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HomeMy WebLinkAbout13-5219 Supreme Co , f Pennsylvania Cou A &M. 0 leas For Prothonotary Use Only: Docket No: �Sl; Cu erland � Coun ty The information collected on this form is used solely,for court administration purposes. This form does not supplement or replace the filing and service of pleadings or other papers as required by lmv or rules of court. Commencement of Action: S O Complaint ❑ Writ of Summons Petition E ® Transfer from Another Jurisdiction Declaration of Taking C Lead Plaintiffs Name: Lead Defendant's Name: T. Mary Chambers Erie Insurance a /k/a Erie Insurance Exchange I Are money damages requested? 0 Yes ® No Dollar Amount Requested: ©within arbitration limits (check one) J outside arbitration limits N Is this a Class Action Suit? [3 Yes ER No Is this an MDJAppeal? ® Yes El No A. Name of Plaintiff /Appellant's Attorney: Casey O. Srogoncik © Check here if you have no attorney (are a Self - Represented [Pro Se] Litigant) Nature of the Case Place an "X" to the left of the ONE case category that most accurately describes your PRIMARY CASE. If you are making more than one type of claim, check the one that you consider most important. I TORT (do not include Mass Tort) CONTRACT (do not include Judgments) CIVIL APPEALS ® Intentional Buyer Plaintiff Administrative Agencies 0 Malicious Prosecution ® Debt Collection: Credit Card © Board of Assessment x Motor Vehicle Debt Collection: Other Q Board of Elections © Nuisance Dept. of Transportation ` 0 Premises Liability Statutory Appeal: Other S ® Product Liability (does not include E mass tort) ®Employment Dispute: Q Slander/Libel/ Defamation Discrimination C n Other: ❑Q Employment Dispute: Other J Zoning Board T Underinsured motorist action © Other: I ' © Other: O MASS TORT Asbestos I N Q Tobacco 0 Toxic Tort - DES ® Toxic Tort - Implant REAL PROPERTY MISCELLANEOUS EJ Toxic Waste © Ejectment [3 Common Law /Statutory Arbitration B © Other: 0 Eminent Domain/Condemnation 0 Declaratory Judgment 0 Ground Rent Q Mandamus E3 Landlord/Tenant Dispute ® Non- Domestic Relations ® Mortgage Foreclosure: Residential Restraining Order PROFESSIONAL LIABLITY ® Mortgage Foreclosure: Commercial Quo Warranto n Dental © Partition © Replevin I © Legal © Quiet Title 0 Other: I ® Medical ® Other: I ® Other Professional: L Updated 11112011 THIS IS A MAJOR JURY MATTER AN ASSESSMENT OF DAMAGES HEARING IS REQUIRED CLEARFIELD & KOFSKY By: Casey O. Srogoncik, Esquire Attorney for Plaintiff Identification No. 204395 Suburban Station Building - Suite 355 1617 JFK Boulevard Philadelphia, PA 19103 (215) 563 -6333 MARY CHAMBERS COURT OF COMMON PLEAS 513 Quail Court CUMBERLAND COUNTY Mechanicsburg, PA 17055 NO. V. /3 M ERIE INSURANCE aWa ERIE INSURANCE EXCHANGE --�� 100 Erie Insurance Place Erie PA 16530 = == ° ; may ` A ^ -1' i NOTICE TO DEFEND You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this Complaint and Notice are served, by entering a written appearance personally or by 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 TO FIND OUT WHERE YOU CAN GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 Liberty Avenue Carlisle, PA 17013 (717) 249 -3166 (800) 990 -9108 C�) GENERAL AVERMENTS 1. Plaintiff, Mary Chambers, is an adult individual who resides at the above - captioned address. 2. Defendant, Erie Insurance a /k /a Erie Insurance Exchange (hereinafter referred to as "Erie ") is a corporation licensed and authorized to conduct and transact business within the Commonwealth of Pennsylvania, with an office for service at the above - captioned address. 3. At all times material hereto, defendant acted or failed to act, by and through their agents, servants, workmen and /or employees, who were then and there acting within the scope of their authority and course of their employment with defendant, in furtherance of defendant's business and on behalf of defendant 4. At all times material hereto, Defendant, Erie, has in the past, and continues in the present, to regularly conduct business in Cumberland County. 5. On' or about November 11, 2011, Plaintiff's motor vehicle was covered by a Pennsylvania policy of motor vehicle insurance, which was issued by Defendant, Erie, and provided underinsured motorist benefits. 6. A copy of the Underinsured Motorist endorsement and /or declaration page is i attached hereto and incorporated herein as Exhibit "A ". 7. On or about November 11, 2011, Plaintiff was operating a motor vehicle traveling on Hilton Avenue approaching its intersection of Oakland Road, York County, Pennsylvania, when she was struck by tortfeasor, Evelyn Updegradff causing her to sustain injury. 