In the Circuit Court of the State of Oregon 

For the County of Wasco 

JOHN BELKNAP, Case No. 15CV30761 

Plaintiff, SUMMONS 

V. 

BERKSHIRE LIFE INSURANCE COMPANY 

OF AMERICA, 

Defendants. 

To: BERKSHIRE LIFE INSURANCE COMPANY 

C/O Corporation Service Company, Registered Agent 

1127 Broadway ST NE, STE 310 

Salem, OR 97301 

You are hereby required to appear an defend the complaint filed against you in the above entitled action within thirty (30) 

days from the date of service of this summons upon you, and in case of your failure to do so, for want thereof, plaintiff(s) will apply to 

the court for the relief demanded in the complaint. 

NOTICE TO THE DEFENDANT: READ 

THESE PAPERS CAREFULLY! 

You must "appear" in this case or the other side will win automatically. To 

"Appear" you must file with the court a legal paper called a"motion" or "answer." 

The "motion" or "answer" must be given to the court clerk or administrator within 

30 days along with the required fifing. fee. It must be in proper form and have 

proof of service on the plaintilf's attomey or, if the plaintiff does not have an 

attomey, proof of service upon the plaintiff. 

If you have any questions, you should see an attomey immediately. If you need 

help in finding an attomey, you may call the Oregon State Bar's Lawyer Referral 

Service at (503) 684-3763 or toll-free in Oregon at (800) 452-7636. 

/s/ MICHAEL J. KNAPP 

SIGNATURE of attorney 

Michael J. Knapp, OSB No. 83394 

Attomey at Law 

621 SW Morrison, Suite 900 

Portland, OR 97205 Telephone: (503) 222-6805 

STATE OF OREGON, County of Multnomah) ss. 

I, the undersigned attorney of record for the plaintiff, certify that the foregoing is an eaact and complete copy of the 

original summons in the above entitled action. 

ATTORNEY OF RECORD FOR PLAINTIFF(S) 

TO THE OFFICER OR OTItER PERSON SERVING TMS SUMMONS: You are hereby directed to serve a true copy of this summons, 

together with a true copy of the complaint mentioned therein, upon the individual(s) or other legal entity(ies) to whom or which this summons 

is directed, and to make your proof of service on the reverse hereof or upon a separate similar document which you shall attach hereto. 

/s/ MICHAEL J. KNAPP 

ATTORNEY FOR PLAINTIFF(S) 

EXHIBIT A 

Page 1 of 12

Case 3:15-cv-02377-PK Document 1-1 Filed 12/22/15 Page 1 of 12
PROOF OF SERVICE 

STATE OF County of ) ss. 

I hereby certify that I made service of the foregoing summons upon the individuals and other legal 

entities to be served, named below, be delivering or leaving true copies of the summons and the complaint 

mentioned therein, certified to be such by the attorney for the plaintiff, as follows: 

PERSONAL SERVICE UPON INDIVIDUAL 

Upon , by delivering such true copy 

to , personally and in person, at 

, at , M. 

SUBSTITUTED SERVICE UPON INDIVIDUAL 

Upon by delivering such true copy 

to , personally and in person, at 

at , M. 

SERVICE ON CORPORATION 

Upon by delivering such true copy 

to 

(specify registered agent, officer (by title), director, managing agent, etc.) , personally and in person, at 

at , M. 

I further certify that I am a competent person 18 years of age or older and a resident of the state of 

service of the State of , and that I am not a party to nor an office, director or 

employee of, nor attomey for any party, corporate or otherwise; that the person, firm or corporation served by me is 

the identical person, firm or corporation named in the action. 

DATED 

SIGNATURE OF INDIVIDUAL 

TYPE OR PRINT NAME 

SHERIFF 

By 

DEPUTY 

EXHIBIT A 

Page 2 of 12

Case 3:15-cv-02377-PK Document 1-1 Filed 12/22/15 Page 2 of 12
1 

2 

3 

4 IN THE CIRCUIT COURT OF THE STATE OF OREGON 

FOR THE COUNTY OF WASCO 

5 

6 JOHN BELKNAP, Case No. i.,~ 

7 Plaintiff, 

COMPLAINT 

g v. 

(Breach of Insurance Contract, 

9 BERKSHIRE LIFE INSURANCE COMPANY Breach of Duty of Good Faith and 

OF AMERICA, Fair Dealing, and Request for 

10 Declaratory Relief) 

Defendants. 

