EXHIBIT A

Case 2:17-cv-04373-GMS Document 1-1 Filed 11/29/17 Page 1 of 19
Brett L. Slavicek (No. 0 193 06) 

James E. Fucetola (No. 029332) 

Trevor R. Orme (No. 032261) 

THE SLAVICEK LAW FIRM 

5500 N. 24th Street 

Phoenix, Arizona 85016 

Telephone: (602) 285-4425 

Telephone: (602) 285-4424 

Fax: (602) 287-9184 

Email: b~~iit,iT;Slati-icekla~~~.cc~Yn. 

~ €Tlt 'a s'ci.?sl~:~vicel<la.~~-.iom 

tt'~VOl"it7;S~%IVIC.E ~:l'c1_L'l'.CC)I7i 

Attorneys for Plaintiff 

STATE Qr~ AZZON,RC 

. DEPT OF IfISURARICE 

6CT 3 12017 

S-IRVICE OF PROC SS 

IN THE SUPERIOR COURT OF THE STATE OF ARIZONA 

IN AND FOR THE COUNTY OF MARICOPA 

CV2017-014262 

TYLER JACOBSON, an individual, 

Plaintiff, 

vs. 

AMERICAN FAMILY INSURANCE 

COMPANY, a foreign corporation; XYZ 

Corporations I-X; ABC Partnerships I-X, 

Case No.: 

SUMMONS 

Defendants. 

THE STATE OF ARIZONA TO DEFENDANT: 

American Family Insurance Company 

c/o Director of Arizona Department of Insurance 

2910 N. 44th Street, Suite 210 

Phoenix, Arizona 85018 

If you wotild like legal advice from a lawy r, 

Contact the Lawyer Referral Service at 

602-257-4434 

or 

www. nlariG.oJ]dlaYllJLer,4•"r 

Sponsored by the 

Maricopa County 13ar AssAclatioFl 

YOU ARE HEREBY SUMMONED and required to appear and defend, within 

the time applicable, in this action in this Court. If served within Arizona, you shall appear 

and defend within twenty (20) days after the service of the Summons and Complaint upon 

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Case 2:17-cv-04373-GMS Document 1-1 Filed 11/29/17 Page 2 of 19
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1 ~ you, exclusive of the day of service. If served out of the State of Arizona -- whether by 

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I direct service, by registered or certified mail, or by publication -- you shall appear and 

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defend within thirty (30) days after the service of the Summons and Complaint upon you 

5 is complete, exclusive of the day of service. Where process is served upon the Arizona 

6 Director of Insurance as an insurer's attorney to receive service of legal process against it 

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in this state, the insurer shall not be required to appear, answer or plead until expiration of 

9 forty (40) days after date of such service upon the Director. Service by registered or 

10 certified mail without the State of Arizona is complete thirty (30) days after the date of 

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filing the receipt and affidavit of service with the Court. Service by publication is 

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13 complete thirty (30) days after the date of first publication. Direct service is complete 

14 when made. Service upon the Arizona Motor Vehicle Superintendent is complete thirty 

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(30) days after filing the Affidavit of Compliance and return receipt or Officer's Return. 

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RCP 4; A.R.S. §§ 20-222, 28-502, 28-503. 

18 YOU ARE HEREBY NOTIFIED that in case of your failure to appear and defend 

19 within the time applicable, judgment by default may be rendered against you for the relief 

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demanded in the Complaint. 

22 i YOU ARE CAUTIONED that in order to appear and defend, you must file an I 

23 I Answer or proper response in writing with the Clerk of this Court, accompanied by the ~ 

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necessary filing fee, withiii the time required, and you are required to serve a copy of any ~ 

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26 Answer or response upon the plaintiffs attorney. RCP 10(d); A.R.S. §12-311; RCP 5. 

27 Requests for reasonable accommodation for persons with disabilities must be made to the ~ 

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pi 

Case 2:17-cv-04373-GMS Document 1-1 Filed 11/29/17 Page 3 of 19
Brett L. Slavicek (No. 019306) 

James E. Fucetola (No. 029332) 

Trevor R. Orme (No. 032261) 

THE SLAVICEK LAW FIRM 

5500 N. 241 Street 

Phoenix, Arizona 85016 

Telephone: (602) 285-4425 

Telephone: (602) 285-4424 

Fax: (602) 287-9184 

Email: brett;ti;slavicclttmv.cc}rn 

jqirnes~(.''.sl~:~~~icel<li:n,~:.coan 

tr~: vorr~i: sl a~-i cekla~~•.cc~rr~ 

Attorneys for Plaintiff 

COPY 

~i.;r.•~,, ' '~ ( ^,. 

