ ....'!'Ii Nut,lB.R 2126119822 WI/AlllJ I. REW 1108 I.AUREI, AVI: (AHI' 1111.1. I'A 17011 "IHi N",",f REEll EDWARD I. 90 90 90 90 9ll 90 90 90 9ll 90 90 90 90 90 90 90 90 [=~oOM"P=-iQ;~~~i:~31 !~~~~;~:~3J I.R.S. 23.1:~T:~T15 'OTAL CHAnOE -'lsy'c(,vritloE 2Mlc"OiERAGe'"' 3nO COvtllMj[n AVOUW .. .--. __,_m_ -----.--.--.,.. - .,.. ..., _. ._ ". --"--r'" 26, 00 , 26, 00 27: 00 : 27: 00 3D' 00 , 30' 00 26: 00 ' 26: 00 moo roM ~OO ~OO woo woo , , ~OO ~OO 27; 00 27: 00 26, 00 26, 00 27: 00 27: 00 26' 00 26' 00 27: 00 27; Oll 26' 00 26' 00 ~oo ~M 27: 00 :, 27: 00 26, 00 ',26, 00 _____L__ -----~__ ______~__ ______~__ _____L__ I I I I I 1439, 00 ' , '1439' 00 I I I I I ft_.ftw.... ft.nw~r.re~ ~._....e. 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II ' 18 -9.1 r,::,n.~ ,,~_. '1, il. 11,1"j(l" (;^lotAU~, Itll (J(J 111 It I, I, . '. 111:,1''' 111111'. 01 Ill'. 0', ,Ar',p'''':,ASlif, It.""ill,';(C: ..-fl,:.', "',"1", 1':'\ t'... ',~ ~ r,c I 5 " J-:lIWARIl I. REUI , t 1108 I.AllRE!. AVI: t , CA/1P III t.L I'A 17011 0 l ..,.:,~ I; N,jVU~h A IteNl NAt.,lte 212609822 REW EDWARD I. IA',f :I SI: 1111.1: /11:110111 AI. liDSI'I TAl. 1'.0. IIOX 2332 IIARRISllllllli, I'A. 17105 717 782-3680 [-iiOOijN-~. --.i.6i..lijff6' -!'[iSOiinOFU I .-.-.. ....-- -.- --... I 1-.... 1"- .., 09,16,93 II, 18,93 ~._____ ._. .."..~_ u,__. .. .__._..... _.. _. '..'-- ,,----..-, - ..... -_.._~.. ,-- ---.,. lOTAL CHAROE 1ST CO'ffnAOE 1'''0 COVEnAOE 3no CO'.Ef\AOE . ----r.-- .---. .-,...-. '1'-- t , , I.R.S. 23.1352215 OAll I SORIAI. SECURITY NO. - 182-46-55 4 HI~TlI ATE - 11/09/54 SEX - /1ARITA. STATUS - /1 RACE - W ATTI:Nll NG 1l0CTOR - 97999 ALl. OTl ER DI~GNO IS - I' 847.0 : POI. ICY 1I0Llll:R ~:/1PLOYER - /10NTGO ERY WARD l'O~ICY 1I0WER - NOT ENTER Ell rNSURA CE COVERAGE CO. A/1E - SEI.F PAY REASON FOR VISIT - PIIY TlIERAPY tlOTE - CERV ICAI. STRAIN OESCA"'llON 1l02013JE /999 : GR P NO.: - ON~: pOLICY NO.: - ? _.__.____.____ __.._l___ ___.,. "...'ECI'.IlQES.QASE.....CES TOTALS ~ ' RE'1t>EAfD OCCUR YOU WILL nrr:rrvt AOCWllO'-lAl AUNQ .. ,J._... . , See Reverse Side If You Have Not Furnished Us Your Health Insurance Information and/or Forms KEEP THIS PORT.lON rOR YOUR RECORDS DETACH ArlO RETURN ThiS PORTION WITH PAYMENT m::~{I:' ~.v, II o:'l'!.::Ar:5.:):s~":;,{~::L I 5'C ~ j O'!.CtIAn,H.D"'f I ' , SEllll.E I1EHOIlJAI. 1I0SI'IlAI. 11'18'93 717 - 782-3"80' ';"I'l~1 'lU I , 1 ,,,nQR?? RHIl MAKE CHECKS PAYAOLE TO: PATI[m Ayour.l --- ---T"~ , , , , , , , .-- , , PATIENT PAY THIS AMOUNT 1',1". (II ,,~i;.>V'.1 t'.'! 11,39.(Hi A'IC'K"~ I 1'10':' , I I . . 0111'11< /I .." ", I.' ^,. II -,AI 1111 ~'I'..11 M', ellHIIIlII', ~,t!!orf Mfi ,""C "I lA, (t"'... '^ '0 III ,,1/1"'1, I\d I '''11 1'/1 I '''''' lllltill "0 d.A, ., . ",,", ">1111.'"" 'U<,o\, EIIIiII . , , - . ..::;..=.~---- <<-:.-.. ,..:,.. '_.-~;-:-:-- \ SBIDLB MBMORIAL HOSPITAL, Plaintitt I IN THI COURT OF COMMON PLIAS I CUMBeRLAND COUNTY, peNNSYLVANIA I I NO. 95-3881 I I orVZL ACTZON - LAW I JURY TRIAL DBMAHDBD I v. BDWARD L. RBBD and DIBRA D. ReID, Defendants AHPWBR TO COMPLAINT AND NEW MATTER . AI'D NOW, this 27th day of September, 1995, come the Defendants by and through their attorney, Archie V. Diveglia, and respectfully represent the followIng: 1. Admitted. 2. Admitted. 3. Admitted. 4. Admitted. , 5. The averments nor denied in that they and belief. in paragraph five can be neither admitted are out of the scope of their knowledge 6. Denied as stated. It is admitted that the demands for payment have been made, but Plaintiff has indicated to the Defendant that he has insurance coverage either through his auto insurance carrier or to his private health carrier and that either one or the. other should pay such billing. 7. Admitted. COUNT I l'LAIli't.IFF V. BDWARD L.J\B.f;~ O. No answer needed. 9. The allegations are neither admitted nor denied in that it is unknown to the Defendant what was the expectation of the Plaintiff in this matter. 10. The averments in paragraph ten denied. The averments in paragraph ten are conclusions of law to which no further response is required. . 11. Admitted. WHEREFORE, Defendants request Plaintiffs prayer for judgment . be dismissed. COUNT II nl\INTUF V. DEBRA ReED 12. No answer needed. 13. Admitted. 14. DenIed. The averments in paragraph 14 are denied as a conclusion of law for which no further response is needed. 15. Denied. The averments in paragraph 15 are denied as a conclusion of law for which no further response is needed. 16. Denied as stated. It is admitted that the demands for payment have been made but Plaintiff has indicated to the Defendant that he has insurance coverage either through hIs auto insurance carrier or to his private health carrier and that either one or the other should pay such billing. 