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HomeMy WebLinkAbout07-6348FLANAGAN and DIBERNARDO, LLP BY: Brian A. McCall, Esquire I.D. No. 83030 150 East Chestnut Street ORIGINAL Attorneys for Petitioner, Lancaster, PA 17602 Erie Insurance Exchange (717) 397-9444 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ERIE INSURANCE EXCHANGE, Petitioner, v. RICHARD BREACH, Respondent. UNDERINSURED MOTORIST ARBITRATION No. 0'7 - ~, 34~ C~ CIVIL ACTION -LAW `~-~ PETITION OF ERIE INSURANCE EXCHANGE TO COMPEL UNDERINSURED ARBITRATION AND APPOINT A NEUTRAL THIRD ARBITRATOR PURSUANT TO CUMBERLAND COUNTY LOCAL RULE 206.1 The instant Petition is filed pursuant to Cumberland County Local Rule 206.1. The Petition is also filed in accordance with 42 Pa.C.S.A. § 3701, et. seq. AND NOW COMES, Petitioner, Erie Insurance Exchange, by and through its Attorneys, Brian A. McCall, Esquire and Flanagan and DiBernardo, LLP and moves this Honorable Court to (1) compel Respondent, Richard Breach to arbitrate Respondent Richard Breach's underinsured motorist claim and (2) appoint a neutral, third arbitrator. 1. Petitioner, Erie Insurance is an insurance company duly licensed to do business in the Commonwealth of Pennsylvania. 2. Respondent, Richard Breach is an adult individual, residing at 1704 Cornell Road, Camp Hill, Cumberland County, Pennsylvania. 3. The above captioned matter arises out of a motor vehicle accident on July 4, 2005, on Creek Road, Monroe Township, Cumberland County, Pennsylvania. 4. Respondent, Richard Breach has alleged injury as a result of the accident. 5. Respondent, Richazd Breach has settled his claim as against the Defendant Elliseth Henry's insurance carrier. 6. At all times relevant hereto, Respondent Richazd Breach was insured on an automobile policy issued by Petitioner, Erie Insurance Exchange which provides underinsured coverage to Richazd Breach. 7. Respondent, Richard Breach has alleged that the settlement he received from Defendant Elliseth Henry's insurance carrier is insufficient to fully compensate him for his injuries and accordingly has commenced an action as against Petitioner, Erie Insurance Exchange for underinsured motorist benefits. 8. On behalf of Respondent, Richard Breach, Robert F. Clazaval, Esquire has appointed Andrew H. Dowling, Esquire to serve as Respondent's azbitrator. 9. On behalf of Petitioner, James G. Nealon, Esquire, has agreed to serve as Petitioner's arbitrator. 10. The parties had previously requested Steven M. Greecher, Esquire to serve as the third, neutral arbitrator. 11. Upon advising Mr. Greecher of their request, Mr. Greecher advised counsel that he and his firm had claims pending against Respondent, Erie Insurance for payment of attorney's fees and coverage issues. 12. In light of these conflicts, Petitioner accepted Mr. Greecher's offer to recuse himself as the neutral azbitrator. 2 13. Both parties have, since then, suggested multiple potential neutrals in this matter, all of whom have been rejected. 14. Respondent has rejected every neutral arbitrator proposed by Petitioner, including former York County Judge, Albert G. Blakey, Esquire, and George B. Faller, Jr., Esquire, who practices in Cumberland County and regularly serves as a respected neutral arbitrator in UIM proceedings. 15. In light of the difficulties in selecting a neutral arbitrator, Petitioner advised Respondent, by way of correspondence dated October 19, 2007, he would be petitioning the Cumberland County Court of Common Pleas to appoint a neutral arbitrator provided the parties could not agree on a neutral within two (2) weeks. 16. The insurance policy entered into between Petitioner, Erie Insurance Exchange and Respondent, Richard Breach, on page four (4) under the section titled "ARBITRATION" mandates the following: After written demand for arbitration by either party, each party will select an arbitrator. These two will select a third. If no selection is made within 30 days, the Judge of the Court of Record, in the county where the arbitration is pendinE, will appoint the third arbitrator. Unless the parties agree otherwise, the arbitration will take place in the county and state of your legal domicile at the time of the accident, and will follow the local rules of procedure and evidence. In all other respects, any arbitration will follow the arbitration provisions of the Arbitration Act of 1927. A true and correct copy of the applicable insurance policy language is attached hereto and marked as Exhibit "A." 17. At the time of the accident, Respondent Richazd Breach was residing at 1704 Cornell Road, Camp Hill Cumberland County Pennsylvania. A copy of the Police Accident Report which evidences Petitioner's residence in Cumberland County is attached hereto and marked as Exhibit "B." 18. Pursuant to the notes section of 42 Pa.C.S.A. § 7302, 42 Pa. C.S.A(d)(2) (relating to special application) shall be applicable to any nonjudicial azbitration pursuant to: (2) An agreement heretofore or hereafter made which expressly provides for azbitration pursuant to the former provisions of the Act of Apri125, 1927 (P.L. 381, No. 248), relating to statutory azbitration. 42. Pa.C.S.A. § 7302 (notes) 19. 42 Pa.C.S.A. § 3705 also specifically provides that "[i]f the agreement to azbitrate prescribes a method of appointment of arbitrators, the prescribed method shall be followed." 42 Pa.C.S.A. § 3705. (emphasis added) 20. Further, 42 Pa.C.S.A. § 3799, regarding venue, provides as follows: § 7319. Venue of court proceedings Except as otherwise prescribed by general rules: (1) An initial application to a court under this subchapter shall be made to the court of the county in which the aere~ ement Rrescribes that the arbitration hearine shall be held or, if the hearing has been held, in the county in which the hearing was held. 21. Petitioner's request to have Cumberland County appoint a neutral, third azbitrator is clearly and unequivocally supported by both the agreement to arbitrate and controlling statutory rule. 4 22. Accordingly, Cumberland County has jurisdiction and/or venue as the Court of Record to appoint a neutral, third abbitrator in this proceeding. 