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HomeMy WebLinkAbout00-08030 _o.:I"~ U"~' ~,..~- ~ , ~,~ ~ STATE FARM INSURANCE COMPANIES, Petitioner : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY, PENNSYL V ANlA : NO, 00-8030 CNIL TERM V. : CNIL ACTION - LAW DONNA SHAMBAUGH, Respondent : JURY TRIAL DEMANDED ANSWER TO PETITION TO COMPEL APPOINTMENT OF AIYJITRATOR AND NOW, comes Respondent, Donna Shambaugh, by and through her counsel Dusan Bratic in response to State Farm Insurance Companies' Petition to Compel Appointment of Arbitrator. 1. The Respondent hereby does appoint Charles E. Schmidt, Jr., Esquire, as its arbitrator. 2. The Respondent has no objection to the Court selecting a neutral arbitrator. 3. The Respondent has no duty to return executed medical authorizations. A full reading of the policy will indicate that on page 7 under paragraph 4d, wherein it states: "under the medical payments, funeral benefits, loss of income and death, dismemberment and loss of sight coverages:" that an authorization will be give to obtain all medical reports and records. This is a claim under the underinsured motorist portion of the policy and as such, medical authorizations are not required. Date/1-- f'-/.. &V Dusan Bratic, Esq. AttomeyLD. 19249 101 South U.S. Route 15 Dillsburg, PA 17019 Attorney for Respondent n,;'>.):':E~~i~~;;i](<{Wt~'Ji; " , I I. .,.",i -. '-0"_.= - ~ C5 STATE FARM INSURANCE COMPANIES, Petitioner : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY, PENNSYLVANIA : NO. 00-8030 CIVIL TERM V. : CIVIL ACTION - LAW DONNA SHAMBAUGH, Respondent : JURY TRIAL DEMANDED CERTIli1CATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing Answer was furnished by U.S. Mail, first class, postage prepaid on this d day of December, 2000, to: RolfE. Kroll, Esquire P.O. Box 932 Harrisburg, P A 17108-0932 Date: I'/....~{ 'f-07/ Dusan Bratic, Esq. AttomeyI.D. 19249 101 South U.S. Route 15 Dillsburg,. P A 17019 Attorney for Respondent ~~ ,oC" ";'r-' 'C..' c -"',D ".1.,-.. ""-'_\'d" i' , '--~ir'~ " .... ROLF E. KROLL, ESQUIRE Pa. Supreme Court I.D. No~ 47243 MARGOLIS EDELSTEIN Post Office Box 932 Harrisburg, Pennsylvania 17108-0932 Telephone: [717] 975-8114 Fax: [717] 975-8124 E-mail: rkroUtalmarl!olisedelstein.com Attorney for: Petitioner STATE FARM INSURANCE COMPANIES , Petitioner IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 00-8030 CIVIL TERM v. CIVIL ACTION ~ LAW DONNA SHAMBAUGH, Respondent JURY TRIAL DEMANDED PETITION TO COMPEL APPOINTMENT OF ARBITRATOR AND NOW, comes Petitioner State Farm Insurance Companies ("State Farm") by and through their counsel, Margolis Edelstein to compel the appointment of an arbitrator on behalf of Respondent Donna Shambaugh ("Ms. Shambaugh") and in support thereof avers the following: 1. At all times relevant hereto, Ms. Shambaugh was insured by Defendant State Farm and handled under State Farm claim number 20-2814-056 with insurance policy number 2812-142-D31-20B. A true and correct specimen policy is attached hereto as Exhibit "A." 2. On or about February 15, 1993, Ms, Shambaugh was injured in an automobile accident wherein State Farm's named insured Ida E Schutz was driving, 3, State Farm coverage for underinsured motorist benefits applies to Ms. Shambaugh as Ms. Shambaugh was a passenger in a vehicle owned and operated by State Farm's policyholder Ida E. Schutz. 4. The State Farm policy provides for arbitration in the event an amicable resolution cannot be reached. 5, State Farm has made numerous attempts to affect an amicable resolution with Defendant. To date these efforts have been to no avail. ~ - ;'.1 " 'l - . .~ ." " "w, . 6. By letters dated June 21, 2000, August 7, 2000 and August 17, 2000, Petitioner, State Fann, has requested that Respondent select an arbitrator and comply with basic discovery obligations imposed upon her by the State Farm policy. To date these efforts have been met with no substantive response. True and correct copies of each of these letters are attached hereto as Exhibits B through D respectively. 7, In the June 21, 2000 letter, State Fann confirmed the current procedural posture of the case and confirrried that James Nealon, Esquire, had been appointed as State Fann's arbitrator in this matter. 8. By letter dated October 17, 2000, State Fann's counsel provided Respondent's counsel with one last chance to comply with the basic obligations of selecting an arbitrator and supply State Fann with medical record authorizations. A true and correct copy of this letter is attached hereto as Exhibit E. 9. To date Respondent has failed to select an arbitrator much less a neutral arbitrator, has failed to return executed record authorizations and, therefore, has failed and refused to comply with his obligations in violation of the terms of the policy. WHEREFORE, Petitioner State Fann requests that this Honorable Court enter an Order selecting Respondent's arbitrator and a neutral arbitrator in this case within 30 days in accordance with the terms of the policy and Pennsylvania law, and that Respondent provide Petitioner with executed medical record authorizations forthwith, By: fE. 0 Attorney I. #47243 Post Office Box 932 Harrisburg, PA 17108-0932 (717) 975-8114 Attorney for Petitioner Ioi,.":~'"^"'" . . -_"0'-" '<-',-,.--.- ;'" --.1"""",.;.,;,,_:--- , 0 ." ~ Q. O' '< ,- ci1 ~ rn .... 3 - " III co " - '" CD CD '< W [ ;;r CD " m ai" .... g 3 s: C;O co c:: - c:: . ~ 0 ~ " c:: co - Ul 0 ;;; 3 iD 0 ~ " g: '" CD ~ 3 0 :J ~ ::!. (JI cg ~ i6 c:: til . :J m n n CD r C 0 (') )Q " 0 n - 0 3 Q :IJ a. ~ "C III JJ JD :J ~ ':< s: " ::I: " 0 '" "S. 3 Q1 CD 01. 0 '" - - - CD o' Co) Co) CD CD 6 CD 8 5" - 0 3 :r co - 0 :J ~ c:: - ::r o .... N' CD Co ::IJ CD "C Cil (JI CD :J Ci - <' S' CD o 00' '. 0" ::u!;; 0)> ZUl mm O::U "m o~ C-c ::uo nc S;:::u -" 3:0 oC "n "-c nn m)> Ul::u )>m -f" 0:= zr- n:< m_ 0" --c UlO Rle :::r: ::u)> m< "m ~)> -fz z)> Qn )>Q nO s;:~ --f 3:- 'n ZO Ul~ c)> ::Un gj-f CIi-c 00 CC -f::U mUl Ul-+ :)> .... zm -f'" ::r:)l -x Ul3: ;h r-~ -rr 3~ < , ' 2 S386 " '7 ,_ - . ~ .,.. .,'''' ,... C>_~, _' - - _~ - , . ., , ...~,-, ~,d '0 "''''._, -A:,,~, '-";~""'-ii!k",; STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY BLOOMINGTON, ILLINOIS A MUTUAL COMPANY DEFINED WORDS WHICH ARE USED THROUGHOUT THE POLICY We define some words to shonen the policy. This makes it easier to reaa and un~rstand. Defmed words are printed in bold face italics. You can pick them out easily. Bodily Injury - means bodily injury to a person and sickness. disease or death which results from iL . CIlT - means a land motor vehicle with four or more wheels, which is designed for use mainly on public roads. It does not include: 1. any vehicle while located for use as a dwell- ing or other premises; or 2. a UUck-tractor designed to pull a uailer or semiuailer. Cllr Business - means a business or job where the purpose is to sell. lease. repair, service, l1'llIISpClrt, store or park land motor vehicles or trailers. Insured - means the person, persons or organization defmed as insureds in the specific coverage. Loss - defined in Section IV. Newly Acquired Cllr - means a replllcement car or an addiJiollQl CIlT. RepliJcement Cllr - means a car purchased by or leased to YO/l or your spouse to replace your .car. This policy will only provide coverage for the repliJcement CIlT if you or your spouse: I. tell us about it within 30 days after its delivery to you or your spouse; and 2. pay us any added amount due. AddiJiollQl Car - means an added car purchased by or leased to you or your spouse. This policy will only provide coverage for the addidollQl CIlT if: 1. itisaprivate ptlSsengercarand we insure all other private passenger cars; or 2. it is other than a private passenger CI1T and we insure all can owned by you or your spouse on the date of its delivery to you or your spouse. This policy provides coverage for the additiolllll CI1T only until the earlier of: 1. 12:01 a.m. on the 31st day after the deliv- ery of the CIlT to you or your spouse; or 2. the effective date and time of a policy issued by us or any other company !hat describes the car on its declarations page. However, you or your spouse may apply for coverage beyond the 30th day for the additiolllll car. Such coverage will be provided only ifboth you and the vehicle are eligible for coverage at the time of application. Non.OwnedCar- means a cllTnot owned, registered or leased by: 1. you, your spouse; 2. any reliJdve unless at the time of the accident or loss: a. the CI1T currently is or has within the last 30 days been insured for liability cover. age; and b. the driver is an insured who does not own or lease the car; 3. any other person residing in the same house- hold as you, your spouse or any reliJdve; or 4. an employer of you, your spouse or any reliJ- tive. Non-owned CI1T does not include a: I. rented car while it is used in connection with the insured's employment or business; or 3 8386 .' ' 2. car which has been operated or rented by or in the possession of an insured during any part of each of the l:JSt21 or more consecutive days. The 21 day limit is multiplied by the number of vehicles described on the declara- tions pages of all car policies issued by us under which the insured is an insured. A non-owned au must be a car in the lawful posses- sion of the person operating it Occupying - means in, on, entering or alighting from. Person - means a human being. Pril'ate Passenger Car - means a car: 1. withrour wheels; 2. of the private passenger or station wagon type: and 3. designed solely to carry persons and their luggage. Relative - as used in Sections I. Ill. IV and V means a person related 10 you or your spouse by blood. marriage or adoption who lives with you. It includes your unmarried and unemancipated child away at school. See Section II for definition used there. Serious injury - means a personal injury resulting in death, serious impainnent of body function or perma- nent serious disfigurement. Unless the injury sustained is a serious injury, each person who is bound by the limited tort election shall be precluded from maintaining an action for any noneconomic loss, except that: (1) An individual otherwise bound by the limited tort election who sustains damages in a motor vehicle accident as the consequence of the fault of another person may recover d:unages as if the individual damaged had elected the full tort alternative when- ever the person at fault: (i) is convicted, or accepts Accelerated Reha- bilitative Disposition (ARD) for driving under the influence of alcohol or a controlled substance in that accident; ~ --<,I '0 ,-.---- (ii) is operating a motor vehicle registered in another state; (Iii) intends to injure himself or another perso~. provided that an individual does not intentionally injure himself or another person merely because his act or failure to act is intentional or done with his realization that it creates a grave risk of caus- ~n~ inj.ury or the act or omission causing the mJUry IS for the purpose of aveningbodily harm to himself or another person; or (iv) has not maintained financial responsibility as required by Chapter 17 of Title 7S of the Pennsylvania Consolidated Statutes, provided that, nothing in this paragraph shall affect the limitation of section 173 I (d)(2) ofTiUe 7S of the Pennsylvania Consolidated Statutes (relating to availability, scope and amount of coverage). (2) An individual otherwise bound by the limited tort election shall retain full tort rights with respect to claims against a person in the business of design. ing, manufacturing. repairing, servicing or otherwise maintaining motor vehicles arising out of a defect in such motor vehicle which is caused by or not cor- rected by an act or omission in the course of such business, other than a defect in a motor vehicle which is operated by such business. (3) An individual otherwise bound by the limited tort election shall retain full tonrighlS ifinjured while an occupant of a motor vehicle other than a private passenger motor vehicle. Spouse - means your husband or wife while living with you. Temporary Substitute Car- means a car not owned by you or your spouse. if it replaces your car for a shon time. lIS use has to be with the consent of the owner. Your car has to be out of use due 10 ilS breakdown. repair, servicing, damage or loss. A temporary substitute car is not considered a non- owned car. Utility Vehicle - means a motor vehicle with: 1. a pickup, panel or van body; and 2. a Gross Vehicle Weight of 10,000 pounds or less. 4 8386 . .' You or Your - means the named insured or named insureds shown on the declarations page. ..I"~ _. , .- :0' " '-"h<'" '".\ "'.-'--" ;. ~ . c'., ":Jj Your Car - means a car or a vehicle described on the declarations page. DECLARATIONS CONTINUED We, the State Farm Mutual Automobile Insurance Company, agree to insure you according to the terms of this policy based: I. on your payment of premium for the cover- ages you chose; and 2. in reliance on your statements in these decla. rations. You agree, by acceptance of this policy that I. the statements in these declarations are your statements and are uue; and 2. we insure you on the basis your statements are uue; and 3. this policy contains all of the agreements between you and us or any of our agents. Unless otherwise stated in the exceptions space on the declarations page, your statements are: 1. Ownership. You are the sole owner(s) of your car. 2. Insurance and License History. Neither you nor any member of your household within the past 3 years has had: . a. vehicle insurance canceled by an insurer; or b. a license to drive or vehicle regislration suspended, revoked or refused. 3. Use. Your car is used for pleasure and busi- ness. WHEN AND WHERE COVERAGE APPLIES When Coverage Applies The coverages you chose apply to accidents and losses that take place during the policy period. The policy period is shown under "Policy Pe. riod" on the declarations page and is for succes- sive periods of six months each for which you pay the renewal premium. Payments must be made on or before the end of the current policy period. The policy period begins and ends at 12:01 A.M. Standard Time at the address shown on the declarations page. Where Coverage Applies The coverages you chose apply: I. in the United StateS of America, its territories and possessions or Canada; or 2. while the insured vehicle is being shipped between their pons. The liability, medical payments, funeral benefits, loss of income and physical damage coverages also apply in Mexico within 50 miles of the UniledStates border. A physical damage coverage loss in Mexico is determined on the basis of cost at the nearest United States point. Uninsured motor vehicle. underinsured mOlOr vehi- cle and death. dismemberment and loss of sight cov- erages apply anywhere in the world. 5 8386 " .., - --..< ,-._~- 0". "~, --~, FINANCED VEHICLES If a creditor is shown in the declarations. we may pay any comprehensive or collision loss 10: 1. you and, if unpaid. the repairer; or 2. you and such creditor. as its interest may appear, when we fmd it is not practical to repair your car, or 3. the creditor. as to its imerest, if your car has been repossessed. When we pay the creditor for loss for which you are not covered. we are entitled to the creditor's right of recovery against you to the extem of our paymem. Our right of recovery shall not impair the creditor's right to recover the full amount of its claim. The coverage for the creditor's interest only is valid - until we terminate it. We will not terminate such coverage because of: 1. any act or negligence of the owner or bor- rower; or 2. a change in the ownership or interest un- known to us, unless the creditor knew of it and failed to tell us within 10 days; or 3. an error in the description of the vehicle. The date of termination of the creditor's interest will be at least 10 days after the date we mail or electroni- cally uansmit the termination notice. REPORTING A CLAIM - INSURED'S DUTIES 1. Notice to Us of an Accident or Loss The insured must give us or one of our agents written notice of the accident or loss as soon as reasonably possible. The notice must show: a. your name; and b. the names and addresses of all persons in- volved; and c. the hour, date, place and facts of the accidem or loss; and d. the names and addresses of witnesses. 4. 2, Notice to Us of Claim or Suit If a claim or suit is made against an insured, that insured must at ollCe send us every demlllld. notice or claim made and every summons or legal process received. 3. Other Duties Under the Physical Damage Coverages When there is a loss, you or the owner of the propeny also shall: a. make a prompt repon to the police when the loss is the result of theft or larceny. b. protect the damaged vehicle. We will pay any reasonable expense incurred to do it. c. show us the damage. when we ask. d, provide all records, receipts and invoices, or certified copies of them. We may make cop- ies. e. answer questions under oath when asked by anyone we name, as often as we reasonably ask. and sign copies of the answers. Other Duties Under Medical Payments. Fu. neral Benefits, Loss of Income, Death, Dis. memberment and Loss of Sight, Uninsured Motor Vehicle and Underinsured Motor Ve. hicle Coverages The person making claim also shall: a. give us all the details about the death. injury. treatment and othcr information we need to dClcrmine thc amount payable. b. under the uninsured motor vehicle and under- insured mOlar vchicle coverages: (I) consent to be examined by physicians chosen and paid by us as often as we 6 8386 '-. , ' reasonably may require. A copy of the report will be sent to the person upon wriuen request. If the person is dead or unable to act, his or her legal repre- sentative shall authorize us to obtain all medical repons and records. (2) let us see the insured ctlr the .person oc- cupied in the accident. (3) send us at once a copy of all suit papers if the person sues the party liable for the accident for damages. c. under the uninsured motor vehicle coverage, repon an accident caused by an unidentified land motor vehicle to the police as soon as practicable and to us within 30 days or as soon as practicable. d. under the medical payments, funeral benefits, loss of income and death, dismemberment and loss of sight coverages: (1) authorize us to obtain all medical reports and records: If the person is dead or unable to act, his or her legal repre- ~ "' ~" I,~ "illi~, --, -~ senrative shall give us the authorization; and (2) give us proof of claim on forms we fur- nish unless we fail to supply them within 10 days after receiving the notice of claim. 5. Insured's Duty to Cooperate With Us The insured shall cooperate with us and, when asked, assist us in: a. making settlements; b. securing and giving evidence; c. attending, and getting wimesses to attend, hearings and trials. The insured shall not, except at his or her own cost, voluntarily: a. make any payment or assume any obligation to others; or b. incur any expense, other than for first aid to others. 7 8386 -I -l , . i '"_ ~ "'.C' _' ,_.. il:'1f' SECTION I - LIABILITY - COVERAGE A This coverage applies to the vehicles for which "A" appears in the "Coverages" space on the declarations page. We will: 1. pay damages which an insured becomes le- gally liable to pay because of: a. bodUy injury to others, and b. damage to or destruction of propeny in- cluding loss of its use, caused by accident resulting from the owner. ship, maintenance or use of your car; and 2. defend any suit against an insured for such damages with auorneys hired and paid by us. We will not defend any suit after we have paid the applicable limit of our liability for the accident which is the basis of the lawsuit. In addition to the limits of liability, we will pay for an insured any costs listed below resulting from such accident. 1. Conn costs of any suit for damages. 2. Interest on damages owed by the insured due to a judgment and accruing: a. after the judgment, and until we pay, offer or deposit in court the amount due under this coverage; or b. before the judgment, where owed by law, and until we pay, offer or deposit in court the amount due under this coverage, but only on that pan of the judgment we pay. 3. Premiums or costs of bonds: a. to secure the release of an insured's prop- eny attached under a coun order. b. required to appeal a decision in a suit for damages if we have not paid our limit of liability that applies to the suit; and c. up to 5250 for each bail bond needed because of an accident or traffic violation. We have no duly to furnish or apply for any bonds. The amount of any bond we pay for shall not be more than our limit of liitbility. 4. Expenses incurred by an insured: a. for loss of wages or salary up to 535 per day if we ask the insured to attend the Irial of a civil suit. b. for first aid to others at the time of the accident. c. at our request. We have the right to investigale, negotiale and settle any claim or suit. Coverage for the Use of Other Cars The liability coverage eXlends to the use, by an insured, of a newly acquired car, a temporary sub- stitute car or a non.owned car. Who Is an Insured When we refer to your car, a newly acquired car or a temporary substitute car, insured means: 1. you; 2. your spouse; 3. the relatives of the first person named in the declarations; 4. any other person while using such a car if its use is within the scope of consent of you or your spouse; and 5. any other person or organization liable for the use of such a car by one of the above in- sureds . When we refer to a non-owned car, insured means: 1. the flISt person named in the declarations; 2. his or her spouse; 3. their relatives; and 8 8386 . '.- ~ ,~ 4. any persall or organization which does not . own or hire lhe CQr but is liable for its use by one of the above persons. 1HERE IS NO COVERAGE FOR NON-OWNED CARS: 1. IF THE DECLARATIONS STATE THE "USE" OF ALL OF YOUR CARS IS OTHER lEAN "PLEASURE AND BUSI. NESS"; OR 2. WHILE: a. BEING REPAIRED, SERVICED OR USED BY ANY PERSON WHILE THAT PERSON IS WORKING IN ANY CAR BUSINESS; OR b. USED IN ANY OTHER BUSINESS OR OCCUPATION. This does not apply to a prirate passellger cor driven or occu- pied by lhe first persall named in lhe declarations. his or her spouse or lheir relatires. Trailer Coverage 1. Trailers designed to be pulled by a private pas- senger CQr or a UliUty vehicle, except those trail- ers in 2a below. are covered while owned or used by an insured. Farm implements and farm wagons are consid- ered trailers while pulled on public roads by a cor we insure for liability. These trailers are not described in the dec1ara- tions and no extra premium is charged. 2. The following trailers are covered only if de- scribed on the declarations page and extra pre- mium is paid: a those trailers designed to be pulled by a pri- rille passenger car or a utility rehicle: (1) if designed to carry persons; or (2) while used with a motor vehicle whose use is shown as "commercial" on the dec- IaratiOIlS page (trailers used only for pleasure use are covered even if not de. scribed and no extra premium paid); or (3) while used as premises for office, store or display purposes; or b. any trailer not designed for use with a private passellger cor or a utility vehicle. 1HERE IS NO COVERAGE WHEN A TRAn.ER IS USED WI1H A MOTOR VEIDCLE OWNED OR HIRED BY YOU WInCH WE 00 NOT IN- SURE FOR LIABILITY COVERAGE. Limits of Liability The amount of bodily injury liability coverage is shown on the declarations page under "Limits of Liability - Coverage A - Bodily Injury, Each Person, Each Accident". Under "Each Person" is the amount of coverage for all damages due to bodily injury to one person. "Bodily injury to one person" includes all injury and damages to others resulting from this bodily injury. Under "Each Accident" is me total amount of coverage, subject to lhe amount shown under "Each Person", for all damages due to bodily injury to tWO or more persons in the same accident. The amount of propeny damage liability coverage is shown on the declarations page under "LimilS of Liability - Coverage A - Propeny Damage, Each Accident". We will pay damages for which an insured is legally liable up to these amounts. The IimilS ofliability are not increased because more than one person or organization may be an insured. A motor vehicle and attached trailer are one vehicle. Therefore, the limits are not increased. When two or more motor vehicles are insured under this section the limits apply separately to each. When Coverage A Does Not Apply In addition to the limitations of coverage in "Who Is an Insured" and "Trailer Coverage": TIiERE IS NO COVERAGE: 1. WHILE ANY VEHICLE INSURED UN- DER lEIS SECTION IS: a. RENTED TO OTHERS. 9 8386 - b. USED TO CARRY PERSONS FOR A CHARGE. This does not apply to lhe use on a share expense basis of: (I) a private fJDSsenger car, or (2) a utility vehicle, if all passengers are riding in that area of lhe vehicle de- signed by the manufacturer of the vehicle for carrying passengers. c. BEING REPAIRED, SERVICED OR USED BY ANY PERSON EMPLOYED OR ENGAGED IN ANY WAY IN A CAR BUSINESS. This does not apply to: (1) you or your spouse; (2) any relative; (3) any resident of your household; or (4) any agent. employee or partner of you, your spouse, any relotive or such resident. This coverage is excess for (3) and (4) above. 2. FOR ANY BODILY INJURY TO: a. A FELLOW EMPLOYEE WHILE ON THE JOB AND ARISING FROM THE MAINTENANCE OR USE OF A VEHI- a..E BY ANOTHER EMPLOYEE IN THE EMPLOYER'S BUSINESS. You and your spouse are covered for such injury to a fellow employee. b. ANY EMPLOYEE OF AN INSURED ARISING OUT OF HIS OR HER EM- PLOYMENT. This does not apply to a household employee who is not covered or required to be covered under any worker's compensation insurance. 3. FOR ANY DAMAGES: a. FOR WHICH THE UNI1ED STATES MIGHT BE LIABLE FOR THE IN- SURED'S USE OF ANY VEHICLE. b. TO PROPERTY OWNED BY, RENTED TO, IN THE CHARGE OFOR 10 8386 ,-, "' ..'~". t_ ',." TRANSPORTED BY AN INSURED. But coverage applies 10 a rented: (1) residence or (2) private garage damaged by a car we insure. 4. FOR ANY OBUGA TION OF AN IN- SURED, OR HIS OR HER INSURER, UN- DER ANY TYPE OF WORKER'S COMPENSATION OR DISABILITY OR SIMILAR LAW. 5. FOR LIABILITY ASSUMED BY THE IN. SURED UNDER ANY CON1RACT OR AGREEMENT. If There Is Other Liability Coverage I. Policies Issued by Us to You, Your Spouse, or Any Relative If two or more vehicle liability coverages pro- vided by us 10 you, your spouse, or any relotive apply to the same accident, the total limits of liability under all such coverages shall not exceed that of the coverage with the highest limit of liability. 2. Other Liability Coverage Available From Other Sources Subjcct to item 1, if other vehicle liability cover- age applies, we are liable only Cor our share oCthe damages. Our share is the per cent that the limit of liability of this policy bears to the total of all vehicle liability coverage applicable to the acci. denL 3. Temporary Substitute Car, Non.Owned Car, Trailer If a temporary substitute car, a non.owned car or a uailer designed for use with a private pas- senger car or utility vehicle has other vehicle liability coverage on it, then this coverage is excess. 4. Newly Acquired Car THIS COVERAGE DOES NOT APPLY IF THERE IS OTHER VEHICLE LIABILITY COVERAGE ON A NEWLY ACQUIRED CAR. Motor Vehicle Compulsory Insurance Law or Fi. nancial Responsibility Law 1. Out-of.State Coverage If an insured under Ibe liability coverage is in anolber state or Canada and, as a non-resident. becomes subject to ilS motor vehicle compulsory insurance, financial responsibility or similar law: a. the policy will be interpreted to give Ibe cov- erage required by Ibe law; and b. the coverage so given replaces any coverage in Ibis policy to Ibe extent required by Ibe law .~~ ~ --, for Ibe insured's operation, mainICnance or use of a car insured under Ibis policy. Any coverage so exICnded shall be reduced to Ibe eXICnt olber coverage applies to Ibe accident. In no event shall a person collect more Iban once. 2. Financial Responsibility Law When certified under any law as proof of future financial responsibility. and while required duro ing the policy period, Ibis policy shall comply wilb such law to Ibe extent required. The insured agrees to repay us for any payment we would not have had to make under the ICnns of this policy except for Ibis agreement. 11 8386 " -", "^-_~~n'~> '- so -', - "'-. ....'"< SECfION n - FIRST PARTY COVERAGES The coverages under this section are provided in accordance with and subject to the Pennsylvania Motor Vehicle Financial Responsibility Act, as amended. MEDICAL PAYMENTS-COVERAGE C2 This coverage applies to the vehi:i;:s for which "C2" appears in the "Coverages" space on the declarations page. What We Pay We will pay for medical expenses for bodily injury to an insured arising out of the maintenance or use of a motor vehicle. Medical expenses - these are expenses incurred for reasonable and necessary medical treaunent and re- habilitation services. This includes expenses for: I. hospital. dental, surgical, psychiatric, psy- chological, osteopathic. ambulance. chiro- practic. nursing and optometric services; 2. licensed physical therapy. vocational reha- bilitation, occupational therapy, speech pa- thology and audiology; 3. medications. medical supplies and prosthetic devices; and 4. nonmedical remedial care and treatment ren. dered in accordance with a recognized relig- ious method of healing. Medical expenses will be paid: 1. ifincurred within 18 months from the date of the accident causing the bodily injury; or 2. without limitation as to time. provided that, within 18 months from the date of the acci- dent causing the bodily injury, it can be de- termined with reasonable medical probability that furlher expenses may be incurred as a result of the bodily injury. The amount we will pay for medical expenses is subject to the limitations of Tilie 75 of the Penn- sylvania Consolidated Statutes. EXTRAORDINARY MEDICAL PAYMENTS- COVERAGE Q This coverage applies to the vehicles for which"Q" appears in the "Coverages" space on the declaratioos page. What We Pay We will pay up to the lifetime aggregate limit of $1,000,000 for those reasonable medical expenses which exceed $100,000. The medical expense must be for bodily injury to an insured caused by accident arising out of the maintenance or use 'of a motor vehicle. Medical expenses - these are expenses incurred for reasonable and necessary medicaltreaunent and re- habilitation services. This includes expenses for: I. hospital, dental. surgical, psychiattic, psy- chological, osteopathic, ambulance, chiro- practic. nursing and optometric services; 2. licensed physical therapy, vocational reha- bilitation, occupational therapy. speech pa- thology and audiology; 3. medications, medical supplies and prosthetic devices; and 4. nonmedical remedial care and treaunent rendered in accordance with a recognized religious method of healing. Medical expenses will be paid: 1. if incurred within 18 months from the date of the accident causing the bodily injury; or 2. without limitation as to time, provided that within 18 months from the date of the acci- dent causing the bodily injury, it can be de- termined with reasonable medical probability that furlher expenses may be incurred as a result of the bodily injury. 12 8386 , The most we will pay in any 12 month period begin- ning 18 months after the date the insured's reason- able medical expenses exceed $100,000 as a result of the bodily injury is $50,000. These expenses must be: 1. for: a. services performed, or b. medical supplies, medication or drugs prescribed by a medical provider licensed by the slate to provide the specific medical services; and 2. for diagnosis, direct care or treatment of the bodily injury. The diagnosis, direct care or trealIIlent must be: a. within the standards of good medical practice,and b. not primarily for the convenience of the patient or medical provider. We have the right to make or obtain an independent review of the medical expenses and services per- formed to determine if they are reasonable and nec- essary for the bodily injury sustained. The amount we will pay for medical expenses is subject to the limitations of Title 75 of the Pennsyl- vania Consolidated S tatotes. REASONABLE MEDICAL EXPENSES DO NOT INCLUDE EXPENSES FOR TREATMENT, SERVICES, PRODUCTS OR PROCEDURES THAT ARE: 1. FOR RESEARCH, OR NOT PRlMARIL Y DESIGNED TO SERVE A MEDICAL OR REHABlLlTATIVE PURPOSE; OR 2. NOT COMMONLY AND CUSTOMAR- II. Y RECOGNIZED TIiROUGHOUT TIlE MEDICAL PROFESSIONS AND WITHIN THE UNITED STATES AS APPROPRl- ATE FOR TIlE 1REA TMENT OF THE BODILY INJURY. ~ ,.,-.-'-' I. ,,",,-.,;, , ...., _~ ~l. LOSS OF INCOME - COVERAGE Z This covelllge applies to the vehicles for which "Z"- with a number beside it appears in the "Coverages" space on the declarations page. ''Z'' with a number beside it is your covCIllge symbol. Check your cov- elllge symbol with the schedule for the limits you have chosen. We will pay income loss benefits with respect to bodily injury to an insured arising out of the maiDle. nance or use of a motor vehlele. Income loss benefits are: 1. 80% of the insured's acwal loss of gross income from work the insured would have performed except for the bodily injury; 2. reasonable expenses acwal1y incurred for: a. hiring a substitute to perform self-em- ployment services to reduce loss of gross income; or b. hiring special help thereby enabling the insured to work and reduce loss of gross income. Income loss benefits do not include: 1. loss of eXpe'.cted income for any period fol- lowing the death of an insured; 2. expenses incurred for services performed fol- lowing the death of an insured; or 3. any loss of income during the first five work- ing days the insured did nOl work after the accident because of the bodily injury. SCHEDULE-COVERAGEZ I Covelllge Maximum Payable Total Maximum Symbol Per Month Benefits ZI $ 1.000 $ 5,000 Z2 1,000 15,000 Z3 1,500 25.000 Z4 2,500 50,000 13 8386 This coverage applies 10 the vehicles for which "F' appears in the "Coverages" space on the declarations page. We will pay for fWleral expenses directly related 10 the funeral, burial, cremation or other fonn of dispo- sition of the remains of an insured. The death must be the result of the accident. The expenses must be incurred within 24 months from the date of the acci. demo Definitions - Coverages C2, Q, Z, Y and F Bodily Injury - means accidental bodily harm 10 a person and that person's resulting illness, disease or death. First Party Benefits - means benefits paid or payable to an insured under Coverages C2, Q, Z, Y or F. Insured - means: 1. you or any relative; 2. any other person: a. occupying your cor or a newly acquired CDr; or b. not occupying a motor vehicle if injured as the result of an accident involving your CDr, or a newly acquired car. A parked and unoccupied motor vehicle is not a motor vehicle involved in the accident unless it was parked so as to cause unrea- sonable risk of injury. Motor Vehicle - means a vehicle which is self-pro- pelled except one which is propelled: 1. solely by human power; or 2. upon rails. 7,500 Relative - means: 5,000 1. your spouse; 14 8386 DEATH, DISMEMBERMENT AND LOSS OF SIGHT - COVERAGE Y This coverage applies to the vehicles for which "Y" with a number beside it appears in the "Coverages" space on the declarations page. "Y" with a number beside it is your coverage symbol. Check your cov- erage symbol with the schedule for the limits you have chosen. We will pay the amount shown in the schedule that applies for death of, or loss 10, an insured arising out of the maintenance or use of a motor vehicle. The death or loss must be the direct result of the accident and not due to any other cause. The death must occur within 24 months from the date of the accident. If the death occurs within 24 hours after the accident, we will pay only the amount that applies to death. Loss must occur within 90 days of the accident. Loss - means the loss of: 1. the foot or hand, cut off through or above the ankle or wrist; or 2. the whole thumb or finger; or 3. all sight. Schedule - Coverage Y Coverage Symbol Yl Y2 S 10,000 S 25,000 Y3 S 5,000 Death Loss of; hands; feet; sight of eyes; one hand & one fOOl; or one hand or one foot & sight of one eye one hand or one foot; or sight of one eye thumb & finger on one hand; or three fingers any two fingers 5,000 10,000 25,000 2,500 5,000 12,500 1,500 1,000 3,000 2,000 _'-,.- "I , - -, -"-- ~. = - - ~"- 1lB..,-_, Payments of Benefits - Coverage Y The death benefit shall be paid 10 the executor.or administrator of the insured's estate. FUNERALBENEnTS-COVERAGEF 2. anyone related to you by blood, marriage or adoption; and 3. a minor in the custody of you, your spouse or a relative resident in your household, even if temporarily resid. ing elsewhere. Limits of Liability - Coverage CZ The amount of coverage for medical expenses is shown on the declarations page under "Limit of Liability - Coverage C2 - Each Person". Limits of Liability - Coverage Z The most we will pay an insured for income loss benefits per month and in the aggregate are shown in the coverage Z schedule next to your coverage sym- bol. Limits of Liability - Coverage Y The amount we will pay because of the death of the insured is shown under your coverage symbol in the Coverage Y schedule. The maximum amount pay. able to an insured for all loss, as shown in the schedule, shall not exceed the death benefit amount shown for your coverage symbol. The amount shown in the schedule for death of or loss to the insured is doubled for an insured who, at the time of the accident, is using the vehicle's complete restraint system as recommended by the vehicle's manufacturer. Limits of Liability - Coverage F The amount of coverage for funeral expenses is shown on the declarations page under "Limit of Liability - Coverage F - &ch Person". Limits of Liability - Coverages CZ, Q, Z, Y and F These coverages are excess over, but shall not dupli. cate, any amount paid or payable to or for the insured under any worker's compensation law. Priorities for the Payment of First Party Benefits J. When more than one policy applies, the person who suffers bodily injury shall recover flTst parry 15 8386 benefItS against applicable insurance coverage in the following order of priority: a. The policy on which the person is a named insured. b. The policy providing coverage because the person is residing in the household of a named insured and is: (1) a spouse or other relative of a named insured; or (2) a minor in the custody of either a named insured or a relative of a named insured. c. The policy covering the motor vehkle occu. pied by the injured person at the time of the accident. II. For a person who is not the occupant of a motor vehicle, the policy on any motor vehi- cle involved in the accident. A parked and unoccupied motor vehicle is not a motor ve. hicle involved in the accident unless it was parked SO as to cause unreasonable risk of injury. 2. TInS POllCY DOES NOT APPLY IF TIiERE IS ANOTIIER POllCY AT A HIGHER PRI- ORITY LEVa. Item a above is considered the highest priority. Item d is the lowest priority. 3. Subject to the above, if an insured is entitled to first party benefllS under more than one cover- age, the maximum recovery under all coverages for any flTst party benefll will not exceed the amount payable under the coverage with the highest limit of liability for thatflTSt party bene- jiL When Coverages C2, Q, Z, Y and F Do Not Apply TIiERE IS NO COVERAGE FOR BODILY IN- JURY: 1. TO ANY PERSON WHOSE CONDucr CONTRIBUTED TO InS OR HER BOD. iLY INJURY IN ANY OF THE FOU.OW. INGWAYS: a. WHILE INIENTIONAllY INJURING OR A TI'EMPTING TO INJURE HIM- SELF. HERSELF OR ANOTHER; b. WHn..E COMr.mTING A FELONY; OR c. WHILE SEEKING TO ELUDE LAW- FUL APPREHENSION OR ARREST BY A LAW ENFORCEMENT om- CIAL. 2. TO ANY PERSON WHO KNOWINGLY CONVERTS A MOTOR VEHICLE if the bodily injury arises out of the maintenance or use of the convened vehicle. This does not apply to you or any relative. 3. TO ANY PERSON WHO OWNS A CUR- RENTI. Y REGISTERED MOTOR VEHI- CLE AND DOES NOT HAVE THE REQUIRED FINANCIAL RESPONSmn.. ITY, EVEN IF THAT PERSON IS OCCU- PYING OR STRUCK BY A MOTOR VEHICLE FOR WHICH FINANCIAL RE- SPONSmn.ITY IS PROVIDED. This does not apply to you or your spouse while occu- pying a vehicle insured under the liability coverage of this policy or when srruck as a pedesttian. 