2 17. Admitted. WlIEREFORE, the prayer for relief of the Plaintiffs should be dismissed. COUNT III lL~~NT1FFS V. DEBRA R~~ 18. No answer required. 19. Denied as a conclusion of law to which no further response is needed. 20. Denied as a conclusion of law to which no further response is needed. . 21. Denied. Plaintiff has no knowledge as to the expectation of the Defendant. 22. Denied as stated. It is admitted that the demands for payment have been made but Plaintiff has indicated to the Defendant that he has insurance coverage either through his auto insurance carrier or to his private health carrier and that either one or the other should pay such billIng. 23. Admitted. WlIEREFORE, Defendant moves the claims of Plaintiff be dismissed. COUNT IV PLAINTIFF V. EDWARD ReED a~ DEBRA REED 24. No answer required. 25. Denied as stated. It is admitted that the demands for payment have been made but Plaintiff has indicated to the Defendant that he has insurance coverage either through his auto 3 insurance carrier or to his private health carrier and that either one or the other should pay such billing. WHEREFORE, Defendant moves this Honorable Court to dismiss all claims of the Plaintiff. lIew MATTBR The averments from paragraphs 1 through 25 are incorporated herein and made a part hereto. 26. The services rendered by the Plaintiff to the Defendant, Edward L. Reed, were believed by the Defendant to be . services related to problems he had relating to a heart attack in August of 1993. However, Plaintiffs' health care carriers indicated that it is of the opinion that the treatments and expenses were related to an automobile accident incurred by the Plaintiff on september 20, 1992 and has denied coverage on that basis. . 27. Plaintiff believes that his auto insurance company is on notice as to this pending claim by the Plaintiff, but that the auto insurance company has yet to render a decision as to payment. 28. Regardless as to whether the services rendered by the Plaintiff were related to the Defendant's heart attack or to the Defendant's automobile accident injuries, there is insurance coverage to provide payment and PlaintIff has fIled a thIrd party Complaint against each Defendant which is attached hereto. 4 WHEREFORE, Defendants move this 1I0norllble Court to dismiss the claims of Plaintiff. Respectfully submitted, DIVEGLIA and KAYLOR, P.C. DATED: t'f-7,,1-fr . By: Archie V. Diveglia, squire Attorney 1.0.#17140 119 Locust street Harrisburg, penns lv nia 17101 (717) 236-5985 Attorney for Defendants . 5 VERIFICATION The foregoing Answer to Complaint and New Matter is based upon information which has been gathered by our counsel in the preparation of the lawsuit. The language of the Answer to Complaint and New Matter is that of counsel and not our own. We have read the Answer to Complaint and New Matter and to the extent that it is based upon information which we have given to our counsel, it is true and correct to the best of our knowledge, information and belief. To the extent that the content is that .. of counsel, we have relied upon counsel in making this . verification. This statement and verification are made subject to the penalties of Pa.C.S. section 4904 relating to unsworn falsification to authorities, which provides that if we make knowingly false averments, we may be subject to crimInal penalties. Dated: 'Ij~1/~ ED~~~ ~~))~ ORAD. REED ~RrIFICATB OF SERVICB AND NOW, this 27th day of september, 1995, I, Bethany A. King, for Archie V. Diveglia, Esquire, hereby certify that a copy of the foregoing Complaint was served by depositing the same in the United states Mail located in Harrisburg, PA, postage prepaid, addressed to the following: Arthur A. Kusic, Esquire 4201 Crums Mill Road P.O. Box 67015 Harrisburg, PA 17112 .' . Bethany Ar ing, Secret Archie v."r iveglia, Esq DIVEGLIA & KAYLOR, P.C. of e and 7.: c- r- .... ~; ~.. ., - . ., ..1 .. .... <TI - ,- ("-.l c>- .... ..'-> \ I I \ I , , ... - SHERIFF'S RETURN - OUT OF COUNTY CASE NO: 1995-03881 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND SEIDLE MEMORIAL HOSPITAL VS, REED EDWARD L ET AL R. Thomas Kline . Sher~ff. who being duly sworn according to law, says, that he made a diligent search and inqu~ry for the within named defendant. to wit: HEALTH AMERICA OF CENTRAL PENNSYLVANIA but was unable to locate deputized the sheriff of Them in his bailiwick. He therefore County. Pennsylvani3. DAUPHIN to serve the w1thin COMPLAINT On October 5th. 1995 this office was in receipt of County. Pennsylvania. the attached return from DAUPHIN Sheriff's Costs: Docketing Out of County Surcharge DAUPHIN COUNTY So answers: _ ~ / ~> ;/ l-'~-_ _ -/ -' d~Fi~~-at;~.Ki~~e.. - -;::- ~;;; Sher~11 18.00 9.00 2.00 30.50 159.50 ARCHIE SIVEGLIA 10/0511995 Sworn and subscr~bed to before me this II!!