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HomeMy WebLinkAbout10-7609'~. David B. Dowling, Esquire Attorney I.D. No. 25452 BROADS & SINON LLP 1 South Market Square, 12th Floor P.O. Box 1146 Harrisburg, PA 17108-1146 (717) 233-5731 Attorneys for Plaintiff AMANDA M. GREENS 66 Sunset Drive Mechanicsburg, PA 17050 Plaintiff v. ERIE INDEMNITY COMPANY; ERIE INSURANCE EXCHANGE; and ERIE INSURANCE GROUP 100 Erie Insurance Place Erie, PA 16530-1104 Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -LAW :NO.lb`~~~~ JURY TRIAL DEMANDED PRAECIPE FOR WRIT OF SUMMONS TO THE PROTHONOTARY: Please issue a Writ of Summons against the Defendant in the above-captioned action. The Writ shall be issued and forwarded to th Sheriff of Berland County. David B. Dowling, Esquire BROADS & SINON LLP ignature of Attorney One South Market Square P. O. Box 1146 Harrisburg, PA 17108-1146 Supreme Court ID No. 25452 (717) 233-5731 Date: December S, 2010 Attorneys for Plaintiff WRIT OF SUMMONS TO THE ABOVE NAMED DEFENDANT: a p ~q~ ~ ~~ o-ck~4~~~4 i+~~5a YOU ARE NOTIFIED THAT THE ABOVE_-NAMED PL~INTIFE F1AS COMMENCED AN ACTION AGAINST YOU. rothonotar~ `- __ L~F ~-~~ ~'RO ~~ ~ D~~;~~ 2~10p~C i~ QM 9~ 37 ~~MBERLAI~D Cp~~~4a:- p~~NSY~,ygt~l 800084.1 SHERIFF'S OFFICE OF CUMBERLAND COUNTY Ronny R Anderson " I1 ED-O I:: I '- Sheriff Ti "F1-- Pf 0 f '.r" .. Jody S Smith ' Chief Deputy 2911 JAN -5 APB 9: 24 Richard W Stewart aERL A_?b L; IvtU, Solicitor "E?tiNS4 t +r%, 11 ,, Amanda M. Greene Case Number vs. Erie Indemnity Company 2010-7609 SHERIFF'S RETURN OF SERVICE 12/14/2010 Ronny R. Anderson, Sheriff who being duly sworn according to law states that he made a diligent search and inquiry for the within named defendant, to wit: Erie Indemnity Company, but was unable to locate them in his bailiwick. He therefore deputized the Sheriff of Erie County, Pennsylvania to serve the within Writ of Summons according to law. 12/17/2010 02:45 PM - Erie County Return: And now December 17, 2010 at 1445 hours I, Bob Merski, Sheriff of Erie County, Pennsylvania, do herby certify and return that I served a true copy of the within Writ of Summons, upon the within named defendant, to wit: Erie Indemnity Company by making known unto Georgiann Froess, Receptionist for Erie Indemnity Company at 100 Erie Insurance Place, Erie, Pennsylvania 16530 its contents and at the same time handing to her personally the said true and correct copy of the same. SHERIFF COST: $37.44 January 04, 2011 SO ANSWERS, RONN R ANDERSON, SHERIFF SHERIFF'S OFFICE OF ERIE COUNTY Bob Merski Sheriff 1w Jon Habursky Chief Deputy rar,RGMwmrr,nnF Capt. James R. Haskins Criminal Division Lt. Jeff Guild Civil / Instructor AMANDA M GREENE vs. ERIE INDEMNITY COMPANY SHERIFF'S RETURN OF SERVICE Case Number 2010-07609M 12/17/2010 02:45 PM - DEPUTY MIKE CANNAVINO, BEING DULY SWORN ACCORDING TO LAW, SERVED THE REQUESTED WRIT OF SUMMONS (WOSM) BY HANDING A TRUE COPY TO A PERSON REPRESENTING THEMSELVES TO BE GEORGIANN FROESS - RECEPTIONIST, WHO ACCEPTED AS "ADULT PERSON IN CHARGE" FOR ERIE INDEMNITY COMPANY AT 100 ERIE INSURANCE PLACE, ERIE, PA 16530. SHERIFF COST: $68.00 December 20, 2010 1 MIKE CA AVINO, DEPUTY SO ANSWERS, r? BOB MERSKI, S ERIFF CommON!WE'.-XLTE h`JTARIAL SEAL KELLY L. SMWELLE, City of Erie, Erie County My Com;ri;,izn Expires July B, 2014 L NOTARY Affirmed and subscribed to before me this 5L7 day of ( /? y Plaintiff Attorney- RHOADS & SINON LLP, ONE SOUTH MARKET SQUARE, PO B 1146, HARRISBURG, PA 17108 AMANDA M. GREENE Plaintiff V. ERIE INDEMNITY COMPANY; ERIE INSURANCE EXCHANGE; and ERIE INSURANCE GROUP Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 10-7609 : JURY TRIAL DEMANDED NOTICE C) p-} You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this complaint and notice are served, by entering a written appearance personally or by attorney and filing in writing with the court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the court without further notice for any money claimed in the complaint or for any other claim or relief requested by the plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. Cumberland County Bar Association 32 South Bedford Street Carlisle, PA 17013 Telephone: (717) 249-3166 David B. Dowling, Esquire Attorney I.D. No. 25452 RHOADS & SINON LLP 1. South Market Square, 12th Floor P.O. Box 1146 Harrisburg, PA 17108-1146 (717) 233-5731 Attorneys for Plaintiff AMANDA M. GREENE IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff CIVIL ACTION -LAW V. : NO. 10-7609 ERIE INDEMNITY COMPANY; ERIE INSURANCE EXCHANGE; and ERIE INSURANCE GROUP Defendant : JURY TRIAL DEMANDED COMPLAINT NOW COME Plaintiff, Amanda M. Greene, by and through her attorneys, Rhoads & Sinon LLP, and file the within Complaint, as follows: PARTIES 1. Plaintiffs, Amanda M. Greene ("Ms. Greene"), is an adult individual residing at 66 Sunset Drive, Mechanicsburg, Cumberland County, Pennsylvania 17050. 2. Defendant, Erie Indemnity Company, Erie Insurance Exchange, and Erie Insurance Group (collectively `Brie Insurance"), is an insurance company duly licensed to transact business in the Commonwealth of Pennsylvania, doing business in Mechanicsburg, Cumberland County, Pennsylvania and has a principal place of business at Rossmoyne Business Center, 4901 Louise Drive, Pennsylvania 17055-0710. VENUE 3. The occurrence giving rise to this cause of action took place exclusively within Cumberland County. Therefore, venue is properly vested in this Court pursuant to Pa. R. Civ. P. 2179(a)(2)(3) & (4). FACTUAL BACKGROUND 4. On December 20, 2007, Plaintiff Amanda Greene was driving northwest on Gettysburg Road in Lower Allen Township, Cumberland County, Pennsylvania. 5. Robert Kessler ("Mr. Kessler"), who was operating a vehicle owned by Billie Strawser ("Mr. Strawser"), pulled from a stop sign on the exit ramp of Route 15 south at Gettysburg Road, colliding with Ms. Greene. 6. According to the police report, a witness observed Mr. Kessler remove his shirt as he was pulling away from the stop sign. The accident witness also stated that Ms. Greene attempted to stop to avoid the collision with Mr. Kessler when he pulled out into her lane of travel, but she was unable to stop. A true and correct copy of the Pennsylvania Police Crash Reporting Form is attached hereto as Exhibit "A." 7. Mr. Kessler was cited with a violation of 75 Pa. C.S. §3714, careless driving. 8. Ms. Greene suffered serious injuries in the accident, including the following; a. facial laceration; b. left knee laceration; C. neck pain; d. injury to her wrists resulting in carpal tunnel syndrome; e. extensive and repeated physical therapy; f. surgery on both wrists. 2 9. Safe Auto provided Erie Insurance with an "Affidavit" signed by Mr. Kessler stating that he had no additional "bodily insurance bonds or liability insurance policies" that provided coverage for him at the time of the accident, other than the coverage under Mr. Strawser's Safe Auto policy. A true and correct copy of the Mr. Kessler's affidavit is attached hereto as Exhibit "B." 10. Mr. Strawser's insurance carrier, Safe Auto Insurance Co. ("Safe Auto"), offered the policy limit of $15,000.00 in return for a release of all claims against Mr. Strawser and Mr. Kessler. The policy limit of $15,000.00 was accepted with the consent of Defendant Erie Insurance, Ms. Greene's insurance carrier. 11. At the time of the accident, Plaintiff was insured with Erie Insurance for two household vehicles. Erie Insurance's policy provided underinsured motorist (UIM) coverage in the amount of $300,000.00 with stacking, resulting in a possible total UIM coverage of $600,000.00. (A copy of the Erie Dec Sheet with policy are attached hereto as Exhibit "C") 12. The underinsured motorist endorsement of the Erie Insurance policy in effect at the time of the accident provides as follows: A. We will pay damages for bodily injury that the law entitles "anyone we protect" or the legal representative of "anyone we protect" to recover from the owner or operator of an "underinsured motor vehicle". B. "Anyone we protects" as used in this endorsement includes "you" and any "relative." C. An "underinsured motor vehicle" is defined as a motor vehicle for which the limits of available liability bonds or insurance or self- insurance at the time of the accident are insufficient to pay losses and damages. 3 19. This count is brought pursuant to 42 Pa.C.S. § 8371 and to recover all damages permitted therein. 20. Defendant Erie Insurance has a clear duty and obligation to pay UIM benefits under its policy and has refused to do so despite the clear, undisputed evidence of Ms. Greene's total liability for the accident. 21. Defendant Erie Insurance has acted in bad faith toward Plaintiff as follows: (a) Recklessly failing to settle the UIM claim against it; (b) Denying and/or delaying Plaintiff's claim for UIM benefits despite production of evidence demonstrating the severity of the injuries and the reckless conduct of Mr. Kessler; (c) Performing an inadequate investigation of Plaintiff's claim. 22. The actions and conduct of Erie Insurance as set forth herein and its refusal to pay adequate UIM benefits after repeated demands constitutes bad faith and a reckless disregard for the rights of the Plaintiff. 23. The conduct of the Erie Insurance is a gross deviation from its duty as an insurer. 24. There exists no legal precedent or factual basis for Defendant's denial of Plaintiff's claim under the specific facts herein presented, and Defendant is therefore, guilty of bad faith. 25. Defendant does not have a reasonable basis to deny and/or delay paying this claim. WHEREFORE, pursuant to the Bad Faith Act, Plaintiff demands judgment against Defendant, Erie Insurance, for an amount which exceeds the jurisdictional amount requiring arbitration pursuant to Pa. R.Civ.P. 1021(c), together with interest, medical costs and expenses, including assisted living costs, cost of suit, delay damages, and all damages permitted under 5 Pennsylvania law. Date: August 11 2011 Respectfully submitted, RHOADS & SINON LLP B 6 One South Market Square PO Box 1146 Harrisburg, PA 17108-1146 (717) 233-5731 Attorneys for Plaintiff VERIFICATION I hereby affirm that the following facts are correct: I am the Plaintiff herein. The attached Complaint is based upon information which I have furnished to my counsel and information which has been gathered by my counsel in preparation of my lawsuit. The language of the Complaint is that of counsel and not of me. I have read the Complaint and, to the extent that the Complaint is based on information which I have given to my counsel, it is true and correct to the best of my knowledge, information and belief. To the extent that the content of the Complaint is that of counsel, I have relied upon counsel in making this Verification. I hereby acknowledge that the facts set forth in the aforesaid Complaint are made subject to the penalties of 18 Pa. C.S. § 4904, relating to unsworn falsification to authorities. AMANDA GRE E Dated: 4 / i ( 351820.1 ,x - E) -F COMMONWEALTH OF PENNSYLVANIA POLICE CRASH REPORTING FORM Case Closed Reportable Crash AA 500 1 0 Yes 0 No Q Yes Q No 7 e e ?vr Crash lumber Page P05775 1 Incident Plumber Police Agency Patrol Zone 45 20071201079 21102 a ® g ' Agency Name Precinct investi ation Date (MM-DD-YYYY) Lower Allen Township ?- 12 -120 -12007 m Dispatch Time (mil) Arrival Time (mil) Investigator Badge Number d 1426 1426 PTL ELIAS A MARTINEZ 1835 ® ® Reviewer Badge Number Approval Date (MM-DD-YYYY) Arlen Lenker 1841 12 0 31 e 2007 - - County County Name Municipality Municipality Name eek Day of NN _ 1-77-71 21 Cumberland -? 102 wer Allen Township O Sun O Thu ® Crash Date (MM-DD-YYYY) Crash Time (mil) No of Units People Injured Killed' *if > 00 Q Mon Q Fri O Tue O Sat 12 0 20 2007 1406 2 5 2 0 complete o O Form F Q Wed Q Unk L J LNorkzone (If Yes, Complete 0 Yes Q No Form M, Section 29) School Bus 0 Yes Q No Related Fool Zone 0 Yes O No Related Notify PENNDOTO Yes Q No maintenance 1121 J Intersection Tvoe q Wa Intersection Multi-Leg ¦ Q y 0 "Y" Intersection 0 0 Off Ramp 0 Railroad Crossing1s71 00 kocation Q Midblock Traffic Circle/ Intersection 0 'T' Intersection O Round About 0 On Ramp Q Crossover O Other n See Over la Route Number Segment (Optional) Travel Lanes Speed Limit O North House Number (if applicable) e 12027 02 35 O South Street Name Street Ending C 0 East For Mid-block crashes only. Use to R. g GETTYSBURG O 0 West Unknown postal House Number and make sure Principal Roadway Street Name is 6 filled in if using this option Interstate Turnpike Turnpike State County Local Road Private Other/ $lgnino 0 0 0 0 0 0 O O (Not Turnpike) (East/West) Spur Highway or Street Road Road Unknown M Route Number Segment (Optional) Travel Lanes Speed Limit 0 North c 0 South -° Street Name Street Ending 0 East O West O E O Unknown g m ` Routea Q Interstate 0 Turnpike O Turnpike 0 state O County 0 Local Road O Private 0 Other/ d (Not Turnpike) (East/West) Spur Highway Road or Street Road Unknown ?- Intersecting Rt Mum Or Mile Post Or Segment Marker h O N Feet F d ort t " N south v Please E Or Intersecting Street Name St Ending D 0 East Or Miles nter o Inform ation L E 0 West ? E °° for BOTH , g b Landmarks if Us'ng o` This Option Intersecting Rt Num Or Mile Post Or Segment Marker ?l 111'''' ? ;; ??I p ! 1 0 North Distance From Crash Scene to Landmark 1 L ILLJJJ IL-JJ 0 ???? . 0 South w d Or Intersecting Street Name St Ending O East (For Crash between Landmark 1 and -+ m 0 West Landmark 2) r m Degrees Minutes Seconds Degrees Minutes Seconds Latitude: 40 13 33 . U00 Longitude: - 76 56 :7-1 000 ® Traffic Control Device O Yield Sign 0 Police Officer or Flagman 0 Not Applicable 0 Traffic Signal Alive RR Crossing 0 Other Type TCD 0 Tm Functionlna Device Functioning Emergency O No Controls O Q Preemptive Improperly r' Controls O Signal g Traffic 0 Stop Sign Passive RR 0 Crossing Controls 0 Unknown Signal Device Not Device Fvnctionin O O g 0 Unknown Functioning Properly d Lane Dosed (If 'Not Applicable", skip rest of the Lane Closure section) lame Closure 0 North 0 East 0 North and South 0 All ® v 0 Not Applicable O Partially 0 Fully 0 Unknown r 0 South 0 West 0 East and West (N,S,E,W) g I I[a Yes Q No O Detoured Unknown 0 Esff, rime 0 < 30 Min. Q 30-60 Min. 0 1-3 hrs 0 3-6 hrs 0 6-9 hrs 0 > 9 hours 0 Unknown FORM • AA300 (tarot) PENNDOT COPY http ://www.dot6. state.pa.us/iconsIPrintlmages/XmIFilesl2007 l 26045121102admin52O080... 2/27/2008 Print (a9?6vrd(n?1®6??9( QfL4fh4 DIF fF'E(I NSY(LVANJ& -j IDOLICIE CRASH REPORTING FORM Page: AA 500 2 Police Use Only 1 1 1: 1= age 2 of 11111111111111111111211 1 Crash Number P0577583 g ? Motor Vehicle in Type Q Transport 0 Hit & Run Vehicle Q Illegally Parked O Legally Parked ONon -Motorized Commercial Vehicle o a Unit 0 Pedestrian Pedestrian on Skates, Disabled From 0 Train Q Phantom Vehicle Q O 0 Yes Q No in Wheelchair, etc Previous Crash (If Yes, Complete Form C) (If 'Pedestrian' or "Pedestrian on Skates, in Wheelchair, etc", Complete Form M, Section 28) Unit No First Name MI Date of Birth (MM-DD-YYYY) 01 ROBERT ?W 69 22 1985 Last Name Telephone Number Delete? 0 KESSLER 7173704325 Address / City /State Zi 661 N FRONT STREET NEWPORT PA 17074 Driver License Number State Class e 1 27555591 PA ? I Alcohol/Drugs Suspected Driver or Pedestrian Physical Condition Ill l l D Ille al Dru s Medication Q No O 9 9 0 Apparent y ega rug O Fatigue Q Medication 0 0 Normal Use 0 Alcohol 0 Alcohol and Drugs O Unknown Had Been 0 Sick O Asleep O Unknown 0 b Drinking i Alcohol Test Type I Q Test Not Givers Q Breath O Other Primary Vehicle Code Violation Charged? v if Q Blood 0 Urine O T st Give 75/3714 CARELESS DRIVING O Yes O No g n e Alcohol Test Results 0 Test Refused 0 Unknown R lt Driver Presence 1=Driver Operated 3=Driver Fled Scene esu s ? Q Test Given, Vehicle 4=Hit and Run e Contaminated Results 2=No Driver 9=Unknown Owner/Driver 00=Not Applicable 02=Private Vehicle Not 04=State Police Vehicle 07=Municipal Police Veh 09=Federal Gov Veh 02 01=Private Vehicle Owned/ Owned/Leased by Driver 05=PENNDOT Vehicle 08=Other Municipal 98=Other Leased by Driver 03=Rented Vehide 06=Other State Gov Veh Government Vehicle 99=Unknown Same as Owner First Name Owner Last Name or Business Name (If Pedestrian, skip this Section) Driver Q SCOTT M STRAWSER Address / City / State / Zip Vehicle Make *Make Code 22 N MILL ST THOMPSONTOWN PA 17094 Dodge 07 VIM Model Year Vehicle Model (see overlay) I 1 D4GP25363B 197227 112003 CARAVAN License Plate Reg. State Est. Speed Vehicle Towed Towed By _ GPW2184 PA 999 Q Yes O No BECKERS Insurance Insurance Company Policy No o 1 Q Yes Q No Q Un- SAFE AUTO PA00474025A00 known * l? p Trailing Type 1=Towing Pass. Veh 4=Mobile/Modular Home 7=Semi-Trailer Tag No Tag Year Tag St g Unit T ? U 2=Towing Truck 5=Camper 8=Other ili e `v ra ng Uit3=Towing Utility Trailer 6=Full Trailer 9=Unknown Direction of 'Vehicle Position F raves 06 -Movement 12 -See Special Usage I 11 Overlay Vehicle Color Vehicle Tyne 05=Large Truck 20=Unicycle, Bicycle, oo 12=Commercial 06=Yellow 03 07=Silver -1 01=Automobile 06=SUV Tricycle cle 07=Van 21 =Other Pedalcycle 07 02=Motorc Passenger 00=Not Applicable Carrier 1 y 01 =Fire Veh 13=Taxi 08=Gold 01=Blue 09=Brown 03=Bus 10=Snowmobile 22=Horse & Buggy 04=Small Truck 11 =Farm Equip 23=Horse & Rider 02=Ambulance 21 =Tractor Trailer 02 =Red 10=Orange (if "02" Complete form 12=Construction Equip 24=Train 03=Police 22=Twin Trailer 08=Other Emergency 23=Triple Trailer 03=White 17=Purple 04=Green 12=Other M, Section 26) 13=ATV 25=Trolley lete 18=Other Type Spec Veh 98=Other (If "20" or -21" Com Vehicle 31 =Modified Veh il T k 11 P 99 U 05=Black 99=Unknown , p Form M, Section 27) 19=Unk. Type Spec Veh 99=Unknown ransport n nown = up = Initial Impact Point Damage Indicator Gradient 3=Downhill Road Alignment I I 00=Non-Collision 14--Undercarriage 01-12=Clock Points 15 T i d U O=None 2= Functional 3 1=Minor 3=Disabling 4=Bottom of Hill 54=Bottom of Hill 1 1=Level 1=Straight 1 ? 2=Curved = owe n t 9=Unknown 2=Uphill 13=Top 99=Unknown 9=Unknown 9=Unknown FORM # AA-500 (12102) PENNDOT COPY http://www. dot6. state.pa.us/icons/Printlmages/XmIFilesl2007l 26045121102admin52O080... 2/27/2008 -M? (:G%d(?f]iZK9M1FALV OF fP€?(r?GdS?'LVAR9A A A Page: [DOUCE CRASH REPORTING FORM AA 500 2 Pdice Usz Only ?cr J OT n 11111111111111111 Gash Number 7 P0577583 g Tvpe Q Motor Vehicle in Transport Q Hit & Run Vehicle Q Illegally Parked Q Legally Parked Q Non - Motorized Commercial Vehicle 0 Unit Q pedestrian Pedestrian on Skates, Disabled From Train Q Phantom Vehicle ? ? Q Yes Q No g in Wheelchair, etc ; Previous Crash (If Yes, Complete Form C) (if 'Pedestrian' or "Pedestrian on Skates, in Wheelchair, etc', Complete Form M, Section 28) Unit No First Name Ml Date of Birth(MM-DD-YYYY) 02 AMANDA ? 02 26 1982 Last Name Telephone Number Delete? Q GREENE 9999999999 Address ! City / State Zi ® 66 SUNSET DR MECHANICSBURG PA 17050 Driver License Number State Class g 1 26270765 PA C 9 b Alcoho!/Drugs Suspected Driver or Pedestrian Physical Condition Q No Q Illegal Drugs Q Medication Q Norprrar lntly Q Itllesgal Drug Q Fatigue Q Medication ? Q Alcohol Q Alcohol and Drugs Q Unknown Had Been Sick Q Asleep Q Unknown b Drinking ® Alcohol Test Type Q Test Not Given Q Breath Q Other Primary Vehicle Code Violation Charged? e Unknown if Q Blood Q Urine Q Q Yes (::)No g Test Given Alcohol Test Results Q Test Refused Q Unknown Res lts Driver Presence 1=Driver Operated 3=Driver Fled Scene u Q Test Given, Vehicle 4=Hit and Run Contaminated Results 2=No Driver 9=Unknown Owneddriver 00=Not Applicable 02=Private Vehicle Not 04=State Police Vehicle 07=Municipal Police Veh 09=Federal Gov Veh 01 01=Private Vehicle Owned/ Owned/Leased by Driver OS=PENNDOT Vehicle 08=Other Municipal 98=Other -eased by Driver 63=Rented Vehicle 06=Other State Gov Veh Government Vehicle 99=Unknown Same as Owner First Name Owner Last Name or Business Name (!f Pedestrian, skip this Section) Driver Q AMANDA GREENE Address / City / State / Zip Vehicle Make *Make Code Ford 12 66 SUNSET DR MECHANICSBURG PA 17050 I VIN Model Year Vehicle Model (see overlay) I 3FAKP 1133YR 190123 2000 ESCORT License Plate Reg. State Est. Speed Vehicle Towed Towed By ERE6752 PA 999 O Yes Q No BECKERS Insurance Insurance Company Policy No l o c , a ERIE Q083009590H Q Yes Q No Q k n nown k ? Trailing T 1=Towing Pass. Veh 4=Mobile/Modular Home 7=Semi-Trailer Tag No Tag Year Tag St c Unit No. of Unit 2=Towing Truck 5=Camper 8=Other T ili °v ng, ra 3=Towing Utility Trailer 6=Full Trailer 9=Unknown y Direction of Vehicle Position ra_veF_ ? O1 Movement *See O1 Special Usage Overlay Vehicle Color Vehicle Type OS=Large Truck 20=Unicycle, Bicycle, ?? 12=Commercial Passenger 06=Yeilow 07 07=Silver OF, 01=Automobile 06=SUV Tricycle cle 07=Van 21 =Other Peclalcycle 02=Motorc 00=Not Applicable Carrier y Oi=Fire Veh 13=Taxi 08=Gold 01=81ue 09=Brown 03=Bus 1 1 O0=Snowmobile 22=Horse & , y 04=Small Truck 11=Farm Equip 23=Horse & Rider Bugg Rider 02=Ambulance 21 =Tractor Trailer 02=Red 10=Orange 03 Whit l (If '02°, Complete Form 12=Construction Equip 24=Train 03=Police 22=Twin Trailer 08=Other Emergency 23=Triple Trailer = e 11=Purp e 04=Green 12=Other M, Section 16) 13=ATV ZS=Trolley (if "20" or "21", Complete 18=0ther Type Spec Veh 98=Other Vehicle 31=Modified Veh i t=Pupil Transport 99=Unknown 05=Black 99=Unknown form M, Section 27) 19=Unk. Type Spec Veh 99=Unknown Initial Impact Point Damage Indicator Gradient 3=Downhill Road Alignment j2 00=Non-Collision 14=Undercarria 01-12=Clock Points 15=To it ed U O=None 2=Functional 1=Minor 3=Disablin9 4=Bottom of Hill 1=Level 5=To of Hill 1=Straight 2=Curved w n kn n 9=U p 2=Uphill 13=Top 99=Unknown n ow 9=Unknown 9=Unknown FORM t AA-5W (12/02) PENNDOT COPY http://www. dot6. state.pa.usliconsIPrintlmageslXmIFiles/2007 1 26045 1 2 1 1 02admin52O080... 2/27/2008 1'rint C;KS 1'?5//SS3 I COMMONWEALTH OF PENNSYLVANIA POLICE CRASH REPORTING (FORM Page AA 500 3 Police use Only I =1 J=age 4 of N- 111111111111111N I Gash Number P0577583 Person Types: A 1=Driver Seat Position: D 00=Not A Passenger/Occupant Safely Eouipment One. i n: E 00=None Used / Not Applicable G O=Not Applicable 2=Passenger 01=Driver - All Vehicles 01 =Shoulder Belt Used 1=Not Ejected 7=Pedestrian 02=front Seat Middle Position 02=Lap Belt Used 2=Totally Ejected 8=Other 03=Front Seat Right Side 03=Lap And Shoulder Belt Used 3=Partially Ejected 9=Unknown 04=Second Row - Left Side Or 04=Child Safety Seat Used 9=Unknown Motorcycle Passenger 05=Motorcycle Helmet Used . 05=Second Row - Middle Position 06=Bicycle Helmet Used H 06=Second Row - Right Side 1 O=Safety Belt Used Improperly Eiection Path: g Sex F =Female B 07=Third Row Or Greater - Left Side 11 =Child Safety Seat Used Improperly 12=Helmet Used Improperly O=Not Ejected / Not Applicable Door Opening 1=Through Side ® c. M=Male U =Unknown 08=Third Row Or Greater - Middle Position 90=Re5traint Used, Type Unknown 99=Unknown Side Window 3=Through Windshield ® 09=Third Row Or Greater - Right Side Safes EOUioment Two: 4=Through Back Door 5=Through Back Door Tailgate Opening l?ua Severity: 10=Sleeper Section of Truckcab F 00--None Used / Not Applicable 6=Through Roof Opening (Sunroof/ Convertible Top Down) o C D=Not injured 1=Killed 11=1n Other Enclosed Passenger Or Cargo Area 01 =Front Air Bag Deployed (for This Seat) 02=Side Air Bag Deployed (For This Seat) 7=Through Roof Opening (Convertible Top Up) 2=Major Injury 3=Moderate 12=1n Open Area (Back Of Pickup, Etc.) 03=01her Type Air Bag Deployed 04=Multiple Air Bags Deployed 9=Unknown Injury 13=Trailing Unit 05=Motorcycle Eye Protection 4=1,finor Injury 8=Injury, Unk 14=Riding On Vehicle Exterior 15=Bus Passenger 06=Bicyclist Wearing Elbow/Knee/Pads 10=Air Bag Not Deployed, Switch On Extrication: O=Not Applicable Severity 9=Unknown if 98=Other 99=Unknown 11 =Air Bag Not Deployed, Switch Off 12=Air Bag Not Deployed, 1=Not Extricated 2=Extricated By Mechanical Means Injury Unk Switch Setting 13=Air Bag Removed (Prior To Crash) 3=Freed By Non - Mechanical Means 8=Other 19=Unknown If Air Bag Deployed 99=Unknown 9=Unknown ? a EMS Agency: LOWER ALLEN Medical Facility: HOLY SPIRIT / HARRISBURG Unit No Person No 01 01 Delete? Date of Birth (MM-DD-YYYY) A B C D E F G H I O 09 - 22 - 1985 11 1? ME] E4 01 00 00 a 0? 1? s Name / Address / Phone EMS Tran rt o same as KESSLER, ROBERT W 661 N FRONT STREET NEWPORT PA 17074 71 spo O Y O N Operator es o Unit No Person No O 1 02 Date of Birth (MM-DD-YYYY) A B C D De0 lete? OS - 20 - 1989 2? 9? 99 1 E F G H I 03 00 1 0 a Name / Address / Phone ERAS Tran t Same as KESSLER NIA 661 N FRONT ST NEWPORT PA 17074 9999999999 spor O Y O N Operator es o Unit No Person No ete? Date of Birth (MM-DD-YYYY) A B C D Del E F G H I - O 1 03 O 03 - 02 - 1957 2? M? [fl 99 03 00 1? 16 1 1? Name / Address / Phone EMS Trans ort same KESSLER ROBERT W 661 N FRONT ST NEWPORT PA 17074 999999 p O N O Y or Operator es o Unit No Person No Delete? Date of Birth (MM-DD-YYYY) A B C D E F G H I O 1 64 O 10 - 18 - 1981 L IF L 99 03 00 1? 0? 1? Name / Address / Phone EMS Tran t Same as Operator STRAWSER, BILLIE JO 22 N MILL ST THOMPSONTOWN PA 17094 9 spor O Yes O No Unit No Person No 02 O1 Ue Date of Birth (MM-DD-YYYY) A B C D 0 e? 02 -F2-6 - 1982 ? Ell' O1 E F G H I 00 04 Name / Address / Phone EMS Tr t Ei same as Operator GREENE, AMANDA M 66 SUNSET DR MECHANICSBURG PA 17050 999 anspor O Yes O No Unit No Person No D Date of Birth (MM-DD-YYYY) A B C D E F G H I Delete? - - ??????1:1? Flame / Address / Phone EMS T t Same as Operator ranspor O Yes O No FORM R AA-SW (IZW) PENNDOT COPY http://www. dot6. state.pa.us/icons/PrintImages/XrnIFilesl2007 l 26045 1 2 1 1 02admin520080... 2/27/2008 _._? COMMOMWEALTH OF PENNSYLVANIA POLICE CRASH REPORTING FORM AA 500 4 Police Use Only Page 1111111111111111 rage or 6 Crash Number __ ? Crash Description 0--Non-Collision 2=Head On 4=Angle 6=Sidesw' B=Hit Pedestrian 4 1=Rear End 3 (O o it ti R Di t R ` pp s e = ear rec on) o ear 5 ideswi a (Backing) Same Birection) 7=HR Fixed Object 0,-Other/Unknown -- a o Welation to Roadway I 1=0n Travel Lanes 3=Median 5=Outside Trafficway 7=Gore (Ramp Intersection) 2=Shoulder 4=Roadside 6=1n Parking Lane 9=Unknown € is N ? a Illumination 1=Daylight 3_=Dark - Street 5=Dawn 8_= ther --- - ---? I 2=Dark - No Lights 6 --Dark -Unknown Street Lights 4=Dusk Roadway Lighting J t _ _ Adv Weather Conditions 1=No 1? Conditwnerse s 3=Sleet (Hail) 5=Fog 7=Sleet & Fog 9=Unknown R ? E ain & Fog 8--Other 2=Assn 4=Snow 6= f L a - - -- ?_ _ - 2=Sand, Mud, Dirt, 4=Slush Road Surface Conditions 0--Dry 6-loe Patches 8---Other 1=Wet Oil 7=W4tpr Standing 5=Ice or 3=Snow Covered or moving - - _ - ' _ H Harm Event L!W NAost? UYil ty Nile Pdumb2r 1 12 F1 0 -- Harmful Events (Harm Event) 30=Hit Fence Or Wall 01=Hit Unit 1 31 =Hit Building Unit No O l 2 ? 0 02=Hit Unit 2 32=Hit Culvert 03=Hit Unit 3 33=Hh Bridge Pier Or Abutment 04=Hit Unit 4 34=Hit Parapet End I 05=Hit Unit 5 35=Hit Bridge Rail 06=Hit Other Traffic unit 36=Hit Boulder Or Obstacle Please Put 3 ? Events in 0 07=Hit Deer On Roadway ?i 08=Hit Other Animal 37=Hit Impact Attenuator l Sequential 09=Collision With Other Non 38=Hit Fire Hydrant I 0 Order 4 ? 0 I Fixed Object 39=Hit Roadway Equipment 11 Struck By Unit 1 40=Hit Mail Box '+' 12=Struck By Unit 2 41 =Hit Traffic Island 16 E 13 42 St k B i Hi U S B k `o Harm Event 1/R Most? Utility Pole Plumber = ruc n = y t 3 t now an 14=Struck By Unit 4 43=Hit Temporary Construction c 1 O 1 F] 0 15=Struck By Unit 5 Barrier 16=Struck By Other Traffic Unit 48=Hit Other Fixed Object f d Unit No 21 =Hit Tree Or Shrubbery 49=Hit Unknown Fixed Object ?', v 02 2 ? 0 22=Hit Embankment 5D=Overturn/Roll Over 23=Hit Utility Pole 51=Struck By Thrown Or Falling 24=Hit Traffic Sign Object ` Please Put 3 C_1 F-1 Events in 25=Hit Guard Rail 52=Pot Holes Or Other 26=Hit Guard Rail End Pavement Irregularities 27=Hit Curb 53=Jacknife Sequential 28=Nit Concrete Or 54=Fire In Vehicle Order 4 0 Longitudinal Barrier 58=Other Non-Collision 29=Nit Ditch 99=Unknown Harmful Event First Unit No Harm Event Most Unit No Harm Event nt ,, rful F 01 !?vent rnrn 02 O1 f 02 __ Driver Action (D) 17=Careless Or Illegal 00=No Contributing Action Backing On Roadway 18 Si i sh t?h = d ng On The Wrong 01=Driver Was Distracted 02=Driving Using Hand Held Phone Side Of Road 0o not r epeat this information on multiple pages 03=Driving Using Hands Free Phone 19=Making Improper Environments rs (EJRlwav I Potential Factors (E/R) 1 00 2 3 04=Making Illegal U-Turn Entrance To Highway 05=Improper/Careless ess Turning 20=Making Improper Exrt 06 T i F W = urn ng rom rong Lane From Highway P 07 di 00=None 11 =Slippery Road Conditions (ice/Snow) 01 =Windy Conditions 12=Substance On Roadway = rocee ng W/O 21=Careless Parking/Unparking Clearance After Stop 22=Over/Under 02=Sudden Weather Conditions 13=Potholes 03=Other Weather Conditions 14=Broken Or Cracked Pavement 08=Running Stop Sign Compensation At Curve 09=Running Red Light 23=Speeding 10 F il T R d 04=Deer In Roadway 15=TCD Obstructed ure a o espon To 24=Driving Too Fast For Conditions Other Traffic Control Device 05=Obstacle On Roadway 16=Soft Shoulder Or Shoulder Drop Off 06=Other Animal in Roadway 28=Other Roadway Factor 25=Failure To Maintain Proper Speed 11 =Tailgating 25=Dnkur Reefing Police (Poi Chase) 12=Sudden Slowing/Stoppin r 07 =Glare 29=Other Environmental Factor g 27=Driver Inexperienced 13=I1legally Stopped On Road 0 08=Work Zone Related 99=Unknown 2g=Failure To Use Specialized Equip 14=Careles5 Passing Or Lane g2=Affected B Ph sical C nditi E Possible Vehicle Failures (V) 12=Wipers 00=None 06=Exhaust 13=Driver Seating/Control y y o on 15=Passing Change No Passing Zone 98=Other Imprper Driving Actions 16=Driving The Wrong Way On 99=Unknown 01=Tires 07=Headlights 14_B , Doors, Hood, Etc 1-Way Street 02=Brake System 08=Signal U9hu 15=r Hitch 04 =Steering System 09=0ther Li hts 15=Wheels Wheels =S 17 Airb i Urdt 01 1 oI 2 ?5 OI 3 07 4 = uspens ags on 10=Horn =Power Train 11=Mirrors 18=Trailer Overloaded T9=Unsecure/Shifted rt O 1 1 00 Trailer Load 2 Umi4 No 2 3 4 20= er Towing rt Obstru 21=Obstructed Windshield 1 00 2 99 Unknown =Workin Pe00d=Noneestrian Action (M 0304=Pushing Vehicle N 01=Entering Or Crossing At 05=Approaching Or leaving Vehide 06 W ki icated Prime Factor Unit No Factor C = or ng On Vehicle Specified Location 02=Walking, Running, logging, 07=Standing nol repeal this information n Ze pages. OI 05 Or Playing 99=OUnknown R V D P 0 0 0 If E/R is the Prime factor Unit No O 1 00 Unit No 00 F6_2__1 Type, leave Unit No blank PENNDOT COPY http://www.dot6. state.pa.us/icons/Printlmages/Xm1Fi1 es/2007126045121102admin520080... 2/27/2008 YU5 / /5?3 Ynnt C.' WS I COMMONWEALTH OF PENNSYLVANIA POLICE CRASH REPORTING FORM Page AA 500 5 Poke Use Only ;'a,ye f o` 111111111111111111 Crash Number P0577583 9 t 2 Narrative and additional witnesses: Accident Investigation Notification Issued? O Property C Original narrative by Ofc. Martinez on 12-20-07 A 2 vehicle reportable crash occurred when unit 1, a white Dodge Cara van bearing PA/GPW2184 operated by Robert Kessler, pulled from a stop sign on the exit ramp of Route 15 south at Gettysburg Rd. Unit 1 collided with unit 2 a silver Ford Escort bearing PA/ERE6752 operated by Amanda Greene. EMS and Fire crews arrived on scene to assist. Greene was transported to Holy Spirit Hospital, while Nia Kessler (passenger in unit 1) was transported to Harrisburg Hospital for treatment. Both vehicles towed by Beckers. Q On this date I was d ispatched to a vehicle crash on Gettysburg Rd. at Route 15. PSO Nye advised that he had arrived on scene of the crash and requested EMS, class 1, for a head injury. I responed to the scene emergency and located the vehicles still con nected on Gettysburg Rd. at SR8007 Seg 860 Ramp F. As I was arriving 2 EMS crews also arrived and began e treating Greene for head injuries. While the EMS crews were treating the patients I began taking pictures of the crash and obtain ing vehicle information. I spoke with a witness by the name of Magdalena Resendiz. She informed me that she was stopped behind unit 1. She observed Kessler remove his shirt as he was pulling away from the stop sign. As he did this unit 2 attempted to stop but was unable to colliding with unit 1. Resendiz completed a written statement. 1 spoke with Kessler and asked him what had happened. Kessler claimed t hat he was stopped at the stop sign and as he was getting ready to leave his parked position he said that the sun was shining in his eyes. As Kessler entered the roadway, Ge ttysburg Rd., he collided with unit 2. Kessler said that he was unable to move the vehicle and exited the vehicle. Kessler had 3 other occupants in the vehicle which were, Nia Kessler, Robert Kessler Sr. and Billie Stawser. Nia O FORM Y A4-500 (IM PENNDOT COPY http://www.dot6. state.pa.us/icons/PrintImages/XmIFilesl2007l 26045121102admin52O080... 2/27/2008 I "Ue / 01 n .J 510LOC ® CMS 8$ PORVIIIi?G FORM R9OQ 0 New Page 111111111111111111 Crash Number ? AA 500 N Nice Use Onty 1 / I f O Change/ P0577583 II_ 11®11 Continuation Narrative and additional witnesses: x Kessler was transported to the hospital due to her being pregnant. Kesslers vehicle had severe disabling damage to the fron t end causing fluids to leak from the engine compartment. No airbags were deployed as a result of the crash. I asked all occupants if they were wearing their seatbelts and they said that they were. I was unable to speak with Greene due to her medical state. I did observe that both airbags in unit 2 did deploy and that her seat belt was in the locked position. It was apparent that Greene was driving legally in the travel lane headed north west. I later spoke with EMS and they informed me that Greene had told them that she was not wearing her seatbelt. Greenes vehicle had disabling damage to the front end which had fluids leaking from the engine compartment After all occupants were removed from the vehicles I contacted Beckers to have the vehicles towed. While Beckers was responding CSO Ramberger and Ofc. Claeys, assisted by PSO Nye provided traffic control for traffic headed east and west on Gettysburg Rd. Traffic wa s detoured into nearby business parking lots to avoid the crash scene. When Beckers arrived the tow truck operator to aded the vehicles on the tow truck and towed the vehicles back to the businesses lot. All occupants from unit 1 had a ride coming near the scene to pick them up. Because of the information that I had recieved from the witness and the description of the crash I will file a citation on Kess ler for carless driving under the vehicle code. AA500 reportable crash form to be completed. c 4 M M it, 4 tt 9 UFW i AR-60M PENNDOT COPY http://www.dot6.state.pa.us/icons/Pn'ntlmages/XmIFilesl2007l 26045 1 2 1 1 02admin52O080... 2/27/2008 "age N of Crash Number: P0577583 Inc Cent Number. 20071201079 (!N-? SR 8007 S Zimmerman Dr a b7 Q] 0 ?\ J http://www. dot6. state.pa.us/icons/Printlmages/XmIFilesl2007l 26045 1 2 1 1 02admin52O080... 2/27/2008 . . J i r :OM14dEBC n ,F C,- ` 114, E SEYG7C, B EDR.' P ,!:SAFE AUTO INS CLAIMS 614 944 7922 08/27/2009 14:59 #878 P.002/002 AFFIDAVIT hereby depose and affirm that I had no bodily injury bonds or liability insurance policies that provided coverage to me or for me relating to the subject accident, which ee -7 b -7 occurred on, , other than-b-1 dP effective from b to which had bodily injury limits each person and r6,r_ each accident. Attached hereto is a true end .correct copy of the declaration sheet applicable to that policy. I verify that the statements made above are true and correct to the beat of my knowledge, information and belief. I understand that false statements herein are made subject to the penalities of IS Pa. C.S. $4904 relating to unsworn falsification " authorities. ate ame Augu&i t8 oil notarial Seal COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL Denise R. Peterson, Notary Public Walker Township, Juniata CountyM co ='saian ea ' Feb 24 2010 ,?Xi-II?iT (2 AMANDA GREENE & RICHARD GREENE 66 SUNSET DRIVE MECHANICSBURG PA 17050-1624 AGENT - FETROW INS ASSOC LLC AGENT PHONE - (717) 766-3200 ************************************************************ * BEENRAPPLIEDOTO!YOURPPOLICY PREMIIUMNCE RATING CREDIT HAS ************************************************************ ITEM 4. AUTOS COVERED AUTO YR MAKE VIN ST 4 90 BUIC REGAL LTD 2G4WD14L5L1449820 PA 5 00 FORD ESCORT ZX2 3FAKP1133YR190123 PA ITEM 5. INSURANCE IS PROVIDED WHERE A PREMIUM COVERAGE. COVERAGES, LIMITS AND ANNUAl M EQUALS THOUSAND $ TER SYM OR INCL, PREMIUM #4 #5 RATING CLASS DDP A2AL-M MM28 A2AL-M FM25 IS SHOWN FOR THE S ARE AS FOLLOWS- - THE LIMITED TORT OPTION APPLIES TO LIABILITY PROTECTION- *****GOOD ALL PRIVATE DRIVER RATES APPLY***** PASSENGER VEHICLES. - BODILY INJURY $300M/PERSON $300M/ACC PROPERTY DAMAGE 100M/ACC 82 6 FIRST PARTY BENEFITS- 6 MEDICAL EXPENSE $100M INCOME LOSS $lM/MONTH, $15M MAXIMUM ACCI 663 646 DENTAL DEATH S25M FUNERAL B 3 ENEFIT $2.5M 1 UNINSURED MOTORISTS COVERAGE- BOD INJ S300M/PERSON 300M/ACC-STACKED UNDERINSUR81) MOTORIST 10 10 S M/PERSON $3000MA/ACC-STACKED 86 86 TOTAL ANNUAL PREMIUM FOR EACH AUTO TOTAL ANNUAL POLICY PREMIUM 317 3 08 $ 625 PREMIUM REDUCTION DUE TO THIS CHANGE $ 30CR ITEM 6. APPLICABLE POLICY ENDORSEMENTS ALL AUTOS - FAP 03/07, UF`106 05/01 AFhF EXCEPTIONS TO DECLA ATIONS ITEMS 01 03/07 AFPA03 03 , A 3/ , 07. UTO 5 - AFPU01 0 07. ANTI-THEFT DISCOUNT APPLIES-ALARM AUTO 5 AUTO/HOME MULTI POLICY DISCOUNT APPLIES PASSIVE RESTRAINT DISCOUNT APPLIES - AUTOMATIC BELTS AUTO 4 PASSIVE RESTRAINT DISCOUNT APPLIES - DUAL AIRBAGS AUTO 5 ANTI-LOCK BRAKE DISCOUNT APPLIED AUTO 5 PAY PLAN DISCOUNT APPLIES ******************************************************************* *- FIRST ACCIDENT FORGIVENESS APPLIES. THE FIRST SURCHARGE FOR A FUTURE AT-FAULT ACCIDENT WILL BE WAIVED. 5299 E. TRINDLE RD. MECHANICSBURG PA 17050 3552 )1017506 mwwlvg ' ¦ Y AGTAEF 10 "'.-3)-l ?y EXPLANATION OF ADULT &/OR YOUTHFUL DRIVER RATING CLASS AUTO 4-TO WORK 6-10 MILES ONE WAY, 8,501 OR MORE MILES ANNUALLY MALE MARRIED AGE 28 AUTO 5-TO WbRK 6-10 RILES ONE WAY, 8,501 OR MORE MILES ANNUALLY FEMALE, MARRIED, AGE 25 MISCELLANEOUS INFORMATION ITEM 7. EACH AUTO WE INSURE WILL BE PRINCIPALLY GARAGED AT THE ADDRESS SHOWN IN ITEM 1, UNLESS ANOTHER ADDRESS IS SHOWN BELOW. ITEM 9. UNLESS A CO-OWNER OR LIENHOLDER IS LISTED BELOW, THE NAMED INSURED IS THE SOLE OWNER OF EACH AUTO WE INSURE. DRIVER* 1 AMANDA GREENE pA 2 RICHARD GREENE PA *IF A DRIVER IS NOT A RESIDENT RELATIVE AS DEFINED IN YOUR POLICY COVERAGES BENEFITS AND RIGHTS MAY BE LIMITED. REFER TO YOUR POLMY AND ITS ENDORSEMENTS FOR TERMS, DEFINITIONS, LIMITATIONS, REDUCTIONS, EXCLUSIONS AND CONDITIONS. THIS POLICY DOES NOT COVER COLLISION DAMAGE TO RENTAL VEHICLES. Q08 3009590 W =- UtC„LAKATIONS E_RIE_ ERI INSURANCE EXCHANGE !?1SURANCE GROUP AMENDED DECLARATIONS 01 FAMILY AUTO POLICY 160 ErieIns.P1 * * EFFECTIVE 10/16/07 Er e. RA 16530 ATTACH THIS TO YOUR POLICY. IE? REASON FOR AMENDMENT - MULTIPLE CHANGES AGENT -- --- ITEM 2. POLICY PERIOD POLICY NUMBER.. AA7020 FETROW INS ASSOC LLC 08/30/07 TO 08/30/08 Q08 3009590 H ITEM 1. NAMED INSURED AND ADDRESS ITEM 3. dTHER INTEREST AMANDA GREENE & RICHARD GREENE 66 SUNSET DRIVE MECHANICSBURG PA 17050-1624 AGENT - FETROW INS ASSOC LLC 5299 E. TRINDLE RD. AGENT PHONE - (717) 766-3200 MECHANICSBURG PA 17050 3552 * CONGRATULATIONS! A PIONEER EXPERIENCE RATING CREDIT HAS * BEEN APPLIED TO YOUR POLICY PREMIUM. ************************************************************ ITEM 4. AUTOS COVERED AUTO YR MAKE VIN ST TER SYM RATING CLASS DDP 4 90 BUIC REGAL LTD 2G4WD14L5L1449820 PA 4D 5 00 FORD ESCORT ZX2 3FAKP1133YR190123 PA 4D A2AL-M M28 A2AL-M FM25 ITEM S. INSURANCE IS PROVIDED WHERE A PREMIUM, OR INCL, IS SHOWN FOR THE COVERAGE. COVERAGES, LIMITS AND ANNUAL PREMIUMS ARE AS FOLLOWS- M EQUALS THOUSAND $ #4 #5 __ - THE LIMITED TORT OPTION APPLIES TO LIABILITY PROTECTION- *****GOOD ALL PRIVATE DRIVER RATES APPLY***** PASSENGER VEHICLES. - BODILY INJURY $300M/PERSON $300M/ACC PROPERTY DAMAGE $100M/ACC FIRST PARTY BENEFITS- 69 86 65 80 MEDICAL EXPENSE $100M INCOME LOSS $1M/MONTH, $15M ACCIDENTAL DEATH $25M MAXIMUM FUNERAL BENEFIT $2.5M UNINSURED MOTORISTS COVERAGE- BOD INJ $300M/PERSON $300M/ACC-STACKED UNDERINSURED MOTORISTS COVERAGE- BOD INJ $300M/PERSON $300M/ACC-STACKED 66 6 3 1 11 90 67 6 3 1 11 90 TOTAL ANNUAL PREMIUM FOR EACH AUTO TOTAL ANNUAL POLICY PREMIUM 332 3 $ 655 23 ` ADDITIONAL CHARGE DUE TO THIS CHANGE $ 185 ITEM 6. APPLICABLE POLICY, ENDORSEMENTS, EXCEPTIONS TO DECLARATIONS ITEMS ALL AUTOS - FAP 03/07, UF2106 05/01, AFPF01 03/07, AFPA03 03/07, OF-6853 04/07* AUTO 4 - AFPU01 03/07. I III ERIE INSURANCE GROUP EW Member Companies: Erie Insurance Exchange • Erie Indemnity Company. Erie Family Life Insurance Company Erie Insurance Company Erie Insurance Company of New York • Erie Insurance Property and Casualty Company Flagship City Insurance Company ERIE INSURANCE GROUP PRIVACY NOTICE The privacy and security of your personal information is important to us. and procedures concerning the personal information about you that we collecThi ts maintain and d sclose in connection with the insurance policies you obtain from us. In order to offer the highest rates, we collect, maintain, and, in some instances, disclose "nonpublic persona luin ocrmatio n" about you WeN no ublic personal information may include your name, address, social security number, wage information, driving record, policy coverages, medical information or credit history, It may also include transaction information such as your premium payment or claims history with us. We appreciate the importance of your personal privacy and are committed to protecting it as we provide for your insurance needs. Collection of Information We obtain nonpublic personal information about you from the following sources: Your insurance Agent or Producer, • From you through applications or other forms such as claim forms or underwriting questionnaires; • Insurance support organizations such as claims reporting services and other parties who provide information on insurance related transactions you have conducted with us, our affiliates, as listed above, or others; • Consumer reporting agencies. We do not sell your information to others for marketing purposes Because we respect your privacy, we do not sell, trade or otherwise disclose your identity or any other personal information about you to third parties for their marketing purposes. This includes information we obtained concerning all applicants, customers and former customers. We may, however, share information regarding your transactions with us with our affiliates, as listed above, or companies that perform marketing services on our behalf to assist us in providing our products and services to you. These companies are required to keep your information confidential. Information we may provide to others We only disclose information about our applicants, customers and former customers as permitted or required by law in conjunction with our normal insurance operations. Here are some examples: • We may disclose information to others such as our claims adjusters and our attorneys in the processing of an insurance claim; • We may be required by a court of law to provide information in connection with a legal proceeding; • We share information with consumer reporting agencies and insurance support organizations; • We may share information with government agencies which conduct examinations of our procedures. Security of your personal information While your nonpublic personal information is under our control, access is limited to those employees who have a legitimate business need for such information with respect to your insurance coverages. In accordance with applicable state and federal regulations we maintain physical, procedural and electronic safeguards to protect the privacy and confidentiality of your nonpublic personal information. Further information For additional information concerning our privacy policy you may write to us at Customer Service De Insurance Place, Erie, PA 16530. You may also contact us through our Website at www.erieinsurance.com?ent, 100 Erie UF2106 5101 (E) * * * Additional information MAY appear on reverse side * * * ERIE INSURANCE GROUP EWE-. PRIVATE PASSENGER AUTO AFPF01 (Ed. 3/07) OF-4625 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FIRST PARTY BENEFITS ENDORSEMENT -- PENNSYLVANIA This endorsement contains provisions applicable to First Party Benefits Coverage and changes provisions contained in your policy to the extent that the provisions in this endorsement are different from those in your policy. Coverage is provided only if a premium for the specific First Party Benefit selected is shown on the Declarations. DEFINITIONS Words and phrases in bold type and quotations are used as defined in this endorsement. If a word or phrase in bold type and quotations is not defined in this endorse- ment, then the word or phrase is used as otherwise defined in the GENERAL POLICY DEFINITIONS section of the policy. "Anyone we protect" means: 1. "you;" 2. a "relative;" 3. an individual specifically named on the "Declarations" for coverage under this First Party Benefits Endorsement, and that person's "relatives;" and 4. anyone else who sustains "bodily injury" while: 2. a ward or any other person under 21 years old in "your" care; or 3. a minor in the custody of a "relative." OUR PROMISE As "you" selected in accordance with the Pennsylvania Motor Vehicle Financial Responsibility Law, as amended, "we" will pay for: 1. medical expenses, 2. funeral expenses, and/or 3. income loss, arising from "bodily injury" to "anyone we protect" due to an accident resulting from the maintenance or use of a "motor vehicle" as a vehicle. "We" will pay these benefits no matter who is at fault in the accident. a. "occupying" an "insured motor vehicle," or b. a nonoccupant of a "motor vehicle" if injured as a result of an accident in Pennsylvania involving an "insured motor vehicle." An unoccupied, parked "insured motor vehicle" is not a "motor vehicle" involved in an accident unless it was parked in a manner so as to create an unreason- able risk of injury. "Bodily injury" or "injury" means accidental bodily harm to a person and that person's resulting illness, disease or death. "Bodily injury" includes mental injury only if it arises out of bodily harm sustained in an accident covered by this endorsement. "Insured motor vehicle" means a "motor vehicle:" 1. to which the Bodily Injury Liability insurance of this policy applies and for which a specific premium is charged, and 1 for which "you" maintain First Party Benefits on this policy as required under the Pennsylvania Motor Vehicle Financial Responsibility Law, as amended. "Relative" means a "resident" of "your" household who is: 1. a person related to "you" by blood, marriage or adoption; BENEFITS Medical Expenses "We" will pay reasonable and necessary charges for: 1. medical treatment, including but not limited to: a. medical, hospital, surgical, nursing and dental services; b. medications, medical supplies and prosthetic devices; and c. ambulance. 