4. TO ANY PERSON WHll.E OPERATING OR OCCUPYING: a. A RECREATIONAL VEHICLE NOT INTENDED FOR mGHW A Y USE; OR b. A MOTORCYCLE. MOTOR-DRIVEN CYCLE, MOTORIZED PEDALCYCLE ORUKE TYPE VEHICLE REQUIRED TO BE REGISTERED UNDER TITLE 75 OF THE PENNSYLVANIA CON- SOLIDA1ED STATUTES. Mental or Physical Examination Whenever the mental or physical condition of a per- son is material to any claim for medical expenses or income loss benefits. a court of competent jurisdic- tion may order the person to submit to mental or physical examination by a physician. If a person fails to comply with the order. the court may order 16 8386 , ,',"'~ l;','"-,--' ,,'. "-"-, ~, . ",f"'" that the person be denied benefits until he or she complies. COMBINED BENEFlTS - COVERAGE M- 'This coverage applies to the vehicles for which "M" appears in the "Coverages" space on the declarations page. What We Pay We will pay for bodily injury to an insured arising out of the maintenance or use of a motor vehil:u: 1. Medical expenses as payable under Coverage C2; 2. Income loss benefits as payable under Cover- age Z; 3. The benefits as payable under Coverage Y3; and 4. Funeral expenses as payable under Coverage F. Limits of Liability 1. The aggregate limit ofliability is shown on the declarations page under "Limit of Liability - Coverage M - Each Person". This is the maxi- mum amount payable for bodily injury to an insured as the result of an accidenL 2. The most we will pay to or for an insured is as follows: Benefit Medical Expenses Limit Up to the Aggregate Limit Up to the Aggregate Limit $25,000 Up to $2,500 Income Loss Death Funeral Expenses ,-' 3. Any amount payable for medical expenses greater than S 100,000 shall be excess over any amount paid or payable under Extraordinary Medical Payments - Coverage Q. Time Limitation Subject 10 the limit of liability: 1. benefits are only payable for expenses and ""~- -',-.' - -~ ," ,"'--", -- loss incurred up 10 three years from the date of the accidenL 2. the death benefit is payable only if death occurs within three years of the date of the accident. Other Provisions Except as amended above, 3ll provisions relating 10 Coverages C2, Z, Y and F apply 10 expense, loss or death benefits of Coverage M. 17 8386 - '--"'. .-'';-'> ,', c . b-'l. SECTION Ill- UNINSURED MOTOR VEHICLE AND UNDERINSURED MOTOR VEHICLE COVERAGES UNINSURED MOTOR VEHICLE - COVERA:!GES U (STACKING OPTION) AND U3 (NON.ST ACKING OPTION) Uninsured Motor Vehicle - Coverage U applies 10 the vehicleS for which "U" appears in the "Cover- ages" space on the declarations page. Uninsured Motor Vehicle -Coverage U3 applies to the vehicles for which "U3" appears in the "Cover- ages" space on the declarations page. Coverages U and U3 We will pay damages for bodily injury an insured is legally entitled to collect from the owner or driver of an uninsured motor vehicle. The bodily injury must be sustained by an insured and caused by accident arising out of the ownership, maintenance or use of an uninsured motor vehicle. The amount we will pay for damages is subject to the limitations of Title 75 of the Pennsylvania Consoli- dated Statutes. Uninsured Motor Vehicle - means: 1. a land motor vehicle, the ownership, mainte. nance or use of which is: a. not insured or bonded for bodily injury liability at the time of the accident; or b. insured or bonded for bodily injury liabil- ity at the time of the accident; but (1) the limits of liability are less than required by the fmancial responsibil- ity act of the state where your ClJr is mainly garaged; or (2) the insuring company denies cover- age or is or becomes insolvent; or 2. an unidentified land motor vehicle whose owner or driver remains unknown and causes bodily injury to the insured. An uninsured motor vehicle does not include a land motor vehicle: 1. insured Wlder the liability coverage of this policy; 2. furnished for the regular use of you, your spouse or any relative; 3. owned or operated by a self-insurer under any motor vehicle financial responsibility law, a motor carrier law or any similar law; 4. owned by any government or any of its politi. cal subdivisions or agencies; S. designed for use mainly off public roads ex- cept while on public roads; or 6. while located for use as a dwelling or other premises. UNDERINSURED MOTOR VEHICLE - COVERAGES W (STACKING OPTION) AND W3 (NON-STACKING OPTION) Underinsured Motor Vehicle - Coverage W applies to the vehicles for which "W" appears in the "Cov- erages" space on the declarations page. Underinsured Motor Vehicle - Coverage W3 applies to the vehicles for which "W3" appears in the....Cov- erages" space on the declarations page. Coverages Wand W3 We will pay damages for bodily injury an insured il- legally entitled to collect from the owner or driver of an underinsured motor vehicle. The bodily injUl') must be sustained by an insured and caused by acci, dent arising out of lhe ownership, maintenance or USl: of an underinsured motor vehicle. The amount we will pay for damages is subject to th( limitations of Title 75 of the Pennsylvania Conso\i. dated Statutes. THERE IS NO COVERAGE FOR BODILY IN JURY ARISING OUT OF TIiE OWNERSHIP MAINTENANCE OR USE OF AN UNDERlN SURED MOTOR VEHICLE UNTll.: 18 8386 . 1. THE LIMITS OF LIABILITY OF ALl BODILY INJURY LIABILITY BONDS AND POLICIES THAT APPLY HAVE BEEN USED UP BYPA YMENTOFJUDG- MENTS OR SETTI..EMENTS TO OTHER PERSONS; OR 2. SUCH LIMITS OF LIABILITY OR RE- MAINING PART OF THEM HAVE BEEN OFFERED TO TI!E INSURED IN WRIT. ING. Underinsured Motor Vehicle - means a land motor vehicle: I. the ownership, maintenance or use of which is insured or bonded for bodily injury liability at the time of the accident; and 2. whose limits of liability for bodily injury liability: a. are less than the amount of the insured's damages; or b. have been reduced by payments to per- sons other than the insured to less than the amount of the insured's damages. An underinsured motor ~'ehicle does not include a land motor vehicle: 1. insured under the liability coverage of this policy; 2. furnished for the regular use of you, your spouse or any relative; 3. owned by any government or any of its politi. cal subdivisions or agencies; 4. while located for use as a dwelling or other premises; 5. designed for use mainly off public roads ex- cept while on public roads; or 6. defined as an uninsured motor vehicle in your policy. Who Is an Insured - Coverages U, U3, Wand W3 Insured - means the person or persons covered by uninsured motor vehicle or underinsured motor vehi- cle coverage. This is: 1. the first person named in the declarations; 2. his or her spouse; 3. their relatives; and 4. any other person while occupying: a. your car, a temporary substiJute car, a newly acquired car, or a lrailer attached to such a car. Such vehicle has to be used within the scope of the consent of you or your spouse; or b. a car not owned by you, your spouse or any relative, or a trailer attached to such a car. It has to be driven by the fllSt person named in the declarations or that person's spouse and within the scope of the owner's consenL Such other person occupying a vehicle used to carry persons for a charge is not an in- sured. 5. any person entitled to recover damages be- cause of bodily injury to an insured under I through 4 above. Deciding Fault and Amount - Coverages U, U3, Wand W3 Two questions must be decided by agreement be- tween the insured and us: 1. Is the insured legally entitled to collect com- pensatory damages from the owner or driver of an uninsured motor vehicle or underin- sured motor vehicle; and 2. If so, in what amount? If there is no agreement, these two questions shall be decided by arbitration at the request of the insured or us. The arbitrators' decision shall be limited to these two questions. The arbitrators shall not award dam. ages under this policy which are in excess of the limits of liability of this coverage as shown on the declarations page. The Pennsylvania Uniform Arbi- tration Act, as amended from time to time, shall apply. 19 8386 . Each party shall select a competent arbitrator. These two shall select a competent and impartial third arbi- trator. If unable to agree on a third one within 30 days, either party may request a judge of a court of record in the county in which the arbitration is pending to select a third one. The written decision of any two arbilllltOrS shall be binding on each party. The cost of the arbiualOr and any expen willless shall be paid by the party who hired them. The cost of the third ;I1'bitrator and other expenses of ;I1'biuation shall be shared equally by both panies. The arbitration shall take place in the county in which the insured resides unless the panies agree to another place. We have the right to obtain statements under oath from the insured, Payment or Any Amount Due - Coverages U, U3, W aDd W3 We will pay any amount due: 1. lO the insured; 2. to a parent or guardian if the insured is a minor or an incompetent person; 3. to the surviving spouse; or 4. to a person authorized by law to receive such paymenL Trust Agreement - Coverages U and U3 1. We are entitled to repayment of the amount we have paid from the proceeds of any recovery the insured makes from any party liable for the bod. ily injury. 2. If the insured has not recovered from the party at fault, he or she shall: a. keep these rights in trust for us; b. execute any legal papers we need; and c. when we ask, take action through our repre- sentative to recover our payments. We are to be repaid our payments, costs and fees of collection out of any recovery. Trust Agreement - Coverages Wand W3 1. We are entitled, lO the extent of our payments, IP the proceeds of any setllement the insured recov- ers from any party liable for the bodily injury, other than payments from bodily injury liability bonds or policies made prior to our paymenL 2. If the insured has not been fully compensated for the bodily injury by the party at feult and we make payment for the bodily injury, the insured shall: a. keep these rights in trust for us; b. execute any legal papers we need; and c. when we ask. take action through our repre- sentative to recover the amount of our pay- ments. . We are to be repaid our payments, COSts and fees of collection out of any such recovery. Limits or Liability - Coverages U and U3 1. The amount of coverage is shown on the decla- rations page under "Limits of Liability - U - Each Person, Each Accident" or "Limits of Li- ability - U3 - Each Person, Each Accident". Under "Each Person" is the amount of coverage for all damages due lO bodily injury to one per- son. "Bodily injury to one person" includes all injury and damages to others resulting from this bodily injury. Under "Each Accident" is the total amount of coverage, subject to the amount shown under "Each Person", for all damages due to bodily injury to two or more persons in the same accidenL 2. Any payment made to a person under this cov- erage shall reduce any amount payable to that person under the bodily injury liability cover- age. 3. The limits of liability are not increased because: a. more than one person is insured.at the time of the accident; or b. more than one uninsured motor vehicle is involved in the same accidenL 20 8386 a-..- ,', ",--, 4. Any amount payable under this coverage shall be reduced by any amount paid or payable to or for the insured: a. by or for any person or organization who is or may be held legally liable for the bodily injury to the insured; or b. for the bodily injury under the liability cov- erage. 5. This coverage shall be excess over and shal1 not pay again any amount paid or payable lO or for the insured under any worker's compensation, disability benefits or similar law. Limits or Liability - Coverage U3 The limits of liability are not increased because more than one vehicle is insured under this policy. Limits of Liability - Coverages Wand W3 1. The amount of coverage is shown on the decla- rations page under "Limits of Liability - W - Each Person, Each Accident" or "Limits of Li- ability - W3 - Each Person, Each Accident". Under "Each Person" is the amount of coverage for all damages due to bodily injury to one per- son. "Bodily injury to one person" includes all injury and damages to others resulting from this bodily injury. Under "Each Accident"is the total amount of coverage, subject to the amountshown Wlder "Each Person", for all damages due to bodily injury to twO or more persons in the same accidenL 2. The limits of liability are not increased because: a. more than one person is insured at the time of the accident; or b. more than one underinsured motorvehic1e is involved in the same accidenL 3. The most we pay will be the lesser of: a. the difference between the amount of the insured's damages for bodily injury, and the amount paid to the insured by or for any person or organization who is or may be held legally liable for the bodily injury; or b. the limits of liability of this coverage. " ..1,'" 4. This coverage shall be excess over and shall not pay again any amount paid or payable to or{or Ihe insured under any worker's compensation, disability benefits or similar law. Limits or Liability - Coverage W3 The limits ofliability are not increased because more than one vehicle is insured under this policy. When CoveragesU, U3, Wand W3 Do Not Apply THERE IS NO COVERAGE UNDER COVER- AGES U, U3, WAND W3: 1. FOR ANY INSURED WHO, WITHOUT OUR WRITTEN CONSENT, SETILES WITH ANY PERSON OR ORGANIZA- TION WHO MAY BE LIABLE FOR THE BODILY INJURY AND THEREBY IM- PAIRS OUR RIGHT TO RECOVER OUR PAYMENTS. 2. TO THE EXTENT IT BENmTS: a. ANY WORKER'S COMPENSATION OR DISABILITY BENEmS INSUR- ANCE COMPANY. b. A SELF-INSURER UNDER ANY WORKER'S COMPENSATION, OR DISABILITY BENEFITS OR SIMILAR LAW. 3. FOR PAIN, SUFFERING OR OTHER NONMONETARY DAMAGES SUS- TAINED BY AN INSURED IF THE BOD- ILY lNJURYIS NOT A SERIOUS INJURY AND THE LIMITATION OF SECTION 173I(d)(2) OF 1Tl1.E 75 OF THE PENN- SYLVANIA CONSOLIDATED STAT- U1ES APPLIES. THERE IS NO COVERAGE FOR BODILY IN- JURY TO AN INSURED UNDER COVERAGE U3: 1. WHILE OCCUPYING A MOTOR VEIn- ell OWNED BY YOU, YOUR SPOUSE OR ANY RELATIVE IF IT IS NOT IN- SURED FOR TInS COVERAGE UNDER TInS POLICY; OR 21 8386 -- -"'^ > 2. TIIROUGH BEING SmUCK BY A MO- TOR VEHICLE OWNED BY YOU, YOUR SPOUSE OR ANY RELATWE. THERE IS NO COVERAGE FOR BODILY IN. JURY TO AN INSURED UNDER. COVERAGE W3: I. WHll..E OCCUPYING A MOTOR VEID- CLE OWNED BY rOll, YOUR SPOUSE OR ANY RELATWE IF IT IS NOT IN- SURED FOR TInS COVERAGE UNDER TInS POLICY; OR 2. TIIROUGH BEING smUCK BY A MO- TOR VEHICLE OWNED BY YOU, YOUR SPOUSE OR ANY RELATWE. Ir There Is Other Coverage - Coverage U If the insured sustains bodily injury: I. while occupying your ClU' and your car is described on the declarations page of another policy providing uninsured motor vehicle coverage, or as a pedestrian, we are liable only for our share. Our share is that per cent of the damages that the limit ofliability of this coverage bears to the total of all uninsured motor vehicle coverage that applies to the accidenL 2. while occupying a vehicle which is not your ClU', this coverage applies as excess to any other uninsured motor vehicle coverage. If coverage under more than one policy ap- plies as excess, we are liable only for our share. Our share is that per cent of the dam- ages that the limit of liability of this coverage bears to the total of all uninsured motor vehi- cle coverage applicable as excess to the acci- dent. Ir There Is Other Coverage - Coverage U3 1. If the insured sustains bodily injury as a pedes- trian and other uninsured motor vehicle coverage applies: a. the total limits of liability under all such coverages shall not exceed that of the cover- age with the highest limit of liability; and ,- ~ "~-'-=,E",.i.,-,~-~." .",.- 'ie:, b. we are liable only for our share. Our share is that per cent of the damages that the limit of liability of this coverage bears to the total of all uninsured motor vehicle coverage appli- cable to the accidenL 2. If the insured sustains bodily injury while occu. pying your car, and your ClU' is described on the declarations page of another policy providing uninsured motor vehicle coverage: a. the total limits of liability under all such coverages shall not exceed that of the cover- age with the highest limit of liability; and b. we are liable only for our share. Our share is that per cent of the damages that the limit of liability of this coverage bears to the total of all such uninsured motor vehicle coverage applicable to the accidenL 3. If the insured sustains bodily injury while occu- pying a vehicle not owned by you, your spouse or any relative, and: a. such vehicle is described on the declarations page of another policy providing uninsured motor vehicle coverage, or b. its driver, other than you, your spouse or any relative, is an insured under another policy, this coverage applies: a. as excess to any uninsured motor vehicle coverage which applies to the vehicle or driver, but b. only in the amount by which it exceeds the primary coverage. If coverage under more than one policy applies as excess: a. the total limit of liability shall not exceed the difference between the limit ofliability of the coverage that applies as primary and the high- est limit of liability of anyone of the cover- ages that apply as excess; and b. we are liable only for our share. Our share is that per cent of the damages that the limit of liability of ll!is coverage bears to the total of 22 8386 all uninsured motor vehicle coverage appli- cable as excess to the accidenL 4. If the insured sustains bodily injury while occu- pying a vehicle DOt owned by lOU, your spouse or any rellltive, and: a. such vehicle is not described on the declara- tions page of another policy providing unin- sured motor vehicle coverage; and b. its driver is: (I) you, your spouse or any rellltive; or (2) any other person not insured under an- other such policy. then: a. the total limits ofliability under all applicable policies issued by us shall not exceed that of the one with the highest limit of liability; and b. we are liable only for our share. Our share is that per cent of the damages that the limit of liability of this coverage bears lO the total of all uninsured motor vehicle coverage appli- cable to the accidenL ' 5. TInS COVERAGE DOES NOT APPLY IF TIiEREIS OTIiER UNINSURED MOTOR VE- HICLE COVERAGE ON A NEWLY AC- QUIRED CAR. HThere Is Other Coverage - Coverage W If the insured sustains bodily injury: I. while occupying your car and your car is described on the declarations page of another policy providing underinsured motor vehicle coverage. or as a pedestrian. we are liable only for our share. Our share is that percent of the damages that the limit of liability of this coverage bears lO the total of all underinsured motor vehicle coverage that applies to the accidenL 2. while occupying a vehicle which is not your car, this coverage applies as excess to any other underinsured motor vehicle coverage. If coverage under more than one policy ap- plies as excess, we are liable only for our 23 8386 share. Our share is that per cent of the dam- ages that the limit of liability of this coverage bears to the total of all underinsured motor vehicle coverage applicable as excess to the accidenL H There Is Other Coverage - Coverage W3 1. If the insured sustains bodily injury as a pedes- trian and other underinsured motor vehicle cov- erage applies: a. the total limits of liability under all such coverages shall not exceed that of the cover- age with the highest limit of liability; and b. we are liable only for our share. Our share is that per cent of the damages that the limit of liability of this coverage bears to the total of all underinsured motor vehicle coverage ap- plicable to the accidenL 2. If the insured sustains bodily injury while occu- pying lOur car, and your car is described on the declarations page of another policy providing underinsured motor vehicle coverage: a. the total limits of liability under all such coverages shall not exceed that of the cover. age with the highest limit of liability; and b. we are liable only for our share. Our share is that per cent of the damages that the limit of liability of this coverage bears lO the total of all such underinsured motor vehicle coverage applicable to the accidenL 3. If the insured sustains bodily injury while occu- pying a vehicle not owned by you, your spouse or any relative, and: a. such vehicle is described on the declarations page of another policy providing underin- sured motor vehicle coverage, or b. its driver. other than you, your spouse or any rellltive, is an insured under another policy, this, coverage applies: a. as excess to any underinsured motor vehicle coverage which applies to the vehicle or driver, but b. only in the amount by which it exceeds the primary coverage. If coverage under more than one policy applies as excess: a. the total limit of liability shall not exceed the difference between the limit of liability of the coverage that applies as primary and the high- est limit of liability of anyone of the cover- ages that apply as excess; and b. we are liable only for our share. Our share is that per cent of the damages that the limit of liability of this coverage bears to the total of all underinsured mOlOr vehicle coverage ap- , plicable as excess to the accidenL 4. If the insured sustains bodUy injury while occu- pying a vehicle not owned by you, your spouse or any relalive, and: a. such vehicle is not described on the declara- tions page of another policy providing under- insured motor vehicle coverage; and b. its driver is: (I) you, your spouse or any relative; or (2) any other person not insured under an- other such policy, ~-c~_-_, ',,,":,, < ", -co " __;.. 'J- then: a. the total limits ofliability under all applicable policies issued by us shall not exceed that of the one with the highest limit of liability; and b. we are liable only for our share. Our share is that per cent of the damages that the limit of liability of this coverage bears to the total of all underinsured motor vehicle coverage ap- plicable to the accidenL 5. THIS COVERAGE OOES NOT APPLY IF TIiERE IS OTHER UNDERINSURED MO- TOR VEHICLE COVERAGE ON A NEWLY ACQUIRED CAR. Consent to Be Bound - Coverages U, U3, Wand W3 Any judgmeni for damages arising out of a suit brought without our written consent is not binding on us unless we: 1. receive reasonable notice of the pendency of the suit resulting in the judgment: and 2. have a reasonable opponunity to protect our interest in the SuiL 24 8386 -"-,-" . ~ "'"El.c SECTION IV - PHYSICAL DAMAGE COVERAGES Loss - means, when used in this section, each dircct and accidental loss of or damage to: I. your ClU; 2. its equipment; or 3. clothes and luggage insured. Equipment means equipment common to the use of the motor vehicle as a vehicle. It also includcs a detachable living quarters unit if you told us about it before the loss and paid any extra premium needed. COMPREHENSIVE - COVERAGE D. This coverage applies to the vehicles for which "D" appears in the "Coverages" space on the declara- tions page. If a deductible applies the amount is shown on the declarations page for the vehicle to which it applies. I. Loss to Your Car. We will pay for loss to your car EXCEPT LOSS BY COLUSlON but only for the amount of each such loss in excess of the deductible amount, if any. Breakage of glass, or loss caused by missiles, falling objects, fue, theft, larceny, explosion, earthquake, windstorm, hail, water, flood, malicious mischief or vandalism, riot or civil commotion, is payable under this coverage. Loss due to hitting or being hit by a bird or an animal is payable under this coverage. 2. We will repay you for transportation costs if your car is slOlen. We will pay upto$16per day for the period that begins 48 hours after you tell us of the theft. The pcriod ends when we offer to pay for the loss. COLLISION - COVERAGE G. This coverage applies to the vehicles for which "0" appears in the "Coverages" space on the declarations page. The deductible amount is shown on the declarations page for the vehicle to which it applies. We will pay for loss to your COT caused by collision but only for the amount of each such loss in excess of the deductible amount. Collision - means your car upset or hit or was hit by a vehicle or other object. Clothes and Luggage - Comprehensive and Collision Coverages We will pay for loss to clothes and luggage owned by thc first person named in the dec1arations. his or her spouse, and their relatives. These items have to be in or on your car. Your car has to be covered undcr this policy for: I. Comprehensive, and the loss caused by rm:, lightning, flood, falling objects, explosion, earthquake or theft. If the loss is due to theft, YOUR ENTIRE CAR MUST HAVE BEEN STOLEN; or 2. Collision, and the loss caused by collision. We will pay up to S200 for loss to clothes and luggage in excess of any deductible amount shown for com- prehcnsive or collision. S200 is the most we will pay in anyone occurrence even though more than one persoll has a loss. This coverage is excess over any othcr coverage. Limit of Liabilit), - Comprehensive and Collision Coverages The limit of our liability for loss to propeny or any pan of it is the lower of: I. thc actual cash value; or 2. the cost of repair or replacement. Actual cash value is determined by the market value, age and condition at the time the loss occurred. Any dcductiblc amount that applies is then subtracted. The cost of repair or replacement is based upon one of the following: 1. the cost of repair or replacement agreed upon by you and us; 2. a compctitive bid approved by us; or 3. an estimalC wriuen based upon the prevailing compctitive price. The prevailing competi- tive price means prices charged by a majority 25 8386 of the repair market in the area where the car is to be repaired as determined by a survey made by us. If you ask, we will identify some facilities that will perform the repairs at the prevailing competitive price. We will in- clude in the estimate parts sufficient to restore the vehicle to its pre-loss condition. Any deductible amount that applies is then sub- tracted. Settlement or Loss - Comprehensive and Collision Coverages We have the right to settle a loss with you or the owner of the propeny in one of the following ways: 1. pay the agreed upon actual cash value of the propeny at the time of the loss in exchange for the damaged propeny. If the owner and we cannot agree on the actual cash value, either party may demand an appraisal as de- scribed below. If the owner keeps the dam- aged propeny, we will deduct its value after the loss from our paymenL The damaged propeny cannot be abandoned to us; 2. pay to: a. repair the damaged propeny or part, or b. replace the propeny or part. If the repair or replacement results in better. ment, you must pay for the amount of better- ment; or 3. return the stolen propeny and pay for any damage due to the theft. Appraisal under item 1 above shall be conducted according to the following procedure. Each party shall select an appraiser. These two shall select a third appraiser. The written dccision of any twO appraisers shall be binding. The cost of the appraiser shall be paid by the party who hired him or her. The cost of the third appraiser and other appraisal expenses shall be shared equally by both parties. We do not waive any of our rights by agreeing to an appraisal. If you give us your consent, we may move the damaged prop- erty, at our expense, to reduce storage costs dur- 26 8386 -'--'6' ing the appraisal process. If you do not give us your consent, we will pay only the storage costs which would have resulted if we had moved tfie damaged propeny. The Settlement of Loss provision for comprehensive and collision coverages incorporates the Limit of Liability provision of those coverages. If we can pay the loss under either comprehensive or collision, we will pay under the coverage where you collect the most. When there is loss to your car, clothes and luggage in the same occurrence, any deductible will be ap- plied first to the loss to your car. You pay only one deductible. EMERGENCY ROAD SERVICE - COVER. AGE H. This coverage applies to the vehicles for which "H" appears in the "Coverages" space on the declarations page. We will pay the fair cost you incur for your car for: 1. mechanical labor up to one hour at the place of its breakdown; 2. towing to the nearest place where the neces- sary repairs can be made during regular busi- ness hours if it will not run; 3. towing it out if it is stuck on or immediately next to a public highway; 4. delivery of gas, oil, loaned battery, or change of tire. WE DO NOTPA Y FOR THE COST OF THESE ITEMS. CAR REl\'TAL EXPENSE - COVERAGE R. This coverage applies to the vehicles for which "R" appears in the "Coverages" space on the declarations page. We will repay you up to $10 per day when you rent a car from a car rental agency or garage due to a loss to your car which would be payable under coverage D or G. starting: 1. when it cannot run due to the loss; or 2. if it can run, when you leave it at the shop for agreed repairs; and ending when: I. it has been repaired or replaced, or 2. we offer to pay for the loss, or 3. you incur 30 days rent, whichever comes flCSt. Any car rent payable under coverage R is RE- DUCED TO THE EXTENT IT IS PA Y ABLE UN- DER COMPREHENSIVE. CAR RENTAL AND TRAVEL EXPENSES - COVERAGE Rl. Th.is coverage applies to the ve- hicles for which "R I" appears in thc "Coverages" space on the declarations page. 1. Car Rental Expense. We will: a. repay you up to $16 per day when you rent a e/ll' from a car rental agency or garage; or b. pay you $10 per day if you do not rent a (/U' while your ear is not usable due to a loss to your car which would bc payable under coverage D or G. This applies during a period starting: a. when your (/U' cannot run due to the loss; or b. if your (/U' can run, when you leave it at the shop for agreed repairs; and ending: a. when it has been repaired or replaced. or b. (I) when we offcr to pay for the loss, if your car is repairable, or (2) five days after we offer to pay for the loss, if: (a) your C/U' was stolen and not re- covered, or (b) we declarc it a total loss, whichever comes firsL "' '- - -'. ,--,'~" - ,I""~, -- ~-< - ,;;"" Any car rent payable under this coverage is REDUCED TO THE EXTENT IT IS PAY- ABLE UNDER COMPREHENSIVE. 2. Travel Expenses. If your ear cannOl cun due to a loss which would be payable under cov- erage D or G more than 50 miles from home, we will repay you for expenses incurred by you, your spouse and any relative for: a. Commcrcial transportation fares to con- tinue to your destination or home. b. Extra meals and lodging needed when the loss to your car causes a delay enroule. The expenses must be incurred between the time of the loss and your arrival at your destination or home or by the end of the fifth day, whichever occurs first c. Meals. lodging and commercial transpor- tation fares incurred by you or a person you choose to drive your car from the place of repair to your destination or home. 3. Rental Car - Repayment of Deductible Amount Expense. We will repay the ex- pcnse of any deductible amount you are reo quired to pay thc owner under comprehensive or collision coverage in cffect on a substitute car rented from a car rcntal agency or garage. Total Amount of Expenses Payable - Coverage Rl I. The most we will pay for the total of the "Car Rental Expense" and "Rental Car - Repayment of Deductible Amount Expense" incurred in any one occurrence is 5400. 2. The most we will pay for "Travel Expenses" incurred by all persons in anyone occurrence is S4oo. CAR RENTAL AND TRAVEL EXPENSES - COVERAGE RS. This coverage applies to the ve- hicles for which "R5" appears in the "Coverages" space on the declarations page. I. Car Rental Expense. a. We will: 27 8386 (1) pay 80% of the rental charge when you ren t a car from a car rental agency or garage. ''Rental cb;l1'ge" means the daily rental rate plus charges for mileage and related taxes; or (2) pay you $ 1 0 per day if you do not rent a car while your car is not drivable due to a loss to your car which would be payable under coverage D or G. b. Payment will be made for a period that (1) starts: (a) when your car is not drivable due to the loss; or (b) if your car is drivable, when you leave it at the shop for agreed repairs; and (2) ends: (a) when your car has been repaired or replaced; or (b) when we offer to pay for the loss, if your car is repairable but you choose to delay repairs; or (c) five days after we offer to pay for the loss if: (i) your car was stolen and not recovered; or (ii) we declare that your car is a total loss; whichever comes flCSL Any car rent payable under this coverage is REDUCED TO THE EXTENT THAT PA YMENTIS MADE UNDER COMPRE- HENSIVE COVERAGE. 2. Travel Expenses. If your car is not drivable due to aloss which occurs more than 50 miles from home and which would be payable un- der coverage D or G, we will pay you for expenses incurred by you, your spouse and any rel4tive for: ~.. .1---. - - - , '.',- - ,,~ ;';""" '." .r..: ,- a. commercial transportation fares to con- tinue to your destination or home; b. extra meals and lodging needed when the loss to your car causes a delay enroute. The expenses must be incurred between the time of the loss and your arrival at your destination or home or by the end of the fifth day, whichever occurs flCSt; and c. meals, lodging and commercial transpor- tation fares incurred by you or a person you choose to drive your car from the place of repair to your destination ar home. 3. Rental Car - Repayment or Deductible Amount Expense. We will pay the expense of any deductible amount you are required to pay the owner under comprehensive or colli- sion coverage in effect on a substitute car rented from a car rental agency or garage. Total AmountorExpenses Payable- Coverage R5 I. The most we will pay for "Car Rental Expense" incurred in anyone occurrence is $500. 2. The most we will pay for "Travel Expenses" incurred by all persons in anyone occurrence is $400. 3. The most we will pay for ''Rental Car - Repay- ment of Deductible Amount Expense" incurred in anyone occurrence is $400. Trailer Coverage 1, Owned Trailer Your trailer is covered: a. when it is described on the dec1arations page of the policy; and b. for the coverages shown as applying lO iL 2. Non-Owned Trailer or Detachable Living Quarters Any physical damage coverage in force on your car applies to a non-owned: a. trailer, if it is designed for use with a private passenger car, or 28 8386 c b. detachabb living quarters unit used by the first person named in the declara- tions, his or ler spouse or their relatives. The most wewill pay under the comprehensive or collision :overage for a loss to such non- owned traileror unit is $500. A non-owned trailer or detachable living qUarters lDIit is one tha: a. is not OWJl:d by or registered in the name of: (1) you, Jlur spouse, any relative; (2) any c.f1er person residing in the same house'old as you, your spouse or any relatip.; or (3) an elllloyer of you, your spouse or any relati\!; and b. has not \::en used or rented by or in the possessiol of you, your spouse or any rela. tive duringany part of each of the last 21 or more comeculive days. The 21 day limit is multiplied by the number of vehicles de- scribed or. the declarations pages of all car policies is;ued by us under which you are insured; ard c. is not renttd and used in connection with the employme,t or business of you, your spouse or any relaive. Coverage ror the Use or Other Cars The coverages in Ibis section you have on your car extend to aloss to anewly acquired car, a temporary substitute car or a IIOn.owned car. These coverages extend to a non-owJed car while it is driven by or in the custody of an ilSured. Insured - as used h this provision means: 1. the flTSt penon named in the declarations; 2. his or her sJOuse; or 3. their relativls. When Coverages D, G, H, R, Rl and RS Do Not Apply THERE IS NO COVERAGE FOR: 1. A NON.OWNED CAR: "~ '~'"- -- a. IF THE DECLARATIONS STATE THE "USE" OF ALL OF YOUR CARS IS OTHER TIlAN PLEASURE AND BUSINESS; b. WHILE BEING REPAIRED, SER- VICED OR USED BY ANY PERSON WHILE THAT PERSON IS WORKING IN ANY CAR BUSINESS; OR c. WHILE USED IN ANY OTIlER BUSI- NESS OR OCCUPATION. This does not apply to a private passenger car driven or occupied by the first person named in the declarations, his or her spouse or their relatives. 2. ANY VEHICLE WHILE: a. RENTED TO OTIIERS; b. USED TO CARRY PERSONS FOR A CHARGE. This does not apply to the use on a share expense basis; OR c. SUBJEcr TO ANY LIEN, LEASE OR SALES AGREEMENT NOT SHOWN IN THE DECLARATIONS. 3. LOSS TO ANY VEHICLE DUE TO: a. TAKING BY ANY GOVERNMENTAL AUTHORITY; b. WAR OF ANY KIND; c. AND LIMITED TO WEAR AND TEAR, FREEZING, MECHANICAL OR ELECTRICAL BREAKDOWN OR FAll.URE. This does not apply when the loss is the result of a theft covered by this policy. Nor does it apply to emergency road service: OR d. CONVERSION, EMBEZZLEMENT OR SECRETION BY ANY PERSON WHO HAS THE VEHICLE DUE TO ANY LIEN, RENTAL OR SALES AGREEMENT. 4. TIRES unless: a. stolen, or damaged by fife or vandalism; or 29 8386 b. other loss covered by this section happens at the same time. 5. TAPES OR DISCS FOR RECORDING OR REPRODUCING SOUND. 6. ANY RADAR DETECTOR. If Thefe Is Other Coverage 1. Policies Issued by Usto You If twO or more vehicle coverages provided by us lO you apply to the same loss or occurrence, we will pay under the coverage with the highest limiL 2. Coverage Available From Other Sources Subject to item I, if other coverage applies to the loss or expenses, we will pay only our share. Our share is that per cent the limit of liability of this policy bears lO the total of all coverage that applies. L-'" ,i --..w ~{- " ;.,.. '. ~ '. _0' ?~'~ 3. Temporary Substitute Car, 'Ion-Owned Car or Trailer If a tempol'tlry substitute car,a non-owned car or trailer designed for use witl1a private passen- ger car has other coverage on.t, then this cover- age is excess. 4. Newly Acquired Car TIIIS INSURANCE DOES NOT APPLY IF THERE IS SIMILAR C07ERAGE ON A NEWLY ACQUIRED CAR. No Benefit to Bailee These coverages shall not benefiuny carrier or other bailee for hire liable for loss. Two or More Vehicles If two or more of your cars are iJSU1'ed for the same coverage, the coverage applies sq:Jarlltely to each. 30 8386 ," , -,., CONDITIONS 1. Policy Changes b. under the liability coverage, until the amount a. Policy Terms, The terms of this policy may of damages an insured is legally liable lO pay be changed or waived only by: has been finally determined by: (1) an endorsement signed by one of our (I) judgment after actual trial, and appeal if executive officers; or any; or (2) the revision of this, policy form to give (2) agreement between the insured, the broader coverage without an extra claimant and us. charge. If any coverage you carry is Bankruptcy or insolvency of the insured or changed to give broader coverage, we his or her estate shall not relieve us of our will give you the broader coverage with- obligations. out the issuance of II new policy as of the c. under uninsured motor vehicle, underinsured date we make the change effective. motor vehicle or any physical damage cover- b. Change orInterest. No change of interest in ages until 30 days after we get the insured's this policy is effective unless we consent in notice of accident or loss. writing. However, if you die, we will protect 3. Subrogation as named insured, except under death, dis- memberment and loss of sight coverage: The rights of recovery of the person to or for (I) your surviving spouse; whom we paid pass to us to the extent of our payments. That person shall: (2) any person with proper custody of your a. not hun our rights to recover; and car, a newly acquired car or a temporary substitute car until a legal representative b. help us get our money back. is qualified; and then Subrogation applies to all coverages except (3) the legal representative while acting death. dismemberment and loss of sight cover- within the scope of his or her duties. age. Policy notice requirements are met by mail- 4. CancelIation ing the notice to the deceased named in- How You May Cancel. You may cancel your sured's last known address. policy by notifying us in writing of the date lO Co Consent or Beneficiary. Consent of the cancel, which must be later than the date you mail beneficiary under death,dismemberment and or deliver it to us. We may waive these require- loss of sight coverage is not needed to cancel menLS by confirming the date and time of cancel- or change the policy. lation to you in writing. d, Joint and Individual Interests. When there How and When We May Cancel. We may are two or more named insureds, each acts for cancel your policy by wriuen notice, mailed or all to cancel or change the policy. delivered to your last known address. The notice 2. Suit Against Us shall give the date cancelIation is effective. There is no right of action against us: If we cancel during the first 59 days folIowing the policy effective date, the cancellation notice will a. until all the terms of this policy have been be mailcd or delivered to you at least 15 days met; and before the cancellation effective date. 31 8386 ".