HomeMy WebLinkAbout11-3926IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL DIVISION
Plaintiff(s) & Address(es)
James L. Adams and '
Teresa M. Adams
10 East South Street
Franklintown, PA 17323
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Case No.
- Civil Term
VS.
Civil Action
Defendant(s) & Address(es)
Erie Insurance . --
100 Erie Insurance Place
Erie, PA 16530 N, c
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PRAECIPE FOR WRIT OF SUMMONS )>
TO THE PROTHONOTARY/CLERK OF SAID COURT:
Issue summons in the above case
Writ of Summons shall be issued and forwarded to Attorn Sheriff. Ci c ch c
Date Signature of Attorney
Print Name: David A. Baric, Esquire
Address: 19 West South Street
Carlisle, PA 17013
Telephone #: (717) 249-6873
Supreme Court ID Number: 44853
TO: Erie Insurance
• • • • •
WRIT OF SUMMONS
YOU ARE NOTIFIED THAT THE ABOVE-NAMED PLAINTIFF(S) HAS/HAVE COMMENCED AN
ACTION AGAINST YOU. L'(4
of on Jerk, C vil Division
Date: 7-a?] -? ? by
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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
JAMES L. ADAMS and THERESA M. ADAMS
Plaintiffs
vs.
ERIE INSURANCE
Defendant
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CERTIFICATE PREREQUISITE TO SERVICE
OF SUBPOENAS PURSUANT TO RULE 4009.22
As a prerequisite to service of subpoenas for documents and things pursuant to Rule 4009.22,
Defendant, Erie Insurance, certifies that:
(1) A Notice of Intent to Serve the Subpoenas with copy of the Subpoenas attached
thereto was mailed or delivered to each party at least twenty (20) days prior to the date on which the
Subpoenas are sought to be served,
(2) A copy of the Notice of Intent, including the proposed Subpoenas, is attached to this
Certificate,
(3) The attorney for the Plaintiff has not filed any objections, and
(4) The Subpoenas which will be served are identical to the Subpoenas which are
attached to the Notice of Intent to Serve the Subpoenas.
GRIFFITH, STRICKLER, LERMAN,
SOLYMOS & CALKINS
BY
Ann Margaret Grab, Es q%611) #55986
Attorney for the Defendant, Erie Insurance
110 South Northern Way
Dated: August 4, 2011 York, PA 17402 (717) 757-7602
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
JAMES L. ADAMS and THERESA M. ADAMS 11-3926 Civil Term
Plaintiffs
vs.
ERIE INSURANCE
Defendant
NOTICE OF INTENT TO SERVE SUBPOENAS TO PRODUCE
DOCUMENTS AND THINGS FOR DISCOVERY PURSUANT TO RULE 4009.21
Ann Margaret Grab, Esquire, counsel for Defendant, Erie Insurance, intends to serve
Subpoenas identical to the ones that are attached to this Notice. You have twenty (20) days from the
date listed below in which to file of record and serve upon the undersigned an objection to the
Subpoenas. If no objection is made, the Subpoenas may be served.
Date:
GRIFFITH, STRICKLER, L ERMAN,
SOLYMOS & CALKINS
BY: J'?'
ANN MARGARET GRAB, ESQUIRE
Supreme Court I.D. No. 55986
Attorney for Defendant, Erie Insurance
110 South Northern Way
York, PA 17402
(717) 757-7602/(717) 757-3783 fax
amgrab@gslsc.com
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
JAMES L. ADAMS and THERESA M. ADAMS 11-3926 Civil Term
Plaintiffs
vs.
ERIE INSURANCE
Defendant
SUBPOENA TO PRODUCE DOCUMENTS OR THINGS
FOR DISCOVERY PURSUANT TO RULE 4009.21 - 4009.27
TO: Dan Dixon
402 East Old York Road
Carlisle, PA 17013
Within twenty (20) days after service of this Subpoena, you are ordered by the Court to produce the
following documents or things:
All records in your possession pertaining to any services (labor, materials, equipment and
fixtures) you serviced, provided or work performed at any properties owned, operated
and/or leased by James L. Adams from January 1, 2006, up to and including the present
time at any of his rental properties, including but not limited to labor, time records,
invoices, purchase orders, receipts for materials, equipment or fixtures, contracts, etc.
at Griffith, Strickler, Lerman, Solymos & Calkins, 110 S. Northern Way, York, PA 17402-3737
You may deliver or mail legible copies of the documents or produce things requested by this Subpoena,
together with the certificate of compliance, to the party making this request at the address listed above.
You have the right to seek, in advance, the reasonable cost of preparing the copies or producing the things
sought.
If you fail to produce the documents or things required by this Subpoena, within twenty (20) days after its
service, the party serving this Subpoena may seek a Court Order compelling you to comply with it.
THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON:
NAME: Ann Margaret Grab, Esq.
ADDRESS: GRIFFITH, STRICKLER, LERMAN, SOLYMOS & CALKINS
110 South Northern Way, York, PA 17402
TELEPHONE: (717) 757-7602
SUPREME COURT ID: 55986
ATTORNEY FOR: Defendant. Erie Insurance
BY THE COURT:
DATE:
Seal of Court Prothonotary / Clerk, Civil Division
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
JAMES L. ADAMS and THERESA M. ADAMS 11-3926 Civil Term
Plaintiffs
VS.
ERIE INSURANCE
Defendant
SUBPOENA TO PRODUCE DOCUMENTS OR THINGS
FOR DISCOVERY PURSUANT TO RULE 4009.21 - 4009.27
TO: Fred Fetrow
2010B Pine Grove Road
Fayetteville, PA 17222
Within twenty (20) days after service of this Subpoena, you are ordered by the Court to produce the
following documents or things:
All records in your possession pertaining to any services (labor, materials, equipment and
fixtures) you serviced, provided or work performed at any properties owned, operated
and/or leased by James L. Adams from January 1, 2006, up to and including the present
time at any of his rental properties, including but not limited to labor, time records,
invoices, purchase orders, receipts for materials, equipment or fixtures, contracts, etc.
at Griffith, Strickler, Lerman, Solymos & Calkins, 110 S. Northern Way, York, PA 17402-3737
You may deliver or mail legible copies of the documents or produce things requested by this Subpoena,
together with the certificate of compliance, to the party making this request at the address listed above.
You have the right to seek, in advance, the reasonable cost of preparing the copies or producing the things
sought.
If you fail to produce the documents or things required by this Subpoena, within twenty (20) days after its
service, the party serving this Subpoena may seek a Court Order compelling you to comply with it.
THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON:
NAME: Ann Margaret Grab, Esq.
ADDRESS: GRIFFITH, STRICKLER, LERMAN, SOLYMOS & CALKINS
110 South Northern Way, York, PA 17402
TELEPHONE: (717) 757-7602
SUPREME COURT ID: 55986
ATTORNEY FOR: Defendant, Erie Insurance
BY THE COURT:
DATE:
Seal of Court
Prothonotary / Clerk, Civil Division
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
JAMES L. ADAMS and THERESA M. ADAMS 11-3926 Civil Term
Plaintiffs
vs. :
ERIE INSURANCE
Defendant
CERTIFICATE OF SERVICE
AND NOW, this W` day of , 2011, 1, Ann Margaret Grab, Esquire, a
member of the firm of GRIFFITH, STRICKLER, LERMAN, SOLYMOS & CALKINS, Esquires,
hereby certify that I have, this date, served a copy of Notice of Intent to Serve Subpoenas by
United States Mail, addressed to the party or attorney of record as follows:
David A. Baric, Esquire
Baric & Scherer
19 W. South Street
Carlisle, PA 17013
GRIFFITH, STRICKLER, LE AN,
SOLYMOS & CALKIN
BY: b
Ann Margaret Grab, Esquire
Attorney for Defendant, Erie Insurance
Supreme Court I.D. #55986
110 South Northern Way
York, Pennsylvania 17402
(717) 757-7602/(717) 757-3783 fax
amgrabggslsc.com
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
JAMES L. ADAMS and THERESA M. ADAMS 11-3926 Civil Term
Plaintiffs
vs.
ERIE INSURANCE
Defendant
CERTIFICATE OF SERVICE
AND NOW, this 41h day of August, 2011, I, Ann Margaret Grab, a member of the firm of
GRIFFITH, STRICKLER, LERMAN, SOLYMOS & CALKINS, hereby certify that I have this date
served a copy of Certificate Prerequisite to Service of Subpoenas Pursuant to Rule 4009.22 by
United States Mail, addressed to the party or attorney of record as follows:
David A. Baric, Esquire
Baric & Scherer
19 W. South Street
Carlisle, PA 17013
(Counsel for Plaintiff)
GRIFFITH, STRICKLER, LERMAN,
SOLYMOS & CALKINS
i
f
By
Ann Margaret Grab, IIJ No 55986
Attorney for Defendant, Erie Insurance
110 S. Northern Way
York, PA 17402
(717) 757-7602
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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
JAMES L. ADAMS and THERESA M. ADAMS
Plaintiffs
VS.
ERIE INSURANCE
Defendant
11-3926 Civil Term--,
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CERTIFICATE PREREQUISITE TO SERVICE
OF SUBPOENA PURSUANT TO RULE 4009.22
t?
As a prerequisite to service of subpoena for documents and things pursuant to Rule 4009.22,
Defendant, Erie Insurance, certifies that:
(1) A Notice of Intent to Serve the Subpoena with copy of the Subpoena attached thereto
was mailed or delivered to each party at least twenty (20) days prior to the date on which the
Subpoena is sought to be served,
(2) A copy of the Notice of Intent, including the proposed Subpoena, is attached to this
Certificate,
(3) The attorney for the Plaintiff has not filed any objections, and
(4) The Subpoena which will be served is identical to the Subpoena which is attached to
the Notice of Intent to Serve the Subpoena.
GRIFFITH, STRICKLER, LERMAN,
SO MO$ & C S
.1
BY
Ann Margaret Grab, Esquire ID #55986
Attorney for the Defendant, Erie Insurance
110 South Northern Way
Dated: August 16, 2011 York, PA 17402
(717) 757-7602/(717) 757-3783
amgrab@gslsc.com
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
JAMES L. ADAMS and THERESA M. ADAMS 11-3926 Civil Term
Plaintiffs
vs.
ERIE INSURANCE
Defendant
NOTICE OF INTENT TO SERVE SUBPOENA TO PRODUCE
DOCUMENTS AND THINGS FOR DISCOVERY PURSUANT TO RULE 4009.21
Ann Margaret Grab, Esquire, counsel for Defendant, Erie Insurance, intends to serve a
Subpoena identical to the one that is attached to this Notice. You have twenty (20) days from the
date listed below in which to file of record and serve upon the undersigned an objection to the
Subpoena. If no objection is made, the Subpoena may be served.
GRIFFITH, STRICKLER, LERMAN,
SOLYMOS & CALKINS
BY:
ANN MARGARET GRAB, ESQUIRE
Supreme Court I.D. No. 55986
Attorney for Defendant, Erie Insurance
110 South Northern Way
?y York, PA 17402
Date: (717) 757-7602/(717) 757-3783 fax
amgrab@gslsc.com
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
JAMES L. ADAMS and THERESA M. ADAMS 11-3926 Civil Term
Plaintiffs
vs.
ERIE INSURANCE
Defendant
SUBPOENA TO PRODUCE DOCUMENTS OR THINGS
FOR DISCOVERY PURSUANT TO RULE 4009.22
To: Dr. Howard J. Zlotoff, Zlotoff, Gilfert & Gold 3600 Trindle Road Camp Hill PA 17011
(Name of Person or Entity)
Within twenty (20) days after service of this Subpoena, you are ordered by the Court to produce the
following documents or things:
Any and all office notes, reports, records, memoranda, correspondence, diagnostic tests
and/or reports, consultation reports, x-rays, progress notes, hospital records, nurses
notes, admission and discharge summaries and records and reports of examinations,
billing and billing records and any other medical records of any kind from January 1, 1990
to the present pertaining to James L. Adams, date of birth: 2/22/59.
at Griffith, Strickler, Lerman, Solymos & Calkins, 110 S._ Northern Wav. York, PA 17402-3737
(Address)
You may deliver or mail legible copies of the documents or produce things requested by this Subpoena,
together with the certificate of compliance, to the party making this request at the address listed above.
You have the right to seek, in advance, the reasonable cost of preparing the copies or producing the
things sought.
If you fail to produce the documents or things required by this Subpoena, within twenty (20) days after its
service, the party serving this Subpoena may seek a Court Order compelling you to comply with it.
THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON:
NAME: ANN MARGARET GRAB, ESQ.
ADDRESS: GRIFFITH, STRICKLER, LERMAN, SOLYMOS & CALKINS
110 South Northern Way, York, PA 17402
TELEPHONE: (717) 757-7602
SUPREME COURT ID: 55986
ATTORNEY FOR: Defendant. Erie Insurance
BY THE COURT:
DATE:
Seal of Court Prothonotary / Clerk, Civil Division
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
JAMES L. ADAMS and THERESA M. ADAMS 11-3926 Civil Term.
Plaintiffs
vs.
ERIE INSURANCE
Defendant
CERTIFICATE OF SERVICE
AND NOW, this ;' `?f day of , f , 2011, I, Ann Margaret Grab, Esquire, a
member of the firm of GRIFFITH, STRICKLER, LERMAN, SOLYMOS & CALKINS, Esquires,
hereby certify that I have, this date, served a copy of Notice of Intent to Serve Subpoena by United
States Mail, addressed to the party or attorney of record as follows:
David A. Baric, Esquire
Baric & Scherer
19 W. South Street
Carlisle, PA 17013
GRIFFITH, STRICKLER, LERMAN,
SOLYMOS & CALKINS
BY:
Ann Margaret Grab, 8quire
Attorney for Defendant, Erie Insurance
Supreme Court I.D. #55986
110 South Northern Way
York, Pennsylvania 17402
(717) 757-7602/(717) 757-3783 fax
amarabggslsc.com
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
JAMES L. ADAMS and THERESA M. ADAMS 11-3926 Civil Term
Plaintiffs
vs.
ERIE INSURANCE
Defendant
CERTIFICATE OF SERVICE
AND NOW, this 16`h day of August, 2011, I, Ann Margaret Grab, a member of the firm of
GRIFFITH, STRICKLER, LERMAN, SOLYMOS & CALKINS, hereby certify that I have this date
served a copy of Certificate Prerequisite to Service of Subpoenas Pursuant to Rule 4009.22 by
United States Mail, addressed to the party or attorney of record as follows:
David A. Baric, Esquire
Baric & Scherer
19 W. South Street
Carlisle, PA 17013
(Counsel for Plaintiff)
GRIFFITH, STRICKLER, LERMAN,
SOLYMOS & CALKINS
By: jez? I - -, -..
Ann Margaret Grab, ID . 55986
Attorney for Defendant, Erie Insurance
110 S. Northern Way
York, PA 17402
(717) 757-7602/(717) 757-3783 fax
amgrab@gslsc.com
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
JAMES L. ADAMS and THERESA M. ADAMS
Plaintiffs
vs.