2. medical and rehabilitative services, including but not limited to: a. medical care; b. licensed physical therapy, vocational rehabili- tation and occupational therapy; c. osteopathic, chiropractic, psychiatric and psy- chological services; and d. optometric services, speech pathology and audiology. 3. nonmedical remedial care and treatment rendered in accordance with a recognized religious method of healing. 1 Payment of medical expenses will be made pursuant to Section 1797 (a) of the Pennsylvania Motor Vehicle Financial Responsibility Law, and as it may be amended. All medical treatment and medical and rehabilitative ser- vices must be provided by or prescribed by a person or facility approved by the Department of Health, the equivalent governmental agency responsible for health programs or the accrediting designee of a department or agency of the state in which those services are provided. "We" use Peer Review Organizations (PRO) which have been approved by the Insurance Commissioner to eval- uate whether or not: treatment; 2. health care services; 3. products; or 4. accommodations; which were provided conform to professional standards of performance and were reasonable and medically neces- sary. "We," the injured person or the provider may request a reconsideration by the PRO within 30 days of the PRO's initial determination. This request for recon- sideration as to the reasonableness and necessity of treat- ment must be made pursuant to Section 1797 (b) of the Pennsylvania Motor Vehicle Financial Responsibility Law, and as it may be amended. If "we" refuse payment of a provider's bill and do not challenge it before a PRO within 90 days of receipt, the injured person may ask the court to review "our" refusal to pay. This 90 day provision does not apply to contin- uing treatment or services. Payment of medical expenses will not exceed 110% of the: 1. prevailing charge at the 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 to 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 customary 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 If trauma center accredited by the Pennsylvania Trauma Systems Foundation under the Emergency Medical Services Act (P.L.164, No.45), or a major bum injury patient by a bum facility which meets all the service standards of the American Burn Association, the amount of payment may not exceed the usual and customary charge. Funeral Expenses If a premium appears on the "Declarations" for this cov- erage, "we" will pay reasonable and necessary expenses directly related to the funeral, burial, cremation or other form of disposition of the remains of the deceased person we protect. The expenses must be incurred as a result of the death of "anyone we protect" and within 24 months from the date of the accident. Income Loss If a premium appears on the "Declarations" for this cov- erage, "we" will pay loss of income meaning 80% of gross income actually lost by "anyone we protect." Loss of income includes reasonable expenses actually incurred for hiring: 1. a substitute to perform the work "anyone we protect" who is self-employed would have performed except for "bodily injury," or 2. special help, thereby enabling a person to work thereby reducing loss of gross income. "We" will not pay for: 1. any loss of income until five full working days have been lost by "anyone we protect" because of the "bodily injury;" 2. loss of expected income for any period following the death of "anyone we protect;" or 3. expenses incurred for services performed following the death of "anyone we protect." Accidental Death If a premium appears on the "Declarations" for this cov- erage, "we" will pay for accidental death arising from "bodily injury" to: 1. "you;" 2. a "relative;" or 3. an individual specifically named on the "Declarations" for coverage under this First Party Benefits Endorsement, and that person's "relatives;" due to an accident resulting from the maintenance or use of a "motor vehicle" as a vehicle. "We" will pay this benefit no matter who is at fault in the accident. This death benefit will be paid to the executor or admin- istrator of the deceased's estate should "bodily injury" cause death within 24 months from the date of the acci- dent. 2 Combination Package If a premium appears on the "Declarations" for "COM- BINATION PACKAGE", "we" will pay for medical expenses, funeral expenses, income loss, and accidental death as described and limited above. "Our" payment is limited to $177,500 in the aggregate or to the expenses or loss incurred within three years from the date of the acci- dent, whichever occurs first. However, within this $177,500, "we" will pay no more than $25,000 for an accidental death benefit nor $2,500 for funeral expenses. Extraordinary Medical Benefits If a premium appears on the "Declarations" for this cov- erage, "we" will pay benefits for reasonable and necessary medical expenses in excess of $100,000 arising from "bodily injury" to "anyone we protect." The "injury" must be due to an accident resulting from the mainte- nance or use of a "motor vehicle" as a vehicle. "We" will pay these benefits no matter who is at fault in the acci- dent. No benefits will be paid under this coverage until such medical expenses exceed $100,000. Subject to a lifetime aggregate limit of $1,000,000, the most "we" will pay on behalf of "anyone we protect" as a result of one accident is $50,000 per year. However, during the first 18 months of eligibility, "we" will make payments in excess of the $50,000 per year limit, subject to the lifetime aggregate limit of $1,000,000. EXCLUSIONS - What We Do Not Cover "We" will not pay for "bodily injury" sustained by "anyone we protect:" 1. who is the owner of a. only one currently registered "motor vehicle" for which Financial Responsibility is not provided; or b. more than one currently registered "motor vehicle" if Financial Responsibility is not pro- vided on any of the vehicles. If Financial Responsibility is provided on some cur- rently registered "motor vehicles" and not provided on others, "we" will not pay for "bodily injury" to the owner while "occupying" or operating an owned "motor vehicle" for which Financial Responsibility is not provided. "Financial Responsibility" means the ability to respond for damages when liable on account of acci- dents arising out of the maintenance or use of a "motor vehicle," in compliance with the requirements set forth in 75 Pa. C.S. 1701 et. seq. 2. while "occupying" or being struck by: a. a motorcycle, motor driven cycle, motorized pedalcycle or like type vehicle required to be reg- istered under Title 75; b. a recreational vehicle not intended for highway use; or c. any other type of "motor vehicle" not required to be registered under Title 75. 3. other than "you," a "relative" or an individual specif- ically named on the "Declarations" for this coverage and that person's "relative," who knowingly steals a "motor vehicle" if the "bodily injury" arises out of the maintenance or use of the stolen vehicle. 4. when the conduct of that person contributed to the "bodily injury" sustained by that person, while: a. intentionally injuring or attempting to inten- tionally injure himself or another, b. committing a felony, or c. seeking to elude lawful apprehension or arrest by a law enforcement official. 5. not "occupying" a "motor vehicle," other than "you," a "relative" or an individual specifically named on the "Declarations" for this coverage and that person's "relative," if the accident occurs outside the Com- monwealth of Pennsylvania. 6. as a direct result of loading or unloading any "motor vehicle," except while "occupying" a "motor vehicle." 7. while maintaining or using a "motor vehicle" while located for use as a residence or premises. 8. due to war, whether or not declared, civil war, insurrection, revolution or rebellion or any accompa- nying acts or conditions. 9. caused by nuclear radioactivity or explosion. 10. arising out of the ownership, maintenance, use, loading or unloading of a vehicle "anyone we protect" owns that is unregistered and not an "insured motor vehicle." 11. resulting from the use of any weapon. 12. resulting from assault and/or battery. LIMIT OF PROTECTION "Our" duty to pay benefits to any one person "we" protect in one accident is restricted to the First Party Benefits limits "you" selected as shown on the "Declara- tions" for one "insured motor vehicle." Benefits will not be increased for any person "we" protect by adding together the limits of protection: 1. under this policy because there are multiple "motor vehicles" covered under this policy, or 2. under multiple "motor vehicle" policies covering "anyone we protect" for the same loss. Any amount payable by "us" for: 1. medical expenses greater than $100,000 will be excess over any amount paid or payable under Extraor- dinary Medical Benefits, and 2. First Party Benefits will be excess over all benefits that "anyone we protect" receives or is entitled to receive under any workers' compensation law or similar law. 3 PRIORITY OF POLICIES "We" will pay First Party Benefits in accordance with the following order of priority. "We" will not pay if there is another insurer at a higher level of priority even if that other insurer has paid its limits. The priority levels shown below are in descending order from highest to lowest: First - The insurer providing benefits to the injured person who is a named insured under its policy. Second - The insurer providing benefits to the injured person as an insured under its policy. Third - The insurer of the "motor vehicle" which the injured person is "occupying" at the time of the accident. Fourth - The insurer providing benefits on any "motor vehicle" involved in the accident if the injured person was not "occupying" a "motor vehicle." If two or more policies have equal priority I. the insurer against which the claim is first made will process and pay the claim as if wholly responsible. The insurer is then entitled to recover contribution pro rata from any other insurer for the benefits paid and the costs of processing the claim. Under the Fourth priority, proration will be based on the number of involved "motor vehicles." 2. the maximum recovery under all policies will not exceed the amount payable under the policy with the highest dollar limits of benefits. RIGHTS AND DUTIES - GENERAL POLICY CONDITIONS The following conditions are added: MEDICAL REPORTS - PROOF OF CLAIM As soon as practicable, "anyone we protect," or someone on such person's behalf, will give "us" written proof of claim, under oath if required, fully describing the nature and extent of "bodily injury," treatment and rehabilitation received and contemplated and other information to assist "us" in determining the amount due and payable. If benefits for income loss are claimed, "anyone we protect" presenting such claim will authorize "us" to obtain details of all earnings paid to such person by an employer or earned since the time of the "injury" or during the year immediately preceding the date of the accident. NONDUPLICATION OF BENEFITS No person "we" protect will recover duplicate benefits for the same elements of loss under this or any other similar automobile insurance including self-insurance. The following condition is deleted.- OUR RIGHT TO RECOVER FROM OTHERS OTHER PROVISIONS All other provisions of the policy apply. 4 ERIE® - ERIE INSURANCE GROUP PRIVATE PASSENGER AUTO AFPA03 (Ed. 3/07) OF-6380 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGE ENDORSEMENT -- PENNSYLVANIA GENERAL POLICY DEFINITIONS "We" may deny coverage for an accident or loss if "anyone we protect" intentionally conceals or misrepre- The following definitions are added under the GENERAL sents any material fact or circumstance in connection POLICY DEFINITIONS section: with the presentation or settlement of a claim. "Noneconomic loss" means pain and suffering and other nonmonetary detriment. "Serious injury" means a personal injury resulting in death, serious impairment of body function or perma- nent, serious disfigurement. RIGHTS AND DUTIES - GENERAL POLICY CONDITIONS CONCEALMENT, FRAUD OR MISREPRESENTATION This condition is deleted and replaced by the following. W 11 ithin the first sixty (60) days this policy is in effect, we may void this policy in its entirety or deny coverage if, before or after an accident or loss, "anyone we protect" has intentionally concealed or misrepresented any mate- rial fact or circumstance concerning this insurance. After this policy has been in effect for sixty (60) days, "we" may void this policy if: I. "anyone we protect" has intentionally concealed or misrepresented any material fact concerning this insurance; 2. "we" could not have reasonably discovered the concealment or misrepresentation within the first sixty (60) days this policy was in effect; and 3. the undisclosed information would have caused "us" to refuse to insure the risk. If "we" void this policy after it has been in effect for sixty (60) days, coverage under the Liability Protection and the First Party Benefits Endorsement will remain in effect for bodily injury or property damage sustained by innocent third parties, provided that such injury or damage is sustained before "we" notify the "Named Insured" that the policy is void. If "we" void this policy after it has been in effect for sixty (60) days, coverage under the Uninsured/Underinsured Motorists Coverage Endorsement, if purchased and indicated on the "Decla- rations," will remain in effect for bodily injury sustained by innocent third parties, provided that such injury or damage is sustained before "we" notify the "Named Insured" that the policy is void. In the event of a fraudulent claim, "we" will not make payment for the accident or loss. TERMINATION Cancellation The following is added.. For cancellations mailed during the first 60 days the policy is in effect, the effective date of cancellation will never be earlier than 15 days after "we" send it. For cancellations mailed after the first 60 days the policy is in effect, "we" will cancel only for one or more reasons permitted by state law, including the following reasons: 1. nonpayment of premium; 2. "Your" driver's license or motor vehicle registration has been under suspension or revocation during the policy period; or 3. concealment of a material fact, making a material allegation contrary to fact, or making a misrepresen- tation of a material fact, where such concealment, allegation or misrepresentation was material to acceptance of the risk. The effective date of cancellation will never be earlier than: a. 60 days after "we" send it; or b. 15 days after "we" send it for nonpayment of premium or when the cause of cancellation is license suspension or revocation. Nonrenewal The following is added: "We" will send this notice at least 60 days in advance of the end of the policy period. MISCELLANEOUS VEHICLE PROVISIONS If a "miscellaneous vehicle" is listed in ITEM 4 on the 'Declarations," the following provisions apply: GENERAL POLICY DEFINITIONS If a "miscellaneous vehicle" is listed in ITEM 4 on the 'Declarations," then the GENERAL POLICY DEFT NITIONS are revised as follows: The following definitions are revised: Under "Owned auto we insure" the following sub- paragraphs are added: 4. any "miscellaneous vehicle" described on the "Declara- tions" for the coverages "you" have purchased; or 5. any "additional miscellaneous vehicle" or "replacement miscellaneous vehicle ." Under 'Temporary substitute" the following paragraph is added: "Temporary substitute" means any "miscellaneous vehicle" which is a substitute for an owned "miscellaneous vehicle" described on the "Declarations" which has been withdrawn from normal use because of a breakdown, destruction, loss, repair or servicing. The "temporary substitute" cannot be owned by "you" and must be used with the permission of the owner. The "temporary sub- stitute" must be the same type of "miscellaneous vehicle" as shown on the "Declarations." The following definitions are added.- "Additional miscellaneous vehicle" means a "miscellaneous vehicle" other than a "replacement miscellaneous vehicle" which "you" acquire, purchase or lease during the policy period. For coverage to apply, "we" must insure all owned "miscellaneous vehicles" of the same type on the date "you" acquire an "additional miscellaneous vehicle." "We" will not automatically cover an "additional miscel- laneous vehicle" when "we" do not already insure a "mis- cellaneous vehicle" of the same type owned by "you." "Additional miscellaneous vehicle" does not include any "miscellaneous vehicle" that "you" acquire, purchase or lease with anyone other than a "relative." Coverage does not apply to an "additional miscellaneous vehicle" regis- tered to a corporation or other business entity. "You" must notify "us," during the policy period, of "your" intention to have this policy apply to the "addi- tional miscellaneous vehicle." If "you" obtain an "addi- tional miscellaneous vehicle" within 30 days prior to the end of the policy period, "you" have 60 days after acqui- sition to notify "us." Should a loss occur involving an "additional miscella- neous vehicle" prior to "your" notifying "us," the "addi- tional miscellaneous vehicle" will have the broadest coverage "you" have purchased for any one vehicle listed on the "Declarations." If "you" do not have: Comprehensive Coverage on any vehicle listed on the "Declarations," then Comprehensive Coverage will apply, subject to a $500 deductible. However, Comprehensive coverage will end seven days after you acquire, purchase or lease the vehicle or when "you" report the "additional miscellaneous vehicle" to "us," whichever occurs first. 2. Collision Coverage on any vehicle listed on the "Declarations," then Collision Coverage will apply, subject to a $500 deductible. However, Collision Coverage will end seven days after "you" acquire, purchase or lease the vehicle or when "you" report the "additional miscellaneous vehicle" to "us," which- ever occurs first. "Replacement miscellaneous vehicle" means a "miscella- neous vehicle" that "you" acquire, purchase or lease within the policy period to replace a "miscellaneous vehicle" of the same type described on the "Declarations." "Replacement miscellaneous vehicle" does not include a "miscellaneous vehicle" that "you" acquire, purchase or lease with anyone other than a "relative." Coverage does not apply to a "replacement miscellaneous vehicle" regis- tered to a corporation or other business entity. "You" must notify "us" during the policy period of "your" intention to have this policy apply to a "replacement mis- cellaneous vehicle." If "you" obtain a "replacement mis- cellaneous vehicle" within 30 days prior to the end of the policy period, "you" have 60 days after acquisition to notify "us." Should a loss occur involving a "replacement miscella- neous vehicle" prior to "your" notifying "us," the "replace- ment miscellaneous vehicle" will have the broadest coverage "you" have purchased for any one vehicle listed on the "Declarations." If "you" do not have: 1. Comprehensive Coverage on any vehicle listed on the "Declarations," then Comprehensive Coverage will apply, subject to a $500 deductible. However, Comprehensive coverage will end seven days after you acquire, purchase or lease the vehicle or when "you" report the "replacement miscellaneous vehicle" to "us," whichever occurs first. 2. Collision Coverage on any vehicle listed on the "Declarations," then Collision Coverage will apply, subject to a $500 deductible. However, Collision Coverage will end seven days after "you" acquire, purchase or lease the vehicle or when "you" report the "replacement miscellaneous vehicle" to "us," whichever occurs first. LIABILITY PROTECTION EXCLUSIONS - What We Do Not Cover Exclusion 14. does not apply to a "miscellaneous vehicle" listed in ITEM 4 on the 'Declarations." OTHER PROVISIONS All other provisions of the policy apply. 2 I NO ERIE,-,, ERIE INSURANCE GROUP PRIVATE PASSENGER AUTO OF-6853 (Ed. 4/07) PENNSYLVANIA -- NOTICE TO POLICYHOLDERS NOTICE OF INSURANCE INFORMATION PRACTICES - As part of our procedure for processing your insurance, personal information such as a credit report, prior insurance claims report, and/or motor vehicle record may be obtained concerning you and other individuals proposed for coverage. No information from our files will be given to anyone without your written consent, except as allowed by law in order to conduct our business. You have the right to know the kind of information we have in your file, to have access to that information, and to request correction of information you believe is inaccurate. We will provide a more detailed description of our information practices, if you so request. FRAUD WARNING - Any person who knowingly and with intent to injure or defraud any insurer files an application or claim containing any false, incomplete or misleading information shall, upon conviction, be subject to imprisonment for up to seven years and the payment of a fine of up to $15,000. PLEASE NOTIFY YOUR AGENT WITHIN 60 DAYS IF YOU: • change your address; • add/delete an auto or lienholder or another party • change your marital status; having a financial interest in your vehicle(s); • change the distance you drive to or from work or - add/delete a licensed driver in your household, school; regardless of whether they have their own automo- bile and insurance; change the use of your vehicle (i.e., business use of vehicle); - modify the appearance or performance of your vehicle with customized equipment. • change the location where your vehicle is principally garaged; This information is needed to properly rate your policy. If there is a change in the information used to develop your policy premium, we may adjust your premium during the policy period effective as of the date the change occurred. CUSTOMER INCENTIVES Neither First Accident Forgiveness nor Feature Fifteen will affect our right to cancel or nonrenew your policy should we decide such action is necessary. For additional information on First Accident Forgiveness or Feature Fifteen, contact your ERIE Agent. Feature Fifteen -- If you have been insured on a voluntary ERIE Auto Insurance Policy for 15 consecutive years, we will not apply a Defensive Driver Plan surcharge for at-fault accidents presented on your policy. A policy lapse of 30 days or more is considered an interruption of coverage and starts a new 15 year period. Violations subject to ERIE's Defensive Driver Plan will continue to result in a surcharge. First Accident Forgiveness (Erie Insurance Exchange Policyholders Only) -- ERIE will forgive the surcharge on the first at-fault accident which is presented on your policy after the policy has been in force for three years. To qualify for this incentive, the policy must be surchargeable accident free for those first three years. Should a surchargeable accident occur in those first three years, a surcharge waiver will not be given on any future accidents. The policy will not be eligible for another surcharge waiver in the event of a future at-fault accident even if the driver responsible for the accident is removed from the policy. If you have more than one auto policy with us, only one accident will be forgiven. In the event of another surchargeable accident, the surcharge on the first accident will con- tinue to be forgiven. However, the first accident will be counted to determine the surcharge amount for a second or subsequent accident. Violations which are subject to ERIE's Defensive Driver Plan will continue to result in a sur- charge. DISCOUNTS - Listed below are the auto insurance discounts which are available from The ERIE. The discounts which have been applied to your policy are indicated on your Declarations. For additional information on these dis- counts, please contact your Agent. You must notify your Agent if you qualify for any of these discounts and they are not indicated on your Declarations. Accident Prevention Course Discount - Available for a three year period if all Named Insureds are age 55 or older as of the policy renewal date and have voluntarily and successfully completed a Motor Vehicle Accident Prevention Course which meets the standards of the State Department of Transportation. The discount will be applied to all motor vehicles on the policy. Age 55 Or Over Discount - Available if you are age 55 or over as of your renewal date AND the principal driver of a private passenger auto listed on your Declarations. Anti-Lock Brakes Discount - Available for autos equipped with anti-lock brakes on all four wheels. Anti-Theft Device Discount - Available for autos equipped with anti-theft devices such as: • security alarms • hood locking mechanisms unlocked by a key or elec- tronic device • manual or automatic switch devices • remote monitoring alarms and central base computer systems, or • identification systems which involve etching VIN or serial number on automobile parts. College Student Discount - Available to reflect the limited use of an auto if a young, unmarried driver: • is a full-time college student; • does not live at home, and • does not have a vehicle at school. Driver Training Discount - Available for drivers under age 21 who have successfully completed a driver training course which meets the standards of the Pennsylvania Department of Education or other educational agency. 100% Farm Use Discount - Available for autos used exclusively in connection with the operation of a farm owned or rented by you. You must reside on the farm. The autos cannot be used regularly in connection with any other business or occupation. If the fourth digit of the Rating Class is "F" the auto has received the Farm Discount. Multi-Car Discount - Available if two or more private passenger autos are insured by the ERIE INSURANCE GROUP and owned and used by the Named Insured or a relative residing in the same household. Multi-Policy Discount - Available if you have an ERIE Family Auto Policy; and an: • ERIE HomeProtector or Mobile HomeProtector Policy; and/or • ERIE Life Policy that meets specified criteria. The discount applies on the Family Auto Policy and the HomeProtector or Mobile HomeProtector policies. Passive Restraints Discount - Available for autos with factory-installed passive seat belts or air bags. Pay Plan Discount - Available if your policy premium is paid under one of the following ERIE pay plans. The discount applied under Plan A is greater than the dis- count applied under Plan B. • Plan A - entire premium is paid by policy effective date. • Plan B - one third of the premium is paid by policy effective date. One third of the premium is paid within 30 days after policy effective date. One third of the premium is paid within 60 days after policy effective date. To qualify for this discount, choose Plan A or Plan B prior to your policy effective date. If you choose one of these payment plans during the policy period, the dis- count will be applied at your next renewal. If you do not make payments in accordance with the terms of the pay plan you selected, you may lose the pay plan dis- count and your premium will be adjusted to reflect quar- terly payments for the remainder of the policy period. Pioneer Experience Rating Credit (PERC) - Available if your policy has a good claim/violation history. Variables that determine the discount percentage may include the violation history of all drivers on the policy, number of years the policy has been in force and the claims experi- ence of all drivers on the policy. Reduced Usage Discount - Available on an auto that will not be driven for at least 90 consecutive days during the policy period. This discount cannot be added retroactively. Youthful Driver Discount - Available to reflect the limited use of an auto due to the graduated licensing program. Unmarried drivers under age 21 who reside with their parents may be eligible for the discount. If "M" appears after the Rating Class in ITEM 4, the auto has received the Multi-Car Discount. 2 NOTICE OF TORT OPTIONS - The laws of the Commonwealth of Pennsylvania give you the right to choose either of the following two tort options. If you wish to change the tort option that currently applies to your policy, please contact your ERIE Agent. "Limited Tort" Option - This form of insurance limits your rights and the rights of the members of your house- hold to seek financial compensation for injuries caused by other drivers. Under this form of insurance, you and other household members covered under this policy may seek recovery for all medical and other out-of-pocket expenses but not for pain and suffering or other non- monetary damages unless the injuries suffered fall within the definition of "serious injury" as set forth in the policy or unless one of several other exceptions noted in the policy applies. Each person who elects the limited tort alternative remains eligible to seek compensation for economic loss sustained in a motor vehicle accident as a consequence of the fault of another person pursuant to applicable tort law. 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 noneco- nomic loss, except that an individual otherwise bound by the limited tort election: 1. who sustains damages in a motor vehicle accident as a consequence of the fault of another person may recover damages as if the individual damaged had elected the full tort alternative whenever the person at fault: a. is convicted or accepts Accelerated Rehabilitative Disposition (ARD) for driving under the influ- ence of alcohol or a controlled substance in that accident; b. is operating a motor vehicle registered in another state; c. intends to injure himself or another person, pro- vided 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 causing injury or the act or omission causing the injury is for the purpose of averting bodily harm to himself or another person; or d. has not maintained financial responsibility as required by the Pennsylvania Motor Vehicle Financial Responsibility Law. 2. shall retain full tort rights with respect to claims against a person in the business of designing, manu- facturing, repairing, servicing or otherwise main- taining motor vehicles arising out of a defect in such motor vehicle which is caused by or not corrected by an act or omission in the course of such business, other than a defect in a motor vehicle which is oper- ated by such business. 3. shall retain full tort rights if injured while an occu- pant of a motor vehicle other than a private pas- senger motor vehicle. "Full Tort" Option - This form of insurance allows you to maintain an unrestricted right for yourself and other members of your household to seek financial compen- sation for injuries caused by other drivers. Under this form of insurance, you and other household members covered under this policy may seek recovery for all medical and other out-of-pocket expenses and may also seek financial compensation for pain and suffering or other nonmonetary damages as a result of injuries caused by other drivers. ABBREVIATIONS USED IN ITEM 5 OF YOUR DECLARATIONS ACC - ACCIDENT BOD - BODILY COLL - COLLISION COMP - COMPREHENSIVE COV- COVERAGE DED - DEDUCTIBLE INJ - INJURY M - THOUSAND MAX - MAXIMUM OCC - OCCURRENCE PERS - PERSONAL PROP- PROPERTY PRSN - PERSON RCV - RECREATIONAL CAMPING VEHICLE TRANSP - TRANSPORTATION WC - WORKERS COMPENSATION WK(S) - WEEK(S) ABBREVIATIONS FOR DRIVER ATTRIBUTES USED ON YOUR DECLARATIONS AA3 - First chargeable accident in a three-year period, first year the surcharge is on policy AA2 - First chargeable accident in a three-year period, second year the surcharge is on policy AA1 - First chargeable accident in a three-year period, third year the surcharge is on policy AB3 - Second chargeable accident in a three-year period, first year the surcharge is on policy AB2 - Second chargeable accident in a three-year period, second year the surcharge is on policy AB1 - Second chargeable accident in a three-year period, third year the surcharge is on policy AC3 - Third chargeable accident in a three-year period, first year the surcharge is on policy AC2 - Third chargeable accident in a three-year period, second year the surcharge is on policy AC1 - Third chargeable accident in a three-year period, third year the surcharge is on policy ACF - Accident/Chargeable Motor Vehicle Request AFY - Accident Free Years APC - Accident Prevention Course ATS - At School Without Car CLU - Comprehensive Loss Underwriting Exchange CSD - College Student Discount DTD - Driver Training Discount F15 - Accident Forgiven Under Feature 15 FAF - First Accident Forgiven FFN - First Accident Forgiven 10S- Inexperienced Operator Surcharge LSP - License Suspension MDT - Mature Driver Training Course-Over Age MVL - Moving Violation MVR - Motor Vehicle Request MV1 - Hit and Run or Leaving the Scene of an MV2 - Drag Racing on a Public Highway MV3 - Driving under Suspension MV4 - Attempting to Evade Arrest in a Car MV5 - Assault with a Car MV6 - Any Misdemeanor or Felony Involving a MV7 - Driving While Intoxicated NSA - Non-surchargeable At-fault Accident NSN - Non-surchargeable Not At-fault Accident NVL - Non-chargeable Violation PAD - Preassigned Driver YDD - Youthful Driver Discount 55 Accident Car ERIE® ERIE INSURANCE GROUP PRIVATE PASSENGER AUTO AFPU01 (Ed. 03/07) OF-8805 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 changes provisions contained in your policy to the extent that the provisions in this endorsement are different from those in your policy. DEFINITIONS Words and phrases in bold type and quotations are used as defined in this endorsement. If a word or phrase in bold type and quotations is not defined in this endorse- ment, then the word or phrase is defined in the GENERAL POLICY DEFINITIONS section of the policy. "Anyone we protect" means: 1. "You" and any "relative;" 2. anyone else, while "occupying" any "owned auto we insure" other than: a. 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 nonprofit social, educational or charitable agencies; or 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; and 4. anyone else while "occupying" a "nonowned auto" other than: a. one "you" are using that is owned or leased by another "resident" of "your" household; b. one furnished or available for the regular use of "you" or any "resident" of "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 nonprofit social, educational or charitable agencies; or e. one being used without the permission of the owner. "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 I insurance first party benefits loss benefit, funeral benefit, combination benefit) in Pennsylvania Motor Vehicle Law. 'ennsylvania motor vehicle (medical benefit, income accidental death benefit, accordance with the Financial Responsibility "Nonowned auto" means, while "you" or a "relative" are using it, 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. "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. The 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 include: 1. "motor vehicles" insured for Liability Protection under this policy; 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" designed for use mainly off public roads; or 4. "motor vehicles" owned, leased, or rented by, fur- nished to or available for the use of "you" or a "rela- tive." "Underinsured motor vehicle" means a "motor vehicle" for which the limits of available liability bonds or insurance or self-insurance at the 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; or 2. "motor vehicles" designed for use mainly off public roads. OUR PROMISE If Uninsured Motorists Coverage is indicated on the "Declarations," "we" will pay damages for bodily injury that the law entitles "anyone we protect" or the legal rep- resentative of "anyone we protect" to recover from the owner or operator of an "uninsured motor vehicle." If Underinsured Motorists Coverage is indicated on the "Declarations," "we" will pay damages for bodily injury that the law entitles "anyone we protect" or the legal rep- resentative of "anyone we protect" 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 vehicle and involve bodily injury to "anyone we protect." Bodily injury means physical harm, sickness, disease or resultant death to a person. Payment of medical expenses will not exceed 110% of the: L prevailing charge at the 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 Bum 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 challenge it before a PRO within 90 days of receipt (90 day provision does not apply to continuing treatment or services), 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 it is obtained with "our" written consent. EXCLUSIONS - What We Do Not Cover 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 "occupying" 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 protect" while "occupying" or being struck by a "miscellaneous vehicle" owned or leased by "you" or a "relative," but not insured for Uninsured or Underinsured Motor- ists Coverage under this policy. 5. punitive or exemplary damages and related defense costs. 6. noneconomic damages sustained in a "motor vehicle" accident by "anyone we protect" unless such person sustained "serious injury." Exclusion 6 applies only when the LIMITED 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. 9. bodily injury sustained by "anyone we protect" while involved in committing a crime. 10. bodily injury to "you" or a "resident" using a non- owned "motor vehicle" or a nonowned "miscellaneous vehicle" which is regularly used by "you" or a "resi- dent," but not insured for Uninsured or Underinsured Motorists Coverage under this policy. 2 I It LIMIT OF PROTECTION Limitations of Payment If coverage is purchased on a "Split Limits" basis, the "Declarations" will show a PER PERSON and PER ACCIDENT limit for Uninsured and/or Underinsured Motorists 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 from 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/Underinsured 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/ Underinsured Motorists Coverage is available for a "trailer," whether attached or unattached to a "motor vehicle" or "miscellaneous vehicle " Uninsured/Underinsured 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 acci- dent. Stacked Coverage If Stacked Uninsured Motorists and/or 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 persons "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" coverages shall be precluded from recovering the amount of: 1. required benefits paid or payable under "First Party Benefits;" and 2. medical and rehabilitation expenses which were paid or are payable under "Extraordinary Medical Bene- fits Coverage," if purchased. OTHER INSURANCE If other similar insurance 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 "occu- pying" 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 insur- ance under all bodily injury liability bonds and insurance policies and self-insurance plans applicable at the time of the accident have been exhausted by payment of their limits or have been resolved by settlement or by final resolution of the court. I . I f PAYMENT OF LOSS When multiple policies apply, payment shall be made in the following order of priority: L 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 Protection. 