~ ~~-. ~t-+ • _ - 

IN THE SUPERIOR COURT OF THE STATE OF ARIZONA 

IN AND FOR THE COUNTY OF MARICOPA 

TYLER JACOBSON, an individual, 

Plaintiff, 

vs. 

AMERICAN FAMILY INSURANCE 

COMPANY, a foreign corporation; XYZ 

Corporations I-X; ABC Partnerships I-X, 

Defendants. 

CaseNo.: 

QV 201 7

,

_01 4-26

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COMPLAINT 

(Breach of Contract & Bad Faith) 

Plaintiff alleges: 

1. Plaintiff is a resident of Maricopa County, State of Arizona. 

2. Defendant American Family Insurance ("American Family") is a foreign 

corporation, duly licensed to sell and administer insurance in the State of Arizona. 

3. XYZ Corporations I-X; ABC Partnerships I-X are partnerships, 

corporations or unincorporated associations subject to suit in a common name whose 

names are unknown and who are, therefore, designated by fictitious names pursuant to 

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Case 2:17-cv-04373-GMS Document 1-1 Filed 11/29/17 Page 4 of 19
Notice of Service of Process

null / ALL

Transmittal Number: 17352595

Date Processed: 11/03/2017

Primary Contact: Legal Department

American Family Mutual Insurance

6000 American Pkwy

Madison, WI 53783

Entity: American Family Insurance Company

Entity ID Number 3184641

Entity Served: American Family Insurance Company

Title of Action: Tyler Jacobson vs. American Family Insurance Company

Document(s) Type: Summons/Complaint

Nature of Action: Contract

Court/Agency: Maricopa County Superior Court, Arizona

Case/Reference No: CV2017-014262

Jurisdiction Served: Arizona

Date Served on CSC: 11/02/2017

Answer or Appearance Due: 30 Days

Originally Served On: CSC

How Served: Certified Mail

Sender Information: Brett L. Slavicek

602-285-4425

Information contained on this transmittal form is for record keeping, notification and forwarding the attached document(s). It does not

constitute a legal opinion. The recipient is responsible for interpreting the documents and taking appropriate action.

To avoid potential delay, please do not send your response to CSC

251 Little Falls Drive, Wilmington, Delaware 19808-1674 (888) 690-2882 | sop@cscglobal.com

Case 2:17-cv-04373-GMS Document 1-1 Filed 11/29/17 Page 5 of 19
Brett L. Slavicek (No. 019306) 

James E. Fucetola (No. 029332) 

Trevor R. Orme (No. 032261) 

THE SLAVICEK LAW FIRM 

5500 N. 241 Street 

Phoenix, Arizona 85016 

Telephone: (602) 285-4425 

Telephone: (602) 285-4424 

Fax: (602) 287-9184 

Email: brett;ti;slavicclttmv.cc}rn 

jqirnes~(.''.sl~:~~~icel<li:n,~:.coan 

tr~: vorr~i: sl a~-i cekla~~•.cc~rr~ 

Attorneys for Plaintiff 

COPY 

~i.;r.•~,, ' '~ ( ^,. 

~ ~~-. ~t-+ • _ - 

IN THE SUPERIOR COURT OF THE STATE OF ARIZONA 

IN AND FOR THE COUNTY OF MARICOPA 

TYLER JACOBSON, an individual, 

Plaintiff, 

vs. 

AMERICAN FAMILY INSURANCE 

COMPANY, a foreign corporation; XYZ 

Corporations I-X; ABC Partnerships I-X, 

Defendants. 

CaseNo.: 

QV 201 7

,

_01 4-26

6~ 

~ 

COMPLAINT 

(Breach of Contract & Bad Faith) 

Plaintiff alleges: 

1. Plaintiff is a resident of Maricopa County, State of Arizona. 

2. Defendant American Family Insurance ("American Family") is a foreign 

corporation, duly licensed to sell and administer insurance in the State of Arizona. 

3. XYZ Corporations I-X; ABC Partnerships I-X are partnerships, 

corporations or unincorporated associations subject to suit in a common name whose 

names are unknown and who are, therefore, designated by fictitious names pursuant to 

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Case 2:17-cv-04373-GMS Document 1-1 Filed 11/29/17 Page 6 of 19
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I Rule 10(f), Arizona Rules of Civil Procedure. Each of these defendants is liable for breach 

of contract or responsible as a matter of law for the acts of others constituting a breach of 

contract. 