ERIE INSURANCE
Defendant
11-3926 Civil Term
CERTIFICATE PREREQUISITE TO SERVICE
OF SUBPOENA PURSUANT TO RULE 4009.22
?.-... A '•r1
As a prerequisite to service of subpoena for documents and things pursuant to Rule 4009.22,
Defendant, Erie Insurance, certifies that:
(1) A Notice of Intent to Serve the Subpoena with copy of the Subpoena attached thereto
was mailed or delivered to each party at least twenty (20) days prior to the date on which the
Subpoena is sought to be served,
(2) A copy of the Notice of Intent, including the proposed Subpoena, is attached to this
Certificate,
(3) The attorney for the Plaintiff has not filed any objections, and
(4) The Subpoena which will be served is identical to the Subpoena which is attached to
the Notice of Intent to Serve the Subpoena.
GRIFFITH, STRICKLER, LERMAN,
7YSOMOS & C S
BY
Ann Mazgazet Grab, ire ID #55986
Attorney for the Defendant, Erie Insurance
110 South Northern Way
Dated: October 25, 2011 York, PA 17402
(717) 757-7602/(717) 757-3783
amgrab@gslsc.com
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
JAMES L. ADAMS and THERESA M. ADAMS 11-3926 Civil Term
Plaintiffs
vs.
ERIE INSURANCE
Defendant
NOTICE OF INTENT TO SERVE SUBPOENA TO PRODUCE
DOCUMENTS AND THINGS FOR DISCOVERY PURSUANT TO RULE 4009.21
Ann Margaret Grab, Esquire, counsel for Defendant, Erie Insurance, intends to serve a
Subpoena identical to the one that is attached to this Notice. You have twenty (20) days from the
date listed below in which to file of record and serve upon the undersigned an objection to the
Subpoena. If no objection is made, the Subpoena may be served.
GRIFFITH, STRICKLER, LERMAN,
SOLYMOS & CALKINS
BY:
ANN MARGARET GRAB, ESQUIRE
Supreme Court I.D. No. 55986
Attorney for Defendant, Erie Insurance
110 South Northern Way
J ' York, PA 17402
Date: / (717) 757-7602/(717) 757-3783 fax
amgrab@gslsc.com
dr
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
JAMES L. ADAMS and THERESA M. ADAMS 11-3926 Civil Term
Plaintiffs
VS.
ERIE INSURANCE
Defendant
SUBPOENA TO PRODUCE DOCUMENTS OR THINGS
FOR DISCOVERY PURSUANT TO RULE 4009.22
To: Erie Insurance
4901 Louise Drive
Rossmoyne Business Center
P.O. Box 2013
Mechanicsburg, PA 17055-0710
Within twenty (20) days after service of this Subpoena, you are ordered by the Court to produce the
following documents or things:
Complete first-party benefits file pertaining to James L. Adams, date of birth: 2122159,
date of accident 11/09/07, including but not limited to application for benefits, medical
records, any payout sheet for medical and wage loss benefits paid, medical bills, medical
reports, peer review reports, photographs, statements, claim notes, declaration page
and/or coverage information reflecting first-party benefits coverage and tort election,
documents submitted in support of or in payment of property damage claims, and any other
documentation in your files.
at Griffith, Strickler, Lerman, Solvmos & Calkins, 110 S. Northern Wav. York. PA 17402-3737
(Address)
You may deliver or mail legible copies of the documents or produce things requested by this Subpoena,
together with the certificate of compliance, to the party making this request at the address listed above.
You have the right to seek, in advance, the reasonable cost of preparing the copies or producing the
things sought.
If you fail to produce the documents or things required by this Subpoena, within twenty (20) days after its
service, the party serving this Subpoena may seek a Court Order compelling you to comply with it.
THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON:
NAME: ANN MARGARET GRAB, ESQ.
ADDRESS: GRIFFITH, STRICKLER, LERMAN, SOLYMOS & CALKINS
110 South Northern Way, York, PA 17402
TELEPHONE: (717) 757-7602
SUPREME COURT ID: 55986
ATTORNEY FOR: Defendant, Erie Insurance
BY THE COURT:
DATE:
Seal of Court Prothonotary / Clerk, Civil Division
r
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
JAMES L. ADAMS and THERESA M. ADAMS 11-3926 Civil Term
Plaintiffs
vs.
ERIE INSURANCE
Defendant
CERTIFICATE OF SERVICE
yyii ???
AND NOW, this +' day of (S?'?4t) , 2011, I, Ann Margaret Grab, Esquire, a
member of the firm of GRIFFITH, STRICKLER, LERMAN, SOLYMOS & CALKINS, Esquires,
hereby certify that I have, this date, served a copy of Notice of Intent to Serve Subpoena by United
States Mail, addressed to the party or attorney of record as follows:
David A. Baric, Esquire
Baric & Scherer
19 W. South Street
Carlisle, PA 17013
GRIFFITH, STRICKLER, LERMAN,
SOLYMOS & CALKINS
BY:
Ann argaret Grab, Esquire
Attorney for Defendant, Erie Insurance
Supreme Court I.D. #55986
110 South Northern Way
York, Pennsylvania 17402
(717) 757-7602/(717) 757-3783 fax
am rab&gslsc.com
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
JAMES L. ADAMS and THERESA M. ADAMS 11-3926 Civil Term
Plaintiffs
VS.
ERIE INSURANCE
Defendant
CERTIFICATE OF SERVICE
AND NOW, this 25 h day of October, 2011, I, Ann Margaret Grab, a member of the firm of
GRIFFITH, STRICKLER, LERMAN, SOLYMOS & CALKINS, hereby certify that I have this date
served a copy of Certificate Prerequisite to Service of Subpoenas Pursuant to Rule 4009.22 by
United States Mail, addressed to the party or attorney of record as follows:
David A. Baric, Esquire
Baric & Scherer
19 W. South Street
Carlisle, PA 17013
(Counsel for Plaintiff)
GRIFFITH, STRICKLER, LERMAN,
SOLYMOS & CALKINS
By:
Ann Margaret Grab, ID No.
Attorney for Defendant, Erie Insurance
110 S. Northern Way
York, PA 17402
(717) 757-7602/(717) 757-3783 fax
amgrab@gslsc.com
;_
~.
JAMES L. ADAMS,
TERESA M. ADAMS,
Plaintiffs
v.
ERIE INSURANCE,
Defendant
_ -_ i
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO.2011-3926 CIVIL TERM
CIVIL ACTION-LAW
So.
PRAECIPE TO REMAIN QPEN ~~ ~
~~ -v
TO THE PROTHONOTARY: ~~ ~
~., ~ ;r~
Please mark this matter to remain open. ..`iK a~a
Settlement discussions remain ongoing between the parties.
Respectfully submitted,
BARIC SC R LLC
Date: August 28, 2012
David A. Baric, Esquire
I.D. 44853
19 West South Street
Carlisle, Pennsylvania 17013
(717) 249-6873
_ __
I
CERTIFICATE OF SERVICE
I hereby certify that on August 28, 2012, I, David A. Baric, Esquire of Baric Scherer L
did serve a copy of the Praecipe To Remain Open, by first class U.S. mail, postage prepaid, to
party listed below, as follows:
Ann Margaret Grab, Esquire
Griffith, Strickler, Lerman, Solymos & Calkins
110 South Northern Way
York, Pennsylvania 17402
L t;
David A. Baric, Esquire
JAMES L. ADAMS, IN THE COURT OF COMMON PLEAS OF
TERESA M. ADAMS, CUMBERLAND COUNTY, PENNSYLVANIA
Plaintiffs
V. NO. 2011-3926 CIVIL TERM
ERIE INSURANCE, CIVIL ACTION-LAW
Defendant
NOTICE
You have been sued in court. If you wish to defend against the claims set forth irihe
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 an 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 OR CANNOT AFFORD ONE, 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, Pennsylvania 17013
(717) 249-3166
JAMES L. ADAMS, IN THE COURT OF COMMON PLEAS OF
TERESA M. ADAMS, CUMBERLAND COUNTY, PENNSYLVANIA
Plaintiffs
V. NO. 2011-3926 CIVIL TERM
ERIE INSURANCE, CIVIL ACTION-LAW
Defendant
COMPLAINT
NOW, come Plaintiffs, James L. Adams and Teresa M. Adams, by and through their
attorneys, BARIC SCHERER LLC, and file the within Complaint and, in support thereof, sets
forth the following:
1. Plaintiffs, James L. Adams and Theresa M. Adams, are adult individuals currently
residing at 10 East South Street, Franklintown, Pennsylvania.
2. Defendant, Erie Insurance ("Erie"), is believed to be a corporation engaged in the
insurance business, which is qualified to business within the Commonwealth of
Pennsylvania, having a principal office at 4901 Louise Drive, Mechanicsburg,
Cumberland County, Pennsylvania.
3. At all times relevant hereto, Plaintiffs were the owners of a certain motor vehicle
which was an insured vehicle under a policy of insurance issued by Defendant,
identified as policy no. Q08-1510130 ("Insurance Policy"). The Insurance Policy
is attached hereto as Exhibit "A" and incorporated herein by reference.
4. The Insurance Policy contained an "Uninsured/Underinsured Motorist Coverage"
which provided coverage for the recovery of damages for bodily injury from the
operator of an underinsured motor vehicle.
5. On or about November 9, 2007, Plaintiff, James L. Adams ("Mr. Adams") was
seriously injured in a motor vehicle accident directly and proximately caused by
the negligence of an underinsured motorist on York Road, Monroe Township,
Cumberland County, Pennsylvania.
6. The underinsured motorist was negligent for failing to operate a motor vehicle at
an unsafe speed in violation of 75 Pa.C.S.A. §3361.
7. As a direct and proximate result of the negligence of the underinsured motorist,
Mr. Adams sustained an (a) achilles tendonitis injury, (b) left knee injury and
pain, (c) left foot pain and broken bone, and (d) right knee injury and pain
requiring four surgeries.
Mr. Adams settled his claim for the policy limits with the carrier for the
underinsured driver with the consent of Defendant in August of 2008.
9. As a direct and proximate result of the aforementioned motor vehicle accident,
Mr. Adams has required medical treatment and has incurred expenses in
connection therewith for medicines, medical care, surgery and other medical
services for which a claim is hereby made.
10. As a direct and proximate result of the aforementioned motor vehicle accident,
Mr. Adams has suffered in the past, continues to suffer and may in the future
continue to suffer aches and pains for which a claim is hereby made.
11. As a direct and proximate result of the aforementioned motor vehicle accident,
Mr. Adams has in the past been and may in the future be unable to perform his
usual duties, occupations and avocations with a consequent loss of earnings,
earning power and earning potential for which a claim is hereby made.
12. Mr. Adams has presented a claim for underinsured motorist benefits to Defendant
and they have denied the amount requested.
COUNT I BREACH OF CONTRACT
13. Paragraphs one (1) through twelve (12) are incorporated herein and made part.
hereof as if stated in full.
14. Plaintiffs entered into an insurance contract with the Defendant as identified in
Exhibit A.
15. Plaintiffs have paid all premiums due under the Insurance Policy.
16. Plaintiffs have performed all conditions precedent necessary to the recovery of
said uninsured motorist benefits, and has complied fully with the claim
procedures and requirements set for in the Insurance Policy.
17. Defendant has breached its contract with Plaintiffs by rejecting Plaintiffs' claim
for uninsured motorist benefits.
18. Defendant has breached its contract with Plaintiff by failing to pay Plaintiff
medical expenses that were a direct and proximate result of the aforementioned
motor vehicle accident.
19. As a direct and proximate result of Defendant's breach of contract, Plaintiff has
sustained, and will continue to sustain, economic injuries in excess of fifty
thousand dollars ($50,000.00).
WHEREFORE, Plaintiffs demand judgment against Defendant for compensatory and./or
consequential damages allowed by law, together with interest, costs of court, and other such
relief as this Honorable Court deems just and proper.
Date: Z q It 3
Respectfully submitted,
B RIC SCHEIR LLC
David A. Baric, Esquire
I.D. 44853
19 West South Street
Carlisle, Pennsylvania 17013
(71.7) 249-6873
VERIFICATION
The statements in the foregoing Complaint are based upon information which has been
assembled by my attorney in this litigation. The language of the statements is not my own. l
have read the statements; and to the extent that they are based upon information which I have
given to my counsel, they are true and correct to the best of my knowledge, information and
belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §
4904 relating to unsworn falsifications to authorities.
DATE:
ames L. Adams
DATE:
Teresa M. Adams
' Policy 408-1510130 Declaration effective 10/10/2007
ERIE®
ERIE INSURANCE EXCHANGE
FAMILY AUTO POLICY
AMENDED DECLARATIONS 03 * * EFFECTIVE 10110/07
ATTACH THIS TO YOUR POLICY.
REASON FOR AMENDMENT - FIRST PARTY BENEFITS COVERAGE AMENDED
AA7888 DEIBLER INS. ASSOC. INC 08/15/07 TO 08115/08 Q08 1510130
JAMES L ADAMS 6 AS LISTED BELOW
TERESA M ADAMS
P 0 BOX 82
FRANKLINTOWN PA 17323-0082
AGENT - DEIBLER INS. ASSOC. INC 26 WESTMINSTER DRIVE
AGENT PHONE - (717) 241-2775 CARLISLE PA 17013 4368
* 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 DD?
1 00 CHEV SILVERADO 1GCEK14V7YE295155 PA 4F C ALAS-M MM48
2 06 CHEV IMPALA SS 2G1WD58C369193147 PA 4F G P A3AL-M FM44
3 06 GULF STREAM CANYO 1NLlYFP2771070455 PA 4F 12
4 93 CHEV PICKUP1500 1GCEK14K9PE135010 PA 4F AlAS-M MM48
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 $ #1 #2 #3 #4
*****GOOD DRIVER RATES APPLY*****
--- THE FULL TORT OPTION APPLIES TO ALL PRIVATE PASSENGER VEHICLES. ---
LIABILITY PROTECTION-
BODILY INJURY $300M/PERSON $300M/ACC 77 110 83
PROPERTY DAMAGE $100M/ACC 52 77 58
FIRST PARTY BENEFITS-
MEDICAL EXPENSE $100M 74 87 87
INCOME LOSS $5M/MONTH, $100M MAXIMUM 37 44 43
ACCIDENTAL DEATH $25M 4 5 5
FUNERAL BENEFIT $2.5M 2 1 2
UNINSURED MOTORISTS COVERAGE-
BOD INJ $300M/PERSON $300M/ACC-UNSTACKED 21 21 21
UNDERINSURED MOTORISTS COVERAGE-
BOD INJ $300M/PERSON $300M/ACC-UNSTACKED 107 107 107
PHYSICAL DAMAGE COVERAGES-
COMPREHENSIVE - $0 DED 48 107 365
COLLISION - $100 DED 104 234 116
OPTIONAL COVERAGES-
ROAD SERVICE 4 4 5
TOTAL ANNUAL PREMIUM FOR EACH AUTO 530 797 486 406
TOTAL ANNUAL POLICY PREMIUM $ 2,219
ADDITIONAL CHARGE DUE TO THIS CHANGE $ 89
ITEM 6. APPLICABLE POLICY, ENDORSEMENTS, EXCEPTIONS TO DECLARATIONS ITEMS
ALL AUTOS - FAP 03/07, UF2106 05/01, AFPF01 03/07, AFPA03 03/07.
AUTO 1 - AFPU01 03/07.
AUTO 2 - AFPU01 03/07.
AUTO 3 - AAAC02 03/07.
AUTO 4 - AFPU01 03/07.