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 1. 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 LAWSUITS AGAINST US This condition is deleted and replaced by the following: "You" must comply with the terms of the policy before "you" may sue "us." Suit must be brought in a court of competent jurisdic- tion in the county and state of "your" legal domicile at the time of the accident. WHAT TO DO WHEN AN ACCIDENT OR LOSS HAPPENS The following is 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 we protect" to join with "us" to bring those "we" allege to be liable into the action as party defendants. OTHER PROVISIONS All other provisions of the policy apply 4 1 CERTIFICATE OF SERVICE I hereby certify that on this day of August, 2011, a true and correct copy of the foregoing Complaint was served by means of United States mail, first class, postage prepaid, upon the following: ERIE INDEMNITY COMPANY ERIE INSURANCE EXCHANGE ERIE INSURANCE GROUP 100 Erie Insurance Place Erie, PA 16530-1104 7 FILED-OFFICE -;,THE pRollipNOTAR i 2412 ??+? -5 AYl 10? 45 AMANDA M. GREENE, HE COURT OF COMMON PLEAS PIa?t1?16ER SYLYANjAC MBERLAND COUNTY, PENNSYLVANIA PENN V. CIVIL ACTION - LAW ERIE INSURANCE COMPANY, NO. 10-7609 ERIE INSURANCE EXCHANGE, and ERIE INSURANCE GROUP, : JURY OF 12 PERSONS DEMANDED Defendants STIPULATION AND NOW, come the parties to the above case, by their respective counsel, who hereby agree and stipulate as follows: 1. Erie Insurance Company and Erie Insurance Group are dismissed from this case. 2. The caption of this case shall be amended to reflect that Erie Insurance Exchange is the sole Defendant. 3. All references in the Complaint to Erie Insurance Company and Erie Insurance Group shall be deemed to apply to Erie Insurance Exchange. 4. The new caption of the case shall be: Amanda M. Greene, Plaintiff V. Erie Insurance Exchange, Defendant In the Court of Common Pleas Cumberland County, Pennsylvania Civil Action - Law No. 10-7609 Jury of 12 Persons Demanded 5. The Ad Damnum Clause of Count I of the Complaint is amended as follows: WHEREFORE, Plaintiff Amanda Greene demands judgment against Defendant Erie Insurance Exchange in an amount in excess of $50,000.00, and all other damages as allowed by Pennsylvania law. 6. Count II of the Complaint, the claim seeking damages for bad faith, is severed from Count I, the claim seeking damages for breach of contract for underinsured motorist benefits. 7. All pleadings, discovery, motions and trial regarding Count II of the Complaint, the bad faith claim, are stayed and shall only commence after a settlement, final verdict or arbitration award with respect to Plaintiff's claim for breach of contract for underinsured motorist benefits, Count I of the Complaint. Respectfully submitted, RHOADS & SINON, LLP Vavid B. Doug, Esquire One South Market Square, 121h oor P. O. Box 1146 Harrisburg, PA 17108-1146 (Attorneys for Plaintiff Amanda M. Greene) DATE: 465327 22740-2849 Attorney I.D. No. 43812 301 Market Street P. O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 (Attorneys for Defendant Erie Insurance Exchange) JOH UFFIE, STEWART & WEIDNER By: John A. Statler, s re CERTIFICATE OF SERVICE I HEREBY CERTIFY that I served a true and correct copy of the foregoing Stipulation upon all parties or counsel of record by depositing a copy of same in the United States Mail at Lemoyne, Pennsylvania, with first-class postage prepaid on the __?ay of J 11 A L* r , 2012, addressed to the following: David B. Dowling, Esquire Rhoads & Sinon, LLP One South Market Square, 12th Floor P. O. Box 1146 Harrisburg, PA 17108-1146 JOHNSON, DUFFIE, STEWART & WEIDNER By: John A. Statler, Esquire Attorney I . D. No. 43812 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Attorneys for Defendants I , AMANDA M. GREENE, v. ERIE INSURANCE COMPANY, ERIE INSURANCE EXCHANGE, and ERIE INSURANCE GROUP, Defendants ORDER NONEW AND NOW, this /D day of LJAMUAld 20/Aupon Stipulation of the parties, it is hereby ORDERED that: 1. Erie Insurance Company and Erie Insurance Group are dismissed from this case. 2. The caption of this case shall be amended to reflect that Erie Insurance Exchange is the sole Defendant. 3. All references in the Complaint to Erie Insurance Company and Erie Insurance Group shall be deemed to apply to Erie Insurance Exchange. 4. The new caption of the case shall be: Amanda M. Greene, Plaintiff v. Erie Insurance Exchange, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 10-7609 JURY OF 12 PERSONS DEMANDED Plaintiff In the Court of Common Pleas Cumberland County, Pennsylvania Civil Action - Law No. 10-7609 Jury of 12 Persons Demanded 5. The Ad Damnum Clause of Count I of the Complaint is amended . as follows: WHEREFORE, Plaintiff Amanda Greene demands judgment against Defendant Erie Insurance Exchange in an amount in excess of $50,000.00, and all other damages as allowed by Pennsylvania law. 6. Count II of the Complaint, the claim seeking damages for bad faith, is severed from Count I, the claim seeking damages for breach of contract for underinsured motorist benefits. 7. All further pleadings, discovery, motions and trial regarding Count II of the Complaint, the bad faith claim, are stayed and shall only commence after a settlement, final verdict or arbitration award with respect to Plaintiff's claim for breach of contract for underinsured motorist benefits, Count I of the Complaint. BY T URT: J. Distribution: ? David B. Dowling, Esquire Rhoads & Sinon, LLP c? One South Market Square, 12`h Floor 3 Z --i PO Box 1146 -000 C- =-r; Harrisburg, PA 17108-1146 John A. Statler, Esquire c? Johnson, Duffle, Stewart & Weidner, P.C. < n c) _,., 301 Market Street _ P. O. Box 109 CX) Lemoyne, PA 17043-0109 CO p, ej lvtad David B.Dowling,Esquire P ,'J E i I r, Attorney I.D.No.25452 RHOADS&SINONLLP n L[f3DEC n t; l {0: `C I South Market Square, 12th Floor P.O.Box 1146 Harrisburg,PA 17108-1146 CUMBERLAND L G J s , (717)233-5731 PENNSYLVANIA Attorneys for Plaintiff AMANDA M. GREENE : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff v. : CIVIL ACTION - LAW ERIE INDEMNITY COMPANY; : NO. 10-7609 ERIE INSURANCE EXCHANGE; and • ERIE INSURANCE GROUP Defendants : JURY TRIAL DEMANDED PLAINTIFF'S MOTION TO COMPEL ANSWERS TO PLAINTIFF'S FIRST SET OF INTERROGATORIES AND FIRST PLAINTIFF'S FIRST REQUEST FOR PRODUCTION OF DOCUMENTS NOW COMES Plaintiff, Amanda Greene (hereinafter "Plaintiff') by and through her counsel, Rhoads & Sinon LLP, to submit the following Motion to Compel Answers to Plaintiffs' First Set of Interrogatories Directed to Defendants and Plaintiffs First Request for Production of Documents Directed to Defendant, pursuant to Cumberland County Rule of Civil Procedure 208.3(a). Plaintiff avers the following: (1) On August 16, 2011 Plaintiff commenced the above-captioned action by filing suit against Defendants Erie Indemnity Company, Erie Insurance Exchange, and Erie Insurance Group (hereinafter, collectively, the "Defendants"), alleging Breach of Contract and Bad Faith arising out of the Defendants' failure to pay for the treatment of the injuries sustained by Plaintiff in a December 20, 2007 automobile accident (hereinafter the "Accident"). (2) Plaintiffs claims are premised on the fact that Plaintiff suffered bodily harm in the Accident, and that Plaintiff continues to suffer from the lingering effects of her injuries. (3) To support its defense in this matter, Defendants have hired an expert, Dr. Lee Harris (hereinafter "Dr. Harris"), to conduct an "independent" medical examination of Plaintiff; this medical examination was conducted on August 12, 2013. (4) In his medical report following this examination, Dr. Harris attempted to undermine each of Plaintiff's injury claims by finding that only a "questionable causal relationship" existed between her carpal tunnel symptoms and the accident, that her diagnosis of fibromyalgia "rests exclusively on subjective criteria of pain and tenderness with no objective markers," that her worsening migraine problems could be attributed to "subjective criteria," that there was "no objective criteria" which explained her chronic pain, and that other problems could be explained by "symptom magnification" or "emotional overlay." Medical Report of Dr. Lee J. Harris, August 12, 2013 (Attached as "Exhibit A"). In short, Dr. Harris completely disregarded all of the Plaintiff's medical problems and ignored the significant effect that the accident had on the Plaintiff's life. (5) In Plaintiff's First Set of Interrogatories Directed to Defendant and Plaintiff's First Request for Production of Documents Directed to Defendant, Plaintiff sought information and documents relating to Dr. Harris's services in order to support its theory that the opinions contained in Dr. Harris's report are slanted in favor of the Defendants due to the fact that Dr. Harris is a professional defense witness in automobile accident cases. (6) While certain documents were produced and some interrogatories regarding Dr. Harris were answered by Defendant, Defendant objected to many of the Plaintiff's interrogatories and document requests on the grounds that such information was beyond the permissible scope of discovery established by Pennsylvania Rules of Civil Procedure 4003.3, 4003.5, 4007.4, and 4011(b), (c), and (e). Furthermore, Defendant claims that Plaintiff has not 2 met its initial burden justifying additional discovery regarding an expert witness under Cooper v. Schoffstall. (7) In Cooper v. Schoffstall, the Pennsylvania Supreme Court recognized a party's right to obtain additional discovery regarding an expert witness upon cause shown. Specifically, the court in Cooper balanced the privacy interests of the expert witness with the opposing party's interest in exposing the witness's bias and held that, "we believe that the appropriate, threshold showing to establish cause for supplemental discovery related to potential favoritism of a non- party expert witness retained for trial preparation is of reasonable grounds to believe that the witness may have entered the professional witness category." Cooper v. Schoffstall, 905 A.2d 482, 494-495 (Pa. 2006) (emphasis added). The Supreme Court continued its analysis by stating that, "the proponent of discovery should demonstrate a significant pattern of compensation that would support a reasonable inference that the witness might color, shade, or slant his testimony in light of the substantial financial incentives. Id. at 495. (8) Under Cooper, once cause is shown to justify the additional discovery, the party seeking discovery may proceed by submitting interrogatories to the witness pursuant to Pennsylvania Rule of Civil Procedure 4004. Id. Furthermore, the subject matter of the interrogatories may include the following: (a) The approximate amount of compensation received and expected in the pending case; the character of the witness's litigation experience; (b) The approximate percentage of work devoted to a specific type of litigation, litigant, attorney, or organization; 3 (c) The approximate number of examinations, investigations, or inquiries performed in a given year, for up to the past three years; (d) The number of times the witness has given testimony in the past three years; (e) The amount of income earned from litigation services in the past three years; and (f) The portion of the witness's overall work devoted to litigation services. Id. The Supreme Court also left open the possibility of further discovery in cases where the witness is shown to be evasive or untruthful in responding to the interrogatories. Cooper v. Schoffstall, 905 A.2d_ at 496. (9) In the present case, a significant pattern of compensation supports Plaintiff's reasonable belief that Dr. Harris's report is slanted in favor of the Defendants. Although Plaintiff is unable to produce comprehensive records of Dr. Harris's history of litigation services without conducting further discovery, Plaintiff's independent investigation of the matter found ample evidence which provides reasonable grounds to believe that Dr. Harris is a professional defense witness. (10) In a 2010 video deposition, Dr. Harris admitted that he stands to make millions of dollars in his lifetime by providing litigation services. Deposition of Dr. Lee J. Harris, M.D., July 6, 2010, at p. 22. (Attached hereto as "Exhibit B"). Regarding his litigation-related work, Dr. 4 Harris estimated that he performs 120 independent medical examinations and about 20 depositions per year. Exhibit B, at p. 21. Furthermore, Dr. Harris stated that at least 90% of his litigation services are provided to defendants. Exhibit B, at p. 21. Of the few cases where Dr. Harris provided litigation services to a plaintiff, Counsel's research was unable to uncover a single case where Dr. Harris provided litigation support to a plaintiff in an automobile accident case. (11) Plaintiff found numerous cases where Dr. Harris sought to undermine the medical claims of an injured plaintiff by stating that the plaintiffs' claims of pain or tenderness were only "subjective," that a plaintiff did not exhibit "objective evidence" to support diagnosis, or that a plaintiff's muscle weakness was merely "symptom magnification" or "effort related." See, collectively, Reports and Affidavits of Dr. Lee J. Harris (Attached hereto as "Exhibit C"). Dr. Harris also frequently questioned the causal link between the injury and the subject of the litigation, often attributing any proven medical problems to a preexisting condition. See Exhibit C. These are the same, predictable opinions contained in Dr. Harris's "independent" medical report in the present case. See Exhibit A. (12) For all of these reasons, Plaintiff has demonstrated reasonable grounds to believe that Dr. Lee J. Harris is a professional defense witness, and has met its burden of justifying additional discovery regarding Dr. Harris under the standard set forth in Cooper v. Schoffstall. (13) Accordingly, Plaintiff asks This Court to compel Defendants to answer interrogatories and produce documents relating to the services of Dr. Harris in compliance with Plaintiff's First Set of Interrogatories Directed to Defendants and Plaintiff's First Request for Production of Documents Directed to Defendant. 5 Respectfully submitted, RHOADS & SINON LLP By: t✓i David B. Dowling One South Market Square P. O. Box 1146 Harrisburg, PA 17108-1146 (717) 233-5731 Attorney for Plaintiff 6 EXHIBIT "A" 690169.1 ABINGTON NEUROLOGICAL ASSOCIATES, Ltd. Ai)tld NEUk(); )GY 0 ( I I (_)nAYCK,;1,API IY /00 .O. JJmes M. Blake, M.D. ldnie Cook,M.0 August. 12, 2013 [Iwo C. weisnmo, Klein, M.D. 0;m M 0. John S. Khoury, M.D. Maureen Bogut, PAC rr<917 Smith, CRNP John A. Statler Johnson Duffle 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 Re: Amanda Greene Date of Accident: 12/20/2007 Dear Mr. Statler: I had the opportunity to see Amanda Greene for an independent medical examination on August 12, 2013. The report includes interview and examination of Claimant as well as review of medical records secured by your office. Ms. Greene was accompanied to the examination by her attorney. History of Present Illness: Amanda Greene is a 31 year old woman who reports she was the driver, uncertain if wearing a seat belt, approaching an intersection when another driver ran the stop sign and she could not stop her vehicle in time, such that the front passenger corner of her car struck the side of the other vehicle. Her front air bags deployed and she struck her head without loss of consciousness, and was bleeding enough from the forehead she had to close her eves until the ambulance arrived and cleaned her up. She was transported to the emergency room quite frightened with complaints of neck, shoulders and low back pain. She subsequently followed up with her primary physician, Dr. Mueller, with continued complaints of neck, shoulders and low back pain, for which she underwent a course of physical therapy including myofascial release for about six months. She found the water therapy was helpful . However, she did not benefit from any land based therapy. After completing the course of therapy, Ms. Greene initially felt better but, as time went on, she has continued in a lot of pain. Additionally, she states that a couple of months following the accident, she also developed numbness and tingling initially in the right and then both hands, for which she ultimately underwent bilateral carpal tunnel surgery with resolution of those symptoms. She presently treats only with her primary physician, Dr. Mueller. 2325 i^0,11y1,inil Rd );tiiiti, 120 I:),15 liii hLiud Avenue, Silite 301 Willow( 1u',O, I,A 1(.1090 Abington, PA 19001 Phone 2)5 957 9250 Phone 215-957-0250 Lix 2 15-9.57-0254 Ox 2 15 9.57-025,1 Re: Amanda Greene Page 2 August 12, 20.1.3 Present Symptoms: Ms. Greene reports a previous history of migraine headaches that had essentially resolved following the birth of her 12 year old daughter and then recurred following the car accident in 2007. She states she can experience migraines once or twice a week but they can last as long as four days in duration. The migraines can either start as a shooting pain in the hack of the head or else in either eye, and progress to a moderate to severe headache ranging between 6-10/10 severity on the pain scale, and she has to lie down in a dark, quiet room because of the light and sound sensitivity. She uses Maxalt which may or may not help to take the edge off and allow her to function with the migraines. Ms. Greene reports constant daily neck pain averaging 7-8/10 severity on the pain scale, although the pain level can escalate to a 10 some days. The neck pain starts at the base of the skull and travels down between the shoulder blades and across to both shoulders. On occasion if the pain is particularly bad, it will travel to the upper arm bilaterally. She no longer experiences any numbness or tingling in the upper extremities. She reports activity aggravates her neck pain, such as cleaning the house, pulling weeds or when she is at work as a hairdresser. In addition to the neck and upper back pain, Ms. Greene also experiences low hack pain which is not as bad as her neck, with good and bad days and overall average severity low back pain between a 5-9/10 on the pain scale. Her back pain is worse if she either sits too long or stands a long time at work leaning over the sink washing hair, or bent over at home scrubbing the tub. She states if her back is particularly bad, she can also have pain in both legs meaning the entire legs from the waist to the feet. When I asked if she experiences any numbness or tingling in the legs, she commented on an incident a few nights ago when she experienced numbness in her legs after sitting on a hard bench for a few hours. She states this has occurred before but "not very often, " Ms. Greene denies any other residual symptoms attributable to the December, 2007 accident. In addition to the Maxalt she uses as needed for migraine, she also uses Ultram and Flexeril at least once a day which provide variable relief, with the Flexerli taken at night making her tired and helping her get to sleep, because she often has a difficult time finding a comfortable position to lie in bed. Past Medical History is otherwise unremarkable and she takes no other regular medications apart from birth control pills. She denies having previously been injured either in an accident or a slip and fall . When T inquired about any previous history of neck or back pain, she acknowledged a little stiffness at the end of a work day. Re: Amanda Greene Page 3 August 12, 2013 When I asked if she had ever treated with a physician for her back prior to the 2007 accident, she replied, she saw a doctor "for a short second" for stiffness in the shoulders which she attributed to being hunched over a chair all day at work. Social History reveals Ms. Greene to be married with two children and a stepdaughter at home, employed as a hairdresser. At the time the accident: occurred in December, 2007, it was her first day back to work following four weeks of maternity leave, and it was the holidays and she did not feel she could miss any further Limo from work and, thus, she was not out of work following this accident. Medical Records Review: EMS report, dated December 20, 2007, indicates Claimant was the unrestrained driver in an accident with frontal impact complaining "my head hurts," also reporting pain in the left knee. She denied losing consciousness and was alert and oriented, with an approximately 1. 5 in. laceration in the mid- forehead just below the hairline, and she was transported to the emergency room. Emergency department record, dated December 20, 2007, indicates another car ran a stop sign leading to a collision, with complaint of head and neck pain associated with forehead laceration. There was no loss of consciousness and no problems referable to the upper extremities. CT scan of the brain was normal. CT scan of the cervical spine revealed no fracture or traumatic malalignment. Left knee x-ray was normal . The forehead laceration was repaired, and she was treated and released. Report of Pr. Scott Moeller, dated December 28, 2007, indicates her chronic neck and back pain were aggravated by the accident, and there were no radiating symptoms, no dizziness, concentration or memory problems. She was said to have used Vicodin, muscle relaxant and Lidoderm without much benefit in the past. There were no neurological findings on examination, and she was felt to have neck and back pain, and, "if she had a concussion, it was very mild. " She returned on January 9, 2008 to have sutures removed from the forehead and left leg. On January 15, 2008, Dr. Mueller indicates her back pain is worse and now 10/10 severity, with neck pain into the shoulders but not the arms, with the question about neck pain leading to migraines for which she was on Topamax possibly explaining tingling in the hands with again no abnormal neurologic findings on examination. On February 8, 2008, she was still in pain after taking Percocet, and was taking Oxycontin as prescribed for low back pain. Re: Amanda Greene Page 4 August 12, 2013 On March 19, 2008, Dr. Mueller indicates she is still having a lot of pain, one to two migraines per week as well, as multiple trigger points. On April 9, 2008, she reported aquatherapy was helping the pain, and she is moving better after taking medication. On April 28, 2008, Dr. Mueller indicates she has tingling and numbness mainly in the right hand which wakes her up at night over the past three weeks, in addition to her usual neck and back pain. On May 14, 2008, she reported increased pain in the knees and was unsure .1.1- this was related to the accident, although she reported they were bruised from striking the dash. She also reported wrist pain and numbness not helped by prednisone or a wrist splint. On June 10, 2008, she reported right knee pain and swelling, doing knee exercises and PT. On July 8, 2008, Dr. Mueller indicates slight improvement in pain, and they discussed carpal tunnel symptoms which began after the accident. On August 20, 2008, she felt she needed time to rest her back after going to work. On September 24, 2008, her pain was stable and she was able to work part time as a hairdresser. On March 4, 2009, pain was controlled on the present medications which allowed her to be more functional in daily activities. On May 27, 2009, she wanted to stop the Lyrica which was not helping but was causing weight gain. On June 24, ;?009, she was tolerating a decrease in medication and was functjonally On September 14, 2009, she was feeling well without specific complaints, still taking pain medications. On October 14, 2009, she noted some increase in pain as she was tapering the dose. On November 12, 2909, Savella was helping with pain. Flu: Amanda Greene Page .5 August 12, 2013 On December 3, 2009, she had a migraine in the past two days and was reducing the dose of Oxycodone and Oxycontin. On December 23, 2009, she noted increased headaches, with a history of migraine since age 10 years. On January 14, 2010, the pain was not controlled. However, she reported the medicine didn't help, and she was interested in trying Suboxone to help get off meds more quickly. Over the next low months, she discontinued narcotic analgesics and was then off Suboxone as of March 11, 2010, when she reported Increased anxiety, neck and back pain. Dr. Mueller authored a short letter, dated November 26, 2010, with the opinion her carpal tunnel, syndrome and related surgeries were a result of the accident, and he enctosed a short abstract discussing a number of patients who developed symptoms of carpal tunnel syndrome within two months following an accident (the symptoms that led to a diagnosis or carpal tunnel syndrome in this case appeared not to have developed until closer to four months post-accident) . There are approximately monthly follow-up notes of Dr. Mueller through the first half of 2011 and then subsequent follow-up report on November 3, 2011 indicating chronic pain from which she was much more functional on medications, able to perform household chores, care for her children and drive a car without being distracted by pain. The next visit on May 21, 2012 again indicates she is much more functional on medication, which at that point included Cymbalta changed to Savella, Flexeril, Ultram and Aaxalt. There are a couple of handwritten plastic surgery notes regarding the forehead laceration. There are some physical therapy records from Cumberland Orthopedic and Spine, with initial note, dated March 5, 2008, indicating she hurt somewhat after the accident but began to have more pain two weeks later which continued to get worse. She had delivered a baby one month before the accident and was presently working two days a week, with her low back being the worst while at work, whereas her upper back hurt more at home trying to hold the baby. There are subsequent treatment notes for referring diagnoses of cervical, thoracic and lumbar strain with a discharge summary, dated Re: Amanda Greene Page 6 August 12, 2013 June 26, 2008, indicating she continues to have difficulty carrying her son or performing gardening for more than twenty minutes. In review of the individual handwritten PT progress notes, there is a notation on March 7, 2008 that digits three-five of both hands tingle at times. EMG/nerve conduction study of the right upper extremity, dated July 2, 2008, was reported to show moderately advanced right carpal tunnel syndrome, and, indeed, the right median sensory and motor distal latencies were significantly prolonged across the wrist. Subsequent left upper extremity EMG/nerve conduction studies, dated November 11, 2008, were reported to show mild prolongation of the left median sensory distal latency across the wrist, with normal findings of left median motor nerve conduction study, with the findings interpreted as consistent with carpal tunnel syndrome involving the left median sensory fibers. Orthopedic report of Dr. Stephen Dailey, dated November 15, 2008, indicates a six-month history of left wrist pain, as well as numbness of all fingers of the right hand, with some numbness and tingling on the left as well . The symptoms would come and go and wake her up at night, and she already had the nerve conduction study demonstrating right carpi] tunnel syndrome. Dr. Dailey injected the left first dorsal compartment for DeQuervain's tenosynovitis, irJd subsequently scheduled her for right endoscopic carpal tunnel release on December 1 , 2008, after which postoperative follow--up visits indicate she was improved, and he subsequently performed left endoscopic carpal tunnel release on January 5, 2009, with a postoperative visit on January 19, 2009 indicating improvement of preoperative symptoms. Also reviewed is deposition transcript of Amanda Greene, taken on March 19, 2012, discussing the course of treatment and symptomatic complaints including neck, upper and lower back pain, with relief of carpal tunnel symptoms which she was told could be a result of the accident from holding onto the wheel too tight, acknowledging the possibility it might be from working as a hairdresser although she did not have these symptoms before. Radiographic Examination: Unenhanced CT scan ot the brain, dated December 20, 2007, reveal the ventricles to be normal in size and configuration for the patient's age. There is no abnormal lucency or density within brain parenchyma. Done windows revealed no evidence of skull fracture. In summary, this is a normal unenhanced CT scan of the brain. Re: Amanda Greene Page 7 August 12, 2013 CT scan of the cervical spine, dated December 20, 2007, reveals normal anatomic configuration, with no evidence of fracture or traumatic malalignment. There is no evidence of focal disc herniation or significant degenerative changes. In summary, this is a normal CT scan of the cervical spine. Examination revealed Ms. Greene to be a well-developed, well- nourished, generally healthy appearing young woman in no acute distress. She was alert and attentive with normal speech, language and memory. Cervical spine examination revealed mildly diminished range of motion in all directions, with subjective tenderness both in the midline and with light touch over paravertebral muscles diffusely in the neck, upper back toward both shoulders and shoulder blades with no palpable spasm.. Lumbar spine examination revealed only mild subjective tenderness when compared to the neck, again without palpable spasm. Lumbar range or motion was essentially normal, able to flex forward to reach within a few inches of her toes, with good lateral bending and negative seated straight leg raising to 90' bilaterally. Cranial nerves II through XII were intact. Motor examination revealed diffuse give-away weakness in virtually every muscle group in both upper and lower extremities reflecting inconsistent effort. Despite my being easily able to overcome her quads and ankle dorsiflexors, she had no difficulty standing supporting her weight and ambulating including walking on her heels and toes demonstrating lull strength in those muscles In which she gave way on manual muscle testing. Tendon reflexes were 2+, easily elicited and symmetrical in both upper and lower extremities with no Babinski sign. Sensory examination revealed intact equal pin sensation in both upper and lower extremities. Cerebellar examination revealed normal coordination in both upper and lower extremities. She ambulated on a narrow base with symmetrical arm swing, was able to walk on both heels and toes as well as tandem with negative Romberg. Re: Amanda Greene Page 8 August_ 12, 2013 Impression: Amanda Greene is presently evaluated more than five and one half years following an intersectional collision with complaint of chronic, daily neck, upper greater than lower back pain as well as aggravation of pre-existing migraine headaches. Post-accident imaging of the brain and cervical spine revealed no traumatic injury. A few months after the accident, she first developed intermittent tingling in the right and subsequently left hand leading to a diagnosis of carpal tunnel syndrome for which she underwent surgical decompression with resolution of that complaint. Dr. Mueller has attributed the development of carpal tunnel syndrome to injury sustained at the time of the accident. Carpal tunnel syndrome has, indeed, rarely been reported following automobile accidents attributed to injury to the wrist from tightly gripping the steering wheel . Those infrequent reported cases generally develop within two weeks post-injury upto as long as two months, with the onset of symptoms in this case being three-four months of questionable causal relationship to the accident, in which there was no injury or complaint referable to the wrists or hands initially to suggest any local injury. 11111111111111.1, including occupational as well as postpartum carpal tunnel, and I would add I do not have any obstetric records concerning her pregnancy, or any primary care notes that pre-date the accident for that matter, although she had already been seeing Dr. Mueller as her primary physician before the December, 2007 accident. — . 1 _ . immlimmommemmimi TjAmiwingil Some physicians have labeled fibromyalgia beginning following an accident as post-traumatic fibromyalgia, although there is again no scientific basis for the determination of fibromyalgia being traumatically induced, and it is simply the subjective report of pain. - • LCC ocay • • NONIMMOMMONOW. _ „ , - - • . . _ Clearly, despite easily being able to overcome virtually every muscle without much resistance, she clearly demonstrated full muscle power able to bear body weight utilizing the same muscles that .1 could easily overcome with manual muscle testing. ,Re: Amanda Greene Pace 9 Aumist, 12, 2013 Ms. Greene sustained a closed head injury with scalp laceration at the time of the December 20, 2007 accident, and her subsequent report of worsening of her pre-ex„isting migraine syndrome could provide historical support for post-traumatic headache disorder or aggravation of migraine based on subjective criteria. The neck and upper back pain could similarly provide historical support for whiplash or cervicothoracic strain and sprain, a soft tissue ;injury typically expected to resolve within a few months of conservative management. . , . . -.„ • - Amanda Greene has successfully returned to pre-accident employment without missing significant time from work, and I would not place any restrictions on her employment or non-occupational endeavors. All 01 the above opinions are expressed to a reasonable degree of medical certainty. 1 reserve the right to modify and/or amend these opinions should any additional pre-accident medical records become available for review. Yours sincerely, 11111 Lee J. Harris, M. D. LJI-1/bs EXHIBIT "B" West law 2010 WL 7561601 (Pa.Com,P1.) Page 1 Court of Common Pleas of Pennsylvania. SOUTH 17TH STREET Philadelphia County Margaret CASTELLI and Salvatore Castelli. UNITED PLAZA -SUITE 1520 Plaintiffs, v. PHI LA DELPHIA,PA 19103 Enrique CA PIRO and Rend l Calla, Defendants, No.04 177, Pt IONE(215)564-1233 July 6.2010. INDEX Videotape Deposition o i l ee Ilarris, M.D. WITNESS Case Type: Vehicle Negligence >> Motor Vehicle V Motor Vehicle LEE VIARRIS, M.D. Jurisdiction: Philadelphia County, Pennsylvania Name of Expert: Lee Harris, M.D. BY: PAGE Area of Expertise: Health Care-Physicians & Health Professionals 7,->Neurologist MS.CARTER Representing: Defendant MR. THOMAS Appearances. EXHIBITS Dully& Partners By: Robert W.Thomas, Esquire TABLE One Liberty Place,55th Floor VIDEOTAPE OPERATOR: The time is now 11:49 1650 Market Street a.m. The following is a Videotape Deposition. My Philadelphia, Pennsylvania 19103 name is Bob Odell of ERSA Court Reporting in Representing the Plaintiffs. Philadelphia, Pennsylvania. This deposition is be- ing taken on July 6, 2010, scheduled for 11:45 a.m. Bennett, Brieklin&Saltzburg at Prizin Medical, 1528 Walnut Street, Phil By: Beth Carter, Esquire adelphia, PA. 1601 Market Street 16th Floor This deposition is for the Court of Common Pleas Philadelphia, Pennsylvania 19103 of Philadelphia County, No. 04177, in the case of Representing the Defendants. Margaret Castelli and Salvatore Castelli versus En- rique Capiro and Renel Calia. TRANSCRIPT OF DEPOSITION, taken by and be- fore ALEXIS PERRICONE, Professional Short- Present for the taking of this Video Deposition is hand Reporter and Notary Public, and ROBERT the Deponent, Dr. Lee Harris, testifying on behalf ODELL, Videotape Specialist., at the OFFICES OF of the Defendant, and Counsel, who will now intro- PRIZM MEDICAL RESOURCES, 1528 Walnut duce themselves. Street, Suite 1807, Philadelphia, Pennsylvania, on Tuesday,July 6,2010,commencing at 11:49 a.m. MR. THOMAS: Robert Thomas for Mr. and Mrs. Castelli. ERSA COURT REPORTERS MS. CARTER: Beth Carter on behalf of the De- fendants. (0 2013 Thomson Reuters.No Claim to Orig. US Gov. Works 2010 WI. 756160 (Pa Corn P1 Page 2 VIDEO CAPE OPERATOR:Thank yOU.Counsel. A. Sure. The court reporter is Alexis Perriconc of ERSA. Neurology refers to disorders of the nervous sys- and the court reporter will now swear in the Wit- tem: the nervous system being comprised of the ness. brain, the spinal cord, and all the peripheral nerves that go off into the arms and legs. So anything from LEE HARRIS, M.D., after having been first duly brain disorders, such as epilepsy and Parkinson's sworn, was examined and testified as follow: disease, to various spinal or spinal cord disorders to pinched nerves that have exited the spine or are go- VIDEOTAPE OPERATOR: We will now begin ing down into the arms and legs all fall under the questioning. field of neurology. DIRECT ON QUALIFICATIONS Q. As a neurologist, do you treat patients with neck and back injuries? BY MS. CARTER: A. Yes, Q. Good morning, Doctor. I wanted to advise the jury that we're not sure exactly when we're going to Q. And does that include complaints of numbness be called for trial in this matter. Therefore, with and tingling down the arms and legs? your permission, were going to be taking your trial testimony via Videotape Deposition. A. Yes. As a neurologist, that's one of the more common symptoms that I see. Is that acceptable with you? Q. Doctor, could you please go through your educa- A. Certainly. tional background with the jury? Q. Doctor, could you please go ahead and introduce A. Sure. yourself to the jury and tell them where your alley is located. I received my M.D. or Medical Degree from the Al- bert Einstein College of Medicine in Bronx, New A. Yes. My name is Dr. I.ee I larris. Currently in York in 1984. Alter graduating from medical the office of Prizm Medical Resources at 1528 Wal- school, I then completed an internship in internal nut Street in Philadelphia. medicine at the Monteliore Hospital, which is affil- iated with Albert Einstein, and then a three-year Q. Doctor,where are your medical offices? residency in neurology at the Columbia Presbyteri- an Medical Center in New York. A. My medical offices where I practice medicine are -- two of them actually -- one of them attached After finishing my three years of neurology resid- to Abington Memorial Hospital in Abington, PA, ency, I then spent an additional year of fellowship and a second on Maryland Road in Willow Grove, winning also at Columbia in clinical neuro- Pennsylvania. physiology, which entailed EEG or brain wave test- ing, as well as ENO or nerve and muscle testing. Q, Do you have a medical specialty? And after finishing up my neurology residency and fellowship at Columbia. I then moved down to the A. Yes, I'm a neurologist. Philadelphia arca where I have been practicing neurology since 1989. Q.Can you briefly tell the jury what that specialty is? '0 2013 Thomson Reuters. No Claim to()rig, I IS Gov. Works. 2010 WI. 7561601 (Pa.Com.P1.) Page 3 Q. In what state are you licensed to practice moll- staff, both in private practice. as well as in the hos- eine? pital. And I serve as Chief of the Neurology Divi- sion at Abington. \vorking to advance in neurologic A. In Pennsylvania. subspecialties for the community. Q.Are you Board certified--strike that. Q. Doctor, I'm going to show you what's been marked Harris-I. And is this a copy of your Cur- Do you hold any Board certifications? rictilum Vitae or your resume, Doctor? A. Yes, 1 actually have three Board certifications. A. Yes, it is. one of them in the general field of neurology, and the other two subspecialties of neurology, one of Q. And, Doctor, does Harris-1 list all of your edit- them being clinical neurophysiology or EEC brain cation and background, your status in the medical wave testing that I mentioned a few moments ago, profession, and training? and the other in electrodiagnostic medicine. Which is the EMG nerve and muscle testing that I also A. Yes, it does, mentioned a few minutes ago. MS. CARTER: At this time, I would move for the Q. Can you briefly explain to the jury what Board admission of Harris-I and offer Dr. Harris as an ex- certification means? pert in the field of neurology and allow cross on qualifications. A. Yes. Board certification, at least in my case, in- volved passing both written and oral examinations MR_THOMAS: Thank you,Counsel. for all three Board subjects to demonstrate expert- ise in those particular specialities or subspecialties. CROSS ON QUALIFICATIONS Q. Do you currently hold any teaching positions BY MR,THOMAS: with any schools here in Philadelphia? Q.Good morning, Doctor How are you? A. Yes. I'm Associate Clinical Professor of the De- partment of Neurology at 'Temple University 1-los- A.Fine,thank you. pital, which involves teaching medical students who ate learning their neurology when they rotate Q. 1 understand you're affiliated with Abington-- with us up at Abington Hospital. A,That is correct. Q. Are you a member of any professional medical societies? Q.--as a practitioner? A. Yes. I'm a member of the American Academy of A.Yes. Neurology, the American Association of Eleeiro- diagnostic Medicine, which is the EMG or Nerve Q. Are you affiliated with any Philadelphia hospit- and Muscle Society, the Philadelphia Neurological als as a practitioner? Society,and perhaps one or two others. A. No, I'm not. Q. And I believe you already testified you're affili- ated with Abington Memorial Hospital? Q. Not Penn or Thomas Jefferson, no other affili- ations other than Abington? A. Yes. I'm a practitioner there of neurology on the A. I'm not on Staff at PCI111. I'm on teaching staff as 2013 Thomson Reuters. No Claim to Orig. I.IS Gov. Works. 2010 WI. 7561601 (Pa,Coin.P1.) Pa.e 4 1 mentioned, ii Temple. 