- day of _c~~a...... 19 ~-.,. A. D. ~. . l~ ~_. .~ .If' ,1 ~ r~ota* , .."........"".-............... .'.;..... -. . C -I . - I d.' ? I 1M I nE'J Court or .::mmO:1 r s:::s or \..:.Jr"::"-:.:!t'l:::n '-'::L::-;~'Y,' anr:sY'lr:::ni:: Edward I.. Reed and Debra D. Reed 'IS. Health America of Centcal Pennsylvania ~o. Q~-~AB] ri"il T~rm .~ ---, --- ~ow, iSfltQmgOr 20, ]\)Oe:; :9--. r. S~..!::: O~ C~r.3z:?.!.A.'ID COt..,.,TY. ?~ co ==-..by li.:=u= t!:: Sh==.5" ai n:l'lphi n C.:.u::ty :0 :::::-.:t: .:.~. '.V:::, :::s =-"7u== =~ -....:- U == ~ ~d :=..!k oi :::: ?,..:_=. ~'?/.-d ~ /J~ {~ .5l1e..~ =t S::::!lu'..:u:d C~u.:Q'. ;>:1. .3. ;:;:;da."1it Or Sem~ So =w=. Shc:::a' oi Cowlt'r. ?~ ==:.:::s_oyoi_ !9_ cosn sn....."!c:z ~~~.GE .-\:: JJJA'Vu oS Swot:: :md S"oI!:sc:-:b:d cccrc - s t_.._. -. . . COMMONWHAI:I'1l OF I'I'NNA: COUNTY 0... DAlJPIIIN: HIIHH1......'S R~:TlIRN NO. 95-3881 Civil Term PAlm 8 [ " I; '; AND NOW: Oct. 2nd III 95 ,lit 1:19 P. ~1. SI-:HVEIl Till' WITHIN _~p.!alll~~f.._D.~f~~~<!l1ts .i\galnstMdl~Il?nal Defendants and ,Notice. UPON Health America of Central Pa. IIY PEHSO:-;AI.I.Y IlANDING '1'0 Charles Mills, Securlty supervlser and person ln charge at tlme of servlce A TRUE ATTESTED COPY OF TilE ORIGINAl. Complaint of Defendants Against AddHional Defendants and Notlce AND MAKING KNOWN TO hlm THE CONTENTS THEREO'" AT hls place of buslness, 2601 Commerce Court Bldg. Harrisburg, Pa. r ! SO ANSWERS n'~~ fl. ~~~ SHERIFF OF DAUPHIN COUNTY, PCNNA ll\'_ ,.. f}l,;~ _~~"t;:- ~EPlIT\' SlltHIF'" Sworn and subsel' j t)l,d l () b3~;~?~:~ J:. !X',Oo\ ,., J ~ . (.vWlUL.. PHOTIIONOTAHY 95 HIlEHI.......S COST ....3JSO H'IA \. . . IN TilE COUHT OF emlt.ION PLEM; CU~1I3EHLANlJ COUNTY, PENNSYI.V N IA CIVIL ACTION _ fthW NO. 95- JIHl1 SEIDLE MEMOHIAL 1I0SPI'I'AL V. EDWAHD L. HEED and DElmA D. HEED V. 1I0RACE MANN INSURANCE COMPA and IIEAL1'1I MlEHICA OF CENTR PENNSYLVANIA ANSWER TO NE~1 MATTER CERTIFICATE OF SEHVICE _ 1 nt:reiJ',' u'rtlfy lhr!t the 'tIiiHlin :.J -li.'ll{ IS it lrW.' JwJ Lont?';t cupy Of t;l-' orlg;n;;1 fil~d in ttllS ."tl(;(1. ~Oll Me t'~I~by 1I0111,e.l (0 plCJd 10 d!.; '....!lIHl ..Cll'rll~qt Wlttll!1 20 d'IS 01 "'C", .... 0'1 fJullju.Jlmcnt Il1"Y be ,'/ I.red again:;! iOU. _ Jllf! Ill..1 I..Uflllld-!d. _ .'olt,Jrfiey I...;, .""._.__ ARTHUR A, KUSIC ATTORNEY AT LAW 4201 CHUMS M'LL ROAO P.O. Bo, 67015 HARRISUUf'G, PENNSYlVAtlIA 17106-7015 (717) 540.5610 . I'. 'II ," * * * * * * * * * * * HORACE KAHN INSURMlCE CO., * and HEALTH AMeRICA OF CENTRAL * PENNSYLVANIA, * AddItIonal Detendants * SIIDLB MBMORIAL HOSPITAL, PlalntlU v. EDWARD L. RleD and DeBRA D. RleD, Datandant. v. IN THE COURT OF COMMON PLEAS CUMBIRLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW No. 95-3881 MlSWER TO NEW MATTER AND NOW comes Plaintiff by and through its attorney Arthur A. Kusic, Esquire and, incorporating herein by reference thereto the averments set forth in paragraphs 1 through 25 of Plaintiff's heretofore filed Complaint, respectfully represents its Answer to New Matter as follows: 26. Neither admitted not denied since whatever Defendant Edward L. Reed believed is under the control of said Defendant, an adverse and hostile party. However, Plaintiff's Billing statements reflect, inter alia, physical therapy treatment, massage, and hot packs. By way of further answer, whatever treatments Defendants' Insures do or do not cover is between Defendants and their Insurers. 27. Neither admitted not denied since whatever Defendant Edward L. Reed believed is under the control of said Defendant, an adverse and hosti 1e party. By way of further answer, whatever Defendants and their Insurers. treatments Defendants' Insures do or do not cover is between 28. Neither admitted nor denied since whatever treatments Detendants' Insures do or do not cover is between Defendants and their Insurers. Plaintiff admits that Defendants have filed a Third Party Complaint against certain Insurers. By way of further answer, P1aintift avers that defendants bear the primary responsibility to pay Plaintiff for services rendered. WHEREFORE, Plaintiff prays your Honorable Court to enter Judgment in its favor and against Defendants Edward L. Reed and Debra D. Reed in the amount of $1,439.00 along with interest at the rate of 6% per annum and the costs of this proceeding. --------- ESQuIRE Roa 17112 r SIIDLB MBMORIAL