ANTI-THEFT DISCOUNT APPLIES-PASSIVE NON-DISAB AUTO 1
ANTI-THEFT DISCOUNT APPLIES-ACTIVE DISAB AUTO 2
ANTI-THEFT DISCOUNT APPLIES-PASSIVE NON-DISAB AUTO 4
AUTO/HOME MULTI POLICY DISCOUNT APPLIES
PASSIVE RESTRAINT DISCOUNT APPLIES - DUAL AIRBAGS AUTO 1
EXHIBIT "A"
Policy Q08-1510130 Declaration effective 10/10/2007 Page No: 2
PASSIVE RESTRAINT DISCOUNT APPLIES - MULTIPLE AIRBAGS AUTO 2
ANTI-LOCK BRAKE DISCOUNT APPLIED AUTO 1
ANTI-LOCK BRAKE DISCOUNT APPLIED AUTO 2
* FIRST ACCIDENT FORGIVENESS APPLIES. THE FIRST SURCHARGE FOR A
* FUTURE AT-FAULT ACCIDENT WILL BE WAIVED.
*******************************************************************
EXPLANATION OF ADULT &/OR YOUTHFUL DRIVER RATING CLASS
AUTO 1-PLEASURE USE, UP TO 8,500 MILES ANNUALLY
MALE, MARRIED, AGE 48
AUTO 2-TO WORK 15-20 MILES ONE WAY, 12,501 OR MORE MILES ANNUALLY
FEMALE, MARRIED, AGE 44
AUTO 4-PLEASURE USE, UP TO 8,500 MILES ANNUALLY
MALE, MARRIED, AGE 48
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.
LIENHOLDER FOR AUTO 2 LIENHOLDER FOR AUTO 3
MEMBERS FIRST CREDIT UNION FIFTH THIRD BANK
P 0 BOX 24046 PO BOX 598
FORT WORTH TX 76124-1046 AMELIA OH 45102-0598
*********************************************************************************
DRIVER* ST
1 JAMES L ADAMS PA
2 TERESA M ADAMS PA
*IF A DRIVER IS NOT A RESIDENT RELATIVE AS DEFINED IN YOUR POLICY,
COVERAGES, BENEFITS AND RIGHTS MAY BE LIMITED. REFER TO YOUR POLICY AND
ITS ENDORSEMENTS FOR TERMS, DEFINITIONS, LIMITATIONS, REDUCTIONS,
EXCLUSIONS AND CONDITIONS.
YOUR COLLISION COVERAGE AND DEDUCTIBLE APPLY TO PRIVATE PASSENGER
AUTOS YOU OR A RESIDENT RELATIVE RENT FOR 45 DAYS OR LESS. THIS IS
SUBJECT TO LIMITS, TERMS AND CONDITIONS IN THE POLICY.
Q08 1510130
INVOICE INFORMATION: DATE DUE PAYMENT DUE
--------- -----------
11-15-07 578.00*
02•-15-08 580.00*
05•-15-08 581.00*
Thank you for choosing Erie Insurance for your auto insurance needs. This policy contains many Xtra
X Protection Features. Wherever an "X" appears in the margin of this policy, you receive Xtra Protection
that is not included in most other auto policies. The protection provided by this policy is in keeping with
the single purpose of our Founders which is, "To provide YOU with as near PERFECT PROTECTION, as
near PERFECT SERVICE, as is humanly possible, and to do so at the LOWEST POSSIBLE COST."
AGREEMENT
ERIE INSURANCE EXCHANGE
In return for "your" timely premium payment, "your" com-
pliance with all of the provisions of this policy, and "your"
signing of a "Subscriber's Agreement" with Erie Indemnity
Company and other "Subscribers," "we" agree to provide the
coverages "you" have purchased. "Your" coverages and limits
of protection are shown on the "Declarations," which are part
of this policy.
This agreement is made in reliance on the information "you"
have given "us" and is subject to all the terms of this policy.
This policy, with coverage agreements, limitations, exclusions
and conditions, the "Declarations," applicable endorsements
and waivers, and the "Subscriber's Agreement" constitute the
entire agreement between "you" and "us."
ERIE INSURANCE COMPANY AND ERIE
INSURANCE PROPERTY & CASUALTY
COMPANY
"Your" signing the "Subscriber's Agreement," which includes
a limited power-of-attorney, permits Erie Indemnity Company,
as Attorney-in-Fact, to make reciprocal insurance contracts be-
tween "you" and other Subscribers and otherwise manage the
business of the Erie Insurance Exchange. This power-of-
attorney applies only to "your" insurance business at the Ex-
change and is limited to the purposes described in the "Sub-
scriber's Agreement."
"Your" responsibility as a "Subscriber" is determined by this
policy and the "Subscriber's Agreement." "You" are liable for
just the policy premiums charged and are not subject to any oth-
er premium liability under this policy.
In return for "your" timely premium payment and "your" com-
pliance with all of the provisions of this policy, "we" agree to
provide the coverages "you" have purchased. "Your" coverages
and limits of protection are shown on the "Declarations," which
are part of this policy.
This agreement is made in reliance on the information "you"
have given "us" and is subject to all the terms of this policy.
This policy, with coverage agreements, limitations, exclusions
and conditions, the "Declarations" and applicable endorsements
and waivers, constitute the entire agreement between "you" and
"us."
GENERAL POLICY DEFINITIONS
Throughout this policy and its endorsements, the following
words and phrases have a special meaning when they appear in
bold type and quotations-
* "Additional auto" or "additional trailer:"
1. "Additional auto" means any "private passenger auto"
other than a "replacement auto" that "you" acquire,
purchase or lease during the policy period. For coverage
to apply, "we" must insure all "private passenger autos"
"you" own on the date "you" acquire, purchase or lease
an "additional auto."
2. "Additional trailer" means any "trailer" other than a
"replacement trailer" that "you" acquire, purchase or
lease during the policy period. For coverage to apply,
"we" must insure all "trailers" "you" own on the date
"you" acquire, purchase or lease an "additional trailer."
"Additional auto" or "additional trailer" does not include
any "auto" or "trailer" that "you" acquire, purchase or lease
with anyone other than a "relative." Coverage does not ap-
ply to an "additional auto" or an "additional trailer" 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 an "additional auto"
or an "additional trailer." If "you" obtain an "additional
auto" or an "additional trailer" within 30 days prior to the X
end of the policy period, "you" have 60 days after acquisi-
tion to notify "us."
Should a loss occur involving an "additional auto" or "addi-
tional trailer" prior to "your" notifying "us," the additional
vehicle will have the broadest coverage "you" have purchased X
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 ap-
ply, subject to a $500 deductible. However, Comprehen-
sive Coverage will end seven days after "you" acquire, X
purchase or lease the vehicle or when "you" report the
additional vehicle to "us," whichever occurs first.
2. Collision Coverage on any vehicle listed on the "Decla-
rations," then Collision Coverage will apply, subject to a
$500 deductible. However, Collision Coverage will end
seven days after "you" acquire, purchase or lease the ve- X
hicle or when "you" report the additional vehicle to "us,"
whichever occurs first.
• "Anyone we protect" is defined separately under the LIABIL-
ITY PROTECTION Section, RIGHTS AND DUTIES -
GENERAL POLICY CONDITIONS Section or any applica-
ble coverage. Refer to each of these sections or the applicable
endorsement for the definition of "anyone we protect" as it
applies to each coverage.
• "Auto" means any land "motor vehicle" with at least four
wheels except a:
L vehicle designed for use principally off public roads;
2. vehicle operated on rails or crawler treads;
3. vehicle located for use as a residence; or
4. "miscellaneous vehicle."
• "Auto business" means the business of selling, leasing, rent-
ing, repairing, servicing, cleaning, painting, storing or parking
"autos," "trailers" or "miscellaneous vehicles."
• "Auto we insure" means:
1. "owned auto we insure;"
2. "temporary substitute;" or
3. "nonowned auto." "Nonowned auto" is defined sepa-
rately under the LIABILITY PROTECTION Section, the
PHYSICAL DAMAGE COVERAGE Section or any ap-
plicable coverage. Refer to each of these sections or the
applicable endorsement for the definition of "nonowned
auto" as it applies to each coverage.
• "Declarations" means "our" form which shows "your" cove-
rages, limits of protection, "owned auto we insure," premium
charges and other information.
This form is part of this policy. "Declarations" include forms
titled Amended Declarations, Revised Declarations, Duplicate
Declarations, New Declarations, Reinstatement of Coverage,
or Continuation Notice.
• "Fungi" means any type or form of fungus, including, but not
limited to, molds, mildews, smuts, mushrooms, yeasts and any
mycotoxin, spores, scents, vapors, gases or byproducts pro-
duced, arising out of or released by any type or form of fun-
gus.
• "Miscellaneous vehicle" means a motorcycle (including a
motorcycle with a sidecar), moped, snowmobile, golf cart, all
terrain vehicle and any similar recreational vehicle. It does not
include a lawn and garden tractor or mower or similar vehicle.
• "Motor vehicle" means any vehicle that is self-propelled and
is required to be registered under the laws of the state in which
"you" reside at the time this policy is issued. "Motor vehicle"
does not include a vehicle:
1. propelled solely by human power;
2. propelled by electric power obtained from overhead
wires;
3. operated on rails or crawler treads;
4. located for use as a residence or premises; or
5. which is a lawn and garden tractor or mower or similar
vehicle.
• "Moving van" means a four or six wheel "motor vehicle,"
such as a compact van or step van, designed mainly to trans-
port household goods. It must be borrowed or rented and dri-
ven by "you" or a "relative" for personal use.
• "Occupying" means in, upon, getting into or getting out of.
• "Owned auto we insure" means any:
1. "auto" or 'trailer" described on the "Declarations" for
the coverages "you" have purchased;
2. "additional auto" or "additional trailer;" or
3. "replacement auto" or "replacement trailer."
• "Private passenger auto" means a four wheel land "motor
vehicle" designed mainly to transport people on public roads.
It includes station wagons and the following types of vehicles,
even with dual rear wheels, when not used for business pur-
poses, except farming or ranching:
1. motor homes;
2. pickups; and
3. vans.
• "Relative" means a "resident" of "your" household who is a:
1. person related to "you" by blood, marriage or adoption; or
2. ward or any other person under 21 years old in "your"
care.
• "Replacement auto" or "replacement trailer:"
"Replacement auto" means any "private passenger au-
to" that "you" acquire, purchase or lease within the poli-
cy period to replace an "auto" described on the "Decla-
rations."
"Replacement trailer" means any "trailer" that "you"
acquire, purchase or lease within the policy period to re-
place a "trailer" described on the "Declarations."
"Replacement auto" or "replacement trailer" does not in-
clude any "auto" or "trailer" that "you" acquire, purchase
or lease with anyone other than a "relative." Coverage does
not apply to "replacement autos" or "replacement trai-
lers" registered 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 auto"
or "replacement trailer." If "you" obtain a "replacement
auto" or "replacement trailer" within 30 days prior to the X
end of the policy period, "you" have 60 days after acquisi-
tion to notify "us."
Should a loss occur involving a "replacement auto" or "re-
placement trailer" prior to "your" notifying "us," the replace-
ment vehicle will have the broadest coverage "you" have pur- X
chased for anv 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 S500 deductible. However, Comprehensive
Coverage will end seven days after "you" acquire, pur- X
chase or lease the vehicle or when "you" report the re-
placement vehicle to "us," whichever occurs first.
2. Collision Coverage on any vehicle listed on the "Decla-
rations," then Collision Coverage will apply, subject to a
5500 deductible. However, Collision Coverage will end
seven days after "you" acquire, purchase or lease the ve-
hicle or when "you" report the replacement vehicle to
"us," whichever occurs first.
X
• "Resident" means a person who physically lives with "you" in
"your" household on a regular basis. "Your" unmarried, un-
emancipated children attending school full time, living away
from home, will be considered "residents" of "your" house-
hold.
• "Suit" means a civil proceeding in which damages are alleged
because of bodily injury or property damage to which this in-
surance applies. "Suit" includes:
1. an arbitration proceeding; or
2. any other alternative dispute resolution proceeding,
to which "anyone we protect" must submit or submit with
"our" consent alleging such damages.
• "Temporary substitute" means any "auto" or "trailer" which
is a substitute for an "owned auto we insure." The "owned
auto we insure" must be withdrawn from normal use because
of its breakdown, destruction, loss, repair or servicing. The
"temporary substitute" cannot be owned by "you" and must
be used with the permission of the owner.
• "Trailer" means a vehicle designed to be pulled by a "private
passenger auto," if not being used for business purposes ex-
cept with a "private passenger auto." In the LIABILITY
PROTECTION Section of this policy, "trailer" includes a
farm wagon or farm implement while used with a "private
passenger auto."
ADDITIONAL ERIE INSURANCE EXCHANGE DE-
FINITIONS
The following words and phrases have a special meaning in
policies issued by Erie Insurance Exchange when they appear in
bold type and quotations.
• "Subscriber" means the person(s) who signed the "Subscrib-
er's Agreement."
• "Subscriber's Agreement" means the agreement, including a
limited power-of-attorney, among the Subscribers and the Erie
Indemnity Company, as Attorney-in-Fact. See the RIGHTS
AND DUTIES - GENERAL POLICY CONDITIONS Section,
SUBSCRIBER'S AGREEMENT.
• "We," "us" or "our" means the Subscribers at Erie Insurance
Exchange as represented by their common Attorney-in-Fact,
Erie Indemnity Company.
• "You," "your" or "Named Insured" means the "Subscriber"
named in Item 1. on the "Declarations" and others named in
Item I. on the "Declarations." Except under the RIGHTS
AND DUTIES - GENERAL POLICY CONDITIONS Section,
these words include the spouse of the "Subscriber" named in
Item L on the "Declarations," provided the spouse is a "resi-
dent."
ADDITIONAL ERIE INSURANCE COMPANY AND
ERIE INSURANCE PROPERTY & CASUALTY
COMPANY DEFINITIONS
The following words and phrases have a special meaning in
policies issued by Erie Insurance Company or Erie Insurance
Property & Casualty Company when they appear in bold type
and quotations.
• "We," "us" or "our" means the Erie Insurance Company or the
Erie Insurance Property & Casualty Company, whichever is
stated on the "Declarations."
• "You," "your" or "Named Insured" means the person(s)
named in Item 1. on the "Declarations." Except in the
RIGHTS AND DUTIES - GENERAL POLICY CONDI-
TIONS Section, these words include the spouse of the per-
son(s) named in Item 1. on the "Declarations," provided the
spouse is a "resident."
LIABILITY PROTECTION
DEFINITIONS
The following words and phrases have a special meaning when
they appear in bold type and quotations in the LIABILITY PRO-
TECTION Section.
• "Anyone we protect" means:
2. while a "relative" is using it, any "private passenger
auto," "moving van," "trailer" or "temporary substi-
tute" 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 reason-
ably believe the permission of the owner exists.
1. "you" or any "relative" using an "auto we insure;"
2. any person using, or any person or organization legally
responsible for the use of, an "owned auto we insure."
This use must be with "your" permission unless the use
is by a "relative;" and
3. any person or organization legally responsible for the
use, by "you" or a "relative," of any "nonowned auto."
This protection applies only if the person or organization
does not own or hire the vehicle being used.