1 don't practice at lemple A. No, I'm not, Hospital, which is in Philadelphia, but I am in- volved in a teaching program for medical students. Q. Well, understanding that -- and Dr. Jaeger, you And I also have a loose affiliation with something understand her -- him to be one of Ms. Castelli's called Penn Neuro Care, which comes out of the treating physicians: is that right? University of Pennsylvania and involves an affili- ation with neurologists out in the community. But, A. That's correct. I'm again, not technically on staff at University of Pennsylvania. Q. Well, the fact that he is an orthopedist and you're a neurologist, did that cause any dilemma for Q. You mentioned this teaching position you have you in offering an opinion about any of the injuries at Temple. having to do with this accident? Is that a tenured position? A. No, There is often overlap between orthopedics and neurology both with regard to the spine, as well A. No, it is not. as the peripheral nerves. Q. Do you get any compensation for that? I suppose I could question whether an orthopedist is qualified to provide a diagnosis of a neurological A. No. Its purely volunteer work to help teach injury in the upper limb, as Dr. Jaeger did here, but, medical students, which is something that I enjoy to me, that's more of a neurological issue than an and something I have done since I've been in prac- orthopedic issue. But, as I said, there's often an Lice. overlap, and both specialties sec both conditions. So its not an issue whatsoever. Q.Do you know Dr. Jaeger? Q. So there was nothing that you felt unable to A. No, 1 do not. comment upon? Q.Do you know what Ins specialty is? A. If there was something that I felt unable to com- ment on, then it would not have been included in A. I believe he's a -- well, 1 think he's orthopedics, my report. I'm not sure if he's a hand specialist as a subspe- cialty of orthopedics. Q. Counsel was kind enough to provide me with a copy of your resume, your Curriculum Vitae. And I Q.Now,you're a neurologist; right? see that it lists a number of presentations beginning On Page 2. A.That's correct. Do you have a copy of your resume there, Doctor? Q. You're not an orthopedist? A. Yes, I do, A. No, fin not. Q. 1 see some of these presentations had to do with Q. And neurologists don't perform surgery; um I multiple sclerosis; is that correct? correct? A. Yes.That's one of many,yes. A. That's correct. Q. And some of your presentations had to do with Q. And you're not a radiologist? Alzheimer's disease? c. 2013 Thomson Reuters. No Claim to Orig. US Gcw. Works 2010 WL 7561601 (Pa.Com.PI.) Pace 5 A. That's convet. A. I don't know if the word pain is in there, I have, again. participated in a wide variety of research Q. Some of them had to do with headache and sin- activities. I don't believe any of them have involved per and con a:am I correct? the spine. per se. Many of these have to do with stroke and Alzheimer's disease and some other A. Yes. neurological disorders. Q. Am I correct that the vast, majority of these Q. Now, Doctor, you have a private practice; is that presentations have nothing to do about what we're correct? here today for? A.That's correct. A. Well, certainly none of these presentations had anything to do with the legal system or justice pro- Q.And it's a neurology practice;correct? cess. As far as any injury, I have given a wide vari- ety of lectures covering everything from the brain A. Yes, it is. through the spinal cord and peripheral nerves. Q. Does that mean that some of the patients that Q. Well, let me just help you, Doctor, with my you're seeing are patients that have problems with question again. multiple sclerosis, fin.example? Am I correct that the vast majority of these present- A. Yes. ations have nothing to do with what were going to be talking about today'? Q. And how about patients with Parkinson's dis- ease, do you also have patients with Parkinson's A. I think that's fair to say,yes. disease? Q. Okay. And I'm looking through the list, and A. Yes, I do. please correct me if I'm wrong, but with regard to the presentations, I don't see the word spine in any Q. Alzheimer's disease patients make up a signitic- of those;am I correct about that? ant portion of your practice? A. I believe that's correct, A. I don't know what you define as significant, but about 5 percent of' my patients have Alzheimer's Q. And I understand that there's a couple of disease. presentations that have to do about headaches, but I also don't see the word pain mentioned anywhere in those presentation titles; am I correct about that? 11111111111111111111111.1111111111 A, Well, the word pain might not be included, but certainly it's encompassed in some of the other presentations. some of the issues that Ms. as et m complained Q. All right. I'm looking on the next pace here, about or some of the alleged diagnoses, whether it's your research activities. And. again, please help me brachial plexus or radiculopathy, pinched nerves, if I'm mistaken here, but I don't see the word pain and so forth, that has to do with a significant por- or spine in any of those research activities; am I tion of my practice is devoted to EMG, which is the correct about that'? nerve and muscle test as an evaluation for peripher- al nerve injuries, whether it he radiculopathy; that q:',)201 "Thomson Reuters. No Claim to Orig. US Gov, Works 2010 WL 7561601 (Pa.Com.P1.) Page 6 is. a pinched nerve coming off the spine, or the bra- Q. And when was that examination, Doctor? cilial plexus, which is a group of nerves behind the collarbone. 11111MONS1111.111.0.111111111111111 A.On March 30th,2010. immooNINISilionmegitimMilincumlo in ruproitm, WO Q. After that examination, did you prepare a report for me'? Q. Arc you able to tell me with any clearer term other than significant'? Because I think that was the A. Yes, I did. term I used, and you said you didn't know what it meant. Q. Do you have a copy of that report, Doctor'? A,Correct, you are. A.Yes, I do. I would say about 25 percent of my practice is de- Q. Before your physical examination of Ms. Cas- voted to EMG and assessment of neuromuscular telli, did you also review some of Ms. Castelli's re- problems. Again, whether it's related to carpal ton- cords, photographs,and testimony? net syndrome or brachial plexus or radiculopatliy; that is, pinched nerves coming off the neck or back, A. Yes, I did. that would be about a quarter of my practice. Q. Doctor, I'm going to show you what's been MR. THOMAS: Doctor, I thank you very much. I marked Harris Exhibit 2.Take a quick look at that. have no further questions on qualifications. Doctor, is that a true and correct copy of your re- REDIRECT ON QUALIFICATIONS port dated April 2,2010 that you wrote to me? BY MS.CARTER: MR.THOMAS: Objection. Q. Doctor, briefly two more. VIDEOTAPE OPERATOR: The time is now 12:04. Going off videotape record. You are the Chief Neurologist at Abington;correct? (Discussion off the video record.) A.That's correct. MR. THOMAS: The Doctor can certainly refer to Q. And you are Board certified in electrodiagnostic his report as necessary during and throughout the medicine,which is EMGs? course of his deposition, but in light of the fact that you've got the Doctor here, I will object to the ad- A. Yes, that's coiTect. mission of the report itself. MS. CARTER: No further questions on qualifica- MS, CARTER: I only had it marked, I understand tions.Thank you, Doctor. your objection.We can go back on. DIRECT EXAMINATION VIDEOTAPE OPERATOR: The time is now 12:04. Back on videotape record. BY MS,CARTER: BY MS, CARTER: Q. Now. Doctor, at my request, did you examine the Plaintiff,Margaret Castelli? Q. And, Doctor, is Harris-2 a true and correct copy of the original report you issued to me on April 2, A. Yes, I did. 2010? T2)2013 Thomson Reuters. No Claim to Orig. US Gov. Works 2010 WI. 7561601 (Pa.Com.PI.) Page 7 A. Yes, it is. She told me she subsequently saw Dr. Jaeger sever- al times, most recently just a week or so prior to the Q. After your examination of Ms. Caste lli, did you time that I saw her. Although, prior to that, she told have an opportunity to review some additional re- ltie she hadn't seen him for quite a while. She told cords'? me that Dr. Jaeger had given her some shots into her left shoulder and both hips and that she had A. Yes, I did. continued with aqua therapy class at the gym a few times a week, as well as having massage therapy Q. Doctor, I want to show-you what's been marked weekly, which had actually been ongoing for a long Harris-3. And is that a copy of the Addendum Re- time before this accident dating back to injuries she port dated May 5, 2010, that you authored directed suffered as a result of a prior accident hack in 2004, to me as a result of your review of additional re- cords? Q. Okay. Doctor, that leads me -- by the time the jury sees your video, they're going to have heard A. Yes, it is. about a 2004 and a July 26, 2007 motor vehicle ac- cident. Q. Doctor, before doing your physical examination of Ms.Castelli,did you ask her What was going on'? Which accident were you retained by the Defense for? A. Yes, A. Regarding the 2007 accident. Q. And you performed a medical history? Q.Okay.Thank you. A. Yes,I did, And. Doctor, did you ask Ms. Caste lli what her cur- Q. What did Ms.Castelli tell you? rent or present symptoms were as of the time that you saw her? A. Ms. Castelli told me she had been the seat belted driver of a car stopped in traffic when she was rear A. Yes, I did. ended and not pushed Forward into the car in front of her. She told me she struck her left elbow on the Q. And what did she tell you? armrest, as well as her right knee on the dash. She went forward and back, hitting the hack of her head A. She told me that she had intermittent; meaning, on the headrest. She told me she was not bleeding, coining and going, left shoulder and upper arm although she felt some bruising from the seat belt pain, which she told me occurred once or twice a on her left shoulder, week, usually if she had done something, such as lifting with her left arm or if someone manipulated She proceeded on to drive to work and later on that the arm in some way. She told me as long as she day went to the hospital with complaints of neck was resting the arm and not using it, she was fine. pain, which she told me was really no longer But when she did use it once or twice a week, she troublesome, as well as elbow, knee, and low back would develop pretty severe pain that would then pain traveling into the legs. taper off alter a while. She told me the pain oc- curred at the top of her left shoulder into the upper She told me she saw her primary doctor a few days arm and occasionally down toward the elbow. later who ordered a course of physical therapy, and However, she denied any pain radiating below the she also saw Dr. Jaeger about a month later with elbow down into the hand. complaints of left shoulder and upper arm pain, as well as some low back pain down into the legs. 1 2013 Thomson Reuters. No Claim to Orig. t IS Gov. Works. 2010 WI„,7561601 (Pa.Com.po Pave 8 She told me, also, she would occasionally expert- tion, which well get to, did you -- and taking the once numbness and tingling in the left upper arm, social medical history -- did you also review some again, if she had done something such as lilting records. photographs, and testimony of Ms. Cas- Ilowever, she also denied that she ever had numb- telli? ness or tingling below the elbow clown into the hand. She told me that her right shoulder really A Yes, I did. didn't bother her much. It was primarily the left shoulder that was troubling her following this acci- Q. Okay. dent. MR.THOMAS:Off the record for just a moment. She told me that in addition to her left shoulder and upper arm pain, she also had low back pain on a (Discussion off the video record.) daily basis, which conies and goes like lightning strikes, she told me, which would occur if site sits VIDEOTAPE OPERATOR: The time is now 12;10. too long or if she walks for more than a block or Going off the video record. two or while lying down in bed at night. She told me her best position was lying in a fetal position in MR. THOMAS: There are some -- so I don't inter- bed. rupt with the objections, there are some comments in Dr. Harris' report about medical conditions that She told me that in addition to pain in the lower are not implicated in this at all; the reports about hack, she had a separate pain in her hips, which was gastroenterology and, also, some findings that the fairly continuous. She denied any pain below the Doctor made regarding marks on her arm, which he hip level in either leg; meaning, she had no radial- opines were self-inflicted possibly. I don't know ing pain or any numbness down into the legs or that any of that has anything to do with that. And, if feet. She told me if she walked more than two or you agree, I ask that you ask the Doctor not to coin- three blocks, she would have to limp with pain. ment on those when offering his opinion about his summary of the review of medical records and ex- O. Doctor, was her past medical history notable? amination. A. Yes, it was, MS. CARTER: Okay. My response to that is as far as the gastroenterology report, it does refer to achy Q. Arid why was that? joints in the neck,shoulders,and upper extremities, A. She had been involved in a previous auto acci- MR. THOMAS: I don't have a problem with that in dent in 2004, at which point she told me she had and of itself, but to the extent that it was, you been rear ended and pushed forward into the car in know, I would have no problem with him saying front of her, and that, as a result, she sustained in- there also is a report of September 14,'05. jury to both brachial plexus; meaning, the group of nerves behind the collarbone, on both right and left MS.CARTER: And T have no problem with that. side as a result of that accident in 200,1. Doctor, I'm going to instruct you that when you go And in addition, she also sustained neck and hack to Page 3, instead of saying a gastroenterology re- injuries in 2004. She told me she had been improv- port.just say a medical report of 9/14/05, and that's ing, but was not fully recovered us of the time of fine. this second accident in 2007. THE WITNESS: Okay. Q. Doctor, in conjunction with a physical examina- MS.CARTER: Is that acceptable? 201.3 Hionison Renters. No Claim to Orig. us Gov. Works. . . 2010 Wt.75n160] (Pa.Com.P1.) Page 9 MR. THOMAS:That's perrect. MS. CARTER: Doctor, again, were going to take out her leeriness. MS.CARTER: Okay. TIIE WITNESS: And the second half of that sen- MR. THOMAS: And can we, also, so I don't have tence? to interrupt, when he gets to the pail about impres- sion -- and forgive me for Mu being able to put my MS. ('AR I ER: Yes, :just her leeriness to discuss the linger on it right now. origin of these scars suggests that they might have been self-inflicted. MS. CARTER: The scars, is that Ishat you're talk- ing about'? THE WITNESS: Okay. Fine. We'll ,just take that out it. MR. THOMAS: Yes. MS, CARTER: Okay, MS.CARTER: Page 5. Under examination? MR.THOMAS: Good, MR. THOMAS: Right. VIDEOTAPE OPERATOR: The time is now 12:13. MS. CARTER: Is she going to claim any type of Back on videotape record. emotional distress or emotional injury or anxiety or anything as a result of this motor vehicle accident? BY MS.CARTER: MR. THOMAS: Well, sure I mean, you know, to Q. Doctor, as part of your review, did you read de- the extent that she can't get around anymore, but position testimony given by Ms.Castelli? there's no claim that the scars were caused in the collision. I don't know that the Doctor frankly has A. Yes, I did. the requisite expertise to offer an opinion that her leeriness to discuss the origin of these scars sug- Q. When you took i history from Ms. Caste lli as gests that they may have been self inflicted. I mean, well as your current complaints, did she tell you I just don't think it's appropriate. It's certainly not that she injured her right arm in the motor vehicle an opinion to a reasonable degree of medical cer- accident that occurred in 2007? tainty. I don't know that as a neurologist he has the requisite expertise to comment on the appearance of A. She actually told me that she had injured her them, let alone make a judgment about the extent or right shoulder in the previous accident in 2004. lack thereof of her leeriness as a basis for his con- clusion. Q. All right. And did you -- in your review of her deposition testimony, did you see where she testi- MS. CARTER: 1 ant willing to take out her leeri- tied in her deposition that any right shoulder corn- ness to discuss the origin of these scars suggests plaints were related to the prior 2004 motor vehicle they might have been self-inflicted. accident? MR.THOMAS: That's fine. MR.'THOMAS: Pin going to object. MS. CARTER: 't'he rest is just simply part of his (Discussion °tithe video record.) physical examination. VIDEOTAPE OPERA FOR: The time is now 12:14. MR. THOMAS: I have no problem with that, Going off videotape record. MR. THOMAS: Unless I'm mistaken, I don't see in 1)2011 Thomson Reuters. No Claim to Orig. [IS(iov Works. 2010 WI. 756 I 60 (Pa.Coin.PI.) Page 10 either report--strike that. strafing degenerative changes in the lower spine. withdraw the objection. Q. And. Doctor. I'm going to show you what's been marked as Defense Exhibit 4. MS.CAR fER: "Data you. We can go back on. MS.CARTER; here's a copy for you,Counsel. VIDEOTAPE OPERATOR: Time is now 12:14. Back on the videotape record. BY MS. CARTER: BY MS.CARTER: Q. Is that a copy of the report that you reviewed and relied upon that you just mentioned? Q. Doctor,you can answer that question, A. Yes, it is. A. Yes. Q.Okay. Please continue, Doctor. The deposition transcript that I read of hers indic- ated that her right shoulder was injured in the previ- A. There was a medical report in June of 1993 talk- oils accident in 2004. And she told 111c that the only ing about numbness and tingling in both hands, problem she was having as far as her shoulders which had been progressive over the past year or so after the 2007 accident was with her left shoulder, and was thought to be bilateral carpal tunnel syn- which had also been injured in the previous acci- drome,as well as bilateral upper extremity pain. dent. Q. And, Doctor, I'm going to show you what's been Q. And, Doctor, did you perform a physical exam- marked Defense Exhibit 5. illation of Ms,Castelli? Is that a copy of the June 27, 2003 report that you A. Yes, I did. just discussed? Q. All right. Sorry. I want to go to the records first A. Yes, it is. I apologize. Q.Okay, Doctor, if you could briefly tell the jury what re- cords you reviewed. And for Court purposes, I'm A. There was a handwritten note, I believe, from going to have to stop you as you go through to have her primary physician on April 19, 2004, which ref- Exhibits marked. But please go ahead and start erences Iter having been in an auto accident a telling the jury what records you reviewed in con- couple weeks earlier with cervical and lumbar junction with your physical examination. strain; meaning, neck and low back injuries, as well as numbness in both hands, pain in both knees. and Certainly, left ankle. I reviewed quite a number of records. Some of them Q. And,Doctor,here's Defense Exhibit 6. were not relevant or contributory, so I may not mention those particular records at this time. Is that a copy of the handwritten note dated April 19,2004,that you just discussed? There was a medical report dating back to March of 1998, which talks about problems with the lower A. Yes, it is. back with pain in the groin felt to be coining ti-urn the lower back and a bone scan ;a that time demon- Q.All right: Q2013 Thomson Reuters. No Claim to Orig. US Gov. Works. 2010 W[,756 i 601 t Pa.Com Sq.) Page II A. There's a medical reply! from September 14, Her persistent chief complaint to Dr. Jaeger was 2005 that, among other things, references achy len. shoulder pain with progressive tingling, as well joints in her neck, shoulders, and upper extremities, as lower back pain with radiation into the left leg, as well as tingling in both hands and possibly which would coiTehate with the radiculopathy that carpal tunnel syndrome. the other doctor had diagnosed her with. There is the first orthopedic report of Dr. Jaeger on Dr, Jaeger felt she had a brachial plexus injury. April 21, 2006, which indicates problems with the which is, again, injury to the group of nerves be- left shoulder, since an auto accident in April 2004, hind the collarbone. A her the nerve comes off the when she had been struck ft from behind at a high spinal cord of the neck and exits the spinal cord as rate of speed, since which time she had been corn- a spinal nerve, it then regroups with another -- other planting of shoulder and low hack problems with spinal nerves behind the collarbone to form what's degenerative changes noted on x-rays, both in the called the brachial plexus, which is the bundle of neck as well as the low back. nerves that then form the individual nerves that go down into the arm and down into the hand. So she She had been previously treated by another doctor was thought to have injury not only in the neck and with diagnoses of cervical swain and radiculopathy, back, but also to this group of nerves of the brachial plexus behind the collarbone in addition to a Q. Doctor, what is radiculopathy? lumbar injury or low back injury with radiculopathy affecting the spinal nerve down into the leg. A. Radiculopathy refers to injury of the spinal nerves that go down into the arm and leg. So, for Q. And, Doctor, that report you mentioned dated example, when the nerve first exits the spinal cord April 21, 2006 has been marked Defense Exhibit 7, in the neck, it's referred to as a spinal nerve. That Doctor, nerve can be injured by a herniated disc or by a bone spur that pinches or compresses the nerve and And that is about 15 months before the accident will typically cause radiating pain with tingling and that were here for ofJuly of 2007;correct? numbness down into the arm or leg depending whether it's coming off the neck or hack. A.That's correct. In this case, the other doctor had diagnosed her Q. And it's about two years after the April 7, 2(104 with both cervical, as well as lumbar radiculopathy; accident? meaning, problems with the spinal nerves coming off the neck, going down into the arm, as well as A. Yes. coming off the low back, going down into the leg. Q. As or April 2Ist, 2006, was Ms. Castelli still There had also been diagnosis of mid thoracic having complaints with neck, mid back, low back, strain and sprain. So in addition to the neck and both shoulders, and both radiculopathy in her anus lower hack, there were also injuries to the middle and her legs two years after the'04 accident? part of the back or thoracic spine. A. Yes,she was. In addition to the diagnoses involving the entire spinal column, she had also been diagnosed with bi- Q.Okay, Doctor,please continue, lateral carpal tunnel syndrome, which is a pinched nerve at the wrist that causes numbness and tingling A. There's a report of EMG and nerve conduction into the hands that she had been complaining, ii hr study. This is the nervy and muscle test that I re- by several physicians around that time. ferred to earlier. This was done on April 5, 2006. at r)2013 Thomson Reuters, No Claim to Orig. US Gov. Works. 2010 WI.7561601 (Pa,('om.P1.) Page 12 which time she was complaining of numbness and A.That's correct. tingling in both hands, more on the left, as well as left shoulder and low back pain. The study was in- Q.Okay„ Doctor,go ahead and continue. terpreted as showing bilateral carpal tunnel syn- drome in addition to a left brachial plexus injury. A. There was a report of a cervical MRI. MR1 stands for magnetic resonance imaging. And it's a Q.And,Doctor,what is an EMG? sophisticated radiological tool similar to an x-ray. but really higher resolution than an x-ray that A. An EMG is a test that's actually administered in demonstrates, in the case of the neck, the vertebrae, two parts. The first pan of the nerve conduction the discs, and the nerves that come out in between study assesses the function of the nerves; in this the different vertebral level where one can have a case, in the arms and the hands themselves, and is pinched nerve and raclieulopathy, as 1 mentioned helpful in determining whether there is any local earlier. And this. again, is back in May of 2006. compression or injury; in this case, the carpal tun- And what that MR1 demonstrated was multi-level nel, which is a pinched nerve that is traveling front degenerative or arthritic changes in the spine asso- the wrist into the hand, and can also give some in- clime(' with a herniated disc to the letl at C6-7, as formation about some of the nerves higher up, such well as another herniation at C5-6, and a third her- as, for example, the brachial plexus. However, the 'nation at C4-5. nerve conduction portion of the study assesses the nerves only in the limb itself, but doesn't address So, again, this is about 14 months prior to the acci- the nerves coining off the spine,the spinal nerve, dent that I was seeing her for in 2007, but was re- ferring to injuries she suffered as a result of the pre- So the second part of the test.. the EMG portion, vious 2004, accident showing three different herni- does, in fact, address the spinal nerves coming oil ated discs in her neck on an MRI back in 2006. the neck or back, and that's performed by way of a thin needle placed in sonic muscles in the arm or Q. Doctor, what's a herniated disc'? leg. And that can give us information about the spinal nerve supply going down into the arm and leg. A. A herniated disc refers to the disc material that has gotten out of place. In our neck or in our back. So, in this case, she was found to have bilateral for that matter, the spinal column is composed of carpal tunnel syndrome; that is. a pinched nerve at the vertebrae, which are bones that are like little the wrist, as well as an injury to the left brachial boxes sitting on top of one another. And in between plexus, this bundle of nerves behind the collarbone those boxes or vertebrae are discs which are like a that I mentioned, jelly-like material that cushion the vertebral bones so there's not rubbing bone on hone. Q. Doctor, I'm going to show you what's been marked Defense Exhibit S. A herniated disc refers to when that jelly-like disc material protrudes out from beyond its confines. If Is that a copy of the EMG report dated May 5,2006? you think of the disc as heing like a jelly donut, or- dinarily, that jelly should remain within the donut. A. Yes, it is. But in the case of a herniated disc, that jelly-like material is extruded out beyond the confines of the Q. And that's about 14 months before this accident donut or the disc, in this case. And when that does that we're here for'? so, it can compress the spinal nerves and cause ra- diculopathy or the radiating pain and tingling down into the ann. (f.'„)2013 Thomson Reuters. No Claim to Orig. HS Gov. Works, 2010 WI. 7561601 (Pa.C7otn.P1.) Page 13 Q. And did she also undergo an MRI of the lumbar was continuing to have significant symptoms in- or the low back as a result of the 2004 motor volving the neck and left shoulder with pain radial- vehicle accident'? inc into the left ann, as well as low back pain radi- ating into the left hip and leg. Dr. Jaeger, at that A. Yes, time back in April of '07, felt she had suffered a serious injury which was still causing persistent On the same date that she underwent the cervical or symptoms three years after the accident. neck MRI back in May of'06, she also had a low back or lumbar MRI. This showed some degenerat- Q.Of 2004'? ive drying out and narrowing of the disc at 1,4-5; that means between the 4th and 5th lumbar verteb- A.Correct. rue. And there was, again, another herniated disc at that level, as well as what's called spondylolisthes- Q. Okay. Doctor, I'm going to show you Defense is. which refers to slippage of one vertebrae on top Exhibit 11 and Defense Exhibit 12, which are the of the other. June 20, 2006 and April 20, 2007 reports of Dr. Jaeger. So this is, again, in the lower back in 2006. 14 months before the 2007 accident, she as found to Are they the two reports you just referenced to the have a herniated disc, as well as degenerative jury? changes and slippage of the vertebrae down in the lower back. A.Yes, they are. Q. Doctor, I'm going to quickly show you Defense Q. All right. And, Doctor, on the April 20, 2007 re- Exhibit 9 and Defense Exhibit 10, port,could you please turn to the last page? Are these the MRI reports dated May 9, 2006 of the A. Yes. neck and low hack? Q. All right. And, Doctor, can you please read that A. Yes,they ale. paragraph to the jury--strike that. Q. Thank you, Doctor. You relied upon this record when you were coming to your -- forming your opinions regarding this Now, Doctor, go ahead and continue with your re- matter;correct? view of records, please. A. Yes. A. After those two MRI scans and the LNG that showed the findings that I mentioned, she followed This report was quite helpful because it was just a up with Dr. Jaeger on June 20, 2006, at which time few months before the accident in .luly of 2007. So his report indicates she was still having lelf it was helpful in providing her condition; that is, shoulder pain, as well as numbness in both hands, the considerable number of symptoms she was still in addition to low hack and left hip pain, suffering from after the 2004 accident, which, ac- cording to Dr. Jaeger, none of the treatments that There is, then, a subsequent report of Dr. Jaeger on had been offered had provided any relief. She was April 20, 2007,just a few months prior to the acci- still having multiple problems, which Dr. Jaeger dent that I was asked to see her about, At that time, thought was a serious injury. And on the last page, she was undergoing physical therapy and had a he goes on to say: She remains disabled, and her variety of treatments that were not helpful, and she disability is great enough to result in significant impairment of bodily functions and that she would 2013 Thomson Reuters. No Claim to Orig. I IS Gov. Works. 2011) WI, 756 I 601 Wil.Com.P1.) Page 14 require further treatment and further evaluations. Q. What do you mean, she complained of subject- And, in fact, he had recommended at that time that lye? she undergo further EMG and MRI testing to evalu- ate these several injuries that she had suffered as a A. Well, when I referred to the term subjective, I'm result of the 2004 accident, talking about something that she tells mc. By defin- ition, any experience of pain or discomfort is sub- Q. Doctor, you discussed an EMG that she had after jective. its not something I can see or measure, but, the 2004 accident, an MRI of the cervical spine or rather, I'm relying on what she is telling me as what the neck after the 2004 accident, and an MRI of the she feels. lumbar spine after the 2004 accident. Q.Okay. Doctor, in your review of records after the 2007 motor vehicle accident, the one that we're here for, A. So she reported, again, subjective tenderness did you see whether there was any objective testing over the left, upper outer arm, as well as in the ex- done? tensor tendons around the left arm and elbow. So in the top of the arm here, when I pushed or pressed A. No. She didn't have any of those tests done alter on the area,she told me it was tender, the 2007 accident. And, in fact, she had really quite limited treatment following that accident. Examination of her lumbar spine or lower hack, again, revealed normal, full range of motion. There I have gone through in the last several minutes was no localized tenderness or spasm. And the quite a lot of evaluations and testing that she had seated straight leg raising test, which is a test to after the 2004 accident from which Dr. Jaeger de- look for a herniated disc pressinu, on the spinal scribes she was still quite seriously Unpaired and nerve, was negative on both sides. In other words, disabled just a few months before this accident. So she did not report any subjective pain radiating out- we're talking about April 2007, at which time she ward from the spine with that maneuver, which is a had already had several tests done, and he was re- negative or normal finding. commending she have even inure tests done, But after the 2007 accident, I didn't see that she had any Examination of her extremities, specifically her or these tests done. arms, revealed no changes in the fingers or skin of the hands to suggest any peripheral nerve injury. Q, Doctor, I want to turn now to your actual physic- -1 here were a number of linear scars in the right al examination of Ms.Castelli, more than left forearm, which she told me was not a result of surgery of any kind, but she, nonetheless. Can you please take the jury through the high had a number of linear scars on both forearms, points or what was significant or not significant in your physical examination oi the Plaintiff? Examination of her cranial nerves; these are the nerves that control vision, racial expression, hear- A.Certainly. ing,and so forth,were all normal. Examination of her neck or cervical spine revealed Examination of her muscle system revealed that she she had full range of motion. There was no local- had no muscle atrophy nor any muscle weakness ized tenderness or muscle spasm. There was also no anywhere in the anus or legs. tenderness over the brachial plexus area; that is, around the collarbone, although she did complain Q. Doctor, what does atrophy mean? of subjective tenderness over the left upper outer arm up in this area as well. A Atrophy refers to shrinkage of a muscle. So, for (1.i1;')2013 Fhomson Reuters. No Claini to Orig. US Gov. Works. 201(1 WI,756 I 60 I (Pa,C'om.PI.) Page 15 example, if you've ever seen anyone who had a Q. Doctor, taking, together your physical examina- broken leg. was in a cast for six weeks, when the tion of Ms. CasteIli and your review of her medical cast is removed, the leg is shrunken or atrophied. In records, testimony, and photographs, did you form that case, it's a result of disuse from not using the any opinions? muscles. We can see the same thing in a muscle that has its nerve supply injured. So whether its A.Yes, I did. from a cervical radiculopathy, a pinched nerve on the neck, or from a brachial plexus injury where the Q, And, Doctor, could you tell the jury what your peripheral nerves behind the collarbone are injured, opinions are after your examination of both Ms, we would expect to see atrophy or shrinkage, as Castelli and her records? well as weakness of the muscles supplied by those nerves. But, in this case, her muscle bulk and A. Certainly. At the time I saw Ms. Castelli in muscle strength were quite normal in both arms and March of this year. 2010, she was presenting almost legs. three years following what appeared to have been a fairly minor rear end accident with virtually no The next portion of the examination is to assess the damage that I could see to the rear of her Jeep with tendon reflexes. This is done with a reflex hammer, complaints of chronic left shoulder and upper arm I'm sure everyone has seen at some point on TV pain, as well as complaints of low back and pain in where a doctor taps on the knee, and the leg jumps. both hips. And what this is doing is actually stretching the tendons at the knee or other places we can test, and Although she claims she had been improving fol- that sends a nerve signal tip to the spine and then lowing a previous accident in 2004, the report of the secondary reflex back down to cause the muscle Dr. Jaeger just a few months prior to this accident to jump. And so the tendon reflexes are quite help- paints a very different picture, not a picture of im- ful in testing the nerve pathway, not only locally at provement, but of chronic, serious, and disabling the site you're tapping, but it sends the signal up injuries from which she was still having consider- through the nerves and the arms and the neck, as able symptoms that had not improved with any well as in the low back from the legs up to the back treatment. and back down. It was hard for me to imagine that she sustained And so they're very helpful in assessing someone much, if any, injury following what appeared to be who has radiculopathy or injury to a spinal nerve, a minor impact in 2007, and certainly no evidence, or for that matter, any injury in the peripheral nerve either from the records 1 reviewed or front my ex- between the neck and the site that you're tapping or amining her, that she had sustained any brachial in the low back to the site you're tapping in the leg, plexus injury or any other neurological injury for that matter. In this case, all of her reflexes were normal and symmetrical or equal on both sides, indicating nor- I thought it was perhaps, at worst, she might have mal functional integrity of the spinal nerves going sustained a strain and sprain of the neck or low down into the arms and legs. back or a soft tissue injury strain that would usually he expected to heal in short order. Other than per- Q. Doctor, was your neurological examination es- haps a few months of physical therapy for soft tis- sentiaIly normal? sue strain and sprain, I didn't feel that any addition- al therapy would be indicated. And if there were A. Yes, it was. There was certainly no objective ab- any ongoing treatment, it would rather be to treat normality whatsoever, her preexisting problems she had been having dat- q:1)2013 Thomson Reuters, No Claim to Orig. US Gov. Works. 2010 WI 7561601 (Pa.Con1.11.) Page 16 ing back to the accident in 2004, and not any longer Q. And. Doctor, after you examined Ms. Caste Ili, related to any possible problems following the acct did you have an opportunity -- you already said that dent in 2007. you did an addendum report because you had sonic additional records to review;correct, Doctor? irsemtgariummennisaminoopuirmssior astatatifiesimik As I in- A.That's correct. dicated, there were no changes in her muscle strength or muscle bulk or in her reflexes or sensa- Q. Okay. And what did you find significant in your tion, nothing at all to implicate any brachial plexus review of the additional records you received? injury or any radiculopathy or really any neurolo- gical injury that I can identify, A. These were records concerning the 2004 acci- dent and injuries and diagnoses related to that acci- i didn't understand why she told me she was out of dent. work for a few months in 2007, She had actually continued working for a month or so after the acci- So starling with an emergency department report on dent, but alter she saw Dr. Jaeeer about a month April 7, 2004, it indicates she was complaining of after the accident, he, for some reason, decided to right shoulder and low hack pain following an acci- pull her out of work for the rest of that year. And, dent with x-rays of her neck and back demonstrat- again, if she was able to work for the month after ing degenerative changes in the spine, including the accident, which you would think would be the slippage of the IA and L5 vertebrae. As I men- period of peak problem following an acute injury, it honed earlier, that was later identified also on an didn't make any sense to rue to pull her out of work MRI scan. a month later. There were treatment records from MRCP with ini- Q. Doctor, in your opinion, was Ms. Castelli able to tial evaluation on April 21, 2004, also indicating continue working from August to December of 2007? complaints of neck and right shoulder, as well as mid and low hack and right hip pain following the A. Yes,she was. accident with persistent symptoms, again, reported during the course of her physical therapy over the Q. In full capacity? next few months. And a multitude of diagnoses offered at that time with a report of one of her treat- A. Yes. ing doctors back then, Dr. Cavoto, in July of '04, providing the opinion that she had sustained multi- Q.Okay. Any other opinions. Doctor? level strain and sprain throughout her entire spine, as well as posttraumatic carpal tunnel syndrome in A. I think those were the bulk of my opinions. But, both hands, as well as an injury to the left ulnar to summarize, sire was coming in with a number of nerve at the elbow, subjective symptoms that I couldn't identity any ob- jective abnormalities to suggest any ongoing neuro- There is an orthopedic report of Dr. Dabney in .tune logical disorder attributable to this'07 accident. of '04 indicating, again, persistent neck and lower hack pain, which was radiating down to the right Again, she had had quite a number or tests and din- knee, as well as pain into the left arm with pins and enose,s by MRI and LMC before the 'accident, tint- needles in both hands. ing back to 2004. Yet, she didn't have any of those tests done after the accident. Q. Doctor, did you review another report of Dr. Jaeger dated October 20,2006? . (1,.') 2013 Thomson Reuters. No Claim to Orig, US Gov. Works. 2010 WI.. 7561601 (Pa.Com.P1.) Page 17 A. Yes, I did. someone tells inc-- Q. And is this a copy of the report, Doctor? Q. Doctor, let me--please just answer my question. A. Yes, it is. Was it helpful for you to have medical records to review in order to form your opinion? Q. And what was significant in that report? MS. CARTER: I'm going to object. A. At that time, Dr. Jaeger said that she had suffered, again, a multitude of injuries dating back VIDEOTAPE OPERATOR: The time is now 12:41. to 2004, but had particular pain and progressive Going off videotape record. tingling in her left arm with her grip strength in the left hand described as profound weakness and a (Discussion off the video record.) number of other abnormalities that he indicated were related to multiple other peripheral nerve MS. CARVER: I think the Doctor was answering problems. your question. Q. And, Doctor, anything in your review of those MR. THOMAS: Well, he was answering another additional records cause you to change or alter your question. My question was: Was it helpful? That previous opinions you already gave the jury? seems to we to be a yes or no question. A. No. On the contrary, they confirmed my under- MS. CARTER: I believe the Doctor can give his standing that she had quite a bit of problems dating answer. Go ahead and ask him again,and he can-- back to the accident in 2004, which continued to be problematic right up till the months just before this MR. THOMAS: Let roe withdraw the question and 2007 accident. state it another way. Q. Doctor, have all the opinions you have given this Go back on the record. jut y. been expressed within a reasonable degree of medical certainty? VIDEOTAPE OPERATOR: The time is now 12:42. Back on videotape record A. Yes,they have. BY MR. THOMAS: MS. CARTER: Doctor, I'm now going to let you go ahead and he cross-examined by the other attorney, Q. Doctor, you have expressed certain opinions here today;is that correct? CROSS-EXAMINATION A. Yes, BY MR. THOMAS: Q. And am I correct that your opinions were based Q. Doctor, you've reviewed quite a few medical re- on a number of things? Number one, it was based cords: con-ect? upon your examination of Ms. Castelli; right? A. Yes, I did, A. Yes. Q. And was that helpful to you in forming your Q. It was based upon the history that she provided opinion? you; is that correct? A. It was helpful in so far as particularly when A. In part,yes. ,.'