8. The negligence and carelessness of the tortfeasor, consisted of the following: r (a) operating the aforementioned vehicle at an excessive rate of speed; (b) failing to have proper and adequate control of the aforementioned vehicle so as to avoid accidents; (c) failing to warn of the approach of the aforementioned vehicle with due regard for the rights and safety of the plaintiff; (d) failing to keep a proper lookout; (f) proceeding through an intersection without clearance; (g) failing to stop; (h) disregarding a stop sign; (i) disregarding the rights and safety of the Plaintiff; 0) failing to use due care under the circumstances; (k) violating the pertinent provisions of the Motor Vehicle Code; (1) negligence per se; and (1) in being otherwise careless, reckless and negligent, the particulars of which are presently unknown to plaintiff but which may be learned by discovery procedures provided by the Pennsylvania Rules of Civil Procedure or which may be learned at the trial of this case. 9. It is alleged and averred that claims against the tortfeasor and /or their insurance carrier have been settled. 10. Plaintiff has previously submitted a claim to the defendant for underinsured motorist benefits. 11. The policy in question does not provide for Arbitration. i I r 12. Recognizing the above, and pursuant to the pertinent motor vehicle insurance policy, Plaintiff herein submit this dispute to the Cumberland County Court of Common Pleas, a court of competent jurisdiction. COUNT PLAINTIFF, MARY CHAMBERS v. DEFENDANT, ERIE BREACH OF CONTRACT 13. Plaintiff, Mary Chambers, incorporates by reference hereto all of the allegations contained in the General Averments, as if they were set forth at length herein. 14. The. aforesaid accident was due solely to the negligence and carelessness of the tortfeasor. 15. On or about November 11, 2011, Defendant, Erie, issued a policy of automobile insurance to Plaintiff, Mary Chambers with regards to the motor vehicle plaintiff was operating at the time of the incident, in accordance with the Motor Vehicle Financial Responsibility Laws of Pennsylvania (75 Pa. C.S. Section 1702, et seq) under Erie Insurance policy number Q06- 3016771 See Exhibit A. 16. On November 11, 2011, and at all times material hereto, the policy of automobile insurance issued !by Erie to Mary Chambers, policy number Q06- 3016771, provided for underinsured motorist benefits. See Exhibit A. 17. The aforesaid policy of insurance issued by Erie to Mary Chambers was in full force and effect on IN 11, 2011. 18. Under the laws of the Commonwealth of Pennsylvania, Defendant, Erie, is required to provide Underinsured Motorist benefits for plaintiff, Mary Chambers, pursuant to an automobile insurance policy number, Q06- 3016771, claim number 010171203979. 19. There is no mandatory arbitration clause in Defendant, Erie insurance policy, more particularly, with regard to an Underinsured Motorist Vehicle Coverage. 20. As a sole and direct result of the original incident, Plaintiff, Mary Chambers, suffered severe and diverse injuries including, but not limited to: cervical sprain and strain, lumbar sprain and strain, shoulder injury, back injury, headaches and musculoskeletal injuries. 21. As a further result of this incident, Plaintiff, Mary Chambers, has been or will be required to receive and undergo medical attention and care and to expend various sums of money and to incur various expenses, and may be required to continue to expend such sums or incur such expenditures for an indefinite time in the future. 22. As a further result of this incident, Plaintiff, Mary Chambers, has or may hereafter suffer a severe loss of earnings and impairment of earning power and capacity. 23. As a further result of this incident, Plaintiff, Mary Chambers, has suffered medically determinable physical and /or mental impairment, which prevents the plaintiff from performing all or substantially all of the material acts and duties that constituted the plaintiffs usual and customary activities prior to the incident. 24. As a direct and reasonable result of the accident aforementioned, Plaintiff, Mary Chmabers, has incurred or may hereafter incur, other financial expenses that exceed or may exceed the amount that Plaintiff may otherwise be entitled to recover. 