X
• "Nonowned auto" means:
1. while "you" are using it, any "auto," "moving van,"
"trailer" or "temporary substitute" not owned or leased
by "you;" or
OUR PROMISE
Bodily Injury Liability Coverage
Property Damage Liability Coverage
If these coverages are indicated on the "Declarations," "we"
will pay all sums that "anyone we protect" legally must pay as
damages caused by an accident covered by this policy. The ac-
cident must arise out of the ownership, maintenance, use, load-
ing or unloading of an "auto we insure."
Damages must involve:
1. bodily injury, meaning physical harm, sickness, disease, or
resultant death to a person; or
2. property damage meaning:
a. physical injury to or destruction of tangible property, in-
cluding loss of its use or
b. loss of use of tangible property which is not physically
injured or destroyed.
"We" may investigate or settle any claim or "suit" for damages
against "anyone we protect," at "our" expense. If "anyone we
protect" is sued for damages covered by this policy, "we" will
defend, with a lawyer "we" choose, even if the allegations are
not true. "Our" obligation to pay any claim or judgment or de-
fend any "suit" ends when "we" have used up "your" limit of
protection by paying judgments or settlements or making a de-
posit in court.
ADDITIONAL PAYMENTS
Payment for the following is in addition to the limit of protec-
tion shown on the "Declarations."
Claim Expenses
"We" will pay:
X4
X
X
court costs to defend or settle, as "we" believe proper, any
claim or "suit" against "anyone we protect," for damages
covered under this section. "Our" payment of the limit of
protection for a settlement, judgment or deposit in court ends
"our" duty to pay under this item.
expenses incurred to investigate and defend or settle, as "we"
believe proper, any claim or "suit" against "anyone we pro-
tect" for damages covered under this section. "Our" pay-
ment of the limit of protection for a settlement, judgment or
deposit in court ends "our" duty to pay under this item.
post judgment interest, but only that portion of the post-
judgment interest which accrues on that part of the judgment
that does not exceed the limit of protection on a "suit" "we"
defend. "Our" payment, offer in writing, or deposit in court
of that part of the judgment that does not exceed the limit of
protection ends "our" duty to pay any post judgment interest
that accrues after the date of "our" payment, written offer or
deposit.
prejudgment interest or delay damages awarded on that part
of any judgment that does not exceed the limit of protection.
If "we" offer in writing to pay the applicable limit of protec-
tion, "we" will not pay any prejudgment interest or delay
damages for the period of time after the offer.
reasonable expenses "anyone we protect" may incur at
"our" request to help "us" investigate or defend a claim or
"suit." This includes up to $300 a day for actual loss of earn-
ings, limited to those days "anyone we protect" attends
hearings or trials at "our" request.
premiums on the following types of bonds, but not for bond
amounts greater than the limit of protection:
a. appeal bond in a "suit" "we" defend;
b. up to $500 for a bail bond premium required because of
an accident or related traffic violation involving an "auto
we insure;" and
c. attachment bond to release property of "anyone we pro-
tect" due to an accident or related traffic violation in-
volving an "auto we insure."
"We" have no duty to apply for or furnish such bonds.
7. reasonable lawyers' fees up to S50 which "anyone we pro- X
tect" incurs because of arrest, resulting from an accident in-
volving an "auto we insure."
First Aid Expenses
"We" will pay reasonable expenses for first aid to other persons
and animals at the time of an accident involving an "auto we X
insure."
EXTRA PROTECTION WHEN TEMPORARILY OUT
OF STATE
If "anyone we protect:"
1. travels to another state, the District of Columbia, a territory
or possession of the United States of America, Puerto Rico
or Canada; and
2. as a nonresident becomes subject to a motor vehicle finan-
cial responsibility law, compulsory insurance law, or other
similar law that imposes insurance requirements which are
greater than the insurance provided by this policy,
then, the Liability Protection under this policy will be increased
to the minimum amount of liability coverage required by law.
Coverage provided to meet the minimum limits will be in lieu of
the insurance otherwise provided by this policy.
The insurance under this provision will be reduced to the extent
that there is other valid and collectible insurance under this or
any motor vehicle insurance policy. In no event will any person
be entitled to receive duplicate payments for the same elements
of loss.
EXCLUSIONS - What We Do Not Cover
"We" do not cover:
t. damage caused by "anyone we protect" to property they
own or are transporting.
2. damage caused by "anyone we protect" to property rented
to them or in their charge. This exclusion does not apply to
household goods or household premises. X
3. damages caused intentionally by or at the direction of "any-
one we protect."
4. an "owned auto we insure" while being used in the "auto
business." This exclusion does not apply if the "owned auto
we insure" is being used by:
a. 'you" or a "resident" of "your" household; or
b. any partner, agent, or employee of "you" or a "resident"
of "your" household.
5. an "owned auto we insure" or a "nonowned auto" while
used in the business of the United States Government where
the United States Government is responsible under the Federal
Tort Claims Act. (28USCA§ 1346, 2671-2680).
6. a "nonowned auto:"
a. while used by "anyone we protect" while employed or
otherwise engaged in the "auto business;"
b. while used in connection with any other business or oc-
cupation of "anyone we protect." This exclusion does
not apply to a "private passenger auto" or "trailer;"
c. while being operated by someone other than "you" or a
relative" even if the "nonowned auto" is in the custody
or control of "anyone we protect;"
d. furnished or available for the regular use of a "relative"
while a "relative" is using it. This exclusion does not ap-
ply if the vehicle is furnished or available for "your"
regular use; or
e. furnished or available by a governmental agency or unit:
1. for "your" use while "you" or a "relative" are using
it; or
2. for a "relative's" use unless being used by "you."
?. bodily injury to employees of "anyone we protect" occur-
ring in the course of employment. "We" will provide cover-
age for such an injury to a domestic employee not covered
and not required to be covered by a workers compensation
law.
8. a vehicle "you" acquire during the policy period or any
"temporary substitute" for it if there is other applicable in-
surance.
9. an "auto we insure" while hired by or rented to others for a
fee or while available for hire by the public. "We" will pro-
tect "you" or a "relative" held responsible for damages
while "occupying" but not driving such a vehicle, if it is a
"nonowned auto." Fee does not include payment received
in a car pool or for trips for nonprofit social, educational, or
charitable agencies.
10. damages for which there is insurance under a nuclear ener-
gy liability insurance policy, even if the limits of protection
under that policy have been used up.
11. an "auto we insure" while being used in any prearranged or
organized racing, speed or demolition contest, stunting activity
or similar activities, or in practice for any such activities.
12. punitive or exemplary damages and related defense costs.
13. bodily injury or property damage arising directly or indi-
rectly, in whole or in part, out of the actual, alleged or
threatened inhalation of, ingestion of, contact with, expo-
sure to, existence of or presence of any "fungi," wet or dry
rot, or bacteria.
14. bodily injury or property damage arising out of the owner-
ship, maintenance, use, loading or unloading of a "miscel-
laneous vehicle."
LIMIT OF PROTECTION
"We" will pay no more than the limit(s) shown on the "Declara-
tions" for one "auto" in any one accident as explained below. It
makes no difference how many persons "we" protect, "autos we
insure," claims are made or "autos" are involved in the acci-
dent.
An "auto" and attached "trailer" are considered one "auto"
under this coverage.
If coverage is purchased on a "Split Limits" basis, the "Declara-
tions" will show a PER PERSON and PER ACCIDENT limit
for Bodily Injury Liability and a PER ACCIDENT limit for
Property Damage Liability. The PER PERSON limit for Bodily
Injury Liability is the most "we" will pay for all damages arising
out of bodily injury to one person in any one accident. The PER
ACCIDENT limit for Bodily Injury Liability is the most "we"
will pay for all damages arising out of bodily injury t:o all per-
sons resulting from any one accident, subject to the PER PER-
SON limit. The PER ACCIDENT limit for Property Damage
Liability is the most "we" will pay for all property damage
caused by any one accident.
If coverage is purchased on a "Single Limit" basis, the "Decla-
rations" will show a PER ACCIDENT limit for Bodily Injury
Liability and Property Damage Liability. This is the most "we"
will pay for all damages arising out of bodily injury and proper-
ty damage caused by any one accident.
If an individual's damages derive from, arise out of or otherwise
result from bodily injury to another person injured in the acci-
dent or the death of another person killed in the accident, "we"
will pay only for such damages within the PER PERSON limit
available to the person injured or killed in the accident.
OTHERINSURANCE
This policy provides primary insurance for any "auto we in-
sure" except a "nonowned auto." The policy's coverage is
excess over any other collectible insurance on a "n.onowned
auto," up to the limit(s) of protection for one "auto."
"We" will, however, provide primary insurance for a motor ve-
hicle "you" do not own if it is insured under a policy issued to a
business engaged in selling, leasing, repairing, servicing, deli-
vering, testing, road testing, parking or storing motor vehicles.
This applies only if "you" or a "relative" are operating the mo-
tor vehicle and are not the owner, operator, employee or agent
of that business.
This insurance will be excess to that of a business engaged in
storing, parking, servicing or repairing motor vehicles if an ac-
cident occurs while "your" "owned auto we insure" is under
control of the owner, operator, employee or agent of that busi-
ness.
If other insurance, collectible or not, covers an "auto" rented or
leased for less than one year and it states that coverage is void if
there is other available insurance, then coverages under this sec-
tion are void.
When there is other insurance applicable to the accident on the
same basis, "we" will pay "our" share. "Our" share is the pro-
portion that "our" limit of protection bears to the total of all
applicable limits.
"We" will never pay more than the limit of protection.
PHYSICAL DAMAGE COVERAGES
DEFINITIONS
The following words and phrases have a special meaning when
they appear in bold type and quotations in the PHYSICAL
DAA,L4GE COVERAGES Section.
• "Loss" means direct and accidental damage or direct and acci-
dental loss.
• "Nonowned auto" means, while "you" or a "relative" are
using it, any "private passenger auto," "moving van," "trai- X
ler" or "temporary substitute" not owned or leased by "you"
or a "relative." The operation or other use by "you" or a "rela-
tive" must be with the permission of the owner or "you" or the
"relative" must reasonably believe the permission of the own-
er exists.
OUR PROMISE - Comprehensive Coverage
X
X
If Comprehensive Coverage is indicated on the "Declarations,"
"we" will pay for "loss" to an "auto we insure" and its equip-
ment not caused by collision or upset. If the "loss" is to an
"owned auto we insure," "we" will only pay if "you" purchased
Comprehensive Coverage for the "owned auto we insure."
"We" will pay for "loss" less the deductible shown on the "Dec-
larations." Comprehensive Coverage includes glass breakage,
contact with persons, animals, birds, missiles or falling objects.
Should only "your" windshield be damaged, "we" will not apply
the deductible if the windshield is repaired rather than replaced.
OUR PROMISE - Collision Coverage
If Collision Coverage is indicated on the "Declarations," "we"
will pay for "loss" to an "auto we insure" and its equipment
caused by collision or upset. If the "loss" is to an "owned auto
we insure," "we" will only pay if "you" purchased Collision
Coverage for the "owned auto we insure." "We" will pay for
"loss" less the deductible shown on the "Declarations."
"We" will not subtract the deductible if the accident is between
an "auto we insure" and another "auto:"
1. insured by the Erie Insurance Group.
X 2. not insured by the Erie Insurance Group, if
a. the "loss" to the "auto we insure" is greater than the de-
ductible amount;
b. the owner of the other "auto" has been identified;
c. the owner or operator of the other "auto" is solely liable
for the "loss;" and
d. there is adequate property damage liability insurance
which protects anyone responsible for the "loss."
OUR PROMISE - Road Service (No Deductible Or
Waiting Period Applies)
If Road Service Coverage is indicated on the "Declarations,"
X "we" will reimburse "you" for reasonable towing and labor costs
required because an "auto we insure" is disabled. Labor must
be done at the site of the disablement. "We" will only pay for
"loss" to an "owned auto we insure" on which "you" have pur-
chased Road Service Coverage.
OUR PROMISE - Transportation Expenses (No
Deductible Or Waiting Period Applies)
If Transportation Expenses - Collision Coverage is indicated on
the "Declarations," "we" will reimburse "you" for transporta-
tion expenses that result from a Collision "loss" to an "owned
auto we insure" that has a premium shown on the "Declara-
tions" for this coverage.
If Comprehensive Coverage is indicated on the "Declarations,"
"we" will reimburse "you" for transportation expenses that re-
sult from a Comprehensive "loss" to an "owned auto we in-
sure" that has a premium shown on the "Declarations" for this
coverage.
Auto rental, bus, or taxi fares are examples of covered Transpor-
X tation Expenses. Payment may start on the day of the "loss" if
the "auto" cannot be driven. If drivable, payment may start the
day "you" leave the "auto" at the garage for repairs.
Payment ends on the day "we" offer settlement or on the day the
"auto:°
1. is replaced;
2. is returned to "you" in usable condition; or
3. could reasonably be expected to be repaired,
whichever comes first.
Transportation Expenses apply whether or not "we" pay for
damages under Comprehensive or Collision Coverage.
Transportation Expenses are provided for loss of use to a "non-
owned auto" if:
1. "you" or a "relative" are legally liable for damages to the
"nonowned auto;" and
2. "we" are provided with actual proof of loss of income.
Total payment under Transportation Expenses, including loss of
use, will not exceed:
1. Transportation Expenses - Comprehensive Coverage, $20
per day nor total more than $900 per loss unless a higher X
limit is shown on the "Declarations."
2. Transportation Expenses - Collision Coverage, the limit
shown on the "Declarations."
ADDITIONAL PAYMENTS (No Deductible Applies
To These Additional Payments)
If Comprehensive Coverage and/or Collision Coverage are pur-
chased, "we" will:
1. pay all reasonable expenses necessary to return "your" sto-
len "auto we insure."
2. reimburse "you" for travel costs, including meals and lodg- X
ing, paid by anyone because "you" were unable to reach
"your" destination after "loss" to an "auto we insure." Pay-
ment will not exceed $75 per person for each "loss." X
3. pay for "loss" to personal effects, including clothes and lug- X
gage, that are normally carried by a person, while the per-
sonal effects are in or upon an "auto we insure." The fol-
lowing restrictions apply:
a. Personal effects must be owned by "you" or a "relative."
b. Money, professional or occupational tools or machines,
sales samples, and merchandise for sale, delivery or ex-
hibition are not considered personal effects.
c. Theft losses are covered only if the entire vehicle is stolen.
d. When "loss" results from a collision, there must be
enough damage to the "auto we insure" to require a Col-
lision "loss" payment by "us."
e. Payment for "loss" to personal effects will not exceed
$350. "We" will only pay for "loss" not covered by other X
insurance.
4. pay all expenses necessary to replace a deployed airbag.
5. reimburse "you" up to $50 for the cost incurred for lock- X
smith services if keys are accidentally locked in an "auto
we insure."
EXCLUSIONS - What We Do Not Cover
"We" will not pay for "loss:"
1. confined to or resulting from wear and tear, freezing, mechan-
ical or electrical breakdown or failure. "We" will pay for such
damage resulting from a covered "loss." A covered "loss"
does not include a "loss" confined to mechanical or electrical
failure or body defects caused by or resulting from faulty 9.
workmanship or negligence by "you" or others.
2. caused intentionally by or at the direction of "you" or a "rel-
ative." 10.