23 As such, Petitioner, Erie Insurance Exchange, respectfully moves this Honorable Court for a Rule to Show Cause why the Court should not appoint a neutral, third arbitrator. WHEREFORE, Petitioner, Erie Insurance Exchange moves this Honorable Court to issue a Rule upon the Respondent, Richard Breach, to show cause, if it has any, why this Honorable Court should not appoint a third arbitrator. Respectfully submitted, FLANAGAN awn tl..II,~BERNARDO, LLP A. McCall, Esquire iey LD. No.: 83030 150 East Chestnut Street Lancaster, PA 17602 (717)397-9444 (717) 397-2397 (facsimile) Attorney for Petitioner, Erie Insurance Exchange 5 VERIFICATION I, Brian A. McCall, Esquire, being duly sworn according to law, depose and state that I am attorney for the Petitioner in this action and that the information contained in the foregoing document is true and correct to the best of my knowledge, information and belief. I understand that any false statements herein are made subject to the penalties of 18 Pa.C.S.A. § 4904 relating to unsworn falsification to authorities. 6 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ERIE INSURANCE EXHANGE, UNDERINSURED MOTORIST Petitioner, ARBITRATION v. NO. RICHARD BREACH, : Respondent. CIVIL ACTION -LAW CERTIFICATE OF SERVICE On this day, I do hereby certify that I served a true and correct copy of the foregoing document upon the following and in the manner indicated below. Service was made by First Class Mail addressed as follows: Robert F. Claraval, Esquire Claraval & Claraval 500 North Third Street, 2°d Floor Harrisburg, PA 17101 Attorney for Respondent, Richard Breach FLANAGAN and ~ERNAR~O, LLP Date: tb • ~ • a-7 ~y; $'ria A. McCall, Esquire ast Chestnut Street Lancaster, PA 17602 (717) 397-9444 Attorney I.D. No. 83030 Attorney for Petitioner, Erie Insurance Exchange 7 ~xti;b.+ fi s t~ ~~ ERIE® ERIE INSURANCE GROUP • ~ PRIVATE PASSENGER AUTO AFPU01 (Ed. 4/03) OF-gg05 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. UNINSURED/UNDERINSURED MOTORISTS COVERAGE ENDORSEMENT -- PENNSYLVANIA This endorsement contains provisions applicable to Uninsured/Underinsured Motorists Bodily Injury Coverage and replaces provisions contained in your policy to the extent that the provisions in this endorsement are different from those in your policy. DEFINITIONS Words in bold type a-•e used as defined in this endorse- ment. If a word in bold type is not defined in this endorsement, then the word is used as otherwise defined in the policy. "Extraordinary Medical Benefits Coverage" means cov- erage for injury arising out of the maintenance or use of a motor vehicle for which medical treatment and rehabilitative services exceed $100,000. "First Party Benefits" means insurance first party benefits loss benefit, funeral benefit, combination benefit) in Pennsylvania Motor Vehicle Law. Pennsylvania motor vehicle (medical benefit, income accidental death benefit, accordance with the Financial Responsibility "Non-owned auto" means any private passenger auto, moving van, trailer, or temporary substitute not owned or leased by you or a relative. The operation or other use by you or a relative must be with the permission of the owner or you or the relative must reasonably believe the permission of the owner exists. 2. motor vehicles that are owned, leased, or operated by a self-insurer within the meaning of the financial responsibility laws, motor carrier. laws or similar laws, unless the self-insurer becomes insolvent; 3. motor vehicles owned or leased by the United States; 4. motor vehicles designed for use mainly off public roads; or 5. motor vehicles owned, leased, or rented by, famished to or available for the use of a Named Insured, a spouse or resident relative of a Named Insured.. "Underinsured motor vehicle" means a motor vehicle for which the limits of available liability bonds or insurance or self-insurance at Che time of the accident are insuffi- cient to pay losses and damages. An underinsured motor vehicle does not include: 1. motor vehicles insured for Liability Protection under this policy; 2. motor vehicles owned or leased by the United States; or 3. motor vehicles designed for use mainly off public roads. "Serious injury" means a personal injury resulting in death, serious impairment of body function or perms- OUR PROMISE nent, serious disfigurement. "Uninsured motor vehicle" means: 1. a motor vehicle for which there is no liability bond or insurance or self-insurance at the time of the acci- dent; 2. a motor vehicle for which the insuring company denies coverage or is or becomes insolvent; or 3. a "hit-and-run" motor vehicle which causes you bodily injury. 7'he identity of the driver and owner of the "hit-and-run" vehicle must be unknown. The accident must be reported to the police or other proper governmental authority within 24 hours or as soon as possible. You must notify us as soon as possible. An uninsured motor vehicle does not ircludc: 1. motor vehicles insured for Liability Protection under this policy; If Uninsured Motorists Coverage is indicated on the ' Declarations, we will pay damages for bodily injury that you or your legal representative are legally entitled to recover from the owner or operator of an nainsured motor vehicle. If Underinsured Motorists Coverage is indicated on the Declarations, we will pay damages for bodily injury that you or your legal representative are legally entitled to recover from the owner or operator of an underinsured motor vehicle. Damages must result from a motor vehicle accident arising out of the ownership or use of the uninsured motor vehicle or underinsured motor vehicle as a motor vchicle and involve bodily injury to you or others we protect. Bodily injury means physical harm, sickness, disease or resultant death to a person. Payment of medical expenses will not exceed I10% of the: r 1. prevailing charge at tl~e 75th percentile; 2. applicable fee schedule, the recommended fee or the inflation index charge; 3. diagnostic-related groups (DRG) payment; or 4. fee established by the Insurance Commissioner, whichever pertains to the specialty service. involved, determined to be applicable in the Commonwealth of Pennsylvania under the Medicare Program for compa- rable services at the time the services were rendered, or the provider's usual and customary charge, .whichever is less. If a fee, charge or payment has not been calculated under the Medicare program for a particular treatment, accom- modation, product or service the amount of the payment may .not exceed 80% of the provider's usual and cus- tomary charge. If acute care is provided in an acute care facility to a patient with an immediately life-threatening or urgent injury by a Level I or Level II trauma center accredited by the Pennsylvania Trauma Systems Foundation under the Emergency Medical Services Act (P.L.164, No. 45), or to a major burn injury patient by a burn facility which meets all the service standards of the American Burn Association, the amount of payment may not exceed the usual and customary charge. Peer Review Organizations (PRO), which have been approved by the Insurance Commissioner to evaluate whether or not: 1. treatment; 2. health care services; 3. products; or 4. accommodations; which were provided conform to professional standards of performance and were medically necessary .and eco- nomically provided, may be used by us. The injured person may request a reconsideration by the PRO within 30 days of the PRO's initial determination. If we refuse payment of a provider's bill and do not chal- lenge it before a PRO within 90 days of receipt (90 day provision does not apply to continuing treatment or ser- vices), the injured person may ask the court to review our refusal to pay. We will not be bound by a judgment against the owner or operator of the uninsured motor vehicle -or underinsured motor vehicle on issues of liability or amount of damages unless i[ is obtained with our written consent. - OTHERS WE PROTECT 1. any relative. 