~- . After the policy has been in force for more than S9 days, any notice of cancellation will be mailed or delivered to you at least: a. 15 days prior to the effective date of the cancellation if such cancellation is because the premium was not paid; and b. 30 days prior to the effective dale of the cancellation if such cancellation is because of any other reason. The mailing of the notice shall be sufficient proof of notice. Unless the policy is canceled within S9 days of its effective date, we will not cancel your policy before the end of the current policy period unless: a. you fail to pay the premium when due; or b. at any time during the policy period your driver's license was under suspension or revocation. If we send you a notice of can. cellation solely because your driver's license was suspended orrevoked due to your failure lO respond to a citation, we will reinstate your policy to provide continuous coverage if you furnish to us, before the cancellation effective date, proof that you have: (1) responded to all citations; and (2) paid all fines and penalties in connection with them. Return or Unearned Premium. If you cancel. premium may be earned on a shon rate basis. If we cancel, premium will be earned on a pro-rala basis. Any unearned premium may be returned at the time we cancel or within a reasonable time thereafter. Delay in the return of unearned pre- mium does not affect the cancellation. .~ ~- , "'1M;',"' '-, S. Renewal Unless we mail or deliver to you a notice of- cancellation or a notice of our intention not to renew the policy, we agree to renew the policy for the next policy period upon your payment of the renewal premium when due. It is agreed that the renewal premium will be based upon the rates in effect, the coverages carried, the applicable limits of liability, deductibles and other elements that affect the premium that apply at the time of renewal. Other elements that may affect your premium include, but are not limited to: a. drivers of your CQr and their ages and marital status; b. your car and its use; c. eligibility for discounts or other premium crcdits; d. applicability of a surcharge based either on accident history, or on other factors. A notice of our intention to not renew will be mailed or delivered to your last known address at least 60 days before the end of the current policy period. The mailing of it shall be sufficient proof of notice. 6. Change or Residence When we receive notice that the location of prin- cipal garaging of a vehicle described on the dec- larations page has been changed, we have the right to recalculate the premium based on the coverages and rates applicable in the new loca. tion. When the change of location is from one Slate to another and you are a risk still acceptable to us at the time you notify us of the change, we shall replace this policy with the policy form current! y in use in the new state of garaging. The word "state" means one of the United States of America, the District of Columbia or a province of Canada. 32 8386 ~ . -f ~_" .' 'I' ._ ~ - ,--~ .- ,- -0,' ~ -; '-'- ~'~ , - 4;, MUTUAL CONDITIONS 1. Membership. The membership fees set out in this policy, which are in addition to the premi- ums, are not returnable but entitle the first insured named in the declarations to insure one vehicle {or any applicable coverage, and lO insurance for llI1Y other ,"overage for which said fees were paid SO long as: a. this company continues lO write such covcr- ages; b. the vehicle lO be insured meets the eligibility requirements of the company; and c. the insured remains a risk desirable to the company. While this policy is in force, the first insured named in the declarations is entitled to VOle at all meetings of members and to receive dividends the Board of Directors in its discretion may de- clare in accordance with reasonable classifica- tions and groupings of policyholders established by such Board. 2. No Contingent Liability. This policy is non- assessable. 3. Annual Meeting. The annual meeting of the members of the company shall be held at its home office at Bloomington, Illinois, on the second Monday of Junc at the hour ofIO:OO A.M., unless the Board of Directors shall elect to change the timc and place of such meeting. in which case, but not otherwise, due notice shall be mailed each mcmber at the address disclosed in this policy at least 10 days prior thcreto. In Willless Whereof. the State Farm Mutual Automobile Insurance Company has caused this policy to be signed by its President and Secretary at Bloomington, lIlinois. and countersigned on the declarations page by a duly authorized representative of the Company. ~/~ SECRETARY C~o.a.~~~~\.9r PRESIDENT 33 8386 -. ,~ ~. , .^- ~ 0- <, .. ~ . ",,- '''S' Page No. WHAT IT IS AND WHERE YOU CAN FIND IT - THE INDEX 6 Reporting a Claim -Insured's Duties - What to do if you have an accident, claim or are sued. 3 Defined Words 5 Declarations Continued 5 When and Where Your Coverage Applies 6 Financed Vehicles - Coverage for Creditor Coverages 8 A .,. Liability - When there is damage to others. 12 CZ - Medical Payments - Pays for an insured's medical expenses. 12 Q - Extraordinary Medical Payments - Pays for an insured's medical expenses. 13 Z - Loss or Income - Pays income loss benefits to an insured. 14 Y - Death, Dismemberment and Loss or Sight - Pays for death of or certain injuries to an insured. 14 F - Funeral Benefits - Pays for an insured's funeral expenses. 16 M - Combined Benefits - Pays medical and funeral expenses, income loss benefits, and for death of or cenain ,injuries to an insured. 18 U - Uninsured Motor Vehicle (Stacking Option) - When the other car or driver is not insured. 18 U3 - Uninsured Motor Vehicle (Non-Stacking Option) - When the other car or driver is not insured. 18 W - Underinsured Motor Vehicle (Stacking Option) - When the other car or driver is underinsured. 18 W3 - Under insured Motor Vehicle (Non-Stacking Option) - When the other car or driver is underinsured. 25 D - Comprehensive - When your car is damaged except by collision or upset Any deductible amounts are shown on the declarations page. 25 G - Collision - When your car is damaged by collision or upset. Deductible amounts are shown on the declarations page. 26 H - Emergency Road Service - When your car breaks down or needs a lOW. 26 R - Car Rental Expense - When you need to rent a car because of damage to your cor. 27 Rl, RS - Car Rental and Travel Expenses - Whell you need to rent a car and pay extra travel expenses because of damage to your car. Conditions 31 I. Policy Changes 31 2. Suit Against Us 31 3. Subrogation 31 4. Cancellation 32 5. Renewal 32 6. Change of Residence ,. 33 Mutual Conditions Policy Form 9838.6 " "". - l ~ I '-~- ,-, , ,-" J.;;-' ..'.. ,c~-" t'. MARGOLIS EDELSTEIN PHILADELPHIA OFFICE THE CURTIS CENTER FOURTH FLOOR INDEPENDENCE SQUARE WEST PHILADELPHIA, PA 1910603304 215-922.1100 FAX 215-922.1772 ATTORNEYS AT LAw DELAWARE COUNTY OFFICE 216 SOUTH ORANGE STREET MEDIA, PA 19063 610-56508311 FAX 610.56508318 POST OFFICE BOX 932 HARRISBURG. PA 17109.0932 PITTSBURGH OFFICE 1500 GRANT BUILDING PITTSBURGH. PA 15219.2203 412.281-4256 FAX 412-842.2380 STREET ADDRESS: 3510 TRINDLE ROAD CAMP HilL. PA 17011 717-975-11114 FAX 717.975-8124 NEW JERSEY OFFICE P.O. BOX 2222 216 HADDON AVENUE WESTMONT, NJ 08108-2896 609-858-7200 FAX 609-1158.1017 WRITER: ROLF E. KROLL DIRECT E~AIL: rkroll_2000@yahoo.com SCRANTON OFFICE THE OPPENHEIM BUILDING 409 LACKAWANNA AVENUE SUITE 3C SCRANTON, PA 18503 570-342-4231 FAX 570-342-4841 June 21, 2000 Dusan Bratic, Esquire 101 S. U.S. Route IS, Suite A Dillsburg, P A 17019 RE: Your Client: State Farm's Insured: Our File No.: Donna Shambaugh Ida E. Schutz 50100.4-0238 Dear Dusan: I am writing to formally advise you of my Entry of Appearance on behalf of State Farm in the underinsured motorist case asserted by your client, Donna Shambaugh. I am writing to advise that it is my understanding that your client has already been paid $25,000 by the liability carrier. It is also my understanding that on January 20, 1997, State Farm made an offer to your client of $2,500 to settle Ms. Shambaugh's underinsured motorist claim. It is my funher understanding that on March 16, 1998, you rejected the offer of settlement but indicated that you would forward additional information. To date, no supplemental information is contained in the file. As this accident took place over seven yeaTS ago, I would greatly appreciate any supplemental medical records that you have regarding Ms. Shambaugh's claim. To expedite the movement of this case, I have enclosed herewith true and correct copies of record authorizations for the healthcare specialists who took part in your client's care and treatment following the motor vehicle accident. These authorizations do not allow me to contact any of these providers directly, nor would I do so without your written consent. Further, it is not my intention to contact these individuals. The sole and exclusive purpose for these authorizations is to ensure that we both have all records penaining to your client's care and treatment both before and after the subj ect motor vehicle accident. To that end, I enclose record authorizations for the following: 1. Total Vision Care; 2. Nevyas Eye Associates; 3. Retina and Oculoplastic Consultants; and, 4. Thomas R. Pheasant. In addition to the foregoing, please provide an authorization for any emergency care rendered to your - client. The police report seems to indicate that some individuals were taken to the emergency room at Sacred Hean Hospital. If there was any emergency care or treatment rendered or for that matter, any care or treatment of any injuries to your client's head, I would appreciate you forwarding appropriate authorizations for those records as well. ~, -~ , -~. -~ _,-~ ~ '>J " . "\tIiP, Dusan Bratic, Esquire June 21, 2000 Page Two I have selected James Nealon as my arbitrator and ask that you select an arbitrator within the next 30 days. These arbitrators can then select a neutral and we can move this case forward to arbitration. I would also like to schedule your client's statement under oath and respectfully request that you forward the executed authorizations to my office in accordance with your client's duties of cooperation outlined in the State Farm policy. By copy of this letter I have notified Mr. Nealon of my request that you select an arbitrator. Please have your arbitrator contact Mr. Nealon directly so that they may select a neutral. Should you have any questions concerning this or any other aspect of this case, please do not hesitate to contact me. /~riC~r Iy, // // /trl/;f7U// VRO~J~' U/1 REKJjab Enclosures cc: James G. Nealon, Esquire ',', . -, ' '1--- .,-- ,':.. MEDICAL INFORMATION RELEASE AUTHORIZATION TO: Retina and Oculoplastic Consultants, P.C. Pennview Place, 220 Grand Avenue CampHill,PA 17011 You are hereby authorized to discuss with and release to RolfE. Kroll, Esquire MARGOLIS EDELSTEIN P.O. Box 932 Harrisburg, P A 17108-0932 all medical information and records regarding your professional medical care and treatment of Donna Shambaugh, Social Security No. 220-34-2066, including, without limitation, all conversations, admission records, initial history and physical, progress notes, order sheets, medical sheets, nurses notes, copies of consultations, x-rays, emergency room notes, LV. anesthesia sheets, physician's office records, radiographic and computerized axial tomography films, and any other matter regarding any opinion, diagnosis or prognosis which you might have pertaining in any way to me. DATE: Donna Shambaugh A photocopy of this medical authorization shall be deemed as authentic as the original. . ' iIldP:~;_: - '''.' ',-,- H~n _ - -" <"-k: MEDICAL INFORMATION RELEASE AUTHORIZATION TO: Total Vision Care You are hereby authorized to discuss with and release to RolfE. Kroll, Esquire MARGOLIS EDELSTEIN P.O. Box 932 Harrisburg, P A 17108-0932 all medical information and records regarding your professional medical care and treatment of Donna Shambaugh, Social Security No. 220-34-2066, including, without limitation, all conversations, admission records, initial history and physical, progress notes, order sheets, medical sheets, nurses notes, copies of consultations, x-rays, emergency room notes, LV. anesthesia sheets, physician's office records, radiographic and computerized axial tomography films, and any other matter regarding any opinion, diagnosis or prognosis which you might have pertaining in any way to me. DATE: Donna Shambaugh A photocopy of this medical authorization shall be deemed as authentic as the original. 1.--,", ~'" '",_,', _H: "'~ ,- , '_, MEDICAL INFORMATION RELEASE AUTHORIZATION TO: Nevyas Eye Associates Two Bala Plaza, 333 City Line Avenue Bala Cynwyd, P A 19004 Y Oll are hereby authorized to discuss with and release to RolfE. Kroll, Esquire MARGOLIS EDELSTEIN P.O. Box 932 Harrisburg, PA 17108-0932 all medical information and records regarding your professional medical care and treatment of Donna Shambaugh, Social Security No. 220-34-2066, including, without limitation, all conversations, admission records, initial history and physical, progress notes, order sheets, medical sheets, nurses notes, copies of consultations, x-rays, emergency room notes, LV. anesthesia sheets, physician's office records, radiographic and computerized axial tomography films, and any other matter regarding any opinion, diagnosis or prognosis which you might have pertaining in any way to me. DATE: Donna Shambaugh A photocopy of this medical authorization shall be deemed as authentic as the original. ~ - " -, ,_f '-.'J , ,_'r'~/ ,;,,_~, . "- -~".,', ""~__'~" MEDICAL INFORMATION RELEASE AUTHORIZATION TO: Thomas R. Pheasant Pennview Place, 220 Grand Avenue Camp Hill, PA 17011 You are hereby authorized to discuss with and release to RolfE. Kroll, Esquire MARGOLIS EDELSTEIN P.O. Box 932 Harrisburg, P A 17108-0932 all medical information and records regarding your professional medical care and treatment of Donna Shambaugh, Social Security No. 220-34-2066, including, without limitation, all conversations, admission records, initial history and physical, progress notes, order sheets, medical sheets, nurses notes, copies of consultations, x-rays, emergency room notes, LV. anesthesia sheets, physician's office records, radiographic and computerized axial tomography films, and any other matter regarding any opinion, diagnosis or prognosis which you might have pertaining in any way to me. DATE: Donna Shambaugh A photocopy of this medical authorization shall be deemed as authentic as the original. ,"-"- f~ _ --. , 0" '-'.,__~,_.__ .-,.., ~f,; MARGOLIS EDELSTEIN PHILADELPHIA OFFICE THE CURTIS CENTER FOURTH FLOOR INDEPENDENCE SQUARE WEST PHILADELPHIA, PA 19106.3304 215-9~.1100 FAX 215-9~.1772 ATTORNEYS AT LAw DELAWARE COUNTY OFFICE 216 SOUTH ORANGE STREET MEDIA, PA 19063 610-565-8311 FAX 610-565-8318 POST OFFICE BOX 932 HARRISBURG. PA 17109.()932 PITTSBURGH OFFICE 1500 GRANT BUILDING PITTSBURGH, PA 15219.~03 412.,28104256 FAX 412-642.2380 STREET ADDRESS: 3510 TRINDLE ROAD CAMP HILL, PA 17011 717.975-6114 FAX 717-975-6124 NEW JERSEY OFFICE P.O. BOX 2222 216 HADDON AVENUE WESTMONT. NJ 06106.2686 609-658.7200 FAX 609-658.1017 WRITER: ROLF E. KROLL DIRECT E-MAIL: rkroll_2000@yahoo.com SCRANTON OFFICE THE OPPENHEIM BUILDING 409 LACKAWANNAAVENUE SUITE 3C SCRANTON. PA 18503 570-34-2-4231 FAX 570-342-4841 August 7,2000 Dusan Bratic, Esquire 101 S. U.S. Route 15, Suite A Dillsburg, PA 17019 RE: Your Client: State Farm's Insured: Our File No.: Donna Shambaugh Ida E. Schutz 50100.4-0238 Dear Dusan: On June 21, 2000, I wrote to you and provided you with record authorizations so that we could move this case forward. I have yet to receive the executed authorizations. Please provide them to me promptly so we can keep this matter moving forward. Also, by copy of this letter, I am requesting that you select an Arbitrator within the next 30 days or I will move the Court to select an Arbitrator for you. Please let me know if this request causes you or your client any undue hardship and I am sure we can work something out. However, I do wish to keep this case moving. !(fJt'w;Ht/ '- Ul:f~jfi It REK/jab cc: James G. Nealon, Esquire 1.-, -~~" ''-'',' . MARGOLIS EDELSTEIN PHILADELPHIA OFFICE THE CURTIS CENTER FOURTH FLOOR INDEPENDENCE SQUARE WEST PHILADELPHIA, PA 19106.3304 215.922.1100 FAX 215-922.1772 ATTORNEYS AT LAw DELAWARE COUNTY OFFICE 216 SOUTH ORANGE STREET MEDIA, PA 19063 610.sss.s311 FAX 610.sss.s318 POST OFFICE BOX 932 HARRISBURG. PA17108.(l932 STREET ADDRESS: 3510 TRINDLE ROAD CAMP HILL, PA 17011 717-975""4 FAX 717.Q75..s124 NEW JERSEY OFFICE P.O. BOX 2222 218 HADDON AVENUE WESTMONT, NJ 06108-2886 608..56.7200 FAX 609..58-1017 PITTSBURGH OFFICE 1500 GRANT BUILDING PITTSBURGH. PA 15219-2203 412.281-4258 FAX 412-ll42.2380 WRITER: ROLF E. KROLL DIRECT E-MAIL: rkroll_2000@yahoo.com SCRANTON OFFICE THE OPPENHEIM BUILDING 409 LACKAWANNA AVENUE SUITE 3C SCRANTON. PA 18503 570-342-4231 FAX 570-342-4941 August 17, 2000 Dusan Bratic, Esquire 101 S. U.S. Route 15, Suite A Dillsburg, P A 17019 RE: Your Client: State Farm's Insured: Our File No.: Donna Shambaugh Ida E. Schutz 50100.4-0238 Dear Dusan: It was nice seeing you at the call of the list. I understand you are having some logistical difficulty at your office. If you would like me to send the record authorizations to your client in the exact form that I forwarded them to you, I will be happy to do so if that will ease your administrative burden. Please let me know if there is any way I can help in moving this case forward. Sincerely, ~~V1/b~;/ Rol~'<~ ,J#~t J ,;!"Y J '/ REK/jab .'[ "7 .. "". '. "'"--~,l-, -"'__~ "'it" . MARGOLIS EDELSTEIN COpy , PHILADELPHIA OFFICE THE CURTIS CENTER FOURTH FLOOR INDEPENDENCE SQUARE WEST PHILADELPHIA, PA 19106.330. 215.922.1100 FAX 215-922-1772 ATTORNEYS AT LAw DELAWARE COUNTY OFFICE 216 SOUTH ORANGE STREET MEDIA, PA 19063 610~565-8311 FAX 610-565-8316 POST OFFICE BOX 932 HARRISBURG. PA 17109-0932 PITTSBURGH OFFICE 1500 GRANT BUILDING PITTSBURGH, PA 15219-2203 412.281-4256 FAX 412-642-2380 STREET ADDRESS: 3510 TRINDLE ROAD CAMP HILL, PA 17011 717..975-8114 FAX 717-975-8124 NEW JERSEY OFFICE p,O, BOX 2222 216 HADDON AVENUE WESTMONT, NJ 08108-2886 609-858-7200 FAX 609-858.1017 WRITER: ROLF E. KROLL DIRECT E-MAIL: rkroll_2000@yahoo.com SCRANTON OFFICE THE OPPENHEIM BUILDING 409 LACKAWANNA AVENUE SUITE 3C SCRANTON, PA 18503 570.0342-4231 FAX 57000342-4841 October 17, 2000 Dusan Bratic, Esquire 101 S. U.S. Route 15, Suite A Dillsburg,PA 17019 RE: Your Client: State Farm's Insured: Our File No.: Donna Shambaugh Ida E. Schutz 50100.4-0238 Dear Dusan: Enclosed please fmd a Petition for Appointment of Arbitrator that I am prepared to file with the Court. I will forego the filing of the Petition if you supply me with the executed medical record authorizations and the appointment of your arbitrator within the next ten days. I would like to avoid any unnecessary judicial intervention. REK/jab Enclosure , " . r_ h",r;.; -",,1 I I I I I . .. CERTIFICATE OF SERVICE I, Jessica Bates, M authorized representative of Margolis Edelstein, hereby certify that I have served a true and correct copy of the foregoing document upon all counselMd parties of record this t1't1:::day of November, 2000, by placing the same in the United States First Class Mail, postage prepaid, at Camp Hill, Pennsylvania, addressed as follows: Dusan Bratic, Esquire 101 S. U.S, Route 15, Suite A Dillsburg,PA 17019 By: ~ l6aiW essica Bates -"-'" '-'--',. .1',.-,-" '" ,.J , _"' ~_'-,~ .-.'- 0 ~ - ". . .. CERTIFICATE OF SERVICE I, Jessica Bates, an authorized representative of Margolis Edelstein, hereby certify that I have served a true and correct copy of the foregoing document upon all counsel and parties of record this ~ay of November, 2000, by placing the same in the United States First Class Mail, postage prepaid, at Camp Hill, Pennsylvania, addressed as follows: Dusan Bratic, Esquire 101 S. U.S. Route 15, Suite A Dillsburg, PA 17019 By: rA,W/ J e ica Bates n -~-"" t:l!id1ltl'I::ci1![j~~.l!i!~~W~!'Wi~:~~i..,,-,;:jjii&ill3~;lilij"'.A;:""1<b'rIE"<l!i~ilmo%iI_iii 11 ..-. ....,I!ii.'-'"..._- -. , _ w_, ,_ _ ~._" ~, -~ > k~li""~'" .~ ii..... ~~,~ "" . " (") L':) 0 c: 0 "n S C) ::;-1 '"DC:!) r1 i-'-:I'i :;g rl1t'",l C") 2:IJ t ..!.,rn -s: -;09 0' _,~J , CI:l".. i~j (f~ ~e:c; -0 K' Q~ ~o ::r. 0 .r:- orn 5>c:: ~ z ':::> :<: +:"' ::i! . -~- I ',~ . -,-_. 1_ "' " .' ~ ~- ~ '.' -,,'~ -' ~ -. --. DEe 0 7 2n~J STATE FARM INSURANCE COMPANIES, Petitioner IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 00-8030 CIVIL TERM v. CIVIL ACTION - LAW DONNA SHAMBAUGH, Respondent JURY TRIAL DEMANDED ORDER AND NOW, this _ day of , 2000, upon consideration of the Petition of State Fann Insurance Companies, it is NOW AND HEREBY ORDERED that respectively, are hereby appointed as Respondent's and neutral arbitrators in this matter and that Respondent produce executed medical record authorizations to Petitioner forthwith. BY THE COURT: J. ~- - ~~, , ~: '11 . ROLF E. KROLL, ESQUIRE Pa. Supreme Court I.D. No'. 47243 ~ARGOLISEDELSTE[N Post Office Box 932 Harrisburg, Penusylvania 17108-0932 Telepbone: [717] 975-8114 Fax: [717] 975-8124 E-mail: rkrolllalman!Olisedelstein.com Dre II '7 "nn, \ ,}V'J Attorney for: Petitioner Respondent C) e 0 c 0 -" IN THE COURT OF CO~j: PLBAS ;~ 31 OF CUMBERLAND CO~~PENNSY-L~ NO. 00-8030 CIVIL TERM~::z 0' i-~~':, ~G :;? f~~3J CIVILACTlON-LAW $:8 ;. 25M '-- -t JURY TRIAL DEMANDED ~ .~ ~ STATE FARM INSURANCE COMPANIES, Petitioner v. DONNA SHAMBAUGH, PETITION TO COMPEL APPOINTMENT OF ARBITRATOR AND NOW, comes Petitioner State Farm Insurance Companies ("State Farm") by and through their counsel, Margolis Edelstein to compel the appointment of an arbitrator on behalf of Respondent Donna Shambaugh ("Ms. Shambaugh") and in support thereof avers the following: 1. At all times relevant hereto, Ms. Shambaugh was insured by Defendant State Farm and handled under State Farm claim number 20-2814-056 with insurance policy number 28l2-142-D3l-20B. A true and correct specimen policy is attached hereto as Exhibit "A." 2. On or about February 15, 1993, Ms. Shambaugh was injured in an automobile accident wherein State Farm's named insured Ida E Schutz was driving. 3. State Farm coverage for underinsured motorist benefits applies to Ms. Shambaugh as Ms. Shambaugh was a passenger in a vehicle owned and operated by State Farm's policyholder Ida E. Schutz. 4. The State Farm policy provides for arbitration in the event an amicable resolution cannot be reached. 5. State Farm has made numerous attempts to affect an amicable resolution with Defendant To date these efforts have bee~ to no avail. \ .. '",", - - ~ ~-~ ~ uti" :-1.'. , 6. By letters dated June 21, 2000, August 7, 2000 and August 17,2000, Petitioner, State Farm, has requested that Respondent select an arbitrator and comply with basic discovery obligations imposed upon her by the State Farm policy. To date these efforts have been met with no substantive response. True and correct copies of each of these letters are attached hereto as Exhibits B through D respectively. 7. In the June 21, 2000 letter, State Farm confIrmed the current procedural posture of the case and confIrmed that James Nealon, Esquire, had been appointed as State Farm's arbitrator in this matter. 8. By letter dated October 17, 2000, State Farm's counsel provided Respondent's counsel with one last chance to comply with the basic obligations of selecting an arbitrator and supply State Farm with medical record authorizations. A true and correct copy of this letter is attached hereto as Exhibit E. 9. To date Respondent has failed to select an arbitrator much less a neutral arbitrator, has failed to return executed record authorizations and, therefore, has failed and refused to comply with his obligations in violation of the terms of the policy. WHEREFORE, Petitioner State Farm requests that this Honorable Court enter an Order selecting Respondent's arbitrator and a neutral arbitrator in this case within 30 days in accordance with the terms of the policy and Pennsylvania law, and that Respondent provide Petitioner with executed medical record authorizations forthwith. By: sqUlre Attorney 1. #47243 Post OffIce Box 932 Harrisburg, PA 17108-0932 (717) 975-8114 Attorney for Petitioner jj_,.""JI"'-"JIiIili ';, ~;__,~-ll "'U Q. O' '< 'TI o .... 3 co <Xl W <Xl m ~ r;!2 ::l Ql ::l _ en CD "S. < 'TI ~ Ql 6r -, 3 g ==- nO :::::.. '" c:: - c:: · 9L ~ ~ 0 )> ::l c:: '" - 00 0 iii 3 CD 0 ~ ~ 2: ~ CD 3 0 ::::l ~ ::!. 00 "'U ~ < c:: '" iil 0 . ::::l m n a CD r C 0 0 ::l ~ " 0 - 0 3 Q JJ a. ~ -g JJ go ::::l " '::<: ~ :J: s: ::l 0 en '< 3 <" Ol CD ::l 0 iir ~ - - '" o' Co> Co> CD '" . 0 CD 0 0 0' ~ 0 3 S' <C - 0 ::::l )> c:: - :T o .... N' CD c. :Il CD "'0 .... CD 00 CD ::::l - a <' S' CD o (ii' ,~ __,' ~~-, '''C' ,~,_ ,'_',,"_,',' ':,-:;.-':,___ ~,;~F '_0 ,,-.' .. I II "'''')' 0" :Il' m 0)> zoo mm O:ll "m o~ c-< :Ilo nc 1j;:Il -"l! S:o OC "n ,,-< na m)> m:ll ~q:: O? z, n:< m_ ." --< 000 Ilk :x :Il)> m< "m ~)> -Iz z)> Cln )>Q nO Ij;~ --I S:' 'n ZO mz c> :Iln !g-l CIi-< 00 cc -I:Il -00 m.... fIl)> .... zm -I'" xl> -x 03: "h ,Co -IT S~ 2 3386 . """ ~ ._~"'-~, ",,'~_J, .~_" _ ,,~!:: STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY BLOOMINGTON, ILLINOIS A MUTUAL COMPANY DEFINED WORDS' WHICH ARE USED THROUGHOUT THE POLICY We define SOllIe words to shonen the policy. This makes it easier to read and und.:l'Stand. Defmed words are printed in bold face italics. You can pick them out easily. Bodily Injury - means bodily injury to a person and sickness, disease or death which results from il . Car - means a land motor vehicle with four Of more wheels. which is designed for use mainly on public roads. It does not include: 1. any vehicle while located for use as a dwell- ing (If other premises; or 2. a trUCk-uactor designed to pull a trailer or semitrailer. Car Business - means a business or job where the purpose is to sell, lease, repair, service, transport, store or parle: land motor vehicles or trailers. Insured - means the person, persons or organizatiol\ defined as insureds in the specific coverage. Loss - defined in Section IV. Newly Acquired Car - means a replacement car or an OJldiJional CIlr. Replacenumt Car-means a CIlrpurchased by or leased to you or your spouse to replace your CIlr. This policy will only provide coverage for the replacement car if you or your spouse: 1. tell us about it within 30 days after its delivery to you or your spouse; and 2. pay us any added amount due. Additional Car - means an added car purchased by or leased to you or your spouse. This policy will only provide coverage for the OJlditiolUll car if: 1. it is a privOle fNlSsenger car and we insure all other privOle passenger cars; or 2. it is other than a private JHlSsenger car and we insure all C/U'S owned by you or your spouse on the date of its delivery to you or your spouse. This policy provides coverage for the OJldiJiolUll car only until the earlier of: 1. 12:01 a.m. on the 31st day after the deliv- ery of the Cf1T to you or your spouse; or 2. the effective date and time of a policy issued by us or any other company that describes the car on its declarations page. However, you or your spouse may apply for coverage beyond the 30th day for the OJldiJiolUll CIlr. Such coverage will be provided only ifboth you and the vehicle are eligible for coverage at the time of application. Non.OwnedCar- means a CllTnot owned, registered or leased by: 1. you, your spouse; 2. any relative unless at the time of the accident or loss: a. the car currently is or has within the last 30 days been insured for liability cover- age; and b. the driver is an insured who does not own or lease the CIlr; 3. any other person residing in the same house- hold as you, your spouse or any relative; or 4. an employer of you, your spouse or any rela- tive. Non.owned car does not include a: I. rented CIlr while it is used in connection with the insured's employment or business; or 3 8386 t 2. car which has been operated or rented by or in the possession of an insured during any part of each of the last 21 or more consecutive days. The 21 day limit is multiplied by the number of vehicles described on the declara- tions pages of all car policies issued by us under which the insured is an insured. A non-owned car must be a car in the lawful posses. sian of the person operating it Occupying - means in, on, entering or alighting from. Person - means a human being. Private Passenger Car - means a car: I. with four wheels; 2. of the private passenger or station wagon type; and 3. designed solely to carry persons and their luggage. Relative - as used in Sections I, Ill, IV and V means a person related to you or your spouse by blood, marriage or adoption who lives with you. It includes your unmarried and unemancipated child away at school. See Section II for definition used there. Serious injury - means a personal injury resulting in death, serious impairment of body function orperma- nent serious disfigurement. Unless the injury sustained is a serious injury, each person who is bound by the limited tort election shall be precluded from maintaining an action for any noneconomic loss, except that; (1) An individual otherwise bound by the limited tort election who sustains damages in a mOlar vehicle accident as the consequence of the fault of another person may recover damages as if the individual damaged had elected the full tort alternative when- ever the person at fault: (i) is convicted, or accepts Accelerated Reha- bililative Disposition (ARD) for driving under the influence of alcohol or a controlled substance in that accident; ,I _ ~'''''' ',.. ~ ;-r'i.< (ii) is operating a motor vehicle registered in another state; (iii) intends to injure himself or another perso~, provided that an individual does not imentionally injure himself or another person merely because his act or failure to act is intentional or done with his realization that it creates a grave risk of caus. ing injury or the act or omission causing the injury is for the purpose of averting ,bodily harm to himself or another person; or (iv) has not maintained financial responsibility as required by Chapter 17 of Title 75 of the Pennsylvania Consolidated Statutes, provided that, nothing in this paragraph shall affect the limitation of section l731(d)(2) of Title 75 of the Pennsylvania Consolidated Slatutes (relating to availability, scope and amount of coverage). (2) An individual otherwise bound by the limited tort election shall retain fun tort rights with respect to claims against a person in the business of design- ing, manufacturing, repairing, servicing or otherwise maintaining motor vehicles arising out of a defect in such motor vehicle which is caused by or not cor- rected by an act or omission in the course of such business, other than a defect in a motor vehicle which is operated by such business. (3) An individual otherwise bound by the limited tort election shall retain full tort rights ifinjured while an occupant of a motor vehicle other than a private passenger motor vehicle. Spouse - means your husband or wife while living with you. Temporary Substitute Car- means a car not owned by you or your spouse, if it replaces your car for a short time. Its use has to be with the consent of the owner. Your car has to be out of use due to its breakdown, repair, servicing, damage or loss. A temporary substitute car is not considered a non. owned car. Utility Vehicle - means a motor vehicle with: I. a pickup, panel or van body; and 2. a Gross Vehicle Weight of 10,000 pounds or less. 4 8386 You or Your - means the named insured or named insureds shown on the declarations page. , -, , ~ - ~- . .~ -' .-~. ~ ~-'_f"~, Your Car - means a car or a vehicle described on the declarations page. DECLARATIONS CONTINUED We, the State Farm Mutual Automobile Insurance Company. agree to insure you according to the terms of this policy based: 1. on your payment of premium for the cover- ages you chose; and 2. in reliance on your statements in these decla- rations. You agree, by acceptance of this policy that: 1. the statements in these declarations are your statements and are true; and 2. we insure you on the basis your statements are true: and 3. this policy contains all of the agreements between you and us or any of our agents. Unless otherwise stated in the exceptions space on the declarations page, your statements are: 1. Ownership. You are the sole owner(s) of your car. 2. Insurance and License History. Neither you nor any member of your household within the past 3 years has had: . a. vehicle insurance canceled by an insurer; or b. a license to drive or vehicle registration suspended, revoked or refused. 3. Use. Your car is used for pleasure and busi- ness. WHEN AND WHERE COVERAGE APPLIES When Coverage Applies The coverages you chose apply to accidents and losses that take place during the policy period. The policy period is shown under "Policy Pe- riod" on the declarations page and is for succes- sive periods of six months each for which you pay the renewal premium. Payments must be made on or before the end of the current policy period. The policy period begins and ends at 12:01 A.M. Standard Time at the address shown on the declarations page. Where Coverage Applies The coverages you chose apply: 1. in the United States of America, its territories and possessions or Canada; or 2. while the insured vehicle is being shipped between their pons. The liability, medical payments, funeral benefits, loss of income and physical damage coverages also apply in Mexico within 50 miles of the United States border. A physical damage coverage loss in Mexico is determined on the basis of cost at the nearest United States point. Uninsured motor vehicle, underinsured mOlOr vehi- cle and death, dismemberment and loss of sight cov- erages apply anywhere in the world. 5 8386 "-". 'J ~ ~ ,-, . "'~-~F. .".:; """,N -". ~-~'1M FINANCED VEHICLES If a creditor is shown in the declarations, we may pay any comprehensive or collision loss to: 1. you and, if unpaid, the repairer; or 2. you and such creditor, as its interest may appear. when we fmd it is not practical to repair your CIlT; or 3. the creditor, as to its interest, if your car has been repossessed. When we pay the creditor for (oss for which you are not covered, we are entitled to the creditor's right of recovery against you to the extent of our payment. Our right of recovery shall not impair the creditor's right to recover the full amount of its claim. The coverage for the creditor's interest only is valid - until we terminate it. We will not terminate such coverage because of: 1. any act or negligence of the owner or bor- rower; or 2. a change in the ownership or interest un- known to us, unless the creditor knew of it and failed to tell us within 10 days; or 3. an error in the description of the vehicle. The date of termination of the creditor's interest will be at least 10 days after the dale we mail or electroni- cally transmit lhe termination notice. REPORTING A CLAIM - INSURED'S DUTIES 1. Notice to Us or an Accident or Loss The insured must give us or one of our agents written notice of the accident or (oss as soon as reasonably possible. The notice must show: a. your name; and b. the names and addresses of all persons in- volved; and c. the hour, date, place and facts of the accident or loss; and d. the names and addresses of wiUlesses. 4. 2. Notice to Us or Claim or Suit If a claim or suit is made against an insured, that insured must at once send us every demand. notice or claim made and every summons or legal process received. 3. Other Duties Under the Physical Damage Coverages When there is a (oss, you or the owner of lhe propeny also shall: a. make a prompt report to the police when the loss is the result of theft or larceny. 6 8386 b. protect the damaged vehicle. We will pay any reasonable expense incurred 1O do it. c. show us the damage, when we ask. d. provide all records, receipts and invoices, or certified copies of them. We may make cop- ies. e. answer questions under oath when asked by anyone we name, as often as we reasonably ask, and sign copies of the answers. Other Duties Under Medical Payments, Fu- neral Benefits, Loss or Income, Death, Dis- memberment and Loss or Sight, Uninsured Motor Vehicle and Underinsured Motor Ve- hicle Coverages The person making claim also shall: a. give us alllhe details about the death, injury, treatment and other information we need to delcrmine the amount payable. b. undcr thc uninsured motor vehicle and under- insured molor vehicle coverages: (I) consent to be examined by physicians chosen and paid by us as often as we -, - "-, reasonably may require. A copy of the report will be sent to the person upon written requesL If the person is dead or unable to act, his or her legal repre- sentative shall authorize us to obtain all medical reports and records. (2) let us see the insured CIlr the person oc- cupied in the accidenL (3) send us at once a copy of all suit papers if the person sues the party liable for the accident for damages. c. under the uninsured mOlOr vehicle coverage, repon an accident caused by an unidentified land motor vehicle to the police as soon as practicable and to us within 30 days or as soon as practicable. d. under the medical payments, funeral benefits, loss of income and death, dismemberment and loss of sight coverages: (1) authorize us to obtain all medical repons and records. If the person is dead or unable to act, his or her legal repre- ",- .' l~'_ H ,. cd ,- I, -.- . ~- "h'_--' "_~.__e,,",'"'__" - , -;~i: sentative shall give us the authorization; and (2) give us proof of claim on forms we fur- nish unless we faillO supply them within 10 days after receiving the notice of claim. 5. Insured's Duty to Cooperate With Us The insured shall cooperate with us and, when asked, assist us in: a. making settlements; b. securing and giving evidence; c. attending, and getting witnesses to attend, hearings and trials. The insured shall not, except at his or her own cost, voluntarily: a. make any payment or assume any obligation to others; or , b. incur any expense, other than for fJrst aid to others. 7 8386 ".>, ,'-, = ,n.nj -C'_',:_,_,,, ";;;;.L,&.;-' "'ff" "~'-""'t:'; SECTION I - LIABILITY - COVERAGE A This coverage applies to the vehicles for which "A" appears in the "Coverages" space on the declarations page. We will: 1. pay damages which an insured becomes le- gally liable to pay because of: a. bodily injury to others, and b. damage to or destruction of propeny in- cluding loss of its use, caused by accident resulting from the owner- ship, maintenance or use of your car; and 2. defend any suit against an insured for such damages with attorneys hired and paid by us. We will not defend any suit after we have paid the applicable limit of our liability for the accident which is the basis of the lawsuit. In addition to the limits of liability, we will pay for an insured any costs listed below resulting from such accident. 1. Court costs of any suit for damages. 2. Interest on damages owed by the insured due to a judgment and accruing: a. after the judgment, and until we pay, offer or deposit in court the amount due under this coverage; or b. before the judgment, where owed by law, and until we pay, offer or deposit in coun the amount due under this coverage, but only on that pan of the judgment we pay. 3. Premiums or costs of bonds: a. to secure the release of an insured's prop- eny attached under a coun order. b. required to appeal a decision in a suit for damages if we have not paid our limit of liability that applies to the suit; and c. up to $250 for each bail bond needed because of an accident or traffic violation. We have no duty to furnish or apply for any bonds. The amount of any bond we pay for shall not be more than our limit of liability. 4. Expenses incurred by an insured: a. for loss of wages or salary up to $35 per day if we ask the insured to attend the trial of a civil suit. b. for first aid to others at the time of the accidenL c. at our requesL We have the right to investigate, negotiate and settle any claim or SuiL Coverage ror the Use or Other Cars The liability coverage extends to the use, by an insured, of a newly acquired car, a temporary sub- stitute car or a non-owned car. Who Is an Insured When we refer to your car, a newly acquired car or a temporary substitute car, insured means: 1. you; 2. your spouse; 3. the relatives of the rust person named in the declarations; 4. any other person while using such a car if its use is within the scope of consent of you or your spouse; and 5. any other person or organization liable for the use of such a car by one of the above in. sureds. When we refer to a non-owned car, insured means: 1. the rust person named in the declarations; 2. his or her spouse; 3. their relath'es; and 8 8386 -.- - 4. any person or organization which does not own or hire the Cll1' but is liable for its use by one of the above persons. THERE IS NO COVERAGE FOR NON-OWNED CARS: I. IF THE DECLARATIONS STA1E THE "USE" OF ALL OF YOUR CARS IS OlllER lHAN "PLEASURE AND BUSI- NESS"; OR 2. WHILE: a. BEING REPAIRED, SERVICED OR USED BY ANY PERSON WHILE THAT PERSON IS WORKING IN ANY CAR BUSINESS; OR b. USED IN ANY OlllER BUSINESS OR OCCUPATION. This does not apply 1O a private JNlssenger car driven or occu. pied by the first person named in the declarations, his or her spouse or their relatives. Trailer Coverage 1. Trailers designed to be pulled by a private pas- senger car or a utility vehicle, except those trail- ers in 2a below. are covered while owned or used by an insured. Farm implements and farm wagons are consid- ered trailers while pulled on public roads by a car we insure for liability. These trailers are not described in the declara- tions and no exaa premium is charged. 