3. to any: 11,
a. tape players;
b. compact disc players or recorders;
c. digital video disc players or recorders;
d. video cassette players or recorders; 12.
e. electronic navigational systems;
f. radios; 13.
g. two-way mobile radios or telephones;
h. scanners;
i. televisions; and 14•
j. any other similar equipment that records, receives or
transmits audio, visual or data signals.
This exclusion does not apply to such equipment, its acces-
sories, attachments and antennas if it is permanently in- 15
stalled.
Payment for "loss" to permanently installed equipment will
be limited to $1,000. This limit will not apply if the equip- 16.
ment is permanently installed:
a. in the opening of the dash, console, or overhead console,
normally used by the auto manufacturer to install such
equipment; or
b. by the auto manufacturer in other locations of the "auto." 17.
Payment for "loss" to tapes, digital video discs or compact
X discs will be limited to no more than ten tapes, digital video
discs or compact discs in any one "loss." Coverage for theft of
tapes, digital video discs or compact discs will be provided
only if the sound equipment is stolen or the entire "auto" is
stolen.
4. to fax machines, personal computers and peripheral equip-
ment and similar electronic equipment.
5. to a vehicle "you" acquire during the policy period or any
"temporary substitute" for it, if there is other applicable
insurance.
6. to a "nonowned auto:"
a. while used in connection with the "auto business;"
b. while used in connection with any other business or oc-
cupation. This exclusion does not apply to a "private
passenger auto" or "trailer;"
c. while being used by someone other than "you" or a "rel-
ative" even if the "nonowned auto" is in the custody or
control of "you" or a "relative;" or
d. furnished or available for the regular use of "you" or a
"relative." A "private passenger auto," "moving van"
or "trailer" (not including a "temporary substitute")
rented or leased to "you" for a period of more than 45
consecutive days will be considered as furnished or
available for the regular use of "you" or a "relative."
due to any act or condition of war, including discharge of any
nuclear weapon (.even it accidental). `Gar (declared or undec-
lared) means a state of armed hostile conflict between states or
nations, civil war, insurrection, rebellion or revolution.
due to radioactive contamination.
to camper bodies unless described on the "Declarations" or
replacing one described there. A camper body is a unit de-
signed and equipped for use as living quarters to be
mounted on an "auto" with a separate cab.
to radar detectors and other equipment designed to give ad-
vance warning of the operation of a speed-measuring device.
to tires caused by road damage, such as a blow out or punc-
ture, unless it results from another "loss" covered by this
policy.
to an "auto we insure" because of destruction or confisca-
tion by governmental or civil authorities if "you," a "rela-
tive" or a person using an "auto we insure" with "your"
permission was involved in illegal activities.
to an "auto we insure" while being used in any prearranged
or organized racing, speed or demolition contest, stunting
activity or similar activities, or in practice for any such ac-
tivities.
resulting directly or indirectly from "fungi," wet or dry rot,
or bacteria, meaning the presence, growth, proliferation,
spread or any activity of "fungi," wet or dry rot, or bacteria,
even if other events or happenings contributed concurrently
or in sequence to the "loss."
due to diminution in value. Diminution in value means any
actual or perceived "loss" in market or resale value that re-
sults from a direct and accidental "loss." Diminution in val-
ue includes any actual or perceived "loss" or reduction in
market or resale value after an "auto we insure" has been
damaged and has been repaired.
LIMIT OF PROTECTION
"We" will pay the Actual Cash Value for "loss" to stolen or
damaged property, but no more than:
1. what it would cost to repair or replace the property with oth-
er of like kind and quality; or
2. the Stated Amount that maybe shown on the "Declarations."
Actual Cash Value reflects fair market value, age and condition
of the property at the time of the "loss."
An "auto" and attached "trailer" are considered to be two sepa-
rate vehicles under these coverages. The limit of protection for
"loss" to any "trailer" not owned by "you" is $2,000. X
An "auto" and its equipment are considered one "auto" under
these coverages including any deductible provision that applies.
Equipment means that which is usual or incidental to the use of
an "auto" as a vehicle.
Equipment includes, but is not limited to:
customized or individually adapted items when built or fit in
or upon pickups or vans:
7. to any "trailer" used as a residence, office, store, display or a. truck caps;
passenger "trailer " b. bay or custom windows;
8. to any "auto we insure" while hired by or rented to others c. interior wood trim;
for a fee, or while available for hire by the public. Fee does d. special lighting fixtures; and
not include payment received in a car pool or for trips for e. window treatments, such as draperies or mini-blinds.
nonprofit social, educational or charitable agencies.
2. equipment that allows a handicapped person to enter, exit or
operate the vehicle;
3. attached child safety seats; and
4. a camper body if it is:
a. described on the "Declarations" or replaces one de-
scribed there; and
X
b, mounted on an "auto."
"Loss" to a camper body while not mounted on an "auto" will
be paid in accordance with the deductibles purchased on the
camper body.
OTHER INSURANCE
When there is other insurance for "loss" to an "auto we insure,"
except a "nonowned auto," "we" will pay "our" share of the
"loss."
When there is "loss" to a "nonowned auto," "we" will pay the
"loss" not covered by other insurance less any applicable de-
ductible. When there is other insurance on a "nonowned auto,"
and it states that coverage is void if there is other applicable
insurance, then coverages under this section are void.
APPRAISAL
If "you" and "we" fail to agree on the amount of "loss," either
party may make written demand for an appraisal. Each party
will select an appraiser and notify the other of the appraiser's
identity within 20 days after the demand is received. The ap-
praisers will select a competent and impartial umpire. If the ap-
praisers are unable to agree upon an umpire within 15 days after
both appraisers have been identified, "you" or "we" can ask a
judge of a court of record in the state where "you" reside at the
time the policy is issued to select an umpire.
The appraisers will then set the amount of "loss." If the apprais-
ers submit a written report of an agreement to "us," the amount
agreed upon will be the amount of "loss." If they cannot agree,
they will submit their differences to the umpire. A written award
by two will determine the amount of "loss."
Each party will pay the appraiser they choose, and equally bear
all other expenses of the appraisal. However, if the written de-
mand for appraisal is made by "us," "we" will pay for the rea-
sonable cost of "your" appraiser and "your" share of the cost of
the umpire.
X
"We" will not be held to have waived any rights by any act re-
lated to appraisal.
LOSS PAYMENT
At "our" option, "we" will pay the "loss" in money, or repair or
replace the damaged or stolen property. At any time before the
"loss" is paid or the property is replaced, "we" may return any
stolen property to "you." "We" will pay the reasonable expense
for its return and for any damage to it. Upon payment of the
"loss," "we" have the right to take all or part of the property at
its agreed or appraised value. There can be no abandonment of
property to "us."
"We" may settle any claim for "loss" with "you" or anyone that
has a legal interest in the property.
For damage to a "nonowned auto," "we" will pay the broadest
amount available among the coverages "you" purchased under
this section.
"You" must assign or transfer to "us" the Certificate of Title for
the "auto" sustaining the "loss" before "we" will make a pay-
ment for all or part of the actual cash value for a total "loss" to
an "auto we insure." A total "loss" will be determined in com-
pliance with the laws of the state in which "you" reside at the
time the policy is issued. This paragraph is not applicable if
"you" choose to retain ownership of the salvage vehicle as part
of the total "loss" settlement.
NO BENEFIT TO BAILEE
No bailee will benefit, directly or indirectly, from this insurance.
LOSS PAYABLE CLAUSE
This clause applies to the Physical Damage Coverages provided
by this policy for the Lienholder named in Item 3. on the "Dec-
larations." It protects the Lienholder's financial interest in the
vehicle insured.
Payment for any "loss" under these coverages will be made in
accordance with the financial interest the "Named Insured" and
the Lienholder, as its interest may appear for specific vehicle(s),
have in the "loss." Payment may be made to the "Named In-
sured" and the Lienholder jointly or to either or both separately.
If separate payments are made, the financial interests of both
will be protected by "us."
When "we" pay the Lienholder for a "loss" for which the "Named
Insured" is not insured, "we" are entitled to the Lienholder's right
of recovery against the "Named Insured," to the extent of "our"
payment. "Our" recovery will not impair the right of the Lien-
holder to recover the full amount of its claim.
The Lienholder will, on demand, pay any premium due under
this policy for coverages which protect the Lienholder's inter-
ests, if the "Named Insured" fails to do so.
The Lienholder's financial interest will be protected regardless of
the acts or neglect of the "Named Insured," subsequent legal
encumbrance or any change in ownership of the property. How-
ever, this clause does not apply, and "we" will not protect, the
Lienholder's financial interest in any case of fraudulent acts or
omissions by the "Named Insured" or anyone representing the
"Named Insured." If "we" cancel or refuse to renew this policy,
no less than 10 days advance notice of such termination will be
mailed to the Lienholder. If this policy is cancelled by the
"Named Insured," "we" will mail notice of cancellation to the
Lienholder. Mailing notice to the Lienholder's address shown on
the "Declarations" will be sufficient proof of notice.
ADDITIONAL COVERAGE
REIMBURSEMENT FOR COVERAGE IN MEXICO AND OTHER FORE=IGN COUNTRIES
WARNING: "We" will not be liable for damages or other
expenses incurred in any foreign country where this policy
X does not apply. In Mexico, however, Collision Coverage, if
purchased, will apply.
X "We" will reimburse "you" for premium paid for up to 30
days of coverage in a foreign country where this policy does
not apply. Reimbursement will be made ONLY for similar
coverages. Such coverages must apply to an "owned auto we
insure," used by "you" or a "relative" in the foreign country.
Reimbursement will not be made to anyone employed, sta-
tioned in the armed services, or attending school in a foreign
country.
RIGHTS AND DUTIES - GENERAL POLICY CONDITIONS
"We," "you" and anyone else protected by this policy must do certain things in order for the terms of this policy to apply.
DEFINITIONS
The following words and phrases have a special meaning when
they appear in bold type and quotations in the RIGHTS AND-
DUTIES - GENERAL POLICY CONDITIONS Section.
COOPERATION
"You" agree to cooperate with "us" by promptly and truthfully
answering all questions about drivers and "autos we insure"
and signing all papers relating to such insurance.
• "Anyone we protect" means:
"you" and "your" spouse, if a "resident" of "your"
household; and
persons or organizations defined as "anyone we protect"
in the LIABILITY PROTECTION Section or any appli-
cable coverage.
ASSIGNMENT
Interest in this policy may be transferred only with "our" writ-
ten consent. "We" may require evidence that all "Named Insu-
reds" approve the assignment.
BANKRUPTCY OF ANYONE WE PROTECT
Bankruptcy or insolvency of "anyone we protect" will not re-
lieve "us" of "our" obligations.
CONCEALMENT, FRAUD OR MISREPRESENTATION
Except as modified by law, this entire policy is void if, before or
after an accident or loss, "anyone we protect" has intentionally
concealed or misrepresented any material fact or circumstance
concerning this insurance.
In the event of a fraudulent claim, "we" will not make payment
for the accident or loss.
CONTINUOUS POLICY
This policy is a continuous policy. It will continue in force until
cancelled by "you" or terminated by "us" as explained in the Ter-
mination Condition. Each year "we" will send "you" a "Declara-
tions" that shows the premium due for the next policy period.
In return for this service, "you" must mail "us" written notice
prior to the new policy period if "you" want to cancel. If "we"
do not receive this notice, this policy remains in force and "you"
must pay "us" the earned premium due for this time.
HOW YOUR POLICY MAY BE CHANGED
Changes To Your Policy
This policy conforms to the laws of the state in which "you"
reside at the time it is issued. If the laws of the state change, this
policy will comply with those changes. "We" will give "you"
the benefit of any change made by "us" if it does not require
additional premium. This change will be effective as of the date
"we" implement the change in "your" state.
"You" may change this policy by asking "us." Asking "our"
Agent is the same as asking "us." "Your" request must contain
enough information to identify "you." If "we" agree with "your"
request, "we" will then issue a "Declarations." If there is a
change in the information used to develop the policy premium,
"we" may adjust "your" premium during the policy period effec-
tive as of the date the change occurred. Premium adjustments will
be made using the rules and rates in effect for "our" use. Changes
that may result in a premium increase or decrease during the poli-
cy period include, but are not limited to:
1. change to "your" address;
2. change to the location where the insured vehicle is principal-
ly garaged;
3. change in "your" marital status;
4. change to the distance "you" drive to or from work or
school;
5. change in the use of "your" vehicle (i.e., business use of a
vehicle);
6. addition or deletion of an 'auto" or lienholder or another
party having a financial interest in "your" vehicle(s);
7. addition or deletion of a licensed driver in "your" household
regardless of whether they have their own "auto" and insur-
ance; and
10
changes which modify the appearance or performance of
"your" vehicle with customized equipment. Customized
equipment includes those items or changes that are other
than what is offered by the auto manufacturer of that specific
model of vehicle or what is added or altered by the auto
dealer when the vehicle is new at the time of original sale.
Equipment added to a vehicle to allow a disabled person to
enter, exit or operate the vehicle is not considered custo-
mized equipment.
Your Duty To Notify Us of Changes
"You" agree to promptly notify "us" if "you" have made any
material changes, including, but not limited to, those listed
above. Changes may result in an increased premium, an adjust-
ment in the coverage available under this policy, or cancellation
or nonrenewal as permitted by law.
LAWSUITS AGAINST US
No legal action may be brought against "us" until there has been
full compliance with all the terms of this policy. The legal liabil-
ity of "anyone we protect" must be determined before "we"
may be sued. This determination may be made by a court of law
or by written agreement of all parties, including "us." No one
has the right to make "us" a party to a "suit" to determine the
liability of "anyone we protect." In the event of a medical, in-
come or funeral payments claim or a Comprehensive or Colli-
sion loss, no "suit" may be brought against "us" until 30 days
after proof of loss is filed.
OUR RIGHT TO RECOVER FROM OTHERS
After "we" make a payment under this policy, "we" will have
the right to recover from anyone else held responsible. "Anyone
we protect" is required to transfer this right to "us," and do
nothing to harm this right.
Anyone receiving payment from "us" and from someone else
for the same accident or loss will reimburse "us" up to "our"
payment.
"We" will pay all reasonable expenses "anyone we protect"
may incur at "our" request to help "us" recover damages from
anyone else held responsible. This includes up to $300 a day for
actual loss of earnings, limited to those days "anyone we pro-
tect" attends hearings or trials at "our" request.
PRIORITY
X This insurance will first protect "you," "your" spouse residing
in "your" household and then others "we" protect.
SUBSCRIBER'S AGREEMENT
The following applies only to policies issued by Erie Insurance
Exchange
The Subscriber ("you" or "your") agrees with the other Sub-
scribers at ERIE INSURANCE EXCHANGE ("ERIE"), a Reci-
procalilnter-Insurance Exchange, and with their Attorney-in-
Fact, the Erie Indemnity Company ("we" or "us"), a Penn-
Sylvania corporation with its Home Office in Erie, Pennsylva-
nia, to the following:
1. "You" agree to pay "your" policy premiums and to ex-
change with other ERIE Subscribers policies providing in-
surance for any insured loss as stated in those policies.
2. "You" appoint "us" as Attorney-in-Fact with the power to:
a. exchange policies with other ERIE Subscribers;
b. take any action necessary for the exchange of such policies;
c. issue, change, nonrenew or cancel policies;
d. obtain reinsurance;
e. collect premiums;
f. invest and reinvest funds;
g. receive notices and proofs of loss;
h. appear for, compromise, prosecute, defend, adjust and
settle losses and claims under "your" policies;
i. accept service of process on behalf of ERIE as insurer;
and
j. manage and conduct the business and affairs of ERIE, its
affiliates and subsidiaries. This power-of-attorney is li-
mited to the purposes described in this Agreement.