2. anyone else, while occupying any owned auto we insure other than: a. one while hied by or rented to others for a fee, or while available for hire by the public. "Fee" does not include payment received in a car pool 2 or for trips for non-profit social, educational or charitable agencies. b. one being used without the permission of the owner. 3. anyone else who is entitled to recover damages because of bodily injury to any person protected by this coverage. 4. anyone else while occupying anon-owned auto other than: a. one you are using that is owned or leased by another person residing in your household. b. one furnished or available for the regular use of you or anyone residing in your household. c. one being operated by anyone other than you or a relative. d. one while hired by or rented to others for a fee, or while available for hire by the public. "Fee" does not include payment received in a car pool or for trips for non-profit social, educational or charitable agencies. e. one being used without the permission of the owner. LIMITATIONS ON OUR DUTY TO PAY What We Do Not Cover -Exclusions This insurance does not apply to: 1. damages sustained by anyone we protect if he, she or a legal representative settled with anyone who may be liable for the damages, without our written consent. 2. the benefit of any workers' compensation or disa- bility benefits carrier or anyone qualifying as a self- insurer under a workers' compensation, disability benefits or similar law. 3. damages sustained by anyone we protect while occu- pying or being struck by a motor vehicle owned or leased by you or a relative, but not insured for Uninsured or Underinsured Motorists Coverage under this policy. 4. damages sustained by anyone we pro'~ect while occu- pying or being struck by a miscellaneous vehicle owned or leased by you or a relative, but aot insured for Uninsured or Underinsured Motorists Coverage under this policy. 5. punitive or exemplary damages and related defense costs. 6. non-economic damages sustained in a motor vehicle accident by anyone we protect unless such person sustained serious injury. Exclusion 6. applies only when the L/M/TED TORT option is selected. 7. bodily injury sustained by anyone we protect resulting from the use of any weapon. 8. bodily injury sustained by anyone we protect resulting from assault and/or battery. 4. bodily injury sustained by anyone we protect while involved in committing a crime. r 0. bodily injury to you or a resident using anon-owned motor vehicle or a non-owned miscellaneous vehicle which is regularly used by you or a resident, but not insured for Uninsured or Underinsured Motorists Coverage under this policy. LIMITS OF PROTECTION Limitations of Payment If coverage is purchased on a "Split Limits" basis, the Declarations will .show a per PERSON and per ACCI- DENT limit for Uninsured and/or Underinsured Motor- ists Bodily Injury. The per PERSON limit for Bodily Injury for one auto is the most we will pay for damages arising out of bodily injury or death to one person in any one accident. The per ACCIDENT limit for Bodily Injury for one auto is the most we will pay for damages arising out of bodily injury or death to all persons resulting fro,n any one accident, subject to the per PERSON limit. If coverage is purchased on a "Single Limit" basis, the Declarations will show a per ACCIDENT limit for Uninsured and/or Underinsured Motorists Bodily Injury. The per ACCIDENT limit for one auto is the most we will pay for all damages arising out of bodily injury resulting from any one accident. Uninsured/IJnderinsured Motorists coverage is not pro- vided for any trailer, whether or not the trailer is attached to another motor vehicle or miscellaneous vehicle. No separate limit of protection for Uninsured/[Jnderinsured Motorists coverage is available for a trailer, whether attached or unattached to a motor vehicle or miscellaneous vehicle. Uninsured/LJnderinsured Motorists coverage does not apply to a miscellaneous vehicle owned or leased by you or a relative unless the miscellaneous vehicle is listed on the Declarations and a premium is shown for this coverage. No one will be entitled to receive duplicate payments for the same elements of loss. If an individual's damages derive from, arise out of, or otherwise result from bodily injury to another person injured in the accident or the death of another person killed in the accident, we will pay only for such damages within the per PERSON limit available to the person injured or killed in the accident. Stacked Coverage If Stacked Uninsured Motorists andJor Stacked Underinsured Motorists Coverage is purchased and the injured person is you or a relative, we will pay no more than the applicable sum of the Uninsured or Underinsured Motorists Coverage limits shown on the Declarations. If the injured person is other than you or a relative, we will pay no more than the applicable Uninsured or Underinsured Motorists Coverage limits shown on the Declarations for the auto involved in the accident, regardless of the number of persor;s we protect, autos we insure, premiums paid, claims made or autos involved in the accident. If none of the autos are involved in the accident, the highest limit of Uninsured or Underinsured Motorists Coverage applicable to any one auto will apply. Unstacked Coverage If Unstacked Uninsured Motorists and/or Unstacked Underinsured Motorists Coverage is purchased, we will pay no more than the Uninsured or .Underinsured Motorists Coverage limits shown on the Declarations for the auto involved in the accident, regardless of the number of persons we protect, autos we insure, pre- miums paid, claims made or autos involved in the acci- dent. If none of the autos are involved in the accident, the highest limit of Uninsured or Underinsured Motor- ists Coverage applicable to any one auto will apply. Reductions The amount of damages paid or payable under this Uninsured or Underinsured Motorists Coverages will be reduced by: 1. the amounts paid or payable by or for those liable for bodily injury to anyone we protect. 