2. The following trailers are covered only if de- scribed on the declarations page and extra pre- mium is paid: . a. those trailers designed to be pulled by a pri- vale passenger car or a utility vehicle: (I) if designed to carry persons; or (2) while used with a motor vehicle whose use is shown as "commercial" on the dec- larations page (trailers used only for pleasure use are covered even if not de- scribed and no extra premium paid); or (3) while used as premises for office, store or display purposes; or b. any trailer not designed for use with a private passenger Cll1' or a utility vehicle. THERE IS NO COVERAGE WHEN A TRAILER IS USED WITH A MOTOR VEHICLE OWNED OR HIRED BY YOU WHICH WE DO NOT IN- SURE FOR LIABll..ITY COVERAGE. Limits of Liability The amount of bodily injury liability coverage is shown on the declarations page under "Limits of Liability - Coverage A - Bodily Injury, Each Person, Each Accident". Under "Each Person" is the amount of coverage for all damages due to bodily injury 1O one person. "Bodily injury to one person" includes all injury and damages to others resulting from this bodily injury. Under "Each Accident" is the total amount of coverage, subject 1O the amount shown under "Each Person", for all damages due to bodily injury to two or more persons in the same accident. The amount of propeny damage liability coverage is shown on the declarations page under "Limits of Liability - Coverage A - Propeny Damage, Each Accident". We will pay damages for which an insured is legally liable up to these amounts. The limits of liability are not increased because more than one person or organization may be an insured. A motor vehicle and attached trailer are one vehicle. Therefore. the limits are not increased. When two or more motor vehicles are insured under this section the limits apply separately to each. When Coverage A Does Not Apply In addition to the limitations of coverage in "Who Is an Insured" and ''Trailer Coverage": mERE IS NO COVERAGE: 1. WHILE ANY VEHICLE INSURED UN- DER lHIS SECTION IS: a. RENTED TO OTHERS. 9 8386 -- b. USED TO CARRY PERSONS FOR A CHARGE. This does not apply to the use on a share expense basis of: (1) a private passenger car; or (2) a utility vehicle, if all passengers are riding in that area of the vehicle de- signed by the manufacturer of the vehicle for carrying passengers. c. BEING REPAIRED, SERVICED OR USED BY ANY PERSON EMPLOYED OR ENGAGED IN ANY WAY IN A CAR BUSINESS. This does not apply 1O: (1) you or your spouse; (2) any relative; (3) any resident of your household; or (4) any agent, employee or parlller of you, your spouse, any relative or such resident. This coverage is excess for (3) and (4) above. 2. FOR ANY BODILY INJURY TO: a. A FELLOW EMPLOYEE WHILE ON THE JOB AND ARISING FROM THE MAINTENANCE OR USEOF A VEHI- CLE BY ANOTHER EMPLOYEE IN THE EMPLOYER'S BUSINESS. You and your spouse are covered for such injury to a fcllow employee. b. ANY EMPLOYEE OF AN INSURED ARISING OUT OF HIS OR HER EM- PLOYMENT. This does not apply 10 a household employee who is not covered or required to be covered under any worker's compensation insurance. 3. FOR ANY DAMAGES: a. FOR WHICH THE UNITED STATES MIGHT BE LIABLE FOR THE IN- SURED'S USE OF ANY VEHICLE. b. TO PROPERTY OWNED BY, RENTED TO, IN THE CHARGE OF OR 10 8386 - ..",-- '. ., ~ -- ,,' " ~-'"_"" _ o'-~ _ <'. . __ ",_", TRANSPORTED BY AN INSURED. But coverage applies to a rented: (l) residence or (2) private garage damagcd by a car we insure. 4. FOR ANY OBLIGATION OF AN IN- SURED, OR HIS OR HER INSURER, UN- DER ANY TYPE OF WORKER'S COMPENSATION OR DISABILITY OR SIMILAR LAW. 5. FOR LIABILITY ASSUMED BY THE IN- SURED UNDER ANY CONTRACT OR AGREEMENT. If There Is Other Liability Coverage 1. Policies Issued by Us to You, Your Spouse, or Any Relative If two or more vehicle liability coverages pro- vided by us to you, your spouse, or any relative apply to the same accident, the total limits of liability undcr all such coverages shall not exceed that of the covcrage with the highest limit of ,liability. 2, Other Liability Coverage Available From Other Sources Subject to item 1, if other vehicle liability cover- age applics, we are liable only for our share of the damages. Our share is the per cent that the limit of liability of this policy bears to the total of all vchiclc liability coverage applicable to the acci- dent 3. Temporary Substitute Car, Non-Owned Car, Trailer If a temporary substitute car, a non-owned car or a trailer designed for use with a private pas- senger car or utility vehicle has other vehicle liability coverage on it, then this coverage istexcess. 4. Newly Acquired Car THIS COVERAGE DOES NOT APPLY IF THERE IS OTHER VEHICLE LIABILITY . COVERAGE ON A NEWLY ACQUIRED CAR. Motor Vehicle Compulsory Insurance Law or Fi- nancial Responsibility Law 1. Out-or.State Coverage H an insured under the liability coverage is in another state or Canada and, as a non-resident, becomes subject to its motor vehicle compulsory insurance, financial responsibility or similar law: a. the policy will be interpreted to give the cov- erage required by the law; and b. the coverage so given replaces any coverage in this policy to the extent required by the law ~" .., ~ .1 _" _ -^ ,~~- "". ~ ,-,.,,, for the insured's operation, maintenance or use of a car insured under this policy. Any coverage so extended shall be reduced to the extent other coverage applies to the accidenL In no event shall a person collect more than once. 2. Financial Responsibility Law When certified under any law as proof of future financial responsibility, and while required dur- ing the policy period, this policy shall comply with such law to the extent required. The insured agrccs to fepay us for any payment we would not have had to make under the terms of this policy except fOf this agreement. II 8386 ...~ , > . -- -., " L . &" ,~,. - 0>'. ,( '," SECfION II - FIRST PARTY COVERAGES The coverages under this section are provided in accordance with and subject to the Pennsylvania Motor Vehicle Financial Responsibility Act, as amended. MEDICAL PAYMENTS - COVERAGE C2 This coverage applies to the vehi;l;:s for which "C2" appears in the "Coverages" space on the declarations page. What We Pay We will pay for medical expenses for bodily injury to an insured arising out of the maintenance or use of a motor vehicle. Medical expenses - these are expenses incurred for reasonable and necessary medical treatment and re- habilitation services. This includes expenses for: 1. hospital, dental, surgical, psychiatric. psy- chological, osteopathic, ambulance. chiro- practic, nursing and optometric services; Z. licensed physical therapy, vocational reha- bilitation, occupational therapy. speech pa- thology and audiology; 3. medications, medical supplies and prosthetic devices; and 4. nonmedical remedial care and treatment ren- dered in accordance with a recognized relig- ious method of healing. Medical expenses will be paid: 1. if incurred within 18 months from the date of the accident causing the bodily injury; or 2. without limitation as to time, provided that, within 18 months from the date of the acci- dent causing the bodily injury, it can be de- termined with reasonable medical probability that further expenses may be incurred as a result of the bodily injury. The amount we will pay for medical expenses is subject to the limitations of Title 75 of the Penn- sylvania Consolidated Statutes. EXTRAORDINARY MEDICAL PAYMENTS- COVERAGE Q This coverage applies to the vehicles for which"Q" appears in the "Coverages" space on the declarations page. What We Pay We will pay up to the lifetime aggregate limit of $1,000,000 for those reasonable medical expenses which exceed $100,000. The medical expense must be for bodily injury to an insured caused by accident arising out of the maintenance or use of a motor vehicle. Medical expenses - these are expenses incurred for reasonable and necessary medical treatment and re- habilitation services. This includes expenses for: 1. hospital, dental, surgical, psychiatric, psy- chological, osteopathic, ambulance, chiro- practic, nursing and optometric services; 2. licensed physical therapy, vocational reha- bilitation, occupational therapy, speech pa- thology and audiology; 3. medications, medical supplies and prosthetic devices; and 4. nonmedical remedial care and treatment rendered in accordance with a recognized religious method of healing. Medical expenses will be paid: I. ifjncurred within 18 months from the date of the accident causing the bodily injury; or 2. without limitation as to time, provided that within 18 months from the date of the acci- dent causing the bodily injury, it can be de- termined with reasonable medical probability that further expenses may be incurred as a result of the bodily injury. 12 8386 The most we will pay in any 12 month period begin- ning 18 months after the date the insured's reason- able medical expenses exceed $100,000 as a result of the bodily injury is $50,000. These expenses must be: 1. for: a. services performed, or b. medical supplies, medication or drugs prescribed by a medical provider licensed by the slate to provide the specific medical services; and 2. for diagnosis, direct care or treatment of the bodily injury. The diagnosis, direct care or treatment must be: a. within the standards of good medical practice,and b. not primarily for the convenience of the patient or medical provider. We have the right to make or obtain an independent review of the medical expenses and services per- formed to determine if they are reasonable and nec. essary for the bodily injury sustained. The amount we will pay for medical expenses is subject to the limitations ofTiue 75 of the Pennsyl- vania Consolidated S taWles. REASONABLE MEDICAL EXPENSES 00 NOT INCLUDE EXPENSES FOR TREATMENT, SERVICES, PRODUCTS OR PROCEDURES TIfAT ARE: 1. FOR RESEARCH, OR NOT PRIMARll.. Y DESIGNED TO SERVE A MEDICAL OR REHABILITATIVE PURPOSE; OR 2. NOT COMMONLY AND CUSTOMAR. IL Y RECOGNIZED THROUGHOUT TIlE MEDICAL PROFESSIONS AND WITIIIN THE UNITED STATES AS APPROPRI- ATE FOR THE TREATMENT OF THE BODILY INJURY. _0_ ~< , LOSS OF INCOME - COVERAGE Z This coverage applies to the vehicles for which ''Z''- with a number beside it appears in the "Coverages" space on the declarations page. "Z:' with a number beside it is your coverage symbol. Check your cov- erage symbol with the schedule for the limits you have chosen. We will pay income loss benefits with respect to bodily injury to an insured arising out of the mainte- nance or use of a motor vehicle. Income loss benefits are: 1. 80% of the insured's acwal loss of gross income from work the insured would have performed except for the bodily injury; 2. reasonable expenses actually incurred for: a. hiring a substitute 10 perform self-em- ployment services to reduce loss of gross income; or b. hiring special help thereby enabling the insured to work and reduce loss of gross income. Income loss benefits do not include: 1. loss of expt".cted income for any period fol- lowing the death of an insured; 2. expenses incurred for services performed fol- lowing the death of an insured; or 3. any loss of income during the first five work- ing days the insured did not work after the accident because of the bodily injury. SCHEDULE-COVERAGEZ I Coverage Maximum Payable Total Maximum Symbol Per Month Benefits Zl $1,000 $ 5,000 'Z2 1,000 15,000 Z3 1,500 25,000 ZA 2,500 50,000 I3 8386 This coverage applies to the vehicles for which "P" appears in the "Coverages" space on the declarations page. We will pay for funeral expenses directly related to the funeral, burial, cremation or other form of dispo- sition of the remains of an insured. The death must be the result of the accident. The expenses must be incurred within 24 months from the date of the acci- dent. Definitions - Coverages C2, Q, Z, Y and F Bodily Injury - means accidental bodily harm to a person and that person's resulting illness, disease or death. First Party Benefits - means benefits paid or payable to an insured under Coverages C2, Q, Z, Y or F. Insured - means: I. you or any relative; 2. any other person: a. occupying your car or a newly acquired car; or b. not occupying a motor vehicle if injured as the result of an accident involving your car, or a newly acquired car. A parked and unoccupied motor vehicle is not a motor vehicle involved in the accident unless it was parked so as to cause unrea- sonable risk of injury. Motor Vehicle - means a vehicle which is self-pro- pelled except one which is propelled: I. solely by human power; or 2. upon rails. 7,500 Relative - means: 5,000 I. your spouse; 14 8386 DEATH, D"ISMEMBERMENT AND LOSS OF SIGHT - COVERAGE Y This coverage applies to the vehicles for which "Y" with a number beside it appears in the "Coverages" space on the declarations page. "Y" with a number beside it is your coverage symbol. Check your cov- erage symbol with the schedule for the limits you have chosen. We will pay the amount shown in the schedule that applies for death of, or loss to, an insured arising out of the maintenance or use of a motor vehicle. The death or loss must be the direct result of the accident and not due to any other cause. The death must occur within 24 months from the date of the accident. If the death occurs within 24 hours after the accident, we will pay only the amount that applies to death. Loss must occur within 90 days of the accidenL Loss - means the loss of: 1. the foot or hand, cut off through or above the an1tle or wrist; or 2. the whole thumb or finger; or 3. aU sight. Schedule - Coverage Y Coverage Symbol Yl Y2 $ 10,000 $ 25,000 Y3 S 5,000 Death Loss of: hands; feet: sight of eyes; one hand & one foot; or one hand or one foot & sight of one eye one hand or one foot; or sight of one eye thumb & finger on one hand; or three fingers any two fingers 5,000 10,000 25,000 2,500 5,000 12,500 1,500 1,000 3,000 2,000 Payments of Benefits - Coverage Y The death benefit shall be paid to the executor..or administrator of the insured's estate. FUNERALBENERTS-COVERAGEF 2. anyone related to you by blood, marriage or adoption; and 3. a minor in the custody of you, your spouse or a relative resident in your household, even if temporarily resid- ing elsewhere. Limits or Liability - Coverage C2 The amount of coverage for medical expenses is shown on the declarations page under ''Limit of Liability - Coverage C2 - Each Person". Limits or Liability - Coverage Z The most we will pay an insured for income loss benefits per month and in the aggregate are shown in the coverage Z schedule next to your coverage sym- bol. Limits of Liability - Coverage Y The amount we will pay because of the death of the insured is shown under your coverage symbol in the Coverage Y schedule. The maximum amount pay- able to an insured for all loss, as shown in the schedule, shall not exceed the death benefit amount shown for your coverage symbol. The amount shown in the schedule for death of or loss to the insured is doubled for an insured who, at the time of the accident, is using the vehicle's complete restraint system as recommended by the vehicle's manufacturer. Limits of Liability - Coverage F The amount of coverage for funeral expenses is shown on the declarations page under "Limit of Liability - Coverage F - Each Person". Limits or Liability - Coverages C2, Q, Z, Y and F These coverages are excess over, but shall not dupli- cate, any amount paid or payable to or for the ins ured under any worker's compensation law. Priorities ror the Payment or First Party Benefits 1. When more than one policy applies, the person who suffers bodily injury shall recoverjirst party 15 8386 benefits against applicable insurance coverage in the following order of priority: a. The policy on which the person is a named insured. b. The policy providing coverage because the person is residing in the household of a named insured and is; (1) a spouse or other relative of a named insured; or (2) a minor in the custody of either a named insured or a relative of a named insured. c. The policy covering the motor vehicle occu- pied by the injured person at the time of the accidenL d. For a person who is not the occupant of a motor vehicle, the policy on any motor vehi- cle involved in the accident. A parked and unoccupied motor vehicle is not a motor ve- hicle involved in the accident unless it was parked so as to cause unreasonable risk of injury. 2. TIllS POLICY DOES NOT APPLY IF THERE IS ANOTHER POLICY AT A mGHER PRI- ORITY LEVEL. Item a above is considered the highest priority. Item d is the lowest priority. 3. Subject to the above, if an insured is entitled to jirst party benefItS under more than one cover- age, the maximum recovery under all coverages for any fust party benefu will not exceed the amount payable under the coverage with the highest limit of liability for lhatfrrst party bene. jiL When Coverages C2, Q, Z, Y and F Do Not Apply mERE IS NO COVERAGE FOR BODILY IN- JURY: 1. TO ANY PERSON WHOSE CONDUCT CON1RIBUTED TO ms OR HER BOD. ILY INJURYIN ANY OF THE FOLLOW- INGWAYS: a. WHILE INTENTIONAllY INJURING OR A TIEMPTING TO INJURE HIM- SELF, HERSELF OR ANOTHER; b. WHILE COMMITTING A FELONY; OR c. WHILE SEEKING TO ELUDE LAW- FUL APPREHENSION OR ARREST BY A LAW ENFORCEMENT om- CIAL. 2. TO ANY PERSON WHO KNOWINGLY CONVERTS A MOTOR VEHICLE if the bodily injury arises out of the maintenance or use of the converted vehicle. This does not apply 1O you or any relative. 3. TO ANY PERSON WHO OWNS A CUR- REN'IL Y REGISTERED MOTOR VEHI. CLE AND DOES NOT HA VE THE REQUIRED FINANCIAL RESPONSmIL- ITY, EVEN IF mAT PERSON IS OCCU- PYING OR STRUCK BY A MOTOR VEHICLE FOR WHICH FINANCIAL RE- SPONSIBILITY IS PROVIDED. This does not apply to you or your spouse while occu. pying a vehicle insured under the liability coverage of this policy or when struck as a pedestrian. 4. TO ANY PERSON WHILE OPERATING OR OCCUPYING: a. A RECREATIONAL VEHICLE NOT INTENDED FOR mGHW A Y USE; OR b. A MOTORCYCLE, MOTOR-DRIVEN CYCLE, MOTORIZED PEDALCYCLE OR LIKE TYPE VEHlCLEREQUIRED TO BE REGISTERED UNDER TITLE 75 OF TIm PENNSYLVANIA CON. SOLIDA1ED STATUTES. Mental or Physical Examination Whenever the mental or physical condition of a per- son is material to any claim for medical expenses or income loss benefits, a court of competent jurisdic- tion may order the person to submit to mental or physical examination by a physician. If a person fails to comply with the order, the court may order 16 8386 that the person be denied benefits until he or she complies. COMBrnEDBENE~S-COVERAGEM- This coverage applies to the vehicles for which "M" appears in the "Coverages" space on the declarations page. What We Pay We will pay for bodUy injury to an insured arising out of the maintenance or use of a motor vehkle: I. Medical expenses as payable under Coverage C2: 2. Income loss benefits as payable under Cover- ageZ; 3. The benefits as payable under Coverage Y3; and 4. Funeral expenses as payable under Coverage F. Limits or LiabiUty I. The aggregate limit of liability is shown on the declarations page under ''Limit of Liability - Coverage M - Each Person". This is the maxi- mum amount payable for bodUy injury to an insured as the result of an accidenL 2. The most we will pay to or for an insured is as follows: Benefit Medical Expenses Limit Up to the Aggregate Limit Up 1O the Aggregate Limit $25,000 Up to $2,500 Income Loss Death Funeral Expenses 3. Any amount payable for medical expenses greater than $100.000 shall be excess over any amount paid or payable under Exuaordinary Medical Payments - Coverage Q. Time Limitation Subject to the limit of liability: 1. benefits are only payable for expenses and ~ , 1,-...- __..' ,} _ "'~","," .f.'-,,,,',, ~~ _";''''', loss incurred up 1O three years from the date of the accidenL 2. the death benefit is payable only if death occurs within three years of the date of the accident. Other Provisions Except as amended above, all provisions relating to Coverages C2, Z, Y and F apply to expense, loss or death benefits of Coverage M. 17 8386 SECTION III - UNINSURED MOTOR VEHICLE AND UNDERINSURED MOTOR VEHICLE COVERAGES UNINSURED MOTOR VEHICLE - COVERAGES U (STACKING OPTION) AND U3 (NON-STACKING OPTION) Uninsured MOlOr Vehicle - Coverage U applies to the vehicles for which "U" appears in the "Cover. ages" space on the declarations page. Uninsured Motor Vehicle - Coverage U3 applies 1O the vehicles for which "U3" appears in the "Cover. ages" space on the declarations page. Coverages U and U3 We will pay damages for bodily injury an insured is legally entitled 1O collect from the owner or driver of an uninsured motor vehicle. The bodily injury must be sustained by an ins ured and caused by accident arising out of the ownership, maintenance or use of an uninsured motor vehicle, The amount we will pay for damages is subject to the limitations of Tille 75 of the Pennsylvania Consoli- dated Statutes. Uninsured Motor Vehicle - means: I. a land motor vehicle, the ownership, mainte. nance or use of which is: a. not insured or bonded for bodily injury liability at the time of the accident; or b. insured or bonded for bodily injury liabil. ity at the time of the accident; but (1) the limits of liability are less than required by the fmancial responsibil. ity act of the state where your Cllr is mainly garaged; or (2) the insuring company denies cover. age or is or becomes insolvent; or 2. an unidentified land motor vehicle whose owner or driver remains unknown and causes bodily injury to the insured. An uninsured motor vehicle does not include a land motor vehicle: I. insured under the liability coverage of this policy; 2. furnished for the regular use of you, your spouse or any relative; 3. owned or operated by a self-insurer under any motor vehicle financial responsibility law, a motor carrier law or any similar law; 4. owned by any govemment or any of its politi- cal subdivisions or agencies; 5. designed for use mainly off public roads ex. cept while on public roads; or 6. while located for use as a dwelling or other premises. UNDERINSURED MOTOR VEHICLE - COVERAGES W (STACKING OPTION) AND W3 (NON-STACKING OPTION) Underinsured Motor Vehicle - Coverage W applies to the vehicles for which "W" appears in the "Cov. erages" space on the dec1arations page. Underinsured Motor Vehicle - Coverage W3 applies to the vehicles for which "W3" appears in the....Cov. erages" space on the declarations page. Coverages Wand W3 We will pay damages for bodUy injury an insured ~ legally entitled 1O collect from the owner or driver of an underinsured motor vehicle. The bodily injUTJ must be sustained by an insured and caused by acci- dent arising out of the ownership, maintenance or uS( of an underinsured motor vehicle. The amount we will pay for damages is subject to thf limitations of Title 75 of the Pennsylvania Consoli- dated Statutes. THERE IS NO COVERAGE FOR BODILY IN- JURY ARISING OUT OF TIlE OWNERSHIP MAINTENANCE OR USE OF AN UNDERIN SURED MOTOR VEHICLE UNTIL: 18 8386 1. THE LIMITS OF LIABILITY OF ALL BODILY INJURY LIABILITY BONDS AND POLICIES THAT APPLY HAVE BEEN USED UP BY PA YMENTOF JUDG- MENTS OR SETI1.EMENTS TO OTHER PERSONS; OR 2. SUCH LIMITS OF LIABILITY OR RE- MAINING PART OF THEM HAVE BEEN OFFERED TO THE INSURED IN WRIT- ING. Underinsured Motor Vehicle - means a land motor vehicle: I. the ownership, maintenance or use of which is insured or bonded for bodily injury liability at the time of the accident; and 2. whose limits of liability for bodily injury liability: a. are less than the amount of the insured's damages; or b. have been reduced by payments to per. sons other than the insured to less than the amount of the insured's damages. An underinsured motor vehicle does not include a land motor vehicle: 1. insured under the liability coverage of this policy; 2. furnished for the regular use of you, your spouse or any relative; 3. owned by any govemment or any of its politi- cal subdivisions or agencies; 4. while located for use as a dwelling or other premises; S. designed for use mainly off public roads ell" cept while on public roads: or 6. defined as an uninsured motor vehicle in your policy. Who Is an Insured - Coverages U. U3. Wand W3 Insured - means the person or persons covered by uninsured motor vehicle or underinsured motor vehi- cle coverage. This is: 1. the fl1'st person named in the declarations; 2. his or her spouse; 3. their relatives; and 4. any other person while occupying: a. your car, a temporary substitute car, a newly acquired car, or a trailer attached 1O such a car. Such vehicle has to be used within the scope of the consent of you or your spouse; or b. a car not owned by you, your spouse or any relative, or a trailer attached to such a car. It has to be driven by the flrst person named in the declarations or that person's spouse and within the scope of the owner's consent Such other person occupying a vehicle used to carry persons for a charge is not an in- sured. 5. any person entitled to recover damages be- cause of bodily injury to an insured under 1 through 4 above. Deciding Fault and Amount - Coverages U, U3, Wand W3 Two questions must be decided by agreement be- tween the insured and us: I. Is the insured legally entitled to collect com- pensatory damages from the owner or driver of an uninsured motor vehicle or underin- sured motor vehicle; and 2. If so, in what amount? If there is no agreement, these two questions shall be decided by arbitration at the request of the insured or us. The arbitrators' decision shall be limited to these two questions. The arbitrators shall not award dam- ages under this policy which are in excess of the limilS of liability of this coverage as shown on the declarations page. The Pennsylvania Uniform Arbi- tration Act, as amended from time to time, shall apply. 19 8386 Each party shall select a competent arbiuator. These two shall select a competent and impartial third arbi- trator. If unable to agree on a third one within 30 days, either party may request a judge of a court of record in the county in which !he arbitration is pending t9 select a third one. The written decision of any two arbittators shall be binding on each party. The cost of the arbitrator and any expen willless shall be paid by the party who hired them. The cost of the third arbiirator and other expenses of arbitration shall be shared equally by both panies. The arbitration shall take place in the county in which . the insured resides unless the panies agree to another place. We have the right to obtain statements under oath from the insured, Payment or Any Amount Due - Coverages U. U3, Wand W3 We will pay any amount due: 1. to the insured; 2. 1O a parent or guardian if the insured is a minor or an incompetent person; 3. to the surviving spouse; or 4. to a person authorized by law to receive such paymenL Trust Agreement - Coverages U and U3 1. We are entitled to repayment of the amount we have paid from the proceeds of any recovery the insured makes from any party liable for the bod- ily injury. 2. If the insured has not recovered from the party at fault. he or she shall: a. keep these rights in trust for us; b. execute any legal papers we need; and c. when we ask, take action through our repre- sentative to recover our payments. We are to be repaid our payments, costs and fees of collection out of any recovery. t..,;., . . .~ ", ..I. e 'lA' '^' J'-' '~ Trust Agreement - Coverages Wand W3 I. We are entitled, to the extent of our payments,tp the proceeds of any settlement the insuredrecov- ers from any party liable for the bodily illiury, other than payments from bodily injury liability bonds or policies made prior to our paymenL 2. If the insured has not been fully compensated for the bodily injury by the party at feult and we make payment for the bodUy injury, the insured shall: a. keep these rights in trust for us; b. execute any legal papers we need; and c. when we ask. take action through our repre- sentative to recover the amount of our pay- ments. ' We are to be repaid our payments. costs and fees of collection out of any such recovery. Limits or Liability - Coverages U and U3 1. The amount of coverage is shown on the decla- rations page under "Limits of Liability - U - Each Person, Each Accident" or "Limits of Li- ability - U3 - Each Person, Each Accident". Under "Each Person" is the amount of coverage for all damages due to bodily injury 1O one per- son. "Bodily injury 1O one person" includes all injury and damages to others resulting from this bodUy injury. Under "Each Accident" is the total amount of coverage, subject to the amount shown under "Each Person", for all damages due to bodily injury to two or more persons in the same accidenL 2. Any payment made to a person under this cov- erage shall reduce any amount payable to that person under the bodily injury liability cover- age. 3. The limits of liability are not increased because: a. more than one person is insured, at the time of the accident; or b. more than one uninsured motor vehicle is involved in the same accident 20 8386 ........... 4. Any amount payable under this coverage shall be reduced by any amount paid or payable to or for the insured: a. by or for any person or organization who is or may be held legally liable for the bOdily injury to the insured; or b. for the bodily injury under the liability cov- erage. 5. This coverage shall be excess over and shall not pay again any amount paid or payable to or for the insured under any worker's compensation, disability benefits or similar law. Limits or Liability - Coverage U3 The limits of liability are not increased because more than one vehicle is insured under this policy. Limits or Liability - Coverages Wand W3 I. The amount of coverage is shown on the decla- rations page under "Limits of Liability - W - Each Person, Each Accident" or "Limits of Li- ability - W3 - Each Person, Each Accident". Under "Each Person" is the amount of coverage for all damages due to bodily injury to one per. son. "Bodily injury to one person" includes all injury and damages to others resulting from this bodily injury. Under "Each Accident" is the total amount of coverage, subject to the amount shown under "Each Person", for all damages due 1O bodily injury to two or more persons in the same accidenL 2. The limits of liability are not increased because: a. more than one person is insured at the time of the accident; or b. more than one underinsured motor vehicle is involved in the same accident 3. The most we pay will be the lesser of: a. the difference between the amount of the insured's damages for bodily injury, and the amount paid to the insured by or for any person or organization who is or may be held legally liable for the bodily injury; or b. the limits of liability of this coverage. 4. This coverage shall be excess over and shall not pay again any amount paid or payable to orfor the insured ,under any worker's compensation, disability benefits or similar law. Limits or Liability - Coverage W3 The limits ofliability are not increased because more than one vehicle is insured under this policy. When CoveragesU, U3, Wand W3 Do Not Apply THERE IS NO COVERAGE UNDER COVER- AGES U, U3, W AND W3: I. FOR ANY INSURED WHO, wrrnOUT OUR WRITTEN CONSENT, SETTLES WITH ANY PERSON OR ORGANIZA- TION WHO MAY BE LIABLE FOR THE BODILY INJURY AND nIEREBY IM- PAIRS OUR RIGHT TO RECOVER OUR PAYMENTS. 2. TO THE EXTENT IT BENEFITS: a. ANY WORKER'S COMPENSATION OR DISABILITY BENEFITS INSUR- ANCE COMPANY. b. A SELF-INSURER UNDER ANY WORKER'S COMPENSATION, OR DISABILITY BENEFITS OR SIMILAR LAW. 3. FOR PAIN, SUFFERING OR OTHER NONMONETARY DAMAGES SUS- TAINED BY AN INSURED IF THE BOD- ILY IN/URYIS NOT A SERIOUS IN/URY AND THE LIMITATION OF SECTION 173l(d)(2) OF TITI..E 75 OF THE PENN- SYLVANIA CONSOLIDATED ST AT- UTES APPLIES. THERE IS NO COVERAGE FOR BODILY IN. JURY TO AN INSURED UNDER COVERAGE U3: 1. WHILE OCCUPYING A MOTOR VEID- CLE OWNED BY YOU, YOUR SPOUSE OR ANY REIATIVE IF IT IS NOT IN- SURED FOR TIllS COVERAGE UNDER TIllS POLICY; OR 21 8386 ~ 2. TIlROUGH BEING SmUCK BY A MO- TOR VEHICLE OWNED BY YOU, YOUR SPOUSE OR ANY RELATIVE. THERE IS NO COVERAGE FOR BODILY IN- JURY TO AN INSURED UNDER COVERAGE W3: 1. WHILE OCCUPYING A MOTOR van- CLE OWNED BY rou, YOUR SPOUSE OR ANY RELATIVE IF IT IS NOT IN- SURED FOR TInS COVERAGE UNDER TInS POLICY; OR 2. TIlROUGH BEING smUCK BY A MO- TOR VEHICLE OWNED BY YOU, YOUR SPOUSE OR ANY RELATIVE. H There Is Other Coverage - Coverage U If the insured sustains bodily injury: 1. while occupying your car and your car is described on the declarations page of another policy providing uninsured motor vehicle coverage, or as a pedestrian, we are liable only for our share. Our share is that per cent of the damages that the limit ofliability of this coverage bears to the total of all' uninsured motor vehicle coverage that applies to the accident. 2. while occupying a vehicle which is not your car, this coverage applies as excess to any other uninsured motor vehicle coverage. If coverage under more than one policy ap- plies as excess, we are liable only for our share. Our share is that per cent of the dam. ages that the limit of liability of this coverage beats to the total of all uninsured motor vehi. cle coverage applicable as excess to the acci- dent. If There Is Other Coverage - Coverage U3 1. If the insured sustains bodily injury as a pedes- trian and other uninsured motor vehicle coverage applies: a. the total limits of liability under all such coverages shall not exceed that of the cover- age with the highest limit of liability; and ,-;e',. 'L;,.c~,_j ',- !i- b. we are liable only for our share. Our share is that per cent of the damages that the limit of liability of this coverage bears to the total of all uninsured motor vehicle coverage appli- cable to the accident. 2. If the insured sustains bodily injury while occu- pying your car, and your car is described on the declarations page of another policy providing uninsured motor vehicle coverage: a. the total limits of liability under all such coverages shall not exceed that of the cover- age with the highest limit of liability; and b. we are liable only for our share. Our share is that per cent of the damages that the limit of liability of this coverage bears to the total of all such uninsured motor vehicle coverage applicable to the accident. 3. If the insured sustains bodily injury while occu- pying a vehicle not owned by you, your spouse or any relative, and: a. such vehicle is described on the declarations page of another policy providing uninsured motor vehicle coverage, or b. its driver, other than you, your spouse or any relative, is an insured under another policy, this coverage applies: a. as excess to any uninsured motor vehicle coverage which applies to the vehicle or driver, but b. only in the amount by which it exceeds the primary coverage. If coverage under more than one policy applies as excess: a. the total limit of liability shall not exceed the difference between the limit of liability of the coverage that applies as primary and the high- est limit of liability of anyone of the cover- ages that apply as excess; and b. we are liable only for our share. Our share is that per cent of the damages that the limit of liability of this coverage bears to the total of 22 8386 ~~, .'. .~" all uninsured motor vehicle coverage appli- cable as excess to the accidenL 4. If the insured sustains bodily injury while occu. pying a vehicle not owned by you, your spouse or any rellltive, and: a. such vehicle is not described on the declara- tions page of another policy providing unin- sured motor vehicle coverage; and b. its driver is: (I) you, your spouse or any relative; or (2) any other person not insured under an- other such policy, then: a. the total limits ofliability under all applicable policies issued by us shall not exceed that of the one with the highest limit of liability; and b. we are liable only for our share. Our share is that per cent of the damages that the limit of liability of this coverage bears to the total of all uninsured motor vehicle coverage appli- cable to the accidenL ' 5. TInS COVERAGE DOES NOT APPLY IF THERE IS OTIiER UNINSURED MOTOR VE- HICLE COVERAGE ON A NEWLY AC. QUIRED CAR. I/'Tbere Is Other Coverage - Coverage W If the insured sustains bodily injury: I. while occupying your car and your car is described on the declarations page of another policy providing underinsured motor vehicle coverage, or as a pedestrian, we are liable only for our share. Our share is that per cent of the damages that the limitofliability of this coverage bears to the lOtal of all underinsured motor vehicle coverage that applies to the accident. 2. while occupying a vehicle which is not your car, this coverage applies as excess to any other underinsured motor vehicle coverage. If coverage under more than one policy ap- plies as excess, we are liable only for our 23 8386 , . .~ -, . ,- share. Our share is that per cent of the dam- ages that the limit of liability of this coverage bears to the total of all underinsured motor vehicle coverage applicable as excess to the accidenL I/'There Is Other Coverage - Coverage W3 I. If the insured sustains bodily injury as a pedes_ trian and other underinsured motor vehicle cov- erage applies: a. the total limits of liability under all such coverages shall Dot exceed that of the cover- age with the highest limit of liability; and b. we are liable only for our share. Our share is that per cent of the damages that the limit of liability of this coverage bears to the total of all underinsured motor vehicle coverage ap- plicable to the accideDL 2. If the insured sustains bodily injury while occu- pying your CIlr, and your car is described on the declarations page of another policy providing underinsured motor vehicle coverage: a. the total limits of liability under all such coverages shall not exceed that of the cover- age with the highest limit of liability; and b. we are liable only for our share. Our share is that per cent of the damages that the limit of liability of this coverage bears to the total of all such underinsured mOlOr vehicle coverage applicable to the accidenL 3. If the insured sustains bodily injury while occu- pying a vehicle not owned by you, your spouse or any relative, and: a. such vehicle is described on the declarations page of another policy providing underin- sured motor vehicle coverage, or b. its driver, other than you, your spouse or any relative, is an insured under another policy, this coverage applies: a. as excess to any underinsured motor vehicle coverage which applies to the vehicle or driver, but ~-. . b. only in the amount by which it exceeds the primary coverage. If coverage under more than one policy applies as excess: a. the total limit of liability shall not exceed the difference between the limit of liability of the coverage that applies as primary and the high- est limit of liability of anyone of the cover- ages that apply as excess; and b. we are liable only for our share. Our share is that per cent of the damages that the limit of liability of this coverage bears to the total of all underinsured motor vehicle coverage ap- , plicable as excess to the accident 4. If the insured sustains bodily injury while occu- pying a vehicle not owned by you, your spouse or any relative, and: a. such vehicle is not described on the declara- tions page of another policy providing under- insured motor vehicle coverage; and b. its driver is: (I) you, your spouse or any relative; or (2) any other person not insured under an. other such policy, -'--"-'--'-""< -,': --:--, .~ '-'{--Ie then: a. the total limits ofliability under all applicable policies issued by us shall not exceed that of the one with the highest limit of liability: and b. we are liable only for our share. Our share is that per cent of the damages that the limit of liability of this coverage bears to the total of all underinsured motor vehicle coverage ap- plicable 1O the accidenL 5. TIllS COVERAGE DOES NOT APPLY IF THERE IS OTIiER UNDERINSURED MO- TOR VEHICLE COVERAGE ON A NEWLY ACQUIRED CAR. Consent to Be Bound - Coverages U. U3, Wand W3 Any judgment for damages arising out of a suit broughl withoUI our written consenl is not binding on us unless we: 1. receive reasonable notice of the pendency of the suit resulting in the judgment; and 2. have a reasonable opponunity to protect our interest in the suiL 2A 8386 . ~ ~^ , . "'. ~ , ~, SECTION IV - PHYSICAL DAMAGE COVERAGES Loss - means, when used in this section, each dircct and accidental loss of or damage to: 1. your car, 2. its equipment; or 3. clothes and luggage insured. Equipment means equipment common to the use of the motor vehicle as a vehicle. It also includes a detachable living quarters unit if you told us about it before the loss and paid any extra premium needed. COMPREHENSIVE - COVERAGE D. This coverage applies to the vehicles for which "D" appears in the "Coverages" space on the declara- tions page. If a deductible applies the amount is shown on the declarations page for the vehicle to which it applies. 