3. "You" agree that as compensation for "us:"
a. becoming and acting as Attorney-in-Fact;
b. managing the business and affairs of ERIE; and
c. paying general administrative expenses, including sales
commissions, salaries and employee benefits, taxes, rent,
depreciation, supplies and data processing,
"we" may retain up to 25% of all premiums written or as-
sumed by ERIE. The rest of the premiums will be used for
losses, loss adjustment expenses, investment expenses, dam-
ages, legal expenses, court costs, taxes, assessments, license
fees, and any other governmental fines and charges, estab-
lishment of reserves and surplus, and reinsurance, and may
be used for dividends and other purposes "we" decide are to
the advantage of the Subscribers.
4. "You" agree to sign and deliver to "us" all papers required to
carry out this Agreement.
5. This Agreement, including the power-of-attorney, will not
be affected by "your" subsequent disability or incapacity.
6. This Agreement is and will be binding upon "you," "us" and
all executors, administrators, successors and assigns.
SURVIVORS' COVERAGE
If "you" die, the policy will cover:
1. "your" spouse if residing in the same household at the time
of "your" death;
2. anyone having proper custody of an "owned auto we in-
sure" until a representative is appointed, but only until the
end of the policy period during which "your" death occurs;
3. "your" legal representative, but only while performing du-
ties as "your" representative and only until the end of the
policy period during which "your" death occurs; and
4. any "relative" covered under this policy on the date of X
"your" death, but only until the end of the policy period dur-
ing which "your" death occurs.
TERMINATION
Cancellation
3. provide "us:"
a. promptly, any papers that relate to the accident or loss;
b. separate, signed, written and/or oral statements contain-
ing all the facts about the claim; and
c. proof of loss to damaged property.
at "our" request, separately:
a. answer all questions about the accident or loss;
b. submit to examinations and statements under oath and
sign transcripts of the same;
c. assist in making settlement;
d. help "us" enforce any right of recovery against anyone
liable to "anyone we protect;"
e. cooperate with "our" investigations and any lawsuits;
f. attend hearings and trials;
g. assist "us" in securing and giving evidence and in obtain-
ing the attendance of witnesses;
h. submit to physical and mental examination by doctors
"we" choose as often as "we" reasonably require. "We"
will pay for these examinations;
i. sign papers to allow "us" to obtain medical reports, earn-
ings statements and copies of records; and
j. allow "us" to inspect and appraise the damaged property
before its repair or disposal.
"You" may cancel this policy by mailing or delivering to "our"
Agent or "us" written notice stating at what future date "you"
want the cancellation to take effect. "We" may waive these re-
quirements by confirming the date of cancellation to "you" in
writing.
"We" reserve the right to cancel for "your" noncompliance with
"our" premium payment plans. "We" do not waive "bur" right to
cancel, even if "we" have accepted prior late payments.
X If this policy is cancelled, "we" will return the pro rata unused
share of "your" premium. Cancellation will be effective even if
"we" have not given or offered any return premium.
Nonrenewal
Should "we" refuse to renew this policy, "we" will do so in
compliance with the laws of the state in which "you" reside.
"We" will notify "you" before the end of the policy period.
Method Of Giving Notice
"We" may cancel or refuse to renew this policy or any coverage
by mailing "you" written notice stating the effective date of
"our" action. Mailing notice to the address shown on the "Dec-
larations" will be sufficient proof of notice. The policy period
will end on the date and time stated in the notice.
WHAT TO DO WHEN AN ACCIDENT OR LOSS
HAPPENS
When there is an accident or loss, "anyone we protect" will:
1. notify "us" or "our" Agent in writing as soon as possible
stating the:
a. name and policy number of "our" Policyholder;
b. time, place and circumstances of the accident or loss; and
c. names and addresses of injured persons and witnesses.
2. promptly notify the police in case of theft.
5. not make payments, assume obligations or incur expenses,
except at their own cost.
6. protect "autos we insure" from further damage. "We" will
pay reasonable costs to do so. "We" will not pay for loss due
to ",your" failure to protect an "auto we insure" from further
damage after a loss.
WHEN AND WHERE YOUR POLICY APPLIES
This policy applies to accidents or losses that occur during the
policy period in the United States of America, its territories and
possessions, Puerto Rico, Canada or between their ports. The
policy period is shown on the "Declarations." Unless otherwise
specified on the "Declarations," the policy period begins and
ends at 12:01 A.M., Standard Time at the stated address of the
"Named Insured."
This policy has been signed on "our" behalf in Erie, Pennsylvania, by "our" President and Secretary. If required by law, it has been
countersigned on the "Declarations" by "our" Authorized Agent.
0
LLntKv?-?
Secretary
President
Erie
I Insurance"
Home Office • 100 Erie Insurance Place • Erie, PA 18530 • 314.870.2000
I sit our wens to a[ pi,,\m enensurance.corn
FAP (Ed. 3'07) OF-8522 12
PRIVATE PASSENGER AUTO
AFPF01 (Ed. 3/07) OF-4625
1493 I
ERIE INSURANCE GROUP
ERIEe
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,
FIRST PARTY BENEFITS ENDORSEMENT -- PENNSYLVANIA
This enelorsement contains provisions applicable to First Party Benef is Cotivi-age and changes provisions contained in )"our
policy to the extent that the provisions in this endorsement are different Iron those in yolo• polkV, Coverage is provided
only Y' a Premitnn for fire specific First Par v Benefit selected is shown on tire Declarations.
DEFINITIONS
[Vords and phrases in bold type anti quotations are used
as defined in this encorsement. if a word or phrase: in
hold type and quotations is not defined in this endorse-
menf, Then the word or phrase is used as otherwise defined
in the GENI•;R.4L 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:
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 hams 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
2. 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:
I, a person related to "you" by blood, marriage or
adoption,
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.
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.
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:
1. 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," rite 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 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 customary charge.
If acute care is provided in an acute care facility to a
patient with an immediately life-threatening or urgent
iniuty by a Level I or Level lI trauuna center accredited
by the Pennsylvania Trauma Systems Foundation under
the Emergency Medical Services Act (P.L.I G4, No.45),
or a major bunt injury patient by a burn facility which
meets all the service standards of the American Burn
Association, the amount of payment may not exceed the
usual and customary charge.
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 prernium 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:
I . 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 "inotor vehicle" as a vehicle. "We" will pay this
benefit no matter tvho 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
5177,500, "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 5100,000 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 S100,000.
Subject to a lifetime aggregate limit of S1,000,000, 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 snake
payments in excess of the $50,000 per year limit, subject
to the lifetime aggregate limit of 51,000,000.
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 Financia[ 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" duly 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 pet-son "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 hve 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 tine
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:
1. 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 bIlowilng conditions are addeck
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, frilly describing the nature
and extent of "bodily injury," treatment and rehabilitation
received and contemplated and other infomnation to
assist "us" in detennining 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 follo+ring canrdition is deleted:
OUR RIGHT TO RECOVER FROM OTHERS
OTHER PROVISIONS
All other provisions of the policy apply.
4
PRIVATE PASSENGER AUTO
AFPA03 (Ed. 3/07) OF-6380
111
ki ERIE INSURANCE GROUP
ERIE,
THIS ENDORSEMENT CHANCES 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 seats any material fact or circumstance in connection
POLICY DETINITIONS section. with the presentation or settlement of a claim.
"Noneconomic loss" means pain and suffering and other
nonmonetary detriment.
In the event of a fraudulent claim; "we" will not make
payment for the accident or loss.
"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 curd replaced by the following:
Within the first sixty (60) days this policy is in effect,
"we" may void this policy in its entirely 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:
1. "anyone we protect" has intentionally concealed or
misrepresented any material fact concerning this
instrance:
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 elrect 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 "ire" 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.
TERMINATION
Cancellation
The fbllowhrg 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 ettcet, "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 misreprescn-
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 firlloudng 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 IrErlf 4 on the
"Declarations," the fallowing Provisions apply:
GENERAL POLICY DEFINITIONS
Il' a "miscellaneous vehicle" is listed in 17E:11 4 on the
"Declarations," then the GENERAL POLIC)' DEFI-
NITIONS are revised as follonvs:
The following c!e/initions are revised:
_1U11r1N'!ng sub
Under "Owned auto we insure" the
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 follaiving 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 jollorvinkq 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, "ire" 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 mimed 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 "its."
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:
L Comprehensive Coverage on any vehicle listed on
the "Declarations," then Comprehensive Coverage
will apply, subiect to a 5500 deductible. However,
Comprehensive coverage will end seven clays 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 appiy,
subject to a S500 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 which-
ever occurs first.
"Replacement miscellaneous vehicle" means a "tniscella-
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 tnis-
cellaneous vehicle." If ",you" obtain a "replacement mis-
cellaneous vehicle" within 30 days prior to the end of the
policy period, "you" have 00 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 S500 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.
?. Collision Coverage on any vehicle listed on the
"Declarations," then Collision Coverage will apply,
subject to a S500 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 appy to a "miscellaneous vehicle"
listed in 1TFM 4 an the "Declarations."
OTHER PROVISIONS
All other provisions of the policy apply.
PRIVATE PASSENGER AUTO
AFPUOI (13d. 03/07) OF-8805
ME,
ERIE INSURANCE GROUP
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
UNINSURED/UN DERINSURED MOTORISTS COVERAGE
ENDORSEMENT -- PENNSYLVANIA
This endorsement Contains Provisions applicable to Uninsuredl Underinsured rffotoi-ists Bodily lifw y Coverage and
changes provisions contained in your police to the extent that the Provisions in this endorsement are different.(•oin thaw in
your policy.
DEFINITIONS
R'ords and phrases in hold type and quotations are used
as defined in this endorsement. If u word or phrase in
bold type and quotations is not defined in this endorse-
ment, then the ivord or phrase is defined in the
GENERAL POLICY DEFINl7'/ON,S 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:
it. 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;"
cf. 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 Benefts" means Pennsylvania motor vehicle
insurance first party benefits (medical benefit, income
loss benefit, funeral benefit, accidental death benefit,
combination benefit) in accordance with the
Pennsylvania Motor Vehicle Financial Responsibility
Law.
"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 taws, 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 "von" 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- 2. health care services;
cient to pay losses and damages. 3. products; or
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 entities "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 entities "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:
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 (. ommissioner,
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
Icss.
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 It trauma center accredited
by the Pennsylvania Trauma Systems Foundation under
the Emergency Medical Services Act (P.L.164, No. 45),
or to a major burn injury patient by a burn facility
which meets all the service standards of the American
Burn Association, (lie 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 riot:
1. treatment;
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 clays of the PRO's initial determination.
If "we" refuse payment of a provider's bill and do riot
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 tinder 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."
Evetusivn 6. applies onlY when the LIMITED TORT
Option is selectul.
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
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 out 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 fi•om, 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 "tve', 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" invoked 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 the
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 tinder
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.
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 sliall 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 "bur" Limit of
Protection.
Ai "bur" option, "twe" 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 lawyeiV fees "we" paid in the action.
RIGHTS AND DUTIES - GENERAL POLICY
CONDITIONS
LAWSUITS AGAINST US
This candition is deleted and replacer! by the Jollo+vnrg.
"You" must comply with the terms of the policy before
"you" may sue "us."
Suit must be brought in a count 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 /b/lowing 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 joist 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
AUTO
AAAC02 (Ed. 3l07) OF-4630
ERIE INSURANCE GROUP
ME,
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PHYSICAL DAMAGE COVERAGE ENDORSEMENT APPLICABLE TO
RECREATIONAL CAMPING VEHICLES
DEFINITIONS
!Words and phrases in bold type and quotations are used
as defined in this endorsement. If a ward or phrase in
bold iype and quotations is not defined in this endorse-
ment, then the trord or phrase it defined in the
GENERAL POLICY DEFINITIONS section of the
Policy.
"Anyone we protect" means:
1. ";you" or any "relative" using an "auto we insure;" and
2. emy person using, or any person or organization
legally responsible for the use of an owned "auto we
insure." This use must be with "your" permission
unless the use is by a "relative."
OUR PROMISE
The .following provisions applicable to RCVS are added
under the Comprthensive and Collision Coverages pro-
vided in your policy.
While "your" "RCV" is at "your" residence or "tempo-
rarily located;" "we" will pay under Comprehensive Cov-
erage for direct and accidental "loss" caused by collision
between "your" "RCV" and another vehicle while "your"
"RCV" is temporarily parked away from any public road.
"Loss" will not be paid under Comprehensive Coverage
when the other vehicle:
1. is owned or driven by "anyone we protect;" or
2. involved in the "loss" is pulling or carrying the
"RCV."
"Temporarily located" means an "RCV:"
1. with a valid and current motor vehicle registration at
the time of "loss," regardless of where the "RCV" is
located at the time of "loss;"
2. with all wheels and tires attached, and functionally
supporting the "RCV;"
3. without a permanent sewer, water or electrical
hook-up; and
4. without attached skirting or structures, including but
not limited to, a deck or porch.
"RCV" (Recreational Camping Vehicle) means a
Camping Trailer, Chassis Mounted Camper, Motor
Home, Travel Trailer, Truck Camper and Van Conver-
sion shown on the "Declarations." It includes:
I. any permanent parts of the "RCV;"
2. equipment furnished originally by the manufacturer
and any replacement of such equipment;
3. spare parts and equipment for attaching the "RCV"
to the hauling vehicle; and
4. outside radio and television antennas, awnings and
cabanas attached to the "RCV."
When "your" "RCV" is not at "your" residence, not "tem-
porarily located," or not in transit, "we" will pay for
"loss" or damage to "your" "RCV" unit caused by:
1. fire or lightning;
2. windstorm;
3. hail;
4. earthquake;
5. explosion;
6. riot or civil commotion;
7. forced landing of any aircrali or its parts or equip-
ment:
$. theft of the entire "RCV;"
9. falling objects;
10. smoke;
IL sonic boom;
12. breakage of glass permanently installed; or
13. volcanic eruption.
ADDITIONAL PAYMENTS
When "your" "RCV" becomes unusable due to a Com-
prehensive or Collision "loss" which happens away from
"your" residence premises "we" will:
I . pay up to S30 per day, not to exceed $300 per "loss,"
for the cost of lodging "your" family because "you"
were unable to reach "your" destination after the
"loss," while "your" "RCV" is being repaired. and
2. pay up to S I per mile, not to exceed $300 per "loss,"
for the cost of returning "your" "RCV" to "you" after
it is repaired.
EXCLUSIONS - What We Do Not Cover
"We" do not cover:
L "loss" to "your" "RCV" or any of its parts because of
conversion or concealment by anyone responsible for
"your' "RCV."
2. marring, scratching, or breaking of internal equip-
ment or furnishings.
OTHER PROVISIONS
All other provisions of the policy apply.