HOSPITAL, * IN THE COURT OF COMMON PLEAS plalntltt * CUMBeRLAND COUNTY, PENNSYLVANIA * v. * CIVIL ACTION - LAW * NO. 95-3881 EDWARD L. RIBD and * DEBRA D. RIED, * Detendants * * v. * HORACE KAHN INSURMlCE CO. and * HBALTH AMIRICA OF CENTRAL * PENNSYLVMlIA, * AddItIonal Detendants * V E R I FIe A T I 0 N I, HARRY A. PARK the SUPERVISOR. OFG6@fRcfI~N of the Seid1e Memorial Hospital verify that the statements made in the Answer to New MAtter are true and correct and that I am authorized to make this Verification on behalf of Seid1e Memorial Hospital. I understand that false statements herein are subject to the penalties of 18 Pa. C. S. Section 4904, relating to unsworn falsification to authority. SE::~E ME~OYAL 7JZ ~RY A. PARK DATE: 10/5/95 v. EDWARD L. REED and DEBRA D. REED : i --, \ . SEIDLE MEMORIAL HOSPITAL Plaintiff : IN THE CaUR) or COMMON PLE:AS : CUMBERLAN190UNTY. PENNSYL VANIA : : CIVIL ACTION - LAW : NO. 95-3881 r : V. HORACE MAN~_~~SY~~~CE CO. and HEALTH AMFfR'tt"^n'OY' CENTRAL PENNSYLVANIA, Additional Defend~IFICATE OF SERVICE : : I. Arthur A. KUSIC. Esquire. do hereby certify that on thIs 11th day of Octiber. . 19.95. I placed in the United States Mail true and correct caples of Answer. to.NewMAtter. "" with.first class postage affixed and addressed to following: Archie V. Diveg1ia, Esquire DIVEGLIA AND KAylor, p.c. 119 Locust Street HArrisburg, PA 17101 C. ESQUIRE rums M' I'/Road P.O. Box 11585 Harrisburg. PA 17112 (717) 540-5610 Attorney for the PlaIntiff Supreme Court 1.0. 07207 ~. RHP/PLDG/#242180.1/102395 4 ,.. IN THB COURT OF COMMON PLIA8 OF CUMBIRLAHD COUNTY, PENNSYLVMlIA CIVIL ACTION - LAW l SEIDLE MEMORIAL HOSPITAL, Plaintitf I . v. No. 95-3S81 EDWARD L. REED and DEBRA D. REED, : Defendants : v. . . . . HORACE MANN INSURANCE CO., and HEALTH AMERICA OF CENTRAL PENNSYLVANIA, Additional Defendants JURY TRIAL DEMANDED ENTRY OF APPEARANCB TO THE PROTHONOTARY: Please enter the appearance of Ronald H. Pollock, Jr., Esquire on behalf of Defendant Horance Mann Insurance Co. in the above-captioned matter. Serve all papers at 126 East King Street, Lancaster, Pennsylvania 17602. I HEREBY CERTIFY that I have this day served a true and correct copy of this praecipe by first class mail, postage prepaid, upon Archie V. Diveglia, Esquire. ( BARLEY, SNYDER, SENFT & COHEN Date: r{2."z:-et--v d/ 3, /99.r . By: 1t4J1r~ Ronald H. Pollock, Jr. Attorneys for Defendant Horace Mann Insurance Co. 126 East King Street Lancaster, PA 17602-2893 (717) 299-5201 Court 1.0. No. 52586 126 East King street Lancaster, PA 17602-2893 (717) 299-5201 Court 1.0. No. 52586 102395 - CERTIrICATI or SBRVICB I HEREBY CERTIFY that I am this day serving a copy of the foregoing Entry of Appearance by first class mail, postage pre- paid, addressed as follows, to: . i r , , , , , Archie V. Diveg1ia, Esquire Diveglia and Kaylor, P.C. 119 Locust street Harrisburg, PA 17101 BARLEY, SNYDER, SENFT & COHEN d) -#- ~//Ul1?' ,I't/' Date:("VA'Z~-e-f./ ~ 3, /99s- By: //' {tl"/ vI I Ronald H. Pollock, Jr. Attorneys for Defendant Horace Mann Insurance Co. -:...... \ . , = n -I r....) W oJ .... -.J ::>= .' - ~ RHP/245707.1/111595 IN THB COURT OF COMMON PLIAB OF CUMBIRLMlD COUNTY, PBNNSYLVANIA CIVIL ACTION - LAW . ,. SEIDLE MEMORIAL HOSPITAL, Plaintiff v. No. 95-38S1 EDWARD L. REED and DEBRA D. REED, Defendants v. : HORACE MANN INSURANCE CO., and HEALTH AMERICA OF CENTRAL : PENNSYLVANIA, Additional Defendants . . JURY TRIAL DEMANDED . . . . ANSWER AND NEW MATTER OF ADDITIONAL DEPEHDMlT HORACB MANN INSURANCB CO. 1. Denied. After reasonable investigation, Defendant is without knowledge and information sufficient to form a belief as to the truth of the averments of paragraph 1, and strict proof thereof is demanded. By way of further answer, a copy of Exhibit "A" is not attached to the copy of the complaint in possession of Additional Defendant. 2. Denied. After reasonable investigation, Defendant is without knowledge and information sufficient to form a belief as to the truth of the averments of paragraph 1, and strict proof thereof is demanded. By way of further answer, a copy of Exhibit "B" is not attached to the copy of the complaint in possession of Additional Defendant. 3. Admitted. 4. Denied. After reasonable investigation, Defendant is without knowledge and information sufficient to form a belief as to the truth of the averments of paragraph 4, and strict proof thereof is demanded. 