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Home My WebLink About98-01567 I , I 1 I I I i I I i I .~ I ~ , \! ~ ~ ~ ~'..' .~'\ ~ \ \I \ ~. '.' ..... .... s:-- ~..""" ."""'C' .~ ," .'''' ."' \ , ! / ;J~V J" /T I 1 I I ( ... ~ :- :5 '- CJ t'-- ~I _I .1 00 , 0- ~ , ( CHIROPRACTIC EVALUATION CENTER BD OFF: 412.374.1414 FAX: 412-374-1416 INDEpENDENT EXAMINA 1l0N PEER REVIEW 218 CENTER ROAD, MONROEVll.LE, I'A 15146.1749 August 31, 1992 ~~~ " St;- /!;'l,,, 'P I t:: fJ i."~fi 0/9" V..... ,;I() l..4~,. $'~ Joanne E. Frank, R.N. Hoover Rehabilitation Services P.O. Box 8872 205 House Avenue Camp Hill, PA 17011-8872 REI 'lOUR FILE II Kathryn Martin CH-16636-792 PRO Dear Ms. Frank: The following is a peer review based on the reoords that you have submitted to me regarding the above named individual. RECORDS REVIEWED: 1. Corresponctence from Dennis J. Fitterer, D.C. dated 8/12/92. 2. Billing Statements from Polyclinic Medical Center, dated 12/26/90. 3. Consultation and Treatment Record from Polyolinic M~dical Center of Harrisburg, dated 12/26/90. 4. ailling Statement from Hampden Township Ambulance Associa- tion, dated 12/26/90. 5. Health Insuranoe Claim Form from Tristan Associates, dated 12/26/90. 6. Treatment Record from William P. Graham, III, M.D., dated 1/2/91 to 5/13/92. 7. Health Insurance Claim Forms from William P. Graham, III, M.D., dated 12/26/90 to 11/20/91. 8. Progress Narratives from William P. Graham, III, M.D., dated 1/16/91, 5/28/91, and 11/21/91. 9. Attending Physician's Report from Dennis J. Fitterer, D.C., ciateci 6/5/92. 10. Medical Report from Dennis J. Fitterer, D.C., dated 5/24/91- 11. Progress Report from Dennis J. Fitterer, D.C., dated 11/7/91. 12. Treatment Recorci from Dennis J. Fitterer, D.C., ., dateci 1/21/91 to 7/21/92. RE: Kathryn Martin REPORT DATE I August PAGE: 2 f.?~ -OS' 8tp ~ I !/ l! 1. '0 l) i;.., /9"... I V", -"'(' 13. Interim Reports from Dennis J. Fitterer, D.C., dated 8/2~J~ 1/9/92, 2/28/92. ,:;'/9 14. confidential Patient Case History, dated 1/20/90. 15. X-ray Repor.t from Ian D. McLean, D.C., D.A.C.B.R., P.C., dated 7/23/92. 16. Itemized Billing statements from D.J. Fitterer, D.C., dated 1/21/91 to 6/17/92. J1r 1992 In regards to your letter dated August 18, 1992 requesting my professional opinion of ~atbrYD Martin, I submit the following. IS THE C,~E RENDERED REASONABLE AND NECESSARY DUE TO INJORIIS SUSTAINED IN THE INCIDENT? Documentation submitted for review supports as reasonable and necessary a trial of chiropractic treatment provided by Dennis J. Fitterer, D.C. for Kathryn Martin's injuries nnd complaints re- lating to the 12/26/90 MVA. On 8/27/92, I spoke with Dr. Fitterer who informed me that Ms. Martin is returning for care on an as needed basis as some of her activities lead to symptoms involving her upper cervioal spine. He also stated that Ms. Martin'S age (7 years old) and her activ- ity level resulted in intermittent exacerbations which slowed her recovery. Therefore, analysis of the file and conversation with Dr. Fitter- er supports a cervioothoracic sprain/strain grade III oomplioated by a seoondary oollision, that being the head against the dash- board which required surgical intervention to her forehead, as well as, a cervical hypolordo~is. This level/grade of injury, the mechanism as reoorded, and the oomplioating variable outlined above indicate a three to six month deoreasing frequenoy relief, therapeutic, and rehabilita- tive chiropraotic treatment regime extended an additional three to six months given the intermittent exaoerbations per the pa- tient's age, as well as, the complicating faotors outlined. An additional recovery period beyond this time frame is not obvi- ous as Ms. Martin does not possess or suffer with, either before or after the injury, advanced age, metabolio disorders, congeni- tal anomalies of the spine, developmental anomalies of the spine, degenerative diso disease, disc protrusion, spondylosis, faoet arthrosis, scoliosis, prior cervical spinal surgery, vertebral " fracture, osteoporosis, previous 1 ~'::' . ':,"'I~ "'," "J 8cp , ", l ~ ,) l. d" I 0 1.'192 "4:1/ ,.... ".!l ('0 ". \,;J' ".":, similar in jury, 'ale. . . RE: Kathryn Martin REPORT DATE: August 31, 1992 PAGE: 3 Appropriate treatment for injuries such as that incurred by Ms. Martin normally consists of a progression of exercises offered as early in the treatment plan as possible with a gradual concur.rent reduction in the use of spinal manipulation and physical thera- peutic modalities as the treatment plan progresses. This ap- proach should then lead to an independent program of pain control and exercises for home management of any benign residual symptO~B that may