2
CERTIFICATE OF SERVICE
I hereby certify that on February A 1 , 2013, I, David A. Baric, Esquire of Baric Scherer
LLC, did serve a copy of the Complaint, by first class U.S. mail, postage prepaid, to the party
listed below, as follows:
Ann Margaret Grab, Esquire
Griffith, Strickler, Lerman, Solymos & Calkins
110 South Northern Way
York, Pennsylvania 17402
David A. Baric, Esquire
JAMES L. ADAMS, IN THE COURT OF COMMON PLEAS OF
TERESA M. ADAMS, CUMBERLAND COUNTY, PENNSYLVANIA
Plaintiffs
V. NO. 2011-3926 CIVIL TERM
ERIE INSURANCE EXCHANGE, CIVIL ACTION-LAW
Defendant
ACCEPTANCE OF SERVICE
AND NOW, this day of ' , r7l , 2013, I, Ann Margaret Grabs, Esquire,
attorney for the Defendant, accept service of the Complaint in the above-captioned matter.
Ann Margaret Grab, Esquire
c� jag, :,
ro M
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
JAMES L. ADAMS and THERESA M. ADAMS 2011-3926 Civil Term
Plaintiffs �•
VS. r. ,
M
ERIE INSURANCE EXCHANGE C
Defendant c `r
=C)
TO: James L. Adams and Theresa M. Adams, Plaintiffs
c/o David A. Baric, Esquire
Baric & Scherer
19 W. South Street
Carlisle, PA 17013
NOTICE TO PLEAD
You are hereby notified to file a written response to the enclosed New Matter within twenty
(20) days from service hereof or a judgment may be entered against you.
GRIFFITH, STRICKLER, LERMAN, SOLYMOS &
CALKINS
BY:
ANN MARGARETYJRAB, ESQUIRE PA#55986
Attorney for Defendant, Erie Insurance Exchange
110 South Northern Way
York, PA 17402
Dated: 13 717-757-7602/717-757-3783 fax
am rab(c gslsc.com
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
JAMES L. ADAMS and THERESA M. ADAMS 2011-3926 Civil Tenn
Plaintiffs
vs.
ERIE INSURANCE EXCHANGE
Defendant
ANSWER AND NEW MATTER OF DEFENDANT, ERIE INSURANCE
TO PLAINTIFFS' AMENDED COMPLAINT
AND NOW comes Defendant,Erie Insurance by their counsel Ann Margaret Grab,Esquire
and Griffith,Strickler,Lerman,Solymos.&Calkins and files the following Answer and New Matter
to Plaintiffs' Amended Complaint as follows:
I Admitted upon information and belief.
2. Admitted.
3. Admitted.
4. Denied. It is specifically denied that the insurance policy contained an
"uninsured/underinsured motorist coverage"which provided coverage for the recovery of damages.
for bodily injury from the operator of an underinsured motor vehicle. On the contrary,it is averred
that aforeidentified policy of insurance contains an uninsured/underinsured motorist coverage
endorsement which provides coverage under certain delineated circumstances.
5. Admitted in part,denied in part. It is admitted that the Plaintiff,James L.Adams was
involved in a motor vehicle accident on November 9,2007. The remaining allegations of paragraph
5 is denied in that after reasonable investigation, answering Defendant is without knowledge or
information sufficient to form a belief as to the truth of the allegations set forth in paragraph 5 of
Plaintiffs' Amended Complaint and same are denied and strict proof thereof demanded.
6. Denied. Paragraph 6 constitutes a conclusion of law to which no responsive pleading
is necessary and same is deemed denied.
7. Denied. It is specifically denied that as a direct and proximate result of the negligence
of the underinsured motorists Mr. Adams sustained an (a) achilles tendonitis injury, (b) left knee
injury and pain, (c)left foot pain and broken bone, and(d)right knee injury and pain requiring four
surgeries. On the contrary,it is averred that the Plaintiff suffered from pre-existing conditions,some
or all of which resulted in the treatment described.
8. Admitted.
9. Denied. It is specifically denied that as a direct and proximate result of the
aforementioned motor vehicle accident,Mr.Adams has required medical treatment and has incurred
expenses in connection therewith for medicines,medical care,surgery and other medical services for
which a claim is hereby made. On the contrary, it is averred that some or all Plaintiffs medical
treatment was not necessitated by the November 9, 2007 motor vehicle accident.
10. Denied. After reasonable investigation,answering Defendant is without knowledge
or information sufficient to form a belief as to the truth of the allegations set forth in paragraph 10 of
Plaintiffs' Amended Complaint and same are denied and strict proof thereof demanded.
11. Denied. After reasonable investigation,answering Defendant is without knowledge
or information sufficient to form a belief as to the truth of the allegations set forth in paragraph 11 of
Plaintiffs' Amended Complaint and same are denied and strict proof thereof demanded.
12. Admitted.
2
a
COUNT I BREACH OF CONTRACT
13. Paragraphs 1 through 12 of Defendant's Answer are incorporated herein as though
fully set forth at length.
14. Admitted.
15. Admitted.
16. Denied. It is specifically denied that Plaintiffs have performed all conditions
precedent necessary to the recovery of said underinsured motorist benefits, and has complied fully
with the claim procedures and requirements set for in the insurance policy. On the contrary, it is
averred that some or all of Plaintiff s alleged injuries and damages are unrelated to the motor vehicle
accident and as such, Underinsured Motorist coverage is no applicable.
17. Denied. It is specifically denied that Defendant has breached its contract with
Plaintiff by rejecting Plaintiffs' claim for underinsured motorist benefits. On the contrary, some or
all of Plaintiff's alleged injuries and damages are unrelated to the motor vehicle accident and as such,
Underinsured Motorist coverage is not applicable.
18. Denied. It is specifically denied that Defendant has breached its contract with
Plaintiff by failing to pay Plaintiff's medical expenses that were a direct and proximate result of the
aforementioned motor vehicle accident. On the contrary, it is averred that some or all of Plaintiff's
alleged injuries and damages are unrelated to the motor vehicle accident and as such,Underinsured
Motorist coverage is not applicable.
19. Denied. It is specifically denied Answering Defendant breached its contract of
insurance with the Plaintiff. The remaining allegations of paragraph 19 are denied in that after
reasonable investigation, answering Defendant is without knowledge or information sufficient to
3
form a belief as to the truth of the allegations set forth in paragraph 19 of Plaintiffs' Amended
Complaint and same are denied and strict proof thereof demanded.
WHEREFORE, Answering Defendant, Erie Insurance Exchange demands judgment in its
favor and against the Plaintiffs,together with interest and costs of suit.
By way of further Answer, Answering Defendants, Judie, Inc. and Jackie B's, asserts the
following:
NEW MATTER
20. Paragraphs 1 through 19 of Defendant's Answer are incorporated herein as though
fully set forth at length.
21. Plaintiffs' Amended Complaint fails to state a cause of action against Answering
Defendant upon which relief can be granted.
22. Plaintiff may have been contributorily and/or comparatively negligent in the
happening of the November 9,2007 motor vehicle accident,which contributory and/or comparative
negligence reduces the amount recoverable from the Defendant.
23. Plaintiff's alleged injuries and damages may have predated the November 9, 2007
motor vehicle accident and not have been aggravated thereby and as such, were not caused by the
motor vehicle accident nor covered under the Underinsured Motorist Endorsement of the policy.
24. The policy of insurance issued by the Defendant requires that all injuries and damages
arise out of the operation of a motor vehicle and because Plaintiff s alleged injuries and damages
may have predated the motor vehicle accident they were not caused thereby and are not compensable
under the policy.
25. Plaintiff has failed to prove that the injuries and damages alleged result from the
November 9, 2007 motor vehicle accident as a condition precedent to Underinsured Motorist
4
coverage pursuant to his policy of insurance with Erie Insurance Exchange.
26. Plaintiffs claims for non-economic damages may be barred because Plaintiff has
elected the limited tort option as set forth in the Pennsylvania Motor Vehicle Financial
Responsibility Law.
27. Plaintiff's recovery may be barred or limited by the amount of uninsured or
underinsured motorist benefits, if any, to which Plaintiff may be entitled to recover.
WHEREFORE, Answering Defendant, Erie Insurance Exchange demands judgment in its
favor and against the Plaintiffs,together with interest and costs of suit.
Respectfully submitted,
GRIFFITH, STRICKLER, LERMAN,
SOLYMOS & LKIN
BY:
A
MARGARtT GRAB, ES IRE PA#55986
Attorney for Defendant, Erie Insurance Exchange
110 South Northern Way
York, PA 17402
717-757-7602/717-757-3783 fax
Dated: amgrabggslsc.com
5
VERIFICATION
I, (as CT. le"e!!77,hereby verify that the statements made in the foregoing Answer and
New Matter to Plaintiffs' Amended Complaint, are true and correct to the best of my personal
knowledge or information and belief,as well as reports,records,conferences and other investigatory
material made available to me. To the extent that the foregoing contains averments which are
inconsistent in fact,I verify that my knowledge or information is sufficient to form a belief that one
or more of them is true,although I am currently unable,after reasonable investigation,to ascertain
which of the inconsistent averments are true.
To the extent that the foregoing contains legal conclusions or opinions,I hereby state that my
Verification is made upon the advice of counsel, upon whom I have relied in the filing this
document.
This Verification is made subject to the penalties of 18 Pa. C.S. § 4904 related to unsworn
falsifications to authorities.
ERIE INSURANCE EXCHANGE
Dated: d 8 /3 By: z evcz
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
JAMES L. ADAMS and THERESA M. ADAMS 2011-3926 Civil Term
Plaintiffs
VS.
ERIE INSURANCE EXCHANGE
Defendant
CERTIFICATE OF SERVICE
AND NOW,thA�day of N" 2013,1,Ann Margaret Grab,a member of the
firm of GRIFFITH,STRICKLER,LERMAN, SOLYMOS&CALKINS,hereby certify that I have
this date served a copy of the Answer and New Matter of Defendant,Erie Insurance Exchange
to Plaintiffs' Amended Complaint by United States Mail, addressed to the party or attorney of
record as follows-,
David A. Baric, Esquire
Baric& Scherer
19 W. South Street
Carlisle, PA 17013
(Counsel for Plaintiffs)
GRIFFITH, STRICKLER, LERMAN, SOLYMOS &
CALKINS
BY:
ANN MARGARET GRAB, ESQUIRE PA#55986
Attorney for Defendant, Erie Insurance Exchange
110 South Northern Way
York, PA 17402
717-757-7602/717-757-3783 fax
am9rab@gslsc.com
JAMES L. ADAMS, IN THE COURT OF COMMON PLEAS OF
TERESA M. ADAMS, CUMBERLAND COUNTY, PENNSYLVANIA
Plaintiffs
V. NO. 2011-3926 CIVIL TERM
ERIE INSURANCE EXCHANGE, CIVIL ACTION-LAW
Defendant
PLAINTIFFS' REPLY TO DEFENDANT'S NEW MATTER
NOW, come Plaintiffs, James L. Adams and Teresa M. Adams, by and through their
attorneys, BARIC SCHERER LLC, and file the within Reply and, in support thereof, sets forth
the following:
20. Paragraphs 1 through 19 of Plaintiffs' Complaint are incorporated herein as
though fully set forth at length.
21. These averments are conclusions of law for which no response is required. To the
extent a response is required, they are denied.
22. These averments are conclusions of law for which no response is required.
To the extent a response is required, they are denied.
23. Denied. By way of further answer, Plaintiff's injuries and damages were
caused by the November 9, 2007 motor vehicle accident and are therefore covered under
the Underinsured Motorist Endorsement of the policy.
24. Denied. The policy of insurance is a written document that speaks for
itself. By way of further answer, Plaintiff's injuries and damages were caused by the
motor vehicle accident. The remaining averments of this paragraph are conclusions of
law to which no response is required. To the extent a response is required, they are
denied.
25. Denied. By way of further answer, Plaintiff's injuries and damages were
caused by the November 9, 2007 motor vehicle accident and are therefore covered under
the Underinsured Motorist Endorsement of the policy.
26. These averments are conclusions of law for which no response is required.
To the extent a response is required, they are denied.
27. These averments are conclusions of law for which no response is required.
To the extent a response is required, it is denied.
WHEREFORE, Plaintiffs respectfully request that this Honorable Court enter
judgment in favor of Plaintiffs and against Defendant as prayed for in Plaintiffs' Complaint.
Respectfully submitted,
IC S ERER LL
Date:
v 13
David A. Baric, Esquire
I.D. 44853
19 West South Street
Carlisle, Pennsylvania 17013
(717) 249-6873
VERIFICATION
The statements in the foregoing Plaintiffs' Reply to Defendant's New Matter are based
upon information which has been assembled by my attorney in this litigation. The language of
the statements is not my own. I have read the statements; and to the extent that they are based
upon information which I have given to my counsel, they are true and correct to the best of my
knowledge, information and belief. I understand that false statements herein are made subject to
the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsifications to authorities.
DATE:
James L. Adams
DATE: �% ~ I&Jz1,2
Teresa M. Adams
CERTIFICATE OF SERVICE
I hereby certify that on May AR, 2013, 1, David A. Baric, Esquire of Baric Scherer LLC,
did serve a copy of the Plaintiffs' Reply to Defendant's New Matter, by first class U.S. mail,
postage prepaid, to the party listed below, as follows:
Ann Margaret Grab, Esquire
Griffith, Strickler, Lerman, Solymos & Calkins
110 South Northern Way
York, Pennsylvania 17402
L7 •
David A. Baric, Esquire
JAMES L. ADAMS, IN THE COURT OF COMMON PLEAS OF
TERESA M. ADAMS, CUMBERLAND COUNTY, PENNSYLVANIA
Plaintiffs , .t
V. NO. 2011-3926 CIVIL TERM
ERIE INSURANCE EXCHANGE, CIVIL ACTION-LAW -c
Defendant rte-
CD
5 L-r
CERTIFICATE PREREQUISITE TO SERVICE
OF A SUBPOENA PURSUANT TO RULE 4009.22
As a prerequisite to service of a subpoena for documents and things pursuant to Rule
4009.22, Plaintiffs certify that:
(1) A notice of intent to serve the subpoena with a copy of the attached subpoena
attached thereto was mailed or delivered to each party at least twenty days prior to
the date on which the subpoena is sought to be served;
(2) A copy of the notice of intent, including the proposed subpoena, is attached to this
certificate;
(3) No objection to the subpoena has been received; and,
(4) The subpoena which will be served is identical to the subpoena which is attached
to the notice of intent to serve.
David A. Baric, Esquire
r
Date: f
JAMES L. ADAMS, IN THE COURT OF COMMON PLEAS OF
TERESA M. ADAMS, CUMBERLAND COUNTY, PENNSYLVANIA
Plaintiffs
V. NO. 2011-3926 CIVIL TERM
ERIE INSURANCE EXCHANGE, CIVIL ACTION-LAW
Defendant
NOTICE OF INTENT TO SERVE A SUBPOENA TO PRODUCE
DOCUMENTS AND THINGS FOR DISCOVERY PURSUANT TO RULE 4009.21
Plaintiffs, James L. Adams and Teresa M. Adams, intend to serve a subpoena identical to
the one that is attached to this notice. You have twenty (20) days from the date listed below in
which to file of record and serve upon the undersigned an objection to the subpoena. If no
objection is made the subpoena may be served.
Date: �/i�/�3 ze
r David A. Baric, Esquire
Baric Scherer LLC
19 West South Street
Carlisle, PA 17013
(717) 249-6873
JAMES L. ADAMS, IN THE COURT OF COMMON PLEAS OF
TERESA M. ADAMS, CUMBERLAND COUNTY, PENNSYLVANIA
Plaintiffs
V. NO. 2011-3926 CIVIL TERM
ERIE INSURANCE EXCHANGE, CIVIL ACTION-LAW
Defendant
SUBPOENA TO PRODUCE DOCUMENTS OR THINGS
FOR DISCOVERY PURSUANT TO RULE 4009.22
TO: Safeguard Properties, Inc.