5. Denied. After reasonable investigation, Defendant is without knowledge and information sufficient to form a belief as to the truth of the averments of paragraph 5, and strict proof thereof is demanded. By way of further answer, Plaintiff's complaint is not attached to the Complaint which is in the possession of Answering Additional Defendant. COUNT I 6. Denied. Additional Defendant hereby incorporates by reference paragraphs 1 through 5 of this Answer and New Matter as if fully set forth herein at length. 7. Denied as stated. It is admitted that Plaintiff Edward Reed was insured by Horace Mann for automobile insurance. It is denied that any automobile accident or injuries arising out of an automobile accident are involved in this case. By way of further answer, the averments of paragraph 7 are denied as they contain conclusions of law to which no responsive pleading is required. 8. Denied. The averments of paragraph 8 are denied as they contain conclusions of law to which no responsive pleading is required. -2- 9. Denied. After reasonable investigation, Answering Defendant is without knowledge or information sufficient to form a belief as to the truth of the averments of paragraph 9, and strict proof thereof is demanded. It is specifically denied that payments were made for the bills which are at issue in this lawsuit. 10. Denied. The averments of paragraph 10 are denied as stating conclusions of law to which no responsive pleading is reguired. By way of further answer, it is specifically not denied that Additional Defendant had notice as to any billing related to any injuries sustained in an automobile accident. 11. Denied. It is specifically denied that the Answering Additional Defendant has any idea what Defendant was told by his health insurance carrier. By further answer, the averments of paragraph 11 are denied as stating conclusions of law to which no responsive pleading is required. After reasonable investigation, Additional Defendant is without knowledge or information sufficient to form a belief as to the truth of the remaining averments of paragraph 11, and strict proof thereof is demanded. WHEREFORE, Additional Defendant, Horace Mann Insurance Co., respectfully requests this Honorable Court to dismiss Count I of Defendant's Complaint with prejudice. -3- COUNT :n 12-18. The averments of paragraphs 12-18 inclusive are directed to Defendants other than Answering Additional Defendant and no responsive pleading is required. NEW MATTER 19. The medical bills which are the subject of this lawsuit are not covered by the policy of insurance by any policy of insurance issued by Additional Defendant to Defendants. 20. Additional Defendant Horace Mann Insurance company has not received notice that any medical bills submitted to it by Defendants are related to injuries sustained in an automobile accident. 21. Defendant has therefore breached insurance contract with Additional Defendant. 22. Additional Defendant reserves the right to assert any defenses based upon its insurance contract with the Defendant. WHEREFORE, Additional Defendant Horace Mann Insurance company requests judgment in its favor and against all other parties to this action. CR08SCL~IM PURSUANT TO P~. R.C.P. 22521d) 23. paragraphs 1 through 22 are incorporated herein by reference. -4- E 24. Liability on the part of Additional Defendant Horace Mann Insurance company is specifically denied. If the averments contained in Defendant's complaint are established, said averments being specifically denied as they may relate to Additional Defendant Horace Mann Insurance Company, then the damages complained of were caused solely or in part by AdditIonal Defendant Health America of Central Pennsylvania. 25. In the event of a finding of liability against Additional Defendant Horace Mann Insurance Company, AdditIonal Defendant Horace Mann Insurance Company hereby asserts its full rIghts to indemnification and contribution against Additional Defendant Health America of Central Pennsylvania, on the basis that they are loan liable, over or jointly and severally liable to Defendant and/or Plaintiff in this action. Date: IIln/fir I I BARLEY, SNYDER, SENFT & COHEN By: -11/i(~jI-!I1/"/) Ronald H. Pollock, Jr. Attorneys for Additional Defendant Horace Mann Insurance Co. 126 East King street Lancaster, PA 17602-2893 (717) 299-5201 Court 1.0. No. 52586 -5- VBRIFICATION I, RONALD H. POLLOCK, JR., hereby verify that I am the attorney for Additional Defendant Horace Mann Insurance Co., and as such I am authorized to make this Verification on its behalf, and that the facts set forth in the within Answer, New Matter and Counterclaim are true and correct to the best of my knowledqe, information and belief. This Verification is made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Date: /1 //7 /rr-- J ' -r~~t Ronald H; Pollock, Jr. ceRTIFICATe OF seRVIce I HEREBY CERTIFY that I am this day serving a copy of the foregoing Answer, New Matter and Counterclaim by first class mail, postage pre-paid, addressed as follows: Arthur A. Kusic, Esquirs 4201 Crums Mill Road Harrisburg, PA 17112 Attorneys for PlaIntiff Archie V. Diveglia, Esquire Diveg1ia and Kaylor, P.C. 119 Locust street Harrisburg, PA 17101 Attorneys for Defendsnts Date: 11/17/'11' BARLEY, SNYDER, SENFT & COHEN By: a--f/ ii/fr-./vJ Ronald H. Pollock, Jr. Attorneys for Defendant Horace Mann Insurance Co. 126 East King street Lancaster, PA 17602-2893 (717) 299-5201 Court I.D. No. 52586 .