25. As a further result of the incident aforementioned, Plaintiff, Mary Chmabers, has suffered severe physical pain, mental anguish and humiliation, and may continue to suffer same for an indefinite time in the future. I WHEREFORE, Plaintiff, Mary Chambers, demands judgment against the Defendant for underinsured motorist benefits in an amount in excess of $50,000.00, plus interest, costs, and attorneys' fees. CLEARFIELD & /ZOFSKY Casey O. Sgo_�c- i1t�Esquire Attorney for Plaintiff, Mary Chambers VERIFICATION The UndersTmed. having read the attached pleading. verifies that the within pleading is based on infonmation furnished to counsel, which information has been gathered bycounsel in the course of this lawsuit. The language of the pleading is that of counsel and not of the signer. Signer verifies that s/he has read the within pleading and that it is true and correct to the best of signer's knowledge, information and belief. To the extent that the contents of the pleadings are that of counsel, verifies has relied upon counsel in taking this Verification. This Verification is made subject to the penalties of 18 Pa. C.S. 4904 relating to unworn falsification of authoritics. f'I �E)iy `i''Ld OF ( jt �R 0 y SEP 13 Am 1.1: 20 .JOHNSON,DUFFIE,STEWART&WEI0) BERLAND COUNTY Attorneys for Defendant, By: John A. Statler PENNSYLVANIA trie Insurance a/k/a Erie Insurance Exchange I.D. No. 43812 301 Market Street P. O. Box 109 Lemoyne, PA 17043-0109 (717) 761-4540 jas @jdsw.com MARY CHAMBERS, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. CIVIL ACTION — LAW ERIE INSURANCE a/k/a ERIE NO. 13-5219 Civil INSURANCE EXCHANGE, Defendant JURY OF 12 PERSONS DEMANDED PRAECIPE FOR ENTRY OF APPEARANCE TO THE PROTHONOTARY: Please enter the appearance of John A. Statler, Esquire of Johnson, Duffie, Stewart & Weidner, P.C. as counsel for Defendant, Erie Insurance a/k/a Erie Insurance Exchange, in the above-captioned matter. Respectfully submitted, JOHNS N, DUF T &WEIDNER By: John A. Statler, Attorney I.D. No. 43812 301 Market Street P. O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Date: September 12, 2013 Attorneys for Defendant, Erie Insurance 579983 a/k/a Erie Insurance Exchange CERTIFICATE OF SERVICE HEREBY CERTIFY that I served a true and correct copy of the foregoing Praecipe for Entry of Appearance upon all parties or counsel of record by depositing a copy of same in the United States Mail at Lemoyne, Pennsylvania, with first-class postage prepaid on the 12th day of September, 2013 addressed to the following: Casey O. Srogoncik, Esquire Clearfield & Kofsky Suburban Station Building — Suite 355 1617 JFK Boulevard Philadelphia, PA 19103 JOHNSON, DUFFIE, STEWART & WEIDNER By: John A. Statler, Esquire Attorney I.D. No. 43812 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Attorneys for Defendant Erie Insurance a/k/a Exchange Insurance Exchange SHERIFF'S OFFICE OF CUMBERLAND COUNTY Ronny R Anderson ) i {_ i c17 111 Sheriff XEttt� of tiirott in In Jody S Smith ° 3 PH J- Chief Deputy Richard W Stewart Solicitor PENNSYLVANIA PENNSYLVANIA errr ° "�Er� Mary Chambers vs. Case Number Erie Insurance a/k/a Eric Insurnace Exchange 2013-5219 SHERIFF'S RETURN OF SERVICE 09/05/2013 Sheriff Ronny R Anderson, being duly sworn according to law, states he made diligent search and inquiry for the within named Defendant to wit: Erie Insurance a/k/a Eric Insurnace Exchange, but was unable to locate the Defendant in the Sheriffs bailiwick. The Sheriff therefore deputizes the Sheriff of Erie, Pennsylvania to serve the within Complaint& Notice according to law. 09/10/2013 11:10 AM -The requested Complaint& Notice served by the Sheriff of Erie County upon Jody Cole, Sect Sup Legal Support, who accepted for Erie Insurance a/k/a Eric Insurnace Exchange, at 100 Erie Place, Erie, PA 16530. Bob Merski, Sheriff, Return of Service attached to and made part of the within record. SHERIFF COST: $37.00 SO ANSWERS, September 13, 2013 RONNY R ANDERSON, SHERIFF lci:Ccu^iy3u:2 5ha�i` -t r!�.^s- SHERIFF'S OFFICE OF ERIE COUNTY Bob Merski sw,E Cp hi r JOHN LOOMIS Sheriff m rc Captain JON HABURSKY ROGER GUNESCH Chief Deputy Lieutenant FORGED WITH PR10E MARY CHAMBER vs. Case Number ERIE INSURANCE A/K/A ERIE INSURANCE EXCHANGE 2013-05219M SHERIFF'S RETURN OF SERVICE 09/10/2013 11:10 AM -DEPUTY RANDY BOGA, BEING DULY SWORN ACCORDING TO LAW, SERVED THE REQUESTED COMPLAINT& NOTICE BY HANDING A TRUE COPY TO A PERSON REPRESENTING THEMSELVES TO BE JODY COLE, SECT SUP LEGAL SUPPORT, WHO ACCEPTED AS"ADULT PERSON IN CHARGE" FOR ERIE INSURANCE A/K/A ERIE INSURANCE EXCHANGE AT 100 ERIE PLACE, ERIE, PA 16530. RAND, DEPUTY SHERIFF COST: $68.00 SO A WERS, tir lL September 11, 2013 === MERSKI, SW'RIFF 1140F' . .0 NOTARIAL SEAL BARBARA D.TURNER,Nosy kW Cmi of Erie,U . • NOTARY Affirmed and and subscribed to before me this //-'4 day of yr " �.3 RONALD A. CLEARFIELD &ASSOCIATES, P.C., Plaintiff Attorney 1 riE PROTHONOTAr ',. 