4. All acts alleged here arose from an occurrence within Maricopa County, 

State of Arizona. 

5. Plaintiff's claims are subject to the jurisdiction of the Superior Court for the 

State of Arizona and request compensation in the amounts above the minimum set for 

jurisdiction in Superior Court for the State of Arizona. 

6. This Court has subject matter jurisdiction and personal jurisdiction over all 

of the parties listed above. 

7. On November 14, 2016, Plaintiff was involved in a motor vehicle accident 

with an underinsured driver. 

8. As a direct result of the accident, Plaintiff suffered severe injuries to include I 

bilaterat wrist and arm fractures. As well, Tyler suffered a pelvis fracture and a fracture ~ 

to his right foot. 

9. As a direct result of the accident and the injuries sustained, Plaintiff incurred I 

medical bills of over $220,000 and it is probable that medical bills will continue to be I 

incurred by Plaintiff in the future. 

10. As a direct result of Plaintiff's injuries, Plaintiff experienced pain, I 

limitations, disfigurement, disability, and discomfort. It is probable that he will continue I 

to endure such experiences in the future. 

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Case 2:17-cv-04373-GMS Document 1-1 Filed 11/29/17 Page 7 of 19
1 11. At the time of the crash, Plaintiff was insured under his parent's American 

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Family Policy No. 0375-7993-07-04-FPPA-AZ, which provided underinsured motorist 

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benefits with per person limits of $100,000. 

5 12. Plaintiff settled with the adverse insurance company for his portion of the 

6 liability policy limit. This did not adequately compensate Plaintiff for his injuries, medical 

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expenses and general damages. Subsequent to the accident, Plaintiff made a claim for the 

9 underinsured motorist coverage limits with Defendant. 

10 13. Defendant American Family does not dispute that Plaintiff's damage 

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resulting from the accident exceed $175,000 ($75,000 underlying liability coverage from 

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13 the at-fault driver plus $100,000 underinsured coverage from American Family). 

14 14. Pursuant to the contract of insurance issued by Defendant, since the claim 

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has not settled, Plaintiff is required to file suit against Defendant for the purpose of proving 

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that underinsured motorist coverage is to be afforded under the Policy. 

18 15. Relying on the definition of "Relative" contained in the Policy, America.n I 

19 Family refused to provide Tyler underinsured motorists coverage. 

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16. Specifically, Defendant's definition of "Relative" states: 

22 Relative means a person living in your household, related to you by blood, 

marriage, or adoption. This includes a ward or foster child. It excludes any 

23 person who, or whose spouse, owns a motor vehicle other than an off-road motor 

vehicle. 

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25 17. At the time of the accident, Tyler was (and has always been) Kathy and I 

26 William Jacobson's. natural son and was residing with his parents. 

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Case 2:17-cv-04373-GMS Document 1-1 Filed 11/29/17 Page 8 of 19
1 18. Defendant American Family admits Tyler is the son of Kathy and William 

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Jacobson by blood and a resident of the household, but denied coverage because Tyler 

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owned his own vehicle, a motorcycle. 

s 19. Kathy and William reasonably expected the definition of "relative" would 

6 be consistent with what is commonly understood as the definition of a"relative" which 

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does not contemplate anything regarding vehicle ownership and certainly contemplates 

9 their natural born son. 

10 20. Kathy and William Jacobson reasonably believed that Plaintiff was an 

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insured under the Policy as nothing in the Declarations Page suggests otherwise or 

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13 mentions an exception or an exclusion regarding relatives who no longer qualify as a 

14 "relative" if he owns his own vehicle. I 

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21. Kathy and William Jacobson's intention and understanding of coverage 

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provided by the underinsured motorists provisions was that any of their relatives, 

ls especially their children, including Tyler, would be covered under the Policy. 

19 22. Neither Defendant American Family nor any of its agents advised Kathy or 

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William Jacobson that any exclusion existed in the Policy that would preclude a relative I 

22 from underinsured coverage if Plaintiff owned his own vehicle. 

23 23. Of the three cars insured by the Policy, one car, a Monte Carlo, was I 

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purchased and insured by Kathy and William Jacobson including for Tyler to drive from I 

2s 

26 time to time. Kathy and William reasonably expected that whether Tyler was driving the I 

27 Monte Carlo or his separately purchased motorcycle, the Policy's underinsured motorists I 

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coverage would apply. 