- ., ,- .. (.... ~. '" "<, r ~:~, 'I _T -I,,, ~ \" ...;' 1< -' -.C ~~: -~:::; t:~- """ ,- '-' '-' u -U = :~~1~1" u::> <.r1 i;: r- -- r~- ,- N f::-: ..~ . '.,~ lU[~ '-j-'" C)';:. ::~~ p:' ,,- <.'-. ~ ';r:-"~ <)( - ,::) ':,r, 8L.. ! ~'; Et. n L )f,~ 1.'.. ~ td. j.. u.. 1'_ \,~ :::; CJ {.i"1 0 t~ ... \--' .. .~ . ~ .1 '; * .' SBIDLB MBMORIAL HOSPITAL, Plaintiff : IN THB COURT OF COMMON PLBAS CUMBBRLAND COUNTY, PBNHSYLVANIA v. : NO. 95-3881 BOWARD L. RBBO and DBBRA D. RBBO, CIVIL ACTION-LAW v. HORRACB MANN INSURANCB CO., : and BBALTH AMBRICA OF CBNTRAL: PBNHSYLVANIA, Defendants HOTICR TO PUlAn TO: Bdward L. Reed and Debra D. Reed and Horrace Mann Insurance Company YOU ARB BBRBBY NOTIFIBO to plead to the enclosed New Matter and Cross Claim of the Defendant, HealthAmerica Pennsylvania, Inc., within twenty (20) days of service hereof, or a default judgment my be entered against you. Date:~- \(0'11:., SRIDLB MBMORIAL HOSPITAL, Plaintiff IN THE COURT OP COMMON PLBAS CUMBBRLAND COUNTY, PBNNSYLVANIA : v. : NO. 95-3881 BDNARD L. RBBD and DBBRA D. RBBD, : v. : CIVIL ACTION - LAW HORRACB MANN INSURANCB CO., : and HBALTH AMBRICA OP CBNTRAL : PENNSYLVANIA, ! ~ . Defendants : ANSWER AND HRIf MATTRR OP ADDITIONAl. DRFRNDAN'I' HRAJ.'I'RllMRRICA PRNNSYLVANTJI.. INC. AND CROSS CLllIM PDRmIl1N'1'TO PA R.C.P. 2252ldl AND HON, comes Additional Defendant, Hea1thAmerica Pennsylvania, Inc. by and through its attorney's, the Law Offices of Darrell C. Dethlefs, and respectfully represents the following: 1. Admitted. 2. Admitted. 3. The averments contained in paragraph 3 is neither admitted nor denied, all information concerning this allegation being within the exclusive possession and control of Defendant and Additional Defendant, Horrace Mann Insurance Company. 4. Admitted in part and denied in part. It is denied that the Additional Defendant is Health America of Central Pennsylvania, the appropriate entity is Hea1thAmerica Pennsylvania, Inc. It is admitted that HealthAmerica Pennsylvania, Inc. is a business corporation licensed to transact health insurance coverage in the Commonwealth of Pennsylvania and has an address located at 2601 Market Place Street, Harrisburg, Pennsylvania 17110-9339. ~.. L 5. Denied. After reasonable investigation, defendant is without knowledge and information sufficient to form a belief as to the truth of the averments incorporated by paragraph 5, and thus strict proof of the averments is demanded at time of trial. COUNT I 6-11. The averments of paragraphs 6 through 11 inclusive are directed to defendants other than answering additional defendant, Hea1thAmerica Pennsylvania, Inc. and thus, no responsive pleading is required by answering additional Defendant, Hea1thAmerica Pennsylvania, Inc. COUNT II 12. Admitted. It is admitted that Hea1thAmerica Pennsylvania, Inc., is the HMO for Edward and Debra Reed. 13. Denied. It is specifically denied that HealthAmerica Pennsylvania, Inc. was presented with a claim from the Plaintiff, Seidle Memorial Hospital, as early as November 19, 1994. It is further denied that the Defendant, Hea1thAmerica Pennsylvania, Inc. failed to provide the Defendant, Edward L. Reed, with a notice of reasons for denial of any properly presented claim. Proof to the contrary is demanded at time of trial. ~, .....~"..-'" .~_...,--::; 14. Denied. Defendant denies that Bdward L. Reed had only an oral advisement that the claim had not been paid because it was believed to be related to the motor vehicle accident of September 20, 1992. By way of further response Defendant denies that the implication that only an oral advisement is insufficient. Proof to the contrary is demanded at time of trial. 15. Denied. The averments contained in paragraph 15 state conclusions of law to which a response is not required. However, if it is judicially determined that a response was required, then it is specifically denied that HealthAmerica Pennsylvania, Inc. does not have a medical basis for said denial. Proof to the contrary is demanded at time of trial. 