1. Loss to Your Car. We will pay for loss to your ClIT EXCEPT WSS BY COUJSION but only for the amount of each such loss in excess of the deductible amount, if any. Breakage of glass, or loss caused by missiles, falling objects, fire, theft, larceny, explosion, earthquake, windstorm, hail, water, flood, malicious mischief or vandalism, riot or civil commotion, is payable under this coverage. Loss due to hitting or being hit by a bird or an animal is payable under this coverage. 2. We will repay you for transportation costs if yourCllT is stolen. We will pay up to $16 per day for the period that begins 48 hours after you tell us of the theft. The period ends when we offer to pay for the loss. COLLISION - COVERAGE G. This coverage applies 1O the vehicles for which "0" appears in lhe "Coverages" space on the declarations page. The deductible amount is shown on the declarations page for the vehicle to which it applies. We will pay for loss to your car caused by collision but only for the amount of each such loss in excess of the deductible amount. Collision - means your car upset or hit or was hit by a vehicle or other object. Clothes and Luggage - Comprehensive and Collision Coverages We will pay for loss to clothes and luggage owned by the first person named in the declarations, his or her spouse, and their relatives. These items have to be in or on your ClIT. Your ClIT has to be covered under this policy for: 1. Comprehensive, and the loss caused by fire, lightning, flood, falling objects, explosion, earthquake or thefl. If the loss is due to theft, YOUR ENTIRE CAR MUST HAVE BEEN STOLEN; or 2. Collision. and the loss caused by collision. We will pay up to S200 for loss to clothes and luggage in excess of any deductible amount shown for com- prehensi ve or collision. 5200 is the most we will pay in anyone occurrence even though more than one persall has a loss. This coverage is excess over any other coverage. Limit of Liability - Comprehensive and Collision Co\'erages The Iimil of our liabilily for loss lO property or any parl of it is the lower of: l. the actual cash value; or 2. the cost of repair or replacement. Actual cash value is determined by the market value, age and condition at the time lhe loss occurred. Any deductible amount that applies is then subtracted. The cost of repair or replacement is based upon one of the following: I. the cost of repair or replacement agreed upon by you and us; 2. a competitive bid approved by us; or 3. an estimate wriuen based upon the prevailing competitive price. The prevailing compeli- live price means prices charged by a majority 25 8386 of the repair market in the area where the car is to be repaired as determined by a survey made by us. If you ask, we will identify some facilities that will perform the repairs at the prevailing competitive price. We will in- clude in the estimate parts sufficient to restore the vehicle to its pre-loss condition. Any deductible amount that applies is then sub- tracted. Settlement or Loss - Comprehensive and Collision Coverages We have the right to settle a loss with you or the owner of the propeny in one of the following ways: 1. pay the agreed upon actual cash value of the propeny at the time of the loss in exchange for the damaged propeny. If the owner and we cannot agree on the actual cash value, either party may demand an appraisal as de- scribed below. If the owner keeps the dam- aged propeny, we will deduct its value after the loss from our paymenL The damaged propeny cannot be abandoned to us; 2. pay to: a. repair the damaged propeny or part, or b. replace the propeny or part. If the repair or replacement results in better- ment, you must pay for the amount of better- ment; or 3. return the stolen propeny and pay for any damage due to the theft, Appraisal under item I above shall be conducted according to the following procedure. Each pany shall select an appraiser. These two shall select a third appraiser. The written decision of any two appraisers shall be binding. The cost of the appraiser shall be paid by the party who hired him or her. The cost of the third appraiser and other appraisal expenses shall be shared equally by both parties. We do not waive any of our rights by agreeing to an appraisal. If you give us your consent, we may move the damaged prop- erty, at our expense, to reduce storage costs dur- 26 8386 "- ~",- ,~~ ., .-'-' -'".- ~ '-"',-,- .....cc',",,, -'-'.- -'~~";"..,;."," "~i$: ing the appraisal process. If you do not give us your consent, we will pay only the storage costs which would have resulted if we had moved lIie damaged property. The Settlement of Loss provision for comprehensive and collision coverages incorporates the Limit of Liability provision of those coverages. If we can pay the loss under either comprehensive or collision, we will pay under the coverage where you collect the mOSL When there is loss to your car, clothes and luggage in the same occurrence, any deductible will be ap- plied first to the loss to your car. You pay only one deductible. EMERGENCY ROAD SERVICE - COVER. AGE H. This coverage applies to the vehicles for which "H" appears in the "Coverages" space on the declarations page. We will pay the fair cost you incur for your car for: I. mechanical labor up to one hour at the place of its breakdown; 2. towing to the nearest place where the neces- sary repairs can be made during regular busi- ness hours if it will not run; 3. towing it out if it is stuck on or immediately next to a public highway; 4. delivery of gas, oil, loaned battery, or change of tire. WE DO NOTPA Y FOR TIiE COST OF THESE l1EMS. CAR RENTAL EXPENSE - COVERAGE R. This coverage applies to the vehicles for which "R" appears in the "Coverages" space on the declarations page. We will repay you up to $10 per day when you rent a car from a car rental agency or garage due to a loss to your car which would be payable under coverage D or G, staning: 1. when it cannot run due to the loss; or 2. if it can run, when you leave it at the shop for agreed repairs; and ending when: I. it has been repaired or replaced, or 2. we offer to pay for the loss, or 3. you incur 30 days rent, whichever comes first. Any car rent payable under coverage R is RE- DUCED TO THE EXTENT IT IS PAYABLE UN- DER COMPREHENSIVE. CAR RENTAL AND TRAVEL EXPENSES - COVERAGE RI. This coverage applies to \he ve- hicles for which "Rl" appears in the "Coverages" space on the declarations page. 1. Car Rental Expense. We will: a. repay you up to $16 per day when you rent a COT from a car rental agency or garage; or b. pay you $10 per day if you do not rent a CIU while your car is not usable due to a loss to your car which would bc payable under coverage D or G. This applies during a period starting: a. when your CIU cannot run due to the loss; or b. if your COT can run, when you leave it aL the shop for agreed repairs; and ending: a. when it has been repaired or replaccd, or b. (1) when we offcr La pay for the loss, if your COT is repairable, or (2) five days after we offer to pay for the loss, if: (a) your CIU was stolen and not re- covered, or (b) we declarc it a total loss, whichever comes first. ...~~,~ .~ ~- Any car rent payable under this coverage is REDUCED TO THE EXTENT IT IS PAY- ABLE UNDER COMPREHENSIVE. 2. Travel Expenses. If your COT cannotrun due to a loss which would be payable under cov- erage D or G more than 50 miles from home, we will repay you for expenses incurred by you, your spouse and any relative for: a. Commercilli transportation fares to con- tinue to your destination or home. b. Extra meals and lodging needed when the loss to your car causes a delay enroule. Thc expenses must be incurred between the time of the loss and your arrival aL your destination or home or by the end of \he fifth day, whichever occurs first c. Meals, lodging and commercial transpor. tation fares incurred by you or a person you choose to drive your car from the place of repair to your destination or home. 3. Rental Car - Repayment of Deductible Amount Expense. We will repay the ex- pense of any deductible amount you are reo quired to pay thc owner under comprehensive or collision cover.lge in effect on a substitute car rented from a car rental agency or garage. Total Amount of Expenses Payable - Coverage RI 1. The mOSL we will pay for the total of the "Car Rental Expensc" and "Rental Car - Repayment of Deductiblc Amount Expense" incurred in any one occurrence is $400. 2. The most we will pay for "Travel Expenses" incurred by all persons in anyone occurrence is $400. CAR RENTAL AND TRAVEL EXPENSES - COVERAGE RS. This coverage applies to the ve- hicles for which "R5" appears in the "Coverages" space on the declarations page. 1. Car Rental Expense. a. We will: 27 8386 (1) pay 80% of the rental charge when you rent a ClII' from a car rental agency or garage. ''Rental cb;l1'ge" means the daily rental rate plus charges for mileage and related taxes; or (2) pay you S 1 0 per day if you do not rent a car while your ClII' is not drivable due 10 a loss to your ClII' which would be payable under coverage D or G. b. Payment will be made for a period that: (1) starts: (a) when your ClII' is not drivable due 1O the loss; or (b) if your ClII' is drivable, when you leave it at the shop for agreed repairs; and (2) ends: (a) when your car has been repaired or replaced; or (b) when we offer to pay for the loss, if your ClII' is repairable but you choose to delay repairs; or (c) five days after we offer to pay for the loss if: (i) your ClII' was stolen and not recovered; or (ii) we declare that your car is a total loss; whichever comes flCSL Any car rent payable under this coverage is REDUCED TO THE EXTENT THAT PAYMENT IS MADE UNDER COMPRE- HENSIVE COVERAGE. 2. Travel Expenses. If your ClII' is not drivable due 1O aloss which occurs more than 50 miles from home and which would be payable un- der coverage D or G, we will pay you for expenses incurred by you, your spouse and any relotive for: ,,," ..J ." ~, ,. ~_ ,1 ,"" ,-- - ""~' ~ ,;'. -""; a. commercial transportation fares to con- tinue to your destination or home; b. extra meals and lodging needed when the loss to your car causes a delay enroute. The expenses must be incurred between the time of the loss and your arrival at your destination or home or by the end of the fifth day, whichever occurs flCSt; and c. meals, lodging and commercial transpor- tation fares incurred by you or a person you choose to drive your ClII' from the place of repair to your destination or home. 3. Rental Car - Repayment or Deductible Amount Expense. We will pay the expense of any deductible amount you are required to pay the owner under comprehensive or colli- sion coverage in effect on a substitute ClII' rented from a car rental agency or garage. Total Amount or Expenses Payable - Coverage R5 1. The most we will pay for "Car Rental Expense" incurred in anyone occurrence is $500. 2. The most we will pay for ''Travel Expenses" incurred by all persons in anyone occurrence is $400. 3. The most we will pay for "Rental Car - Repay- ment of Deductible Amount Expense" incurred in anyone occurrence is $400. Trailer Coverage 1. Owned Trailer Your trailer is covered: a. when it is described on the declarations page of the policy; and b. for the coverages shown as applying to iL 2. Non-Owned Trailer or Detachable Living Quarters Any physical damage coverage in force on your ClII' applies to a non-owned: a. trailer, if it is designed for use with a private passenger car, or 28 8386 _ H~ ~ ,,~.t-l.. b. detachabb living quarters unit used by the first person named in the declara. tions, his or ler spouse or their relatives. The most wewill pay under the comprehensive or collision ;overage for a loss to such non. owned rraileror unit is S5oo. A non-ownedrraileror detachable living quarters unit is one th:t: a. is not oWlCd by or registered in the name of: (I) you,>,ur spouse, any relative; (2) any otter person residing in the same house'old as you, your spouse or any relatip.; or (3) an elllloyer of you, your spouse or any retalill; and b. has not ben used or rented by or in the possession of you, your spouse or any rela- tive during any part of each of the last 21 or more comecutive days. The 21 day limit is multiplied by the number of vehicles de- scribed or. the declarations pages of all car policies imed by us under which you are insured; ard c. is not rentfd and used in connection with the employme1t or business of you, your spouse or any relaive. Coverage for the Use of Other Cars The coverages in litis section you have on your car extend 1O a loss to 8newly acquired car, a temporary substitute car or a /lOn.owned car. These coverages extend to a non-oWled car while it is driven by or in the custody of an i1rsured. insured - as used h this provision means: 1. the fITSt penon named in the declarations: 2. his or her sJouse; or 3. their reIativlS. WheD Coverages D" G, H, R, Rl and RS Do Not Apply THERE IS NO COVERAGE FOR: 1. A NON-OWNED CAR: _ .."__~ l - ..I' ~~,1 ~,<" a. IF THE DECLARATIONS STATE THE "USE" OF ALL OF YOUR CARS IS OTHER THAN PLEASURE AND BUSINESS; b. WHILE BEING REPAIRED, SER- VICED OR USED BY ANY PERSON WHILE THAT PERSON IS WORKING IN ANY CAR BUSINESS; OR c. WHILE USED IN ANY OTHER BUSI- NESS OR OCCUPATION. This does not apply to a private passenger car driven or occupied by the first person named in the declarations, his or her spouse or their relatives. 2. ANY VEHICLE WHILE: a. RENTED TO OTHERS; b. USED TO CARRY PERSONS FOR A CHARGE. This does not apply to the use on a share expense basis; OR c. SUBJECT TO ANY LIEN, LEASE OR SALES AGREE!v1ENT NOT SHOWN IN THE DECLARATIONS. 3. LOSS TO ANY VEHICLE DUE TO: a. TA~NGBYANYGO~MENTAL AUTHORITY; b. WAR OF ANY KIND; c. AND LIMITED TO WEAR AND TEAR, FREEZING, MECHANICAL OR E..ECTRICAL BREAKDOWN OR F All.URE. This does not apply when the loss is the result of a theft covered by this policy. Nor does it apply to emergency road service; OR d. CONVERSION, EMBEZZLEMENT OR SECRETION BY ANY PERSON WHO HAS THE VEHICLE DUE TO ANY LIEN , RENTAL OR SALES AGREEMENT. 4. TIRES unless: a. stolen, or damaged by fICe or vandalism; or 29 8386 b. other loss covered by this section happens at the same time. 5." TAPES OR DISCS FOR RECORDING OR REPRODUCING SOUND. 6. ANY RADAR DETECTOR. If There Is Other Coverage 1. Policies Issued by Us to You If two or more vehicle coverages provided by us 1O you apply 1O the same loss or occurrence, we will pay under the coverage with the highest limiL 2. Coverage Available From Other Sources Subject to item 1, if other coverage applies to the loss or expenses, we will pay only our share. Our share is that per cent the limit of liability of this policy bears to the total of all coverage that applies. ;:""'. . "I '" "-,,,. ~-" ,., -;::.o~,_, "', =_~, .,- :"-,, 3. Temporary Substitute Car, \lon-Owned Car or Trailer If a temporary substitute car,a non-owned car or trailer designed for use witba private passen- ger CIlr has other coverage on ,t, then this cover- age is excess. 4. Newly Acquired Car TInS INSURANCE DOES NOT APPLY IF THERE IS SIMILAR C07ERAGE ON A NEWLY ACQUIRED CAR. No Benefit to Bailee These coverages shall not benefitUlY carrier or other bailee for hire liable for loss. Two or More Vehicles If two or more of your CtUS are ilSured for the same coverage, the coverage applies sqlarately to each. 30 8386 . CONDITIONS I. Policy Changes a. Policy Terms. The terms of this policy may be changed or waived only by: (I) an endorsement signed by one of our executive officers; or (2) the revision of this policy form to give broader coverage without an extra charge. If any coverage you carry is changed to give broader coverage, we will give you the broader coverage with- out the issuance of a new policy as of thc date we make the change effective. b. Change orInterest. No change of interest in this policy is effective unless we consent in writing. However, if you die. we will protect as named insured, except under death, dis- memberment and loss of sight coverage: (I) your surviving spouse; (2) any person with proper custody of your CIlI', a newly acquired car or a temporary substitute CIlI' until a legal representativc is qualified; and then (3) the legal representative while acting within the scope of his or her duties. Policy notice requirements are mct by mail- ing the notice to the deceascd named in- sured's last known address. c. Consent or Beneficiary, Consent of the beneficiary under death, dismembermcnt and loss of sight coverage is not needcd to cancel or change the policy. d. Joint and Individual Interests. When thcre are two or more named insureds, each acts for all to cancel or change the policy. 2. Suit Against Us There is no right of action against us: a. until all the terms of this policy havc been met; and b. undcr the liability coverage, until the amount of damages an insured is legally liable to pay has been finally determined by: (1) judgment after actual trial, and appeal if any; or (2) agreement between the insured, the claimant and us. Bankruptcy or insolvency of the insured or his or her estate shall not relieve us of our obligations. c. undcr uninsured motor vehicle, underinsured motor vehicle or any physical damage cover- ages until 30 days after we get the insured's notice of accident or loss. 3. Subrogation The rights of recovery of the person to or for whom we paid pass to us to the extent of our paymcnts. That person shall: a. not hurt our rights to recover; and b. hclp us get our money back. Subrogation applies to all coverages except dcath, dismemberment and loss of sight cover- age. 4. Cancellation How You May Cancel. You may cancel your policy by notifying us in writing of the date 10 cancel, which must be later than the date you mail or dcliver it to us. We may waive these require- mcnts by confirming the date and time of cancel- lation to you in writing. How and When We May Cancel. We may cancel your policy by wriuen notice, mailed or dclivered to your last known address. The notice shall give the date cancellation is effective. If we cancel during the flCst59 days following the policy effective date, the cancellation notice will be mailed or delivercd 10 you at least 15 days before the cancellation effective date. 31 8386 After the policy has been in force for more lhan 59 days, any notice of cancellation will be mailed or delivered to you at lease a. 15 days prior to the effective date of the cancellation if such cancellation is because the premium was not paid; and b. 30 days prior to the effective date of the cancellation if such cancellation is because of any other reason. The mailing of the notice shall be sufficient proof of notice. Unless the policy is canceled within 59 days of its effective date, we will not cancel your policy before the end of the current policy period unless: a. you fail to pay the premium when due; or b. at any time during the policy period your driver's license was under suspension or revocation. If we send you a notice of can- cellation solely because your driver's license was suspended orrevoked due to your failure to respond to a citation, we will reinstate your policy to provide continuous coverage if you furnish to us, before the cancellation effective date, proof that you have: (I) responded to all citations; and (2) paid all fines and penalties in connection with them. Return or Unearned Premium. If you cancel. premium may be earned on a shon rate basis. If we cancel, premium will be earned on a pro-rat:! basis. Any unearned premium may be returned at the time we cancel or within a reasonable time thereafter. Delay in the return of unearned pre- mium does not affect the cancellation. .' ., ",., a . _~ . ,_., ,~,_ H,-"__' -~~;, 5. Renewal Unless we mail or deliver to you a notice 0[- cancellation or a notice of our intention not 1O renew the policy, we agree to renew the policy for the next policy period upon your payment of the renewal premium when due. It is agreed that the renewal premium will be based upon the rates in effect, the coverages carried, the applicable limits of liability, deductibles and other elements that affect the premium that apply at the time of renewal. Other elements that may affect your premium include, but are not limited to: a. drivers of your car and their ages and marital status; b. your car and its use; c. eligibility for discounts or other premium credits; d. applicability of a surcharge based either on accident history, or on other factors. A notice of our intention to not renew will be mailed or delivered to your last known address at least 60 days before the end of the current policy period. The mailing of it shall be sufficient proof of notice. 6. Change or Residence When we receive notice that the location of prin- cipal garaging of a vehicle described on the dec- larations page has been changed, we have the right to recalculate the premium based on the coverages and rates applicable in the new loca- tion. When the change of location is from one st:!te to another and you are a risk still acceptable to us at the time you notify us of the change, we shall replace this policy with the policy form currently in use in the new state of garaging. The word "state" means one of the United States of America, the District of Columbia or a province of Canada. I 32 8386 . . [ ,,-'" . ~'- .'-'"'--0'.-._' " MUTUAL CONDITIONS 1. Membership. The membership fees set out in this policy, which are in addition to the premi- ums, are not returnable but entitle the flCSt insured named in the declarations to insure one vehicle for any applicable coverage, and to insurance for any other ,"overage for which said fees were paid so long as: a. this company continues 1O write such covcr- ages; b. the vehicle to be insured meets the eligibilily requirements of the company; and c. the insured remains a risk desirable to the company. While this policy is in force, the fust insured named in the declarations is entitled to VOle at all meetings of members and to receive dividends the Board of Directors in its discretion may de- clare in accordance with reasonable classifica- tions and groupings of policyholders established by such Board. 2. No Contingent Liability. This policy is non- assessable. 3. Annual Meeting. The annual meeting of the mcmbcrs of the company shall be held at its home office at Bloomington, Illinois, on the second Monday of Junc at the hour of IO:()() A.M., unless the Board of Directors shall elect to change the timc and place of such meeting, in which case, but not otherwise, due notice shall be mailed each mcmber al the address disclosed in this policy at least 10 days prior thereto. In Willle5s Whereof, the State Farm Mutual Automobile Insurance Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois, and countersigned on the declarations page by a duly authorized representative of the Company. ~/~ SECRETARY C~Q.I.~~~~\.91" PRESIDENT 33 8386 ~ - . '", .~, Page No. WHAT IT IS AND WHERE YOU CAN FIND IT - THE INDEX 6 Reporting a Claim - Insured's Duties - What to do if you have an accident, claim or are sued. 3 Defined Words 5 Declarations Continued 5 When and Where Your Coverage Applies 6 Financed Vehicles - Coverage for Creditor Coverages 8 A - Liability - When there is damage to others. 12 C2 - Medical Payments - Pays for an insured's medical expenses. 12 Q - Extraordinary Medical Payments - Pays for an insured's medical expenses. 13 Z - Loss or Income - Pays income loss benefits to an insured. 14 Y - Death, Dismemberment and Loss of Sight - Pays for death of or cenain injuries to an insured. 14 IF - Funeral Benefits - Pays for an insured's funeral expenses. 16 M - Combined Benefits - Pays medical and funeral expenses, income loss benefits, and for death of or certain injuries to an insured. 18 U - Uninsured Motor Vehicle (Stacking Option) - When the other car or driver is not insured. 18 U3 - Uninsured Motor Vehicle (Non-Stacking Option) - When the other car or driver is not insured. 18 W - Under insured Motor Vehicle (Stacking Option) - When the other car or driver is underinsured. 18 W3 - Underinsured Motor Vehicle (Non-Stacking Option) - When the other car or driver is underinsured. 25 D - Comprehensive - When your car is damaged except by collision or upset Any deductible amounts are shown on the declarations page. 25 G - Collision - When your car is damaged by collision or upset. Deductible amounts are shown on the declarations page. 26 H - Emergency Road Service - When your car breaks down or needs a tow. 26 R - Car Rental Expense - When you need to rent a car because of damage to your car. 27 Rl, RS - Car Rental and Travel Expenses - When you need to rent a car and pay exua travel expenses because of damage to your car. Conditions 31 1. Policy Changes 31 2. Suit Against Us 31 3. Subrogation 31 4. Cancellation 32 5. Renewal 32 6. Change of Residence 33 Mutual Conditions Policy Form 9838.6 .", - _.,-~ ~- ".->-" ,--,-,,,".,- '. .!lith MARGOLIS EDELSTEIN PHILADELPHIA OFFICE THE CURTIS CENTER FOURTH FLOOR INDEPENDENCE SQUARE WEST PHILADELPHIA, PA 19108-3304 21501122-1100 FAX 21501122.1772 ATTORNEYS AT LAw DELAWARE COUNTY OFFICE 218 SOUTH ORANGE STREET MEDIA, PA 1_ 810.ssU311 FAX 810.ssU318 POST OFFICE BOX 932 HARRISBURG, PA 17108.0932 PITTSBURGH OfFICE 1500 GRANT BUILDING PITTSBURGH. PA 1~19-2203 412-28104258 FAX 412~.2380 STREET ADDRESS: 3510 TRINDLE ROAD CAMP HILL. PA 17011 71701175-8114 FAX 717.975-8124 NEW JERSEY OFFICE P.O. BOX 2222 218 HADDON AVENUE WESTMONT. NJ 08108-2888 8Oe..58-7200 FAX 809-858-1017 WRITER: ROLF E. KROU DIRECT E-MAIL: rkroll_2000@yahoo.com SCRANTON OFFICE THE OPPENHEIM BUILDING 408 LACKAWANNA AVENUE SUITE 3C SCRANTON. PA 18503 570-342-1231 FAX 570-342_1 June 21,2000 Dusan Bratic, Esquire 101 S. U.S. Route 15, Suite A Dillsburg, P A 17019 RE: Your ClieDt: State Farm's Insured: Our File No.: DODDa Shambaugh Ida E. Schutz 50100.4-0238 Dear Dusan: I am writing to formally advise you of my Entry of Appearance on behalf of State Farm in the underinsured motorist case asserted by your client, Donna Shambaugh. I am writing to advise that it is my understanding that your client has already been paid $25,000 by the liability carrier. It is also my understanding that on January 20, 1997, State Farm made an offer to your client of $2,500 to settle Ms. Shambaugh's underinsured motorist claim. It is my further understanding that on March 16, 1998, you rejected the offer of settlement but indicated that you would forward additional information. To date, no supplemental information is contained in the file. As this accident took place over seven years ago, I would greatly appreciate any supplemental medical records that you have regarding Ms. Shambaugh's claim. To expedite the movement of this case, I have enclosed herewith true and correct copies of record authorizations for the healthcare specialists who took pan in your client's care and treatment following the motor vehicle accident. These authorizations do not allow me to contact any of these providers directly, nor would I do so without your written consent. Funher, it is not my intention to contact these individuals. The sole and exclusive purpose for these authorizations is to ensure that we both have all records pertaining to your client's care and treatment both before and after the subject motor vehicle accident. To that end, I enclose record authorizations for the following: 1. Total Vision Care; 2. Nevyas Eye Associates; 3. Retina and Oculoplastic Consultants; and, 4. Thomas R. Pheasant. In addition to the foregoing, please provide an authorization for any emergency care rendered to your - client. The police report seems to indicate that some individuals were taken to the emergency room at Sacred Hean Hospital. If there was any emergency care or treatment rendered or for that matter, any care or treatment of any injuries to your client's head, I would appreciate you forwarding appropriate authorizations for those records as well. " _,v. --, <- , ,-, - . ~-, Dusan Bratic, Esquire June 21, 2000 Page Two I have selected James Nealon as my arbitrator and ask that you select an arbitrator within the next 30 days. These arbitrators can then select a neutral and we can move this case forward to arbitration. I would also like to schedule your client's statement under oath and respectfully request that you forward the executed authorizations to my office in accordance with your client's duties of cooperation outlined in the State Farm policy. By copy of this letter I have notified Mr. Nealon of my request that you select an arbitrator. Please have your arbitrator contact Mr. Nealon directly so that they may select a neutral. Should you have any questions concerning this or any other aspect of this case, please do not hesitate to contact me. ,AIiCer:, , // /' /~'/ ~ ' /1, ~ /. '..' / / ' '/ v Rolf. 011 REKljab Enclosures cc: James G. Nealon, Esquire , t" ,,, ',-'''' ,-,"",- .".'.- ,,,.,.. '-,' ~',,, MEDICAL INFORMATION RELEASE AUTHORIZATION TO: Retina and Oculoplastic Consultants, P.C. Pennview Place, 220 Grand Avenue Camp Hill, P A 17011 You are hereby authorized to discuss with and release to RolfE. Kroll, Esquire MARGOLIS EDELSTEIN P.O. Box 932 Harrisburg, PA 17108-0932 all medical information and records regarding your professional medical care and treatment of Donna Shambaugh, Social Security No. 220-34-2066, including, without limitation, all conversations, admission records, initial history and physical, progress notes, order sheets, medical sheets, nurses notes, copies of consultations, x-rays, emergency room notes, LV. anesthesia sheets, physician's office records, radiographic and computerized axial tomography films, and any other matter regarding any opinion, diagnosis or prognosis which you might have pertaining in any way to me. DATE: Donna Shambaugh A photocopy of this medical authorization shall be deemed as authentic as the original. " , ,~-" ""', 1,- ,_< "'_ _',-' ',,; - i:.. '~'-'i-.""_,-,,,c-- - '''-''':''-::i MEDICAL INFORMATION RELEASE AUTHORIZATION TO: Total Vision Care You are hereby authorized to discuss with and release to RolfE. Kroll, Esquire MARGOLIS EDELSTEIN P.O. Box 932 Harrisburg, P A 17108-0932 all medical information and records regarding your professional medical care and treatment of Donna Shambaugh, Social Security No. 220-34-2066, including, without limitation, all conversations, admission records, initial history and physical, progress notes, order sheets, medical sheets, nurses notes, copies of consultations, x-rays, emergency room notes, LV. anesthesia sheets, physician's office records, radiographic and computerized axial tomography films, and any other matter regarding any opinion, diagnosis or prognosis which you might have pertaining in any way to me. DATE: Donna Shambaugh A photocopy of this medical authorization shall be deemed as authentic as the original. ".,. ." ~ 0'"'_'" .'~""',~,',<"',,,","'-~, '~'"'J;; MEDICAL INFORMATION RELEASE AUTHORIZATION TO: Nevyas Eye Associates Two Bala Plaza, 333 City Line Avenue Bala Cynwyd, P A 19004 You are hereby authorized to discuss with and release to RolfE. Kroll, Esquire MARGOLIS EDELSTEIN P.O. Box 932 Harrisburg, P A 17108-0932 all medical information and records regarding your professional medical care and treatment of DOlUla Shambaugh, Social Security NQ. 220-34-2066, including, without limitation, all conversations, admission records, initial history and physical, progress notes, order sheets, medical sheets, nurses notes, copies of consultations, x-rays, emergency room notes, I.V. anesthesia sheets, physician's office records, radiographic and computerized axial tomography films, and any other matter regarding any opinion, diagnosis or prognosis which you might have pertaining in any way to me. DATE: DOlUla Shambaugh A photocopy of this medical authorization shall be deemed as authentic as the original. ',"''''- "M ,-' ,,," "," ~', ",. ;. .0" -' ", -;", ". "r{ MEDICAL INFORMATION RELEASE AUTHORIZATION TO: Thomas R. Pheasant Pennview Place, 220 Grand Avenue Camp Hill, P A 17011 You are hereby authorized to discuss with and release to RolfE. Kroll, Esquire MARGOLIS EDELSTEIN P.O. Box 932 Harrisburg, PA 17108-0932 all medical information and records regarding your professional medical care and treatment of Donna Shambaugh, Social Security No. 220-34-2066, including, without limitation, all conversations, admission records, initial history and physical, progress notes, order sheets, medical sheets, nurses notes, copies of consultations, x-rays, emergency room notes, LV. anesthesia sheets, physician's office records, radiographic and computerized axial tomography films, and any other matter regarding any opinion, diagnosis or prognosis which you might have pertaining in any way to me. DATE: Donna Shambaugh A photocopy of this medical authorization shall be deemed as authentic as the original. . .. ~,~' ,~ '" "" -', , ..' -~. ~,y--,-,-," ,'\"- ~..~x MARGOLIS EDELSTEIN PHILADELPHIA OFFICE THE CURTIS CENTER FOURTH FLOOR INDEPENDENCE SQUARE WEST PHILADELPHIA, PA 19108.3304 215-922.1100 FAX 215-922.1772 ATTORNEYS AT LAw DELAWARE COUNTY OFFICE 218 50UTH ORANGE STREET MEDIA. PA 19083 810-565-&311 FAX 610-5650&318 POST OFFICE BOX 932 HARRISBURG. PA 17108-ll932 PITTSBURGH OFFICE 1500 GRANT BUILDING PITTSBURGH. PA 15219-2203 412-28104258 FAX 412-842-2380 STREET ADDRESS: 3510 TRINDLE ROAD CAMP HILL. PA 17011 717-975-8114 FAX 717.9750&124 NEW JERSEY OFFICE P.O. BOX 2222 218 HADDON AVENUE WESTMONT, NJ 08108-21188 809-858-7200 FAX 809-858-1017 WRITER: ROLF E. KROLL DIRECT E~AIL: rkroll_2000@yahoo.com SCRANTON OFFICE THE OPPENHEIM BUILDING 409 LACKAWANNA AVENUE SUITE 3C SCRANTON. PA 18503 570-34204231 FAX 570-342-4841 August 7, 2000 Dusan Bratic, Esquire 101 S. U.S. Route 15, Suite A Dillsburg, PA 17019 RE: Your Client: State Farm's Insured: Our File No.: Donna Shambaugh Ida E. Schutz 50100.4-0238 Dear Dusan: On June 21, 2000, I wrote to you and provided you with record authorizations so that we could move this case forward. I have yet to receive the executed authorizations. Please provide them to me promptly so we can keep this matter moving forward. Also, by copy of this letter, I am requesting that you select an Arbitrator within the next 30 days or I will move the Court to select an Arbitrator for you. Please let me know if this request causes you or your client any undue hardship and I am sure we can work something out. However, I do wish to keep this case moving. !(f!t4< J#I '" fL~~i(i It REK/jab cc: James G. Nealon, Esquire ~I- '-"" " , .-' ~-' ., '=,--~~-~' ,- '-'- _-.c, <_ "',.- ,-.-:.-;.-",..;,;,:;. MARGOLIS EDELSTEIN PHILADELPHIA OFFICE THE CURTIS CENTER FOURTH FLOOR INDEP~NDENCE SQUARE WEST PHILADELPHIA, PA 19106-3304 215-92:-1100 FAX 215-922.1772 ATTORNEYS AT LAw DELAWARE COUNTY OFFICE 218 SOUTH ORANGE STREET MEDIA, PA 19083 810.se5oi311 FAX 810.se5oi318 POST OFFICE BOX 932 HARRISBURG. PA 17108.0932 PITTSBURGH OFFICE 1500 GRANT BUILDING PITTSBURGH. PA 15219-2203 412-281-4258 FAX 412-842-2380 STREET ADDRESS: 3510 TRINDLE ROAD CAMP HILL. PA 17011 717.975-8114 FAX 717.975-8124 NEW JERSEY OFFICE P.O. BOX 2222 218 HADDON AVENUE WESTMONT, NJ 0810_88 809-858.7200 FAX 609-858.101T WRITEIl: ROLF E. KROLL DIREC" E-MAIL: rkroll_2000@yahoo.com SCRANTON OFFICE THE OPPENHEIM BUILDING 409 LACKAWANNA AVENUE SUlTE3C SCRANTON. PA 18503 570-342-4231 FAX 570-342-4941 August 17,2000 Dusan Bratic, Esquire 101 S. U.S. Route 15, Suite A Dillsburg, P A 17019 RE: Your Client: State Farm's Insured: Our File No.: Donna Shambaugh Ida E. Schutz 50100.4-0238 Dear Dusan: It was nice seeing you at the call of the list. I understand you are having some logistical difficulty at your office. If you would like me to send the record authorizations to your client in the exact form that I forwarded them to you, I will be happy to do so if that will ease your administrative burden. Please let me know if there is any way I can help in moving this case forward. Sincerely, I, /. ~#2.~ /4:/ffF;/ ROl~~:~,j#/? REKljab " " ~. ., -I., "",'.1- "~l~ _..:o,~."i,'.~'_ :115' MARGOLIS EDELSTEIN tOPY , . PHILADELPHIA OFFICE THE CURTIS CENTER FOURTH FLOOR INDEPENDENCE SQUARE WEST PHIlADELPHIA, PA 1910.-3304 215-922-1100 FAX 215.922.1772 ATTORNEYS AT LAw DELAWARE COUNTY OFFICE 216 SOUTH ORANGE STREET MEDIA, PA 19083 610-565-8311 FAX 610-565-8318 POST OFFICE BOX 932 HARRISBURG. PA 17108.0932 PITTSBURGH OFFICE 1500 GRANT BUILDING PITTSBURGH, PA 15219.2203 412-281-4256 FAX412-<l42.2380 STREET ADDRESS: 3510 TRINDLE ROAD CAMP HILL, PA 17011 717-975-8114 FAX 717.975-8124 NEW JERSEY OFFICE P,O, BOX 2222 218 HADDON AVENUE WESTMONT, NJ 08108.2886 609-858-7200 FAX 609-858.1017 WRITER: ROLF E. KROLL DIRECT E~AIL: rkroll_2000@yahoo.com SCRANTON OFFICE THE OPPENHEIM BUILDING 409 LACKAWANNA AVENUE SUITE 3C SCRANTON. PA 18503 570-342-4231 FAX 570-342-4841 October 17, 2000 Dusan Bratic, Esquire 101 S. U.S. Route 15, Suite A Dillsburg, PA 17019 RE: Your Client: State Farm's Insured: Our File No.: Donna Shambaugh Ida E. Schutz 50100.4-0238 Dear Dusan: Enclosed please fmd a Petition for Appointment of Arbitrator that I am prepared to file with the Court. I will forego the filing of the Petition if you supply me with the executed medical record authorizations and the appointment of your arbitrator within the next ten days. I would like to avoid any unnecessary judicial intervention. REKljab Enclosure ". ^ ,.'n"" ' '_~"'"~^'~_"d._,O'_~' ~_",~_,,""._.,,~_).--~,~,___, _',_"~'_ . . CERTIFICATE OF SERVICE I, Jessica Bates, an authorized representative of Margolis Edelstein, hereby certifY that I have served a true and correct copy of the foregoing document upon all counsel and parties of record this /1-!J:;.day of November, 2000, by placing the same in the United States First Class Mail, postage prepaid, at Camp Hill, Pennsylvania, addressed as follows: Dusan Bratic, Esquire 101 S. U.S. Route 15, Suite A Dillsburg,PA 17019 By: 1:s~s ~atvJ _, .0, ;'.__ .-0.".".0, . _, " ." '". ___~", .. . CERTIFICATE OF SERVICE I, Jessica Bates, an authorized representative of Margolis Edelstein, hereby certifY that I have served a true and correct copy of the foregoing document upon all counsel and parties of record this ~ay of November, 2000, by placing the same in the United States First Class Mail, postage prepaid, at Camp Hill, Pennsylvania, addressed as follows: Dusan Bratic, Esquire 101 S. U.S. Route 15, Suite A Dillsburg, PA 17019 By: ~~~ Je ica Bates ,'~' I . ....... '" '."~'~ 'j,,; "~'iC" '",.;.- - "'~~"''''>~''';'___'.;,_ ,'."C, ' DEe 0 7 200aj J~ STATE FARM INSURANCE COMP ANTES, Petitioner IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 00-8030 CNIL TERM v. CNIL ACTION - LAW DONNA SHAMBAUGH, Respondent JURY TRIAL DEMANDED ORDER AND NOW, this _ day of , 2000, upon consideration of the Petition of State Farm Insurance Companies, it is NOW AND HEREBY ORDERED that respectively, are hereby appointed as Respondent's and neutral arbitrators in this matter and that Respondent produce executed medical record authorizations to Petitioner forthwith. BY THE COURT: J. , I 1_>IIl ~~WjJ~-:&k';'f[,1jJfY~~t,~::~v(5:,fi~?i;';J:~3j:r*'7;j-z_if;it&e,;-',;;~);:A;,;;:i-~ - 1. .w ~::;~ "" ....t/l !i;'t/l~ 0'" , ~c::I~ a<l' III . t/l r\' . ". ~ 1lO!' o = tol ....r\'t/l ",(I>'" .... = 0....... \0 V"; . !D t/l = ". r\' !D ~ 0.1;.,'X'- - 'iJ' ---, ~(,) I Q1 , 0 ~~ r _ r z . 0 ~~ -ll " 0 o > =0 3: > ::0 )>Q ~ 0 o r II - z Ul '" ~ fTl ~ 0 fTl rr ~ Ul -l fTl Z /....-..'..','"''-''. ~/ ' 'Y,~\ I '1 "'~J ~ ]? 'J I ~ ) .~ I:::> .:;.) ''-~9 'l;'\.1,\~~ ,c. ,,'II, i r_l" '(>~\\\ U-'~\'1f.):r-:::':J I,:,~, \,. J,; ~!J C ~n '." " '..' t.:":') ,-\ .., U i I , , !I f: 1; ;'1 i~ f t w t I \': ;, 1:' 1r, 1," lIi Q.' :~; ,'1:0 i! ~!, ~ ! II , ! t! t'; II ~i I' I ~: " -j~7Alfr~%~.;:;;:,rY:;;;!ii'JJ,if&;.';:,;;1!;:&,t~&,nt~0t~i11l~;i~)';fl\~~:j~1qijf:, ~S~:~!>f~~;%Y}~~(?~{EiYt~,z;'U'~i1~;{f},~W:~~.~3;~~;~;':;}f::;11;),;;1;___ 1_ fY) i{ ;r. ::; .:..~~;::; .t '" ,~ e, ~'-J wi l:i ,f.~"'''''-''-=''''', f,~v\..o- '\ " \ -.i,:, i. .....~ ~ ~ -: '<1. ~ "" ' 'J' r:; . t.~- \:'~t! _._~.~/-I^' z w I- U) ~ ...J 0( W-l o ~ w Ul >- W U) z ...J ~ o ~ C)<( 0:: ~ L n <<,,~\t-~>}1 G) \ \ '"~'--"':\\'\ \\,"\,( \\1 oc.v;:o mOlo 3C;::;; "-1m I::::!, ... =::l ...., w- 0.. a "Om':- )>;:om ~ocn --.Jm..o oc..c ...J. ar ~ ~o 0" lr- ~~ c , Z .J - .J ~I o . in ~ t'J(j IhL LL ,.1_ . ';.r~'II'.--' ..-~i "'-'SI?;:-i;I~;f~'i~;.'fO-~1?iMi.1?j;-,'~,*'i:i~:$l{~'R~tK,:fu~jI5~T0;~~~~ '=' - , ~ IL ~.. ~, - ,- , ,"', , ,-, , 0 ,-~- " ... ROLF E. KROLL, ESQillRE Pa. Supreme Court LD. No. 47243 MARGOLIS EDELSTEIN Post Office Box 932 Harrisburg, Peunsylvania 17108-0932 Telephone: Fax: E-mail: [71 7] 975-8114 [71 7] 975-8124 rkrollliilmar!!olisedelstein.com Attorney for: Petitioner STATE FARM INSURANCE COMPANIES, Petitioner v. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA NO. DO - StilO C?c.c.:>~{ 'y-~ CNIL ACTIO~~iA W DONNA SHAMBAUGH, "* 7/ "'.v'l 1"":\ Respondent r I' u:l:I,- rY'. \ VR.lc.>e, Q~p J.J,ll, ~{} 17011 JURY TRIAL DEMANDED ~- PRAECIPE TO ISSUE WRIT OF SUMMONS TO THE PROTHONOTARY: Kindly issue a Writ of Summons to the Defendant in the above-captioned matter and transmit the Writ to the Sheriff of Cumberland County for service. Respectfully submitted, MARGQPS EDELSTEIN ~ By: , (RolfE. 