This is from:
http://www.cmu.edu/policies/Landlord-Tenant/djcourt.htm

In Pennsylvania, landlord-tenant cases are usually filed in District Justice Court. You may have heard this kind of court referred to as Small Claims Court. Filing suit in District Justice Court is a relatively simple proccess. You don't need a lawyer to represent you. You can file a claim in District Justice Court as long as your damages (i.e., amounts claimed) are under $8,000. A filing fee (ranging from $37.50 to $82.50, depending on the amount in dispute) is required. If you win your case, the other party will usually be required to reimburse you for the filing fee.
There are several District Justice Court offices in Pittsburgh; each one has jurisdiction over a certain geographic area. To determine which office has jurisdiction over your claim, call the District Justice Court Administrative office at 412-350-5485. Once you've determined the appropriate office, you can start your action by filing a claim there, stating what the dispute is and what your damages are. The District Justice will schedule a hearing where all parties will have the right to tell their stories, present witnesses and documents and question each other's witnesses. After the parties are done presenting their cases, the District Justice will make a decision, either at the end of the hearing or by mail. (If a hearing is scheduled and you don't show up, you automatically lose.)

If you don't agree with the decision, you can file an appeal with the Court of Common Pleas within 30 days of the District Justice's decision. A Common Pleas Court case is a more formal process and requires following all the regular court rules and procedures. You will probably want a lawyer to advise you if you file an appeal.

Presenting Your Case.You should prepare for your hearing with the District Justice by thinking about your case and gathering all the evidence you can to support your side of the story. Evidence can take the form of your own testimony, the testimony of others with relevent knowledge, and documentary evidence. For instance, if your case is about not receiving your security deposit, your evidence might consist of your own and your rommate's testimony that the apartment was clean and undamaged when you moved out, photos taken of the clean apartment, and receipts for payments for cleaning services or cleaning products.

If you can't afford an attorney, you can obtain low-cost legal assistance from the Allegheny County Bar Association

James,

Thank you for taking the time to write that great letter. My problem is that I'm a transsexual, have been living full-time for a year, and while I've removed a lot of facial hair w/electroylsis, I still have a fair way to go. Do you know if there's insurance precedent for covering electrolysis for TS? Do you know how I'd need to re-word the letter you wrote to get it covered?

Kathryn

That one is harder, as your doctor is not saying that the hair removal is to correct a problem, or help to see the progress of ongoing treatment. If however you have a co-operative doctor, you may give it a go, because if your insurance covers any part of treatment for transsexualism, they must treat all phases of the treatment within reason, and hair removal is very basic to living as a woman. They may not pay for your new chin (no one said you have to be a pretty woman) but hair all over your face is unacceptable as a woman (you have to at least pass as a credible woman for your own safety)

I don't have time to write much now, but that is what you have to work with. Good luck.

On June 16th, I filed suit. The secretary/receptionist seemed very confused by my request, and said, to paraphrase, "You lost three grievances and you think you can win a suit?" (I thought her job was to have me fill out a form, not question my sanity.)

The District Justice sent a letter to me stating that the Insurance company has said that they will defend themselves. I hope they don't show up, because the chance of me losing my composure is very high. I'm going to arm myself with all the ammo suggested in this post. When it's over, I'll post the outcome.

Actually, they are hoping YOU don't show up.

It will help if you have your doctor's co-operation here. Although I understand that most won't show up and testify for you, it is in your best interests to find out how your small claims court will accept absentee testimony from a doctor. Some will take a letter and an invitation to call the doctor while in chambers, others will take a notarized statement from the doctor.

Remember, to them this is all about stone walling you. These are the people who refuse to pay for your life saving surgery, hoping that you die before you successfully sue them to get it done, all while taking out a secret life insurance policy on your life so that they actually make money on you when you die prematurely. Take nothing but a full judge, not a mediation, an actual judge and a full hearing. If you have the chance, go for a jury trial. Can you find a jury sypathetic to an insurance company?

Federal or state district court? Not sure about your state's rules, but if you're in federal court you must demand a jury trial at the proper time:

http://www.law.cornell.edu/rules/frcp/Rule38.htm

Most of these cases will be in your area's Small Claims Court Division. What ever is the place where landlord/tennant disputes are settled. This puts you in the driver's seat, because you are the one who files. You don't need to pay a lawyer, but THEY DO HAVE TO PAY FOR LEGAL REPRESENTATION. Your cost to sue them, less than $50 plus any lost work time for the hearing(s)

You effectively put the insurance company in the situation that it costs them money to fight your suit, instead of their obstanance costing you money while you wait.

I really don't understand why people are not comprehending that I am talking about your local version of the court shown on shows like Judge Judy, The People's Court, Judge Joe Brown, and stuff like that.

Here are the highlights from my hearing. They are not necessarily in order and definitely not complete.