2. the amounts paid or payable to anyone we protect under the Liability Protection of this policy. Payment under these coverages to or for anyone we protect will reduce the amount of damages they may be entitled to recover from those protected under the Liability Protection of this policy. A person who recovers damages under Uninsured Motorists Coverage cannot recover damages under Underinsured Motorists Coverage for the same accident. In ,any action for damages for Uninsured Motorists bene- fits or Underinsured Motorists benefits arising out of the maintenance or use of a motor vehicle, a person who is eligible to receive benefits under First Party Benefits cov- erages shall be precluded from recovering the amount of I. required benefits paid or payable under First Party Benefits; and 2. medical and rehabilitation expenses which wen paid or aze payable under Eztraordinary Medical Benefits Coverage, if purchased. OTHER INSURANCE If anyone we protect has other similar insurance that applies to the accident, we will pay our share of the loss, subject to the other terms and conditions of the policy and this endorsement. Our share will be the proportion the limit of protection of this insurance bears to the total Limit of Liability of all applicable insurance. For bodily injury to anyone we protect while occupying a motor vehicle you do not own, we will pay the amount of the loss up to the applicable limit(s) shown on the Declarations, less the amount paid or payable by other insurance. When the accident involves underinsured motor vehicles, we will not pay until all other forms of insurance under all bodil;~ injury liability bonds and insurance policies and self-insurance plans applicable at the time of the accident hav.: been exhausted by payment of their limits or have been resolved by settlement or 6y final resol- ution of the court. ~- ARBITRATION Disagreement over: 1. whether or not an}'one we protect is legally entitled to recover damages from the owner or operator of an uninsured motor vehicle or underinsured motor vehicle; or 2. the amount of damages; shall be settled by arbitration. The decision of the arbitrators shall be limited to, and binding on, these two issues. However, the amount of damages can never exceed the Uninsured or Underinsured Motorists Cov- erage limits shown on the Declarations. All other disagreements shall be decided by a court of competent jurisdiction and not by azbitration. Disagree- ments to be determined by such court include, but are not limited to: 1. stacking; 2. residency; 3. statutes of limitations; 4. whether or not a claimant is a person we protect under this endorsement; 5. the validity of coverage selections or waivers exe- cuted pursuant to the .Pennsylvania Motor Vehicle Financial Responsibility Law; 6. our rights and duties or your rights and duties under this policy; 7. the interpretation of defined terms, the insuring agreement, exclusions, the limits of protection, the trust agreement, this arbitration clause, or any other of the policy's terms and conditions; or 8. the degree to which either -party is bound by a deci- sion made by an arbitration panel which a party claims is outside the scope of the arbitration. A decision shall not be binding on any issue not prop- erly the subject of arbitration. Either party may stay arbitration or execution of any judgment or awazd until the final resolution of whether an issue is properly subject to arbitration. After written demand for azbitration by either party, each party will select an arbitrator. These two will select a . third. If no selection is made within 30 days, the Judge of the Court of Record, in the county where the azbi- tration is pending, will appoint the third arbitrator. Unless the parties agree otherwise, the arbitration will take place in the county and state of your legal domicile at the time of the accident, and will follow the local rules of procedure and evidence. Each party will pay the azbitrator he chooses and equally beaz the expenses for the third and all other expenses of the arbitration. Fees to lawyers and expert witnesses are to be paid by the party hiring them. In all other respects, any arbitration will follow the arbi- tration provisions of the Arbitration Act of 1927. PAYMENT OF LOSS When multiple policies apply, payment shall be made in the following order of priority: 1. A policy covering the motor vehicle the injured person is occupying at the time of the accident. 2. A policy covering a motor vehicle not involved in the accident with respect to which the injured person is an insured. If two or more policies have equal priority, the insurer against which the claim is first made shall process and pay the claim as if wholly responsible. Thereafter, the insurer is entitled to recover a pro rata contribution from any other insurer for the benefits paid and claims costs incurred. If we are the insurer against which the claim is first made, we will not pay more than our Limit of Pro- tection. At our option, we will pay: 1. anyone we protect; 2. the surviving spouse; 3. the legal representative; or 4. anyone legally entitled to recover. TRUST AGREEMENT When we owe payment to anyone under this cov- erage, they will: a. hold in trust for us all rights of recovery against the other party; b. do whatever is required to secure these rights, and do nothing to harm them; and c. sign and deliver to us all relevant papers. 2. When we pay anyone under this coverage, they will: a. repay us out of any damages recovered from the legally liable party; b. take any action necessary to recover payments made under this coverage, through a lawyer chosen by us; and c. repay us from any recovery for expenses, costs or ' lawyers' fees we paid in the action. RIGHTS AND DUTIES -GENERAL POLICY CONDITIONS WHAT TO DO WHEN AN ACCIDENT OR LOSS HAPPENS The following duties are added: If claimants or their representatives bring action for damages, copies of suit papers must be sent to us at once. In an action against us, we may require anyone wee protect to join with us to bring those we allege to be liable into the action as party defendants. 