16. Denied. The averments contained in paragraph 16 state conclusions of law to which a response is not required. If it is judicially determined that a response was required, then Additional Defendant, HealthAmerica pennsylvania, Inc. denies that it does not have a physician's report indicating the basis of the denial of the claim. Proof to contrary is demanded at time of trial. 17. Denied. The averments contained in paragraph 17 state conclusions of law to which a response is not required. If it is determined that a response was required, then it is specifically denied that additional Defendant, HealthAmerica Pennsylvania, Inc. has duty under the contract with defendant to pay for such ..-,.,-~~." billing. It is further denied that its failure to pay is a breech of its agreement with Defendant. proof to the contrary is demanded at time of trial. lB. Denied. The averments contained in paragraph 1B state conclusions of law to which a response is not required. If it is determined that a response was required, then it is specifically denied that the failure of Additional Defendant, Health America Pennsylvania, Inc. to either payor supply written notices as to the reason of its failure to pay the billing of Seidle Memorial Hospital is contrary to unfair insurance practice act of the Commonwealth of pennsylvania. It is further denied that the aforementioned is an act of bad faith entitling plaintiff punitive damages. Proof to the contrary is demanded at time of trial. WHEREFORE, Additional Defendant, HealthAmerica Pennsylvania, Inc. respectfully requests that judgment be entered in favor of Additional Defendant, HealthAmerica pennsylvania, Inc. and against Defendant, Edward L. Reed and Debra D. Reed. NEW MA'l"l'BR. 19. The medical bills which are the subject of this lawsuit are not covered by the policy of insurance by any policy of insurance issued by Additional Defendant, HealthAmerica Pennsylvania, Inc. to Defendants. 20. Additional Defendant, Hea1thAmerica Pennsylvania, Inc. has not received notice that any medical bills submitted to it by Defendants are related to injuries covered by a policy of insurance with Hea1thAmerica Pennsylvania, Inc. 21. Defendants have therefore breached their insurance contract with Additional Defendant, Hea1thAmerica Pennsylvania, Inc. 22. Additional Defendant, Hea1thAmerica Pennsylvania, Inc. reserves the right to assert any defenses based upon its insurance contract with the Defendant. WHBRBFORB, Additional Defendant Hea1thAmerica Pennsylvania, Inc. requests jUdgment in its favor and against all other parties to this action. CROSS C'T.Il.IM PUR,clUANT TO PA. R.C.P. 2252ldl 23. Paragraphs 1-22 are incorporated herein by reference. 24. Liability on the part of the Additional Defendant, Hea1thAmerica Pennsylvania, Inc. is specifically denied. If the averments contained in Defendant's complaint are established said averments being specifically denied as they may relate to additional Defendant, Hea1thAmerica Pennsylvania, Inc. then the damages complained of were caused solely or in part by the Additional Defendant, Horace Mann Insurance Company. :\ 25. In the event of a finding of liability against the additional Defendant, Hea1thAmerica Pennsylvania, Inc. additional Defendant, Hea1thAmerica Pennsylvania, Inc. hereby asserts its full right to indemnification and contribution against additional Defendant, Horace Mann Insurance Company, on the basis that Horace Mann Insurance is alone liable. or in the alternative jointly and severally liable to Defendant and/or Plaintiff in this action. Date:.;;!- l(,_cfb LAW OFFICES OF DARRBLL C. DBTHLBFS By: 'u1//lmO J .fT1J~,,, MJ.chael J. tioilfrl- Bsquire Attorney for Addi~ional Defendant, HealthAmerica Pennsylvania, Inc. Attorney ID# 58851 Wagner Building-Suite 205 355 North 21st Street Camp Hill, PA 17011 (717)975-9446 VERIFICATION I hereby verify thllt the stlltements of fllct mllde In the foregoIng Answer, New MlItter IInd Cross CIlIlm lire true IInd correct to the best of my knowledge, Information IInd belIef. I understand thllt any false stlltements thereIn are subject to the crlmlnlll penalties contained In 18 PII. C.S. 6 4904, relating to unsworn flllslflclltlon to authoritIes. :il'r/m<rJi..m, }L ",~M N. Timothy IIrnesche1l1, VIce PresIdent, General Counsel JlealthAloorica l'l;onnsylvAlulI, Inc. Dated: CRRTIFICATR OP SRRVICR Il, AND NOW, this It::, day of ~, 1996, I do hereby certify that a true and correct copy of the foregoing ANSWBR, NBN MATTBR AND CROSS CLAIM has been served upon the following by depositing a true and correct copy in the United States Mail, at Camp Hill, Pennsylvania, addressed as follows: Arthur A. Kusic, Esquire 4201 Crums Mill Road Harrisburg, PA 17112 Attorney for Plaintiff, Seidle Memorial Hospital Ronald H. Pollock, Esquire 126 East King Street Lancaster, PA 17602-2893 Attorney for Defendant, Edward L. & Debra D. Reed Archie v. Diveglia, Esquire 119 Locust Street Harrisburg, PA 17101 Attorney for Additional Defendant, Horrace Mann Insurance Company Respectfully Submitted, LAW OFFICES ?F DARRELL C.. DfjB! , /1/7' / r; /7 / By: /,1/ l (t, {.. 