.(!)2013 Thomson Reuters. No Claim to Orig. US Gov. Works. 2010 WI. 7561601 (Pa.Com.PI.) Page 18 Q. And it was also based in part on the medical re- A. I don't know that I have an independent recollec- cords you reviewed; is that correct'? lion of -- would I recognize her if I saw her now? Probably riot. A. Yes. Q.Okay. Do you remember me being there with her? Q. And am I correct that 1 recall your answer 10 one of Counsel's questions that your review of the re- A. I know when I first came into the room today, I cords of Dr. Jaeger was helpful to you in Riming recognized you. So I — that must have been when I your opinion;correct? met you. A. Yes, It was certainly helpful, particularly the re- Q. The exam was -- I think you had just come back cords of Dr. Jaeger before the 2007 accident us es- from the islands that day;do you remember that? tablishing the severity and multitude of problems she was having just before this accident in 2007. A. I don't remember,but its quite possible. Q. Ms. Castelli hail been involved in a prior colli- Q Okay. I took some notes (luring the exam And I sion, right? just wanted to ask you if this sounded accurate to )ou. A. That's correct MS. CARTER: I'm going to object. Q. And three years later, she was still having some problems;right? VIDEOTAPE OPERATOR: The time is now 12:44. Going off videotape record. A.That's correct. (Discussion off the video record,) Q.Okay. Let me ask you this. MS. CARTER: Unless you're making yourself a You mentioned earlier on your direct examination witness and making yourself available for cross- that -- you used the phrase when referring to some examination, your notes are not going to he admiss- records that preceded the injuries that you were see- ible or should not be used against the Doctor. ing her for. I just want to make sure the jury is not con fused, MR.THOMAS: Okay. You are not one of her treating physicians:correct? MS. CARTER: My objection is noted. A. No, I was not. VIDEOTAPE OPLRATOR: The time is now 12:44. Back on videotape record. Q. And there was no doctor/patient relationship between the two of you? BY MR. THOMAS: A. That's correct. Q. Du you remember what time your examination or Ms. Castelli was scheduled to begin? Q. You were examining Ms. Castelli at the request of Defense Counsel;right? A. No, I do not. A.That's correct. Q. If I told you 3:30, would that refresh your memory at all? Q. Okay. Do you remember Ms.Castelli? '0 20 13 Thomson Reuters. No Claim to Orig. US Gov. Works. 2010 WL 7561601 (Pa.Com.P1,1 Pace 19 A. No. Honestly, what time it started or ended Q.And what is Prizm Medical Resources? would really,' have no relevance to the case an than any patient I see in my office, I don't make a A. It's a company for which I do some part-Lime note of what time it starts or stops. I know that my work performing independent medical examina- role is to take a history, to provide a physical exam- lions,as 1 did in this case. ination and review records, and put it all together to arrive at conclusions. So the timing, frankly, is ir- Q. Performing you said what? relevant to me. A. Independent medical examinations, Q. Well, let me ask you this. Q. What do you mean by that? Would it be fair to say that your examination of Ms. Castelli took approximately ten minutes? The cx- A. It refers to an examination by someone who is amination itself,not the history. independent from the treating physicians. As I'm sure you know, someone who is involved in an ac- A. I don't honestly know. I know I performed a cident and brings legal action has their own doctors complete neurological examination. If I have a that have treated them and provide reports. And my young, healthy person who is able to do everything role, as I understand it, that I have been asked to do that I ask without any difficulty, and after having is to review the case, to review the treatment re- been examining people for 20 years, I guess it's cords both before and after the accident, to inter- possible that an examination could be concluded in view and examine the person, and come up with my ten minutes, but 1 don't, again, have any independ- own opinions or conclusions as to what, if any, cat recollection as to how long it took, neurological injury might have resulted from the accident. So that's what I did here. Q. Okay. Let me ask you if you'd agree with this. Q. And just so the jury is not confused, by jade- It's my understanding that it's your opinion that Ms. pendent medical examination, you haven't been ap- Castelli had some medical problems prior to the Jo- pointed by the Court to examine Ms. Castelli as an ly 26,2007 collision; is that right? independent witness:correct? A. 'That's correct. A. -That's correct. I have not been, Q. Would you agree with me that someone with Q. And Counsel and I didn't get together and jointly those -- that it's not a good thing for someone for decide that we'd have you took at her independently those -- with those medical conditions to he in- and offer an opinion;right? volved in a collision?It's not a good thing; right? A. I don't honestly know if you got together and A. Well, I don't know that it's ever a good Ming to made that,decision or not. be involved in a collision. Q. Well,you cot hired by the Defendant;didn't you? Q. All right. Let's talk a little bit about where we arc today A. Nat's correct, What is the name -- this is not your office We arc Q. Okay. This is -- you offered testimony about not in your office today; right'? your practice. And in those circumstances, there is a doctor/patient relationship: right? A. No. That's correct. This is the office of Priem Medical Resources. 2013 Ihonison Reuters. No Claim to Orig. (IS(iov, Works. 2010 Wt. 7561601 (Pa.Com.PI.) Page 20 A. That's correct. Q. And on previous occasions when you've offered deposition testimony and trial deposition testimony, Q. Okay. And this is something different, however. you understood that you were under oath; right? This work that you're doing here today isn't related to your practice. The money that you get from this A. Yes, of course. doesn't go to your practice. It goes to you: right? Q. A. That's correct. • - Q.Okay. How much are you getting paid today? '. ,ffiliviramumniti a month A. For my time away from the office for prepara- I'm talking aeon le exams at al a Lion and giving the deposition today, the fee is $2,000. Does that sound about right? Q. Okay. And am I correct that you also get paid MS, CARTER:Objection. about $400 for examining Ms. Castelli and prepar- ing a report? VIDEOTAPE OPERATOR: The time is now 12:51. Going off videotape record. A That's about right. I think it's actually $500 now. (Discussion off the video record.) Q. Oh, it's gone up. MS. CARTER: I believe your prior question was You've been working for Prizm for like 12 years how many exams you did for Prizm in a year. 1 now;right? don't know what the depositions say in terms of whether the question was just to Prizm or if he does A. I don't remember exactly, but that sounds about sonic related to his own practice, right, MR.THOMAS:Okay. Q. Well -- okay. And how many exam -- when you do an exam and a report, you have a single fee for VIDEOTAPE OPERATOR: The time is now is that; right? Its not a separate fee for the exam and a 12:51,Going back on videotape record. separate fee for the report? BY MR.THOMAS: A. That's correct. Its all inclusive. Q. Do you do this work for somebody other than Q. Flow many exams do you do for Priem in a year, Prizm,too? if you could estimate for me? A. Yes, I do. A. In a year? I'm going to -- it will be more of a guess than an estimate, but maybe, I want to say. 40 Q.And who do you do that for? or 50 in a year. A. Well, I do them for another Ii mu in ktwo culled Q. Well, I have the benefit or 'momo some depos- Perspective Consulting. And 1 also do some inde- itions that you've given before. And 1 think -- you pendent medical examinations within iny own prac- understand that you're under oath here;right? tice. A.01course. 2013 Thomson Reuters. No Claim to Orig. US Gov. Works. ■■■ 2010 WI 7561601 (I'a.Com.1)1.) Pas.te 21 iniummilifll011.1106611111111111111111111111.11111.11.11.11 A.Ihatsuundc about right. Q.And you've been doing that for 10 to 12 years? spurn* t, A.That's correct. Q.Thank you, Doctor. I appreciate that. Q. So, and if I remember correctly from one of your earlier resumes,you were born in 1957; right? And, again, talking about whomever you hire your- self out to do this, whether it's Prizm or somebody A. You have a good memory. That's correct. else, about ININIMMINIMMUMMIIIIMINI WW1 Q. So you're going to he working for some time still;right,maybe another 10, 15 years? A. 1010.1111111111111111111110.1.1111/111011.1.ft A. I hope so, yes. 1 enjoy what I do. I have no plans to retire any time soon. Q. And so just doing the math, if you're doing 20 Q. Right. And this is a nice supplement to your in- depositions like today a year at 52,000 each, that's come; correct, this business you have serving as a about 540,000 a year for that; right? Does that witness and examining people for defendants; COT- sound right'? rect? A. The math sounds right, yes. MS.CARTF.R:Objection. Q. And then say -- what did we decide on, Doctor, VIDEOTAPE OPERATOR: The time is now 12:54, for how many exams and reports you do? Going off videotape record. A. I said 10 or 12 per month. (Discussion off the video record.) Q. Okay. Well, let's say, 10 because 1 went to public MS. CARTER: At no time was he asked or was it school,and the math %vitt be easier for me, established that it was for defendants. A. Okay. MR.THOMAS: You can go hack on the record. Q. So that's like 120 a year. And what should we VIDEOTAPE OPERATOR: The time is now 12:54. figure for the cos) of those five, or is it more accur- Back on videotape record, ate to say four? BY MR.THOMAS. A. I think we could say 500. Q. Okay. .0111=0, A. I don't want you to underestimate after all. Q. So that's another 600( - • , Q. Okay. And am I also correct that when you're ©2013 Thomson Reuters.No Claim to Orig. US Gov. Works. 2010 Wt. 7561601 (Pa.Com.P1.) Pane not doing them for the defendants, that its reports also get money for what's going on here today? and videotape depositions that you're preparing for your own patients? That's What makes up the other A. I would imagine they do. They have to pay the 5 or 10 percent? rent. hut I'm not familiar with their particular fin- ances. A. Well, when I'm not doing this, the vast majority of what I do is, in fact,taking care of patients. Q. Right. But what I'm saying is, there's a fee charged, you get part of it, and Prim gets part of it; Q. Right. right? A. This business, as you call it, is a very small A. I believe so,yes. minority of what I do. 95 percent of what I do on a daily basis is take care of patients, see patients in Q. Okay. And, to that extent, you have a relation- the office, take care of acutely, neurologically ill ship. One person is payine. Two people are taking patients in the hospital.That's mostly what I do. the money; right? Q. Okay. -• A. Okay. lf you want to use that terminology-- Q. Yeah. =1111111111.111111111111.111.11111111111' = -- I suppose that's fair to say. Q. Well, that's the terminology I want to use. ailliiiiiM1111111111111.11111.1111111.1110 And you would like to keep that going;right? A. Yes, I would. Q. Let me ask you this. A. ONIMPOIN.Miniiiiiiiii.....1111) 111111...1 In making this determination about the nature and extent of the injuries sustained by Ms. Castelli in Q. And you'd like to keep that relationship going the collision of July 26, '07, or in determining with these people that hire you for defendants; right? whether she sustained any injuries at all in that; okay, wouldn't it have been helpful for you to have A. I'm not certain what you're referring to by a rein- seen her prior to the collision to be able to see her ['Unship. I don't have a relationship with people and see what her condition was'? Would that have who hire me. I am a good neurologist,just like 1 am been of help to you? in my own practice. And I got referrals because people recognize that I do a good job and so they A. I would say not, no. Because I was -- had the ad- refer cases in, whether it's in toy awn office to see vantage of having all the medical records of her patients for the purposes of treatment or in this treatment both before and after, which gives me a case, but I don't have any relationship the term very good picture of her condition before and after. you use. Mere are many patients in my own practice who Q Well, with regard to Prizm, at least. don't they chart, in Inct, have the benefit of the medical re- cords for before and after. Most patients or many patients in my practice. I see them for one visit. 1 ©2013 Thomson Reuters. No Claim to Orig. US Gov. Works, 2010 WL 75616011Pa.Com.P1.) Page 23 may or may not have any records. 1 take a history A.'that's correct. Ifs not in my report-- arid examine them. On the basis of that one visit. I formulate an opinion or a conclusion as to what's MR. THOMAS: Objection. going on with them neurologically. THE WITNESS: -- I did look at that-- So, in fact, in this case. I was at a great advantage, in fact, having a lot of medical records concerning MR.TIIOMAS: I'm going to object. her multiple symptoms and problems before and then the limited treatment she had after the acci-dent. VIDEOTAPE OPERATOR: The time is now I o'clock. Going off videotape record. Q Well, let me ask you the question in another way then. (Discussion off the video record.) Would it have been a bad thing if you had, in addi- MR.THOMAS: Nonresponsive. tion to examining her two-and-a-half years after the collision, have examined her a month before the MS. CARTER: Your objection is noted, but he collision? Would that have been a bad thing? hasn't answered to anything that's nonresponsive yet. So go back on, and he can finish his response. A. I don't know that it would have been a bad thing. And you have a nonresponsive and motion to strike Would it have been necessary or helpful? No. She it. had a normal neurological examination when I saw her. MR. THOMAS: Okay. Is it possible she may have had an abnormal exam- VIDEOTAPE OPERATOR: The time is now I ination when she was complaining about all those o'clock. Back on videotape record. problems front 2004? I mean. would it have made a difference? I don't quite know how it would have THE WITNESS: I did -- as you asked me, did I made a difference. She had a normal examination look at that report, yes, I did look at the report this when I saw her. morning. And, in fact, the complaints that Dr. Jae- ger recorded in that note are quite similar to corn- Q. I think you mentioned that when you saw Ms. plaints that he had recorded back in 2006 or 2007, Castelli, she told you that she had seen Dr. Jaeger before this accident. So it was helpful because it several weeks before she had seen you;correct? looked like it could have just as well been a report that he authored before this accident. A. Yes. VIDEOTAPE OPERATOR: The time is now 1 Q. Okay. Did you ever see a report from Dr. Jaeger o'clock, Going off videotape record. having to do with that examilination? (Discussion off the video record.) A. I just had no opportunity to look at it this morn- ing. MR. THOMAS: I'll just renew that objection and move to strike as nonresponsive. Q. Ant I correct that your opinions as set forth in your report do not profess to rely upon what was And, also, my question was whether it was in his stated by or found by Dr. Jaeger at the time of that report, and his answer was no. Also, move to strike examination? That's not in your report;correct? on the basis to the extent it constituted an opinion that was riot Set forth in his report. MS. CARTER: I understand your objection. 2013 Thomson Reuters. No Claim to Orig. US Gov. Works. 2010 WI,7561601 (Pa.C.orn.P1.) Page 24 VIDEOTAPE OPERATOR: The time is now I:01. to you by the other attorney, Ms. Castelli's attorney, Back on videotape record, that caused you to alter your opinions in any man- ner that you've already given this jury? MR. IHOMAS; Doctor, I have no further questions for you.Thank you. A.No, I do not. THE WITNESS: You're welcome. Q. In fact, do you recall any questions asked by op- posini4 Counsel that even took on your opinions at REDIRECT EXAMINATION BY MS.CARTER: A. Not particularly, no. Q. Doctor, very few follow-up. MS. CARTER: Doctor, I have no further questions for you. Thank you. Did the fact that you were paid for your time in do- ing an examination and paid for your time doing MR. THOMAS: No further questions. Thank you, this Videotape Deposition cause you to write false Doctor. opinions in your reports? THE WITNESS: Thank you. A. No, of course not. The beauty of this type of work is that I get paid the same amount whether my V IDEOTA PE OPERM OR: The time is now I:03, opinions arc helpful or harmful. And there have and that concludes this Videotape Deposition. been many occasions where I have been hired by an attorney to evaluate someone who has been injured (Exhibits Ilarris-I, liarris-2, I larris-3, Defense-4, in an accident that, in tact, l have provided the Defense-5, Defense-6, Defense-7, Defense-8, De- opinion that, yes, they were injured. And whether fense-9, Defense-10. Defense-I I, Defense-12, and its helpful to them or not really doesn't make any Defense-I3 were marked for identification at this difference to me because I have integrity, and I time.) have to give an opinion that I believe in and can live with. (Whereupon, the Witness was excused, and the Videotape Deposition was concluded at 1;03 p.m.) Q. Are you willing to put your entire reputation on the line for me or 2500 bucks? END OF DOCUMENT A No, of course not. I'm Chief of the Neurology Division at what I consider to be a respectable com- munity hospital. And most of what I do is taking care of patients. And this is a nice supplement to my salary and is something I do on a limited basis. But, you know, what 1 do is what I do every day. I see patients; I review a case: and I provide an opin- ion. And it's nice that I get paid for it, but that in no way would sway my opinion. Q. Doctor, let's get back to the important part in this case. First of all, do you recall any questions being asked CO 2013 Thomson Reuters, No Claim to Orig. US Gov. Works„ EXHIBIT "C" West I aw 2012 WI, 8 I 23625 (F.D.Pa.) Paoe 1 For Opinion See 2012 WL 5987551 2012 WE, 45 year old man who reports he was working as a 5987552, 20 I 1 WL 1085621 ,2011 WL 995855 CNA when a bed came down and trapped his left leg between the ankle and knee for between fifteen United States District('ourt. F.D. Pennsylvania. and thirty minutes. It was painful at the time and he Charles 1-1. THOMPSON, developed pins and needles in the left leg and Riot v. as if it was asleep. When he was finally extricated MED-MIZLR, INC.,et al, from the bed, he was taken to the emergency de- No. 5:10C V02058 parlment, where x-rays revealed no fracture and he June 25,2012. was Oven an immobilizer for the leg and sent for an MRI which he was told showed nerve damage. (Report or Affidavit of Lee J. Harris, NH)) He treated with the work doctors and had physical therapy for about a year. Case Type: N/A >.>N/A Jurisdiction: E.D.Pa. Mr. Thompson reports he had a foot drop which Name of Expert: Lee J. Harris. M.D. would cause him to trip when the foot did not raise Area of Expertise: Health Care-Physicians & properly while walking. He was given a MAFO Health Professionals >Neurologist brace which he no longer wears because the toot Representing: Unknown drop improved within nine-eighteen months. He initially required a walker to assist ambulation, Paul C. Troy gradually improving to the point of walking with a cane which he still uses if he is going to walk any Kane, Pugh, Knoell, Troy & Kramer, LLP Attor- distance. He states that he still has residual numb- neys-at-Law ness in the outer aspect of the left leg as well as in- termittent aching pain. 510 Swede Street Present Symptoms. Mr. Thompson reports if he sits Norristown. PA 19401 for more than fifteen to twenty-five minutes, he will develop an aching and stiffness in his lower leg Date of Incident: 6/15/08 causing him to have to change position or get up. II he is not able to get up such as driving some dis- Deur Mr. Troy: Lance and he is seated for more than about forty minutes, the pain becomes unbearable and he will I had the opportunity to see Charles Thompson for have to stop the car and get out to adjust position, an independent medical examination on June 25, He reports a constant numbness involving the later- 2012. The report includes interview and examina- al aspect of his lett calf below the knee, with inter- lion of Mr. Thompson us well as review of medical mittent pins and needles once or twice is month in records secured by your office. Also included with the leg in the lateral and anterior leg down to about the packet of records were two CD's containing the ankle, not into the foot or toes. He reports his films which are not neurologically relevant to the leg feels fatigued if he is required to walk any dis- ease. Mr. Thompson was accompanied to the exam- lance which is when he will take the cane with him, ination by his attorney, John Frock, who brought while other times if he is walking a short distance, w ith him al recent orthopedic report, he may not need it. History of Present Illness: Charles Thompson is a Mr. Thompson reports that prior to the work injury, 2013 Thomson Reuters. No Claim to Orig.US Gov. Works, 2012 WI.. 8123625 (L.D.Pa.t Page 2 he already had problems with walking and balance Pre-accident primary care notes, dating hack to related to a childhood illness, but he was able to 2002, include a review of systems indicating a his- walk independently without assistance of a cane. toty of low back problems at that time. and able to work full time as a CNA lifting and car- tying which he has not been able to do since the A subsequent note on September 24, 2002 indicates work injury in 2008. complaint of back pain from an old injury thirteen years ago, with periodic flare-ups of back pain for Air. 'Thompson is no longer treating with anyone s,-hich he was prescribed Flexeril and Tylenol No 3. specifically regarding the left ley and lust fall vs up with his ,family physician filr general medical There is another note in 2002 (the exact date is cut care. lk is not on any prescription medication re- off on the copy) indicating he was rear-ended by a garding the leg and states he has nut returned to large trailer with complaint of mid-back pain in- work in any capacity and is receiving Social Recur- volving the thoracic and upper lumbar region. ito Disability, On June 15, 2003, he complained of progressive Past Medical History is notable for roseola as a balance problems with gradually diminished lane- young child which left him with speech impairment don of the lower extremities causing difficulty with and balance problems such that he was unable to going down steps to do laundry and muscle weak- walk a straight line before the work injury. ness of the legs for which an MR1 was recommen- However, he was able to walk independently ded because of his progressive symptoms. There is without a cane, including ability to lift and carry also an indication of tendonitis in the right foot which lie cannot do since then because he loses his with some flattening of the arch. balance and requires the cane for support. His med- ical history is otherwise notable only for high cho- There are subsequent notes indicating increasing lesterol and esophageal reflux. When I inquired balance issues affecting ability to perform his job as about any previous work injuries, he replied he a CNA, with MRI referenced as showing cerebellar might occasionally have a back strain that would atrophy. cause him to miss work for a day or so but no pro- longed or serious injury, and he has never been in- In December, 2003, notes reference a slip and fall *imed in a car accident. on the ice with complaint of back pain. Social History reveals Mr. Thompson was cm- Neurology report of Dr. Roderick Hines, dated ployed as a CNA at the time of the work injury. April 20, 2004, indicates unsteady gait as well as having done so between 1985 and 2008, and he has speech impairment, with a seizure in childhood at- not returned to work in any capacity since the work trihuted to a severe reaction to the measles vaccine, injury in 2008. He says they wanted to send him with associated cognitive dysfunction as well. He back to work at the nursing home in a sit-down job reported progressive difficulties with his balance but there was no sit-down work available, lie lives over the past several years. in a townhouse with a roommate. lie is able to drive, There is a subsequent fall on the ice in December, Medical Records Review: Plaintiff's Second 2008 with complaint of pain for which Advil was Amended Complaint alleges that while attempting not helping. to connect an electrical bed, the frame unexpectedly lowered and trapped his left kg, causing nerve in- 'there is a letter from primary physician, Dr. Traci jury to the left common peroneal and tibial nerves. Kohl, dated September 26, 2009. indicating diffi- culty working as a CNA because of balance difti- ©2013 Thomson Reuters. No Claim to Orig. US Gov. Works 2012 WI_8123025(E.D.Pa.) Page 3 culties attributed to left common peroneal and tibial On July 11, 2008, worknel notes numbness and nerve injuries, with speech impediment also making tingling are slightly less but he had the same degree it difficult fOr him to work at a profession requiring of foot drop and was still using a walker and wear- communication with the public. ing a MAFO brace on the left foot. Incident report, dated June 15, 2008. indicates Mr. On August 5. 2008, there were continued symptoms Thompson was working on a bed vitli the remote and he was still going to PT. control, when his leg got pinched in the bed mech- anism,for which he was extricated mid transported On August 27, 2008, he reported the pins and ,ffilbuiance to the hospital, needles have diminished significantly, although there was still sonic numbness with slight improve- There is a notice of compensation payable referen- went in the foot drop. cing left common peroneal nerve injury. On September 25, 2008, he again reported signilic- Lancaster General Emergency Department report, ant lessening of the pins and needle sensation al- dated June [5, 2008, indicates his leg got stuck an- though there was persistent loot drop for which he derneath the nursing home bed, with his leg pinned wore a brace and was still using the walker, with for about twenty-live to thirty minutes, There was pre-existing gait disorder compounded by the indentation just above the left patella, and he repor- peroneal nerve injury. ted paresthesias of the foot and difficulty extending the foot and big toe likely secondary to peroneal On November 7, 2008, he reported episodes of nerve compression. X-rays of the left knee, tibia numbness and tingling becoming less frequent and and fibula revealed no traumatic injury. the physical therapist also noted some improvement in motor function, and he was still ambulating with MRI of the left knee, dated June 17, 2008, was re- the walker and wearing the MAFO brace, still too ported to show minimal edema of the left common unsteady to advance to a cane. peroneal nerve superior to the fibular head related to focal neuritis or injury. On December 1, 2008, numbness in the leg was slowly decreasing and he had increased ability to Worknet occupational medicine note, dated June move the foot, still using the MAFO brace and 10, 2008, indicates a little pain in the left knee and walker lower leg, although he was most concerned about weakness and dropping of the left foot with numb- On January 5, 2009, he was now ambulating with a ness and tingling. He was unable to dorsitlex the cane instead of a walker and found physical therapy left foot and had very little movement of the toes, helpful, with no numbness or tingling at this point, with limited inversion and eversion and decreased although there was still some weakness and foot sensation throughout the left foot. Ile was referred drop which he did not think had improved since the for MRI of the left knee with results noted above last visit a month ago. and subsequently referred for physical therapy at NovaCare. On February 5, 2009, he continued to note progress, ambulating with a cane except with snowy weather, Follow-up Worknet note on June 27, 2008 indicates when he would use the walker. There was no numb- he is in physical therapy wearing a MAFO brace ness or tingling of the leg although he still had and a walker, not really having pain but mostly weakness of the foot and ankle, complaining of numbness and tingling with persist- ent foot drop The next visit on March 9, 2009 indicates he is still having some numbness along the lateral left call CO 2013 Thomson Reuters, No Claim to Orig. US Gov. Works. ....,...........,. _. __. 2012 WI_8123625(E.D.Pa,) Page 4 with no tingling, burning or pain, and he was still ion and toe extension which had been 0/5 at the in - working with physical therapy on gait stability and tin] evaluation of June 25. 2008 were now 4-115 at was quite unsteady without the cane, using a walker discharge, with similar mild weakness of ankle in- for longer distances and wet surfaces, still going to version and plantar Flexion, P h twice a week. There are additional physical therapy notes between On April 20, 2009, he continued to wear the MAFO April and JUlle, 2009 at a different facility indicat- brace because of foot drop, but did not have any ing he has made no progress, with continued poor pain,numbness or tingling. balance and limited gait not expected to he able to return to his previous job duties. Most updated Worknet note, dated June 30, 2009, indicates that physical therapy has resulted in no Functional capacity evaluation, dated September 4, further improvement in the past two months, and it 2009, concludes he performed at the sedentary was telt he had reached maximum medical im- physical demand level and did not exhibit the abil- provement and still had an area of numbness in the ity to balance independently, with all standing and leg with significant difficulty with dorsiflexion as walking performed with a single point cane such well as some weakness of eversion. although that all functional testing was performed in a seated plantar flexion and inversion were intact, and it was position, felt he would have permanent work restrictions in- volving sit-down work with ability to stand and Primary care follow-up note, dated January 7, 2010. walk for ten to fifteen minutes twice an hour and indicates soreness in the left great toe on a couple would still need the MAFO brace as well as his of occasions, and it was questioned whether he still cane, as well as a walker if he had to walk longer needs the brace because he no longer has a foot distances. drop which was resolved. There is subsequently no mention of foot drop or leg complaints on April 8, EMG and nerve conduction studies, dated July 9, 2010 or August 20, 2010, at which time he was go- 2008, were reported to show both left common ing to the gym exercising six days a week and not . peroneal and tibial neuropathy, with prominent fib- needing the cane for short distances but still using it rillations and positive sharp waves involving the for long distances when legs get tired, and he still left anterior tibialis, peroneus longus and solcus could not lift heavy objects without losing his hal- muscles(supplied by the above two nerves). ance. There is a subsequent repeat [MG, nerve conduc- There are some documents concerning Social Se- tion study, completed on November 19, 2008. curity Disability application and evaluations which which no longer shows denervation changes in the discuss not only the left leg weakness but also soleus muscle, although there were still 2 fibrilla. speech and cognitive impairments (dating back to tions and positive sharp waves in the tibialis anteri- his childhood), with clinical disability evaluation, or and peroneus longus muscles consistent with lett dated January 5, 2010, indicating he had always common peroneal neuropathy, with interval 1111- been unsteady but never required a cane to assist provement in the tibial neuropathy. ambulation until the peroneal nerve injury in 201)8. lle had learning disability and had gone to school There are multiple treatment notes from NovaCare through tenth grade with difficulty and was judged between June 25, 2008 and April 22, 2009, with to have borderline intellectual functioning- discharge summary at that time demonstrating sig- nificant improvement in left hint/ankle muscles al- Orthopedic report of Dr. John Renner, dated May though not completely normal. The ankle dorsiflex- 24, 2012, indicates persistent left leg weakness ©"4113 Thomson Reuters. No Claim to Orig. LIS Gov Works. 2012 WI.8123625(E.D.Pa,) Page 5 causing difficulty with ambulation and balance, tired with a measuring tape in the calves found to only able to stand for fifteen to twenty minutes be- be bilaterally symmetrical, fore his leg fatigues, associated with aching pain in the leg with prolonged sitting, lie was described as Tendon reflexes were I- and symmetrical in both having weakness of left toot eversion with good upper limbs, 2 at both knees and I ! at both ankles dorsiflexion, inversion and plantar flexion. It was with HO Babinski sign. felt his residual peroneal nerve injury with muscle weakness caused him to have difficulty with ambit- sensory examination revealed subjective decreased lotion and balance, such that he was not able to re- pinprick involving the left lateral calf down into the um' to his previous employment and ■vould only he small toe of the left foot, with normal sensation in qualified for a sedentary job with intermittent the anterior and medial calf and medial toes. standing but no prolonged walking. Cerebellar examination revealed prominent dys- Also reviewed is deposition transcript of the metria on heel-to-shin testing bilaterally. claimant taken on February 15, 2012, at which time he described the work injury and subsequent symp- He ambulated with a broad-based ataxic gait and toms, with present report of intermittent tingling a assistance of a cane. He was able to take one to two couple of times a week if he has been sitting for steps bearing his weight OH both heels and toes hi- awhile, at which point it would be harder to walk laterally but with considerable loss of balance and when he first gets up, although the symptoms nearly fell doing so and had to be supported in or- would dissipate after he got up and moved around. der to accomplish this. He reported some achiness in the leg, rated 4-5/10 severity as compared to an 8/10 in the months fol- Impression: Charles Thompson is presently evalu- lowing the incident, and he was not taking any pre- ated four years following a work injury consisting scriptiou medications and had not seen any physi- of compression neuropathy of the left common clans regarding the leg in the past few year s. peroneal and initially tibial nerves, with [MCI doc- umenting axon loss involving the call muscles sup- Evamination irevealed Mr. Thompson to be a well- plied by these two nerves, with the subsequent developed, well-nourished, generally healthy ap- LNG four to five months later demonstrating near pearing roan in no acute distress. He was alert and resolution of the tibial nerve injury but with persist- attentive with mild to moderate dysarthria, normal cot axonal injury involving the common peroneal language and memory. nerve, He initially had severe foot drop with 0/5 strength in peroneal innervated muscles which sub- Cranial nerves II through XII were notable for hi- sequently improved to only very mild weakness at lateral esophoria (lazy eyes), although ocular motil- the time he was discharged from physical therapy. it was intact with bilateral horizontal nystagmus This improvement in muscle strength correlated which he states has been residual of his childhood with resolution of his fbot drop such that he was roseola. Remaining cranial nerves were intact, able to discontinue using the MAFO brace, Motor examination revealed normal muscle power As a result of the above peroneal nerve injury su- in both upper and right lower extremities. In the left perimposed on his baseline imbalance dating back lower extremity, ihere was effort related weakness to a childhood neurological illness, Mr. Thompson involving all muscle groups both above and below has had persistent imbalance requiring a cane ever the knee, although with encouragement, muscle since the work injury in June, 2008 which preven- power was significantly better. There was no meas- ted him from returning to work as a CNA and con- urable atrophy of lower extremity muscles meas. finites to prevent him from returning to his previous 6-::,2013 Thomson Reuters. No(Um to Orig. US Gov. Works. 2012 WI.8123625(E.D.Pa.) Page 6 employment. CNA up until the work injury in Jane, 2008, and he has not been able to return to work in that position I agree with Dr. Benner he would he qualified to since then, primarily because of persistent problems function in a sedentary capacity, and his established with balance that have never returned to baseline disability is connected only in pail to the work in- prior to the work injury. Compared to the paralysis jury and, in addition, to pre-existing neurological of peroneal muscles initially, he has enjoyed a sig- injury dating back to childhood, with cognitive and niticant albeit incomplete recovery from the work speech impairment as well as the pre-existing bal- injury which has prevented him from returning to once disorder, the pre-injuly employment as a CNA but would not interfere with return to a sedentary employment Ca- Today's neurologic examination revealed subjective pacity, with • sensory change in partial distribution of the left common peroneal nerve, with decreased pin sensa- tion involving the lateral calf into the lateral left All of the above opinions are expressed to a reason- tbot. 11=11111111.1111.1miditimmili..... able degree of medical certainty. improTtni1911/trage to the peroneal nerve distribution, with effort re lated weakness in virtually all muscles of the left END OF DOCUMENI leg both above and below the knee. In fact, with support for balance, he was able to bear his body weight walking on heels and toes of both legs demonstrating excellent muscle power. At the time of the work injury, his left lower CN- tremny neuropathy became superimposed on his baseline balance disturbance which has sub- sequently improved from using a walker to now a cane if he has to walk a distance. 11.110000.1 wI , • . I - 1111141111111110111/ The history and records document that Mr. Thompson was capable of working lull time as a k 2013 Thomson Reuters.No Claim to Orig. LlS Gov, Works. VVestlaw 2010 WI,7539414 (Pa,Com.P1,) Paee 1 Court olCommon Pleas of Pennsylvania. could continue to work up to 4 days a week. Philadelphia County Mark PESCE,et al. I reviewed vocational/disability report prepared by v, .lasen Walker dated 5/24/10 who noted findings Michael A. BUCHAKJ1AN, D.C. during the course of his examination 1111111111.1 No.0809004360. May 27,2010, uihermorc, he quo c meuical records rot , Pesce's treating neurologists who placed no restric- Your File 0: 15019-00104 dons on his activities including employment. (Report or Affidavit of Lcc J. Harris, M.D.) l agree with the conclusions of Jasen Walker that Mr. Pesce's decision to limit his employment to 4 Case Type: Medical Malpractice-Facility Clin- days per week as well as the decision to enter into ie/Center/Group early retirement is voluntary on his part and not a Case Type: Medical Malpractice-Procedures & result of restrictions or limitations imposed by his Treatment>> Failure to Diatinoserf real condition or his physicians. Case Type: Medical Malpractice-Procedures & Treatment>> Informed Consent All of the above opinions are expressed to a reason- Case Type: Medical Malpractice-Physicians & able degree of medical certainty, Ilealth Professionals>>Chiropractor Jurisdiction: Philadelphia County, Pennsylvania Name of Expert: Lee J. Harris. M.D. END OF DOCUMENT Area of Expertise: Health Care-Physicians & I'lealth Professionals:>>Neurologist Representing: Defendant Kimberly A. McCarthy Marshall, Dennehey,Warner,Coleman&Coggin 620 Freedom Business Center,Ste 300 King of Prussia, PA 19406 Dear Ms. McCarthy: 1 had the opportunity to review additional reports concerning Mark Pesce, and would like to send you this addendum to my previous reports. Reports from Mr. Pesce's primary physician Dr. Philip Liaw on 5/1/08 indicates his condition was improving and he could increase his work load to 4 days a week as tolerated, with a subsequent note of 7/27/08 again indicating he has been improving and .'-':12013 'Thomson Reuters, No Claim to Orig. US Gov. Works, _ s s_.a.,x,vw ,fp4.. uy r...,. ,.....e.—z e:w,«- ---.s.•r.,...,,.:. x h+saFewa'Hrr Westlaw 2010 WL 7539415(Pa.Cont.Pl.) Page 1 Court of Common Pleas of Pennsylvania. 2, Dr.Guy Rordorf Philadelphia County Mark PESCE,et al, 3.Chiropractic report of Dr.Jay Cohen v, Michael A.BUCHAKJIAN, D.C. 4. Dr. Philip Liaw No.0809004360. May 19,21)10. 5. Vocational report of Dr.Mark Lukas Your File#: 15019-00104 Review of the above plaintiffs expert reports does not alter the opinions expressed in my April 13, (Report or Affidavit of Lee J. Harris, M.D.) 2010 report. Case Type: Medical Malpractice-Facility >> Chin- In view of the radiological findings of markedly at- ic/Center/Group tenuated left vertebral artery without visualized dis- Case Type: Medical Malpractice-Procedures &, section, as well as the evidence of prior left cere- Treatment>>Failure to Diagnose/Treat bellar infarction also in the distribution of the left Case Type: Medical Malpractice-Procedures & vertebral artery, Treatment>> Informed Consent Case Type: Medical Malpractice-Physicians & Health Professionals>>Ch iropractor Jurisdiction: Philadelphia County,Pennsylvania Name of Expert: Lee J. Harris,M.D. Area of Expertise: Health Care-Physicians & I lealth Professionals>>Neurologist Al] of the above opinions are expressed to a reason- Representiug: Defendant able degree of medical certainty. Kimberly A. McCarthy END OF DOCUMENT Marshall,Dennehey, Warner,Coleman&Goggin 620 Freedom Business Center,Ste 300 King of Prussia, PA 19406 Dear Ms. McCarthy: I had the opportunity to review plaintiffs expert re- ports concerning Mark Pesce, and 1 would like to send you this addendum to my report of independ- ent medical examination,dated April 13,2010. The following expert reports were reviewed: I. Dr. Lewis Rothman 2013 Thomson Reuters. No Claim to Orig. US Gov. Works. West law 2010 WI 7539416 (Pa.Com,Pl.) Page 1 Court o I Common Pleas of Pennsylvania. 