4 LAWSUITS AGAINST US OTHER PROVISIONS The entire section is changed to read: All other provisions of the policy apply. You must comply with the terms of the policy before you may sue us. 5 ~~Fb'`~ r- ~NtMOIV11VEAlTH OF PEP1PlSYLVANIA ' ' ~ POLICE CRASH REPORTING FORM Case Closed Reportabk Gash Page ~ 500 ~ ~ Yes O N~ ,~ Yep O N~ a t ,~. _ -- Incident Gash Numiber P0669868 a t't O 2. ~ A en N Z ~ Police Agency Patrol Zone ~ ~ ~ ~ Z p ame ~ Di h OUI~ PrechM Inv ation Date (MM-DD-YYY~ C,4RC.~ s c.E 0 ? - ~ - 2 o p S spatc Time (min ~ 7 ~ S Arrival Time (mil) / 7 3 3 Investi ator Bad a Number Ar ~ 7 . Sco-~- ~r~~w~~ 6 9 9 ~ Reviewer 0 Badge Number Aeeroval r]nts ' r~.u~_nn vw.n y ~_-~ - L_ r- t County CouAn Name MuniapaG Munici Name - '- Qatir d wit R Z ~ BF ~l C t~.l1~ . ~MJ4 p ,Z C ~ Crash Date {MM DD YY O 7 o .vep~ CJP O sun O Thu 3 - - YY) M +I Crash Tyne (mr7) No of Unlts Peo a In' red Kilkd• *If > 00 S Mon Oki ~~ :~ _ ~?" a ' 2 m 4 5 j it Worl¢ yes, Complete ~ ! 7/ O School Bus a o 3 0 ,$- o w~ ~ ~` Owed O unit O one O Yes ~ No _ . _ . _ __ S No •M ~'~ 29) - _ ~ Related Q Y~ •- ~ ~ - School Zone Related 0 Y~ ®No Notify PENN'DOTO Y~ ~ ~ _ - - s • ~` O 4 Way Intersect+on Q 'Y' Ir-tersea+on O MuIU-leg Interx+ctron ~ MidbloCk Maintenance Off Rare .--. - . • ~ _ - ... - Q P O Ra+Iroad Cnxs+ng ! 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Q 30-ti0 Min. ~ 1-3 hrs O 3-6 hrs Q 6-9 hrs Q > g hours O (~~ FOReA ~ AA-S00 (13.02) PEkIdDOT COPY 1----_ . i . ~ ,., CgRAilApi~W~ALYCi 01` e'~RIPoSV~YAMiA I~I~~ ~S~ ~~0~~~~ ~~~ ~111~1~IIIII~11nOa Crash Alc.r>>~,.r ~ AA 500 2 P~ Page: °z°-" ~~` ,~9s~ a z_ P 0 6 6 9 8 6 8 o ~ Motor Vehicle in ~o ~~ Transport d Hit & Run Vehice Q Illegally Parked Q Legally parked O Pedestrian Q Pedestrian on Skates, Disabled kom ~ Non -Motorized C.omnkrnta/ Vehtd~e ~ in Wheekhair, etc Q Previous Crash 0 Train ~ Phantom Vehicle Q Yes ~ ~ (ff 'Pedestrian • or 'P'edestrian vn Skate; in wheelchair, etc•, tom /ete Form M, Section 28) Unit No p~ Name (d Ye; Complete Form 4 Q ~ r L ~ , ~ ~ T ~ Mt Oate of Birth (MM-00.YYYY) Delete? last Name ® ~ Z ~ ~ r ~ Address / Clt /State 0 ~ .ra r nsd,~ Drrver Eicerua Number ~ Z Z / ! ~ / ~ ~ A/ o4Druas_ w~y~~ ~ No 0 glegal Drugs a J ~ Akohol (~ Akohol and Drugs Ak~/~Ol lest TYae o` ~ Test Not Grven ~ Breath v Q Blood = Q Unne A/west Rew/tr ~ test Refused J t a• Q Test Grven, t ~ Contam-nated Resr.dts ~. 7 / Q Stat~ Class - A [~] (~ Medication ~ NAp pa~ ly .w a.w[us[IPO al Drug O U I ~ Unknown « ~ Fatigue se Q l1AedKation ~ Had Been Dnnki Q ~ Q ,asleep Q Unknavvn Q Other Pdrriary Veh/de Co de Vlo/atlon ~ ~ G ~'' .-~-- - b ~ 02.. Charged? l • Yes a rb .I 0 vvrnrertirtver 00=Not Applicable O1=Private Vehr<le Ovvnedl .' O - ~ -Leased by Driver r• Same of ~wrs,.~ Name -- - Model Year zaoZ Velrfde Towed Yes QNO Federal Gov Veh 9a-Other ~InknON~lr Vehicle Make •Mak~ ~ k4R 3 7 Vehkle Model (sec ovprla -----.--..>, o , • Y~ O ~ O un- o ry known UsAA ~AsuRcT T y J.v / Cl . ~ D 905' D ~. 7/0/ o a rallln 1=Towing Pass. Veh tlnrt No. of ^ T Trailing ~ c!r+ft ^ 2=Towing Truck 4--Mob' ife~Modufar Home T=Semi-Trailer S=Camper Tag No Tag Year Ta ;, Units: 3=towing Utility Trai ler 6=FuM Trailer g~ef g J 9~lnknown ~ ~ Dired/on o1 a •Vehlde Position 4 G rave •Mov~ement ~ 'See J / Overlay Speria/ Usaae -------~ Vehicle Color y~~ Tbne (~"~--~ 06=Ye{kwv r ^ r ~ 1 07=Silver ~ 01=Automobile lr ~ 05=Lar9e Tnrck 06=5W 20=Uri~cycle, Bicyde, T . ~e O Q t2=Corm~ercial m ! -L,~L.J O 023Motor le t38=Gold ~ 01=Blue (>9=brown 03=Bus 07=Van 10=Snowmobile 11=Other Pedalcycle 22=Horse 2, Bu =Not Applicable O1=Fire Veh Ca 13 T 02=Red i0=Orange 04=5maq Truck 03=Whfte 11=Pur le Uf 01 ;Completerorm M 11=Farm Equip i2=Construesion Equip ggy 23=Horse b Rader 24=Train 02.Ambulance 03=Pdice = axi 21=Traeeor Trailer 2 , 5ecfion 26) ~=Green 12=Other {if 10" or "Zt ;Complete OS=Black 99=Unknow 13=ATV 18~ther Type Spec Veh 25=Trolley 9$=Oth 2=TwrnTra~ler 08=Other Emergenq 23=T' Trawler Vehicle ~ . n Form M, Section 27) 19=Unk. Type Sic Veh er 99-Unk 11=Pu i1 Tran 31=AAo dfiwed Veh Initial !m Pbint v ~ 00={Von{dlis'ron 01-12=C1ock points i3=Top FORM ~ M•500 (12021 - Hoorn P sport 99--tlnkrtowrr _ . _ . _ Damn Arrdcator Gradient _ __ - 14=Undercarriage O~lone 2=Fundron~ 3=~wnhiM R~ i5=Towed Urnt a t:Minor 3=Drsablrng ~ i=Leve{ 4=Bottom of Hifl 1=Straigl~ 99=Unknown 9=Unknown 2=Uphill 9=U~narrnli a 2durved PEhr>~DOT COPY =---- 02=Private Vehrde Plot Owned/leased by Driver 03=Rented Vehrcfe Dnvrr Prrserxe 1=Ornrer Operated 3=Orrver Fled Scene Vehrcle 4=Hrt and Run 2=JVo Driver 9=tJnknown O4=State Polio Vehicle 07=Muniapat Polio Veh OS.PENN00T Veh~de 08=Other Muniapal 06=Other Stale Gov lleh Governmertr Vehic'r .~__ _ ~YYne/ Cast NafflR Of Ru I ' I , f •+. ~4~tRAOi~~fEAt~FO O~ s~E~1Rl5Yd.dARl~/9 •~,j POtICE C~SFO Q~EROQI;TOi19G ~Ri4R 11f I~~I~t~~I~WI~p Crash Number AA 500 2 ~~~ o~y Page: 2'~~ ._. ~ P 0669868 • Motor Vehicle in ra '~ rye Transport O Hit & Run Vehicle Q ~1 Parked Unit ~qY O legally Parked ONon -Motorized ~ Vehkie O Pedestrian O PedesVian on Skates. Disabled From Q Yes • Np In Wheelchair, ric O Previous Crash O Train O Phantom Vehicle (If •Pedestrlan• or •Pedesir3an on Skate in >ri/heekhair, etc', Com /ete Form M, Section ?8) pf Yes; Conrpfete form Cy Unit No first Name Q ~ n / C MI Oate of B1rtl~ (MM-DD-YYYY) Del fast Name ne u e Address / G /State 7/7 7.~- b~66 ~ ~ ~p Driver license Number p ,~ ~~ ~ 7 6) .~ O ~ ~ .2 O State Class ~ ~ L~ 0 rr'' ~ ~( Alcoho!/pNOS Susaected Orfv+er ar RedesMan Physrca/ Condition 1 ~ I • No O Illegal Drugs O Medicaton ~ APpar~tly Illegal Drug ~ " O Alcohol O Alcohol and Oru 1'10 Ouse O Fatigue Q Medication ' ~ , 9s O Unknown ~ Alcohol Test Tune O O~nkBeen O Sick Q Asleep O Unknown :. ~ Test Not Given O Breath O Other Primary Vehicle Code Violation ; Zi : Q Blood O Unne Unknown ri Charged) ' ~ .; O Test Given /I~ON~ O Yes • No ' (> . almho(Tr!st Results 0 Test Refused Unknown pny~ i O Rewlts lYresen~ 1 ~rlver Operated 3.Dnver Hed Scene ~• W Test Given, Vehicle :l ~' O Contaminated Results © 4=Hit and Run I 1~Io Driver 9=Unknown ~ li OwnedDriver 00=Not Applicable 02=Private Vehicle Plot ') O1.Private yebrde Owned/ Ownedleased Driver ~=State Pdree Vehicle 07aMunidpal PoFce Veh Gw Veh Q Z leased Drivrr by 05•PENNDOT Vehicle 08~pther Munic>pal 9~Otf-er j by 03=Reused Vehicle _ - -• - - - Of>=Other State Gail Veh Govemtnent Vehicle 99 Sarre as Owner first Nanse ... .__._ _-- •_ --.- - ---:-•- •:~-~,_-- : -:_ -- _, ---- . -O~wsner tsst Name or Business Name (if Prdestrran, skip dra Section} '' ' ~'~ - Driver O 1/ ~ p ~ ~ A. ~ - Address / Gty /State / 7.rp I Vehicle Make +v~, Cods 0 e Nr~ A ~~. ~ ~70~/ Fo~~ 12 VIN ~1 I J~ /, (,~ ~ R G 2 ~ ! S ~ I Year V.e..hi~cle^ Model See license Plate Reg, ~~ ~ ~ / V R VS E ~ ~ ~ speed Ve1Ud` a T_, o~ Tcwed I Ms4ncr Msurance Com n ~ `~ Q • Yes Q No /uF~ti IS ~ y _ Polley No ~ Yes O~ O known f E N S. C 11gn1(o ~ I ~ ..Q oZ ! 