20I3 SEP 214 All II: 03 JOHNSON,DUFFIE,STEWART&WEIDNER n ri 148Lfatkai p Attorney s for Defendant, ` E bfc/a Erie Insurance Exchan e By: John A. Statler 1 9 I.D. No. 43812 301 Market Street P. 0. Box 109 Lemoyne, PA 17043-0109 (717) 761-4540 jas @jdsw.com MARY CHAMBERS, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA v. • CIVIL ACTION — LAW ERIE INSURANCE a/k/a ERIE : NO. 13-5219 Civil INSURANCE EXCHANGE, Defendant : JURY OF 12 PERSONS DEMANDED STIPULATION AND NOW, come the parties to the above case, by and through their respective counsel, who hereby agree and stipulate as follows: 1. The proper Defendant in this case is Erie Insurance Exchange. 2. Erie Insurance is not a proper Defendant. 3. The caption of the case should be amended to reflect that Erie Insurance Exchange is the only Defendant. 4. All references in the Complaint to "Erie Insurance a/k/a Erie Insurance Exchange" shall be deemed to apply to Erie Insurance Exchange. Respectfully submitted, JOHNSQN, DUFFIE, STEWART & WEIDNER • By: John A. Statler,-- •uire Attorney I.D. No. 43812 301 Market Street P. O. Box 109 Lemoyne, PA 17043-0109 /i ci 7/3 Telephone (717) 761-4540 Date: / Attorneys for Defendant, Erie Insurance a/k/a Erie Insurance Exchange CLEARFIELD O'SKY By: Z- Ca-- 0. rogoncik, Esquire Attorney I.D. No. 204395 Suburban Station Building — Suite 355 1617 JFK Boulevard Philadelphia, PA 19103 Attorneys for Plaintiff, Mary Chambers Date: C+/ (7 /( 3 580002 r CERTIFICATE OF SERVICE I HEREBY CERTIFY that I served a true and correct copy of the foregoing Stipulation upon all parties or counsel of record by depositing a copy of same in the United States Mail at I-1 Lemoyne, Pennsylvania, with first-class postage prepaid on the 2- 5 day of 2013 addressed to the following: Casey O. Srogoncik, Esquire Clearfield & Kofsky Suburban Station Building — Suite 355 1617 JFK Boulevard Philadelphia, PA 19103 JOHNSON, DUFFIE, STEWART &WEIDNER • A 4 _ By: John A. Statler, Esquire Attorney I.D. No. 43812 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Attorneys for Defendant Erie Insurance Exchange 13 S£P 27 PM 2: 2 I ICU �)OYVFYCOMMON PLEAS OF MARY CHAMBERS, Plaintiff CUMBE �OUNTY, PENNSYLVANIA V. CIVIL ACTION — LAW ERIE INSURANCE a/k/a ERIE NO. 13-5219 Civil INSURANCE EXCHANGE, Defendant JURY OF 12 PERSONS DEMANDED ORDER AND NOW, this o?k, day of 2013, upon stipulation of the parties, it is hereby ORDERED that: 1. Erie Insurance is dismissed from this case. 2. Erie Insurance Exchange is substituted as the only Defendant in this case. 3. All references in the Complaint to Erie Insurance a/k/a Erie Insurance Exchange shall be deemed to apply to Erie Insurance Exchange, only. 4. The caption of this case shall be reformed to read as follows: MARY CHAMBERS, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. CIVIL ACTION — LAW ERIE INSURANCE EXCHANGE, NO. 13-5219 Civil Defendant JURY OF 12 PERSONS DEMANDED BY THE COURT: J. Distribution: Casey O. Srogoncik, Esquire, Clearfield & Kofsky, Suburban Station Building — Suite 355, 1617 JFK Boulevard, Philadelphia, PA 19103 / ✓ John A. Statler, Esquire, Johnson, Duffie, Stewart&Weidner, 301 Market Street, P. O. Box 109, Lemoyne, PA 17043-0109 CAP oded ,s 411 Qo CLEARFIELD,KOFSKY & PENNEYS By: Casey O. Srogoncik, Esquire Attorney for Plaintiff= w L. Identification No. 204395 rn ; Suburban Station Building - Suite 355 _' 1617 JFK Boulevard + Philadelphia, PA 19103 -- (215) 563-6333 >c�) '-` MARY CHAMBERS : COURT OF COMMON PLEAS ' `' : CUMBERLAND COUNTY c� v. : 13-5219 ERIE INSURANCE a/k/a ERIE INSURANCE EXCHNAGE • • AFFIDAVIT OF SERVICE I, Casey O. Srogoncik, Esquire, Attorney for Plaintiff, being duly sworn according to law, depose and say, that on September 10, 2013, the Defendant, Erie Insurance a/k/a Erie Insurance Exchange, was served with the Civil Action Complaint by the Erie County Sheriff in the above-captioned matter. A true and correct copy of the Sheriffs return is attached hereto. The facts contained herein are true and correct to the best of my knowledge, information and belief. CASEY O. SR CIK, ESQUIRE SWORN TO AND SUBSCRIBED befo• me op this (c' ay of , 2013 - 1V5Cgif NOTARY PU IC OMMONWEA TN OF PENNSYLV• Notarial Seal Mary E.Mattox, Notary Public City of Philadelphia, Philadelphia County My Commission Expires June 16, 2017 NEMSER,PENNSYLVANIA ASSOCIATION OF • ARIES SHERIFF'S OFFICE OF ERIE COUNTY Bob Merski c©ukrr, JOHN LOOMIS Sheriffs pee. Captain JON HABURSKY ROGER GUNESCH Chief Deputy Lieutenant FORGED WITH FR1OE MARY CHAMBER vs. Case Number ERIE INSURANCE A/K/A ERIE INSURANCE EXCHANGE 2013-05219M SHERIFF'S RETURN OF SERVICE 09/10/2013 11:10 AM -DEPUTY RANDY BOGA, BEING DULY SWORN ACCORDING TO LAW, SERVED THE REQUESTED COMPLAINT& NOTICE BY HANDING A TRUE COPY TO A PERSON REPRESENTING THEMSELVES TO BE JODY COLE, SECT SUP LEGAL SUPPORT, WHO ACCEPTED AS "ADULT PERSON IN CHARGE" FOR