011, squire AttorneyI.D. #47243 Post Office Box 932 Harrisburg, P A 17108-0932 (717) 975-8114 Attorney for Petitioner .' ,,~ '- - .. '" ,) ~'~'~ " ~ . CERTIFICATE OF SERVICE I, Jessica Bates, an authorized representative of Margolis Edelstein, hereby certifY that I have served a true and correct copy of the foregoing document upon all counsel and parties of record this ~ ~ day of November, 2000, by placing the same in the United States First Class Mail, postage prepaid, at Camp Hill, Pennsylvania, addressed as follows: ---*' Dusan Bratic, Esquire 101 S. U.S. Route 15, Suite A Dillsburg,PA 17019 :.j :,1 By: 1~li;~ &i= ySSlCa Bates ,~io---"~'~;'"""'" ~~":l1_'lill@~~~hW!",,,,*,,*.'.k0~~8;M',;t'W~if;.,,ill,i!~,","!i;,l*l;;.,'~~~~,~~iUs;1hIiIIi!:ildll lllt/' 'N" ,', .' ~~< .. d..-' _-', ',;J.;,.. ,..-'-.,.","_. .... ~ ~ ~ t.r A }.-o r~f "---< -.:z- r' f':\~ ~ "- '::::'r c.,- ....... ~ "Dv ~ 1: ~ .~ ft( ~ ~ ~ 0 , . -- g (3 () Cl 0 ~ l.i'- C a 'Tl B - I S z '0 t va::; 0 tJ' ~ ~ mm ~.:: ; I~r"-~ Z:rJ zr- .. ,,- ; - ('~ (j) )....,. -~ _:10 ~ -<~:':" ~j~~: r-::r--', ~'-~ :J::',.i-" ""'70 -,- ::5,:22 t-C) ---"-,, p(= s=: t:1rn L ~ =< .. fu -Xl -< ii'f:it~';'?P!,:l+-::itJ'.!~f(r~M,: ~~'-:"'f::,,~.t:;~,~!1.fl~~:,;,)~;~';~g ,,,J;JJ!r~!JCi"~' ,;-";.:; ,"",:r, ,", ",,.,\;-_ "W"" -" - , -~ ~ . Commonwealth of Pennsylvania County of Cumberland STATE FARM INSURANCE COMPANIES Court of Common Pleas w. No, ______QQ~_8_Q~Q_~JLyiJ__~~~_________ 19____ OONNA SHAMBAUGH 718 Meadow Drive Camp HIll, PA 17011 In _______~iyj.J_)1,9:ti.Q!L-__:wli.__mm___m__ To ____~~~_~~~~~_______________________ You are hereby notified that ________gt~jt~_F9L~_Jjl~gr~_QQ~_rJl~i~~---------------------_________________________________ the Plaintiff ha s commenced an action in __un____n.civiL 11<:'1:; QU_=-_.LaJol:.nn_nn_n_n_nnn against you which you are required to defend or a default judgment may be entered against you, (SEAL) Date curtis R. Long .------------------------------------------------ Prothonotary NOv~~L]._4.L_~Jl_Q.L lL__ ~__2.__??~ Deputy L:{-' ;"" '~~'-""_b-<. -, liItil~~~~ijll~i!l:Jif.{<dt"""i.~'!;'"';;'~"''-''-_''''~'i&,,,*"h;'1<t.;:,:;;~~il,;.i/.~" iIilltiilf'J.illl~::M' t",~~"..rnilfl'~2/;',;t:...m~1Ii!li~_ ~ir''''' 1 , ~ I -']H~'d" I 0-.]8 (fl f--lo . 0 I ~ -.]0 Of-' 'n ~ t;;~ I. Ii. t-h '... ~ 0 '" ...~ <: :Il~ 0 -.....]::It=Ul tt:l ... I '" 0' >< . f-' ~~i i 0:> I"'g r 0 0:>-.] "'~ 1i' .;~ W I--' NLQ w 0 > I--'"f:::r.~ t'00 rt .. ...w f-' ... ;;J~c: ~ 0 s ;;J f-' g ~ ... j - ... €a <: I 1-'<: l ... f-' t<:I : I -.][0 f-' -.] rn 0 f-' ..0 i .... f-' ~ 0 1:1 f-' 0:> t<:I g I 0 0 '" ~ w - N <D ~ I I H I t<:I I (fl "J.J'lIJlU n "~"~~~_., .,,~,w,~_,_ ~"",-.1i"':, .".,' _,."". ,_,\"C~""'" c. _ ,''''''-' "po, ._~" '.'_ -~,', - -~ '--'. -, "~ ill' """"""tk"""''''''.~'='- , "'~~ ., "" t .1 ~llli!b/l~'':f,~l SHERIFF'S RETURN - NOT FOUND CASE NO: 2000-08030 P COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND STATE FARM INSURANCE COMPANIES VS SHAMBAUGH DONNA R. Thomas Kline ,Sheriff or Deputy Sheriff, who being duly sworn according to law, says, that he made a diligent search and inquiry for the within named defendant, DEFENDANT SHAMBAUGH DONNA but was unable to locate Her in his bailiwick. He therefore returns the WRIT OF SUMMONS , NOT FOUND , as to the within named DEFENDANT , SHAMBAUGH DONNA VALID ADDRESS, HOWEVER DEFT. COULD NOT BE LOCATED PRIOR TQ EXPIRATION DATE OF 12/14/00, 6 ATTEMPTS. Sheriff's Costs: Docketing Service NOT FOUND RETURN Surcharge 18.00 9.30 5.00 10.00 .00 42.30 ~ So answe . ..:.___ ~ie - Sheriff of Cumberland County MARGOLIS, EDELSTEIN 12/14/2000 Sworn and subscribed to before me this If~ day of ~ d2.tnrO A.D. Q t2~- ~. i'1L -' .//,....... r~thonotary J "~ ",- "' --" l' . . TRUE COPVFROM RECORD In Testimony whereof, I here unto IllIl my hano and the seal of said Court at Carlll;e JIa ~s tt;:5, o!,1h) . .~~ ""OIftonotary Commonwealth of Pennsylvania County of Cumberland STATE FARM INSURANCE COMPANIES Court of Common Pleas VI. No, __m_QQ::-_8_Q~Q_~.iyjJ__'r~!llLmm_ 19_m DONNA SHAMBAUGH 7lB Meadow Drive Camp HIll, PA 17011 In _ ____ _ 5;.i yj.J"Jj,9.tj,.QD __-_ _ ~"'_______m_______ To ____~~~_~~~~~~_______________________ " You are hereby notified that ________~t~jt~_f~~_Jll~~<Yl~_~J2~i~~-----.------------------------------------------------ the Plaintiff ha S commenced an action in ____________.civil.Ac:tioo_=-_-LalAL______________________ against you which you are required to defend or a default judgment may be entered against you, (SEAL) Curtis R. Long .------------------------------------------------ Prothonotary Date NOv~mP_~L1__4.L_~.9_QL lL__ ~Dgt;--~~ L_~t~~\!m,i&r~Wi~OO&!'Jit~~M.!.iir*W.jI,;j;"Wt~_~_';'0,iJ;~0'Jl\t'~:"-<.t<j@."~i!.;",!j!>>..l"!lliJi.~I_lMk4Iil!lll~~!t!;:;JJ~~Ht:M ilI1ll1tLM: ,~ J/r'- ~.~ .....<. , ~ ... :'. -J'-: 1.. If , , , ~ , , , , -JHaf'tl::<l , 0-J8 , , I Ul , f-'. . 0 :0 ~ I , -J0110f-' ~ ~j I I I , , I . 11' Hl ,..... >-3 I '0 , '-0 .....f3l J<: l':I , 10 , -....J=#:Ul tr1 '....- ::atf I , U1 O"~. if-' , I I , I"'~ J ~~I i 1 100 , 1:>< , '0 , 00-J11'-O;:;: t"~ , ~f\.)1..Q w In I w I ~: ~4::0'" NO 'rt , 0 ...w f-' '..... 'tl0 ffi , ~: ;g f-' '0 :><11t:: ~ 1 0 1:0 1 ..... ji .....5l , <: , f-'<: c:: I f-' l':I i I -JCD ~ I ..... -J {Jl 0 1 f-' , f-' .0 Ii , , .... f-' , 0 == f-' I >-3 , 00 I CD , I I l':I 1 ~ 1 , 0 I 0 I , '-0 1 I I , ~ , W I 1 , tv , , - , , I <D !!i: I , , 1 1 , , I , , H 1 , l':I I I Ul ~ e:Y ~ !;;?C;! t..-,' !1.S'l-l1 i____- (~:' lVU, '...._l S~, ~,.;...-.. r;*~, ~-"-'~- !U"l.J': ~,=- @tJ J'u~ - ..,.~" .. ,,- -~ " ~~, ,~ .. ,0._ -,--, , ^,. "~""'~"",-. I I --~ m(j, , STATE FARM INSURANCE COMPANIES, Petitioner : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY, PENNSYLVANIA : NO, 00-8030 CIVIL TERM V. CIVIL ACTION - LAW DONNA SHAMBAUGH, Respondent JURY TRIAL DEMANDED ANSWER TO PETITION TO COMPEL APPOINTMENT OF ARBITRATOR AND NOW, comes Respondent, Donna Shambaugh, by and through her counsel Dusan Bratic in response to State Fann Insurance Companies' Petition to Compel Appointment of Arbitrator. 1. The Respondent hereby does appoint Charles E. Schmidt, Jr., Esquire, as its arbitrator. 2. The Respondent has no objection to the Court selecting a neutral arbitrator. 3. The Respondent has no duty to return executed medical authorizations, A full reading of the policy will indicate that on page 7 under paragraph 4d, wherein it states: "under the medical payments, funeral benefits, loss of income and death, dismemberment and loss of sight coverages:" that an authorization will be give to obtain all medical reports and records. This is a claim under the underinsured motorist portion of the policy and as such, medical authorizations are not required. Date/)..- ('/.. &1/ Dusan Bratic, Esq. AttorneyLD. 19249 101 South U.S. Route 15 Dillsburg, P A 17019 Attorney for Respondent ,-.- ~ ,- ) STATE FARM INSURANCE COMPANIES, Petitioner : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY, PENNSYLVANIA : NO. 00-8030 CIVIL TERM V. : CNIL ACTION - LAW DONNA SHAMBAUGH, Respondent : JURY TRIAL DEMANDED CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing Answer was furnished by U.S. Mail, first class, postage prepaid on this d day of December, 2000, to: RolfE. Kroll, Esquire P.O. Box 932 Harrisburg, P A 17108-0932 Date: It.~{ 'f-erv Dusan Bratic, Esq, Attorney J.D. 19249 101 South U.S. Route 15 Dillsburg, P A 17019 Attorney for Respondent . . "- ~~. ' -,~;" . , ,I, - ",-,- """".'_ c---;'_'." ~:, .' ROLF E. KROLL, ESQUIRE Pa. Supreme Court I.D. No. 47243 , MARGOLIS EDELSTEIN I'ost Office Box 932 Harrisburg, Pennsylvllnia 17108-0932 Telephone: [717] 975-8114 Fax: [717] 975-8124 E-mail: rkroIl!iil.marl!olisedelstein.com DEe 11) '/ Z~-J Attorney for: Petitioner Respondent l.) 0 0 c: c> -n IN THE COURT OF COM~ POOS ;tn OF CUMBERLAND CO~PEf;jNS\i~ NO. 00-8030 CIVIL TERM ~:i: en i3.6 !<: CJ -0 .':; =+1 CIVIL ACTION _ LAW d:;: G :x ee' n ~() r::- (~m Pc: '::~-t Z .". JURY TRIAL DEMANDED ::';! :i?- ~ STATE FARM INSURANCE COMPANIES, Petitioner v. DONNA SHAMBAUGH, PETITION TO COMPEL APPOINTMENT OF ARBITRATOR AND NOW, comes Petitioner State Farm Insurance Companies ("State Farm") by and through their counsel, Margolis Edelstein to compel the appointment of an arbitrator on behalf of Respondent Donna Shambaugh ("Ms. Shambaugh") and in support thereof avers the following: 1. At all times relevant hereto, Ms. Shambaugh was insured by Defendant State Farm and handled under State Farm claim number 20-2814-056 with insurance policy number 2812-142-D31-20B. A true and correct specimen policy is attached hereto as Exhibit "A." 2. On or about February 15, 1993, Ms. Shambaugh was injured in an automobile accident wherein State Farm's named insured Ida E Schutz was driving. 3. State Farm coverage for underinsured motorist benefits applies to Ms. Shambaugh as Ms. Shambaugh was a passenger in a vehicle owned and operated by State Farm's policyholder Ida E. Schutz. 4. The State Farm policy provides for arbitration in the event an amicable resolution cannot be reached. 5. State Farm has made numerous attempts to affect an amicable resolution with Defendant. To date these efforts have been to no avail. - , .0-_' _,~ .J... ii';-, 6. By letters dated June 21, 2000, August 7, 2000 and August 17, 2000, Petitioner, State Farm, has requested that Respondent select an arbitrator and comply with basic discovery obligations imposed upon her by the State Farm policy. To date these efforts have been met with no substantive response. True and correct copies of each of these letters are attached hereto as Exhibits B through D respectively. 7. In the June 21, 2000 letter, State Farm confirmed the current procedural posture of the case and confirmed that James Nealon, Esquire, had been appointed as State Farm's arbitrator in this matter. 8. By letter dated October 17,2000, State Farm's counsel provided Respondent's counsel with one last chance to comply with the basic obligations of selecting an arbitrator and supply State Farm with medical record authorizations. A true and correct copy of this letter is attached hereto as Exhibit E. 9. To date Respondent has failed to select an arbitrator much less a neutral arbitrator, has failed to return executed record authorizations and, therefore, has failed and refused to comply with his obligations in violation of the terms of the policy. WHEREFORE, Petitioner State Farm requests that this Honorable Court enter an Order selecting Respondent's arbitrator and a neutral arbitrator in this case within 30 days in accordance with the terms of the policy and Pennsylvania law, and that Respondent provide Petitioner with executed medical record authorizations forthwith. By: fE. 'Kro Attorney I. #47243 Post Office Box 932 Harrisburg, P A 17108-0932 (717) 975-8114 Attorney for Petitioner <1~:iFf@\ "'tl Q. o' '< cr ~ 3 CD CD W CD en -u o r - Q J..-""...,....,- fij;p l:!!] ~ ~~ mo ~ c · ~ JJ JJ s: ;e SO ::> III ::> - ~ (!) ~ ~ S)" -t 3 g "" rr ::::.. <D c: - c: . ~ o )> ::> c: <D _ en 0 6i 3 i' 0 ~ g: CD 3 o ::J ~. en <ll c: iil . ::J Cl (1 (!) o () 15 0 a. 3 ~-g <ll ::J ;,':< ~ ::I: ::> 0 % 3 Q'j (!) ::> iii' 0 - ::;; (Q o' tl (!) (Q . 8 OJ o 0' - 0 3 5' <C - o ::J -." . ...~- __~-'61" '. 5' o en' )> c: - ~ o ~ N' (!) c. ::Il CD '1:l al (Jl (!) ::J 1ii - <' (!) 0'"0 :I:Ir- m Olo zen mm O:C ,,~ 00 Coo( :Co nc >:c -'"0 S:O oC "n "00( nn mlo en:c ~~ 0:= z!< n, m_ ." -< eno Rk :J: :Clo m< '"Om ~lo :::!z zlo G)n loQ nO >~ --t s:- on zo en~ ~lo mn c-t 00< 00 cC -t:l:l men en-t :)lo ... zm -t" J:)> -;I; CIli: ch r-G, -If 3~ ,~ >,'- 2 ~386 "" , - -.ilL1\~' ,-, '-C', STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY BLOOMINGTON, ILLINOIS A MUTUAL COMPANY DEFINED WORDS' WHICH ARE USED THROUGHOUT THE POLICY We define some words to shorten the policy. This makes it easier to reaa and understand. Dermed words are printed in bold face italics. You can pick them out easily. BodUy Injury - means bodily injury to a person and sickness, disease or death which results from iL , Car :... means a land motor vehicle with four or more wheels. which is designed for use mainly on public roads. It does not include: I. any vehicle while located for use as a dwell- ing or other premises; or 2. a truck-tractor designed to pull a trailer or semitrailer. Car Business - means a business or job where the purpose is to sell, lease, repair, service, transpon, store or park land motor vehicles or trailers. Insured - means the person, persons or organization defined as insureds in the specific coverage. Loss - defined in Section IV. Newly Acquired Car - means a replacement car or an addilioTUll car. Replacement Car - means a car purchased by or leased to you or your spouse 1O replace your car. This policy will only provide coverage for the replacement car if you or your spouse: 1. tell us about it within 30 days after its delivery to you or your spouse; and 2. pay us any added amount due. AdditioTUll Car - means an added car purchased by or leased to you or your spouse. This policy will only provide coverage for the additioTUll car if: 1. it is a privDle passenger car and we insure all other privDle passenger cars; or 2. it is other than a private passenger car and we insure all Cll1'S owned by you or your spouse on the date of its delivery to you or your spouse. This policy provides coverage for the addilioTUll car only until the earlier of: I. 12:01 a.m. on the 31st day after the deliv- ery of the car to you or your spouse; or 2. the effective date and time of a policy issued by us or any other company that describes the car on its dec1arations page. However, you or your spouse may apply for coverage beyond the 30th day for the additioTUll car. Such coverage will be provided only if both you and the vehicle are eligible for coverage at the time of application. Non.OwnedCar- means a car not owned, registered or leased by: 1. you, your spouse; 2. any relative unless at the time of the accident or loss: a. the car currently is or has within the last 30 days been insured for liability cover- age; and b. the driver is an insured who does not own or lease the car; 3. any other person residing in the same house- hold as you, your spouse or any relative; or 4. an employer of you, your spouse or any rela- tive. Non-owned car does not include a: I. rented car while it is used in connection with the insured's employment or business; or 3 8386 2. car which has been operated or rented by or in the possession of an insured during any part of each of the last 21 or more consecutive days. The 21 day limit is multiplied by the number of vehicles described on the declara- tions pages of all car policies issued by us under which the insured is an insured. A non-owned car must be a car in the lawful posses- sion of the person operating it. Occupying - means in, on, entering Of alighting from. Person - means a human being. Pri~'ate Passenger Car - means a car: I. with four wheels: 2. of the private passenger or station wagon type; and 3. designed solely to carry persons and their luggage. Relative - as used in Sections I, IlI, IV and V means a person related to you or your spouse by blood, marriage or adoption who Jives with you. It includes your unmarried and unemancipated child away at school. See Section II for definition used there. Serious injury - means a pefsonal injury resulting in death, serious impairment of body function orperma- nent serious disfigurement. Unless the injury sust:lined is a serious injury, each person who is bound by the Jimited ton election shall be precluded from maintaining an action for any noneconomic loss, except that: (1) An individual otherwise bound by the limited ton election who sust:lins damages in a motor vehicle accident as the consequence of the fault of another person may recover damages as if the individual damaged had elected the full ton alternative when- ever the person at fault: (i) is convicted, or accepts Accelerated Reha- bilitative Disposition (ARD) fOf driving under the influence of alcohol or a controlled substance in that accident; ;C,. '.'<.-. -. ..t.Miij ;... ~, (ii) is operating a motor vehicle registered in another state; (iii) intends to injure himself or another person, provided that an individual does not intentionally injufe himself Of anothef person mefely because his act or failure to act is intentional or done with his realization that it creates a grave risk of caus- !n~ in j,Dry or the act or omission causing the injury IS fOf the purpose of aveningbodily harm to himself or another person; or (iv) has not maint:lined financial responsibility as required by Chapter 17 of Title 75 of the Pennsylvania Consolidated Statutes, provided that, nothing in this paragraph shall affect the limitation of section 173 I (d)(2) of Title 7S of the Pennsylvania Consolidated Statutes (relating to availability, scope and amount of coverage). (2) An individual otherwise bound by the limited ton election shall retain full tort rights with respect to claims against a person in the business of design- ing, manufacturing, repairing, servicing or otherwise maint:lining motor vehicles arising out of a defect in such motor vehicle which is caused by or not cor- rected by an act or omission in the course of such business, other than a defect in a motor vehicle which is operated by such business. (3) An individual otherwise bound by the limited ton election shall retain full ton rights ifinjured while an occupant of a motor vehicle other than a private passenger motor vehicle. Spouse - means your husband or wife while Jiving with you. Temporary Substitute Car - means a car not owned by you or your spouse, if it replaces your car for a shan time. Its use has to be with the consent of the owner. Your car has to be out of use due to its breakdown, repair, servicing, damage or loss. A temporary substitute car is not considered a non- owned car. Utility Vehicle - means a motor vehicle with: I. a pickup, panel or van body; and 2. a Gross Vehicle Weight of 10,000 pounds or less. i' f 4 8386 .........~- You or Your - means the named insured or named insureds shown on the declarations page. . , ~L ~ I .. -'.<-"- ",," "-.' '--'''W~ -- Your Car - means a car or a vehicle described on the declarations page. DECLARATIONS CONTINUED We, the State Farm Mutual Automobile Insurance Company. agree to insure you according to Lhe terms of this policy based: 1. on your payment of premium for the cover- ages you chose; and 2. in reliance on your statements in these decla- rations. You agree, by acceptance of this policy that: 1. the statements in these declarations are your statements and are true; and 2. we insure you on the basis your statements are true; and 3. this policy contains all of the agreements between you and us or any of our agents. Unless otherwise stated in the exceptions space on the declarations page, your statements are: 1. Ownership. You are the sole owner(s) of your car. 2. Insurance and License History. Neither you nor any member of your household within the past 3 years has had: ' a. vehicle insurance canceled by an insurer; or b. a license to drive or vehicle registration suspended, revoked or refused. 3. Use. Your car is used for pleasure and busi- ness. WHEN AND WHERE COVERAGE APPLIES When Coverage Applies The coverages you chose apply to accidents and losses that take place during the policy period. The policy period is shown under "Policy Pe- riod" on the declarations page and is for succes- sive periods of six months each for which you pay the renewal premium. Payments must be made on or before the end of the current policy period. The policy period begins and ends at 12:01 A.M. Standard Time at the address shown on the declarations page. Where Coverage Applies The coverages you chose apply: 1. in the United States of America, its territories and possessions or Canada; or 2. while the insured vehicle is being shipped between their ports. The liability, medical payments, funeral benefits, loss of income and physical damage coverages also apply in Mexico within 50 miles of the United States border. A physical damage coverage loss in Mexico is determined on the basis of cost at the nearest United States point. Uninsured motor vehicle, underinsured motor vehi- cle and death. dismemberment and loss of sight cov- erages apply anywhere in the world. 5 8386 ~. . - , ~. '" ,,',,-,.., "." " ' ""'_' '0 ~ FINANCED VEHICLES If a creditor is shown in the declarations, we may pay any comprehensive or collision loss to: 1. you and, if unpaid, the repairer; or 2. you and such creditor, as its interest may appear, when we fmd it is not practical to repair your car; or 3. the creditor, as to its interest, if your car has been repossessed. When we pay the creditor for loss for which you are not covered, we are entitled to the creditor's right of recovery against you to the extent of our payment. Our right of recovery shall not impair the creditor's right to recover the full amount of its claim. The coverage for the creditor's interest only is valid - until we terminate it. We will not terminate such coverage because of: 1. any act or negligence of the owner or bor- rower; or 2. a change in the ownership or interest un- known to us, unless the creditor knew of it and failed to tell us within 10 days; or 3. an error in the description of the vehicle. The date of termination of the creditor's interest will be at least 10 days after the dale we mail or electroni- cally transmit the termination notice. REPORTING A CLAIM - INSURED'S DUTIES 1. Notice to Us or an Accident or Loss The insured must give us or one of our agents written notice of the accident or loss as soon as reasonably possible. The notice must show: a. your name; and b. the names and addresses of all persons in- volved; and c. the hour, date, place and facts of the accident or loss; and d. the names and addresses of witnesses. 2. Notice to Us or Claim or Suit If a claim or suit is made against an insured, that insured must at once send us every demand, notice or claim made and every summons or legal process received. 3, Other Duties Under the Physical Damage Coverages When there is a loss, you or the owner of the propeny also shall: a. make a prompt report to the police when the loss is the result of theft or larceny. b. protect the damaged vehicle. We will pay any reasonable expense incurred to do it. c. show US the damage, when we ask. d. provide all records, receipts and invoices, or certified copies of them. We may make cop- ies. e. answer questions under oath when asked by anyone we name, as often as we reasonably ask, and sign copies of the answers. 4. Other Duties Under Medical Payments, Fu- neral Benefits, Loss or Income, Death, Dis- memberment and Loss or Sight, Uninsured Motor Vehicle and Underinsured Motor Ve- hicle Coverages The person making claim also shall: a. give us all the details about the death, injury, treatment and other information we need to determine the amount payable. b. under the uninsured motor vehicle and under- insured motor vehicle coverages: (I) consent to be examined by physicians chosen and paid by us as often as we 6 8386 reasopably may require. A copy of the repon will be sent to the person upon written request If the person is dead or unable 1O act, his or her legal repre- sentaPve shall authorize us to obtain all medical repons and records. (2) let us see the insured car the person oc- cupied in the accident. (3) send us at once a copy of all suit papers if the person sues the party liable for the accident for damages. c. under the uninsured motor vehicle coverage, repon an accident caused by an unidentified land motor vehicle to the police as soon as practicable and to us within 30 days or as soon as practicable. d under the medical payments, funeral benefits, loss of illcome and death, dismemberment and loss of sight coverages: (1) authorize us to obtain all medical repons and records. If the person is dead or unable to act, his or her legal repre- Cl.. _ n" ,-; ~- Li!lI!QIIIOj/!~rj sentative shal1 give us the authorization; and (2) give us proof of claim on forms we fur- nish unless we fail to supply them within IO days after receiving the notice of claim. 5. Insured's Duty to Cooperate With Us The insured shall cooperate with us and, when asked, assist us in: a. making setllements; b. securing and giving evidence; c. attending, and getting witnesses to attend, hearings and trials. The insured shall not, except at his or her own cost, voluntarily: a. make any payment or assume any obligation to others; or b. incur any expense, other than for first aid to others. 7 8386 -.- ""~ ~ ,01..,..,<- l.'l"== SECTION I - LIABILITY - COVERAGE A This coverage applies to the vehicles for which "A" appears in the "Coverages" space on the declarations page. We will: 1. pay damages which an insured becomes le- gally liable to pay because of: a. bodily injury to others, and b. damage to or deslruction of property in- cluding loss of its use, caused by accident resulting from the owner- ship, maintenance or use of your car; and 2. defend any suit against an insured for such damages with attorneys hired and paid by us. We will not defend any suit after we have paid the applicable limit of our liability for the accident which is the basis of the lawsuit. In addition to the limits of liability, we will pay for an insured any costs listed below resulting from such accident. 1. Court costs of any suit for damages. 2. Interest on damages owed by the insured due to a judgment and accruing: a. after the judgment, and until we pay, offer or deposit in conn the amount due under this coverage; or b. before the judgment, where owed by law, and until we pay, offer or deposit in court the amount due under this coverage, but only on that part of the judgment we pay. 3. Premiums or costs of bonds: a. to secure the release of an insured's prop- erty attached under a court order. b. required to appeal a decision in a suit for damages if we have not paid our limit of liability that applies to the suit; and c. up to $250 for each bail bond needed because of an accident or traffic violation. We have no duty to furnish or apply for any bonds. The amount of any bond we pay for shall not be more than our limit of liability. 4. Expenses incurred by an insured: a. for loss of wages or salary up to S35 per day if we ask the insured to attend the triaI of a civil suit. b. for first aid to others at the time of the accident. c. at our requesL We have the right to investigate, negotiate and settle any claim or suit. Coverage ror the Use or Other Cars The liability coverage extends to the use, by an insured, of a newly acquired car, a temporary sub- stitute car or a non-owned car. Who Is aD Insured When we refer to your car, a newly acquired car or a temporary substitute car, insured means: I. you; 2. your spouse; 3. the relatives of the first person named in the declarations; 4. any other person while using such a car if its use is within the scope of consent of you or your spouse; and 5. any other person or organization liable for the use of such a car by one of the above in- sureds. When we refer to a non-owned car, insured means: 1. the fu:st person named in the declarations; 2. his or her spouse; 3. their relatives; and 8 8386 ~~ ~~ 4. any person or organization which does not own or hire the car but is liable for its use by one of the above persons. THERE IS NO COVERAGE FOR NON-oWNED CARS: 1. IF THE DECLARATIONS STAlE THE "USE" OF ALL OF YOUR CARS IS OTHER THAN "PLEASURE AND BUSI- NESS"; OR 2. WHILE: a. BEING REPAIRED, SERVICED OR USED BY ANY PERSON WHILE THAT PERSON IS WORKING IN ANY CAR BUSINESS; OR b. USED IN ANY OTHER BUSINESS OR OCCUPATION. This does not apply to a private passenger car driven or occu- pied by the first person named in the declarations, his or her spouse or their reUztives. Trailer Coverage 1. Trailers designed to be pulled by a private pas- senger car or a utility vehicle, except those trail- ers in 2a below, are covered while owned or used by an insured. Farm implements and farm wagons are consid- ered trailers while pulled on public roads by a car we insure for liability. These trailers are not described in the declara- tions and no exua premium is charged. 2. The following trailers are covered only if de- scribed on the declarations page and extra pre- mium is paid: a. those trailers designed to be pulled by a pri- vate passenger car or a utility vehicle: (I) if designed 1O carry persons; or (2) while used with a motor vehicle whose use is shown as "commercial" on the dec- larations page (trailers used only for pleasure use are covered even if not de- scribed and no extra premium paid); or 'r. (3) while used as premises for office, store or display purposes; or b. any trailer not designed for use with a private passenger car or a utility vehicle. 'mERE IS NO COVERAGE WHEN A TRAILER IS USED WITIl A MOTOR VEHICLE OWNED OR HIRED BY YOU WHICH WE DO NOT IN- SURE FOR LIABll..I1Y COVERAGE. Limits or Liability The amount of bodily injury liability coverage is shown on the declarations page under "Limits of Liability -Coverage A -Bodily Injury, Each Person, Each Accident". Under "Each Person" is the amount of coverage for all damages due to bodily injury to one person. "Bodily injury to one person" includes all injury and damages 1O others resulting from this bodily injury. Under "Each Accident" is the total amount of coverage, subject to the amount shown under "Each Person", for all damages due to bodily injury to two or more persons in the same accident. The amount of propeny damage liability coverage is shown on the declarations page under "Limits of Liability - Coverage A - Propeny Damage, Each Accident". We will pay damages for which an insured is legally liable up to these amounts. The limits of liability are not increased because more than one person or organization may be an insured. A motor vehicle and attached trailer are one vehicle. Therefore, the limits are not increased. When two or more motor vehicles are insured under this section the limits apply separately to each. When Coverage A Does Not Apply In addition to the limitations of coverage in "Who Is an Insured" and ''Trailer Coverage": THERE IS NO COVERAGE: 1. WHILE ANY VEHICLE INSURED UN- DER THIS SECTION IS: a. REN1ED TO OTHERS. 9 8386 b. USED TO CARRY PERSONS FOR A CHARGE. This does not apply to the use on a share expense basis of: (1) a private passenger car; or (2) a utility vehicle, if all passengers are riding in that area of the vehicle de- signed by the manufacturer of the vehicle for carrying passengers. c. BEING REPAiRED, SERVICED OR USED BY ANY PERSON EMPLOYED OR ENGAGED IN ANY WAY IN A CAR BUSINESS. This does not apply to: (1) you or your spouse; (2) any relalive; (3) any resident of your household; or (4) any agent, employee or parmer of you, your spouse, any relative or such resident. This coverage is excess for (3) and (4) above. 2. FOR ANY BODILY INJURY TO: a. A FELLOW EMPLOYEE WHILE ON THE JOB AND ARISING FRClM THE MAINTENANCE OR USE OF A VEHI- CLE BY ANOTHER EMPLOYEE IN THE EMPLOYER'S BUSINESS. You and your spouse are covered for such injury to a fellow employee. b. ANY EMPLOYEE OF AN INSURED ARISING OUT OF HIS OR HER EM- PLOYMENT. This does not apply to a household employee who is not covered or required to be covered under any worker's compensation insurance. 3. FOR ANY DAMAGES: a. FOR WHICH THE UNITED STATES MIGHT BE LIABLE FOR THE IN- SURED'S USE OF ANY VEHICLE. b. TO PROPERTY OWNED BY, RENTED TO, IN THE CHARGE OFOR 10 8386 ',,- , ~V_'_'_"'<'._ " - . ."" -""T ' "iLl W:, TRANSPORTED BY AN INSURED. But coverage applies to a rented: (1) residence or (2) private garage damaged by a car we insure. 4. FOR ANY OBLIGATION OF AN IN- SURED, OR HIS OR HER INSURER, lJN- DER ANY TYPE OF WORKER'S COMPENSATION OR DISABILITY OR SIMILAR LAW. 5. FOR LIABILITY ASSUMED BY THE IN- SURED UNDER ANY CONTRACT OR AGREEMENT. If There Is Other Liability Coverage 1. Policies Issued by Us to You, Your Spouse, or Any Relative If two or more vehicle liability coverages pro- vided by us to you, your spouse, or any relative apply to the same accident, the total limits of liability under all such coverages shall not exceed that of the coverage with the highest limit of . liability. 2. Other Liability Coverage Available From Other Sources Subjcct to item I, if other vehicle liability cover- age applies, we are liable only for our share of the damages. Our share is the per cent that the limit of liability of this policy bears to the total of all vehicle liability coverage applicable to the acci- dent 3. Temporary Substitute Car, Non-Owned Car, Trailer If a temporary substitute car, a non.owned car or a trailer designed for use with a private pas- senger car or utility vehicle has other vehicle liability coverage on it, then this coverage is excess. 4. Newly Acquired Car THIS COVERAGE DOES NOT APPLY IF THERE IS OTHER VEHICLE LIABILITY COVERAGE ON A NEWLY ACQUIRED CAR. Motor Vehicie Compulsory Insurance Law or Fi. nancIaI Responsibility Law 1. Out-of-State Coverage If an insured under the liability coverage is in another state or Canada and, as a non-resident, becomes subject to its motor vehicle compulsory insurance, financial responsibility or similar law: a. the policy will be interpreted to give the cov- erage required by the law; and b. the coverage so given replaces any coverage in this policy to the extent required by the law " ~ " j '~ '= . ~--~ . ~ ~ -- .--~ for the insured's operation, maintenance or use of a car insured under this policy. Any coverage so extended shall be reduced to the extent other coverage applies to the accident In no event shall a person collect more than once. 2. Financial Responsibility Law When certified under any law as proof of future financial responsibility, and while required dur- ing the policy period, this policy shall comply with such law to the extent required. The insured agrecs to repay us for any payment we would not have had to make under the terms of this policy except for this agreement. 11 8386 ~~ , . ~ -'lli-4!:'i SECfION n - FIRST PARTY COVERAGES The coverages under this section are provided in accordance with and subject to the Pennsylvania Motor Vehicle Financial Responsibility Act, as amended. MEDICAL PAYMENTS - COVERAGE C2 This coverage applies to the vehi:i:lS for which "C2" appears in the "Coverages" space on the declarations page. What We Pay We will pay for medical expenses for bodily injury to an insured arising out of the maintenance or use of a motor vehicle. Medical expenses - these are expenses incurred for reasonable and necessary medical treatment and re- habilitation services. This includes expenses for: 1. hospital, dental, surgical, psychiatric, psy- chological, osteopathic, ambulance, chiro- practic, nursing and optometric services; 2. licensed physical therapy, vocational reha- bilitation, occupational therapy, speech pa- thology and audiology; 3. medications, medical supplies and prosthetic devices; and 4. nonmedical remedial care and treatmentren- dered in accordance with a recognized relig- ious method of healing. Medical expenses will be paid: 1. if incurred within 18 months from the date of the accident causing the bodily injury; or 2. without limitation as to time, provided that, within 18 months from the date of the acci- dent causing the bodily injury, it can be de- termined with reasonable medical probability that further expenses may be incurred as a result of the bodily injury. The amount we will pay for medical expenses is subject to the limitations of Title 75 of the Penn- sylvania Consolidated Statutes. EXTRAORDINARY MEDICAL PAYMENTS- COVERAGE Q This coverage applies to the vehicles for which"Q" appears in the "Coverages" space on the declarations page. What We Pay We will pay up to the lifetime aggregate limit of $1,000,000 for those reasonable medical expenses which exceed 5100,000. The medical expense must be for bodily injury to an insured caused by accident arising out of the maintenance or use of a motor vehicle. Medical expenses - these are expenses incurred for reasonable and necessary medical treatment and reo habilitation services. This includes expenses for: 1. hospital, dental, surgical, psychiatric, psy- chological, osteopathic, ambulance, chirl}- practic, nursing and optometric services; 2. licensed physical therapy, vocational reha- bilitation, occupational therapy, speech pa- thology and audiology; 3. medications, medical supplies and prosthetic devices; and 4. nonmedical remedial care and treatment rendered in accordance with a recognized religious method of healing. Medical expenses will be paid: 1. if incurred within 18 months from the date of the accident causing the bodily injury; or 2. without limitation as to time, provided that within 18 months from the date of the acci- dent causing the bodily injury, it can be de- termined with reasonable medical probability that further expenses may be incurred as a result of the bodily injury. 12 8386 The most we will pay in any 12 month period begin- ning 18 months after the date the insured's reason- able medical expenses exceed $100,000 as a result of the bodily injury is $50,000. These expenses must be: 1. for. a. services performed, or b. medical supplies, medication or drugs prescribed by a medical provider licensed by the state to provide the specific medical services; and 2. for diagnosis, direct care or treatment of the bodily injury. The diagnosis, direct care or treatment must be: a. within the standards of good medical practice,and b. not primarily for the convenience of the patient or medical provider. We have the right to make or obtain an independent review of the medical expenses and services per- fonned to determine if they are reasonable ami nec- essary for the bodily injury sustained. The amount we will pay for medical expenses is subject to the limitations of Title 75 of the PelUlsyl- vania Consolidated Statutes. REASONABLE MEDICAL EXPENSES DO NOT INCLUDE EXPENSES FOR TREATMENT, SERVICES, PRODUCTS OR PROCEDURES THAT ARE: 1. FOR RESEARCH, OR NOT PRIMARILY DESIGNED TO SERVE A MEDICAL OR REHABILITATIVE PURPOSE; OR 2. NOT COMMONLY AND CUSTOMAR- IL Y RECOGNIZED THROUGHOUT THE MEDICAL PROFESSIONS AND WITHIN THE UNITED STATES AS APPROPRI- ATE FOR THE TREATMENT OF THE BODILY INJURY. - , . ll', LOSS OF INCOME - COVERAGE Z This coverage applies to the vehicles for which ''Z''- with a nwnber beside it appears in the "Coverages" space on the declarations page. '7:' with a nwnber beside it is your coverage symbol. Check your cov- elllge symbol with the schedule for the limits you have chosen. We will pay income loss benefits with respect to bodily injury to an insured arising out of the mainte- nance or use of a motor vehicle. Income loss benefits are: 1. 80% of the insured's actual loss of gross income from work the insured would have performed except for the bodily injury; 2. reasonable expenses actually incurred for. a. hiring a substitute 10 perform self-em- ployment services to reduce loss of gross income; or b. hiring special help thereby enabling the insured to work and reduce loss of gross income. Income loss benefits do not include: 1. loss of eXJX"oCted income for any period fol- lowing the death of an insured; 2. expenses incurred for services performed fol- lowing the death of an insured; or 3. any loss ofincome during the first five work- ing days the insured did not work after the accident because of the bodily injury. SCHEDULE - COVERAGE Z I Coverage Maximum Payable Total Maximum Symbol Per Month Benefits ZI $1,000 $ 5.000 Z2 1,000 15,000 Z3 1,500 25,000 7A 2,500 50,000 13 8386 - . 