050l~ hl ri Trams 1=Towi P e Unr No of T~ ng ass Veh 4><PAobrle/Modular Home 7=Semi-Trailer Tag Na T Y ~ ~ . Trailing a Unit ~ 2=Towing Truck 5~amper 8~her ag ear Tag St Unrls: 3=ToWing Utility Trailer tr~ull Trader 9=Unkrwwrt ~~ ~ dkectlorr of .. > ra a -Vehicle Posltkin 0 ~ +Movement .~ !~ ~ OveYfay ~l Usage VeVColor yr- ~ ~- 05=large Truck 20=x• 06=Yellow 01=Automobile 06=5W Kf'de, Bicycle, ~ 12 P 08=Gokfr ~ 01=Motorcycle 07=Van 21--Other Pedalcyde 00=Not Applicable C~ Ot~Btue 09=Brown 03=Bus i0=Snowmobile 22=Hone 8 Buggy O1=Fire Veh 13_Ta,d 02-Red i0=0ran 04=Small Truck it=Farm Equip 23=Horse & R•der OZ=~~lartce 21~TractarTraBer - 03=White 11=Pur ~ ~f "02 ;Complete Farm 12=Construction Equip 24=Train 03=Pdice 22=Twin Trailer PI M, Section 26) 13=ATV 25=Trolley 08=Other Emergency 23~Tripie Trager 04=Green 12=Other p 18_-Other T Vehicle OS~Black 99=Unknown of 10'or 21 ; Com lete YPe Spec Veh 98=Other 31~Modifierf Veh form M, Section ?7} 19=Unk. Type Spec Veh 99=Unknown 11=~PR Transport 99=UnknoMrt ln/tia! Impact Po/nt Darnaoe /ndkator _ Gradient _ _ __ . _ _ - - 00=Non-Copision 14dJndercarriage 0~1one 2~urxtional 3=Downhill Road A___.~rgnrn~ert 01-12=Clock points 15=Towed Unrt a 1:MrnCr 3•Disabling 1=1evr1 5_Bottom of Hill 1=~~ _ _ _ 13_ Top 99=Unknown 9~Jnknown ~ 2=Uphill oP oI fiJ! © 2„Cu~ __ --- =: ,_ -= = -_ _--_ . _ - ---- - 9=Unknown 9•-lkrluwwn FORM I M•SGO (1202) - -•-- • - ~. -r--• _-' --._ ... - _ _ - -- - - - -_ - - PEAIf+lDOT COPY '-- '- - ~ ~ - ' - • ' COflAAflONWEALTH OF PENNSYLVANIA POLICE CRASH REPORTING FORM AA 500 3 ~ ~y Page z- ~ 9S ~_ . _., ,rte. /4 1=Driver 2=Passen er mar Pbsitirn: - - p 00=Not A Passe edOccupant 01=D i AU 7=Pedestrian r ver - V ~cles 02=Front Seat Middle Position B=Other 9=Unknow 03xfront Seat Right Side n 04=Second Raw • Left Side Or Motorcycle Passenggeerf 05=Second Row . Midde Position 06.Second Row .Right Side B Female 07xThird Row Or Greater - M=Male Leh Side niaiisiiiu'i,i ~..,. ~ P 0669868 ~? 0=Not Applicable 1=Not Ejected 2.Totally El1ected 3=Partially Ejected 9.Unknown H ftQCilon Path- 0=Mot Ejected 1 Not 1 vTh/AI IAh Side flnr +~,«• ~I~wu„renr vnP• QO=None Used /Not Applicable 01=Shoulder Belt Used 02=lap Belt Used 03=Lap And Shoulder Belt Used 04=Child Safety Seat Used 05=Motorcycle Helmet Used 06=8i'cycle Helmet Used 10=Safety Belt Used Improperly 11=Child Safety Seat Used Improperly ~ 7_{.Inl...~. 11.-J ~- E ---- - -_- _ - Middle~osition S ~ ype Unknown 99=Unk = r~ e m --3t 0 1 09=Third Row Or Greater • Right Side 4..Through Back poor j~ ~ ;J ~~ lnriurv Sererirv- ~ 0=Not Injured 10=51eeper Section of Tnxkcab 11=1n Other Enclosed ~dfEl7C-Eatlinmenr Tura; F OOdVone Used /Not Applicable Ot~ 5=Through Back poor Tajlg~ 0 6=Through RooF Opern ~~ypp~j ~ J 1=Killed 2=Major injury Passenger Or Cargo Area t 2=tn Open Area ront Air pI 02•Side Air Ba~Deeppfoy°~edd(For Th SeaU 03=0ther T gAi Convertible T ov 7=Through Roof~flpeni C ~ ( onvertibk T U ' d 3--Moderate jury (Back Of Pickup. Etc.) 13=Trajlin Ur>;t ype r B pepj~ 04~Nultiple Air Bags pepk~ op p) 9=Unknown I 4=Minor Injury 8=Injury, Unk g 14>=Ftrding On Vehicle Exterior 1 S=bus Passenger 05=Motor OS_Bicydt~ earreukj Elbo /~ICnedPads 0 i Severity 9=Unknown if 98=Other 99_Unknown 1 =Air Ba Not De ! 11=.4ir Bag Not 0 p ~~ SHniCh ~ g eP~Yed. Switch Off ( 0~• I APP stable Injury 12~4rr Bag Not Deployed, 1=Not Extncated i ~ Unk Svwtch Seth 2~Exincated By Mecharncal Means 13=AIr Bag Removed~Prror To Crash) 3=Freed BY Non . Mer#sanrcal Means 19-Unknown if Ayr Bag Oeptoyed 8=Other 99=Unknown 9=Unknown tea EMS Agency ~/ - - -• - ~Yfl/tlfr Medial Facility: ~yN,~ ~ - .. _ .l .Unit No - -Person No: - Date of Birth (MM-DD-YYYY) - .. ._ - - "~~ 1 OeteteT A B C D E F G H I ,~, a~m0 ,Z-o~- daa~~ a~ aoao 1 Name /Address /Phone ~ ~ ^ ^~ Y ~( Same as Ot~erator EMS Transport • - : ~~•- __--- -. - ---- _ _ _ O Yes ~ No Unit No Person No Delet~T• Datr: of Birth (MM-OD-YYY1~ _ _ .._ .: A .-~ B C~-.-. ~ - . _ - -. - -__ '- - -' ~ - - ~ OiL ~ O C ~ G~'- ~fo ~3 O, DE OF- G•~H--1---- Name /Address /Phone o ao mm m a oa EMS Transport O Yes ~ No - s ------ ~t~ -_ - _ Unit No ~ Person No -~•Date of girl . rn ~ Detetet I~---IL.._JI O ~ - Name /Address /Phone Same as Operator Unit No Person No date of &h m m OeleteT o [~]- Name /Address /Phone ~~~©~~ 0 3 0 3 [~ p~0~ (~~ /! , __ A [ /~. ~/ EMS T lfHn !l t'rt 17 f~~~ /7i'll 737- ~j2f'o ~ O Yes • No - oaam~~aao EMS Transport O Yes O No .,,,' E F G H ^^~m I Same as Operator EMS Transport _ __ - O Yes O No Unit No Person No Date of Birth (MM-DD-YYYY) A B C D OeQe7 ~-m- ~^^~ E F G H I Name /Address /Phone ~ ~ aQ~ Same as Operator EMS Transport FORr1•AA30G{1LQ2) ~- '- - --'-~-- ----•_---- - _-=-~-----_. rr=- ~_-- -`__ __ OYC~S _ PEf~1Rl?OT COPY - .. _ _._....~___-_ _ ,' - _. ._ ~I. COMAIiOMyyEgLTH OF PEPdiVSYLVANtA • POLICE CRASH REPORTIPIG FORWi Pa wlO~l~~~I(I~Ira~ G h AA 500 4 "~ orrr z s ge ~ as Nutttdyer P 0669868 Crash Descrietfon 0=Non-Collision ® p=H~ On e c o ~ 1_Rear End 3= ar to Rear ~ ,6~~I • 5 ~ sw~~ ~Sart 6=Skies (t7ppp~ Direction) B-Hif ~~ € Relation t»__ R~~y ~ 1=0n Travel Lanes 3•:.Me6an t. Dtredion) 5 - 7=Hit Fixed Object g=O,N~ is ~ Illumin ti 2-_Shotdder 1=~ k ht 4=Roadside _ Outside Tra.+tkway Ei=M Paric(ng lane 7d3ore (Ramp Mttersecpon) Ef=Ur>known ~ a on ~ Y g © 2=Oar1c - No 3=C)ark -Street Lights 5=0avtrtt ti B=Other ~ treat 4=Dtrsk Ra dwa~~ ~ ea on rGons - 3=Sleet Hai _ S=Fog 7_GI~~ u a 2=Rain 43Srtow 6=Rain b Fog e=Ottter Road Surface Conditions 0=Ory a 2sSand. Alud, Girt, ,=Siush 8=be Patr~tee --- - - 1=Wet 3=Srtow Covered 5_Ioe , 7=W~t~ ; Standtrtg 1 ~ ~ _..-- -..w~~ . YIi IIYIIIYq" 1 Unlt No ~ 2 0 1~ Please Put m ~ 0 ' Events in 3 Sequential • c Order '~ amL~O u~ ~ ' ° Hamt Event UR Most7 UtiBty pole Number I~ t ~ ~ Unit No ~ ~ ~ ~ cam= m a ~ ~ 3 W ^ O . ~ Please Put Events In ~ 'Sequential I i Order 4 m ~ ~ ~) ~ fist Unit No Harm Event Most Unit No Hann Event n ~mful 1T ~ful Eve"`'" ~ ~ Q .~ vethe Z'-r ~ ~ D ,~ ~~~ rash 0o Ila npn el. /flan m n„hp- paper Entrironmerttal /Roadway Poren-tic/ Fa, fors (E/1t j 1 D O 2~ 3 00=None 11=Sb Road Conditions (ke/Sno„ v) , Ol_Windy Conditions 12=Sine On Roadway 02=Sudden Weather Condttiorts 13=Fbthr~ ! 03~ttter Weather Conditions 1l~roken Or Cracked Paverttent 04:Oeer In Roadway IS_TCD Obstructed OS_-Obistade On Roadway 16=Soft ShotWer Or Shoulder Drop Ofd + Ot>_-Other Mirnai In Roadway 28_-Other Roadway Factor u+ Ij 07=Glare 29=Other Envtrortrnerttal Factor i o t~ 08=Work Zone Related 99=Unkrrown . + w ~ Possible Vehicle Failurrs (tQ 12=VV!pers .