and often do persist given the nature of the injury. IS CONTINUED CARE APPROPRIATE? -AHl)- I~ CARE IS NO LONGER ~ECESSARY, WHEN SHOULD IT HAVE BEEN DISCON- TINUED? In my opinion and within a reasonable degree of chiropractic cer- tainty, maximal chiropractic rehabilitation was obtained by 7/23/92. By 7/23/92, a full 18 months of active chiropractic care have been allocated to address the self contained injury and the x-ray report fr.om Ian D. McLean, D.C., D.A.C.B.R., reads "The cervical lordosis appears well maintained. There is a minor degree of posterior subluxation of C3, however, for a patient of this age this is a likely variant of normal. The range of motion on flex- ion and extension is adequate." Additionally, Dr. Fitterer offered as early as 5/21/91 on the medical report "The patient is responding well to care," and on the 2/28/92 Interim Report "For an active 7 year old, she is im- proving favorably." Hence, treatment beyond 7/23/92 is not clinically substantiated. This is not to say that Ms. Martin will not continue to have com- plaints or that treatment does not make her feel good, only the clinical benefit of additional chiropractio treatment is remote at this time post injury and when considering the application of treatment which includes 82 separate office visits. Again, I have noted that in spite of an extended treatment peri- od, Dr. Martin has managed the case most conservatively and with- out the introduction or recommendation of excessive treatment modalities or applications. ca I i , " . 'I ~ Aqr....llt The parties agree as follows: 1.0 R.I.... all4 Oiaoharq. 1.1 In oonsideration of the payments set forth in Section 2, the Claimant hereby completely releases and forever discharges the Insureds and the Insurer from any and all past, present, or future claims, demands, obligations, actions, causes of action, Wrongful death claims, rights, damages, costs, losses of services, expenses and compensation of any nature whatsoever, whether based on a tort, contract or other theory of recovery, which the Claimant now has, or which may hereafter accrue or otherwise be aoquired, on aooount of, or may in any way grow out of the incident described in Recital A above, includingr without limitation, any and all known or unknown claims for bodily and Personal injuries to the Claimant, or any future Wrongful death claim of the Claimant's representatives or heirs, which have reSUlted or may result from the alleged acts or omissions of the Insureds. 1.2 This release and discharge shall also apply to the Insureds' and the Insurer's past, present and future offioers, directors, stockholders, attorneys, agents, servants, representatives, employees, SUbSidiaries, affiliates, partners, predecessors and SUccessors in interest, and assigns and all other persons, firms or corporations with whom any of the former have been, are now, or may hereafter be afflli.ated. 1.3 This release, on the part of the Claimant, shall be a fully binding and complete settlement among the Claimant, the Insureds and the Insurer, and their heirs, assigns and SUccessors. 2 , .' . . 1.4 The claimant acknowledges and agrees that the release and discharge set forth above is a general release. The Claimant eltpressly waives and assumes the risk of nny and all claims for dnmages which exist as of this dat~, but of which the Claimant does not know or suspect to exist, whether through ignoranoe, oversight, error, negligence, or otherwise, and which, if known, would materially affect the Claimant I s decision to enter into this Settlement Agreement. The Claimant further agrees that he has accepted payment of the sums specified herein as a complete compromise of matters inVOlving disputed issues of law and fact. The Claimant assumes the risk that the facts or law may be other than the Claimant believes. It is understood and agreed to by the parties that this settlement is a compromise of a doubtful and disputed claim, and the payments are not to be construed as an admission of liability on the part of the Insureds, by whom liability is expressly denied. 2.0 Payments In consideration of the release set forth above, the Insurer on behalf of the Insureds agrees to pay to the individual(s) named below ("Payee(s) ") the sums outlined in this Section 2 below: 2.1 periodio Payments. Kathryn Martin "payee" in the Insurer agrees to make payment to following manner: (i) Annual guaranteed payments: Commencing on August 11, 2002, Seven Thousand Dollars ($7,000.00) per year for four (4) years. (ii) Lump sum guaranteed payments: On August 11, 2007 guaranteed payment of Fifteen Thousand Dollars ($15,000.00); On August 11, 2009 guaranteed payment of Fifteen Thousand Dollars ($15,000.00); 3 , ~, ~ " On August 11/ 2014 guaranteed payment Thousand Dollars ($31/000.00). of Thirty-one All sums set forth herein constitute damages on account of personal injuries and sickness, within the meaning of seotion 104(a) (2) of the Internal Revenue Code of 1986, as amended. 