1:.... DEATH, DISMEMBERMENT AND LOSS OF SIGHT - COVERAGE Y This coverage applies to the vehicles for which "Y" with a number beside it appears in the "Coverages" space on the declarations page. "Y" with a number beside it is your coverage symbol. Check your cov- erage symbol with the schedule for the limits you have chosen. We will pay the amount shown in the schedule that applies for death of, or loss to, an insured arising out of the maintenance or use of a motor vehicle. The death or loss must be the direct result of the accident and not due to any other cause. The death must occur within 24 months from the date of the accident. If the death occurs within 24 hours after the accident. we will pay only the amount that applies to death. Loss must occur within 90 days of the accident Loss - means the loss of: 1. the foot or hand, cut off through or above the ankle or wrist; or 2. the whole thumb or finger; or 3. all sight Schedule - Coverage Y Coverage Symbol Y2 S 10,000 Y3 S 25,000 Y1 S 5,000 Death Loss of: hands; feet; sight of eyes; one hand'& one foot; or one hand or one foot & sight of one eye one hand or one foot; or sight of one eye thumb & finger on one hand; or three fingers any two fingers 5,000 10,000 25,000 2,500 5,000 12,500 3,000 2,000 7,500 5,000 14 8386 1,500 1,000 , ., -'. l' -;> Payments of Benefits - Coverage Y The death benefit shall be paid to the executor.Dr administrator of the insured's estate. FUNERAL BENEFITS - COVERAGE F This coverage applies to the vehicles for which "F' appears in the "Coverages" space on the declarations page. We will pay for funeral expenses directly related to the funeral, burial, cremation or other form of dispo- sition of the remains of an insured. The death must be the result of the accident The expenses must be incurred within 24 months from the date of the acci- dent Definitions - Coverages C2, Q, Z, Y and F Bodily Injury - means accidental bodily harm to a person and that person's resulting illness, disease or death. First Party Benefits - means benefits paid or payable to an insured under Coverages C2, Q, Z, Y or F. Insured - means: 1. you or any relative; 2. any other person: a. occupying your car or a newly acquired car; or b. not occupying a motor vehicle if injured as the result of an accident involvingyour car, or a newly acquired car. A parked and unoccupied motor vehicle is not a motor vehicle involved in the accident unless it was parked so as to cause unrea- sonable risk of injury. Motor Vehicle - means a vehicle which is self-pro- pelled except one which is propelled: 1. solely by human power; or 2. upon rails. Relative - means: 1. your spouse; 2. anyone related to you by blood, marriage or adoption; and 3. a minor in the custody of you, yoUI' spouse or a relative resident in your household, even if temporarily resid. ing elsewhere. Limits or Liability - Coverage C2 The amount of coverage for medical expenses is shown on the declarations page under "Limit of Liability - Coverage C2 - EaCh Person". Limits or Liability - Coverage Z The most we will pay an insured for income loss benefits per month and in the aggregate are shown in the coverage Z schedule next to your coverage sym- bol. Limits or Liability - Coverage Y The amount we will pay because of the death of the insUl'ed is shown under YOUl' coverage symbol in the Coverage Y schedule. The maximum amount pay. able to an insured for all loss, as shown in the schedule, shall not exceed the death benefit amount shown for your coverage symbol. The amount shown in the schedule for death of or loss to the insured is doubled for an insured who, at the time of the accident, is using the vehicle's complete restraint system as recommended by the vehicle's manufacturer. Limits or Liability - Coverage F The amount of coverage for funeral expenses is shown on the declarations page under "Limit of Liability - Coverage F - Each Person". Limits or Liability - Coverages C2, Q, Z, Y and F These coverages are excess over, but shall not dupli- cate, any amount paid or payable to or for the ins ured under any worker's compensation law. Priorities ror the Payment or First Party Benefits 1. When more than one policy applies, the person who suffers bodily injury shall recover fll'st party 15 8386 " . o. "' 'j'.-' OJ!; L-.ii benefits against applicable insurance coverage in the following order of priority: a. The policy on which the person is a named insured. b. The policy providing coverage because the person is residing in the household of a named insured and is: (l) a spouse or other relative of a named insured; or (2) a minor in the custody of either a named insured or a relative of a named insured. c. The policy covering the motor vehicle occu- pied by the injured person at the time of the accident d. For a person who is not the occupant of a motor vehicle, the policy on any motor vehi. cle involved in the accident. A paIked and unoccupied motor vehicle is not a motor ve- hicle involved in the accident unless it was parked so as to cause unreasonable risk of injury. 2. TInS POLICY DOES NOT APPLY IF THERE IS ANOTHER POLICY AT A mOHER PRI. ORITY LEVEL. Item a above is considered the highest priority. Item d is the lowest priority. ,I I , 1'1 :'.1 " :J il 3. Subject to the above, if an insured is entitled to first party benefits under more than one cover- age, the maximum recovery under all coverages for any fll'st party benefu will not exceed the amount payable under the coverage with the highest limit of liability for thatfll'St party bene- fiL When Coverages C2, Q, Z, Y and F Do Not Apply THERE IS NO COVERAGE FOR BODILY IN- JURY: 1. TO ANY PERSON WHOSE CONDUCT CONTRIBUTED TO HIS OR HER BOD- ILY INJURY IN ANY OF THE FOLLOW- INGWAYS: ~ --- - - , - a. WHll.E INTENTIONALLY INJURING OR ATTEMPTING TO INJURE HIM- SELF, HERSELF OR ANOTHER; b. WHILE COMMITTING A FELONY; OR c. WHll.E SEEKING TO ELUDE LAW- FUL APPREHENSION OR ARREST BY A LAW ENFORCEMENT OFFI- OAL. 2. TO ANY PERSON WHO KNOWINGLY CONVERTS A MOTOR VEHICLE if the bodily injury arises out of the maintenance or use of the converted vehicle. This does not apply to you or any relalive. 3. TO ANY PERSON WHO OWNS A CUR- 'RENTI.. Y REGISTERED MOTOR VEHI- ,CLE AND DOES NOT HAVE THE : REQUIRED FINANCIAL RESPONsmn.- . ITY, EVEN IF THAT PERSON IS OCCU- . PYING OR STRUCK BY A MOTOR VEHICLE FOR WHICH FINANOAL RE- SPONSffiILITY IS PROVIDED. This does not apply to you or your spouse while occu- pying a vehicle insured under the liability coverage of this policy or when struck as a pedestrian. 4. TO ANY PERSON WHILE OPERATING OR OCCUPYING: a. A RECREATIONAL VEHICLE NOT INTENDED FOR HIGHWAY USE; OR b. A MOTORCYCLE, MOTOR-DRIVEN CYCLE, MOTORIZED PEDALCYCLE OR LIKE TYPE VEHICLE REQUIRED TO BE REGISTERED UNDER TITLE 75 OF THE PENNSYLVANIA CON- SOLIDATED STATUTES. Mental or Physical Examination Whenever the mental or physical condition of a per- son is material to any claim for medical expenses or income loss benefits, a court of competent jurisdic- tion may order the person to submit to mental or physical examination by a physician. If a person fails to comply with the order, the court may order 16 8386 - ~ '., , .' ~- - -~ .,"~ ,,-,-,--,,. that the person be denied benefits WItil he or she complies. COMBINED BENEFITS - COVERAGE M- This coverage applies to the vehicles for which "M" appears in the "Coverages" space on the declarations page. What We Pay We will pay for bodUy injury to an insured arising out of the maintenance or use of a motor vehit:ie: 1. Medical expenses as payable under Coverage C2; 2. Income loss benefits as payable under Cover- age Z; 3. The benefits as payable under Coverage Y3; and 4. FWleral expenses as payable under Coverage F. Limits or LiabiIity 1. The aggregate limit ofliability is shown on the declarations page under "limit of Liability - Coverage M - Each Person". This is the maxi- mum amoWlt payable for bodUy injury to an insured as the result of an accident 2. The most we will pay to or for an insured is as follows: Benefit Medical Expenses Limit Up to the Aggregate Limit Up to the Aggregate Limit $15,000 Up to $2,500 Income Loss Death Funeral Expenses . 3. Any amount payable for medical expenses greater than $100,000 shall be excess over any amount paid or payable under Extraordinary Medical Payments - Coverage Q. Time Limitation Subject to the limit of liability: 1. benefits are only payable for expenses and "-~". r.. ,~_u ,,_"",,-"_-,~__~_,_ .~;,; loss incurred up to three years from the date of the accident 2. the death benefit is payable only if death occurs within three years of the date of the accident. Other Provisions Except as amended above, all provisions relating to Coverages C2, Z, Y and F apply to expense, loss or death benefits of Coverage M. 17 8386 . SECTION III - UNINSURED MOTOR VEHICLE AND UNDERINSURED MOTOR VEHICLE COVERAGES UNINSURED MOTOR VEHICLE - COVERAGES U (STACKING OPTION) AND U3 (NON-STACKING OPTION) Uninsured Motor Vehicle - Coverage U applies Ul the vehicles for which "U" appears in the "Cover- ages" space on the declarations page. Uninsured Motor Vehicle - Coverage U3 applies to the vehicles for which "U3" appears in the "Cover- ages" space on the declarations page. Coverages U and U3 We will pay damages for bodily injury an insured is legally entitled to collect from the owner or driver of an uninsured motor vehicle. The bodily injury must be sustained by an insured and caused by accident arising out of the ownership, maintenance or use of an uninsured motor vehicle. The amount we will pay for damages is subject to the limitations of Title 75 of the Pennsylvania Consoli- dated StatUtes. Uninsured Motor Vehicle - means: I. a land motor vehicle, the ownership, mainte- nance or use of which is: a. not insured or bonded for bodily injury liability at the time of the accident; or b. insured or bonded for bodily injury liabil- ity at the time of the accident; but (1) the limits of liability are less than required by the fmancial responsibil- ity act of the stale where your car is mainly garaged; or (2) the insuring company denies cover- age or is or becomes insolvent; or 2. an unidentified land motor vehicle whose owner or driver remains unknown and causes bodily injury to the insured. An uninsured motor vehicle does not include a land motor vehicle: I. insured under the liability coverage of this policy; 2. furnished for the regular use of you, your spouse or any relative; 3. owned or operated by a self-insurer under any motor vehicle financial responsibility law, a motor carrier law or any similar law; 4. owned by any government or any ofits politi- cal subdivisions or agencies; 5. designed for use mainly off public roads ex- cept while on public roads; or 6. while located for use as a dwelling or other premises. UNDERINSURED MOTOR VEHICLE - COVERAGES W (STACKING OPTION) AND W3 (NON-STACKING OPTION) Underinsured Motor Vehicle - Coverage W applies to the vehicles for which "W" appears in the "Cov- erages" space on the dec1arations page. Underinsured Motor Vehicle - Coverage W3 applies to the vehicles for which "W3" appears in the....Cov- erages" space on the declarations page. Coverages Wand W3 We will pay damages for bodily injury an insured ~ legally entitled to collect from the owner or driver of an underinsured motor vehicle. The bodily injury must be sustained by an insured and caused by acci- dent arising out of the ownership, maintenance or USE of an underInsured motor vehicle. The amount we will pay for damages is subject to thf limitations of Title 75 of the Pennsylvania Consoli. dated S tatuleS. THERE IS NO COVERAGE FOR BODILY IN. JURY ARISING OUT OF THE OWNERSHIP MAINTENANCE OR USE OF AN UNDERlN SURED MOTOR VEHICLE UNTll..: 18 8386 1. THE LIMITS OF LIABILITY OF ALL BODILY INJURY LIABILITY BONDS AND POLICIES THAT APPLY HAVE BEEN USED UPBY PA YMENTOF JUDG- MENTS OR SETTLEMENTS TO OTHER PERSONS; OR 2. SUCH LIMITS OF LIABILITY OR RE- MMMNGPART OF TIffiM HAVE BEEN OFFERED TO THE INSURED IN WRIT- ING. Underinsured Motor Vehicle - means a land motor vehicle: 1. the ownership, maintenance or use of which is insured or bonded for bodily injury liability at the time of the accident; and 2. whose limits of liability for bodily injury liability: a. are less than the amount of the insured's damages; or b. have been reduced by payments to per- sons other than the insured to less than the amount of the insured's damages. An underinsured motor vehicle does not include a land motor vehicle: 1. insured under the liability coverage of this policy; 2. furnished for the regular use of you, your spouse or any relative; 3. owned by any government or any of its politi- cal subdivisions or agencies; 4. while located for use as a dwelling or other premises; 5. designed for use mainly off public roads ex- cept while on public roads; or 6. defined as an uninsured motor vehicle in your policy. Who Is an Insured - Coverages U, U3, Wand W3 Insured - means the person or persons covered by uninsured motor vehicle or underinsured mOlar vehi- cle coverage. _ )ll;;tl!,- This is: 1. the first person named in the declarations; 2. 3. his or her spouse; their relatives; and 4. any other person while occupying: a. your car, a temporary substitute car, a newly acquired car, or a trailer attached to such a car. Such vehicle has to be used within the scope of the consent of you or your spouse; or b. a car not owned by you, your spouse or any relative, or a trailer attached to such a car. It has to be driven by the fIrSt person named in the declarations or that person's spouse and within the scope of the owner's consent Such other person occupying a vehicle used to carry persons for a charge is not an in- sured. 5. any person entitled to recover damages be- cause of bodily injury to an insured under 1 through 4 above. Deciding Fault and Amount - Coverages U, U3, Wand W3 Two questions must be decided by agreement be- tween the insured and us: 1. Is the insured legally entitled to collect com- pensatory damages from the owner or driver of an uninsured motor vehicle or underin- sured motor vehicle; and 2. If so, in what amount? If there is no agreement, these two questions shall be decided by arbitration at the request of the insured or us. The arbitrators' decision shall be limited to these two questions. The arbitrators shall not award dam- ages under this policy which are in excess of the limits of liability of this coverage as shown on the declarations page. The Pennsylvania Uniform Arbi- tration Act, as amended from time to time, shall apply. 19 8386 Each party shall select a competent arbitrator. These two shall select a competent and impartial third arbi- trator. If unable to agree on a third one within 30 days, either party may request a judge of a coun of record in the county in which the arbitration is pending to select a third one. The written decision of any two arbitrators shall be binding on each party. The cost of the arbitrator and any expen witness shall be paid by the party who hired them. The cost of the third arbitrator and other expenses of arbitration shall be shared equally by both parties. The arbitration shall take place in the county in which the insured resides unless the parties agree to another place. We have the right to obtain statements under oath from the insured. Payment or Any Amount Due - Coverages U, U3, Wand W3 We will pay any amount due: 1. to the insured; 2. to a parent or guardian if the insured is a minor or an incompetent person; 3. to the surviving spouse; or 4. to a person authorized by law to receive such paymenL " . Trust Agreement - Coverages U and U3 1. We are entitled to repayment of the amount we have paid from the proceeds of any recovery the insured makes from any party liable for the bod- ily injury. 2. If the insured has not recovered from the party at fault, he or she shall: a. keep these rights in truSt for us; b. execute any legal papers we need; and c. when we aSk, take action through our repre- sentative to recover our payments. We are to be repaid our payments, costs and fees of collection out of any recovery. ~ ~ "] - '~!~t Trust Agreement - Coverages Wand W3 1. We are entitled, 10 the extent of ourpayments,lP the proceeds of any settlement the insured recov- ers from any party liable for the bodily injury, other than payments from bodily injury liability bonds or policies made prior to our paymenL 2. If the insured has not been fully compensated fIX the bodily injury by the patty at fl!ult ar.d we make payment for the bodily injury, the insured shall: a. keep these rights in trust for us; b. execute any legal papers we need; and c. when we ask, take action through our repre- sentative to recover the amount of our pay- ments. . We are to be repaid our payments, costs and fees of collection out of any such recovery. Limits or Liability - Coverages U and U3 1. The amount of coverage is shown on the decla- rations page under "Limits of Liability - U - Each Person, Each Accident" or "Limits of Li- ability - U3 - Each Person, Each Accident". Under "Each Person" is the amount of coverage for all damages due to bodily injury to one per- son. "Bodily injury to one person" includes all . mjury and damages to others resulting from this bodily injury. Under "Each Accident" is the total amount of coverage, subject to the amount shown under "Each Person", for all damages due to bodily injury to two or more persons in the same accidenL 2. Any payment made 10 a person under this cov- erage shall reduce any amount payable to that person under the bodily injury liability cover- age. 3. The limits of liability are not increased because: a. more than one person is insured. at the time of the accident; or b. more than one uninsured motor vehicle is involved in the same accident 20 8386 4. Any amount payable under this coverage shall be reduced by any amount paid or payable to or for the insured: a. by or for any person or organization who is or may be held legally liable for the bodily injury to the insured; or b. for the bodily injury under the liability cov- erage. 5. This coverage shall be excess over and shall not pay again any amount paid or payable 10 or for the insured under any worker's compensation, disability benefits or similar law. Limits of Liability - Coverage U3 The limits of liability are not increased because more than one vehicle is insured under this policy. Limits or LiabiUty - Coverages Wand W3 1. The amount of coverage is shown on the decla- rations page under "Limits of Liability - W - Each Person, Each Accident" or "Limits of Li- ability - W3 - Each Person, Each Accident". Under "Each Person" is the amount of coverage for all damages due to bodily injury to one per- son. "Bodily injury to one person" includes all injury and damages to others resulting from this bodily injury. Under "Each Accident" is the total amount of coverage, subject to the amount shown under "Each Person", for all damages due to bodily injury to two or more persons in the same accidenL 2. The limits of liability are not increased because: a. more than one person is insured at the time of the accident; or b. more than one underinsured motor vehicle is involved in the same accident 3. The most we pay will be the lesser of: a. the difference between the amoum of the insured's damages for bodily injury, and the amo.unt paid to the insured by or for any person or organization who is or may be held legally liable for the bodily injury; or b. the limits of liability of this coverage. 4. This coverage shall be excess over and shall not pay again any amount paid or payable to odor the insured under any worker's compensation, disability benefits or similar law. Limits or Liability - Coverage W3 The limits of liability are not increased because more than one vehicle is insured under this policy. When CoveragesU, U3, Wand W3 Do Not Apply THERE IS NO COVERAGE UNDER COVER- AGES U, U3, W AND W3: 1. FOR ANY INSURED WHO. WITHOUT OUR WRITIEN CONSENT, SETTLES WITH ANY PERSON OR ORGANIZA- TION WHO MAY BE LIABLE FOR THE BODILY INJURY AND THEREBY IM- PAIRS OUR RIGHT TO RECOVER OUR PAYMENTS. 2. TO THE EXTENT IT BENEFITS: a. ANY WORKER'S COMPENSATION OR DISABILITY BENEFITS INSUR- ANCECOMPANY. b. A SELF-INSURER UNDER ANY WORKER'S COMPENSATION, OR DISABll.ITY BENEFITS OR SIMILAR LAW. 3. FOR PAIN, SUFFERING OR OTHER NONMONETARY DAMAGES SUS- T AINED BY AN INSURED IF THE BOD- ILY INJURY IS NOT ASERIOUS INJURY AND THE LIMITATION OF SECTION 1731(d)(2) OF TITLE 75 OF THE PENN- SYLVANIA CONSOLIDATED STAT- urES APPLIES. THERE IS NO COVERAGE FOR BODILY IN- JURY TO AN INSURED UNDER COVERAGE U3: 1. WHILE OCCUPYING A MOTOR VEHI- CLE OWNED BY YOU, YOUR SPOUSE OR ANY RELATIVE IF IT IS NOT IN- SURED FOR THIS COVERAGE UNDER THIS POLICY; OR 21 8386 =~"-~ " ," 2. THROUGH BEING STRUCK BY A MO- TOR VEHICLE OWNED BY YOU, YOUR SPOUSE OR ANY RELATIVE. THERE IS NO COVERAGE FOR BODILY IN- JURY TO AN INSURED UNDER COVERAGE W3: 1. WHILE OCCUPYING A MOTOR VEHI- CLE OWNED BY YOU, YOUR SPOUSE OR ANY RELATIVE IF IT IS NOT IN- SURED FOR THIS COVERAGE UNDER THIS POLICY; OR 2. THROUGH BEING STRUCK BY A MO- TOR VEHICLE OWNED BY YOU, YOUR SPOUSE OR ANY RELATIVE. If There Is Other Coverage - Coverage U If the insured sustains bodily injury: 1. while occupying your car and your car is described on the declarations page of another policy providing uninsured motor vehicle coverage, or as a pedestrian, we are liable only for our share. Our share is that per cent of the damages that the limit ofliability of this coverage bears to the total of all Wlinsured motor vehicle coverage that applies to the accident. 2. while occupying a vehicle which is not your car, this coverage applies as excess to any other Wlinsured motor vehicle coverage. If coverage WIder more than one policy ap- plies as excess, we are liable only for our share. Our share is that per cent of the dam- ages that the limit ofliability of this coverage bears to the total of all uninsured motor vehi- cle coverage applicable as excess to the acci- dent. IrThere Is Other Coverage - Coverage U3 1. If the insured sustains bodily injury as a pedes- ttian and other uninsured motor vehicle coverage applies: a. the total limits of liability under all such coverages shall not exceed that of the cover- age with the highest limit of liability; and .' ,-- ~ ~ '" #the,:, b. we are liable only for our share. Our share is that per cent of the damages that the limit of liability of this coverage bears to the total of all uninsured motor vehicle coverage appli- cable to the accident 2. If the insured sustains bodily injury while occu- pying your car, and your car is described on the declarations page of another policy providing uninsured motor vehicle coverage: a. the total limits of liability under all such coverages shall not exceed that of the cover- age with the highest limit of liability; and b. we are liable only for our share. Our share is that per cent of the damages that the limit of liability of this coverage bears to the total of all such Wlinsured motor vehicle coverage applicable to the accident 3. If the insured sustains bodily injury while occu- pying a vehicle not owned by you, your spouse or any relative, and: a. such vehicle is described on the declarations page of another policy providing uninsured motor vehicle coverage, or b. its driver, other than you, your spouse or any relative, is an insured WIder another policy, this coverage applies: a. as excess to any Wlinsured motor vehicle coverage which applies to the vehicle or driver, but b. only in the amount by which it exceeds the primary coverage. If coverage under more than one policy applies as excess: a. the total limit of liability shall not exceed the difference between the limit ofliability of the coverage that applies as primary and the high- est limit of liability of anyone of the cover- ages that apply as excess; and b. we are liable only for our share. Our share is that per cent of the damages that the limit of liability of this coverage bears to the total of 22 8386 th " ~ " I all uninsured motor vehicle coverage appli- cable as excess to the accident 4. If the insured sustains bodily injury while occu- pying a vehicle not owned by you, your spouse or any re/aJive, and: a. such vehicle is not described on the declara- tions page of another policy providing Wlin- sured motor vehicle coverage; and b. its driver is: (I) you, your spouse or any relative; or (2) any other person not insured WIder an- other such policy, then: a. the total limits of liability under all applicable policies issued by us shall not exceed that of the one with the highest limit of liability; and b. we are liable only for our share. Our share is that per cent of the damages that the limit of liability of this coverage bears to the total of all uninsured motor vehicle coverage appli- cable to the accident . 5. THIS COVERAGE DOES NOT APPLY IF THERE IS OTHER UNINSURED MOTOR VE- HICLE COVERAGE ON A NEWLY AC. QUIRED CAR. II There Is Other Coverage - Coverage W If the insured sustains bodily injury: 1. while occupying your car and your car is described on the declarations page of another policy providing Wlderinsured motor vehicle coverage, or as a pedestrian, we are liable only for our share. Our share is that per cent of the damages that the limit ofliability of this coverage bears to the total of all Wlderinsured motor vehicle coverage that applies to the accident 2. while occupying a vehicle which is not your car, this coverage applies as excess to any other Wlderinsured motor vehicle coverage. If coverage WIder more than one policy ap- plies as excess. we are liable only for our 23 8386 C' _ _ ,~"' ", share. Our share is that per cent of the dam- ages that the limit of liability of this coverage bears to the total of all underinsured motor vehicle coverage applicable as excess to the accident U There Is Other Coverage - Coverage W3 1. If the insured sustains bodUy injury as a pedes- bian and other underinsured motor vehicle cov- erage applies: a. the total limits of liability WIder all such coverages shall not exceed that of the cover- age with the highest limit of liability; and b. we are liable only for our share. Our share is that per cent of the damages that the limit of liability of this coverage bears to the total of all underinsured motor vehicle coverage ap- plicable to the accidenL 2. If the insured sustains bodily injury while occu- pying your car, and your car is described on the declarations page of another policy providing underinsured motor vehicle coverage: a. the total limits of liability under all such coverages shall not exceed that of the cover- age with the highest limit of liability; and b. we are liable only for our share. Our share is that per cent of the damages that the limit of liability of this coverage bears to the total of all such underinsured motor vehicle coverage applicable to the accident 3. If the insured sustains bodily injury while occu- pying a vehicle not owned by you, your spouse or any relative, and: a. such vehicle is described on the declarations page of another policy providing underin- sured motor vehicle coverage, or b. its driver, other than you, your spouse or any relative, is an insured under another policy, this coverage applies: a. as excess to any underinsured motor vehicle coverage which applies to the vehicle or driver, but .,","",. ~~ i',_ -r;" b. only in the arnoWlt by which it exceeds the primary coverage. If coverage under more than one policy applies as excess: a. the IOtallimit of liability shall not exceed the difference between the limit ofliability of the coverage that applies as primary and the high- est limit of liability of anyone of the cover- ages that apply as excess; and b. we are liable only for our share. Our share is that per cent of the damages that the limit of liability of this coverage bears to the total of all Wlderinsured motor vehicle coverage ap. , plicable as excess to the accident 4. If the insured sustains bodily injury while occu- pying a vehicle not owned by you, your spouse or any relative, and: a. such vehicle is not described on the declara- tions page of another policy providing under- insured motor vehicle coverage; and b. its driver is: (1) you, your spouse or any relative; or (2) any other person not insured under an. other such policy. Lu-LL 1_ ;. '"~. -, ~"- " ~~-f;;- then: a. the IOtallirnits ofliability under all applicable policies issued by us shall not exceed that of the one with the highest limit of liability; and b. we are liable only for our share. Our share is that per cent of the damages that the limit of liability of this coverage bears to the total of all Wlderinsured motor vehicle coverage ap- plicable to the accident. 5. THIS COVERAGE DOES NOT APPLY IF THERE IS OTHER UNDERINSURED MO- TOR VEHICLE COVERAGE ON A NEWLY ACQUIRED CAR. Consent to Be Bound - Coverages U, U3, Wand W3 Any judgment for damages arising out of a suit brought without our written consent is not binding on us unless we: 1. receive reasonable notice of the pendency of the suit resulting in the judgment; and 2. have a reasonable opponunity to protect our interest in the suit. 24 8386 --~ , "'.,_"..:J _ '""""-'~~-""'-, SECTION IV - PHYSICAL DAMAGE COVERAGES Loss - means, when used in this section, each dircct and accidental loss of or damage to: 1. your car; 2. its equipment; or 3. clothes and luggage insured. Equipment means equipment common to the use of the motor vehicle as a vehicle. It also includes a detachable living quaners unit if you told us about it before the loss and paid any extra premium needed. COMPREHENSIVE - COVERAGE D. This coverage applies to the vehicles for which "D" appears in the "Coverages" space on the declara- tions page. If a deductible applies the amount is shown on the declarations page for the vehicle to which it applies. 1. Loss to Your Car. We will pay for loss to your car EXCEPT LOSS BY COLLISION but only for the amount of each such loss in excess of the deductible amount, if any. Breakage of glass, or loss caused by missiles, falling objects, fire, theft,larceny, explosion, earthquake, windstorm, hail, walCr, fiood, malicious mischief or vandalism, riot or civil commotion, is payable under this coverage. Loss due to hitting or being hit by a bird or an animal is payable undcr this coverage. 2. We will repay you for transportation costs if your car is stolen. We will pay up to $16 per day for the period that begins 48 hours after you tell us of the theft The period ends when we offer to pay for the loss. COLLISION - COVERAGE G. This coverage applies to the vehicles for which "G" appears in the "Coverages" space on the declarations page. The deductible amount is shown on the declarations page for the vehicle to which it applies. We will pay for loss to your car caused by collision but only for the amount of each such loss in excess of the deductible amount. Collision - means your car upset or hit or was hit by a vehicle or other object. Clothes and Luggage - Comprehensive and Collision Coverages We will pay for loss to clothes and luggage owned by the first person named in the declarations, his or her spouse, and their relatives. These items have to be in or on your car. Your car has to be covered under this policy for: 1. Comprehensive, and the loss caused by fue, Iighming, fiood, falling objects, explosion, earthquake or theft. If the loss is due to theft, YOUR ENTIRE CAR MUST HAVE BEEN STOLEN: or 2. Collision, and the loss caused by collision. We will pay up to 5200 for loss to clothes and luggage in excess of any deductible amount shown for com- prehensi ve or collision. 5200 is the most we will pay in anyone occurrence even though more than one persoll has a loss. This coverage is excess over any other coverage. Limit of Liability - Comprehensive and Collision Coverages The limit of our liability for loss to property or any parI of it is the lower of: 1. the actual cash value; or 2. the cost of repair or replacement. Actual cash value is determined by the market value, age and condition at the time the loss occurred. Any dcductible amount that applies is then subtracted. The cost of repair or replacement is based upon one of the following: 1. the cost of repair or replacement agreed upon by you and us; 2. a competitive bid approved by us; or 3. an estimalC written based upon the prevailing competitive price. The prevailing competi- tive price means prices charged by a majority 25 8386 of the repair market in the area where the car is to be repaired as determined by a survey made by us. If you ask, we will identify some facilities that will perform the repairs at the prevailing competitive price. We will in- clude in the estimate parts sufficient to restore the vehicle to its pre-loss condition. Any deductible amount that applies is then sub- tracted. Settlement or Loss - Comprehensive and Collision Coverages We have the right to settle a loss with you or the owner of the propeny in one of the following ways: 1. pay the agreed upon actual cash value of the propeny at the time of the loss in exchange for the damaged propeny. If the owner and we cannot agree on the actual cash value. either party may demand an appraisal as de- scribed below. If the owner keeps the dam- aged propeny, we will deduct its value after the loss from our payment The damaged propeny cannot be abandoned to us: 2. pay to: a. repair the damaged propeny or pan, or b. replace the propeny or pan. If the repair or replacement results in better. ment, you must pay for the amount of better- ment; or 3. return the stolen propeny and pay for any damage due to the theft Appraisal under item 1 above shall be conducted according to .the following procedure. Each party shall select an appraiser. These two shall select a third appraiser. The written decision of any two appraisers shall be binding. The cost of the appraiser shall be paid by the pany who hired him or her. The cost of the third appraiser and other appraisal expenses shall be shared equally by both parties. We do not waive any of our rights by agreeing to an appraisal. If you give us your consent. we may move the damaged prop- erty, at our expense, to reduce storage costs dur- 26 8386 - ~.. - ~ ;I~ .ll............~~~!;:; ing the appraisal process. If you do not give us your consent, we will pay only the storage costs which would have resulted if we had moved t1ie damaged property. The Settlement of Loss provision for comprehensive and collision coverages incorporates the Limit of Liability provision of those coverages. If we can pay the loss under either comprehensive or collision, we will pay under the coverage where you collect the most. When there is loss to your car, clothes and luggage in the same occurrence, any deductible will be ap- plied first to the loss to your car. You pay only one deductible. EMERGENCY ROAD SERVICE - COVER- AGE H. This coverage applies to the vehicles for which "H" appears in the "Coverages" space on the declarations page. We will pay the fair cost you incur for your car for: I. mechanical labor up to one hour at the place of its breakdown; 2. towing to the nearest place where the neces- sary repairs can be made during regular busi- ness hours if it will not run; 3. towing it out if it is stuck on or immediately next to a public highway; 4. delivery of gas, oil,loaned battery, or change of tire. WE DO NOT PAY FOR THE COST OF THESE ITEMS. CAR RE!\'TAL EXPENSE - COVERAGE R. This coverage applies to the vehicles for which "R" appears in the "Coverages" space on the declarations page. We will repay you up to $10 per day when you rent a car from a car rental agency or garage due to a loss to your car which would be payable under coverage D or G. starting: 1. when it cannot run due to the loss: or 2. if it can run, when you leave it at the shop for agreed repairs; -- and ending when: 1. it has been repaired or replaced, or 2. we offer to pay for the loss. or 3. you incur 30 days rent, whichever comes f1/'St. Any car rent payable under coverage R is RE- DUCED TO THE EXTENTIT IS PAYABLE UN- DER COMPREHENSIVE. CAR RENTAL AND TRAVEL EXPENSES - COVERAGE Rl. This coverage applies to the ve- hicles for which "RI" appears in the "Coverages" space on the declarations page. I. Car Rental Expense. We will: a. repay you up to $16 per day when you rent a car from a car rental agency or garage; or b. pay you $10 per day if you do not rent a car while your car is not usable due to a loss to your car which would be payable under coverage D or G. This applies during a period starting: a. when your car cannot run due to the loss; or b. if your car can run, when you leave it at the shop for agreed repairs; and ending: a. when it has been repaired or replaced, or b. (I) when we offer to pay for the loss, if your car is repairable, or (2) five days after we offer to pay for the loss, if: (a) your car was stolen and not re- covered, or (b) we declare it a total loss, whichever comes first . -"" ---..I~~' ~,~.,~~ c Any car rent payable under this coverage is REDUCED TO THE EXTENT IT IS PAY- ABLE UNDER COMPREHENSIVE. 2. Travel Expenses. If your car cannot run due to a loss which would be payable under cov- erage D or G more than 50 miles from home, we will repay you for expenses incurred by you, your spouse and any relative for: a. Commercial transportation fares to con. tinue to your destination or home. b. Extra meals and lodging needed when the loss to your car causes a delay enroute. The expenses must be incurred between the time of the loss and your arrival at your destination or home or by the end of the fifth day, whichever occurs first. c. Meals, lodging and commercial transpor- tation fares incurred by you or a person you choose to drive your car from the place of repair to your destination or home. 3. Rental Car - Repayment of Deductible Amount Expense. We will repay the ex- pcnse of any deductible amount you are re- quired to pay the owner under comprehensive or collision coverage in effect on a substitute car rented from a car rcntalagency or garage. Total Amount of Expenses Payable - Coverage RI I. The most we will pay for the total of the "Car Rental Expensc" and "Rental Car - Repayment of Deductiblc Amount Expense" incurred in any one occurrence is 5400. 2. The most we will pay for "Travel Expenses" incurred by all persons in anyone occurrence is S400. CAR RENTAL AND TRAVEL EXPENSES - COVERAGE R5. This coverage applies to the ve- hicles for which "R5" appears in the "Coverages" space on the declarations page. 1. Car Rental Expense. a. We will: 27 8386 (1) pay 80% of the rental charge when you ren t a car from a car rental agency or garage. "Rental charge" means the daily rental rate plus charges for mileage and related taxes; or (2) pay you $10 per day if you do not rent a car while your car is not drivable due to a loss to your car which would be payable under coverage D or G. b. Payment will be made for a period that: (1) starts: (a) when your car is not drivable due to the loss; or (b) if your car is drivable, when you leave it at the shop for agreed repairs; and (2) ends; (a) when your car has been repaired or replaced; or (b) when we offer to pay for the loss, if your car is repairable but you choose to delay repairs; or (c) five days after we offer to pay for the loss if: (i) your car was stolen and not recovered; or (ii) we declare that your car is a total loss; whichever comes fll'Sl Any car rent payable under this coverage is REDUCED TO THE EXTENT THAT PAYMENT IS MADE UNDER COMPRE- HENSIVE COVERAGE. 2. Travel Expenses. If your car is not drivable due to a lass which occurs more than 50 miles from home and which would be payable un- der coverage D or G, we will pay you for expenses incurred by you, your spouse and any relative for: a. commercial transportation fares to con- tinue 10 your destination or home; b. extra meals and lodging needed when the loss to your car causes a delay enroute. The expenses must be incurred between the time of the loss and your arrival at your destination or home or by the end of the fifth day, whichever occurs fll'St; and c. meals, lodging and commercial transpor- tation fares incurred by you or a person you choose to drive your car from the place of repair to your destination or home. 3. Rental Car - Repayment or Deductible Amount Expense. We will pay the expense of any deductible amount you are required to pay the owner under comprehensive or colli- sion coverage in effect on a substitute car rented from a car rental agency or garage. Total AmountorExpenses Payable - Coverage RS 1. The most we will pay for "ear Rental Expense" incurred in anyone occurrence is $500. 2. The most we will pay for "Travel Expenses" incurred by all persons in anyone occurrence is $400. E3. The most we will pay for "Rental Car - Repay- ment of Deductible Amount Expense" incurred in anyone occurrence is $400. Trailer Coverage 1. Owned Trailer Your trailer is covered: a. when it is described on the declarations page of the policy; and . b. for the coverages shown as applying to it 2. Non-Owned Trailer or Detachable Living Quarters Any physical damage coverage in force on your car applies to a non-owned: a. trailer, if it is designed for use with a private passenger car, or 28 8386 -" ..1 -~ b. detachabe living quarters unit used by the first person named in the declara- tions, his or Ier spouse or their relatives. The most wewill pay under the comprehensive or collision :overage for a loss to such non. owned traileror unit is 5500. A non-ownedtrailer or detachable living quarters unit is one thl: a. is not owa:d by or registered in the name of; (I) you,]lur spouse, any relative; (2) any oner person residing in the same house'old as you, your spouse or any relatip.; or (3) an e~loyer of you, your spouse or any relatil/; and b. has not I::en used or rented by or in the possession of you, your spouse or any rela- tive during any pan of each of the last 21 or more comecutive days. The 21 day limit is multiplied by the number of vehicles de- scribed or. the declarations pages of all car policies is:ued by us under which you are insured; ard c. is not renud and used in connection with the employmC1t or business of you, your spouse or any re/aive. Coverage ror the Use or Other Cars The coverages in lhis section you have on your car extend to a loss to anewly acquired car, a temporary substitute car or a lIOn-owned car. These coverages extend to a non-owled car while it is driven by or in the custody of an ilSured. Insured - as used h this provision means: 1. the flISt perron named in the declarations; 2. his or her s~ouse; or 3. their relativ!s. When Coverages D, G, H, R, Rl and RS Do Not Apply THERE IS NO COVERAGE FOR; 1. A NON-OWNED CAR: 29 8386 . " 0' ~ ~,~_ a. IF THE DECLARATIONS STATE THE "USE" OF ALL OF YOUR CARS IS OTHER THAN PLEASURE AND BUSINESS; b. WHILE BEING REPAIRED, SER- VICED OR USED BY ANY PERSON WHILE THAT PERSON IS WORKING IN ANY CAR BUSINESS; OR c. WHILE USED IN ANY OTHER BUSI. NESS OR OCCUPATION. This does not apply to a private passenger car driven or occupied by the first person named in the declarations, his or her spouse or their relatives. 