ERIE INSURANCE A/K/A ERIE INSURANCE EXCHANGE AT 100 ERIE PLACE, ERIE, PA 16530. RAND, DEPUTY SHERIFF COST: $68.00 SO A WERS, AO 61 ilde; September 11, 2013 =:= MERSKI, SH'RIFF OP NOTARIAL SEAL DttiteMA D.TURNER,Nosy City*of Erie,Erie County NOTARY Affirmed and subscribed to before me this / 466 day of / J RONALD A. CLEARFIELD &ASSOCIATES, P.C., Plaintiff Attorney • SHERIFF'S OFFICE OF CUMBERLAND COUNTY Ronny R Anderson Sheriff att„o of Cafaaatrwrr� Jody S Smith Chief Deputy _ Richard W Stewart Solicitor iCE OF Ti t-ERIP; Mary Chambers vs. Case Number Erie Insurance a/k/a Eric Insurnace Exchange 2013-5219 SHERIFF'S RETURN OF SERVICE 09/05/2013 Sheriff Ronny R Anderson, being duly sworn according to law, states he made diligent search and inquiry for the within named Defendant to wit: Erie Insurance a/k/a Eric Insurnace Exchange, but was unable to locate the Defendant in the Sheriffs bailiwick. The Sheriff therefore deputizes the Sheriff of Erie, Pennsylvania to serve the within Complaint& Notice according to law. 09/10/2013 11:10 AM -The requested Complaint&Notice served by the Sheriff of Erie County upon Jody Cole, Sect Sup Legal Support, who accepted for Erie Insurance a/k/a Eric Insurnace Exchange, at 100 Erie Place, Erie, PA 16530. Bob Merski, Sheriff, Return of Service attached to and made part of the within record. SHERIFF COST: $37.00 SO ANSWERS, September 13, 2013 RONNY R ANDERSON, SHERIFF ;c)COu tySuiie Sheritf,Tc.eoscft cc. 2.313 OCT 15 E 1: :c JOHNSON,DUFFIE,STEWART&W1ERLAND COUNTY Attorneys for Defendant, By: John A. Statler PENNSYLVANIA Erie Insurance Exchange I.D. No. 43812 301 Market Street P. O. Box 109 Lemoyne, PA 17043-0109 (717) 761-4540 jas @jdsw.com MARY CHAMBERS, : IN THE COURT OF COMMON PLEAS OF Plaintiff • CUMBERLAND COUNTY, PENNSYLVANIA v. CIVIL ACTION — LAW • ERIE INSURANCE EXCHANGE, NO. 13-5219 Civil • Defendant • JURY OF 12 PERSONS DEMANDED NOTICE TO PLEAD TO: MARY CHAMBERS, Plaintiff c/o Casey O. Srogoncik, Esquire Clearfield & Kofsky Suburban Station Building — Suite 355 1617 JFK Boulevard Philadelphia, PA 19103 YOU ARE REQUIRED to plead to the within Answer With New Matter within 20 days of service hereof or a default judgment may be entered against you. JOH • ► DUFFIE, STEW A RT &WEIDNER By: John A. Statler�- .wire Attorney I.D. No. 438 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Attorneys for Defendant Erie Insurance Exchange DATE: October (1 , 2013 a JOHNSON,DUFFIE,STEWART&WEIDNER Attorneys for Defendant, By: John A. Statler Erie Insurance Exchange I.D. No. 43812 301 Market Street P. 0. Box 109 Lemoyne, PA 17043-0109 (717) 761-4540 jas @jdsw.com MARY CHAMBERS, • IN THE COURT OF COMMON PLEAS OF Plaintiff • CUMBERLAND COUNTY, PENNSYLVANIA • v. CIVIL ACTION — LAW • ERIE INSURANCE EXCHANGE, NO. 13-5219 Civil • Defendant • JURY OF 12 PERSONS DEMANDED ANSWER OF DEFENDANT ERIE INSURANCE EXCHANGE TO PLAINTIFF'S COMPLAINT INCLUDING NEW MATTER AND NOW, comes the Defendant, Erie Insurance Exchange, by its attorneys, Johnson, Duffie, Stewart & Weidner, P.C., who file the following Answer and New Matter in response to the Plaintiff's Complaint in this case: 1. Admitted on information and belief. 2. Denied as stated. Erie Insurance Exchange is an unincorporated, reciprocal insurance exchange, licensed and authorized to do business in Pennsylvania. It is admitted that Erie Insurance Exchange has a principal place of business at 100 Erie Insurance Place, Erie, Erie County, Pennsylvania. 3. The averments in this paragraph constitute conclusions of law to which no response is required. 4. Admitted. I 5, Admitted. 6. Admitted. 7. It is admitted that the Plaintiff was involved in a motor vehicle accident on November 11, 2011. It is further admitted that the Plaintiff alleges that she sustained injuries in the accident. 8. The averments in this paragraph constitute conclusions of law to which no response is required. In the event a response is deemed to be required, Defendant is without information sufficient to form a belief as to the truth or falsity of the averments in this paragraph and subparagraphs and, therefore, denies the same and demands strict proof at the time of trial, if deemed material. 9. Admitted. 10. Admitted. 11. Admitted. 12. Admitted. COUNT I PLAINTIFF, MARY CHAMBERS v. DEFENDANT, ERIE INSURANCE EXCHANGE BREACH OF CONTRACT 13. Defendant incorporates by references its answers to the averments in paragraphs 1 through 12 of the Plaintiff's Complaint as if set forth at length. 14. The averments in this paragraph constitute conclusions of law to which no response is required. In the event a response is to be required, Defendant is without information sufficient to form a belief as to the truth or falsity of the averments in this paragraph and, therefore, denies the same and demands strict proof at the time of trial if deemed material. 