7-20-05 I started off by saying that I have Polycystic Ovarian Syndrome and insulin resistance, both of which result in hirsutism, which is a male hair pattern on a woman. The insurance company's definition of medical necessity says that they will cover a service that "will, or is reasonably expected to, reduce or ameliorate the physical, mental, or developmental effects of an illness, condition, injury, or disability." I gave him a copy of this, along with both letters from my gynecologist (see my above timeline that I posted on Thu May 19 2005 06:08 PM, under the dates of 6-2-04 and 1-18-05).

Along with that I gave him a copy of a note from my PCP (I put a '?' by the words I wasn't sure of) stating: "Miss? [Hir-Fem] has PCOS with high DHEAS and testosterone levels. This causes severe? hirsutism and has caused her emotional distress. She has had CT scans of abd? and pelvis which are negative? for any masses and will need hormonal intervention? and electrolysis to treat and ameliorate her condition."

I wanted to show him my beard photo, but he said that wasn't necessary.


The judge asked the insurance rep whether Insurance denies that I have these illnesses. She said that they have no problem with the diagnoses.

She gave the judge a copy of "55 Pa. Code § 1141.59. Noncompensable Services.", listing what they will not pay for. She pointed out # (1): "Procedures not listed in the Medical Assistance program fee schedule"; and #(13): "Cosmetic surgery as defined in § 1141.2. Exception: Cosmetic surgery is a covered service when performed in order to improve the functioning of a malformed body member, to correct a visible disfigurement which would affect the ability of the person to obtain or hold employment, or as postmastectomy breast reconstruction."

She also gave him a copy of "55 Pa. Code § 1141.2. Definitions." Cosmetic surgery is defined as "A surgical procedure the primary purpose of which is to improve the appearance of the patient." A list of examples is given.

Something that doesn't make any sense to me is that she gave the judge copies of things that argue in my favor, such as my letters to Insurance dated 10-22-04 and 12-24-04, and my speech from grievance #2 (in my timeline it's dated 1-24-05, but it should be 2-24-05).


One of her exhibits was my GYN's letter dated 9-3-04, which I hadn't seen before (I have this dated ?-?-04 in the time line). It states:

"As you can see from the enclosed photograph, Ms. [Hir-Fem] has excessive hair growth on her chin. She also has black, coarse hair on her back, chest and abdomen.

"Although by her history androgen levels in the past have been abnormal, they currently are within normal limits except for an elevated DHEA-S.

"She currently is being treated with Metformin ER on recommendation of an endocrinologist. She continues to have hirsutism. Oral contraceptives and/or spirolactone may be attempted in the future but these drugs are known to only slow the growth and thin out the existing hair shaft. They also may exhibit side effects during the course of treatment.

"For this reason, I am requesting electrolysis for Ms. [Hir-Fem]."



As an example, the judge asked her if a person had kidney disease and their growth was stunted as a result, would insurance pay to have their bones lengthened so they wouldn't have to be 4' 6"? She said it would only be covered if it prevented organ damage.


He asked her if I lose this case, can I request reimbursement for future treatments. She said I could, but a precedent would have been set against it. He asked her if Insurance loses would they appeal, and she said that they would be forced to. He told me that if we tie, he will side with Insurance.


The judge said that he felt this was not a case of someone lying or of Insurance's denial of my condition. The insurance rep started to say "As a woman, I can sympathize-", but he interrupted to tell her that a man can sympathize too.


He asked me if electrolysis is permanent. I said that there is a small percentage of treated hairs that will grow back, but most will be permanently removed. The insurance rep said she disagrees; electrolysis may kill what hairs I have had treated, but because of a hormonal imbalance, I will continue to produce new hairs. This is when I pulled out my PCP's prescription for Depo-Provera (from my visit to the doctor just two days before) and said that the imbalance will be taken care of.


At the end I asked if I could show him the photo, and he let me. He was very nice - he said that he was sympathetic to what I was going through. Maybe it was because of his disposition that I managed not to cry, although I did shake all over repeatedly. He even told me not to be nervous, but that actually shook me up more, my voice started to break and I almost lost control.



7-23-05 I received a letter from the judge notifying me that judgment was entered for the plaintiff (that's me!). They owe me the full amount I paid for electrolysis plus the fee for filing the law suit.

I just wanted to say CONGRATULATIONS!!! I've been following this and really pulling for you!!

Good luck with your treatments!

Savannah

And thus I say once again, "Is it alright to say I told you so?"

Ladies and gentlemen, INSURANCE DOES PAY FOR ELECTROLYSIS as long as you have a doctor who will work with you, and you refuse to take any of the insurance company's B.S. and you insist, and force them in the end if you must, by filing a cheap small claims court case.

In my area, that court case would have cost $30 or less to file.

Much love and congratulations to you dearest Hair-Fem!

Now, just for the satisfaction, why don't you take the time to go back to the court clerk's office and share your award letter with that unsympathetic secretary who asked you how you figured you could win a case in court when you had lost grievances to the company who would have to pay if you were successful.