2007 and any possible relationship to previous Philadelphia County chiropractic manipulation. Mr. Pesce was accom- Mark PESCE,et al, panied to the examination by his attorney, Stephen v. Pokiniewski. Michael A. BUCI IAKJIAN, D.C. No.08091)04300. Historj' Preseni Illness: Mr. Pesce is a 59 year April 13.2010. old man who reports he was treating intermittently with a chiropractor for about a year for complaints Your File 4: 15019-0(1104 of low back pain prior to a stroke in February, 2(107, He states he never complained of neck pain (Report or Affidavit of Lee J. Harris, M.D.) but the chiropractor habitually would manipulate his neck as well as his back in order to align him Case Type: Medical Malpractice-Facility properly, according to the patient's report, He vis- ic/Center/Group ited the chiropractor on February 24, 2007, at Case Type: Medical Malpractice-Procedures & which time he underwent both low back and cer- Treatment>> Failure to Diagnose/treat viral adjustment and heard a loud crack in his neck Case Type: Medical Malpractice-Procedures & but felt okay at that point around 12:00 noon. Treatment>>Informed Consent Case Type: Medical Malpractice-Physicians & When preparing to go to bed that night around mid- Health Professionals>>Chiropractor night, he developed a sudden massive headache Jurisdiction: Philadelphia County, Pennsylvania over the left eye and felt unsteady when standing Name of Expert: lee J. Harris, M.D. up. The symptoms persisted and he went to the Area of Expertise: Health Care-Physicians & emergency room where his blood pressure was very Health Professionals>:> Neurologist high and he was admitted to intensive care. In addi- Representing: Defendant lion to the headache and unsteadiness, he developed spinning dizziness, double vision, numbness in the Kimberly A. McCarthy left face and right side of the body as well as severe hiccups. He also had speech and swallowing difii- Marshall, Dennehey, Warner,Coleman&Goggin culty. 620 Freedom Business Center,Ste 300 He spent about a week in the hospital and then an- other three weeks at Moss Rehab before returning King of Prussia. PA 194(16 home. lie initially used a walker, then graduated to a cane and eventually was able to ambulate inde- Dear Ms. McCarthy: pendently without assistance. He completed a course of outpatient physical therapy at Moss which I had the opportunity to see Mark Pesce for an inde- has since finished. Fle was initially on a thick liquid pendent medical examination on March 4, 2010. diet but his swallowing subsequently improved and 'the report includes interview and examination of he now enjoys a regular diet although he has to be Mr. Mee as well as review of medical records and careful and he often feels there is something in his radiographs secured by your office. In examining throat. His speech has also improved, although Mr Pesce and reviewing the medical records, I ENT follow-up has demonstrated a persistent para- have been asked to provide an opinion concerning a lysis of the left vocal fold. brain stem stroke Mr. Pesce suffered in February. rs25 2 0 13 Thomson Reuters.No Claim to Orig. HS Gov. Works 2010 WL 7539416(Pa.Com.Pl.) Page 2 At the time of his stroke, Mr. Pesce was on Con- pins and needles on the entire right side of his body madin started in the hospital and continued tar sev- from the shoulder down the arm as well as the right eral months. When I inquired about a patent lora- trunk into the entire right leg. This is perceived as a men ovale, he indicated he saw a cardiologist at discomfort which is actually worse now than it was Penn who discounted any connection to the stroke, shortly alter the stroke, and he tells me he has been diagnosed with a central pain syndrome. He was Mr. Pesce was initially followed neurologically by previously on Lyric° to help the symptoms but this Dr. Klazmer but subsequently transferred to Dr. has since been discontinued and his primary doctor Brock at Jefferson who he saw most recently a few has just kept him on the Lidoderm patch which he months ago. applies to the right hip, thigh, shin and foot and helps maintain the discomfort to a tolerable level, When discharged from the hospital, Mr. Pesce was treated with antihypertensive medication although Mr. Pesce continues to note intermittent loss of bat- he states his blood pressure subsequently returned ancc from time to time which varies from day to to normal and this was discontinued and he cur- day. He states he has to think about it when walking rently just takes Zocor for cholesterol as well as a and will often walk next to a wall to steady himself baby aspirin. He also uses a Lidoderm patch for his if needed or grab onto a desk if it is nearby. right leg, Mr. Pesce reports continued problems with both At this time, MT. Pesce reports a constant dull head- short and long-term memory since the stroke, and ache across the left eye to the center of the forehead he regularly travels with notes to help him. He rated at 5110 intensity. In the late summer of 2009, tends to forget dates and states he has good and bad he was experiencing sharp headaches on the left days. While he states this has been present since the side lasting seconds on a daily basis for a couple of stroke, he reports not having gone to a specialist or months in which he was told could he an aftermath had any specific evaluation for this. He also reports of his stroke. This still occurs periodically, perhaps excessive fatigue if he has done a lot of activity at once per week. work, Mr. Pesce reports that his voice cracks late in the Past Medical Ilistog is otherwise unremarkable day or if he has done a lot of talking. It is swallow- and he was not on any regular medication prior to ing has improved to the point of a regular diet al- the stroke, Ile does report a previous episode of though he feels there is something stuck in his throat. vertigo while driving home from work in about November, 2006, at which time he had spinning Mr. Pesce reports intermittent double vision which dizziness and fuzzy vision which subsided after five comes and goes when he is fatigued and has not to ten minutes. By the time he got home, he was really gotten any better or worse over time, able to walk into the house unassisted and felt fine after lying down for a short time. Following the Over the past six months, he has noted his Ica eye- stroke some months later, he had an episode while lid may droop when he is fatigued. lying in bed in which the ceiling fan looked like it was moving over to the wall for about five minutes. Mr. Pesce reports constant coldness and pins and Ile denies any other history of stroke-like symp- needles on the left side of the face including the toms. He had no prior known history of hyperten- lips, and he has no sensation on the left side of his sum or hyperlipidemia, although he has been main- lace when shaving. tamed on Zocor for cholesterol since the stroke and was temporarily on blood pressure medicine which Mr. Pesci.: reports persistent and constant coldness, has since been discontinued as he was told his 2013 Thomson Reuters. No Claim to(trig. US Gov. Works: 2010 WL 7539.416(Pa.Com.P1.) Page 3 blood pressure returned to normal. ;nes lower back pain beginning two days after a leg workout, with findings including segmental dys- Soda/ //ivory reveals Mr. Pesce to have been em- function upon motion palpation at C3-4 and L4-5 ployed at the Philadelphia Airport as the airport with adjustments performed on the cervical, spokesperson coordinating news media. Ile states thoracic and lumbar spine similar to what had been he first returned to work after the stroke in July, performed on many previous visits. 2007 two days per week and gradually increased his time to the present level of four days per week six I reviewed Mr. Pesce's oral deposition of, dated to eight hours per day, sometimes less. While he is September I. 2009, at which time he discussed his still a department head, he describes his position as treatment with Dr. t3uchakjian, adding that he had playing a back-up role in that he assigns the never been warned about any possible adverse ef- spokesperson position to another supervisor who feels from chiropractic treatment. Enclosed within reports to him. Whereas he would previously walk the chiropractic records is an informed consent to through the airport from place to place, he now chiropractic treatment signed by Mr. Pesce on finds he is fatigued doing so and will either drive to December 31, 2005 which includes a statement a location or even skip events. He also reports chili- concerning reported cases of vertebral artery injury culty at home with activities such as cutting the which can cause stroke on rare occasion resulting in grass or shoveling snow, and he has no stamina to serious injury. The consent form goes on to state walk or ride a bicycle with his wife which he did in that Mr. Pesce had an opportunity to discuss and the past, and states that all normal activities have acknowledge the above risks with the chiropractor been curtailed due to diminished stamina. and consented to chiropractic treatment including spinal adjustments. Family History reveals that his father, age 86, had coronary stents about ten years ago. His mother, Records from Frankford Hospital-Torresdale reveal age 83, is healthy. and there is no family history ol admission between February 25, 2007 and March 5, stroke. 2007 for an ultimate diagnosis of lateral medullary infarction, the emergency department report indic- Medical Records Revicw: A medical malpractice aces Mr. Pesce awoke at 12:30 a.m. with a left- civil action is reviewed, which claims that the de- sided headache and left face tingling with unsteady fendant, Chiropractor Michael Uuchakjian, per- gait and with a blood pressure of 216/113 on ar- formed cervical manipulation on the plaintiff on rival, There was concern for a subarachnoid hemor- several occasions and after one of these adjustments rhage for which a lumbar puncture was performed on February 24, 2007, Mr. Pesce awoke early the and revealed clear fluid without evidence of bleed, following morning with headache, facial numbness and walking difficulties which ultimately led to a Neurology consultation of Dr. Sirken on February diagnosis of medullary infarct which the complaint 25, 2007 corroborates the above history, with ex- alleges is due to improperly performed cervical ad- amination demonstrating a partial left sixth nerve justments by Dr. Buchakjian, palsy with nystagmus on left gaze as well as left upper extremity dysmetria felt to be consistent with There are a number of chiropractic records from a left brain stein infarction for which further work- Chiro Center at Body Crafters between December up was recommended. 16, 2005 and February 24, 2007 which, for the most part, indicates complaints of mid and lower back A CAT scan of the brain on admission on February pain and an occasional complaint of right jaw and 25, 2007 revealed encephalomalacia within the left shoulder pain as well and occasional right-sided cerebellum thought to be due to an old infarct, with neck soreness. The visit of February 24, 2007 indie- no acute changes. 2013 Hiomson Reuters. No Claim to°rig,. LIS Gov. Works. 2010 WI„, 75394 I 6(Pa,Com. Page 4 Carotid ultrasound on February 25. 2007 revealed started on Zocor for hyperlipidcmia as well as Nor- no significant stenosis, vase for his newly diagnosed hypertension. MRI or the brain on February 25, 2007 was repor- The patient was seen for physical and occupational led to show an acute lell lateral medullary infarct as therapy as well as speech therapy for a hoarse voice well as an old left cerebellar infarct. An MRA al and swallowing difficulty and ultimately transferred the neck revealed a very attenuated proximal let to Moss Rehab from March 5, 2007 through March vertebral artery which appeared to be occluded at 24, 2007 with a discharge status indicating ambula- the mid-cervical level with otherwise normal circu- don 10 twenty-five feet with supervision and min- lation in the brain. imal assist with a rolling walker. He was discharged on Norvasc for blood pressure, low dose aspirin and Echocardiogram revealed a normal lett ventricular Coumadin, Zocor for cholesterol and Neurontin for systolic function. However, transesophageal echo- hiccups. cardiogram revealed evidence of a patent foramen ovale, with redundancy of the intra-atrial septum Ophthalmology handwritten note, dated March 8, with borderline criteria for atrial septal aneurysm 2007, indicates he has had nystagmus and diplopia associated with mild right to left shunt at rest since the stroke which was getting better. demonstrated by contrast study with agitated saline. Neuro-ophthalmology report of Dr. Volpe on Extensive blood work looking for a hyperco- March 14, 2007 indicates double vision secondary agulable state was essentially unremarkable. to brain stem infarct with a prognosis for spontan- eous recovery. Subsequent progress notes from medicine and neur- ology service recorded the above examination find- A follow-up note 1-ruin Dr Volpe on November 7, ings, and the neurologist ‘1,as concerned for the pos- 2007 indicates continued improvement in double sihility of left vertebral artery dissection. In addi- vision, although he realized things were nut perfect Lion, the presence of a patent foramen ()vale sugges- and he still had episodes of double vision when fa- ted a cardioembolic source for which the patient tigued with almost no restrictions, and he was back was ultimately placed on Coumadin, to driving comfortably as well as being back at work part time. The neurology note of February 28, 2007 reviews a repeat MRA with gadolinium which demonstrated a There are post-hospital physical therapy follow-up hypoplastic left vertebral artery with occlusion in notes over the next few months. the mid to upper cervical region without dissection. Handwritten notes of Dr. Carl Rosenbaum and Phil- A cardiology note on March 3, 2007 raises the lip Lim, are reviewed between March, 2007 through question of stroke related to paradoxical embolism mid-2009, with gradual release to work, with fol- through a patent foramen ovate. low-up notes indicating gradual improvement such that he was cleared to work uptu four days a week A neurology note of March 3. 2007 indicates the as tolerated as of February 2, 2009. history of recent chiropractic manipulation thought to account for vertebral artery dissection (although Ophthalmology report of Dr. Edward Deglin on no dissection was demonstrated on the above stud- April 21, 2007 indicates momentary flashes of light ies). to the left side five days previously with no evid- ence of a retinal detachment. In addition to the patent foramen ovale, Mr Pesce was also found to have it high LDL of 131 and was Neurology follow-up reports of Dr. .lay Klazincr are t'r-')2013 Thomson Reuters. No Claim to Orig. US Gov. Works. 2010 WI,7539416(Pa.Com,P1.) Page 5 reviewed between April 16, 2007 and May 31, from medication. Ile ambulated without an assistive 2007, with the initial note indicating the etiology of device with fluent speech. Cervical range of motion his vertebral artery occlusion was unclear but may was limited to about sixty-live percent of normal. have been related to a dissection, with plans to re- Strength was normal although he had some dys- peat an MRA to see if there was re-canalization. metria on the left and decreased sensation below the left eye and incomplete abduction of the left eye A note of Dr. Klazmer on May 31, 2007 indicates a with inability to walk tandem. Dr. Stillo wondered one-week history of increased gait unsteadiness if left vertebral artery atresia with low flow might with right leg pain thought to be due to either account for 'CIA's and the ultimate stroke versus a Baclofen or brain stem infarct for which a repeat stroke related to possible patent foramen ovate for brain MRI was recommended, with the gait un- which further vascular evaluation was recommit- steadiness and leg pain subsequently resolving. 1 le ded, was felt to be doing well neurologically when Dr. Klazmer saw him on November 14, 2007 and was Neurology report of Dr. William McBride and Dr, being aggressively treated For his hypertension and David Brock on November 27, 2007 indicates Mr. hyperlipidemia. Pesce informed hint he had a lefi brain stem stroke shortly after undergoing chiropractic manipulation A sleep study done on May I. 2007 for a history of of his cervical spine and still had some right-sided snoring was reported to show both central and ob- dysesthesias with improvement in his balance. It struetive sleep apnea. does not appear these physicians had access to the medical records concerning other findings, al- I here is a video swallowing study report of May 4, though the conclusion was that a vertebral dissec- 2007 indicating no frank aspiration. The study was don was the most likely etiology of his strokes and interpreted as essentially normal and significantly as it was now nine months since the stroke, his anti- improved from the previous study. coagulation could be discontinued. MRI of the brain, dated May 9, 2007, reveals the There are a number of follow-up rehab medicine old left medullary and left cerebellar infarcts as notes of Dr. Arthur Gershkoff between July, 2007 well as absent left vertebral artery flow consistent and May, 2009, with right hemibody coldness and with occlusion, achiness for which 1.,yrica was initiated with some improvement. Report of Dr. Joseph Stillo on July 6, 2007 indic- ates a history of neck pain for which he had been A note of Dr. Gershkoff on December 17, 2007 in- receiving cervical adjustments by a chiropractor. dicates he has undergone extensive evaluation in- Ile also reports a previous episode in November, eluding a neurovascular surgeon, and a vertebral- 2000 when he had a few minute episode of vertigo artery dissection from a chiropractic maneuver had while driving and had to pull over for a few not been ruled out. He as off Coumadin for the pat- minutes. His double vision had been steadily de- ent foramen ovale as of December 17, 2007, at dining although there was persistent vertigo i,vith which time he was complaining of some sexual head movement, with resolution of hiccups vertigo had dysfunction thought possibly to be related to his been problematic initially at the time of his stroke. stroke. He had returned to work a few days per His vocal difficulty had improved to normal, al- week as of March 17, 200X and was working three though he still had right arm and leg dysesthesias. to four days a week as of June 23. 2008 and I le had stopped using a cane. He had recently, a September 22, 20(18. al which time Dr. Gershkoff couple of months earlier, had an episode of visual described him as being fully independent in all hallucinations felt to he either TIA or adverse elIeet activities of daily living and mobility, although hc ©2013 Thomson Reuters, No Claim to Orig. US Gov. Works, 7010 Wl, 7539416(Pa.Com.131.) Page 6 was still bothered by right-sided hot and cold sensa- though Mr. Pesce seems to be of the opinion that lions in the arm and Ice and tended to lose his voice Dr. Brock told him these headaches were due to a late at night. stroke, I see no indication that is the case from re- viewing this note nor do I see headaches mentioned His most updated note of Dr. Gershkoff on May 27, previously in the medical records. 2009 indicates he is working about four days a week, six hours each day as an administrator of the Repeat MRI of the brain, dated September 12, Philadelphia Airport but was continuing a home ex- 2009, revealed old infarcts in the left cerebellum ercise program for thirty minutes daily on a station- and left medulla with no acute intracranial abnor- ary bike. He still had right-sided paresthesias and mality, intermittent minimal left facial pain. He also had minimal persistent double vision. Also reviewed are oral depositions of John Ed- mondson, dated July 1, 2009, in addition to Mark Cardiology report of Dr. Howard Herrmann on and Alice Pesce, dated September I, 2009 and September 11, 2007 indicates he reviewed the September 18, 2009, respectively. Mr. Pesce de- transesophageal echocardiogram which showed a scribed a variety of symptoms he was still experien- patent foramen ovale with mild to moderate right to cing in which he attributed to the stroke, many of left shunting which could have resulted in a para- which he discussed with me at the time of his IME, doxical embolism causing the stroke, although Dr. including problems with short-term memory. Mrs. Herrmann felt that occlusion of the vertebral artery Pesce testified that she ran into Dr. Buchakjian a due to an embolism would be unusual, with dissec- few weeks after the stroke, at which time he indic- tion following chiropractic manipulation represent- aced he had initially felt his adjustment might have ing an alternate possibility. Ile was requested to caused the stroke but after doing some Online re- have a second opinion with Dr. Scott Kasner, al- search, he thought it was unlikely. though I have no report to suggest that was itCCOM- plished. Radiographic Evanthiation: Several radiological studies were provided on CD, only some of which There are a couple of ENT reports of Dr. Maurits were neurologically relevant and reviewed. Boon on June 2, 2008 and January 12, 2009 which both indicate subjective worsening or raspiness 01 CAT scan of the brain conducted on February 25, his voice although his vocal quality was near nor- 2007, when Mr. Pesoe presented to the emergency trial on both visits. [.aryngoscopy revealed left vo- room shortly after the onset of stroke symptoms, re- cal fold paralysis and he was felt to he doing reas- veals a moderately large area of encephalomalacia onably well on both visits with no specific interven- in the left lateral cerebellum consistent with an old lion recommended. stroke. "I lie study is otherwise unremarkable, with no evidence of acute infarct or bleed, and no appre- Neuro-ophthalmology report of Dr. Nicholas Volpe ciable abnormality in the brain stem where a lateral on March 4, 2009 indicates he has continued to medullary stroke was subsequently seen on MRI. make a remarkable recovery with almost no resid- ual deficits from his stroke, with rare vertigo or bat- MRI of the brain dated February 25, 2007 reveals ance difficulty and no double vision, faint increased signal on diffusion weighted and flair and T2-weighted images in the posterolateral Follow-up handwritten note which may be from Dr. left medulla consistent with an acute infarct. Better Brock (the signature is illegible) indicates he began seen on the flair and T2-weighted images is a larger to have severe left-sided sharp headaches a month area of increased signal in the left cerebellar hemi- ago as well as left eye drooping when tired. Al- sphere consistent with an old infarct. ©2013 Thomson Reuters.No Claim to Orig. US Gov. Works. 2010 WI_,7539416(Pa.Com.P1.) Page 7 MRA of the brain dated February 25, 2007 reveals the entire right upper and lower extremities. absent flow in the left vertebral artery consistent with occlusion further down in the neck which is Cerebellar examination did not reveal dysmetria on not imaged on this study. 'Fhe right vertebral as finger-to-nose or heel-to-shin testing. well as both carotids are normal in caliber. as are the remainder of visualized intracranial vessels. When Mr. Pesce first entered the office, he walked the length of the hall briskly without hesitation or MRA of the neck dated February 27, 2007 reveals apparent ataxia. When I asked him to ambulate as nonnal carotid bifurcations bilaterally as well as a part of the examination, he walked more slowly and normal appearing right vertebral artery. One of the cautiously but on a narrow base and was able to series demonstrates absent flow within the left ver- walk on both heels and toes. He had difficulty tebral artery throughout its course. On another walking tandem. With eyes closed in the Romberg series, there is questionably barely a wisp of flow in position, he began to fall to the left. the proximal left vertebral artery which then disap- pears at the mid-cervical level. No dissection is impression: Mr. Pesce presents approximately three visualized. years after suffering a left lateral medullary (brain stem) infarction attributable to vertebral-artery oc- Fsamination revealed Mr. Pesce to be a \veil- elusion. At the time he presented to the emergency developed, well-nourished, generally healthy up- room on February 25. 2007, a CAT scan and sub- pearing middle-aged man in no acute distress. He sequent MR.1 revealed an old left cerebellar infarct was alert and attentive with normal speech, Ian- which is also in the distribution of the left vertebral guage and memory for marry details of his personal artery. By history, he had experienced an episode of history. There was no aphasia or neglect. There was vertigo a few months prior to the stroke which may at times a faint hint of dysphonia although his have been another isehemic event in the territory of speech was generally clear and strong without dys- the left vertebral artery. arthria. As part of his evaluation for stroke, an MRA re- Blood pressure was 160/90 in the right arm, sitting, vealed a very attenuated left vertebral artery which, pulse 80 and regular with no carotid bruit. both without and with contrast, was found to he oc- cluded without evidence of dissection. During the Cranial nerve examination revealed full visual course of that hospitalization, he was found to have fields, fundi not visualized, full oculomotility with a patent foramen ovale with borderline criteria for subtle left beating horizontal nystagmus on extreme atrial septal aneurysm with right to left shunt, and it lett gaze, no ptosis, symmetrical pupils, symmetric- WM felt strongly enough that the stroke might be al facial movements, symmetrical hearing and mid- embolic from the heart that he was placed on Coti- line tongue and palate. There was diminished pin madin. sensation in all three divisions of the left side of the face. Some of the neurologists have suggested that his stroke might be causally related to the cervical Motor examination revealed normal muscle bulk chiropractic manipulation which he had about and power in both upper and lower extremities with twelve hours prior to the onset of stroke symptoms. no pronator drift. While vertebral artery dissection has been reported in the medical literature to occur in relation to Tendon reflexes were I+ and symmetrical in both chiropractic manipulation, a recent study in 2008 upper and lower extremities with no Babinski sign. found no difference in the incidence of vertebral artery stroke in patients who had visited a chiro- Sensory examination revealed hypalgcsia involving ©2013 Thomson Reuters. No Claim to Orig. US Gov. Works. 2010 WE 7539416(Pa.Com,PL.) Page 8 proctor versus their primary care physician in prox- According to the medical records reviewed, Mr. imity to their stroke, raising a question whether the Pesce enjoyed a remarkable recovery from his chiropractic manipulation was at fault. stroke, with report of Or. Volpe in March, 2009 in- dicating almost no residual deficits, with rare ver- Furthermore, while the possibility of chiropractic tigo or balance difficulty and no residual double manipulation causing vertebral artery dissection has vision. Similarly, the ENT physician, Dr. Boon, de- been raised, no dissection was actually demon- scribed near normal vocal quality even at times strated on MRA including with gadolinium which when Mr. Pesce complained of worsening prob- simply showed occlusion but not dissection. lens. Furthermore, his presenting CAT scan and MRI at - the time of his stroke demonstrated an old left cere bellar infarction in the same vertebral artery distri- • • hution which suggests (as postulated by Dr. Sti11o) that a congenitally hypoplastic vertebral artery • • likely accounted for episode of vertigo a few _ . months prior to his stroke as well as the old left . . cerebellar infarct and, ultimately, the left lateral For example, his repor • • ea ac e medullary infarct when the vessel finally coin- across the left eye as well as the sharp headaches he pletely occluded in February,2007. experienced in the summer of 2009 which he claims he was told could be an aftermath of his stroke are Apart from the possibility of vertebral artery dis- not described by his treating physicians with the ex- section (which has never been documented) due to ception of a notation in one of Dr. Gershkoffs re- chiropractic manipulation as well as the possibility ports indicating intermittent minimal left facial pain of congenitally hypoplastic left vertebral artery ac- which is in contrast to the constant moderate left- counting for the old cerebellar infarct and the new sided headaches recorded by Mr.Pesce. lateral medullary infarct in February, 2007, there is also a possibility that his strokes were due to para- in addition, not only is memory loss not reported in doxical embolism from a patent foramen ovate as- any of the medical records, there is no expectation sociated with atrial septal aneurysm. Studies in the that memory loss would be a residual symptom medical literature looking at the combination of from left lateral medullary stroke. patent foramen ovale with atrial septal aneurysm have demonstrated an increased risk of stroke in In addition, while he testified that he has double young people (younger than age 55) and Mr. vision on a daily basis, he reported no residual Pesce's transesophageal echocardiogram, in fact, re- double vision when he last saw Dr. Volpe in March, vealed the combination of patent foramen ovale and 2009. He also reports the new onset of left eyelid borderline criteria for atrial septa} aneurysm sug- drooping over the past six months, certainly not at- gestin�g an additional risk factor for stroke, not to tributable to the stroke that occurred three years ago. mention recurrent stroke which has been reported in upto twenty-two percent of patients with the coot- There is no question that Mr. Pesce suffered a left bination of patent foramen ovale and an-ial septal lateral medullary infarction in February, 2007 with aneurysm. some residual si ns and sym toms. However, A�with the above twee pos�slrr t les a being considerations. • _'r 2013 Thomson Reuters. No Claim to Orig. US Gov. Works. 2010 WI,7539,116(Pa.Com,PI.) Page 9 ' . ['his fact 11111111111111.11111 was also evident in examining Mi. Pesce, in that he walked down the hall from the waiting room to the examining room briskly and without hesitation, yet walked more slowly and cautiously when I specific- ally tested inn NI lation. In summary, Mr. Pesee suffered a left brain stem stroke of unknown cause in February, 2007 with minor residual symptoms \vhich the medical re- cords suggest are of a much lesser degree than what he now complains of A connection to the chiro- practic manipulation might be considered tempor- ally related in that it was performed the day before but does not automatically imply a causal relation- ship, with other factors being equally, if not more likely, particularly given the fact that CAT scan and MRI at the time of his stroke already demonstrated an old stroke in the same distribution above his Un- derdeveloped left vertebral artery which is the likely cause of his preceding episode of vertigo in the months prior to his stroke, accounts for the old left cerebellar stroke in the same distribution, and none of which can be blamed on chiropractic ma- nipulation. All of the above opinions are expressed to a reason- able degree of medical certainty. I reserve the right to modify and/or amend these opinions should addi- tional materials become available. END or DOCUMENT (c7)7013 Thomson Reuters, No Claim to Orig. US Gov. Works. West law 2007 WI. 1686021 (E,D.Pa.) Page 1 Fur Dockets Sec 2:05ev05803 Ms. Gariffo is a 62-year-old woman who reports she was leaving work on a rainy day, when she United States District Court, E.D, Pennsylvania. slipped on a piece of plywood that was covering a GARIFFO, hole on the ground, causing her to fall onto her out v. stretched right hand and arm, She does not recall BERLIN et al, striking any other part of her body or losing con- No.05CV05803. sciousness. She had immediate wrist pain and her January 2.2007. husband took her to the emergency room where she was found to have a wrist fracture and they placed (Report or Affidavit of 1,ec Hanis. M it in a splint. Case Type: Premises Liability & fall The following day, Ms. Gariffo saw an orthopedist Jurisdiction: F.D.Pa. who placed rler in a cast for approximately six to Name of Expert: Lee J. Harris. M.D. eight weeks, during which time there was swelling Area of Expertise: Health Care-Physicians & in the hand and pain in the wrist into the thumb. Health Professionals>>Neurologist She continued to have pain into the hand, wrist, arm Representing: Unknown and shoulder after the cast was removed, for which she was re-splinted. She had a course of physical Beth R,Golden, Esq. therapy which helped only slightly. Snyder& D'Annunzio Ms. Gariffo was referred to a neurologist, Dr. Singh, who performed injections and acupuncture 1515 Market Street, Suite 400 with only temporary relief She currently still treats with a neurologist, Dr. Hunter, who has talked Philadelphia. PA 19102-2091 about the possibility of surgery. Re: Claimant: Nancy GaritTo PRESENT SY 41P7O.VIS: Claim No: 953707-097 Ms. Gariftb reports continuous pain in the right hand through the wrist to the elbow and up to the DOI: 10119/04 shoulder and right side of the neck which can be severe at times. The pain is worse with any use of Prizm File No: 8774 the hand or arm and she states she can't hO the arm beyond a certain point, which causes it to vibrate Dear Ms. Golden: and tingle and shake in the forearm and upper arm. She says she cannot use the right arm at all as a res- 1 had the opportunity to see Nancy Gariffo for an ult of pain and that the right hand is always cold Independent Neurologic Examination on January 9, and clammy. She states the above symptoms have 2007. The report includes interview and exarnina- been present from the very beginning and have only Lion of Ms. Garai.), as well as review of available slightly lessened over time. medical records secured by your office. Ms. Gariffo was accompanied by her attorney, Bruce Ginsburg. Ms. Gariffo reports that she uses Tylenol or Motrin during the day which "calms it down" for a little HISTORY OF PRESENT ILLNESS: and then Ulmun at night which also helps a little 2013 Thomson Reuters. No Claim to Orig. US Gov. Works, 2007 WI. 1686021 (E.D.Pa.) Page 2 with the pain. with no complaints arid had an intact neurovascular exam, and a new well padded short arm cast was Ms. Gariffo denies any other symptoms related to applied: this cast was removed by Dr. Anapolle on this incident. 12/6/04. PAST MEDICAL HISTORY: On 1/3/05, Dr. Anapolle indicates the claimant had continued severe pain into the right wrist and hand Past medical history is otherwise unremarkable and with occasional cold feelings and sweating as well Ms. Gariffo takes no regular medications. She has as some tingling in the fingers. had gall bladder surgery in the past. She denies any prior injuries and states she never had problems Physical therapy evaluation of Cathleen C. Soper with her neck,arm or hand. on 12/13/04 indicates decreased range of motion with pain and difficulty completing activities of SOCIAL HISTORY: daily living, for which a course of therapy was initi- ated. Social history reveals the claimant to he married and living, with her husband in a house. At the time Neurologic report of Dr. Manish Singh dated or the incident, Ms. Gariffo was working as day- 1/17/05 indicates continued complaints of pain, shift manager for a shirt shop which involved fold- numbness and tingling in the right hand following ing and operating a press. She was out of work until the injury. The right hand was noted to be some- July 2005, when she only returned for a month and what cooler and elythematous as compared to the could no longer do it because of persistent pain. left. Ms. Garin states she is quite limited at home and There are some follow-up handwritten notes from she cannot run a vacuum or open jars. She states Dr. Singh indicating persistent symptoms in the she can "cook a little" and when she goes shopping, hand with no new symptoms reported. Over the she has to lift everything with her left arm and can- next few months, she improved with therapy and not really lift anything with her right hand. She is had Stellate ganglion blocks performed. able to drive. On 7/18/05, there was said to be some increase in MEDICAL RECORDS REIYEW: wrist pain since returning to work in retail and un- packing boxes. There was also at that time a new Emergency department report dated 10/19/04 indic- complaint of right shoulder pain. ates the claimant, tripped and fell sustaining a right wrist tincture with contusion to the right knee and On 9/2005, there was a report of neck and back shoulder. There was no indication of head injury or pain as well, and she felt as if she was going to pass loss of consciousness, Out. Report of Dr. David Anapolle dated 10/22/04 indic- Lumbar MRI report of 10/11/05 indicates disc de- ates right wrist pain following a trip and fall for siccation of the lower levels with no disc herniation which a closed reduction was recommended. or bulging and no change compared to a prior study dated 11/29/03. Subsequent note dated 11/8/04 indicates some tingling in the fingers where the cast was pinching Cervical MR1 report dated 10/24/05 indicates near the base of the right thumb. There was marked straightening of the curvature, with minimal spon- improvement after modification of the cast. dylosis and no disc herniation or bulging. As of 11/24/04, Dr, Anapolle indicates she presents K1)2013 Thomson Reuters. No Claim to Orig. US Gov. Works. 2007 WL 1686021 (E.D.Pa.) Page 3 Neurological report of Dr. Kevin Hunter dated Evaluation dated 7/24/06, Vocational Evaluation 12/12/05 indicates that at the time of her original dated 8/4/06, and Analysis of Potential Earning Ca- tlin, the claimant struck her head and lost con- pacity dated 8/23/06. sciousness. This is the first time I have seen this mentioned throughout the medical records, She EX,1,14/NA T/O;V: noted persistent paresthesias down the right arm as well as through the neck and into the left arm and Examination reveals Ms. Gari flo to be a well- both legs, in addition to low back pain. These are developed, well-nourished, generally healthy-ap- also new symptoms not previously appearing in the pearing woman who was alert, attentive and fully records. She was said to have been experiencing oriented with normal speech, language and memory. syncopal episodes since August 2005 and had been evaluated at Jefferson with extensive testing. There Cervical spine examination revealed subjective ten- was give-way weakness in the right upper and derness diffusely over the midline as well as right lower extremities with loss of sensation in a stock- paracervical down into the right parathoracic region ing-glove distribution, extending into the right shoulder girdle, anterior chest wall and diffusely throughout the right arm. Follow-up report from Dr. Hunter dated 1/18/06 in- dicates neck pain into the right arm and low back She was tender to even light pressure on the pain into the legs with continued weakness of the muscles and soil tissues, but not to simply stroking tight arm and wrist, as well as sensory loss. Thomas the skin at any area. There ‘vas intact cervical range Jefferson University Hospital records were refer- of motion and no palpable spasm. Moving down in- enced as having been an unremarkable CT of the to the right upper extremity, I could appreciate no brain and cardiac testing, asymmetry with regard to swelling erythema, skin temperature,sweat,hair or nail pattern. EMG was reported by Dr. 1-hinter on 2/8106 as showing a mild peripheral neuropathy in the lower Cranial nerves 2-12 were intact. extremities. There was no indication of radiculo- pathy. Motor examination revealed variable give-way in- volving the muscles of the right hand, although EMC, report of Dr. hunter dated 3/1/06 indicates when both sides were tested together, either one or mild carpal tunnel syndrome as well as possible both gave way, such that there was really no object- right C6 radiculopathy. ive weakness and no muscle atrophy appreciated. The lower extremities were strong and equal. Report of Dr. Hunter on 5/1/06 indicates continued right arm pain and weakness as well as low back Tendon reflexes were 2-1 and symmetrical in both paM, upper and lower extremities,with no Babinski's sign. Physical therapy report dated I/19706 indicates Sensory examination revealed subjective tingling intilti-focal complaints of pain involving the legs andior pain throughout the entire right upper ex- with swelling of the ankles and pain in the feet. low veil-dry front the right side of the neck into the hack and right arm with diffuse radiating pain shoulder, upper arm and hand, with the exception symptoms throughout the chest, hack, shoulder and of the small finger of the right hand. The lower ex- neck for which it was recommended she be referred tremities were equal. to a pain management program. Cerebellar examination did not reveal dysmetria on Also reviewed are reports of Functional Capacity )2013 Thomson Reuters, No Claim to Orig. US Gov, Works, • 2007 WL 1686021 (k D Pd.) Page 4 finger to nose testing. She ambulated on a narrow base with symmetrical arm swing and no ataxia. I could find no evidence of any other neurological disorder attributable to the 10/19/04 incident. IiI4PRESSION: Thank you for the opportunity to evaluate Nancy Ms. Gariffo presents a little more than two years Gariffb, and please feel free to contact me if further status post trip and fall at which time she sustained questions remain. All of the above opinions are a right wrist fracture, with preliminary records at made within a reasonable degree of medical cer- that time indicating absolutely no other complaints. tainty. At the time the cast was removed, she had persist- ent pain, swelling and tingling into the hand which she states has persisted and has become associated END OF DOCUMENT with more diffuse pain throughout the right arm up into the shoulder and neck, While she states these symptoms have been present since the outset, only the right wrist and hand were initially involved. A question of complex regional pain syndrome was addressed by her previous neurologist, Dr. Singh. however, does her present neuro°gist, Or. un er r escribe changes supporting that diagnosis. I can find no evidence Ms. Gariffo sustained any cervical spine injury or radiculopathy as a result of this fall, It is possible she may developed mild post traumat- ic carpal tunnel syndrome, which can occur follow- ing wrist fracture. According to Dr. Hunter's EMG report, the involvement would indeed be quite mild, as the motor latency and amplitude across the carpal tunnel was normal, with the only reported abnormality being a mildly prolonged sensory distal latency. 