11 AMOUNT OF PRAYER: $168,480 

ORS 21.160(1)(c) 

12 Claim Not Subject to Mandatory 

13 Arbitration 

14 Jury Trial Requested 

15 

Plaintiff alleges as follows: 

16 I, BACKGROUND INFORMATION 

17 1. 

18 At all material times, plaintiff was a resident of Wasco County, Oregon. 

19 2 

20 Defendant Berkshire Life Insurance Company of America (hereinafter "Berkshire'~ is an 

21 insurance company duly authorized to t.ransact business in the state of Oregon. 

22 3. 

23 At all material times, plaintiff was covered by two disability insurance policies issued by 

24 Berkshire. Berkshire assigned policy numbers Z0148340 and Z1743940 to these policies (hereinafter 

25 "the Berkshire policies.') 

26 

Page 1- COMPLAINT - Breach of Insurance Contract, Breach of Duty of Good Faith and Fair Dealing, 

and Request for Declaratory Relief 

M[ceAeL J. KNAer 

ATTORNHY AT LAW 

621 SW MowusoN STxseT, Surra 900 

PORTLAND, OREGON 97205 

(503)222-6508 0 FAx (503) 222-6518 a mknapp@spiretech.com 

EXHIBIT A 

Page 3 of 12

Case 3:15-cv-02377-PK Document 1-1 Filed 12/22/15 Page 3 of 12
1 4. 

2 The Berkshire policies are specialty disability insurance policies that Berkshire issues 

3 exclusively to medical professionals. Both policies provide for payment of monthly disability 

4 insurance benefits if the insured is unable to perform the material and substantial duties of their 

5 "occupation" because of an injury. Both policies also state that: 

6 If your occupation is limited to a single medical specialty certified by the 

American Board of Medical Specialties or a single dental specialty 

7 recognized by the American Dental Association, we will deem your specialty 

to be your occupation. 

8 5. 

9 At all material times, plaintiff was employed as a medical doctor, he was board certified as 

10 a podiatrist, and he limited his practice to podiatry. 

11 6. 

12 On or about January 10, 2010, plaintiff severely injured the ring finger on his right hand in 

13 a motorcycle accident. 

14 7• 

15 As a result of this injury, plaintiff was unable to perform the material and substantial duties 

16 of his occupation as a podiatrist. 

17 8. 

18 

Plaintiff submitted a claim for disability insurance benefits to Berkshire in February 2010. 

9. 

19 

Berkshire reviewed plaintifPs claim for benefits, and determined that he was "totally 

20 

disabled" under the terms of the Berkshire policies. 

21 

10. 

22 

In July 2010, Berkshire started paying plaintiff monthly disability benefits, and continued to 

23 pay plaintiff benefits until November 2013. 

24 11. 

25 On November 23, 2013, Berkshire representative Michael Palrniere sent a letter to plaintiff 

26 notifying him that Berkshire unilaterally decided to cut off his monthly disability benefits. Mr. 

Page 2- COMPLAINT - Breach of Insurance Contract, Breach of Duty of Good Faith and Fair Dealing, 

and Request for Declaratory Relief 

M[cHAEL J. KIVAYP 

ATTORNEY AT LAW 

621 SW MoxRisox STaEEr, Surm 900 

PoRTt,Arm, OxscoN 97205 

(503)222-6508 a FAx (503) 222-6518 * mknapp@spiretech.com 

EXHIBIT A 

Page 4 of 12

Case 3:15-cv-02377-PK Document 1-1 Filed 12/22/15 Page 4 of 12
1 Palmiere indicated in this letter that Berkshire had determined that plaintiff was no longer disabled 

2 from performing the material and substantial duties of a podiatrist, so he was no longer entitled to 

3 receive disability benefits under the terms of his Berkshire policies. 

4 12. 

5 On January 3, 2014, plaintiff s then attorney John Shaw sent a letter to Mr. Palmiere in which 

6 he asked for a copy of all of Berkshire's file records related to Berkshire's decision to terminate 

7 plaintifPs monthly disability benefits. 

13. 

8 

9 

On February 12, 2014, Mr. Palmiere sent Mr. Shaw a letter in which he provided notice that 

10 

Berkshire was unwilling to provide copies of its records related to its decision to terminate plaintiff's 

benefits. 

11 

14. 

12 

On April 29, 2014, Mr. Shaw sent Mr. Palmiere a letter in which he questioned the reasons 

13 Berkshire cited for its decision to terminate plaintiffs benefits. 

14 15. 

15 On June 17, 2014, Mr. Palmiere sent Mr. Shaw a letter in which he reported that Berkshire 

16 had decided to stick with its decision to terminate plaintiff's benefits as of November 2013, but 

17 added that plaintiff had 180 days to "appeal our decision." 