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Case 2:17-cv-04373-GMS Document 1-1 Filed 11/29/17 Page 9 of 19
1 24. Prior to Defendant American Family denying underinsured coverage for 

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Tyler's injuries, the Jacobsons did not know the nature or effect of the definition of 

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"Relative" in the terms of the Policy and, if the Jacobsons had known that there was any 

5 question regarding whether any relative living with them would no longer be considered 

6 a relative, they would have sought a different insurance policy than the Policy offered by 

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American Family. 

9 25. To date, Defendant has not issued Underinsured Motorist coverage payment 

10 to Plaintiff. 

BREACH OF CONTRACT 

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13 26. Plaintiff reasserts Paragraphs 1-25 of the Complaint as if fully I 

14 I reincorporated herein. 

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27. Plaintiff's parents purchased an insurance policy from Defendant, under ~ 

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which Plaintiff was an insured, which included Underinsured Motorist coverage. 

18 28. Plaintiff was injured in a motor vehicle crash and suffered injuries requiring I 

19 medical treatment. 

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29. Plaintiff submitted medical bills and records to Defendant and demanded I 

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22 that Defendant issue payment to him for Underinsured Motorist coverage. 

23 30. Defendant's failure to make a good faith offer constitutes a breach of I 

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contract. 

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26 31. As a direct and proximate result of the breach, Plaintiff has incurred direct I 

27 and consequential damages. 

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32. Such breach is material and without cause, reason or defense. 

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Case 2:17-cv-04373-GMS Document 1-1 Filed 11/29/17 Page 10 of 19
BAD FAITH 

33. Plaintiff reasserts Paragraphs 1-32 of the Complaint as if fully 

reincorporated herein. 

34. Plaintiff has a contract of insurance with Defendant. 

35. Implicit in every contract of insurance is the duty of good faith and fair 

dealing. 

36. Defendant's failure to adequately investigate, failure to treat Plaintiff's 

claim with equal consideration, failure to make a good faith offer, failure to make 

reasonable efforts to alleviate the necessity of litigation and failure to pay a reasonable 

amount to Plaintiff is a breach of the covenant of good faith and fair dealing. 

37. Defendant failed to issue any checks within 30 days of having all the 

necessary information for claim adjudication, in violation of A.R.S. §20-462. 

38. Defendant still has not issued a proper check made out to Plaintiff. 

39. Defendant breached the duty and acted in bad faith by: (a) placing ~ 

Defendant's interests ahead of that of their insured and intended beneficiary, Plaintiff I 

herein; and (b) refusing to issue Underinsured Motorist coverage payment to Plaintiff. 

40. Defendant was aware that among the purposes of insurance is to provide I 

peace of mind and emotional and financial security to persons such as Plaintiff, yet I 

Defendant intentionally failed to make Underinsured Motorist coverage payments to I 

Plaintiff without a reasonable basis for such action. In so doing, Defendant intentionally I 

~ and consciously pursued a course of conduct knowing that it created a substantial risk of ~ 

I significant harm to Plaintiff. 

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Case 2:17-cv-04373-GMS Document 1-1 Filed 11/29/17 Page 11 of 19
41. Defendant knew that it acted without a reasonable basis or failed to perform 

an investigation or evaluation adequate to determine whether its action was supported by 

a reasonable basis. 

42. As a direct and proximate result of Defendant's breach of contract and bad 

faith, Plaintiff has suffered damages of $100,000 for unpaid Underinsured Motorist 

coverage. 

43. As a direct and proximate result of Defendant's breach of contract and bad 

faith, Plaintiff has suffered financial stress, emotional distress, anxiety, worry and 

inconvenience. 

44. Upon information and belief, Defendant acted with a consistent pattern to 

undermine the security of its own insurance policies to the detriment of its insureds 

including Plaintiff, to the extent that it constitutes a conscious disregard of the substantial 

likelihood that such conduct is likely to cause injury and constitutes conduct sufficient to 

incur a penalty of punitive damages. 

45. Plaintiff is therefore entitled to punitive damages in an amount sufficient to ~ 

stop such conduct and deter similar conduct in the future. 

WHEREFORE, Plaintiff requests that judgment be entered against the Defendant I 

as follows: 

1. For Underinsured Motorist coverage payment of $100,000 paid directly to I 

I Plaintiff; 

2. For general damages in an amount deemed a fair and reasonable sum in I 

I excess of the minimum jurisdictional limits of this court; 

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Case 2:17-cv-04373-GMS Document 1-1 Filed 11/29/17 Page 12 of 19
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3. For punitive damages in an amount deemed fair and reasonable; 

4. For attorney's fees and taxable costs pursuant to A.R.S. §12-341.01; 

5. For pre- and post judgment interest at the statutory rate of ten percent (10%) 

per annum pursuant to A.R.S. § 44-1201; 

6. For interest pursuant to A.R.S. § 20-462; and 

7. For such other and further relief as the Court deems just and appropriate. 

RESPECTFULLY SUBMITTED this 30 day of October, 2017. 