3.0 payee's Rights to Payment. The Claimant acknowledges that the Periodic payments cannot be accelerated, deferred, increased or decreased by the Claimant or any Payee, nor shall the Claimant or any Payee have the power to sell, mortgage, encumber, or anticipate the Periodio Payments, or any part thereof, by assignment or otherwise. 4.0 payee'. Beneficiary Any payments to be made after the death of any Payee, pursuant to the terms of this Settlement Agreement, shall be made to their named beneficiary. If no person or entity is so designated by the Payee, or if the person designated is not living at time of the Payee's death, such payments shall be made to the estate of the Payee. The Payee may request in writIng that Assignee change the payee and/or beneficiary designation under this Agreement. The Assignee will do so but will not be liable, however, for any payment made prior to receipt of the request or so soon thereafter that payment could not reasonably be stopped. 5.0 Consent to Qualified Assignment 5.1. will make 130(c) of Insurer's The Claimant acknowledges and agrees that the Insurer a "qualified assignment", within the meaning of Seotion the Internal Revenue Code of 1986, as amended, of the liability to make the Periodic Payments set forth in 4 #.' . . ".. ; Seotion 2. 1 to Allstate Settlement corporation ("the Assignee"). The Assignee's obligation for payment of the Ped,odio Payment. shall be no greater than that of the Insurer (whether by judgment or agreement) immediately preceding the assignment of the Periodio Payments obligation. 5.2 Suoh assignment shall be aooepted by the Claimant without right of rejection and Dhall oompletely release and disoharge the Insureds and the Insurer from the Periodic Payments obligation assigned to the ABsign~e, The Claimant reoognizes that the Assignee shall be the sole obligor with respect to the Periodic Payments obligation, and that all other releases with respect to the Periodic Payments obligation that pertain to the 1i.abil i ty of the InSllrer shall thereupon become final, irrevocable and absolute. 6.0 Right to Purchas. an Annuity The Insurer, itself or through its Assignee, will fund the liability to make the Periodic Payments through the purchase of an annuity policy from Allstate Life Insurance company. The Insurer or the Assignee shall be the sole owner of the annuity policy and shall have all rights of ownership. The Insurer or the Assignee may have Allstate Life Insurance Company mail payments directly to the Payee(s). The Claimant shall be responsible for maint~ining a currant mailing address for Payee(s) with Allstate Life Insurance Company. 7.0 Discharge of Obligation The obligation of the Insurer and/or Assignee to make each Periodic Payment shall be discharged upon the mailing of a valid check in the amount of such payment to the desi.gnated address of the Payee(s) named in Section 2 of this Settlement Agreement. 5 . "', . ,'''''' . 8.0 aepre.entation of Compreben.ion of Dooument In entering into this Settlement Agreement the Claimant represents that the terms of this Settlement Agreement have been oompletely read and are fully understood and voluntarily aooepted by the Claimant. 9.0 Warranty of Capaoity to Ixeoute Agreement The Claimant represents and warrants that no other person or entity has, or has had, any interest in the claims, demands, obligations, or causes of action referred to in this Settlement Agreement, except as otherwise set forth herein; that the Claimant has the sole right and exclusive authority to execute this Settlement Agreement and receive the sums specified in it; and that the Claimant has not sold, assigned, tranSferred, conveyed or otherwise disposed of any of the olaims, demands, obligations or causes of action referred to in this Settlement Agreement. 10.0 Confidentiality The parties agree that neither they nor' their representatives shall reveal to anyone, other than as may be mutually agreed to in writing, any of the terms of this Settlement Agreement or any of the amounts, numbers or terms and conditions of any sums payable to Payee(s) hereunder. 11.0 Governing Law This Settlement Agreement shall ~e construed and interpreted in aocordanoe with the laws of the Commonwealth of Pennsylvania. 6 ,..'''.,...-.-----. ....'" ,- ... , 12.0 ~4dltlon.1 DOOua.nte ." p.r"'. ..r.' 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