18 16. 

19 On December 9, 2014, Mr. Shaw submitted plaintifPs appeal, and provided Berkshire 

20 additional information in support of plaintiff's claim for ongoing disability insurance benefits. This 

21 included plaintiff s updated medical records from C.T. Woolley, M.D., the doctor who performed 

22 surgery to repair the damage to plaintiff's finger, and reports prepared by two additional doctors who 

23 evaluated the current condition of plaintiff's injured finger, and the impact of the injury on his ability 

24 to perform the material and substantial duties of a podiatrist. 

25 

17. 

26 

On February 26, 2014, Mr. Palmiere sent Mr. Shaw a letter in which he said that Berkshire 

was initiating an appeal review process for plaintiff's claim, and that a different Berkshire 

Page 3- COMPLAINT - Breach of Insurance Contract, Breach of Duty of Good Faith and Fair Dealing, 

and Request for Declaratory Relief 

1VIICHARL J. I{NAYP 

ATTORNRY AT LAW 

621 SW MoRR[soN STRaEr, SurrR 900 

PORTLArm, OttEGON 97205 

(503)222-6508 0 FAx (503) 222-6518 0 mlmapp@spicetech.com 

EXHIBIT A 

Page 5 of 12

Case 3:15-cv-02377-PK Document 1-1 Filed 12/22/15 Page 5 of 12
1 

2 

3 

4 

5 

6 

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8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

representative was assigned to handle the appeal. 

18. 

On March 17, 2015, Mr. Shaw sent Berkshire representative Charlene Blair a fax which 

included a written statement authorized by Dr. Woolley, in which Dr. Woolley stated in part: 

Dr. Belknap sustained a nonunion PIP joint condle fracture in 2010. The 

necrotic bone fragment was resected and a tissue arthroplasty and collateral 

ligament repair was accomplished in an attempt to presenre a stable joint 

and induce some tissue metaplasia. However, his PIP joint has developed 

more degeneration over time, which has reduced his ROM, grip strength and 

hand function coordination. Since 7/2010, his right hand has remained 

impaired, and has slowly developed a further reduction in ROM and strength. 

Dr. Belknap's impaired hand will not reliably allow him to perform complex 

physical exams on the feet or conduct fracture reductions and casting in the 

office. In the OR, he cannot consistently or painlessly operate drills and kwire drivers to place hardware for fracture repair and joint fusion work, nor 

can he reliably manipulate joints and bones for con-ect positioning with his 

impaired hand. 

For musculoskeletal surgeons, procedures and surgery comprise the majority 

of their job duties. Therefore, Dr. Belknap cannot conduct the significant 

material and substantial portion of his job. 

19. 

On July 16, 2015, Ms. Blair sent Mr. Shaw a letter in which she reported that following an 

appeal review Berkshire decided to stick with its decision to cut off plaintiff's disability benefits as 

of November 2013, and that plaintifps file with Berkshire is now closed. 

II. FIRST CLAIM FOR RELIEF 

Breach of Insurance Policy Contract 

20. 

Plaintiff realleges and incorporates by reference the allegations set forth in paragraphs 1 

through 19, above. 

21. 

Plaintiff has remained disabled under the terms of the Berkshire policies since he injured his 

finger in January 2010. 

Page 4- COMPLAINT - Breach of Insurance Contract, Breach of Duty of Good Faith and Fair Dealing, 

and Request for Declarratory Relief 

MIC9AEL J. KIVAPP 

ATTORNEY AT LAw 

621 SW MoRxisoN STtzEET, SurrE 900 

PoxTLAND, OxEGON 97205 

(503)222-6508 0 FAx (503) 222-6518 0 mkmapp@spiretech.com 

EXHIBIT A 

Page 6 of 12

Case 3:15-cv-02377-PK Document 1-1 Filed 12/22/15 Page 6 of 12
1 22. 

2 Berkshire wrongfully terminated plaintiff's disability benefits in November 2013, and has 

3 wrongfully refused to pay plaintiff monthly disability insurance benefits since that time. 

4 23. 

5 Berkshire has thereby breached the contracts of insurance set forth in the Berkshire policies. 

6 - 24. 

7 Berkshire policy Z1743940 provides for payment of a monthly disability benefit to plaintiff 

8 

in the amount of $3,200. 

25. 

9 

10 

Plaintiff has therefore suffered monetary damages in the amount of $76,800 (24 months x 

$3,200 =$76,800) since November 2013 as a result of Berkshire's wrongful termination of his 

11 

benefits under policy Z1743940. 