THE SLAVICEK LAW FIRM 

By ~~1 — 

Bre lavicek 

James E. Fucetola 

Trevor R. Orme 

5500 N. 24t' Street 

Phoenix, Arizona 85016 

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Case 2:17-cv-04373-GMS Document 1-1 Filed 11/29/17 Page 13 of 19
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Brett L. Slavicek (No. 0 193 06) 

James E. Fucetola (No. 029332) 

Trevor R. Orme (No. 032261) 

THE SLAVICEK LAW FIRM 

5500 N. 241 Street 

Phoenix, Arizona 85016 

Telephone: (602) 285-4425 

Telephone: (602) 285-4424 

Fax: (602) 287-9184 

Email:1~1.~ttici~sla~~.i ceklt~~~°.com 

l 

a ine a s'ir.slavicf~.v~-. ckl c<»~~~ ~--- -- -- 

tri.vc?rrci;sl avi cek.law.cc}m 

Attorneys for Plaintiff 

r 

ad. 

--• ~ 

~.,. ~ 

~ Y 

IN THE SUPERIOR COURT OF THE STATE OF ARIZONA 

IN AND FOR THE COUNTY OF MARICOPA 

TYLER JACOBSON, an individual, 

Plaintiff, 

vs. 

AMERICAN FAMILY INSURANCE 

COMPANY, a foreign corporation; XYZ 

Corporations I-X; ABC Partnerships I-X, 

Defendants. 

CaseNo.: GII'L'01 7-01 4262 

CERTIFICATE OF COMPULSORY 

ARBITRATION 

The undersigned certifies that they know the dollar limits and any other limitations 

set forth by the local rules of practice for the applicable superior court, and further certify 

that this case is not subject to compulsory arbitration, as provided by Rules 72 through 77 

of the Arizona Rules of Civil Procedure. 

Case 2:17-cv-04373-GMS Document 1-1 Filed 11/29/17 Page 14 of 19
1 DATED this 71ifaay of October, 2017. 

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THE SLAVICEK LAW FIRM 

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0 

COPY of the foregoing hand delivered 

this ~ day of October, 2017 to: 

Arbitration Department 

Maricopa County Superior Court 

201 W. Jefferson 

Phoenix, Arizona 85003 

d 

Byo / 

'efi ristina Jaime 

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By 

Brett L. Slavicek 

James E. Fucetola 

Trevor R. Orme 

5500 N. 241 Street 

Phoenix, Arizona 85016 

Attorneys for Plaintiff 

Case 2:17-cv-04373-GMS Document 1-1 Filed 11/29/17 Page 15 of 19


Brett L. Slavicek (No. 0 193 06) 

James E. Fucetola (No. 029332) 

Trevor R. Orme (No. 032261) 

THE SLAVICEK LAW FIRM 

5500 N. 2411 Street 

Phoenix, Arizona 85016 

Telephone: (602) 285-4425 

Telephone: (602) 285-4424 

Fax: (602) 287-9184. 

Email: brett;ir:,sl~viceklt~~~-.co_m 

~axric:s~Lr`slavicel<1i.w.c;c»ni 

trevorin;slavic.eklaw.rof n 

Attorneys for Plaintiff 

IN THE SUPERIOR COURT OF THE STATE OF ARIZONA 

IN AND FOR THE COUNTY OF MARICOPA 

r~ TYLER JACOBSON, an individual, Case No.: 017-0142 

Plaintiff, 

vs. JURY DEMAND 

AMERICAN FAMILY INSURANCE 

COMPANY, a foreign corporation; XYZ (Breach of Contract) 

Corporations I-X; ABC Partnerships I-X, 

Defendants. 

Pursuant to Rule 38(b), Arizona Rules of Civil Procedure, Plaintiff demands a trial 

by jury of all issues in the above entitled action. 

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Case 2:17-cv-04373-GMS Document 1-1 Filed 11/29/17 Page 18 of 19
DATED this Day of October, 2017. 

THE SLAVICEK LAW FIRM 

By 

Brett L. Slavicek 

James E. Fucetola 

Trevor R. Orme 

5500 N. 24th Street 

Phoenix, Arizona 85016 

Attorneys for Plaintiff 

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Case 2:17-cv-04373-GMS Document 1-1 Filed 11/29/17 Page 19 of 19