650 Safeguard Plaza
Brooklyn Heights, Ohio 44131
Within twenty(20)days after service of this subpoena, you are ordered by the court to
produce the following documents or things:
Any and all invoices,work orders, and/or similar documents for property
preservation work performed on the zip codes listed on Exhibit"A,"
incorporated herein by reference, beginning November 2007 to present.
You may deliver or mail legible copies of the documents or produce things requested by
this subpoena,together with the certificate of compliance,to the party making this request at the
following address:
Baric Scherer LLC
19 West South Street
Carlisle, PA 17013
c/o David A. Baric,Esquire
You have the right to seek in advance.the reasonable cost of preparing the copies or
producing the things sought.
If you fail to produce the documents or things required by this subpoena within twenty
(20)days after its service,the party serving this subpoena may seek a court order compelling you
to comply with it.
This subpoena was issued at the request of the following person:
David A. Baric, Esquire
I.D. #44853
19 West South Street
Carlisle, Pennsylvania 17013
(717) 249-6873
Attorney for Plaintiffs
BY THE COURT,
DATE: BY:
Prothonotary
SEAL OF THE COURT
Property Preservation County Zip Codes
Safeguard Properties, Inc.
County Name: Zip Code Worked: County Name: Zip Code Worked:
Cumberland County- 19 Dauphin County-35
17001 17018 17110
17007 17023 17112
17011 17028 17113
17012 17032 17120
17013 17033 17121
17015 17034 17122
17025 17036 17123
17027 17048 17124
17043 17057 17125
17055 17061 17126
17065 17101 17127
17070 17102 17128
17072 17103 17129
17081 17104 17130
17089 17105 17140
17093 17106 17177
17241 17107
17257 17108
.17266 17109
Perry County- 5 York County-25
17020 17019 17342
17040 17311 17345
17053 17313 17347
17068 17314 17354
17090 17315 17356
17317 17362
17318 17368
Adams County- 18 17319 17370
17301 17353 17321 17371
17303 17372 17323 17402
17304 17375 17327 17404
17306 17329 17406
17307 17331 17407
17310 17332 17415
17316 17339
17320
17324
17325
17337
17340
17343
17344
17350
This was our normal work area however we did go out of our area on occasion to complete work
order requests, such as Warfordsburg in Franklin County.
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
JAMES L. ADAMS and THERESA M. ADAMS 11-3926 Civil Term
Plaintiffs C-
vs. m c
ERIE INSURANCE —ac�
F ..,'
Defendant
• g cis =� �w�-�;
CERTIFICATE PREREQUISITE TO SERVICE
OF SUBPOENAS PURSUANT TO RULE 4009.22
As a prerequisite to service of subpoenas for documents and things pursuant to Rule 4009.22,
Defendant, Erie Insurance, certifies that:
(1) A Notice of Intent to Serve the Subpoenas with copy of the Subpoenas attached
thereto was mailed or delivered to each party at least twenty(20)days prior to the date on which the
Subpoena is sought to be served,
(2) A copy of the Notice of Intent,including the proposed Subpoenas,is attached to this
Certificate,
(3) Twenty days has passed and the attorney for the Plaintiff has not filed any objections,
and
(4) The Subpoenas which will be served is identical to the Subpoena which is attached to
the Notice of Intent to Serve the Subpoenas.
GRIFFITH, STRICKLER,LERMAN,
S(`SLYMOS &C]ALKINS
BY V'Y
Ann Margaret Grab,Esquire ID#55986
Attorney for the Defendant,Erie Insurance
110 South Northern Way
Dated: June 17,2013 York,PA 17402
(717) 757-7602/(717) 757-3783
amgrab @gslsc.com
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
JAMES L. ADAMS and THERESA M. ADAMS 11-3926 Civil Term
Plaintiffs
vs.
ERIE INSURANCE
Defendant
NOTICE OF INTENT TO SERVE SUBPOENAS TO PRODUCE
DOCUMENTS AND THINGS FOR DISCOVERY PURSUANT TO RULE 4009.21
Ann Margaret Grab, Esquire, counsel for Defendant, Erie Insurance, intends to serve
Subpoenas identical to the ones that are attached to this Notice. You have twenty(20)days from the
date listed below in which to file of record and serve upon the undersigned an objection to the
Subpoenas. If no objection is made, the Subpoenas maybe served.
GRIFFITH, STRICKLER, LERMAN,
SOLYMOS & CALKINS
Yi
BY: (
ANN MARGARET GRAB, ESQUIRE#55986
Attorney for Defendant, Erie Insurance
110 South Northern Way
f York, PA 17402
Date: ''-/l�1 �� (717) 757-7602/(717) 757-3783 fax
/( amgrab @gslsc.com
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
JAMES L. ADAMS and THERESA M. ADAMS 11-3926 Civil Tenn
Plaintiffs
vs.
ERIE INSURANCE
Defendant
SUBPOENA TO PRODUCE DOCUMENTS OR THINGS
FOR DISCOVERY PURSUANT TO RULE 4009.22
To: Keystone Podiatric Medical Associates, Dillsburg Foot&Ankle Center, 2B Barlow Circle,
Dillsburg, PA 17019
(Name of Person or Entity)
Within twenty (20) days after service of this Subpoena, you are ordered by the Court to produce the
following documents or things:
Any and all office notes, reports, records, memoranda, correspondence, diagnostic tests
and/or reports, consultation reports, x-rays, progress notes, hospital records, nurses
notes, admission and discharge summaries and records and reports of examinations,
billing and billing records and any other medical records of any kind from January 1, 2011
to the present pertaining to James L. Adams, date of birth: 2122/59.
at Griffith, Strickler, Lerman, Solymos& Calkins, 110 S. Northern Way, York, PA 17402-3737
(Address)
You may deliver or mail legible copies of the documents or produce things requested by this Subpoena,
together with the certificate of compliance, to the party making this request at the address listed above.
You have the right to seek, in advance, the reasonable cost of preparing the copies or producing the
things sought.
If you fail to produce the documents or things required by this Subpoena, within twenty (20) days after its
service,the party serving this Subpoena may seek a Court Order compelling you to comply with it.
THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON:
NAME: ANN MARGARET GRAB, ESQ.
ADDRESS: GRIFFITH, STRICKLER, LERMAN, SOLYMOS & CALKINS
110 South Northern Way, York, PA 17402
TELEPHONE: (717) 757-7602
SUPREME COURT ID: 55986
ATTORNEY FOR: Defendant, Erie Insurance
BY THE COURT:
DATE:
Seal of Court Prothonotary/Clerk, Civil Division
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
JAMES L. ADAMS and THERESA M. ADAMS 11-3926 Civil Term
Plaintiffs
VS.
ERIE INSURANCE
Defendant
SUBPOENA TO PRODUCE DOCUMENTS OR THINGS
FOR DISCOVERY PURSUANT TO RULE 4009.22
To: Dr. Katherine Gallagher/Dillsburq Family Health Center, 204 Mumgher Lane Dillsburq PA 17019
(Name of Person or Entity)
Within twenty (20) days after service of this Subpoena, you are ordered by the Court to produce the
following documents or things:
Any and all office notes, reports, records, memoranda, correspondence, diagnostic tests
and/or reports, consultation reports, x-rays, progress notes, hospital records, nurses
notes, admission and discharge summaries and records and reports of examinations,
billing and billing records and any other medical records of any kind from January 1, 2011
to the present pertaining to James L. Adams, date of birth: 2/22/59.
at Griffith, Strickler, Lerman, Solymos & Calkins, 110 S. Northern Way, York, PA 17402-3737
(Address)
You may deliver or mail legible copies of the documents or produce things requested by this Subpoena,
together with the certificate of compliance, to the party making this request at the address listed above.
You have the right to seek, in advance, the reasonable cost of preparing the copies or producing the
things sought.
If you fail to produce the documents or things required by this Subpoena, within twenty (20) days after its
service, the party serving this Subpoena may seek a Court Order compelling you to comply with it.
THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON:
NAME: ANN MARGARET GRAB, ESQ.
ADDRESS: GRIFFITH, STRICKLER, LERMAN, SOLYMOS & CALKINS
110 South Northern Way, York, PA 17402
TELEPHONE: (717) 757-7602
SUPREME COURT ID: 55986
ATTORNEY FOR: Defendant, Erie Insurance
BY THE COURT:
DATE:
Seal of Court Prothonotary/Clerk, Civil Division
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
JAMES L. ADAMS and THERESA M. ADAMS 11-3926 Civil Term
Plaintiffs
vs.
ERIE INSURANCE
Defendant
SUBPOENA TO PRODUCE DOCUMENTS OR THINGS
FOR DISCOVERY PURSUANT TO RULE 4009.22
To: OIP, 3399 Trindle Road, Camp Hill, PA 17011
(Name of Person or Entity)
Within twenty(20) days after service of this Subpoena, you are ordered by the Court to produce the
following documents or things:
Any and all office notes, reports, records, memoranda, correspondence, diagnostic tests
and/or reports, consultation reports, x-rays, progress notes, hospital records, nurses
notes, admission and discharge summaries and records and reports of examinations,
billing and billing records and any other medical records of any kind from January 1, 2011
to the present pertaining to James L. Adams, date of birth: 2/22/59.
at Griffith, Strickler, Lerman. Solymos& Calkins, 110 S. Northern Way, York, PA 17402-3737
(Address)
You may deliver or mail legible copies of the documents or produce things requested by this Subpoena,
together with the certificate of compliance, to the party making this request at the address listed above.
You have the right to seek, in advance, the reasonable cost of preparing the copies or producing the
things sought.
If you fail to produce the documents or things required by this Subpoena, within twenty (20) days after its
service, the party serving this Subpoena may seek a Court Order compelling you to comply with it.
THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON:
NAME: ANN MARGARET GRAB, ESQ.
ADDRESS: GRIFFITH, STRICKLER, LERMAN, SOLYMOS & CALKINS
110 South Northern Way, York, PA 17402
TELEPHONE: (717) 757-7602
SUPREME COURT ID: 55986
ATTORNEY FOR: Defendant, Erie Insurance
BY THE COURT:
DATE:
Seal of Court Prothonotary/Clerk, Civil Division
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
JAMES L. ADAMS and THERESA M. ADAMS 11-3926 Civil Term
Plaintiffs
vs.
ERIE INSURANCE
Defendant
SUBPOENA TO PRODUCE DOCUMENTS OR THINGS
FOR DISCOVERY PURSUANT TO RULE 4009.22
To: Dr. Shannon R. Walters, 121 West King Street, PO Box 763, East Berlin, PA 17316
(Name of Person or Entity)
Within twenty(20) days after service of this Subpoena, you are ordered by the Court to produce the
following documents or things:
Any and all office notes, reports, records, memoranda, correspondence, diagnostic tests
and/or reports, consultation reports, x-rays, progress notes, hospital records, nurses
notes, admission and discharge summaries and records and reports of examinations,
billing and billing records and any other medical records of any kind from January 1, 2011
to the present pertaining to James L. Adams, date of birth: 2122159.
at Griffith Strickler Lerman Solymos & Calkins, 110 S. Northern Way, York, PA 17402-3737
(Address)
You may deliver or mail legible copies of the documents or produce things requested by this Subpoena,
together with the certificate of compliance, to the party making this request at the address listed above.
You have the right to seek, in advance, the reasonable cost of preparing the copies or producing the
things sought.
If you fail to produce the documents or things required by this Subpoena, within twenty (20) days after its
service, the party serving this Subpoena may seek a Court Order compelling you to comply with it.
THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON:
NAME: ANN MARGARET GRAB, ESQ.
ADDRESS: GRIFFITH STRICKLER, LERMAN, SOLYMOS &CALKINS
110 South Northern Way, York, PA 17402
TELEPHONE: (717) 757-7602
SUPREME COURT ID: 55986
ATTORNEY FOR: Defendant, Erie Insurance
BY THE COURT:
DATE:
Seal of Court Prothonotary/Clerk, Civil Division
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
JAMES L. ADAMS and THERESA M. ADAMS 11-3926 Civil Term
Plaintiffs
VS.
ERIE INSURANCE
Defendant
CERTIFICATE OF SERVICE
AND NOW this day of `` , 2013, I, Ann Margaret Grab, Esquire, a
member of the firm of GRIFFITH, STRICKLER, LERMAN, SOLYMOS &CALKINS,Esquires,
hereby certify that I have, this date, served a copy of Notice of Intent to Serve Subpoenas by
United States Mail, addressed to the party or attorney of record as follows:
David A. Baric, Esquire
Baric & Scherer
19 W. South Street
Carlisle, PA 17013
GRIFFITH, STRICKLER, LERMAN,
SOLYMOS & CALKINS
All--s
BY:
Ann Margaret Grab, Esquire, PA# 55986
Attorney for Defendant, Erie Insurance
Supreme Court I.D. #55986
110 South Northern Way
York, Pennsylvania 17402
(717) 757-7602/(717) 757-3783 fax
amgrab@g_slsc.com
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
JAMES L. ADAMS and THERESA M. ADAMS 11-3926 Civil Term
Plaintiffs
VS.
ERIE INSURANCE
Defendant
CERTIFICATE OF SERVICE
AND NOW, this 17d' day of June, 2013, I, Ann Margaret Grab, a member of the firm of
GRIFFITH,STRICKLER,LERMAN, SOLYMOS&CALKINS,hereby certify that I have this date
served a copy of Certificate Prerequisite to Service of Subpoenas Pursuant to Rule 4009.22 by
United States Mail, addressed to the party or attorney of record as follows:
David A. Baric, Esquire
Baric& Scherer
19 W. South Street
Carlisle, PA 1701.3
(Counsel for Plaintiff)
GRIFFITH, STRICKLER, LERMAN,
SOLYMOS & CALKINS
By: C/--
Ann Margaret Grab, ID No. 55986
Attorney for Defendant, Erie Insurance
110 S.Northern Way
York, PA 17402
(717) 757-7602/(717) 757-3783 fax
amgrab @gslsc.com
JAMES L. ADAMS,
TERESA M. ADAMS,
Plaintiffs
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
v. NO. 2011-3926 CIVIL TERM
ERIE INSURANCE EXCHANGE, : CIVIL ACTION -LAW
Defendant :
PRAECIPE TO DISCONTINUE
TO THE PROTHONOTARY:
Kindly mark the above -captioned action as settled and discontinued with prejudice.
Respectfully submitted,
BARIC SCHERER LLC
Date: May 6, 2014
David A. Baric, Esquire
I.D. # 61974
19 West South Street
Carlisle, PA 17013
(717) 249-6873
Attorney for Plaintiffs
CERTIFICATE OF SERVICE
I hereby certify that on May 6, 2014, I, David A. Baric, Esquire of Baric Scherer LLC, did
serve a copy of the Praecipe To Discontinue, by first class U.S. mail, postage prepaid, to the party
listed below, as follows:
Ann Margaret Grab, Esquire
Griffith, Strickler, Lerman, Solymos & Calkins
110 South Northern Way
York, Pennsylvania 17402
David A. Baric, Esquire