2. ANY VEHICLE WHILE; a. RENTED TO OTHERS; b. USED TO CARRY PERSONS FOR A CHARGE. This does not apply to the use on a share expense basis; OR c. SUBJECT TO ANY LIEN, LEASE OR SALES AGREEMEr-.'T NOT SHOWN IN THE DECLARATIONS. 3. LOSS TO ANY VEHICLE DUE TO: a. TAKING BY ANY GOVERNMENTAL AUTHORITY; b. WAR OF ANY KIND; c. AND LIMITED TO WEAR AND TEAR, FREEZING, MECHANICAL OR ELECTRICAL BREAKDOWN OR FAll.URE. This does not apply when the loss is the result of a theft covered by this policy. Nor does it apply to emergency road service; OR d. CONVERSION, EMBEZZLEMENT OR SECRETION BY ANY PERSON WHO HAS THE VEHICLE DUE TO ANY LIEN, RENTAL OR SALES AGREEMENT. 4. TIRES unless: a. stolen, or damaged by flIe or vandalism; or b. other lass covered by this section happens at the same time. 5. TAPES OR DISCS FOR RECORDING OR REPRODUCING SOUND. 6. ANY RADAR DETECTOR. If There Is Other Coverage 1. Policies Issued by Us to You l( two or more vehicle coverages provided by us to you apply to the same loss or occurrence, we will pay under the coverage with the highest limiL 2. Coverage A vaUable From Other Sources Subject to item 1, if other coverage applies to the lass or expenses, we will pay only our share. Our share is that per cent the limit of liability of this policy bears to the total of all coverage that applies. . - I ,". -~ ,'. '. , ' - , '< " I 1;'--' - ".' __.~ ,,:~ -~J ,,' .. ~ 1 3. Temporary Substitute Car, \Ion-Owned Car or Trailer l( a temporary substitute car,a non-owned car or Irailer designed for use witha private passen- ger car has other coverage OM, then this cover- age is excess. 4. Newly Acquired Car THIS INSURANCE DOES NOT APPLY IF THERE IS SIMILAR C07ERAGE ON A NEWLY ACQUIRED CAR. No Benefit to Bailee These coverages shall not benefit lilY carrier or other bailee for hire liable for loss. Two or More Vehicles If two or more of your CIII'S are irsured for the same coverage, the coverage applies S4l3r3tely to each. 30 8386 . "' l , -. tr~ """" CONDITIONS 1. Policy Changes a. Policy Terms. The terms of this policy may be changed or waived only by: (1) an endorsement signed by one of our executive officers: or (2) the revision of this policy form to give broader coverage without an extra charge. If any coverage you carry is changed to give broader coverage, we will give you the broader coverage with- out the issuance of a new policy as of the date we make the change effective. b. Change orInterest. No change ofinterest in this policy is effective unless we consent in writing. However, if you die, we will protect as named insured, except under death, dis- memberment and loss of sight coverage: (1) your surviving spouse; (2) any person with proper custody of your car, a newly acquired car or a temporary substitute car until a legal representative is qualified; and then (3) the legal representative while acting within the scope of his or her duties. Policy notice requirements are met by mail- ing the notice to the deceased named in- sured's last known address. c. Consent or Beneficiary. Consent of the beneficiary under death. dismemberment and loss of sight coverage is not needed to cancel or change the policy. d. Joint and Individual Interests. When there are two or more named insureds, each acts for all to cancel or change the policy. 2. Suit Against Us There is no right of action against us: a. until all the terms of this policy have been met; and b. under the liability coverage, until the amount of damages an insured is legally liable to pay has been finally determined by: (1) judgment after actual trial, and appeal if any; or (2) agreement between the insured, the claimant and us. Bankruptcy or insolvency of the insured or his or her estate shall not relieve us of our obligations. c. under uninsured motor vehicle, underinsured motor vehicle or any physical damage cover- ages until 30 days after we get the insured's notice of accident or loss. 3. Subrogation The rights of recovery of the person to or for whom we paid pass to us to the extent of our payments. That person shall: a. not hurt our rights to recover; and b. help us get our money back. Subrogation applies to aU coverages except death, dismemberment and loss of sight cover- age. 4. Cancellation How You May Cancel. You may cancel your policy by notifying us in writing of the date to cancel, which must be later than the date you mail or deliver it La us. We may waive these require- ments by confrrming the date and time of cancel- lation to you in writing. How and When We May Cancel. We may cancel your policy by written notice, mailed or delivered to your last known address. The notice shall give the date cancellation is effective. If we cancel during the frrst 59 days following the policy effecLive date, the cancellation notice will be mailed or delivered to you at least 15 days before the cancellation effcctive date. 31 8386 ;.~J ~'_~"_" After the policy has been in force for more than 59 days, any notice of cancellation will be mailed or delivered to you at least: a. 15 days prior to the effective date of the cancellation if such cancellation is because the premium was not paid; and b. 30 days prior to tbe effective date of the cancellation if such cancellation is because of any other reason. The mailing of the notice shall be sufficient proof of notice. Unless the policy is canceled within 59 days of its effective date, we will not cancel your policy before the end of the current policy period unless: a. you fail to pay the premium when due; or b. at any time during the policy period your driver's license was under suspension or revocation. If we send you a notice of can. cellation solely because your driver's license was suspended or revoked due to your failure to respond to a citation, we will reinstate your policy to provide continuous coverage if you furnish to us, before the cancellation effective date, proof that you have: (1) responded to all citations; and (2) paid all fines and penalties in connection with them. Return or Unearned Premium. If you cancel. premium may be earned on a shon rate basis. If we cancel. premium will be earned on a pro-rata basis. Any unearned premium may be returned at the time we cancel or within a reasonable time thereafter. Delay in the return of unearned pre- mium does not affect the cancellation. ~- , j-- -'-,../- . '" ~ ,. ~ 5. Renewal Unless we mail or deliver to you a notice of- cancellation or a notice of our intention not to renew the policy, we agree to renew the policy for the next policy period upon your payment of the renewal premium when due. It is agreed that the renewal premium will be based upon the rates in effect, the coverages carried, the applicable limits of liability, deductibIes and other elements that affect the premium that apply at the time of renewal. Other elements that may affect your premium include, but are not limited to: a. drivers of your car and their ages and marital status; b. your car and its use; c. eligibility for discounts or other premium credits; d. applicability of a surcharge based either on accident history, or on other factors. A notice of our intention to not renew wiIl be mailed or delivered to your last known address at least 60 days before the end of the current policy period. The mailing of it shall be sufficient proof of notice. 6. Change or Residence When we receive notice that the location of prin- cipal garaging of a vehicle described on the dec- larations page has been changed, we have the right to recalculate the premium based on the coverages and rates applicable in the new loca- tion. When the change of location is from one state to another and you are a risk still acceptable to us at the time you notify us of the change, we shall replace this policy with the policy form currently in use in the new state of garaging. The word "state" means one of the United States of America, the District of Columbia or a province of Canada. I 32 8386 -. . -~ 'I 1-'_" ,;.;;- -~~=-'-"-' "~-"'~~--'n. _o_'~.d~ ,.",-,.,"'0 " MUTUAL CONDITIONS 1. Membership. The membership fees set out in this policy, which are in addition to the premi- ums, are not returnable but entitle the first insured named in the declarations to insure one vehicle for any applicable coverage, and to insurance for any other coverage for which said fees were paid so long as: a. this company continues to write such covcr- ages; b. the vehicle to be insured meets the eligibility requirements of the company; and c. the insured remains a risk desirable to the company. While this policy is in force, the first insured named in the declarations is entitled to vote at all mcctings of mcmbers and to receive dividends the Board of Directors in its discretion may de- clare in accordance with reasonable classifica- tions and groupings of policyholders established by such Board. 2. No Contingent Liability. This policy is non- assessable. 3. Annual Meeting. The annual meeting of the mcmbcrs of the company shall be held at its home office at Bloomington, Illinois, on the second Monday of June at the hour of 10:00 A.M., unless the Board of Directors shall elect to change the timc and place of such meeting, in which case, but not otherwise, due notice shall be mailed each mcm bcr at the address disclosed in this policy at least 10 days prior thcreto. In WiPless Whereof, the State Farm Mutual Automobile Insurance Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois, and countersigned on the declarations page by a duly authorized representative of thc Company. ~/~ SECRETARY C~o.s.t1~)<"^' \. 9r PRESIDENT 33 8386 ~ ~ . --'---'- ~:.L'-_ . f ~ I" ~. ~-', "" " ""~'i Page No. WHAT IT IS AND WHERE YOU CAN FIND IT - THE INDEX 6 Reporting a Claim - Insured's Duties - What to do if you have an accident. claim or are sued. 3 Defined Words 5 Declarations Continued 5 When and Where Your Coverage Applies 6 Financed Vehicles - Coverage for CredilOr Coverages 8 A - Liability - When there is damage 10 others. 12 C2 - Medical Payments - Pays for an insured's medical expenses. 12 Q - Extraordinary Medical Payments - Pays for an insured's medical expenses. 13 Z - Loss or Income - Pays income loss benefits to an insured. 14 Y - Death, Dismemberment and Loss or Sight - Pays for death of or cenain injuries to an insured. 14 F - Funeral Benefits - Pays for an insured's funeral expenses. 16 M - Combined Benefits - Pays medical and funeral expenses, income loss benefits. and for death of or certain injuries to an insured. 18 U - Uninsured Motor Vehicle (Stacking Option) - When the other car or driver is not insured. 18 U3 - Uninsured Motor Vehicle (Non-Stacking Option) - When the other car or driver is not insured. 18 W - Underinsured Motor Vehicle (Stacking Option) - When the other car or driver is underinsured. 18 W3 - Under insured Motor Vehicle (Non-Stacking Option) - When the other car or driver is underinsured. 25 D - Comprehensive - When your car is damaged except by collision or upset Any deductible amounts are shown on the declarations page. 25 G - Collision - When your car is damaged by collision or upset. Deductible amounts are shown on the declarations page. 26 H - Emergency Road Service - When your car breaks down or needs a lOw. 26 R - Car Rental Expense - When you need to rent a car because of damage 10 your car. 27 Rl, RS - Car Rental and Travel Expenses - When you need to rent a car and pay extra travel expenses because of damage to your car. Conditions 31 1. Policy Changes 31 2. Suit Against Us 31 3. Subrogation 31 4. Cancellation 32 5. Renewal 32 6. Change of Residence 33 Mutual Conditions Policy Form 9838.6 ~J "it , . _I OJ' ..- ~-- "_c" liC" , ,~-, '--, MARGOLIS EDELSTEIN PHILADELPHIA OFFICE THE CURTIS CENTER FOURTH FLOOR INDEPENDENCE SQUARE WEST PHILADELPHIA, PA 1910603304 215-922-1100 FAX 215-922.1772 ATTORNEYS AT LAw DELAWARE COUNTY OFFICE 216 SOUTH ORANGE STREET MEDIA, PA 19083 610.a&508311 FAX 6100565-6319 POST OFFICE BOX 932 HARRISBURG, PA 17106.0932 PITTSBURGH OFFICE 1500 GRANT BUILDING PITTSBURGH. PA15219-2203 412-26104256 FAX 412-642.2360 STREET ADDRESS: 3510 TRINOLE ROAD CAMP HILL. PA 17011 717-975-8114 FAX 711-975-8124 NEW JERSEY OFFICE P.O. BOX 2222 216 HADDON AVENUE WESTMONT, NJ 09109-2886 llO9-856.7200 FAX 609-856.1017 WRITER: ROLF E. KROLL DIRECT E-MAIL: rkroll_2000@yahoo.com SCRANTON OFFICE THE OPPENHEIM BUILDING 409 LACKAWANNA AVENUE SUITE 3C SCRANTON,PA19503 570-342-4231 FAX 570-34204941 June 21, 2000 Dusan Bratic, Esquire 101 S. U.S. Route IS, Suite A Dillsburg,PA 17019 RE: Your Client: State Farm's Insured: Our File No.: Donna Shambaugh Ida E. Schutz 50100.4-0238 Dear Dusan: I am writing to formally advise you of my Entry of Appearance on behalf of State Farm in the underinsured motorist case asserted by your client, Donna Shambaugh. I am writing to advise that it is my understanding that your client has already been paid $25,000 by the liability carrier. It is also my understanding that on January 20,1997, State Farm made an offer to your client of $2,500 to settle Ms. Shambaugh's underinsured motorist claim. It is my further understanding that on March 16, 1998, you rejected the offer of settlement but indicated that you would forward additional information. To date, no supplemental information is contained in the file. As this accident took place over seven years ago, I would greatly appreciate any supplemental medical records that you have regarding Ms. Shambaugh's claim. To expedite the movement of this case, I have enclosed herewith true and correct copies of record authorizations for the healthcare specialists who took part in your client's care and treatment following the motor vehicle accident. These authorizations do not allow me to contact any of these providers directly, nor would I do so without your written consent. Further, it is not my intention to contact these individuals. The sole and exclusive purpose for these authorizations is to ensure that we both have all records perwining to your client's care and treatment both before and after the subject motor vehicle accident. To that end, I enclose record authorizations for the following: 1. Total Vision Care; 2. Nevyas Eye Associates; 3. Retina and Oculoplastic Consultants; and, 4. ThOIl1llS R. Pheasant. In addition to the foregoing, please provide an authorization for any emergency care rendered to your - client. The police report seems to indicate that some individuals were taken to the emergency room at Sacred Heart Hospital. If there was any emergency care or treatment rendered or for that matter, any care or treatmenl of any injuries to your client's head, I would appreciate you forwarding appropriate authorizations for those records as well. ~'. " ol d" .,' . "'-. ,_;"~,,,_-,,,,,, Po' '~~,;, - .- - -- .ltilili~'~L! Dusan Bratic, Esquire June 21, 2000 Page Two J have selected James Nealon as my arbitrator and ask that you select an arbitrator within the next 30 days. These arbitrators can then select a neutral and we can move this case forward to arbitration. I would also like to schedule your client's statement under oath and respectfully request that you forward the executed authorizations to my office in accordance with your client's duties of cooperation outlined in the State Farm policy. By copy of this letter I have notified Mr. Nealon of my request that you select an arbitrator. Please have your arbitrator contact Mr. Nealon directly so that they may select a neutral. Should you have any questions concerning this or any other aspect of this case, please do not hesitate to contact me. ~~ncer y., . / /' /~~? 7#f'/ ;' . 712//1 v Rolf. 011 REK/jab Enclosures cc: James G. Nealon, Esquire .. ~ ^ c. "I c_-"I. ,-' -, ,-~ i<--;>o '!o_ ,C- ..:"' ',c0' .0._.",',,--'_ 0-' ,,' '_'..,~ '" " MEDICAL INFORMATION RELEASE AUTHORIZATION TO: Retina and Oculoplastic Consultants, P.C. Pennview Place, 220 Grand Avenue Camp Hill, PA l7011 You are hereby authorized to discuss with and release to RolfE. Kroll, Esquire MARGOLIS EDELSTEIN P.O. Box 932 Harrisburg, P A 17108-0932 all medical information and records regarding your professional medical care and treatment of Donna Shambaugh, Social Security No. 220-34-2066, including, without limitation, all conversations, admission records, initial history and physical, progress notes, order sheets, medical sheets, nurses notes, copies of consultations, x-rays, emergency room notes, LV. anesthesia sheets, physician's office records, radiographic and computerized axial tomography films, and any other matter regarding any opinion, diagnosis or prognosis which you might have pertaining in any way to me. DATE: Donna Shambaugh A photocopy of this medical authorization shall be deemed as authentic as the original. . , -, f _ I ) " ..,-~o> -. ,-, - """-'. r.,M- "~.',", _ ,~, '-"\;', MEDICAL INFORMATION RELEASE AUTHORIZATION TO: Total Vision Care You are hereby authorized to discuss with and release to RolfE. Kroll, Esquire MARGOLIS EDELSTEIN P.O. Box 932 Harrisburg, P A 17108-0932 all medical information and records regarding your professional medical care and treatment of Donna Shambaugh, Social Security No. 220-34-2066, including, without limitation, all conversations, admission records, initial history and physical, progress notes, order sheets, medical sheets, nurses notes, copies of consultations, x-rays, emergency room notes, LV. anesthesia sheets, physician's office records, radiographic and computerized axial tomography films, and any other matter regarding any opinion, diagnosis or prognosis which you might have pertaining in any way to me. DATE: Donna Shambaugh A photocopy of this medical authorization shall be deemed as authentic as the original. :.....-..il ^--,.~ ,- . -'<_"~"'.' v'. _"__'.__, ':_" ,.,;., . - -&.;j~ MEDICAL INFORMATION RELEASE AUTHORIZATION TO: Nevyas Eye Associates Two Bala Plaza, 333 City Line Avenue Bala Cynwyd, P A 19004 You are hereby authorized to discuss with and release to RolfE. Kroll, Esquire MARGOLIS EDELSTEIN P.O. Box 932 Harrisburg, PA 17108-0932 all medical information and records regarding your professional medical care and treatment of Donna Shambaugh, Social Security No. 220-34-2066, including, without limitation, all conversations, admission records, initial history and physical, progress notes, order sheets, medical sheets, nurses notes, copies of consultations, x-rays, emergency room notes, I.V. anesthesia sheets, physician's office records, radiographic and computerized axial tomography films, and any other matter regarding any opinion, diagnosis or prognosis which you might have pertaining in any way to me. DATE: Donna Shambaugh A photocopy of this medical authorization shall be deemed as authentic as the original. "~ "'R-. ~ 'C ,~"- u..' ,,' ',.,_ "" ,,'.-.' ., MEDICAL INFORMATION RELEASE AUTHORIZATION TO: Thomas R. Pheasant Pennview Place, 220 Grand Avenue Camp Hill, PA 17011 You are hereby authorized to discuss with and release to RolfE. Kroll, Esquire MARGOLIS EDELSTEIN P.O. Box 932 Harrisburg, P A 171 08-0932 all medical infonnation and records regarding your professional medical care and treatment of Donna Shambaugh, Social Security No. 220-34-2066, including, without limitation, all conversations, admission records, initial history and physical, progress notes, order sheets, medical sheets, nurses notes, copies of consultations, x-rays, emergency room notes, LV. anesthesia sheets, physician's office records, radiographic and computerized axial tomography films, and any other matter regarding any opinion, diagnosis or prognosis which you might have pertaining in any way to me. DATE: Donna Shambaugh A photocopy of this medical authorization shall be deemed as authentic as the original. . _", .', -'0: ""'-"" _"/ MARGOLIS EDELSTEIN PHILADELPHIA OFFICE THE CURTIS CENTER FOURTH FLOOR INDEPENDENCE SQUARE WEST PHILADELPHIA, PA 19106-3304 215-922.1100 FAX 215.922.1712 ATTORNEYS AT LAw DELAWARE COUN1Y OFFICE 216 SOUTH ORANGE STREET MEDIA. PA 19063 610-565-8311 FAX 610-56506318 POST OFFICE BOX 932 HARRISBURG, PA 17108.0932 PITTSBURGH OFFICE 1500 GRANT BUILDING pmSBURGH, PA 15219-2203 412-281-4256 FAX 412"42.2380 STREET ADDRESS: 3510 TRINOLE ROAD CAMP HILL. PA 17011 717-975"114 FAX 717.975..124 NEW JERSEY OFFICE P.O. BOX 2222 216 HADDON AVENUE WESTMONT, NJ 08108-2986 809..58.7200 FAX 609..58.1017 WRITER: ROlf E. KROLL DIRECT E-MAIL: rkroll_2000@yahoo.com SCRANTON OFFICE THE OPPENHEIM BUILDING 409 LACKAWANNA AVENUE SUITE 3C SCRANTON, PA 18503 570-342-4231 FAX 570-342-4841 August 7, 2000 Dusan Bratic, Esquire 101 S. U.S. Route 15, Suite A Dillsburg, PA 17019 RE: Your Client: State Farm's Insured: Our File No.: Donna Shambaugh Ida E. Schutz 50100.4-0238 Dear Dusan: On June 21, 2000,1 wrote to you and provided you with record authorizations so that we could move this case forward. I have yet to receive the executed authorizations. Please provide them to me promptly so we can keep this matter moving forward. Also, by copy of this letter, I am requesting that you select an Arbitrator within the next 30 days or I will move the Court to select an Arbitrator for you. Please let me know if this request causes you or your client any undue hardship and I am sure we can work something out. However, I do wish to keep this case moving. !(fJt4'j# '" Uf~~j6! REK/jab cc: James G. Nealon, Esquire '';'" .J 1,1- ," ,," .' "'''~ ."!. o _~_" , '.- MARGOLIS EDELSTEIN PHILADELPHIA OFFICE mE CURTIS CENTER FOURTH FLOOR INDEPENDENCE SQUARE WEST PHILADELPHIA, PA 19106-3304 21500922-1100 FAX 215-922.1772 ATTORHEysATLAW DELAWARE COUNTY OFFICE 218 soom ORANGE STREET MEDIA, PA 19083 610-585-9311 FAX 610-585-9316 POST OFFICE BOX 932 HARRISBURG. PA 17106.0932 PITTSBURGH OFFICE 1500 GRANT BUILDING PITTSBURGH. PA 15219-2203 412.28104258 FAX 412-642.2360 STREET ADDRESS: 3510 TRINDLE ROAD CAMP HILL. PA 17011 717-975-8114 FAX 717.975-8124 NEW JERSEY OFFICE P.O. BOX 2222 218 HADDON AVENUE WESTMOHT. HJ 081064668 609-858.7200 FAX 609-858.1017 WRITER: ROLF E. KROLL DIRECT E-MAIL: rkroll_2000@yahoo.com SCRANTON OFFICE mE OPPENHEIM BUILDING 408 LACKAWANHAAVENUE SUITE 3C SCRANTON. PA 16503 570-34204231 FAX 570-342......1 August 17, 2000 Dusan Bratic, Esquire 101 S. U.S. Route 15, Suite A Dillsburg, P A 17019 RE: Your Client: State Farm's Insured: Our File No.: Donna Shambaugh Ida E. Schutz 50100.4-0238 Dear Dusan: It was nice seeing you at the call of the list. I understand you are having some logistical difficulty at your office. If you would like me to send the record authorizations to your client in the exact form that I forwarded them to you, I will be happy to do so if that will ease your administrative burden. Please let me know if there is any way I can help in moving this case forward. Sincerely, ~~/J I ~/ff~ ROI~~:~,Jd/-i REKljab I ~ I . LlJIl -~..tl'E_ MARGOLIS EDELSTEIN (Copy . . PHILADELPHIA OFFICE THE CURTIS CENTER FOURTH FLOOR INDEPENDENCE SQUARE WEST PHILADELPHIA, PA 19106.3304 215-922-1100 FAX215.g22.1772 ATTORNEYS AT LAw DELAWARE COUNTY OFFICE 216 SOUTH ORANGE STREET MEDIA, PA 19063 610-565-8311 FAX 610-565-8318 POST OFFICE BOX 932 HARRISBURG, PA 17106.0932 PITTSBURGH OFFICE 1500 GRANT BUILDING PITTSBURGH, PA 15219..2203 412-261-4256 FAX 412-842.2380 STREET ADDRESS: 3510 TRINOLE ROAO CAMP Hill. PA 17011 717-975-8114 FAX 717-975-8124 NEW JERSEY OFFICE P.O. BOX 2222 216 HADDON AVENUE WESTMONT, NJ 08108-2886 609-858..7200 FAX 609-858.1017 WRITER: ROLF E. KROLL DIRECT E~MAll: rkroll_200o@yahoo.com SCRANTON OFFICE THE OPPENHEIM BUILDING 409 LACKAWANNA AVENUE SUITE 3C SCRANTON, PA 18503 570-342-4231 FAX 570-342-4841 October 17, 2000 Dusan Bratic, Esquire 101 S. U.S. Route 15, Suite A Dillsburg, PA 17019 RE: Your Client: State Farm's Insured: Our File No.: Donna Shambaugh Ida E. Schutz 50100.4-0238 Dear Dusan: Enclosed please find a Petition for Appointment of Arbitrator that I am prepared to file with the Court. I will forego the filing of the Petition if you supply me with the executed medical record authorizations and the appointment of your arbitrator within the next ten days. I would like to avoid any unnecessary judicial intervention. REKfjab Enclosure ~= "" "'" . . d:.L 'C " ~ -","'. '- "> ~- .",-., "" iiJ:'~ ;'1 . . CERTIFICATE OF SERVICE I, Jessica Bates, an authorized representative of Margolis Edelstein, hereby certify that I have served a true and correct copy of the foregoing document upon all counsel and parties of record this / 'J*"day of November, 2000, by placing the same in the United States First Class Mail, postage prepaid, at Camp Hill, Pennsylvania, addressed as follows: Dusan Bratic, Esquire 101 S. U.S. Route 15, Suite A DilIsburg, PA 17019 By: 1:s~ ~atw , ~ , ~ l:-. ~_. " c. to:;. . ... CERTIFICATE OF SERVICE I, Jessica Bates, an authorized representative of Margolis Edelstein, hereby certify that I have served a true and correct copy of the foregoing document upon all counsel and parties of record this JJ!!:day of November, 2000, by placing the same in the United States First Class Mail, postage prepaid, at Camp Hill, Pennsylvania, addressed as follows: Dusan Bratic, Esquire 101 S. U.S. Route 15, Suite A Dillsburg,PA 17019 By: ~"""" Je ica Bates hdv/ I I ,~' 0.,', " ~'" . .' ,\ , , ROLF E. KROLL, ESQUIRE Pa. Supreme Court I.D. No. 47243 MARGOLIS EDELSTEIN Post Office Box 932 Harrisburg, Pennsylvania 17108-0932 Telephone: [717] 975-8114 Fax: [717] 975-8124 E-mail: rkroll(al.mare:olisedelstein.com Attorney for: Petitioner STATE FARM INSURANCE COMPANIES, Petitioner IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 00-8030 CNIL TERM v. CNIL ACTION - LAW DONNA SHAMBAUGH, Respondent JURY TRIAL DEMANDED PRAECIPE TO WITHDRAW PETITION TO COMPEL APPOINTMENT OF ARBITRATOR TO THE PROTHONOTARY: Kindly withdraw Respondent's Petition to Compel Appointment of Arbitrator in the above-captioned matter. Respectfully submitted, By: ,E uire Attomey . #47243 Post Office Box 932 Harrisburg, PA 17108-0932 (717) 975-8114 Attorney for Respondent ", ,-- ..,';"', - - ;;~- .- /.,- ,. ~, rO"- . CERTIFICATE OF SERVICE I, Jessica Bates, an authorized representative of Margolis Edelstein, hereby certify that I have served a true and correct copy of the foregoing document upon all counsel and parties of record this 311- day of January, 2001, by placing the same in the United States First Class Mail, postage prepaid, at Camp Hill, Pennsylvania, addressed as follows: Dusan Bratic, Esquire 101 S, U.S, Route 15, Suite A Dillsburg, PAl7019 By: T' &ff{l essica Bates F'""-< .~ "";'~"f""'-'i!'j[~~~~'':-t1~j(","~3;;~J}{I<;:'';'~;:il'-''tli'i';(l~'}:<'~'ir<i>\)~I~l$o'1!,t1J~~~lIliilliiiiU~I]llIiLl.t ~k ~ ~ ,- '., __,~__< " ."0 ~ <, 1."0<=.......""" ~ " , ! ~ ' 0 0 C '-!-, ~ ~-- .,., -0 f'D PI rn f1'~ ::-0 Z :J> - z , I UJ)> ct~ ~~=; " ~-=) ~ 'v g~~~ 0-(") ~~O 'r- Z "'" 5J =2 :D en -~ -. ~~- ,. ,'-, " -- -.=,. -,;,-,-,. ~. . "I> JI STATE FARM lNSURANCE COMPANIES, Petitioner IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 00-8030 CNIL TERM v. CNIL ACTION - LAW DONNA SHAMBAUGH, Respondent JURY TRIAL DEMANDED PRAECIPE TO WITHDRAW APPEARANCE TO THE PROTHONOTARY: Please withdraw the appearance of Rolf E. Kroll on behalf of State Fann Insurance Companies. MARGOLIS EDELSTElN By: RolfE. 011, Attorney LD. 7243 Post Office Box 932 Harrisburg, P A 17108-0932 (717) 975-8114 PRAECIPE TO ENTER APPEARANCE TO THE PROTHONOTARY: Please enter the appearance of Brigid Q. Alford on behalf of State Fann Insurance Companies. Boswell, Tintner, Picolla & Wickersham By: Brigid Q. for, E 315 North Front S t Harrisburg, PA 17101 DATE: September 25, 2001 ~~ .. . STATE FARM INSURANCE, COMPANIES, PLAINTIFF v. DONNA SHAMBAUGH, DEFENDANT - 0'" :--'I:~~J::s:_:, - "" "':'i_:.___",C" ""-] "-'" ,,'~" ~-', ""~,,,,,,, ',oh"+ -,^"",~,,,-,,"S" , -- """ -. '__ "~'Oj : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : NO. 00-8030 CIVIL TERM : CIVIL ACTION - LAW : JURY TRIAL DEMANDED CERTIFICATE OF SERVICE I do hereby certify that I have served on this date a true and correct copy of the foregoing Praecipe to Withdraw Appearance and Praecipe to Enter Appearance on the following by first- class mail, postage prepaid and addressed as follows: Date: September 25,2001 Dusan Bratic, Esquire Bratic & Portko 101 South Center, Suite A 101 South U.S. Route 15 Dillsburg, PA 17019 Brigid ~i ~" . ~'^. ,... '-,' ---'--;-,', '':}j'-' ;..,;';' '~". -".- -;~;:,:~",:;i~;-L "'., ,,' "^~" ~. w , ..,' ,:,.a.. "" ,,' ,.,;c,,,~~',J;';,,;,,,,, . ','.,ep'C".","'.""," .""" . ". ,,""'q , o c <::~ u(:ij rnf~") ~5::1 ~ . KC'f ..J--""..._, z\....' j;.D c-::- ~.~"7 '=j -<; ...'.""H ."."'.1 . '" C) , '::r-j en ", ,} r,,, ('" " '--, '-,'J C) ?: -1J.. ._.l , :n 01 r-,f) ~ .~- :D -< -' ,.--- -~" , '." , " ,.~"O "."" . ~ ,_ __",-" '~,x" .- :-----_<_;,-_~L,--",,_;k .,- ,-, "_ - "-~ '_'-_';:'';--' ,'m2,;,~'/'-" _, __" , :"'-6:,,@ Brigid Q. Alford, Esquire Supreme Court lD. #38590 Jeffrey E.. Piccola, Esquire Supreme CourtI.D>#18018 BOSWELL, TlNTNER. PICCOLA & WICKERSHAM 315 North Front Street Post Office Box 741 Harrisburg, Pennsylvania 17108-0741 Attorneys for Petitioner State Farm Insurance Companies STATEF~INSURANCE COMPANIES, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA Petitioner v. No. 00-8030 DONNA SHAMBAUGH CIVIL ACTION - LAW Respondent JURY TRIAL DEMANDED CERTIFICATE PREREOUISITE TO SERVICE OF SUBPOENAS PURSUANT TO RULE 4009.22 As a prerequisite to service of subpoenas for documents and things pursuant to Rule 4009.22, Defendant certifies that: (I) a notice ofintentto serve the subpoenas with copies of the subpoenas attached thereto was mailed or delivered to each party at least twenty days prior to the date on which the subpoena is sought to be served, (2) a copy of the notice of intent, including the proposed subpoenas, is attached to this certificate, (3) no objection to the subpoenas has been received, and ~..^. ~- ~ " . .-;.",,' ,,',-' ~"--"'~ ''---,.-,:. '-',,1. _I',,, ---~,. .' '"0.-- _. ," -- _-,~:..:..; ,~'';'i" '!-;i,~;';;":~~\,,\~'_;';,-,>c. .,"".,1 (4) the subpoenas which will be served are identical to the subpoenas which are attached to the notice of intent to serve the subpoenas. Respectfully submitted, By: Brigid Q. ~lford, Esq Supreme Court #3859 Jeffrey E. Piccola, Esquire Supreme Court #18018 Boswell, Tintner, Piccola & Wickersham 315 North Front Street Harrisburg, P A 171 0 1 (717) 236-9377 Attorneys for Petitioner Date: l.f: It.do;.. I ' Brigid Q. Alford, Esquire Supreme Court 1.0. #38590 Jeffrey E.. Piccola, Esquire Supreme Court I.D> #18018 BOSWELL. TININER. PICCOLA & WICKERSHAlvI 315 North Front Street Post Office Box 741 Harrisburg, Pennsylvania 17l08.074l Attorneys for Defendant Donna Shambaugh STATE FARM INSURANCE COMPANIES, Petitioner IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYL VANIA v. No. 00-8030 DONNA SHAMBAUGH Respondent CIVIL ACTION - LAW JURY TRIAL DEMANDED NOTICE OF INTENT TO SERVE SUBPOENAS TO PRODUCE DOCUMENTS AND THINGS FOR DISCOVERY PURSUANT TO RULE 4009.21 Petitioner State Farm Insurance Companies intends to serve subpoenas identical to the ones that are attached to this notice upon the following: I. Retina & Oculoplastic Consultants, P.C. 2. Total Vision Care 3. Nevyas Eye Associates 4, Thomas R. Pheasant 5. Sacred Heart Hospital You have twenty (20) days from the date listed below in which to file of record .and serve upon the undersigned an objection to the subpoena. If no objection is made, the subpoena may be served. Date: 31J1 b~ Respectfully submitted, By: ~PI.'(.<:_f::...,-:.;,)lid.-'?vL Brigid Q.'Alford,Esquiie I , Supreme Court #38590-- Boswell, Tintner, Piccola & Wickersham 315 North Front Street Harrisburg,PA 17101 (717) 236-9377 Attorneys for Petitioner .~ h '. I~~ __I~ < "',- *,.;-.'. --" ".L~i'-"". . COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND STATE FARM INSURANCE COMPANIES, Petitioner v. DONNA SHAMBAUGH, Respondent File No. 00-8030 SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANTTO RULE 4009.22 ~O: Nevyas Eye Associates (Name of Person or ::ntity) .'Jithin twenty (20) days after service of this subpoena. you are ordered by the court to produce the following ::ocu~enrs or thinf;s: Any and all medical records,. treatment records, correspondence, referrals, . etc. reqardinq your professional care and treatment of Donna Shambaugh (Social Security No. 220-34-2066), from January 1980 through the present day. =.r 315 North Front- St-r.,.,t-.~"rr;"hl1rg. PlI 171111 (Address) /ou may deliver or mail legible copies of the documents or produce things requested by this subpoena, together ::ith the certificale of compliance, to the party making this request at the address listed above. You have the right :::: seek in advance the reasonable cost of preparing the copies or producing the things sought. ! you fail to produce the documents or things rec;uired by this subpoena within twenty (20) days after its service, ::ce party serving this subpoena ",ay seek a court order compelling you to comply wilh it. -:-HIS SUBPOENA WAS ISSUED AT THE REQUEST 0;= TrlE ;=OlLOWING PERSON: 'Jame Briqid Q. Alford, Esquire ~dd~ss: 315 North Front Street Harrisburg, PA 17101 -elephone: (717) 236-9377 3uoreme Court 10 ;; 38590 ':'.ttori'ley For: State Farm Insurance Companies l~"c' _dl...., h:/J (, ,:2yJ~ Seal of the Court L BY THE COU (Eft. 7/97) _._u ',.; 1,,-,,_ t. '"C_>, ~~'<' - --~ ""'''- - , COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND STATE FARM INSURANCE COMPANIES, Petitioner v. DONNA SHAMBAUGH, Respondent File No. 00-8030 SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANTTO RULE 4009.22 0: Thomas R. Pheasant, M_D. (Name of Person or =miry) 'Ithin twenty (20) days after service of this su:opoena. you are ordered by the court to produce the following :::ocuments or thin!;s: Any and all medical records, .treatment records, correspondence, referrals, etc. regardinq your professional care and treatment of Donna Shambauqh (Social Security No. 220-34-2066). from Januarv 1. 1980 throuah the present date. 315 North Frnnr !==:r"'jQjQ+-.~.:lr,..ic::::nl1"'1J p~.1i1n1 (Accress) "'ou may deliver or mail legible copies of the doc~ments or produce things requested by this subpoena. together !lith the certificate of compliance, to the party making this request at the address listed above. You have the right :0 seek in advance the reasonable cost of preparing the copies or producing the things sought. f you fail to produce the documents or things required by this subpoena within t;venty (20) days after its service, :;-:e ;tany servir,g this subpoena may seek a cour~ order c::;~~e!ling you to comply with it. 7'HIS SUBPOENA WAS ISSUED AT THE "EQUEST OF Tri:: FOllOWING PERSON: ~ame Brigid Q. Alford, Esquire ~jjress: 315 North Front Street Harrisburg, PA 17101 ~elephone: (717) 236-9377 Supreme COUit JD ;; 38590 :".!torney For: State Farm Insurance Companies Seal of the Court :)ate: ,c;~ &, ,Jjj;} (Eff.7/97) " "'""'- '"'".." I -; ',< v.,~.._". \,t',- '''.-'- COMMON~EALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND STATE FARM INSURANCE COMPANIES, Petitioner v. DONNA SHAMBAUGH, Respondent File No. 00-8030 SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANTTO RULE 4009.22 0: Sacred Heart Hospital (Name of Person or ::nllty) Vithin twenty (20) days after serJice of this subpoena. you are ordered by the court to produce the fallowing ::acuments or thinGs: Any and all medical records, treatment recordA. correspondence. referrals. etc. regardin~your professional care and treatment of Donna Shambaucrh (Social Security No. 220-34-~0661 from January 1. lqRO throucrh the present date. 315 North Fr()l1r Srrppr,H,n-ri"rmrg, PlI 17101 (AcCress) vou may deliver or mail legible copies oi the dac:.Jme!1ts or produce things requested by this subpoena. together !/ith the certificate of compliance, to the party making this requ.est at the address listed above. You have the right :::: seek in advance the reascnable cost at preparing the copies or producing the t.'iings sought. ; yeu fali to produce the documems or things required by this subpoena within twenty (20) days after its service, :J-:e party serving this subpoena ~ay seek a cour-c order cOr7:;:ielIing yaw to comply wirh it. -:-:-:IS SU8POENA WAS ISSUEiJAT THE REQUEST 0;: Ti-iE ;:OlLOWING PERSON: 'lame Briqid Q. Alford, Esquire -'::dress: 315 North Front Street Harrisburg, PA 17101 -elephone: (717) 236-9377 Supreme Court 10 # 38590 ..;..ttorney For: State Farm Insurance Companies :;ate: Fe b t )(tJQ Seal of the Cawrt PretMonata c41.ua ~ ~A . 'lJ6pufy (Err, 7/97) - "', " .1." el,'-.~"oo-; ","._ ,,,-',, ,,~; '--" ',",",,'.'_,h,,; ~ ~ ~ COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND STATE FARM INSURANCE COMPANIES, Petitioner v. DONNA SHAMBAUGH, Respondent File No. 00-8030 SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 0: Retina & Oculoplastic Consultants, P.C. (Name of Person or Entity) Vithin twenty (20) days after service of this subpoena, you are ordered by the court to produce the following :::ocuments or things; Any and all medical records,.treatment records, correspondence, referrals, etc. reqarding your professional care and treatment of Donna Shambauqh {Social Secuity No. 220-34-20661, from Januarv 1, 1980 throuqh the present date. 315 North Front Street, Harrisburg, PA 17101 (Adtress) '!::ou may deliver or mail/egible copies of the documents or produce things requested by this subpoena, together ::ith the cerlificate of compliance, to the party making this reques; at the address listed above. You have the right :: seek in advance the reasonable cost of preparing the copies or producing the things sought. f you fail to produce the documents or things required by this subpoena within twenty (20) days after its service, :.-'a ,carty serving this subpoena may seek a coun ordar compelling you to comply with it. -:-,,15 SUBPOENA WAS ISSUED AT THE REQUEST 0;= THE FOLLOWING PERSON: '.Jama Rrigid O. Alfor<l. Esquire ;dd~ss: 315 North Front Street Harrisburq, PA 17101 ;"e1ephone: (717) 236-9377 3iJpreme COuit JD ;; 38590 -'<torney For: State Farm INsurance Companies BY THE COURT: :Cata: hb. G 2rJO~ Seal of the Court (Eff. 7/97) ~ '-" - .' y" .'"' --,~ . 1--" I _, ,Ii, ~ ,:::c,>;;, ;,.'"" .~,,;,~''''_;__ ",,,,' ~,:~- __1, < COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND STATE FARM INSURANCE COMPANIES, Petitioner v. DONNA SHl\.MBAUGH, File No. 00-8010 Respondent SUBPOENA TO FRODUCE DOCUMENTS ORTHINGS FOR DISCOVERY PURSUANTTO RULE 4009.22 ~O: Total Vision Care (Name of Person or Entity) Vi thin twenty (2D) days after service of this subpoena. you are ordered by the court to produce the following ::ocuments or thinGS: . Any Ann All m~ni~Hl records, .treatment records, correspodence, referrals, etc. regarning ynnr professional care and treatment of Donna Shambaugh (Social Se~nrity No. 220-34-20661. from January 1, 1980 through the present date. 315 North Front Street, Harrisburq. PA 17101 (Adoress) "':;u f71ay deliver or mail legible copies of the dccuments or produce things requested by this subpcena. together .'nth the certificate of compliance. to the party r.;aking this request at the address-listed above. You have the right :c seek in advance the reasonable cost of preparing the copies or producing the things sought. f you fail to produce the documents or things rec;uired by this subpoena within tNenty (20) days after its service, :_~e party serving this subpoena may seek a cour; order compelli:lg you to comply with it. ;-;-'1$ SUBPOENA WAS ISSUED AT THE REOUEST OF TH: FOLLOWING PE:=ISON: 'Jame Briqid Q. Alford, Esquire ,-::dress: 315 North Front Street Harrisburg, PA 17101 -eJeohone: (7171 236-9377 Supreme COUit 10 :; 38590 ':'.ttorr'ley For: State Farm Insurance Companies :;ate: hb to ,pe)t);} Seal of the Court (Eft. 7/97) '" -~",'" '~" ,-. - - '-~' ,'- ,,' - - -,j, r-_.! '-"-I.--~; x . ',C'_,'. ,,; .'-,' '-'A~' . . '-",-, -"_~" ";;'-,_;;',.,~.,"" :~__, ":,, ; '.' ":~I CERTIFICATE OF SERVICE I do hereby certify that I have served a true and correct copy of the foregoing Petitioner's Notice of Intent to Serve Subpoenas to Produce Documents and Things for Discovery Pursuant to Rule 4009.21 by fIrst-class United States mail upon the following parties at the addresses set forth below: Dusan Bratic, Esquire Bratic & Portko 101 South Center, Suite A 101 South U.S. Route 15 Dillsburg, PA 17019 By: \ /J . . / . _' V')rt,. );. ' i,:/ ;....(...~ ..~ I,.L""'..~'~'-,""I.._-_.- I' -, Brigid Q: Alford, Esquire l, Date: ~La(IoL .,. ~". -. - '.,' ...J .... ,. .c. '."."_".' ..c ....... . .... ',. ....".Pc.,.. '.,. , .... "j CERTIFICATE OF SERVICE I do hereby certifY that I have served a true and correct copy of the foregoing Certificate Prerequisite to Service of a Subpoena on the following by first-class mail, postage prepaid and addressed as follows: Dusan Bratic, Esquire Bratic & Portko 101 South Center, Suite A 101 South U.S. Route 15 Dillsburg,PA 17019 By: Date: "//((pr [ c ,,"O;-..'ff ,~ "' n^ " ,~,~~-.. -,. [j' - '< L"-. '~&-Jj f1:;1lli~i\!jj;fillll' "'f~ _ ',,_~ ~. "'Wr *,,'~'lll'" " c Ui)' fTi"_ "7F''-' (0 ~~i ';::'C L --I -< , o C :"~." , ,~, -"I: o r",.) 7';00 tJ' -e... -~ (::::;. Z1 ()''', u, , , "'.-' .'"t) :_:1',: ':? =-:-; ?i~~ ~~ :=i 55 -< r- cx> if.