12 

26. 

13 Plaintiff will continue to suffer damages in the future at the rate of $3,200 per month as long 

14 as Berkshire continues to refuse to provide plaintiff monthly disability benefits under policy 

15 Z1743940. 

16 27 

17 Berkshire policy Z0148340 provides for payment of a monthly disability benefit to plaintiff 

18 in the amount of $3,820. 

19 28. 

20 Plaintiff has therefore suffered monetary damages in the amount of $91,680 (24 months x 

21 $3,820 =$91,680) since November 2013 as a result of Berkshire's wrongful termination of his 

22 benefits under policy Z0148340. 

23 29. 

24 Plaintiff will continue to suffer damages in the future at the rate of $3,820 per month as long 

25 

as Berkshire continues to refuse to provide plaintiff monthly benefits under policy Z0148340. 

26 

Page 5- COMPLAINT - Breach of Insurance Contract, Breach of Duty of Good Faith and Fair Dealing, 

and Request for Declaratory Relief 

MICHABL J. IKNAFP 

ATTORNEY AT LAW 

621 SW MORRISON STREET, SuTE 900 

PORTI.ANn, OREGON 97205 

(503)222-6508 0 FAx (503) 222-6518 0 mlmapp@spiretech.com 

EXHIBIT A 

Page 7 of 12

Case 3:15-cv-02377-PK Document 1-1 Filed 12/22/15 Page 7 of 12
1 30. 

2 Plaintiff has been forced to hire attorneys to contest Berkshire's decision to terminate his 

3 disability benefits, and to pursue this insurance coverage lawsuit. As a result, plaintiff is entitled to 

4 an award of his attorney fees on this claim pursuant to ORS 742.061. 

5 31. 

6 Plaintiff is also entitled to an award of prejudgment interest on this claim pursuant to OR.S 

7 82.010. 

8 III. SECOND CLAIM FOR RELIEF 

Breach of Implied Covenant of Good Faith and Fair Dealing 

9 32. 

10 Plaintiff realleges and incorporates by reference the allegations set forth in paragraphs 1 

11 through 19, above. 

12 33. 

13 The Berkshire policies include an implied covenant of good faith and fair dealing. This 

14 covenant requires Berkshire to effectuate plaintiff's reasonable expectation of coverage during 

15 any review by Berkshire of plaintiff's entitlement to receive disability benefits under the terms of 

16 the Berkshire policies. 

17 

34. 

18 

Berkshire breached this covenant of good faith and fair dealing when it conducted a 

19 

biased, one sided and incomplete review of plaintift's entitlement to ongoing coverage under the 

Berkshire policies after November 2013. Berkshire did so with a goal of limiting its financial 

20 

exposure to plaintifPs claim. 

21 

35. 

22 As a result of Berkshire's breach of the covenant of good faith and fair dealing, plaintiff 

23 has suffered monetary damages as described in paragraphs 24 through 29, above. 

24 36. 

25 Plaintiff is entitled to an award of attorney fees on this claim pursuant to ORS 742.061. 

26 

Page 6- COMPLAINT - Breach of Insurance Contract, Breach of Duty of Good Faith and Fair Dealing, 

and Request for Declaratory Relief 

R'IICHAEL.T. KWAPP 

ATTORNEY AT LAW 

621 SW MowusoN SraEaT, Surre 900 

PoeTLANn,OREOoN 97205 

(503)222-6508 & FAx (503) 222-6518 0 mlmapp(@spiretech.com 

EXHIBIT A 

Page 8 of 12

Case 3:15-cv-02377-PK Document 1-1 Filed 12/22/15 Page 8 of 12
11 

2 1 

3 

4 

5 

6 

7 

8 

37. 

Plaintiff is entitled to an award of prejudgment interest on this claim pursuant to ORS 

1 20.010. 

IV.THIRD CLAIM FOR RELIEF 

PlaintifPs Request for Declaratory Relief 

38. 

Plaintiff realleges and incorporates by reference the allegations in paragraphs 1 through 

1 19, above. 

39. 

9 

10 

Plaintiff is entitled to a judicial declaration by the court that (a) plaintiff has been entitled 

to receive monthly disability benefits from Berkshire since November 2013, and (b) plaintiff is 

11 

entitled to continue to receive monthly disability benefits from Berkshire until he reaches age 65, 

12 

as long as he remains disabled under the terms of the Berksbire policies. 

13 

V.REQUEST FORJURYTRIAL 

14 40. 