011111111.11111 -i- iimiairminalia../11111111IMM/11 . . t 2013 Thomson Reuters, No Claim to Orig. US Gov, Works Westlaw 2003 WL 25279374(E.D.Pa,) Page I For Opinion See 74 Fed. R. kvid. Serv, 418 , 2006 Mr. Coney reports that since he was last seen in WL 5116719 2006 WL 2601507 , 2006 WI. January, he continues in chronic pain. He reports 2583581 constant sharp and burning pain in the right foot, calf and intermittently in the posterior thigh, as well United States District Court, E.D, Pennsylvania. as intermittent low back pain. Although the pain is CONEY et al. constant, it is aggravated by walking and he still v. uses a cane. He denies any tingling in the leg or NPR, INC. foot. lie still reports chronic neck and right No.2:03CV01324. shoulder pain which is unchanged. October 30,2003. Mr, Coney reports he has continued to treat with (Report or Affidavit of Lee J. I larris, M.D.) Dr. Park and has been tried on a variety of medica- tions, which are only mildly helpful. He has under- Case Type: Maritime Longshoreman Act gone a lumbar epidural steroid injection without re- Jurisdiction: E.D.Pa. lief (two prior injections had also been unsuccess- Name of Expert: Lee J. Harris. M.D, rut). The next step proposed by Dr. Park is a ten- Area of Expertise: tlealth Care-Physicians & day trial of a spinal cord stimulator, which the I lealth Professionals 7>>Neurologist claimant is interested in pursuing. Representing: Unknown Mr. Coney reports he is tillable to drive a car at all Lisa Rich because he is unable to shift his position to look at oncoming traffic, Since having been seen in Janu- Perspective Consulting, Inc. ary, Mr. Coney has still not returned to work in any capacity. 35 Evansburg Road Mr. Coney's current medications include MSIR, Collegeville, PA 19426 Soma and Zonegran. Re: Claimant: Michael Coney MEDICAL RECORDS REVIEW: Claim No: ... OWCP-03-27999 Orthopedic Independent Medical Examination re- port of Dr. Mario Arena dated 1/9103 indicates im- DOI: ...6/15/01 pression of resolved lumbosacral sprain and strain with underlying degenerative disc disease, as well PC1 File No: 32604 as a resolved right shoulder sprain and significant non-organic component to his symptoms, Dear Ms, Rich: Records of Dr. John Park reviewed beginning I had the opportunity to see Michael Coney for an 1/13/03 indicating persistent back and right lower Independent Neurologic Re-Examination on Octo- extremity pain which persisted on 2/6/03. ber 28, 2003. I had previously evaluated Mr. Coney on 1/7/03 and had the opportunity to review some A report of Dr. Park dated 3/12/03 indicates the additional medical records along with the exantina- opinion that the claimant's condition does not fulfill lion at this time, a diagnosis of complex regional pain syndrome, but he felt there was evidence of chronic lumbosacral ti7-..)2013 Thomson Reuters, No Claim to Orig. US Gov. Works 2003 WI.25279374 (E.D.Pa Page 2 radiculopathy related to the\York injury, per limbs. 2i and symmetric at both knees and ank les. Report of Dr. Andrew Freese dated 3/13/03 indic- ates the claimant has been disabled as a result of Sensory examination revealed subjective dim in- this work injury. ished pin prick involving the small toe of the right rot, but was intact in all other '?? in both upper and Follow-up reports of Dr. Park dated 5/28/03, lower extremities. There was no limb or gait ataxia. 6/30/03 and 9/4/03 indicate persistent back and can- He again ambulates with the assistance of a cane didate for a spinal cord stimulator. which he holds in his la hand, moving slowly with an antalgic limp. There is a subsequent letter from Dr. Park dated 9/19/03 indicating the claimant has exhausted all IMPRESSION: therapeutic modalities and that a spinal cord Stimu- lator would be the next step, Since his last visit in January, little has changed for Mr. Coney subjectively in that he continues to corn- / \ l A RNA 770N plain of chronic back and especially right leg pain. Since that time, the records indicate he has under- Examination reveals Mr. Coney to he a yell- gone trials of medication and a third lumbar epidur- developed, well-nourished, generally healthy-ap- al steroid injection without relief and is set to pur- pearing, young, white male who was in no acute sue a trial of spinal cord stimulation. distress, He was alert and oriented with normal speech, language and memory. Lumbar spine examination revealed subjective ten- derness over the midline spinous processes with no . paravedebral tenderness or spasm. There was al- most no lumbar range of motion in any direction. , . , including lateral rotation, which he indicated . „ caused an increase in back pain. I was unable to get him lying or even fully seated on the table to check straight leg raising as he indicated he could not put his weight clown on his buttock without aggravating All 01 the above opinions are expressed within a his pain, reasonable degree of medical certainty. Thank you for the opportunity to evaluate Michael Coney Cranial nerves 2-12 were intact, today, and please feel free to contact me if further questions remain Motor examination revealed no focal atrophy or ob- jective weakness in the upper or lower extremities. The upper limbs were symmetrically strong. There END OF DOCUNIEN'F was diffuse give-way Ireakness throughout both lower extremities, more prominently on the right. lie would barely make any effort to move any muscles in the right lower extremity despite his ability to ambulate maintaining his body weigh al- ternately on either toot. Tendon reflexes were 1+and symmetric in the up- C`)2013 Thomson Reuters. No Claim to Orig. US Gov. Works. West law 2003 WL 24219536(E.D.Pa.) Page I For Opinion See 2004 WI, 1427137 .2002 WL and subsequently completed on danualy 17, 1990. 32349878, 2002 WI.32349870 There was brief postoperative urinary incontinence, which resolved without fret:intent. United States District Court,ED. Pennsylvania. SEGALOW, Report of Dr. Nair on Amway 30, 1990 indicates V. he is ambulating well but continued 10 have prab- Joan CROWE, R.N. et al. Ions with manual dexierity. No. 00-5642. September 24,2003. Report of Dr. James Gold on March 22, 1993 indic- ates he was in an auto accident the month before (Report or Affidavit of 1,ee !lards,M.D.) and complained of increasing numbness of the ex- tremities, poor dexterity, Increasing numbness in Case Type: Medical Malpractice-Facility >> Other the fret, increasing urinal), and bowel urgency. Facilities There was weakness in both arms with brisk re- Jurisdiction: E.D.Pa. Ilexes oral diminished sensation felt to be due to a Name of Expert: I,ee J. Harris, ID cervical contusion and aggravation of myelopathy Area of Expertise: Health Care-Physicians & Health Professionals >> internist Report of Dr. Gaul on April 2. 1993 indicates an- Representing: Unknown other accident a few days earlier with complaints of diffuse headaches, dizziness. left arm numbness and Craig M.straw again weakness and loss of sensation in both upper Deasey,Mahoney and Bender. Ltd limbs. A cervical MR1 was referenced as having Suite 1300, 1800 Jf Kennedy Blvd. shown abnormal signal within the cord related to Pihiladelphia, PA 19103-2978. old trauma. Dear Mr. Straw: Follow-up with Dr. Gaul on April 29, 1993 indic- ates he still has severe neck pain. Some improve- 1 had the opportunity to review medical records on ment but persistent neck pain with radiation into Ricky Segalow and 1 would like to send),ou this re- the left arm was noted on June 15, 1993 and he was port of my findings. In reviewing the records and still limping. Neck, mid and low back pain into the preparing this report, I have been asked to address, buttock and leg with di/fuse sensory findings was specifically, Ilk Segalow's neurological condition again reported on September 7, 1993. during and after his incarceration in Bucks County Correctional Facility. Hahnemann University Hospital records were re- viewed between July 10, 1995 and July 15, 1995 in- Report of Dr. Somnoth Na,", dated January 2, (heating he had been transferred from Doylestown 1990, indicates numbness in both upper extremities Hospital due to progressive weakness of the lower arm difficulty walking with urinary frequency. extremities as well as increased bladder ineantin- There was weakness of the hands with difficulty ence following two prior automobile accidents, manipulating liii buttons. There was weakness of both upper and lower ex- tremities' lvith Jiiii i,iishi ed sensation, decreased A cervical All?I revealed stenos/5 with vpurN. lor rectal tone ,ind severe ataxia with falling. Urologic which a cervical lamawctomy was rci:oinmendea wOrk-11/,denlOil.sMiled i us'unn'c)c'en iC bluCider, Emergency department report of July 15, 1995 in- ©2013 lhomson Reuters. No Claim to Orly., US Gov. Works 20U3 WI,24219536(E.D.Pa.) Page 2 dicates claimant bud been discharged that morning discharged using a single point cane as well as a but returned with continued ,shaking of the right left ankle-16o, orthosis. The Foley catheter was arm and leg indicating he was unable In straight placed with plans to remove it on an outpatient basis, cath himse1fsterilely in prison. Report of Dr. Peter Sinaiko, dated December 13, A handwritten consultation 4,1111), 15, 1995 ludic- 2001, indicates claimant has a neurogenic bowel cites that right arm .shows ci line tremor, which aim- and bladder as a result of cervical myelopathy and peared to be under voluntary control and it was previous laminectomy for which he was on intermit- suspected he was malingering. tent self:catheterization He was felt to require twelve catheters a day clue to a small capacity blad- Letter from Dr. Robert Schwartzman, dated July 24, der. 1995, indicates he has severe cervical stenosis with spinal cord atrophy, and needs sterile calhetcriza- Subsequent report of Dr. Sittaika on December 19, tion equipment and a clean place Ti) catheterize 2002 indicates that urine culture showed no growth himself and he, thus. required no more than six catheters a slay. Report from Hahnemann Emergency Room, dated November lb', 1995, indicates weakness in the ho Report of Dr. Robert Sing, dated January 23, 2001, arm and both legs with diminished sensation, indicates he ercuitined the claimant and reviewed medical records. He discussed treatment of the Cervical AIR1 report of December 6, 1905 indicates neurogenic bladder and bowel dysfunction as well sponcklosis at several levels with mild spinal sten- as his concern that physical therapy was important CIS is but no myelopathy. to tretd the claimant's cervical radiculomyelopathy. He was thought to he suffering from ci severe inca- Report of Dr. ,i4urray Robinson on February 23, pacitating disease that would continue to decom- 1996 indicates he has had gait instability since age pensate and that his care in prison was substand- 18 with subsequent worsening over the past two to ard. three years. with numbness throughout his entire body, difficulty ambulating urinating and defecat- Report of Dr„lohn dated .0Yovember 4, tog. Ile had been straight cat/nag himself for the 2002, indicates complaint of low back and leg pain. past year anti using a cane for the last two months. He was noted to have undergone a second cervical He was diffusely weak thought to be related to a fusion in 1999 by Dr. Young at Temple. He had progressive cervical myelopathy, been released from prison in February, 2002 and had noticed a worsening of symptoms over the last Report of Dr, Leonard Kamen on Illarch 19, 1996 few months. There teas diffuse arm and leg weak- indicates the insidious onset of neck and back pails tleSS, which appeared to be give-way in nature. He over the years previously treated by chiropractic ambulated with a cane and had diminished sensa- manipulations. He was currently complaining of tion in both arms and legs. A lumbar 41R1 was re- neck pain as well as back pain into both /owe,. ex- viewed showing questionable L4:5 grade 1 spon- tremities with numbness in both feet us well cis the dylolisthesis with moderate central spinal stenosis. upper limbs. There was diffuse weakness associated .4 subsequent hIllIbur myelogrum and post- with a spastic ataxic gait It't g a COW for sup- meelogrum CT scan revealed spinal swamis at L-1-5, port. Follow-up reports of Dr Cifelli on November 2.5, Aloss Rehab Hospital records were revielvea between May 1, 1996 and itlav 15, 1996 indicating .5pinal cord physical and occupational therapy and ©20[3 Thomson Reuters. No Claim to Orig. US Gov. Works 2003 WL 24219536(E.I:).Pa.1 Page 3 2002 and December IN. 2002 indicates severe pain April 7, /995 indicates he was called to sign farms with buckling of the legs and fulls. Dr. c/felli sub- fir refusal of,medication. Report of May 10, 1995 sequently pcerfurmed bilateral decompra.s.sive L-1-5 indicates that he had refused physical therapy he- /anrinectomies and firaminotena`es on January 2, cause he mild not like the looks of therapist.— lie 2003. was ambulating with a limp and required rto assist- ance. A follow-up note of February 10, 2003, indicates the claimant was doing quite well and very pleased Note 0/May. 26, /995 indicates a complaint that the with the results of'surgery, frith complete relief of left leg and arm were dragging along with constant his leg pain and improved seensation in both Piet pain in the neck and back and he thought he should After being admitted for two weeks' at Moss Rehab, he in the hospital. he was now about to start outpatient physical tlreer- crl?y'. There are .subsequent notes in June and duly indic- ating he was involved with rehab. Report of Dr, Harry Schs+art_ on .lanacar3' 6. 2003 indicates the claimant had undergone the deconc- Report of July 16, 1995 indicates the claimant was pressive tan/nectonry. He had been walking tale- lying in bed unable to get up and paralv_ed ftcan pendently with a single point cane and no assistivc the waist down. He subsequently sat up, got himself devices. at home and had evsn been doing some run- into the wheelchair and then had no difficulty- set- tling, There was cliigirse,/our limb weakness. Sen.s'o- tinny out opt and stun ding. bore was intact to touch and propr'iwceprion. lie uas to he admitted to Moss Rehab for further therapy. There are subsequent handwritten notes regarding terologic status and treed to sell-catheterize. Follow-up note ,front Dr. Schwartz on March 13, 2003 indicates he continues with outpatient physic- Handwritten note of' :August 3, /995 indicates al therapy and was doing so well hut he had now claimant is to be transferred to rehab the following been trartsitioned .from a quad-cane to a single week and did not want am' passive motion or ma- point cane. There was still mild diffuse weakness in nipulation. He was thought to require an exercise all finer limbs. program, 1/nrchvritten medical records /roar Bucks County Notes from November, 1995 indicates he was re- Corrections health Services are reviewed between turned to prison to be on bedrest with medications .ti/arch, 1995 and 1996 and then November, 1998 fir muscle spasm. through April, /999 and then front May. 2001 through Fchruaty, 2002. Report of November 29, 1995 indicates he ambu- lated into the dispensary without assistance and History and physical, dated March 10, /995, iodic- that self=catheterization was going well and he had cues the history of lotninactomy and spoil cord in- no recurrence ofspasnrs, duty. Handwritten note of 5/arch 1(1,, /995 hie/fro/es he was./Ound hying on his back on the floor stating Handwritten note of Dr. Robinson on February 23, he was ""all locked up'' anal could not move. 11e, 1996 indicates he has progressive quadriparesis thereafter, rolled to his sick, pushed himself.up arm and should he rt,/erred for neurologic evaluation sea up, gut to his Jeer tied sat on his hunk. A .sub- rind gratin A/RI as Well as being moved to house at-- secJuent note of March 24, 1995 indicates' he heat rest. There care cr PH, notes into Marc./r, 1996 and not taken ibuprofen or aspirin as ordered and had then a nap unto November 9, /998 when the notes refused physical iherahy, A subsequent note of again pick up. a 2013 Thomson Reuters.No Claim to Orig. 11S Gov.Works, • 2003 WE,24219536 (E.D.I'a.) Page 4 A note oh December 16, 1998 indicate) he no/ken au '2, 2002. into the dispensary rapidly and unassisted com- plaining about a limited number of catheters lie I had the opportunity to review deposition (ran- teas receiving. His feet were nuclear, and he had an scripts of Ricky. Segalow regarding his care in and ulcer on the right.lifth toe. Foot care was recom- OW n/prison and various allegations regarding his mended and subsequently documented to lie coin- care. 1 also reviewed deposition transcripts of R.N. pleiccl. ,hmn C'rowe, Warden J, .411e,: Nesbitt, Pala Mi- chaels, Dora Segalow, Dr, Louis Brandt, Dr. James Report of April 7, 1999 indicates he presented with Ripley, Dr. L. Polk and transcripts of proceedings socks he had worn.for three days by his own de- before the Honorable Bruce IV Kauffman, (Ishii, and he insisted he could only wear new socks and would not wear washed socks. Radiographic Esamination: Lumbar myelogram, dated November 20, 2002, reveals symmetric block A subsequent note on April 8, 1999 indicates he re- of flow of contrast material due to severe spinal /uses to clean his feet. stenosis at the level of 1.4-5. There is again a gap after Apra. 1999 until Alen', Past-welog,rciphic CT of the lumbar spine. dated 2001 indicating he denies acute illness and was November 20, 2002, similarly reveals significant self:catheterLing five to six times a day. Sub- degenerative spinal stenosis at L4-5. The radiolo- Sequent notes indicate catheters being dispensed gist's report of associated right-sided disc hero/- and he denied needing any lubrication or any fur- anon at this level is nut appreciated on the films Cher problems. A later note indicates he was issued currently available for review, KV Gel for carhop!. use and was issued a shower chair and encouraged to ask if he needed supplies Plain x-rays of the lumbar spine, dated November for medical issues, Ile subsequently reported he 25, 2002, reveal chlsc height to he maintained Pea'- tins lain, the shower chair and later noted he hail icles are bodet at all levels. There is degenerative enough lubricant for his selkatheteri:ation. There change most prominent at L4-5, Only AP and oh- are subsequent notes indicating he has enough lub- lique views are submitted and a true lateral view is rieant for self:catheteri:ation. A cane was later is- not available. there is no fracture or subluxation sued and lw reported he had a shower chair. evident. A note of December /3, 2001 indicates urethral rib- Repeal lumbar spine x-ray, dated December 18, struction for which he was to be catheterized Riven 2002, again reveals degenerative change, maximal times a day. at L4-5, There has been no significant change when compared to the prior study. Report of February .5, 2002 indicates avenue toe- nails with poor foot hygiene and he was not wash- Impression: Review of the above medical records ing his feel or far socks. on Ricky Sega/ott' indicates he had a progressive degenerative disorder of both the cervical and There are several memos abdicating re.thsal c■I lumbar spine dating hack many years far which he ireininem including refusal of pli 'SiCcli (17C1clpy on initially underwent el??einnpressive surgery for the Nlarch 21, 1995. refiisal of recommended bedrest cervical spine in 1990, then suflered progressive an duly 16, 1995, refusal to clean bicfeet or (1king' deterioration following fi series of automobile ciCcl- his socks on April 8, 1990, refusal of aniihiones ,'.11 dents in 1993 resuliing in increasing weakness, gait December 1-1, 21101, refusal of physical therapy on ihllieulty and tieuragenic bladder requiring sell: January 23, 2002, refusal of dental care on Fe/tin- callteteri:ation. ©2013 'Thomson Reuters. No Claim to Orig, US Gov. Works. 2003 Wt,24219536 (L.D.Pu,) Page 5 lien subsequently required a second cervical surgery in 1999 curd later lumbar surgery dot' to spinal stenosis in 2001. Jr appears that his subsequent condition was quite stable, having been relieved of pain, improvement in his gait .suc/i that he could ambulate at home ts•ith nn assistive device anti could even do Some running. Review of Ili' Medical rcx/r•ds' ap/7ecrrc t0 indicate reaSoncrhle it)ii1/ccrl evaluation and treatment /roar a neurologic 'taut/joint during his clif/t'rern periods of incarcerutiorr. fret, his second cervical surgery in 1999 occurred less than a year offer he returned from prison alter having been out on his rnt'n fir some two and one- half pears. /regardless of his allegations concerning his perceived care while incarcerated, there is no medical scientific evidence that the natural histor y of his progressive spinal degenerative disorder was. impacted in any way as a result of iris care in or out of prison during that time, All of the above opinions are expressed within a reasonable degree of medical certainty. I trust the above report accurately swnurari_es the medical records reviewed concerning Rick}' Sega- low, and please feel free to contact me if further questions, remain. Yours sincerely, Lee J, Harris,M.D. END OF DOCUMENT CO 2013 Thomson Reuters.No Claim to 064 US(inv. Works. West Law 2003 WL 25279373(E.D.Pa.) Page 1 For Opinion See 74 Fed, R. Evict.Serv.418 ,2000 HISTORY OF PRESEN7'ILLNESS: WL 5116710, 2000 W1. 2601507 • 2000 WI, 258358 I Mr. Coney is a 45-year old man who claims he was injured on the job as a longshoreman on 6/15/01. United States District(ourt, E.D. Pennsylvania. He states he was helping unload freight from a ship CONEY et al. and while puilinc.: a rod out of a box, he turned and v. shitted his weight, when his right foot caught on a NPR, INC. grate, causing him to twist his back. He developed No.2:03CV01324. immediate low hack pain arid states he was sent to January 8,2003. NovaCare for evaluation, including x-rays, ice and ultrasound. Ile reports he had difficulty scheduling (Report or Affidavit of Lee J. Harris, M.D.) appointments and, instead, came under the care ot Dr. Suiferrnan for physical therapy as well as med- Case Type: Maritime>>-Longshoreman Act ication without relief. He states he underwent two Jurisdiction: E,D.Pa, or three lumbar injections, with no relief. lie states Name of Expert: Lee J. Harris, MI), he has most recently come under the care of Dr. Area of Expertise: Health Care-Physicians & John Park for pain management at Jefferson and Health Professionals>>.Neurologist just had another MRI done a couple of weeks ago. Representing: Unknown PRESENT SYMPTOMS: Christopher Field, Esquire Mr. Coney describes constant low hack pain which Field, Womack& Kawczynski increases with any activity or movement. He is not able to tell me whether there is any radiating pain 137 South Broadway into the lower extremity, but he does report con- stant pain in the right outer calf as well as the outer Suite 13-1 portion of his right foot and inside his knee, South Amboy, NJ 08879 Mr. Coney states that numbness comes and goes. in the toes of his right foot and that he also has inter- Re: Claim: Michael Coney mittent pain in the great toe of his left foot. He de- scribes weakness in his right leg and has been using Claim No:... OWCP 03-27999 a cane ever since a fall about a year ago when his leg gave out. Ile also wears a back brace. DOI: ...6/15/01 Mr. Coney also reports constant neck pain which he PCI File No: ... 29578 thinks started a couple of weeks or perhaps even a couple of months after his back, with burning pain Dear Mr. Field: in the right shoulder as well as in the upper arm, forearm and sharp pain in his right hand. He denied I had the opportunity to see Michael Coney for an any numbness or tingling in the hands. He states Independent Neurologic Examination on January 7, that during some recent rainy weather, both hands 2003. The report includes interview and examina- went into a claw-like posture and he could not open don of Mr. Coney, as well as review of available them. He otherwise has no symptoms in his left medical records secured by your office. CO 2013 Thomson Reuters.No Claim to Orig.US Gov. Works 2003 WL 25279373 (E.D.Pa.) Page 2 hand. concludes that there are acute and chronic changes predominantly in the right 1.5 distribution. PAST MEDICAL HISTORY. IM E report of Dr. Menachern Metter dated Mr. Coney's current medications include Celebres, 10/22/01 indicates complaints of mid lumbar, thigh Scalia and Lortab for pain, and calf pain with aching also in the feet associated with pins and needles in the toes. He was noted to Past medical history reveals that Mr. Coney sus- have a number of positive Waddell's signs consist- tamed a low back injury at work about fifteen years ent with symptom magnification. He was neurolo- ago and lost about one and one-half years from gically objectively intact with symmetric reflexes work at that time He is otherwise healthy and takes and no vasomotor changes. His complaints were no regular medications,other than those listed above, thought to be non-anatomic, with no clinical find- ings to suggest lumbosaeral radiculopathy. SOCIAL HISTORY.- Neurosurgical report of Dr. Andrew Freese dated Social history reveals the claimant to be married 10/3(1/01 indicates lower back and right leg pain and living in a house. 1k has not been able to return with numbness and tingling in the toes. There was to work as a longshoreman since the injury and no true motor weakness or reflex asymmetry. There states that he is not able to do much of anything at was noted to be decreased light touch and pin prick home and even requires assistance from his wife to down the posterolateral aspect of the right leg. His dress himself', MRI scan was reviewed and thought to show de- generative changes with disc herniations and disc MEDICAL RECORDS REVIEW: desiccation, Epidural injections were recommen-ded. Report of Dr. Milton Soiferman dated 7/5/01 indic- Report of Dr Eric Ratner dated 11/13/01 indicates ales the claimant was-working on a ship where the complaints of back pain radiating into the right footing was not safe and when he turned the oppos- thigh and leg, with diminished sensation in the right ite way, he pulled his back and presented With coin- 1.5-S1 distribution. Epidural steroid injections were plaints of severe lower back and hip pain, again recominended. Lumbar MRJ report dated 817/01 indicates degener- Report of Dr. Guy Fried dated 12/10/01 indicates ative disc disease at the two lower lumbar levels, pain from the neck into the thoracic spine and then with a moderate broad L4-L5 disc herniation and down to the right leg with numbness and tingling in shallow spur and broad disc protrusion at L5-S1, the right leg. Sitting straight leg raise was negative and there was no low back spasm. Strength and re- Orthopedic report of Dr. Gad Guttman dated flexes were normal. He was noted to have non- 9/11/0 I indicates the claimant had a prior work in- dermatomal sensory loss in the right leg. Pulses, jury 13 years ago and suffered neck, right shoulder hair and nail pattern were all normal, He was not and lower hack pain and was out for one to two thought to have any evidence of clinical radiculo- years at that time. He was presently complaining of pathy,but did display positive Waddell signs. lower back pain with occasional pain in the toes of both feet, as well as son-le pain in the base of his Lumbar epidural steroid injection was administered neck, lie was neurologically intact and thous_7ht to by Dr. Ratner on 12/13/01 and again on 1/31/02. have soft tissue injuries. Cervical MRI report dated 2/13/02 indicates disc EMG report of Dr. Steven Mandel dated 9/29/01 ©2.013 1 homson Reuters. No Claim to(trig, US Gov. Works. 2003 WI,25279i73 (E.D.Pa.) Page 3 bulging without herniation at ('5-6 as well as some motion, with sensitivity to touch of the skin on his minor spondylotic ridging at C4-5 and C6-7. back. Reflexes were sluggish but symmetrical. There was hypersensitivity and dysesthesias nil Right shoulder MR1 report dated 2/13/02 indicates over his lower extremities, with no evidence of at- , tendinitis and acromial spurring. rophy. There was give-way weakness of toe extens- ors. He was thought to have developed reflex sym- Report of Dr. Mandel dated 2/6/02 indicates corn- pathetic dystrophy, although 1 do not see that Dr. plaint of right shoulder and arm pain, as well as 1,ee actually described any objective findings of right 4th and 5th finger complaints. There was also this disorder, said to he some bowel incontinence. Muscle power was normal with no atrophy. Reflexes were normal Report of Dr. Freese dated 4/22/02 indicates a dis- and symmetric and sensation was said to he normal cogram was performed, hut, unfortunately, was as well. An EMG was performed and thought to positive at three levels such that surgery was not re- show evidence of bilateral cubital tunnel syndrome, commended. with findings consistent with, but not diagnostic ol right thoracic outlet syndrome. Report of Dr. Meller dated 5/27/02 disagrees with the conclusion of reflex sympathetic dystrophy. Report of Dr. Freese dated 3/7/02 indicates he had been forced to pursue work hardening which made Report of Dr. Lee dated 7/30/02 indicates that re- his back and right leg symptoms worse. Ilex sympathetic dystrophy or arthralgia does not always have consistent characteristics with every IME report of Dr. Meller dated 3/15/02 indicates patient, but he still felt that Mr. Coneys symptoms burning at the lumbar spine, both buttocks and pos- and findings were consistent with that diagnosis. tenor right thigh and calf, as well as symptoms in the right small finger, in addition to episodes of EUMINA 770/V: bowel and bladder incontinence. There were again positive Waddell's signs with range of motion im- Examination reveals Mr. Coney to be a well- proving when he. was distracted, as well as non- developed, well-nourished, generally healthy-ap- physiological tenderness, but normal objective clin- pearing, young, white male who was in no acute ical exam. Ile was felt to be fully resolved by ob- distress. He was alert and oriented with normal jective measures and could return to work, speech, language and memory. He moved slowly, with much moaning and groaning and shifting of Psychiatric report of Dr. Wolfram Reiger dated position. 4/2/02 indicates no diagnosable psychiatric dis- order. Cervical spine examination revealed subjective ten- derness to light palpation over right trapczius CT scan of the lumbar spine dated 4/9/02 was re- muscles without palpable spasm. There was no ten- ported to show disc degeneration at f.4-L5 and derness to light touch. There was markedly dimin- L5-S I, with a left paramedian nuclear herniation at ished cervical range of motion in all directions L4-L5 and a far right lateral nuclear herniation at when specifically tested, although at other times L3-L4 arid broad-based disc protrusion at L5-S I. when he was distracted, his cervical range of mo- tion was clearly much more complete. Orthopedic report of Dr. Bong Lee dated 4/16/02 indicates complaints of low back pain into the but- Lumbar spine examination revealed subjective ten- tocks and down the hack of both legs. lie had been derness to light palpation over right lower lumbar using a carte due to losing his balance and strength paraspinal muscles without associated spasm. There for the past few months. There was limited range of was no midline on left paralumbar tenderness, ©2013 Thomson Reuters, No Claim to Orig. LIS Gov. ■Vorks. 2003 WL 25279373 (L.D.Pa.) Page 4 'there was no tenderness whatsoever to light touch years following, a work injury that, by history, over the skin. There 111s markedly diminished sounds like a simple lumbar sprain and strain which lumbar range of motion in all directions, Ile corn- long since should have resolved, His vlR I scans re- planted of central low back pain with straight leg vealed pre-existing degenerative disc disease with raising at about 60 degrees on the right when tested associated herniations. supine, with similar complaints with bent leg rais- ing. At some ,oint afler his initial low back sprnin,111111 Examination of the spine and extremities revealed no asymmetry with regard to temperature, color, sweat, hair or nail pattern. Cranial nerves 2-12 were intact. Motor examination revealed diffuse mild give-way weakness throughout the right upper extremity, with no observable atrophy or objective weakness. in the right lower extremity, there was hardly any . There is effort offered whatsoever in any of the muscle no clinical evidence of any cervical or lumbosacrul groups, which he said were diffusely weak; yet, at radiculopathy or any peripheral nerve entrapment, other times, when 1 was testing range of motion, he There is no evidence to support the presence of any actually resisted my efforts, exhibiting good reflex sympathetic dystrophy, To my knowledge, strength until I asked him to relax. Again, there was there has never been described in the medical re- no observable atrophy. cords any dystrophic findings to support that dia- gnosis and the tenderness he repotted today was Tendon reflexes were I-- and symmetric in both up- only on palpation of the musculature and not with per limbs, 2! at both knees and ankles, with no light touch over the skin. Babinski signs. I urn at a loss to account for Dr. Bong Lee's repor- Sensory examination revealed subjective dimin- ted findings, and he is apparently the only one in- [shed pin prick in the right upper arm, but was oth- volved in Mr. Coney's treatment this past year and erwise intact and equal throughout all dermatomes one-half who has described such findins and in both upper and lower extremities. is clearly 1111111111110011111.111111100MiriMMINS" Cerebellar examination did not reveal dysmetria on IlinEWERMMINETEIM Finger to nose testing. From an objective standpoint, Mr. Coney has fully He ambulated slowly with the assistance of a cane recovered from the lumbar sprain he suffered as a held in his left hand, as well as wearing a lumbar result of the work injury on 6115/01. I can find no support, which he removed for the examination. He evidence that he sustained any other injury at any was able to undress himself independently, but time and any workup directed at his neck, shoulder asked for his wife's help to get himself dressed again, and upper extremity complaints is, in my opinion, unrelated to the work injury. His escalation and LIIPRESS/ON: spread of symptoms to different areas cannot be ex- plained on a physical basis and his examination Mr. Coney presents approximately one and one-hall t,2013 Thomson Reuters. No Claim to Orig. US Gov. Works 2003 WI.25279373 (E.D.Pa.) Page 5 today is dominated by findings of symptom magni- fication as had been reported by several previous examiners. I reiterate there is no evidence of any neurological disorder or, for that matter, any ongoing physical disorder attributable to the 6/15101 work injury and, specifically, no evidence to support the presence ot any reflex sympathetic dystrophy. All of the above opinions arc expressed within a reasonable degree of medical certainty. Thank you for the opportunity to evaluate Michael Coney today, and please feel free to contact ine it further questions remain. END OF DOCUMENT 2013 'Thomson Reuters. No Claim to Orie. US Goy. Work Westlaw 2002 WL 34695962 (Pa.Com.FI.) Page I Court of Common Pleas of Pennsylvania, 'nation of Mr DiFilippo, as well as review of avail- Chester County able medical records secured by your office. Mr. Daniel J. DI FILIPPO, DiFilippo was accompanied by Lois Campana, a v. nurse consultant from his attorney's office. Thomas M. MCCAFFERTY. No,200110378. HISTORY OF PRESENT ILLNESS: October 24, 2002, Mr. DiFilippo is a 35-year old man who claims he (Report or Affidavit of Lee J. Harris, M.D.) was injured in an automobile accident in January 2000. He states he was the unrestrained driver, of a Case Type: Vehicle Negligence>>Excessive Speed pickup truck approaching an intersection when an- Case Type: Vehicle Negligence Intersection other car ran a stop sign and T-boned his vehicle on Case Type: Vehicle Negligence >> Motor Vehicle the passenger's side, causing him to spin around v, Motor Vehicle and jump the curb. He states he hit his back on the Case Type: Vehicle Neel igence ..>>Stop Sign armrest and when getting out of the car a minute or Case Type: Vehicle Negligence *>•-, Negligent En- so later, he developed severe low back pain for trustment-Vehicle which he was evaluated in the emergency room, Case Type: Vehicle Negligence •>> Weather Con- treated and released. (Minns Jurisdiction: Chester County, Pennsylvania Mr. DiFilippo thereafter came under the care of a Name of Expert: Lee J. Han-is, M.D. chiropractor for low back pain with treatment in- Area of Expertise: Health Care-Physicians & eluding lumbar epidural injections. Ile states he Health Professionals>>Neurologist also treated with some other doctors, but cannot re- Representing: Unknown call the names and he still treats with a chiropract- or, the name of whom he could recall, who he last Linda Chaining saw about two weeks ago and treats with periodic- ally for flare-ups with adjustments. He is also en- Perspective Consulting, Inc. gaged in therapy which involves exercises at his gym. 35 Evansburg Road P/?/ESENT S POP TOMS: Collegeville, PA 19426 Mr, DiFilippo describes a constant nagging lower back pain with episodic sharp and severe pain Claim No: 664-19-4769-9 which knocks the wind out of him a couple times per week lasting a few seconds for no reason. The D01: 1/20100 pain is so severe that his legs crumble and he can't walk. This sharp pain is not triggered by any partic- PCI File No:28719 ular activity and could occur just sitting do nothing. His back pain is also aggravated by sitting for a Dear Ms. Gunning: long period of time Or other activities, such as va- cuuming. He describes a constant, numb tingling I had the opportunity to see Daniel DiFilippo for an feeling in the toes of both feet. Independent Neurologic Examination on October 22, 2002. The report includes interview and exam- Mr. DiFilippo denies any and all other symptoms ID 2013 Thomson Reuters. No Claim to Orig. US Coy. Works. 2002 Wt.34695962(Pa.Com.Pl.) Page 2 related to the accident When I specifically asked A number of handwritten chiropractic notes of Dr. him about problems with the neck and hands, he Carl C. I Tiller were reviewed, states that his neck bothers him "every now and then", but he does not consider this to be a signific- A report of Dr. Carl Goodman dated 12/15/00 in- ant problem for him. dicates that chiropractic treatment was not helpful and he continued to complain of low back pain with P,4ST MEDICAL HISTORY': spasms and tenderness in the lumbar spine. There was no mention of any cervical or other symptoms. Past medical history is otherwise unremarkable. He takes no regular medication, Ile indicates that he Handwritten notes from EMG dated 1/5/01 appear takes no pain medicine as he doesn't want to "cover to indicate left L4 and bilateral L5 radiculopathy, En it up", but wants to know if he is having the pain so reviewing the raw data from the EMG, there was no he can avoid doing what might be triggering it He active den ervation. states there is no prior history of accidents with in- juries and no prior history of any low back syn- Report of Dr. Lance Yarus dated 1/9/01 indicates a drome or chiropractic care before the accident chief complaint of low back pain. Ile also had neck pain, which recently developed and increases with SOCIAL HISTORY: activity, associated with left hand numbness_ Re- flexes in the upper limbs were normal with no setts- Social history reveals the claimant to be single and ory loss. There was some paracervical tenderness. living alone in a house. He states that he is cm- Reflexes were symmetrical in the lower extremities. ',toyed as a general contractor and missed three There was thought to he mild weakness of the right months from work and has since returned, but 110 great toe with some sensory Joss in the right leg longer does any heavy work and, instead, does compared to the left. more of the organizing and overseeing of the work. He states he no longer does weight training, which Physical therapy notes from MRCP were reviewed. he had done in the past, due to limitations related to his lower back. Report of Dr. Yarus dated 2/13/01 indicates follow- up regarding low back symptoms. There were neg- mEnK.:A I. RECORDS RE F7E'll/: alive sitting root signs. Reflexes remained symmet- ric, but he, again, had some sensory loss and weak- Chester County Hospital Emergency Department ness of the right great we. record dated 1/20/00 indicates the claimant's truck was broadsided without loss of consciousness. lie Report of Dr. Yarus dated 2/21/01 indicates low complained of low back pain with tingling in the back spasm as well as some tingling in the leh ansi feet. There was also stillness in the neck. X-rays of and both reel the cervical spine, left knee and lumbosacral spine revealed no abnormalities. He was treated and re- Orthopedic report of Dr. Randall Smith dated leased. 6/28/01 indicates constant low back pain with tingling in both legs. There was also neck pain with Report of MR1 of the lumbar spine dated 2/8/00 in- tingling in the upper extremities, tell greater than dicates mild disc desiccation of the three lower right lumbar discs with moderate broad central herni- ation at 1,3-4. mild to moderate left lateral protru- Report of MR1 of the cervical spine dated 7/19/01 sion at 1,4-1,5 and minimal central disc protrusion revealed mild spondyloticridging at C6-7 and to a at L5-St. lesser extent, C5-6, with no evidence of disc herni- ation. 