15. Admitted. 16. Admitted. 17. Admitted. 18. Denied as stated. Defendant Erie was required to offer underinsured motorist coverage to the Plaintiff, Mary Chambers. 19. Admitted. 20. Denied. After reasonable investigation, Defendant is without information sufficient to form a belief as to the truth or falsity of the averments concerning the nature and extent of the Plaintiff's alleged injuries, losses and/or damages and/or their causal relation to the subject accident and, therefore, denies the same and demands strict proof at the time of trial if deemed material. 21. Denied. After reasonable investigation, Defendant is without information sufficient to form a belief as to the truth or falsity of the averments concerning the nature and extent of the Plaintiff's alleged injuries, losses and/or damages and/or their causal relation to the subject accident and, therefore, denies the same and demands strict proof at the time of trial if deemed material. 22. Denied. After reasonable investigation, Defendant is without information sufficient to form a belief as to the truth or falsity of the averments concerning the nature and extent of the Plaintiff's alleged injuries, losses and/or damages and/or their causal relation to the subject accident and, therefore, denies the same and demands strict proof at the time of trial if deemed material. 23. Denied. After reasonable investigation, Defendant is without information sufficient to form a belief as to the truth or falsity of the averments concerning the nature and extent of the Plaintiff's alleged injuries, losses and/or damages and/or their causal relation to the subject accident and, therefore, denies the same and demands strict proof at the time of trial if deemed material. 24. Denied. After reasonable investigation, Defendant is without information sufficient to form a belief as to the truth or falsity of the averments concerning the nature and extent of the Plaintiff's alleged injuries, losses and/or damages and/or their causal relation to the subject accident and, therefore, denies the same and demands strict proof at the time of trial if deemed material. 25. Denied. After reasonable investigation, Defendant is without information sufficient to form a belief as to the truth or falsity of the averments concerning the nature and extent of the Plaintiff's alleged injuries, losses and/or damages and/or their causal relation to the subject accident and, therefore, denies the same and demands strict proof at the time of trial if deemed material. WHEREFORE, Defendant Erie Insurance Exchange respectfully requests that the Plaintiff's Complaint be dismissed and that judgment be entered in favor of Defendant Erie Insurance Exchange and against the Plaintiff, Mary Chambers. NEW MATTER By way of additional answer and reply, Defendant Erie Insurance Exchange raises the following New Matters: 26. The Plaintiff's claims are barred in whole or in part and/or are limited by the provisions of the Pennsylvania Motor Vehicle Financial Responsibility Law, 75 Pa.C.S.A. §1701, et seq., and especially by §1722 of that law. 27. Discovery may reveal that some or all of the Plaintiff's injuries and conditions pre- existed the date of the subject accident and were not caused or aggravated by the accident. 28. Discovery may reveal that some or all of the Plaintiff's injuries and conditions were caused or aggravated by events that occurred subsequent to the date of the subject accident. 29. To the extent that the Plaintiff has been paid or will be paid in the future for some or all of her damages, then claims for those damages are barred by the defense of payment and by §1722 of the Pennsylvania Motor Vehicle Financial Responsibility Law. 30. Erie Insurance Exchange is entitled to a credit set off for the limits of all liability insurance policies covering the third party tortfeasor, Evelyn Updegraff, at the time of the subject accident. 