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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
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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
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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.
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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
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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
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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;
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(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.
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You or Your - means the named insured or named
insureds shown on the declarations page.
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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.
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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
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8386
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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-
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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.
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8386
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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
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8386
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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.
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8386
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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
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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
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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.
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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
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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
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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
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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
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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.
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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
," ,
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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.
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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
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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.
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SECRETARY
C~o.a.~~~~\.9r
PRESIDENT
33
8386
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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
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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.
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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.
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Enclosures
cc: James G. Nealon, Esquire
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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.
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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.
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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.
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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.
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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.
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REK/jab
cc: James G. Nealon, Esquire
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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
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MARGOLIS EDELSTEIN
COpy
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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
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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
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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/
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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:
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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
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Attorney for:
Petitioner
Respondent
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IN THE COURT OF CO~j: PLBAS ;~ 31
OF CUMBERLAND CO~~PENNSY-L~
NO. 00-8030 CIVIL TERM~::z 0' i-~~':,
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CIVILACTlON-LAW $:8 ;. 25M
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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.
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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
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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;
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(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.
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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
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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
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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-
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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
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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
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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
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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
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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
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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.
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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
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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.
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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
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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,
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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
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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
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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:
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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:
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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.
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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.
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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
. .
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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
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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.
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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:, , //
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REKljab
Enclosures
cc: James G. Nealon, Esquire
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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.
" ,
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'''-''':''-::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.
".,.
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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.
',"''''-
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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.
.
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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
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REK/jab
cc: James G. Nealon, Esquire
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_-.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
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_..: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
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.
.
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
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..
.
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
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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:
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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
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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
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By:
1~li;~ &i=
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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:{-'
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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
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So answe . ..:.___
~ie -
Sheriff of Cumberland County
MARGOLIS, EDELSTEIN
12/14/2000
Sworn and subscribed to before me
this If~
day of ~
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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
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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
,-.-
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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
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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
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CIVIL ACTION _ LAW d:;: G :x ee' n
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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.
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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
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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;
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(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.
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4
8386
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You or Your - means the named insured or named
insureds shown on the declarations page.
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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
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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-
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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
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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
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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
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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
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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.
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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
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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
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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
,
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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
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.' ~- - -~
.,"~ ,,-,-,--,,.
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.
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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
.' ,--
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#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
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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_
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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.
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8386
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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-
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8386
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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;
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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
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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:
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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
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8386
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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:
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8386
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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.
.
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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
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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
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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.
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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
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8386
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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.
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SECRETARY
C~o.s.t1~)<"^' \. 9r
PRESIDENT
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8386
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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
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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.
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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.
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REK/jab
Enclosures
cc: James G. Nealon, Esquire
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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.
.
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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
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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.
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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.
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REK/jab
cc: James G. Nealon, Esquire
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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,
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REKljab
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MARGOLIS EDELSTEIN
(Copy
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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
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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:
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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:
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Je ica Bates
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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
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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
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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
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STATE FARM INSURANCE,
COMPANIES,
PLAINTIFF
v.
DONNA SHAMBAUGH,
DEFENDANT
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: 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
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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
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(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
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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
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Seal of the Court
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BY THE COU
(Eft. 7/97)
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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:
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(Eff.7/97)
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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)
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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)
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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)
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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:
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V')rt,. );. '
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Brigid Q: Alford, Esquire
l,
Date: ~La(IoL
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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
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