11..- ,../ Michael J. Py~ sh" squire Attorney ID# ~8851 Wagner Building-Suite 205 355 North 21st Street Camp Hill, PA 17011 (717)975-9446 CBRTIFICATE OF SBRVICB -'" I AND NOW, this ~ day of ~, 1996, I do hereby certify that a true and correct copy of the foregoing ANSWBR, NEW MATTBR MID CROSS CLAIM has been served upon the following by depositing a true and correct copy in the United States Mail, at Camp Hill, Pennsylvania, addressed as follows: .' Arthur A. Kusic, Esquire 4201 Crums Mill Road Harrisburg, PA 17112 Attorney for Plaintiff, Seidle Memorial Hospital Archie V. Diveglia, Esquire 119 Locust Street Harrisburg, PA 17101 Attorney for Defendant, Edward L. Reed and Debra D. Reed , Ronald H. Pollock, Esquire 126 East King Street Lancaster, PA 17602-2893 Attorney for Additional Defendant, Horrace Mann Insurance company I By: Respectfully su~ed, OFF~~ES OF D~E/:7:J THLEFS / . ;1,dCJ' Q. .~ Michael J. Attorney I # 1 Wagner Building-Suite 205 355 North 21st Street Camp Hill, PA 17011 (717)975-9446 LAW RHP/259309.1/022396 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW SEIDLE MEMORIAL HOSPITAL, Plaintiff No. 95-3881 vs. EDWARD L. REED and DEBRA D. REED, Defendants vs. HORACE MANN INSURANCE CO. and HEALTHAMERICA OF CENTRAL PENNSYLVANIA, Additional Defendants JURY TRIAL DEMANDED ADDITIONAL DEFENDANT HORACE MANN INSURMlCE CO.'S REPLY TO CROSSCLAIM PURSUANT TO PA. R.C.P. 2252ldl OF HEALTHAMERICA OF PENNSYLVANIA. INC. 23.-25. The averments of paragraphs 23 through 25 inclusive are denied as stating conclusions of law to which no responsive pleading is required. BARLEY, SNYDER, SENFT & COHEN By: -/!d:/) AtIl/1 Ronald H. Pollock, Jr., Esq. Attorney for Defendant Horace Mann Insurance Co. 126 East King Street Lancaster, PA 17602-2893 (717) 299-5201 LD. No. 52586 veRIFICATION I, RONALD H. POLLOCK, JR., hereby verifY that I am the attorney for Additional Defendant Horace Mann Insurance Co., and as such I am authorized to make this Verification on its behalf, and that the facts set forth in the within Reply are true and correct to the best of my knowledge, information and belief. This Verification is made subject to the penalties of 18 Pa. C.s. section 4904 relating to unsworn falsification to authorities. Date: JP;h( I 7y~/~~ Ronald H. Pollock, Jr. -, CERTIFICATE OF SERVICe I HEREBY CERTIFY that a true and correct copy of Additional Defendant Horace Mann Insurance CO. 's Reply to crossclaim pursuant to Pa. R.C.P. 2252(d) of Hea1thAmerica of Pennsylvania, Inc. has been served this .)\ day of February, 1996, by first class mail, postage prepaid, upon: Arthur A. Kusic, Esquire 4201 Crums Mill Road Harrisburg, PA 17112 Archie V. Diveglia, Esquire 119 Locust street Harrisburg, PA 17101 Michael J. Pykosh, Esquire Wagner Building -- suite 205 355 North 21st street camp Hill, PA 17011 BARLEY, SNYDER, SENFT & COHEN BY:~/~~- Ronald H. Pollock, Jr., Esq. Attorney for Defendant Horace Mann Insurance Co. 126 East King street Lancaster, PA 17602-2893 (717) 299-5201 I.D. No. 52586 Cl \.~) ') C. U) '" ~. ..., ., r;~, ..q , ~.) .:?] ~ .) ,'r:'t t:'1 A , .' ....., --;'1 - :: :1) .("') ,. jnl ,. ',-'1 "i " . C', :.~ 0 * * * * * * * * * * * HORRACE MANN INSURANCE CO. * and HEALTH AMERICA OF CENTRAL * PENNSYLVANIA, * Additional Defendants * SEIDLE MEMORIAL HOSPITAL, plaintiff v. EDWARD L. REED AND DEBRA D. REED, Defendants v. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 95-3881 , PRAECIPE TO THE PROTHONOTARY: Please mark the above captioned matter settled, satisfied and Discontinued. RESPECTFULLY SUBMITTED: ~~. ARTHUR. C, ESQUllre--.. 4201 Crums Mill Road Harrisburg, PA 17112 (717) 540-5610 supreme Court No. 07207 Attorney for Plaintiff' . AR V. DIVE I, ESQUIRE DIVEGLIA AND KAY'O , P.C. 119 Locust Stre t Harrisburg, PA (717) 236-5985 Attorney 1.0. # 17140 Attorney for Defendants ~)p~ Ronald H. P~~Ck, Jr., Esquire BARLEY, SNYDER, SENFT & COHEN 126 E. King Street Lancaster, PA 17602-2893 (717) 299-5201 Attorney for Additional Defendant Horrace Mann Insurance Co. 205 r', J;:' ,-) _oJ ; " ," -,., -, :-. i;, I -..:J C,.' a ...... " , ~:, . , ;, ; ":1 i.1 :., ) . D .~