~ ~ ' OO~lorte o ~ OfiaExhaust 13~rtver Seatin9lConVd . ~ I; 01-Tires i~7_Headlt~ghts 14=Body, Daors. Hood, Etc i ~ 02=Brake System 08=Signal Lghts I S=firatter Hitch e 03:Steering System l)4=0tlter t,ghts 1~Wheels `rte 04=Suspension 10=Hom i7~lirbags i 05=Power Train 11=Mivors 18=Trailer Orerbaded ~ Unit ~ t Q 0 2 1 1 1 19~Jnsecurttl5hifted v ~ 0 L_~~LLL~~-J11 TraBe- load 20~rnproper Towinngg 21 ~bstnxted Windshield 1 M1Ubnlt 0~ 1 p v 2(-`T---1 99=UnkrwKm ' indicated Prime factor L-- U~ nitJNo factor Code Oo tnl repeat Ina inrplm~Upn pn O 1! ~ ~ muhQle Wiles j~ E/R V D p i C~ (~ ~ Q !f E/R is the Prime factor _ _ __ ____ - Type, leave Unit No blank Nartnful fvsnts (Harm Event) 01=HrtlMrt 1 02=Hit Unit 2 03=Hit Unit 3 04=Hit Unit 4 OS=Hit Unit 5 06=Hrt Other Traffic Untt 07=Hrt Geer 08=Hrt Other Antmal 09=Cditstort With Other Non Feed Object 11=Stnxk 8y Unrt 1 12=5Uudc 8y Unrt 2 13=Strtxk BY Unrt 3 14.asm,dc sy unit a 15=Stnxk 8y Und S 1 C~Struck By Outer Traffic Urwt 21=Hrt Tree Or Shrubbery 22=Hrt Embankment 23=H+t Utility Pok 24=Hrt Traffic Start 25cHit Guard Ratt 2ti=Hrt Guard Wi' End 27=Hrt Curb 28.Hrt Cortuete Or lortgttta~'irtal Barrier 29=Hrt Duch oo;No Contr+ttubng Action 01 _pr+ver Was Distracted 02=Onv+ng US!ng Hand He)d Phone ~~ ~V~e~9aj,H~arTtds free Phone 05:1mprape'r~iC~a ++reless Turrtirg 06=Tumxtg from Wrong Lane 07=CPtooeedrrtg h~Stop 08=RtutNng Stop n 09=Running Red ~• 10=Failure To ~ 0 To Other Trafftrd Device 11 aT . 12=5~ g pp~ng 13=IllegaRya! t~On Read 14=Careless Passing Or Lane Change 15=Passing to No Pacing Zone t ti=Orivirtg T1te Wrong Way On 1-Way Street Nott O ~ t~ Z 2 m 3 m 4 Unit (~'~-~ No ~ 1 Q Q 2~ 3m4 Pedestrian Action 03=Workin ~--'~~ 04=Pushing Vehicle 01=Entering t>< Crossing At 05=Approaching Or Leaving Veftide Specified t+xation 06~Working On Vehicle 02=~alPk~tynyrn9 unn:ng, Jo99~9. 07=Startdtng _ 98=Other Unit No ~ ~ Unit No ~ m 30=Hit Fence Or WaN 31=Hit Building 32~fft Culttert ?3~Irt Brkdge pier Or Abutment 34=Hrt Parapet End 35~1it Bridge Rail 36=Hrt Boulder Or obstaCe On Roadway 37=Htt Impact gttenwtar 38=Hrt Fare Hydrant 4O=Htt A~ta~ Bwt~ ~~~ 41=Hrt TraffK Is+artd 42=Hrt Snow sank 43 9atmaemPo-~Y Cortstructan 48~itt Other Faced q~~ 49=Hrt Unknown Foted Obit 50=overtum/Ro!) over 51=Struck By Thnowrt Or faAtng 52=Pot Holes Or Other Payment hrrgularities 53=Jatiu+de 54>¢tre M Vehde 58--Othe- NarKoEston 99=llnknown Harmful Event 17~areless or INegal -'-~ 18=Dr~rvin~g On The Side Of Road 19=Making I Entrance To 2 ~~ ~~ Etat 21 careless ~9 Z2=OrerAlnder Compensation At Curve 23=Speedutg 24--Driving Tao fast FQr Cortdit+orts 25=failure To ttAainfatn -,~ Speed 26=Dmrer Fleeing Pbltae lPd Chase) 27=0rtvrr Ire 28=Failure To 1l se Spedai~ 92=Affected By Pftysrcal CpWb~ 98=Other Improper DrivrxJ Acdorts 99=Unknown soata ~ n,n-soa{+a/aai --- • - -- - --•- --,_ __ _ __ F'ERi~DOT COPY ____. ~~ ~ - f ~ . . GOMMOPIIAIEALTH OF PEPVNSYLVAPIIA ~ - -- ~ `~~ ~!' 1I II POLICE CRASH REPORTiPlG FORM ~I P ~l1~~I ~I JI~~~ ~I ~~ tr h AA 500 5 '"~ ~~ '~ ~~ ss _ ~~ ~ ~ s - o e ~~' 0669868 ! t _• _ ti .. .. - • • .........-i-....-...I._.._._.1.......... ~ ~ y.......„I._.-._...j.. _.__i....._... . ..-.. _ i ..: i t i - .... -_ _• __._ : j • ~ Y2 -F--- : may... ..i.~ i •' j' • ._.__... _..-._.j._. a-......._i-_~ . ~ .....µ...._..... j ~ ~ t 4._.~1 t • i .._ 1 • t i ...i...._..... _.~_... .. .-.«... i....r 1 : : t __.. ... ~, i : i t /r ..~_. t•_--_..i._..... 1 i i t w/ • i _.._.4_ .... _..-_ 1 ..~ . ~ jo 2 ! t 1 7 j i ~ j • i j t • • ; t i .... . -.... j ? ! t ».... ... • i . • ; ; ; 1 ...;.. ••ti - yy { ........_:. W j __j ._..~.....«.....w... ...r : T j i F t f . _._.....4 ._.._ { • i ~........-_. ~ i i r i : r .. . •... ~..!... ... _.. ~ •'• _ , _. r...._ r _ .y...-- _.. F , r _._ ; . - ._;... i, ... . _ .» a . ... ~ • . , , wttness idame ~ f ~ . Address • - - • ~ :i ~ t b SA1 /T7~1 ~ u - VN ~D Phone : ' ~ ~ iti S /~'~~I,~ 5 ;~ Plarrative and additional witnesses: - .. _: ~. ~ - _ - .. - _--- --- .. .+ ~. Accident Invpstigat~n Nodficatlon Issued? • . . ~ ~ Property Damage Q + .E, ~ N~ ~ ' /Y/ vr' r w.~ s ~.Y sue rh/is G.t.+s~1 ~.~ r ~ c. Lys>~st.1 / . !lrVyr e~S TiuAvrtJw.._ i.~1~.r _ .. n.. __ . i - z~~ser ~ -~~a ,~cr ~rirro r~ .B~..cnt~v't y ~ r~~ zK~ ~/ O Z• titrir- v yr b ci t C~4,u ~ecac,~ .rL .v ~ ~ 4 ~ 2 -sue ~ - Ni RG~ Fr <ias' ~ r~ O. ~ .~. B E ,~- /L i IRS. ~i Y iT'r- , ,:,rr -~~-4c~~% bier L ~IL~_4 7rC ! ~ ~ ~ ~ T a e Btr£~ c i~ -e~ tP~.ySA~~,~ C~2os~iaG. t•~ ~r,~la ~~rt ~ 0~2. ! y/twF .~~,~r~ ~ e w-r- TtE>? 5~ oar 7/~l~oS .ar /7~DA+~3 /~i a~ s-~vev ~ ~,,~,,,.- y U~ttr / ~ ' , . .een ~~ t~~ .,~,~~ Tpwr6Q.e S ~ ,~~ ~ ~4_C~' nAF oN r~ g .a„ _~rtt --- Q-_ ~ l~ ~ £ ~ Tl S t I Qr- S-r~ ~- o, R Nis c ~sSc . -- ! I a V,yIrZ. (l~viT Go ~• m f.RsK t ~~"Z.~A :~~ ~~'_~T -.,r~flbv~ss.Q !=ot~a . ~ _ - = r~,qr-Y~`~rZ Stao Ta !Er ?~I d '~,! - ~ o - ~ „~-soo t~~y _ _ • ! . .,t • - ~ _- - _ ' i•t oF l s.Q ksF~. - ~ - - - • • PEI~~DOY COPY -• ~ P~.GQE G&61$I}0 Qi~t?®Qi'71i1iG 11:OQ3RfJ Pa ~ New ~~~~0~~~'~~~lu~'~I~ Crash Nunnber AA aU0 N a+-~ ~ n p p D.Z" ~~9~ ~ T ~ Change/ !" ~ 6 ! p Continuation Pdarrative and addttionai rvitr~esses ~~ ie 7~rlcFiC .vS sit l C -~ - No,« O -O s! ?533 ~.-1, z ~I ~~ ~ o ae4a~~ ~ -" Fi=.1~1ID0? L'O~Y SP 7-518(11-95) • PENNSYLVANIA STATE POLICE PUBLIC INFORMATION RELEASE REPORT Traffic Accident PSP CARLISLE ~arrr~ oFr:~ CPL.. ALAN THE H02-14.92954 r. EISENHART 07/04/05 Creek Rd. at #1375, Monroe Twp. - ~- - ~ -~--~ •• • • ~~~~~~~~ ~ ~ ~~~~~ ~ ~ operator ~z: Richard BREAC.~I arrisburg, PA Camp Hill, PA Unit #1: 2002 Honda Civic Unit #2: 1994 Ford TAURUS Minor damage/towed Moderate damage/towed .- This accident occurred as Unit #1 was traveling west on Creek Rd. Unit #1 failed to negotiate a curve and crossed into the path of Unit#2 which was traveling east on Creek Rd. Unit #2 was struck in the front end by the driver's side of.Unit #1. IT SHOULD BE NOTED THAT THIS IS A CORRECTED NEWS RELEASE. THE ORIGINAL WAS SUBMITTED ON 07/04 AND LISTED UNIT#2 AS THE UNIT THAT LOST COfJTROL IN THE CURVE ~ WHICH WAS A MISTAKE. I r /f s ~ ~ -- ~ Vl An lnternationallyAccredited Law Enforcement Agency ~. ~ ~~ b •o ~ ~ w w fii r,'~ c" ~, _ 1-- :- ~ `_..7 ...~ r.~ t.-a _.~ C"> 4~.{ ^~.) V "l Cam) C,.? ~._ C~ -~ f~ -:~r-1 .' [, .I :, {. y `-~ {°t`~ :-~! .1J ~-C U IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ERIE INSURANCE EXHANGE, UNDERINSURED MOTORIST Petitioner, ARBITRATION ~. No. a7 • L3 Y~ ~~ ~ ~ ~, RICHARD BREACH, Respondent. CIVIL ACTION -LAW RULE TO SHOW CAUSE AND NOW, this 1 day of 2007, upon consideration of Petitioner, Erie Insurance Exchange's Petition to Compel Underinsured Arbitration and Appoint a Neutral, Third Arbitrator, a Rule is issued upon Respondent, Richard Breach to show cause why a neutral, third arbitrator should not be appointed by the Court. Rule returnable ~ days after service thereof. BY THE COURT: ~_, `-' The Honorable Edgar '(~ ....J ._.