10 2013 Thomson Reuters. No Claim to Orig. US Gov. Works 2002 WI_34695962 (Pa.Com.P1.1 Page 3 Report of Dr. Goodman dated 8/31/01 indicates that Sensory examination revealed subjective decreased his back pain remained a problem and he was also pin prick throughout the entire left lower extremity complaining of neck pain and was dropping things. compared to (he right from the upper thigh all the An EMG was performed and thought to show evict- way down to the toes. Sensation was intact in all ence of bilateral carpal tunnel syndrome as well as other dermatomes. Proprioception was intact bilat- bilateral C5 and right CO radicu tonality. erally. Neuroradiological review of lumbar MRI by Dr. F. Cerebellar examination did not reveal dysmetria on Joshua Barnett in a report dated 2/25/02 indicates finger to nose or heel to shin testing. minimal disc desiccation at L3-4 and LA-L5, with no evidence for disc herniation, He ambulated on a narrow base with arm swing, and was able to walk on both heels and toes, He Review of this same MRI by Dr. -rodd Siegel in a swayed to either right or left side with eyes closed report dated 9/12/02 reveals multi-level disc desic- in the Romberg position. cation in the lumbar spine with annular bulging rep- resenting a degenerative process, with no evidence INIPRESS7ON: of disc herniation at any level. Dr. Siegel also looked at the cervical spine and found evidence of Mr. Di Filippo presents almost three years following minimal bulging and no evidence of disc herni- an intersectional collision with complaints of per- ation. These changes were felt to be unrelated to the sistent low back pain as well as numbness in both accident in question. feet Today's neurologic examination revealed IIIII Specifically, there was no EXAM/NA PON: focal atrophy. weakness or reflex asymmetry to support the presence of any lumbosacral radiculo- Examination reveals Mr. DiFilippo to he a well- path). developed, well-nourished, generally healthy-ap- pearing. young, white male who was in no acute distress. He was alert, attentive and fully oriented . „ - with normal speech, language and memory. _ Lumbar spine examination revealed moderately di- minished range of motion in all directions, which While initial report of lumbar MRI indicated herni- was, in large part, voluntary as he was cautious ation and/or protrusion in the setting of disc desic- about not triggering any pain. There was no local- cation at a few levels, two independent neuroradi- ized lumbar tenderness or spasm. Straight leg rais- ologists reviewing the study indicate there was ing was negative to 80 degrees bilaterally, nothing other than degenerative change, with no evidence of disc herniation, If there was any evid- Cranial nerves 2-12 were intact. once of radiculopathy at one time, as reported on EMG, there is certainly no clinical evidence to sup- Motor examination revealed no rocal atrophy or port it at this time. There is also no evidence for muscle weakness in the upper or lower extremities any problems affecting the cervical spine or carpal and there was no pronator drift. tunnel and the claimant did not even have any symptoms referable to these areas at the present "fendon reflexes were It and symmetric in both up- time, nor were they evident for the first year fol- per limbs, 2+ at both knees and I at both ankles, lowing the injury,according to the medical records, with downgoing toes bilaterally. At this time, Mr. Di!'Hippo presents with persistent CO 2013 Thomson Reuters. No Claim to Orig. US Gov, Works, 2002 WI.34695962 (Pa.Com.PI.) Page 4 subject lumbar symptoms which do not correlate with any objective abnormalities of any ongoing physical disorder attributable to the January, 2000 automobile accident. The history of records reviewed does not reveal evidence of any pre-existing conditions or prior in- juries. The treatment tendered has been reasonable in so fir as evaluation and treatment for the lumbar spine. From t - ive standpoint, r. tippo continues to have low hack syndrome, which has limited his physical cap- abilities such that he has returned to work in a more or less lighi duty capacity. It would appear that maximum medical benefit tuts been reached and he only treats periodically now with a chiropractor as needed for flare-ups and no additional medical intervention is felt to he required Thank you for the opportunity to evaluate Daniel DiFilippo today, and please feel flee to contact me if further questions remain. END OF DOCUMENT t 20 13 Thomson Reuters. No Claim to Orig. US(joy, Works. __ - - u��'| �v'G����'S' �N� �~'`/ ' Willie Nlathis v. Exel Inc. and Edward Ramos; 2007 Jury Verdicts U,EXIS 36893 U0A}01758 August 30. 2007 Headline: Truck Exited Line ^fParked Vehicles, Caused('rash: Plaintiff Published Date: ZO08'0]'2y Topic: Motor Vehicle Tractor-Trailer ' Motor Vehicle - Parking Lot Injury: 5pnoJy|hia.Arthritis Slate: Pennsylvania Court: Philadelphia Court of Common Pleas Plaintiff Counsel Thomas ]. Duffy Firm Name: Duffy & Keenan Address: Philadelphia, PA Plaintiff Name: (Willie Mathis) Kenneth I', Fulginiti Firm Name: Duffy and Keenan Address: Phi|ade|yb.o. PA Plaintiff Name: (Willie Mathis/ Defendant Counsel David F. White Firm Name: Marshall, 8eumhey, Warner, Coleman & Gov:gin Address: King of Prouxio. PA Defendant Name: (Edward Ramos, Exel inc,) Judge: Eugene Maier Case Summary On April 19, 2004, ilain11 Willie Mathis, a 41-year-old truck driver, was driving his tractor through Exel Incorpo- rated's rated's parking lot,jn North Philadelphia.when a jockey truck,being operated by Mervin Sanders,emerged from in be- tween two parked tractors and hit the passenger side portion of Mathis' tractor between the side door and the wheel base. The force of the collision caused Mathis to become jolted around inside the cabin of his tractor. Mathis sued the owner of the jockey truck, Exel Inc., Westerville, Ohio, and one of its employees that plaintiff's cnux' mlkdiomd m be the controller of yard operations at the site, Edward Kuom», for negligent operation of a motor ve- hido. Plaintiff's counsel argued that Exel wa fully liable tor the collision because Matins was di wing his tractor in a lane des- *muted for travel in its parking lot when the jockey truck exited a line of parked tractors along the side of the travel lariL' and struck Mathis' tractor, Injury Text: Following &ccvUidvn. Mathis hcpn` experiencing tremendous pain in his spine. He visited an orthopedist who de- /enoio*d that he had aggravated a dormant genetic condition called ankylosing xp"nUyUtis' commonly referred to :is hamhoo spine. Pl:ii it ill'.s riiirrsel argued that,once person develops arikylosirtg,spondylttis.the spine hardens cans- it caus- ing them serious buck pain for the reni:tinderof their lie. Plaintiff's counsel usscnud that the collision in Exel'x park- ing |mmg,4,red Nlatkis' m/kyk~inxspmndyhtisand he required over 150 spinal injections, ranging from nerve Nncux, epidurals and |yd"rxive, up m 'hc time of trial. Plaintiff's counsel that Mathis would require that type of treatment for the mm of his life and he would never he able to work again, Om11121 sought to recover Page 2 of 3 Willie Mathis v. Exel Inc. :ind Edward Ramos; 2007 Jury Verdicts LEX1S 36893 $450,000 for the worker's compensation lien for Mathis' past medical treatment. SI million for future medical dam- ages to provide Mathis with ongoing injections and aqua therapy, $1.5 million for Mathis past and future wage loss damages and unspecified damages for past and future pain and suffering. Counsel for the defendant argued that Mathis didn't sustain and injury because the x-rays, EMGs and MRIs of his back didn't display so much as a herniated disc in the area where Mathis' claimed to have been injured.1111111111111 0111.111=111111111111.111111111111E00111101.11 Insurer: Liberty Mutual for both defendants Plaintiff Expert(s) Daniel Hopkins. Ph.D. Address: West Conshohocken, PA Specialty: Economics Affiliation; Kenneth Fulginiti, Thomas Duffy Dennis MI. M.D. Address: Upland, PA Specialty: Physical Medicine Affiliation: Kenneth Fulginiti, Thomas 1-)utiv Irene C. Mendelsohn Address: Penn Valley, PA Specialty: Vocational Rehabilitation/CounselMg Affiliation: Kenneth Fulginiti, Thomas Duffy Leonard Popovich, D.O. Address: Philadelphia, PA Specialty: General Practice Affiliation: Kenneth'Fulginiti, Thomas Duffy Stuart Kauffman, D.O. Address: Philadelphia. PA Specialty: Pain Management Affiliation: Kenneth Fulginiti. Thomas Duffy 1111111111.11111111111 Joe Bernstein, M.D. Address: Philadelphia, PA Specialty: Orthopedics Affiliation: David White Address: Abington, PA Specialty: Neurology Affiliation: David White Stephen Schorr Address: Philadelphia, PA Specialty: Accident Investigation & Reconstruction/ Failure Analysis/Product Liability Affiliation: David White Stephen Thomas, M.D. Address: Pittsburgh. PA Specialty: Anesthesia Affiliation: David White Award: S 3,750,000 MELAINE SHELLENHAMMER Page 9n[3 Willie Mathis v. Exd Inc. and Edward Ramos; 2007 Jury Verdicts LEXIS 36893 Award Details: Four days intO the trial the puries agreed to a settlement whereby Eel paid Mathis $375000O. 7 A �Y � �� 7� � �� ?~ � � A � �~ „� rdi x /n0c Media*°pe^.= uz All Rights Reserved Further duplication without permission/"prohibited vord/cmeap:» wmnsylmni"ncpn*Vol.5 MG[-A|N8BRELLBN(|ANk46K 4iitLexisNexis. David Thomas and Nancy Lanard vs. Lorraine Levin; 2005 Jury Verdicts LEX1S 44838 03-1 )219 April 14, 2005 Headline: Rear-ender Caused Neck and Shoulder Injuries for Couple Published Date: 2005-06-06 Topic: Motor Vehicle - Rear-ender Injury: Neck, Shoulder, Cervical Strain, Cervical Strain, Radiculopathy, Radiculopathy State: Pennsylvania Court: Montgomery County Court of Common Pleas Plaintiff Counsel Louis Jay Arnold Firm Name: Louis Jay Arnold Law Offices Address: Philadelphia, PA Plaintiff Name: (David Thomas, Nancy Lanard) Defendant Counsel Philip Farber Address: Philadelphia, PA Defendant Name: (Lorraine Levin) Judge: Arthur Tolson Case Summary On Feb. 22, 2002, plaintiff David Thomas. 58, a business owner, was driving down Norristown Road in Maple Glen with a passenger.plaintiff Nancy Lanard, 52, an attorney. Thomas brought his BMW 740 model to a gradual stop to make a left turn and was rear-ended by another BMW 740 driven by Lorraine Levin, who did not see or realize that Thomas's vehicle was stopped in front of her, Injury Text: Both plaintiffs went to the emergency room at Abington Memorial Hospital in suburban Philadelphia after the crash, Thomas claimed an impingement in his left shoulder and cervical radiculopathy. Stuart Trager, an orthopedic sur- geon hired by the defense.examined`i'homas and opined that some of his injuries were related to the car crash. Lanard claimed neck in'tiries and cervical radiculopathy. They barb had extensive physical therapy following the collision. Thomas and Lanard did not seek medicals, as they were all reimbursed by their insurer. They did claim an unspeci- fied amount of damages for pain and suffering and loss of enjoyment of life. Trial Length Post 'Trial Status 111st1rci': All-State MFLAINF SIILLLLNI-IAMMER Page 2 of 2 David Thomas and Nancy Lanard vs. Lorraine Levin: 2005 Jury Verdicts LEXIS 44838 Plaintiff Expert(s) Jennifer Chu. 114.D Address: Philadelphia, PA Specialty: Psychiatric Evaluations Affiliation: Louis Arnold Richard Kaplan Address: Philadelphia. PA Specialty: Psychiatry Affiliation: Louis Arnold Richard Mandel, M.D. Address: Philadelphia, PA Specialty: Orthopedic Surgery Affiliation: Louis Arnold Defendant Expert(s) Lee Harris, M.D. Address: Abington. PA Specialty: Neurology Affiliation: Philip Farber Stuart Trager, M.D. Address: Philadelphia, PA Specialty: Orthopedic Surgery Affiliation: Philip Farber Award: $ 75,000 Award Details: Judge Arthur Tilson handed down a judgement for the plaintiffs, awarding Thomas$35,000 and La- nard $40,000, Before trial, the parties entered into a high-low agreement. For Thomas the high was $75,000 and the low was $25,000. Fur Lanard the high was $75,000 and the low was $15,000. VVERDICT „ h www.verdicisearch.comiindex.isb Copyright 2012 ALM Media Properms, 1.1,C, All Rights Reserved Further duplication svithinit permission is prohibited VerdicLScarch Pennsylvania Rower Vol 2 MELAINE SHELLENFIAMNIFiff ex sNex i s George Fudala ,Jr. and Annette Fudala v. Gianni Fiocca and Mark Pokotilow; 2008 Jury Verdicts LEXIS 30083 060402743 March 26, 2008 Deadline: Man Sustained Ll Endplate Fracture in Rear-ender Published Date: 2008-07-05 Thpic: Motor Vehicle - Rear-ender- Motor Vehicle - Lane Change - Motor Vehicle- Speeding - Motor Vehicle - Sud- den Emergency Defense Injury: Fracture, LI, Loss of Consortium, Epidural Injections, Rhizotorny, Chiropractic. Physical Therapy State: Pennsylvania Court: Philadelphia Court of Common Pleas Plaintiff Counsel Joseph M. DeSimone Firm Name: I..aw Office of Joseph M. DeSimone PC Address: Bensalem, PA Plaintiff Name: (Annette Fudala Defendant Counsel Harry B. Gosnear Firm Name: Britt, Hankins & Moughan Address: Philadelphia, PA Defendant Name: (Gianni Fiocca) H. Joseph Byron Firm Name: McCormick & Priore PC Address: Philadelphia, PA Defendant Name: (Mark Pokotilow) Judge: Frederica Massiah-Jackson Case Summary On May 16, 2004, plaintiff George Fudala Jr., 43, a repair technician, was driving his sedan in the left-hand east- bound lane of Woodhaven Road in Trevose. He had slowed for traffic just past the Millbrook Road Overpass when he was struck from behind by a sedan driven by Gianni Fiocca. Fudala sustained back injuries in the collision. After hitting Fudala's right rear bumper with his driver's side front end, Fiocca's sedan entered the right eastbound lane and struck a vehicle that was stopped behind Mark Pokolilow's car. Pokotiliow's car was disabled and partially blocking the eastbound lane of traffic at the time of the accident. Fudala sued Fiocca for negligent operation d a motor vehicle and also tiled a negligence claim against Pokotilow. Fu- dala's spouse filed a loss of consortitim claim. Fudala's counsel alleged that Fiocca was fully responsible for the collision because he was speeding and faded to keep a clear distance. from Fudala's vehicle. He also alleged Pokotilow was liable for the collision because he failed to direct his vehicle out of the Lute of traffic after sustaining a flat tire. Fiucca alleged that Fudala caused the collision when he turned in front of him into the right-hand lane of south- bound Woodhaven Road. Claiming the sudden emergency defense, Fiocca's counsel asserted that there was no way for Fiocca to avoid striking Fudala. Injury Text: • .MELA1NE SHELLENHAMMER Page 2 of 3 George.9udn(uJr. and Annette Podnu v. Gianni Floccnuxd Mark Pnkmi|vw; 7008 Jury Verdicts LEXIS 30083 Two days after the collision,Iudala left work and visited his general physician in response to pain in his back.The phy- sician referred him to multiple doctors, including a chiropractor, neurological surgeon and orthopedist, all of wisotit treated Fudala br art LI endplatc fracture over the course of eight riiunths.Pluirnitis'counsel contended that Fudala also had to undergo physical therapy sporadically for four months. a well its epidural injcciionsand rbiznwmy to ease his nerves. Counsel presented x $|7.oOOczocomedical lien into damages. Counsel also alleged Fvd,|u sustained 39.000 in past lost wages while he was undergoing treatment because he missed one week of wor itinediately upon heeiinrng inj tired arid several hundred Flours ul work while receiving treat- merit. He placed the total number of time h`da\v was out of work at 480 hours. He also sought to recover unspeci- fied damages b,rPndx(u's past and future pain and m0fering. . �. ,,. Trial Length Jury Deliberation Jury Poll Post Trial Status Insurer: State Facto for Fiocca Erie for Pokotilow BiainUffRxppf$> Francis K1cCuffrny, D.C. Address: Philadelphia, K^ Specialty: Chiropractic A# |iatiw, ]use `DeSimwnc Leonard A. Dmnn. M,D. Address: I luntingdon Valley. PA Specialty: Neurosurgery Affiliation: De Sitnone Defendant Expert(s) Andrew Shacr, MD. Address: Phuladel ph a. PA Specialty: Radiology A0|kuiox� R Byron, Gosnear Lee (tunis, M.D. Address: Abirigruti. PA Specialty: Neurosurgery Affiliation: B. Uymo, HaoyGo+/uor Award: $ 82.50O Award Details: The jury Found Fivccu 60 percent liahle and Pudo|x 40 percent liable kx/hu collision, George Fu' dirla was awarded$55,000 in damage and Annette Fvdxa was awarded 8J7,50V The plaintiffs' total recovery,after re- ductions fur comparative negligence, was $49.500. [ A - ^°°mu�oomoumun��°' Page 3 of 3 George Fudala Jr. and Annette Fudala v. Gianni Fincea and Mark Pokotilow; 200S Jury Verdicts LEXIS 30083 Copyright 2012 AINI Media Propetties,LLC. All Rights Reserved Further duplication without permission is prohibited Verdict Search Pennsylvania Reporter VOL 5 'MELA INT; SHELL iEN HAMMER • LexisNexis• Allen Burke v. Edward McGough; 2006 Jury Verdicts LEX1S 46398 050300014 August OK, 2006 Headline: Minor Crash Resulted in Lumbar Herniation, Radieulopathy: Plif Published Date: 2000-09-30 Topic: Motor Vehicle- Left Turn - Motor Vehicle - Intersection - Motor Vehicle - Stop Sign Injury: Herniated Disc, Lumbar, Radiculopathy, Leg State: Pennsylvania Court: Court of Common Pleas, Philadelphia County Plaintiff Counsel Marc F. Greenfield Firm Name: Rand Spear & Associates. Address: Philadelphia. PA Plaintiff Name: (Allen Burke) Defendant Counsel K. Reed Haywood Firm Name: MeKissock & Iloffman Address: Philadelphia, PA Defendant Name: (Edward Mc Gough) Judge: Joseph I. Papalini Case Summary On Feb. 8, 2004, plaintiff Allen Burke, a clerical worker in his mid-30s, was driving westbound on Marlborough Street in Philadelphia through its intersection with Gerard Avenue when the rear passenger side of his car was struck by the front of a car driven by Edward McGough. He was attempting to turn left onto westbound Marlborough Street front Gerard Avenue. Claiming injuries, Burke sued Mc Gough for negligent operation of a motor vehicle. Plaintiff's counsel contended that the accident was Mc Gough's fault because Burke had the right of way, and Mc Gough, who was facing a stop sign, made his left turn too early before traffic was clear. Injury Text: Burke claimed a herniated disc in his lumbar area, and a radiculopathy condition that radiated pain into his right leg. Burke treated withphysical therapy and trigger point injections, lis out-of-pockei medical costs were $2,149. Burke sought pain and suffering damages, contending that the back and leg pain prohibited him from playing soccer and basketball once or twice per week as he'd been accustomed. Moreover, he could not sit for long periods of time, which negatively impacted his experience at work. Trial Length MELAINE SHELL ENHAMMER Page 2 of 2 Allen Burke v. Edward Mc Gough: 2006 Jury Verdicts LEXIS 46398 4.0 days Plaintiff Expert(s) Stephen [ichi` 80D. Address: Philadelphia, PA Specialty: Radiology Affiliation: Marc Greenfield Other Expertls) Address: Abington, PA Specialty: Neurology Affiliation: K. Haywood Todd OcDo|, M.D. Address: Philadel Specialty: Neuroradiology Affiliation: K. Haywood Award: $ 0 Award Details: The jury found that Burke did not suffer a serious impairment to a bodily function, and declined Lu give an award. The parties stipulated before trial that Mc Gough would pay Burke's medical costs worth 52.149. j''/ V E R D l C 7` S F All Rights Reserved Furthet duplication without perm/mor is prohibited *rd/pu"rcx Pennsylvania Vol,s \4E.A|NB 8OULLCN8AM>iER ��K�"v�S�4�X�S' n�� ^^~' ' Christopher Amuso v. Kathleen Holland; 2013 Jury Verdicts LEX1S 7163 2O||'DD5m May 3|. J0!3 Headline: Plaintiff: Collision Caused Ongoing Neck, Back Injuries Published Date: ZO|3~0'29 Topic: Motor Vehicle Rear-ender - Motor Vehicle Weather Conditions Injury Bulging Disc,Cervical, Bulging Disc, Lumbar, Strains and Sprains, Steroid [njocUo^, Physical Therapy Radicular Pain /Radiculitis. Racliciilopitliy. Arm, Leg, Numbness. Head. Myofascial Syndrome State: Pennsylvania Court: Montgomery County Court of Common P1ctm Plaintiff Counsel 'John LA,<^ Firm Name: Lowenthal and Abrurns. �C Address: Philadelphia, PA Plaintiff Kane: (Christopher Amuso, Christopher Amos()) Defendant Counsel Lui`uEDmzUi Firm Name: Hvhshmun & Flood Address: Plymouth Meeting. PA Defendant Name: (Kathleen Holland) Judge: Thunias C. Branca Case Summary Un March 2' 2O09. plaintiff Christopher Amuuo. ]7. 0 car dcw,!c,. was operating u van ^n Route 4Z2io Upper Provi- dence Ih°oship,whvothcreuroihi^vehic|e°a`^uockh>/huou,v[uYo/kswagenPuxuutupxmtodhyQam|cvuHo- \xod. 8o||and had hit a patch airc which caused her sedan w start spinning and strike Amuoo's van. The impact caused Ammo's van to spin out of control and exit the roadway /" the right, where it came to a rest on the shoul- der. Holland's Passat continued to spin m the \r0 and her vehicle came to a rest on the roadway's shoulder, Anmso claimed that upon impact he struck his head on the driver's side window, and he continued to jostle about in the van "dale it spun vn the roadway. He alleged that he suffered bulging discs to his neck and back. Ammo sued Holland, alleging negligent operation of a motor vehicle. The parties entered into a high-low agreement of$100`000'$10.000. Awum'n counsel argued that HN|*nddm,c too fast for the icy and snowy conditions, and pointed to how Amu," drove over the same icy patch without incident, Injury Text: The next day.Amoco, complaining of neck and low-hack /,um, presented to an emergency mom where he was exam- ined and told to follow up with an orthopedic surgeon. He then followed up with an orthopedic surgeon who recom- mended injections; however. Amuso declined the treatment and sought opinions front a neurosurgeon and pain- management specialist. who both suggested physical therapy. In May 2009.6musv underwent an \Ju| of his lumbar spine. which reportedly showed bulging from L2-3 to L4-5. An NRT in June allegedly revealed bulging otC4'5. From Aug. 10 to Sept. 16. 2(09. Amoco treated with eight sessions of physical |hempy In addition to the bulges. he was diagnosed with strains and sprains, mdim|npvdy/n his cervical and lumbar^mmc, myvfao iu} pain syndrome MLA LINE SHELLENH AMMER Page 2 of 3 Christopher Amoco ,. Kathleen Holland; 2013 Jury Verdicts L£%|S 7)6} m those areas, and ncn|Oia pan*/huico to his upper left thigh regiun.in which he experienced numbness. In fall 2009.6muxv moved to California, and he claimed thai for the next year he continued to experience pain and limita- tions in his neck and back, but did not seek treatment or his condition. On March 2, 20 Am u so preset ted to an it hoped i c sot geot i wl to treated h iii wi On March 2, 2011,Amuso presented to an orthopedic.surgeon who tretited him with pain medication Ii pa in nedic at km an ci whom he con- ooucdtvse*/hwug,hNn,unterinDecemb,r,Amtisn moved to Aricona twhere he resided at the time of trial).lii Janti- my 2012. he presented to a poin'nmnagcmcn/ specialist, who rnovioceU 8mm^mundergo steroid injen|om' which he did (a 1.0u| ^| /.^" ,c,^im", In his neck and back) though August 2012. Amusoxuxgummcovorvabpm|,tedammto[*43.744.88iop,stm*dicn| open*s. Dnmogesk`rh'mr* medkn/ *x' pmnseuwumoms^upoc Pursuant to the high-low agreement, the parties agreed to rely on reports submitted by medical professionals instead of live /uuimony.Amum`'s counsel cited his treating physicians' records as well as a report submitted by his pain- management specialist(Ajay Narwani), who concluded in his report that Amuov would require periodic visits mn spe- cialist k/rpni/meJicmi0000Jinjevhnnshnthc/xmofhis|i6.Accovdin8 Ammo's neurosurgeon,the m,ndX|upur- oubecica, a permanent condition, was caused by the seat belt constricting a nerve in his upper leg. Amosumuid that he experiences pain rvo,y day and relies on pain medication in order to function. Um claimed that hcisunuNc 'vra|kmdri,o\nngdixtancma,drnonotuh [vr)oogprdndom[hmowi,hmoupchewcingimoeosedis- comfort. According to Aoum", if he attempted the physical activities (fishing, &pifiog, weightlifting, horseback rid- i^g) that he enjoyed ym-accdeo/' he would he out of commission for at least two days. He sought to recover an un- specified amount in 000'pom`omie damages for past and future pain and suffering. .�- . �` `,^.` ���_=�� .`'�^�.'—.`�.����-~.~^�� � , � __-_ - - _ `�~~~+^.. Trial Length Jury Deliberation Jury Poll PLAINTIFF NAME PROPERTY AWARD Christopher Anion $ 148.745 Insurer: Plaintiff Amounts: (Christopher Amuso) &43.745 Personal ho,y: pmt Medical Cost $100,000 Personal Injury: pai is a id suffering Plaintiff Expert(s) • Harold J. Gos(g. MD. Address: Reading, Specialty: Physical Medicine Affiliation: treating doctor,did not testifyper aOmeenient between parties,records read into evidence by plaintifrs coun- sel. John Aris James T. H= M.D. Address: Wyomissing, PA Specialty: Pain Management Affiliation: treating doctor, did not teaihpnragreement between pxrt(`x, records read into evidence by pliuntifls coun- sel, ]omAh, Lance O. Yxnn, D,O. V[LA/NESHDLLENH,A61&tEK Page 3 of 3 Christopher Ammo v. Kathleen Holland; 2013 Jury Verdicts LLX13 7163 Address; Leha on, PA Specialty: Orthopedic Surgery A{fiiioh'm: treating J`ctv« (lid not /c^/ifyp«r agreement between parties, records r id ii to cv d rice by ph ii in If'S Cnuu' *j. JohnAris Craig II, Johnson, K8D. Address: West Reading, PA Specially: Affiliation: treating doctor,did not testifyper agreement between parties,records read into evidence by plaintiff's coun- sel, Joh"Ado Ajay M. Nu,wuoi, M.D. Address: Chandler. AZ Specialty: Pain Management Affiliation: treating doctor. did not testifyper agreement between parties, report read into evidence by plaintiff's coun- sel, JohnAd^ _^.^°.~.. Address:Abington, PA Specialty: Neurology Affiliation: did not testifyper agreement between parties, report read into evidence by defense counsel, 1.,uisa 8un`Ui Award: $ l43,745 Award Details: The jury found that Holland was negligent and that her negligence was a factual cause of harm to Arouxn, who was awarded $143`744.88 in damages. The award was molded to $100,000 pursuant to the parties' high -low agreement, "� p� Copyright Media Properties, uc All Rights Reserseil Further u .mw.w/xm^permission is prohibited VerrlietSeareh Weekly CERTIFICATE OF SERVICE I hereby certify that on this ,., Ot,DA day of December, 2013, a true and correct copy of the foregoing document was served by means of United States mail, first class, postage prepaid, upon the following: John A. Statler, Esquire Johnson, Duffle, Stewart & Weidner 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 :Li".D--OFFICE Johnson, Duffie, Stewart&Weidner 20 14 DEC V V PH 1 L: V 0 By:John A. Statler, Esquire CUMBERLAND COUNTY I.D. No. 43812 P E N N S Y LVA N I AAttorneys for Defendants 301 Market Street P. O. Box 109 Lemoyne, Pennsylvania 17043-0109 (717) 761-4540 jas @jdsw.com AMANDA M. GREENE, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. CIVIL ACTION — LAW NO. 10-7609 ERIE INSURANCE EXCHANGE, JURY OF 12 PERSONS DEMANDED Defendants RESPONSE OF DEFENDANT ERIE INSURANCE EXCHANGE TO PLAINTIFF'S MOTION TO COMPEL ANSWERS TO PLAINTIFF'S FIRST SET OF INTERROGATORIES AND PLAINTIFF'S FIRST REQUEST FOR PRODUCTION OF DOCUMENTS AND NOW, comes Defendant Erie Insurance Exchange, by and through its attorneys, Johnson, Duffie, Stewart &Weidner, P.C., who file the following response to the Plaintiff's Motion to Compel Answers to Plaintiff's First Set of Interrogatories and First Request for Production of Documents: 1. It is admitted that Plaintiff commenced suit by filing a Complaint on or about August 16, 2011. The averments in the Complaint speak for themselves. This Honorable Court by Order dated January 10, 2012, approved a Stipulation of the parties to sever and stay the Plaintiff's bad faith claim in this case. 2. It is admitted that the Plaintiff claims to have suffered bodily harm and injuries as a result of a motor vehicle accident that occurred on December 20, 2007. It is further admitted that the Plaintiff claims to continue to suffer from the effects of the injuries allegedly sustained in that accident. 3. Denied as stated. It is specifically denied that Defendant hired Dr. Lee Harris to support a defense in this matter. Rather, Dr. Harris was asked to perform an independent medical evaluation of the Plaintiff. It is admitted that the independent medical evaluation was performed on August 12, 2013. 4. Denied as stated. It is denied that Dr. Harris attempted to undermine each of the Plaintiffs injury claims. It is admitted that Dr. Harris stated that the Plaintiff's carpal tunnel syndrome had only a questionable causal relationship to the motor vehicle accident. It is further admitted that Dr. Harris stated that Plaintiff's diagnosis of multi focal pain and tenderness which has been diagnosed by her treating physicians as fibromyalgia, a widespread pain disorder of unknown etiology, rests exclusively on subjective criteria pain and tenderness with no objective markers. It is further admitted that Dr. Harris stated that Ms. Greene sustained a closed head injury with scalp laceration at the time of the December 20, 2007 accident, and her subsequent report of worsening of her pre-existing migraine syndrome could provide historical support for post-traumatic headache disorder or aggravation of migraine based on subjective criteria. It is further admitted that Dr. Harris stated that Ms. Greene's persistent chronic pain complaints are not well explained on the basis of any objective criteria, of which there are none. It is further admitted that Dr. Harris stated that neurological examination of Amanda Greene revealed no objective abnormalities. He further stated that her report of widespread subjective tenderness to light touch, as well as the diffuse give-away weakness could reflect either symptom magnification or emotional overlay. It is specifically denied that Dr. Harris completely disregarded all of the Plaintiff's medical problems and ignored the effect that the accident had on the Plaintiff's life. 2 5. It is admitted that Plaintiff propounded a First Set of Interrogatories and First Set of Request for Production of Documents Directed to Defendant in which Plaintiff sought information about Dr. Harris's prior work as a medical expert. 6. Admitted. 7. Admitted. 8. Admitted. 9. Denied. It is specifically denied that a significant pattern of compensation supports Plaintiff's belief that Dr. Harris's report is slanted in favor of the Defendants. It is further denied that the Plaintiff has produced ample evidence which provides reasonable grounds to believe that Dr. Harris is a professional witness. 10. It is admitted that in a 2010 deposition, Dr. Harris stated that he has earned approximately $100,000 per year performing independent medical examinations and providing deposition testimony. In that deposition, he stated that he performs approximately ten independent medical examinations per month and one to two depositions per month. Clearly, that is a very small portion of Dr. Harris's work as a physician. A complete copy of Dr. Harris's Curriculum Vitae is attached hereto as Exhibit A. Dr. Harris is the Chief of Neurology at Abington Memorial Hospital in Abington, Pennsylvania. The vast majority of his time is spent as a practicing physician and not performing IMEs or attending depositions. While Dr. Harris testified that he is retained by Defendants in 90% of the cases in which he provided litigation services, he also testified that there have been many occasions where he has been hired by an attorney to evaluate someone who has been injured in an accident and, in fact, he provided the opinion that the person was in fact injured. Dr. Harris further stated that he gives his opinion regardless of whether it is helpful to the person who has hired him. (See Deposition of Dr. Harris, page 24, Exhibit B to Plaintiff's Motion to Compel.) 3 11. Denied as stated. It is denied that Dr. Harris sought to undermine the medical claims. of the injured Plaintiff in the reports attached to the Plaintiff's Motion as Exhibit C. Rather, Dr. Harris gave his opinions regarding the injuries sustained in the particular accident and the subsequent symptoms and disabilities that could be causally related to the injuries sustained in the accident. It is further denied that the opinions of Dr. Harris are "predictable." 12. It is specifically denied that the Plaintiff has demonstrated that Dr. Lee J. Harris is a professional witness and further denied that the Plaintiff has met her burden of justifying additional discovery regarding Dr. Harris under the standards set forth in Cooper v. Schoffstall. 13. Defendant requests this Honorable Court to deny the Plaintiff's Motion to Compel Defendant's to answer interrogatories and produce documents relating to the services of Dr. Harris as requested in Plaintiff's First Set of Interrogatories and First Request for Production of Documents Directed to Defendant. WHEREFORE, Defendant Erie Insurance Exchange respectfully requests this Honorable Court to deny the Plaintiff's Motion to Compel Answers to Plaintiff's First Set of Interrogatories and First Request for Production of Documents. Respectfully submitted, JOHN FFIE, STE BART &WEIDNER By: John A. Statler, Esquire Attorney I.D. No. 43812 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Attorneys for Defendants DATE: `?.mil Z� 1 Erie Insurance Exchange 598472 4 EXHIBIT A f I Lee J. Harris, M.D. Chief,Neurology Division Abington Memorial Hospital 1245 Highland Avenue,Suite 301 2325 Maryland Road,Suite 120 Abington,PA 19001 Willow Grove,PA 19090 Phone 215-886-7000,Fax 215-887-1471 Phone 215-957-9250,Fax 215-957-9254 Academic Degrees B.A.—Biopsychology, Vassar College,Poughkeepsie,NY 1979 M.D.—Albert Einstein College of Medicine, Bronx,NY 1984 Residency and Internship Internship—Internal Medicine, Montefiore, Hospital, Albert Einstein College 1984-1985 Of Medicine, Bronx,NY Resident—Neurology,Neurological Institute of New York, Columbia 1985-1988 Presbyterian Medical Center,New York,NY Chief Resident—Neurology,Neurological Institute of New York, Columbia 1987-1988 Presbyterian Medical Center, New York,NY Fellowships Clinical Neurophysiology—Neurological Institute of New York, Columbia 1988-1989 Presbyterian Medical Center,New York,NY Certifications Neurology—American Board of Psychiatry and Neurology 1989 Clinical Neurophysiology—American Board of Clinical Neurophysiology 1989 Examiner Clinical Neurophysiology Boards 1991 Electrodiagnostic Medicine—American Board of Electrodiagnostic Medicine 1995 Licensure Pennsylvania—MD-043442-E t Appointments Clinical Associate Professor(adjunct reappointment)—Department of Neurology, 2009- Temple University School of Medicine, Philadelphia, PA Clinical Assistant Professor(adjunct reappointment)—Department of Neurology, 1991-2009 Temple University School of Medicine, Philadelphia, PA Clinical Instructor(adjunct appointment)—Department of Neurology, 1989-1991 Temple University School of Medicine, Philadelphia, PA Assistant Attending Neurologist—Department of Neurology, Harlem Hospital, 4988-1989 New York,NY Clinical Instructor—Neural Science Course, College of Physicians and Surgeons, 1986-1987 Columbia University,New York,NY Research Assistant—Department of Neurophysiology, Rockefeller University, 1979-1980 New York,NY Current Hospital Affiliations Abington Memorial Hospital --Abington, PA Senior Physician Chief,Neurology Division Associate Director,Neurosciences Institute Medical Director,EEG Lab Medical Director,Abington Balance Center Stroke Committee Member Awards Philadelphia Magazine's Top Doctors(Neurology) 1999 General and Departmental Honors—Biopsychology, Vassar College, 1979 Poughkeepsie,NY Phi Beta Kappa—Vassar College, Poughkeepsie,NY 1979 Chemistry Prize—Vassar College, Poughkeepsie,NY 1978 Presentations Introduction to Neurology for the Medical Resident Evaluation of Stupor and Coma Evaluation and Treatment of Stroke Neurophysiological Testing 1� Emergency Room Management of Headache Headache Management for the Family Physician Migraine-Hormonal Influences Epilepsy Diagnosis and Management Peripheral Neuropathy Guillain-Barre Syndrome Advances in Parkinson's Disease Parkinson Disease Update and Use of Stalevo Restless Legs Syndrome-Diagnosis and Treatment Carpal Tunnel Syndrome and Related Upper Extremity Nerve Entrapments EMG and Nerve Conduction Studies Evaluation and Treatment of Diabetic Neuropathy Multiple Sclerosis-Importance of Early Diagnosis and Treatment Multiple Sclerosis-The EVIDENCE Trial Multiple Sclerosis-Patient Education Symposiums Local speaker for Bayer Multiple Sclerosis-Patient Education Symposiums Local speaker for Biogen-current Multiple Sclerosis-Copaxone Head-to-Head Trials Teva National Speaker Bureau-current Multiple Sclerosis-Rebif Patient Education Speaker Seronno Local and National Speaker Bureau Multiple Sclerosis-Gilenya Physician and Patient Education Speaker Novartis Regional Speaker Bureau-current Alzheimer Disease Update and Use of Namenda Alzheimer Disease-Use of Exelon Patch in the Long Term Care Setting Alzheimer Disease-Screening and Diagnosis Research Activities Ocrelizumab in Comparison to Rebif for Relapsing Multiple Sclerosis 2011- IMS-III Interventional Management of Stroke 2011- POINT Platelet-Oriented Inhibition in New T1A and Minor Ischemic Stroke 2010- STRATIFY 2 to assess the prevalence of JCV antibodies in MS patients 2010-2011 ELAN trial of oral ELND005 vs placebo in patients with mild to moderate 2008- Alzheimer Disease ELAN trial of IV Bapineuzemab vs placebo in patients with mild to moderate 2008- Alzheimer Disease ALIAS Albumin in Acute Stroke 2007- IRIS Insulin Resistance in Ischemic Stroke 2006-2010 NABSCOUNT Neutralizing Antibodies in Multiple Sclerosis 2006-2008 PROFESS Aggrenox vs Plavix for secondary stroke prevention 2004-2006 CHANT Cerebral Hemorrhage And NXY-059 Treatment 2004-2006 i i l s 3 i t SAINT II (NXY-0029)Acute Stroke Study 2004-2006 ONO Acute Stroke Study 2003 Compliance Assessment for Reminyl (CARE) Study: Assessment of Reminyl 2001 for the treatment of Alzheimer's Disease Argatroban In Acute Ischemic Stroke(ARGIS-1) 2001-2002 Intravenous Magnesium Efficacy in Stroke (IMAGES)Trial: A Randomized,2001 Double-Blind, Placebo-Controlled Trial of Intravenous Magnesium Sulfate in Acute Stroke VITATOPS: Vitamins to Prevent Stroke 2001 U.S. Migraine Assessment Protocol III (USMAPIII): Protocol observing 2001-2002 efficacy and tolerability of Maxalt in the treatment of migraine headache Blockade of the GP IIB/IIIA Receptor to Avoid Vascular Occlusion (BRAVO) 1999-2001 An Open-Label, Long-Term Observational Study of the Safety and 2000-2001 Tolerability of Sumatriptan Nasal Spray in the Treatment of Migraine in Adolescents (SMART)U.S. Migraine Assessment Protocol II(USMAPII): Protocol observing 2000 efficacy and tolerability of Maxalt in the treatment of migraine headache A Randomized Double-Blind,Parallel Group, Single-Attack Evaluation of 2000 Sumatriptan 50 mg and 100 mg Versus Placebo During a Migraine Headache at The First Sign of Pain A Double-Blind, Placebo-Controlled Safety, Efficacy and Dose Response Trial 1998-1999 of three Intravenous Doses of BMS-204352 The Effects of 2000 mg of Citicholine on Clinical Outcome and the Evolution 1998-1999 of Lesion Volume in Human Stroke Multicenter Study to Evaluate the Safety and Efficacy of Intravenous 1997-1999 Fosphenytoin in Patients with Acute Ischemic Stroke Thrombolytic Therapy in Acute Ischemic Stroke(ATLANTIS): Compound 1996-1998 Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke Clinical Evaluation of Donepezil for the Treatment of Alzheimer Disease 1996-1998 Professional Societies American Academy of Neurology t American Association of Electrodi agnostic Medicine Philadelphia Neurological Society { Pennsylvania Neurological Society National Multiple Sclerosis Society i 4 7 .._ I CERTIFICATE OF SERVICE HEREBY CERTIFY that I served a true and correct copy of the foregoing Stipulation upon all parties or counsel of record by depositing a copy of same in the United States Mail at Lemoyne, Pennsylvania, with first-class postage prepaid on the Z-7 day of December, 2013, addressed to the following: David B. Dowling, Esquire Rhoads & Sinon, LLP One South Market Square, 12`h Floor P. O. Box 1146 Harrisburg, PA 17108-1146 JOHNS UFFIE, STEWART &WEIDNER By: John A. Statler, Esqu Attorney I.D. No. 43812 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Attorneys for Defendant AMANDA M. GREENE, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. ERIE INDEMNITY COMPANY; : NO. 2010—7609 CIVIL TERM ERIE INSURANCE EXCHANGE, : And ERIE INSURANCE GROUP, : Defendant • ORDER OF COURT AND NOW, this 611-1 day of JANUARY, 2014, a Rule is entered upon Defendants' to Show Cause why the Plaintiffs Motion to Compel should not be granted. Rule returnable twenty (20) days after service. If Defendant files a response we will conduct an evidentiary hearing on Thursday,February 13,2014, at 11:00 a.m. in Courtroom# 3 to give Plaintiff the opportunity to satisfy the threshold requirements of Cooper v. Schoffstall, 905 A.2d 482 (Pa. 2006). By ti ._ou , Edward E. Guido, J. avid B. Dowling, Esquire For the Commonwealth A. Statler, Esquire For the Defendant nI �� �� * l Court Administrator — �,J --; �� :sld Coxi*ex AMANDA M. GREENE, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. ERIE INDEMNITY COMPANY; : NO. 2010—7609 CIVIL TERM ERIE INSURANCE EXCHANGE; : AND ERIE INSURANCE GROUP, : Defendants ORDER OF COURT AND NOW, this 18TH day of FEBRUARY, 2014, after conference with counsel, and with their agreement that an evidentiary hearing is not necessary and having heard argument on the issue, Plaintiff's Motion to Compel is GRANTED. Defendant shall provide and serve full and complete answers and responses, without objection, to Plaintiff's Interrogatories and Document Requests within twenty (20) days of this Order. B e Court Edward E. Guido, J. /id B. Dowling, Esquire Box 1146 Harrisburg, Pa. 17108 John A. Statler, Esquire 301 Market Street P.O. Box 109 Lemoyne, Pa. 17043 c-y • sld rn rzs rri rz eeri.E.S Mad tr_r_L) cZ) /02. / t,0 r xa. David B. Dowling, Esquire Attorney 1.D. No, 25452 RHOADS & S[NON LLP 1 South Market Square, 12th Floor P.O. Box 1146 Harrisburg, PA 17108-1146 (717) 233-5731 Attorneys for Plaintiff AMANDA M. GREENE Plaintiff V. ERIE INDEMNITY COMPANY; ERIE INSURANCE EXCHANGE; and ERIE INSURANCE GROUP Defendants II (.2,11/1BL. I-16 A fy : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : CIVIL ACTION - LAW : NO. 10-7609 : JURY TRIAL DEMANDED PRAECIPE TO MARK THE ACTION SETTLED, DISCONTINUED AND ENDED TO THE PROTHONOTARY: Please mark the above captioned matter Settled, Discontinued and Ended upon payment of your costs only. Respectfully submitted, RHOAD & S1NON LLP David B. Dow ing One South Market Squa P. 0. Box 1146 Harrisburg, PA 17108-1146 (717) 233-5731 Attorney for Plaintiff CERTIFICATE OF SERVICE I hereby certify that on this 20th day of May, 2014, a true and correct copy of the foregoing document was served by means of United States mail, first class, postage prepaid, upon the following: John A. Statler, Esquire Johnson, Duffle, Stewart & Weidner 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 ot/n-1,t_ Cynthia L. Santone