15 Plaintiff requests a jury trial in this case. 

16 

17 WHEREFORE, plaintiff prays for: 

18 A. A judgment against Berkshire in the amount of $76,800, based on Berkshire's 

19 wrongful refusal to pay plaintiff monthly disability benefits under policy 

20 Z1743940 after November 2013. 

21 B. A judgment against Berkshire in the amount of $91,680, based on Berkshire's 

22 1 wrongful refusal to pay plaintiff monthly disability benefits under policy 

23 Z0148340 after November 2013. 

24 C. An additional judgment against Berkshire based on the amount of monthly 

25 benefits under policies Z174394 and Z0148340 that Berkshire withholds from 

26 1 

Page 7- COMPLAINT - Breach of Insurance Contract, Breach of Duty of Good Faith and Fair Dealing, 

and Request for Declaratory Relief 

IVI[CBAAEL J. KIYAPP 

ATI'oRNEY AT LAW 

621 SW MOx[uSON STREaT, SutTe 900 

PoRTLAND, OREooN 97205 

(503)222-6508 0 FAx (503) 222-6518 0 mknapp@spiretech.com 

EXHIBIT A 

Page 9 of 12

Case 3:15-cv-02377-PK Document 1-1 Filed 12/22/15 Page 9 of 12
1 plaintiff between the filing of this lawsuit and the entry of judgment. The exact 

2 amount of these damages will be proven at trial. 

3 D. The judicial declaration that plaintiff asked for in paragraph 39, above. 

4 E. Plaintiff's attorney fees, pursuant to ORS 742.061. 

5 F. Prejudgment interest on each of plaintifPs past due monthly disability benefits 

6 pursuant to ORS 82.010. 

7 E. Such other relief that the Court deems just and proper. 

8 

9 

DATED this 12' day of November, 2015. 

10 /s/ MichaelJ. Knapp 

11 

12 Michael J. Knapp, OSB #833943 

13 Attorney for Plaintiff 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

Page 8- COMPLAINT - Breach of Insurance Contract, Breach of Duty of Good Faith and Fair Dealing, 

and Request for Declaratory Relief 

MtcaAEt J. KntnrP 

ATTORNEY AT IAW 

621 SW Moaxisox STREsT, SutTe 900 

PoxTLArro, OREGoN 97205 

(503)222-6508 a FAx (503) 222-6518 0 mknapp@spiretech.com 

EXHIBIT A 

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Case 3:15-cv-02377-PK Document 1-1 Filed 12/22/15 Page 10 of 12
EXHIBIT A 

Page 11 of 12

Case 3:15-cv-02377-PK Document 1-1 Filed 12/22/15 Page 11 of 12
Page 1 of 1 

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Pact. 

REGISTER OF ACTIONS 

CASE No. 15CV30761 

JOHN BELKNAP vs BERKSHIRE LIFE INSURANCE COMPANY OF § Case Type: Contract 

AMERICA § Date Filed: 11/12/2015 

§ Location: Wasco 

§ 

§ 

PARTY INFORMATION 

Defendant BERKSHIRE LIFE INSURANCE COMPANY 

OF AMERICA 

Plaintiff BELKNAP, JOHN MICHAEL J KNAPP 

Retained 

503 222-6508(V 

EVENTS & ORDERS OF TIlE (touRT 

OTHER EVENTS AND HEARINGS 

11/12/2015 crnpj.#int 

Created: 11/13/2015 11:14 AM 

11/12/2015 Service 

BERKSHIRE LIFE INSURANCE COMPANY OF 23/2015 AMERICA Served 

Returned 12/08/2015 

Created: 11/13/2015 11:14 AM 

12/08/2015 Certificate 

of Service by Corporate Service - Pursuant to ORCP 7D (3)(b)(i) via Personal Service to Sharon Walls Clerk on Duty in the Office of the 

Registered Agent; Served. November 23rd, 2015 

Created: 12/17/2015 9:07 AM 

FINANCIAL INFORMATION 

Plaintiff BELKNAP, JOHN 

Total Financial Assessment 531.00 

Total Payments and Credits 531.00 

Balance Due as of 12/22/2015 0.00 

11/13/2015 Transaction Assessment 531.00 

11/13/2015 xWeb Accessed eFile Receipt #2015-1545395 BELKNAP, JOHN (531.00) 

https ://publicaccess.courts.oregon.gov/PublicAccessLogin!CaseDetail.aspx?CaseID=254.. . 12/22/2015 

EXHIBIT A 

Page 12 of 12

Case 3:15-cv-02377-PK Document 1-1 Filed 12/22/15 Page 12 of 12