Document gbORVpjw2RDdNQRbxv5MRMXgQ
STATE OF MAINE SKOWHEGAN, SS. SHERWIN WILLIAM COMPANY,
Plaintiff vs.
Defendant
TWELFTH DISTRICT COURT DIVISION OF SOMERSET CIVIL ACTION DOCKET NO.
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] ] ] NOTICE AND ACKNOWLEDGMENT ] FOR SERVICE BY MAIL ] PURSUANT TO MAINE RULE OF ] CIVIL PROCEDURE 4(c)(1)
3 ]
TO:
The enclosed Summons and Complaint are served pursuant to Rule 4(c)(1) of the Maine Rules of Civil Procedure. The Complaint is self explanatory. This matter is civil not criminal.
Please complete the acknowledgment at the bottom of this form and return one copy of the completed form in the enclosed postagepaid return envelope so that it will be received by the sender within 20 days of the date of mailing.
You will note that the Summons required that an Answer be
filed to this Complaint within 20 days from the date you
acknowledge receipt of this notice. Judgment by default might be
entered against
if an Answer
Dated: July 20,
HEWES & NYE 48 Free Street Portland, Maine (207) 773-2000
1994
lichard N. Hewes, Esquire Attorney for Plaintiff
04101
ACKNOWLEDGMENT OF RECEIPT OF SUMMONS AND COMPLAINT
I acknowledge that I received a copy of the Summons and Complaint relative to the above-captioned matter, on the date listed below. I understand that, to avoid judgment by default against me, I must file an Answer to this Complaint with Superior Court in Cumberland County located in Portland, Maine as required by the Summons.
Date:
acknowlg.lvt
Signed: _____________________________________
Defendant
(007-SWP-005802983
STATE OF MAINE SKOWHEGAN, SS.
SHERWIN WILLIAMS COMPANY, Plaintiff
vs.
Defendant
TWELFTH DISTRICT COURT DIVISION OF SOMERSET DOCKET NO.
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] COMPLAINT
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NOW COMES Sherwin Williams Company, Plaintiff, and complains
against
as follows:
1. Sherwin Williams Company is a corporation licensed to do business in the State of Maine;
2. Defendant, is a resident of Skowhegan, County of Somerset, State of Maine;
3. On or about January 29, 1990,
sustained
a work-related injury in the course of his employment at
Sherwin Williams Company;
4. benefits reflecting 70% account of the injury;
has received workers7 incapacity since January
compensation 29, 1990 on
5. > average weekly wage was set at $830.91 in the September 25, 1991 Decree issued by the Maine Workers7 Compensation Commission;
6. has received $3 87.75 per week in workers7 compensation benefits since August 21, 1990;
7. From August 21, 1990 through October 1, 1991, a period of
58.2857 weeks,
received $471.87 per week in long
term disability benefits for a total of $27,503.27;
8. From October 2, 1991 through February 29, 1992, a period
of 21.428 weeks,
: received $259.81 per week in long
term disability benefits for a total of $5,567.20;
9. From August 21, 1990 through February 29, 1992, received a total of $33,070.48 in long term
disability benefits from Sherwin Williams Company;
(007-SWP-005802984 CONFIDENTIAL
N41625.01
REDACTED
10. Sherwin Williams Company was self-insured and made these payments to
11. From August 21, 1990 through October 1, 1991, a period of
58.2857 weeks, :
received $125.27 per week for a
total of $7,301.44 in workers' compensation benefits from
Plaintiff's workers' compensation insurance carrier on account of
the compensable January 29, 1990 injury;
12. From October 2, 1991 through February 29, 1992, a period
of 21.428 weeks,
received $259.81 per week in
workers' compensation benefits for a total of $5,567.20 from
Plaintiff's workers' compensation insurance carrier;
13. workers' compensation February 29, 1992;
received a total of $12,868.64 in benefits from August 21, 1990 through
14. Pursuant to Sherwin Williams Company's long term
disability contract, Sherwin Williams Company was entitled to
reduce long term disability benefit payments by the amount of
workers' compensation benefits received by
for any
period during which
received workers' compensation
benefits; (see attached Exhibit A, pages 15 and 16 of
"Benefits in Perspective Income If You Are Disabled".)
15. was entitled to receive, and did
receive, $33,070.48 from Sherwin Williams Company for long term
disability benefits between August 21, 1990 and February 29, 1992.
. received $12,868.19 in workers' compensation
benefits during this period.
did not reimburse
Sherwin Williams Company for these workers' compensation benefits
received while he received long term disability benefits;
16. Sherwin Williams had a right to receive from
the amounts that ;
received in
workers' compensation benefits;
17. Sherwin Williams Companv had a right to possess the
workers' compensation benefits that ...
received while
he received long term disability benefits;
18. Sherwin Williams Company has demanded possession of the
amounts that
received in workers' compensation
benefits from August 21, 1990 through February 29, 1992.
has refused to repay these amounts to
Sherwin Williams Company. This has resulted in an overpayment to
in the amount of $8,324.17. Sherwin Williams has
a right to recoup this overpayment.
0007-SWP-005802985 CONFIDENTIAL
WHEREFORE, Plaintiff demands judgment against Defendant in the amount of $8,324.17 plus interest and costs.
Dated at Portland, Maine this 20th day of July, 1994.
HEWES & NYE 48 Free Street Portland, Maine (207) 773-2000
04101
Richard N. Hewes, Esquire Attorney for Plaintiff
complaint.lvt
(007-SWP-005802986 CONFIDENTIAL
EXHIBIT A
Benefits in Perspective
INCOME IF YOU ARE DISABLED
A Summary Of
The Sherwin-Williams Company Disability Plans
For Salaried Employees
(and other employees approved for coverage under these plans)
{007-SWP-005802987 CONFIDENT!AT
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0007-SWP-005802988 CONFIDENTIAL
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