~ ~ ;~ ~_ ~ -~ ~ ' ~""' `~ fir, ,~ ~ ~"`"" c~,.+ -- J i_ {~ _~ ~~ t..i- ~ ~ ~._ ~ r°- ... ~~ ~.-~ fl ----.... .,. -.. r ERIE INSURANCE EXCHANGE, Petitioner v. RICHARD BREACH, Respondent IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 07-6348 CIVIL ACTION -LAW RESPONDENT'S ANSWER TO ERIE INSURANCE EXCHANGE'S PETITION TO COMPEL UNDERINSURED ARBITRATION AND APPOINT A NEUTRAL, THIRD ARBITRATOR Introduction Respondent Richard Breach agrees with Erie Insurance Exchange that the Court should appoint a third arbitrator. In fact, on October 22, 2007 Richard Breach filed a Petition for Rule to Show Cause in the Court of Common Pleas of Dauphin County as to why the Court should not appoint a third arbitrator. The Honorable Lawrence F. Clark, Jr. issued a Rule to Show Cause against Erie dated October 25, 2007 with a response due in 5 days. Curiously, Erie filed a Motion to Strike that Petition and filed a nearly identical Petition with the Cumberland County Court. By Order dated October 29, 2007 to No. 11028 CV 2007 Judge Clark Ordered that Erie's Petition to Strike will not be entertained. 1-13. The averments contained in Erie's Petition at paragraphs 1-13 are generally admitted. Those paragraphs describe the typical underinsured situation where Mr. Breach has settled his case with the tortfeasor and has now moved forward requesting underinsured arbitration. The unusual aspect of this case is that the third arbitrator agreed upon by all parties, Steven M. Greecher, Jr., Esq., recused himself because of a perceived conflict of interest with Erie. Following that Mr. Breach's counsel has suggested many proposed third arbitrators, all of whom were rejected by Erie. 14. Admitted in part and denied in part. It is admitted Albert G. Blakey, Esq. and George B. Faller, Jr. were both rejected by Mr. Breach's counsel. In addition, defense counsel has rejected the following well-qualified third arbitrators: Karen Coates, Esq., Lacey Hayes, Esq., and Richard Maffett, Esq. 15-22. Defendant argues that Cumberland County has venue for this Court to appoint the third arbitrator. Respondent Richard Breach agrees with that analysis. However, clearly Erie Insurance also does business in Dauphin County and thus venue also lies in Dauphin County as well as Cumberland County. Moreover, Erie has appointed a Dauphin County attorney, James G. Nealon, III, Esq., as its arbitrator. Richard Breach has appointed Andrew H. Dowling, Esq. as his arbitrator, also a Dauphin County attorney. Moreover, the two expert witnesses who will testify on behalf of Richard Breach are Dr. Steven Morganstein and Richard L. Sieber. Both Dr. Morganstein and Mr. Sieber have their primary offices in Dauphin County. The choice of venue selected by the petitioner, in this case Richard Breach since he filed his Petition for a Rule to Show Cause first, should be given great weight. There can be no harm to Erie Insurance if the Dauphin County Court through the Honorable Lawrence F. Clark, Jr. appoints the third arbitrator. Judicial economy would be saved if the Dauphin County matter is permitted to proceed since Judge Clark has already issued a Rule returnable in five days from the date of service. Service of that Rule upon Erie's counsel occurred October 29, 2007. For all of these reasons it is respectfully requested that the Cumberland County Court deny Erie Insurance Exchange's Petition and defer the appointment of the third arbitrator to the Honorable Lawrence F. Clark, Jr. of Dauphin County. t. 1 a Da e CLARAVAL & CLARAVAL B. ROBERT F. RAVAL 500 North Third Street, 2°d Floor Harrisburg, PA 17101 (717) 233-4780 Supreme Court I.D. # 19222 Attorneys for Plaintiff ERIE INSURANCE EXCHANGE, : IN THE COURT OF COMMON PLEAS OF Petitioner :CUMBERLAND COUNTY, PENNSYLVANIA v. : N0.07-6348 RICHARD BREACH, . Respondent :CIVIL ACTION -LAW CERTIFICATE OF SERVICE I hereby certify that I have this day served a true and correct copy of the attached Respondent's Answer to Erie Insurance Exchange's Petition to Compel Underinsured Arbitration and Appoint a Neutral, Third Arbitrator via fascimile and first class United States mail to the following person: Brian A. McCall, Esq. Flanagan and Associates 150 East Chestnut Street Lancaster, PA 17602 Fax: (717) 397-2397 Date: ///a.~(~~ T CLARAVAL & CLARAVAL h By Vvt~Cl, DENISE I. WILLIAMS C'~. r`' c~ ~ C-3 -~ ~ ~ - - -~. rT t . ` 1 C.J'1 a ,-;, . ~~ ` . f ~ i ,_ ~-~"{„ ~ -- ti ERIE INSURANCE EXCHANGE, IN THE COURT OF COMMON PLEAS OF PETITIONER :CUMBERLAND COUNTY, PENNSYLVANIA V. RICHARD BREACH, RESPONDENT 07-6348 CIVIL TERM ORDER OF COURT AND NOW, this day of November, 2007, following review of the petition of Erie Insurance Exchange and the answer of Richard Breach, this court will only act on the petition if the prior petition seeking the same relief filed by Richard Breach in Dauphin County is not acted upon by that court. By tl~~Coy~l; Edgar B. ayley, Brian A. McCall, Esquire For Petitioner ~pp i 4;S ~,~ l~.- I Robert F. Claraval, Esquire f f L~ f D7 For Respondent :sal C"'~ r,.~ 4' ~-~3 ~ e.,,;t _ ~ f ~'..~ "; ' °'`*.. F'i'b T E __.. . "!~1 +T: CTI , ` , -- .~,: -~ %- a t~:. ~"ae ; ~: ,~ r}~i -=~ .._ ,..~ ~. -.. "~ ~ NAL IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ERIE INSURANCE EXHANGE, UNDERINSURED MOTORIST Petitioner, ARBITRATION v. 07-6348 CIVIL TERM RICHARD BREACH, Respondent. CIVIL ACTION -LAW PRAECIPE TO THE PROTHONOTARY: Please mark the above-captioned matter discontinued. FLANAGAN and fey I.D. No.: 83030 Attorney for Petitioner, Erie Insurance Exchange 150 East Chestnut Street Lancaster, PA 17602 (717) 397-9444 Dated: ~t • X5.0-1 DISCONTINUANCE CERTIFICATE AND NOW, ~Q[~ / [_ _ ~ pp7 suit has been marked as above directed. ~"I -. CERTIFICATE OF SERVICE I, Brian A. McCall, Esquire, hereby certify that I have this day served a true and correct copy of the foregoing Praecipe to Discontinue on the following person and in the manner indicated below: First Class Mail, Postage Pre-Paid: Robert F. Claraval, Esquire Claraval & Claraval 500 North Third Street, Second Floor Harrisburg, PA 17101-1167 Date: it • Is . 07 150 East Chestnut Street Lancaster, PA 17602 (717) 397-9444 Attorney I.D. No. 83030 Attorney for the Petitioner, Erie Insurance Exchange FLANAGAN and DIBERNARDO, LLP a o -,~ -; -a,=- ~ _ _ _ ~-: _ ~ ,J Ci i ~ ~- ~ ' ;~° ~.. ~~ ~ ~ N ~