31. In the event that it is determined that the Plaintiff is entitled to recover past or future lost wages as a result of the subject accident, then Erie Insurance Exchange is entitled to a credit set off of up to $15,000 for first party income loss coverage. WHEREFORE, Defendant Erie Insurance Exchange respectfully requests that the Plaintiff's Complaint be dismissed and that judgment be entered in favor of Defendant Erie Insurance Exchange and against the Plaintiff, Mary Chambers. Respectfully submitted, JO , 'UFFIE, STEWART &WEIDNER A By: John A. a - Es•uire Attorney I.D. No. 3812 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Attorneys for Defendant, Erie Insurance Exchange DATE: October If , 2013 584581 22740-3150 VERIFICATION I, t of 1 is , hereby acknowledge that Erie Insurance Exchange is the Defendant in this action and that I am authorized to make this verification on its behalf; that I have read the foregoing Answer of Defendant Erie Insurance Exchange to Plaintiff's Complaint; and that the facts stated therein are true and correct to the best of my knowledge, information and belief. I understand that any false statements herein are made subject to penalties of 18 Pa. C.S. Section 4904, relating to unsworn falsification to authorities. ERIE INSURANCE EXCHANGE By: C' % 1 DATE: /0/0/3 CERTIFICATE OF SERVICE I HEREBY CERTIFY that I served a true and correct copy of the foregoing Answer of Defendant to Plaintiffs Complaint, including New Matter upon all parties or counsel of record by depositing a copy of same in the United States Mail at Lemoyne, Pennsylvania, with first-class postage prepaid on the 11th day of October, 2013 addressed to the following: Casey O. Srogoncik, Esquire Clearfield & Kofsky Suburban Station Building — Suite 355 1617 JFK Boulevard Philadelphia, PA 19103 JOHNSON, DUFFIE, STEWART & WEIDNER By: John A. Statler, • Attorney I.D. No. 43812 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Attorneys for Defendant Erie Insurance Exchange CLEARFIELD & KOFSKY By: Casey O. Srogoncik, Esquire Attorney for Plaintiff Identification No. 204395 Suburban Station Building-Suite 355 1617 JFK Boulevard Philadelphia, PA 19103 cn (215) 563-6333 MARY CHAMBERS : COURT OF COMMON PLEAS nr et, ° : CUMBERLAND COUNTY ,701 r_4 V. . 'TK C' b (? _- : NO. 13-5219 c) _ c} ERIE INSURANCE EXCHANGE : v : CIVIL ACTION PLAINTIFFS' REPLY TO NEW MATTER OF DEFENDANT, ERIE INSURANCE EXCHANGE Plaintiff, by and through her attorneys, Clearfield & Kofsky, hereby responds to Defendant, Erie Insurance Exchange as follows: 26-31. Denied. Denied as a conclusion of law to which no responsive pleading is required by the Pennsylvania Rules of Civil Procedure. To the extent an answer is required, after reasonable investigation, plaintiff is without the knowledge or information sufficient to form a belief as to the truth of the averments contained in these paragraphs. Accordingly, strict proof thereof is demanded at the time of trial. WHEREFORE, Plaintiff requests this Honorable Court to deny Defendant's New Matter, and enter judgment in her favor and against the Defendant. CLEARFIELD & KOFSKY BY: CASE SROGONCIK, ESQUIRE Attorney for Plaintiff • VERIFICATION I, CASEY O. SROGONCIK, ESQUIRE, hereby verify that I am the attorney for Plaintiff in the attached REPLY TO NEW MATTER, and that the facts set forth herein are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are subject to the penalties of Title 18 Pa. C.S.A. Section 4904 relating to unworn f falsifications to authorities. CLEARFIELD, KOFSKY& PENNEYS ocoN CASEY O. SR` CIK ESQUIRE Attorney for Plaintiff DATED: 10/22/2013 ii r\311-t silIl/ E- _, 2314 FEB 14 F1 t,: 07 CUMBERLAND COUNTY JOHNSON, DUFFIE,STEWART&WEIDNER PENNSYLVANIA Attorneys for Defendant, By: John A. Statler Erie insurance a/k/a Erie Insurance Exchange I.D. No. 43812 301 Market Street P. O. Box 109 Lemoyne, PA 17043-0109 (717) 761-4540 jas @jdsw.com MARY CHAMBERS, • IN THE COURT OF COMMON PLEAS OF Plaintiff • CUMBERLAND COUNTY, PENNSYLVANIA • • V. CIVIL ACTION —LAW • • ERIE INSURANCE EXCHANGE, NO. 13-5219 Civil • Defendant • JURY OF 12 PERSONS DEMANDED 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 hereby certifies that: 1) A Notice of Intent to serve the subpoenas with a copy of the subpoenas attached thereto, was mailed or delivered to each party at least 20 days prior to the date on which the subpoenas were sought to be served; 2) A copy of the Notice of Intent, including the proposed subpoenas, are attached to this certificate; and 3) The subpoenas to be served are identical to the subpoenas attached to the Notice of Intent. JOHNSI , : • IE, ST:, ART & WEIDNER By: John A. Statler, Esqui Attorney I.D. No. 43812 301 Market Street P. O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Date: February 12, 2014 Attorneys for Defendant 605819 Erie Insurance Exchange s ' JOHNSON,DUFFIE,STEWART&WEIDNER Attorneys for Defendant, By: John A. Statler Erie Insurance a/k/a Erie Insurance Exchange I.D. No. 43812 301 Market Street P. 0. Box 109 Lemoyne, PA 17043-0109 (717)761-4540 jas©jdsw.com MARY CHAMBERS, IN THE COURT OF COMMON PLEAS OF Plaintiff • CUMBERLAND COUNTY, PENNSYLVANIA v. • CIVIL ACTION — LAW • ERIE INSURANCE EXCHANGE, • NO. 13-5219 Civil • Defendant • JURY OF 12 PERSONS DEMANDED NOTICE OF INTENT TO SERVE SUBPOENAS TO PRODUCE DOCUMENTS AND THINGS FOR DISCOVERY PURSUANT TO RULE 4009.21 TO: Casey O. Srogoncik, Esquire Clearfield & Kofsky Suburban Station Building — Suite 355 1617 JFK Boulevard Philadelphia, PA 19103 PLEASE TAKE NOTICE that Defendant Erie Insurance Exchange intends to serve subpoenas identical to the ones attached to this notice. You have 20 days from the date listed below in which to file on record and serve upon the undersigned an objection to the subpoenas. If no objection is made, the subpoenas may be served. JOHNSO DUFFIE, W•R &WEIDNER By: John A. Statler, •uire Attorney I.D. No. 4381 301 Market Street P. 0. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Attorneys for Defendant Erie Insurance Exchange DATED: January 14, 2014 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND• Mary Chambers •Plaintiff . File No. 13-5219 Civil VS. . Erie Insurance Exchange • Defendant SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: PinnacleHealth cr Harrisburg Hospital, Health Information, 1 11 S. Front Street,Harrisburg,PA 17101 (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 radiology reports and radiology CD's (other than mammograms)taken at Community General Osteopathic Hospital pertaining to Mary Chambers, DOB: 12/04/1951; SSN: xxx-xx-2935 from January 1,2001 to present. at Johnson, Duffie, Stewart& Weidner, 301 Market Street, Lemoyne, PA 17043-0109 (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: John A.Statler,Esquire ADDRESS: Johnson,Duffie,Stewart&Weidner 301 Market Street,PO Box 109 Lemoyne,PA 17043-0109 TELEPHONE: 717-761-4540 SUPREME COURT ID#43812 ATTORNEY FOR: Defendant BY THE COURT. _ / .r 1 Prothonotary,Civil Division Date: ' �b i / _. eal f the Court Deputy COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND• Mary Chambers • Plaintiff : File No. 13-5219 Civil VS. • Erie Insurance Exchange • Defendant SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: PinnacleHealth CardioVascular Institute,Emad Iskandar,DO, 1000 N.Front St.,Worm leysburg,PA 17043 (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 medical records, outpatient records, hospital records, operative reports, radiology reports and correspondence pertaining to Mary Chambers, DOB: 12/04/1951; SSN: xxx-xx-2935 from January 1, 2012 to present. at Johnson, Duffie, Stewart& Weidner, 301 Market Street, Lemoyne, PA 17043-0109 (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: John A.Statler,Esquire ADDRESS: Johnson,Dune,Stewart&Weidner3 301 Market Street,PO Box 109 Lemoyne,PA 1743-0109 TELEPHONE: 717-761-4540 SUPREME COURT ID#43812 ATTORNEY FOR: Defendant BY THE COURT: r Prothonotary,Civi Division Date: r !! G_ _ // ' Seal of th Court Deputy COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Mary Chambers • 13 5219 Civil Plaintiff • File No. VS. Erie Insurance Exchange •• Defendant SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: Devonshire Family Health Center,2850 Commerce Drive, Suite 300,Harrisburg, PA 17110 (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 medical records, outpatient records, hospital records, operative records, radiology reports and correspondence pertaining to Mary Chambers, DOB: 12/04/1951; SSN: xxx-xx-2935 from January 1, 2002 to present. at Johnson, Duffle, Stewart& Weidner, 301 Market Street, Lemoyne, PA 17043-0109 (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: John A.Statler,Esquire ADDRESS: Johnson,Duffle,Stewart&Weidner 301 Market Street,PO Box 109 Lemoyne,PA 17043-0109 TELEPHONE: 717-761-4549 SUPREME COURT ID#43812 ATTORNEY FOR: Defendant THE COURT:,. + Prothonotary,Civil Division Date: 0 b I / _i— -eal of Court Deputy COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND• Mary Chambers ••Plaintiff . File No. 13-5219 Civil VS. . Erie Insurance Exchange • Defendant SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: Arlington Orthopedics, 805 Sir Thomas Court,Harrisburg, PA 17109 (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 medical records, outpatient records, hospital records, radiology reports and radiology CD's pertaining to Mary Chambers, DOB: 12/04/1951; SSN: xxx-xx-2935 from November 11, 2011 to present. at Johnson, Duffle, Stewart& Weidner, 301 Market Street, Lemoyne, PA 17043-0109 (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: John A.Statler,Esquire ADDRESS: Johnson,Dame,Stewart&Weidner 301 Market Street,PO Box 109 Lemoyne,PA 17043-0109 TELEPHONE: 717-761-4540 SUPREME COURT ID#43812 ATTORNEY FOR: Defendant BY THE COU• : w / !/ Prothonotary,Civil Division Date: 410 iti J / _ W/1/ Sea of the Court Deputy COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Mary Chambers • Plaintiff • File No. 13-5219 Civil VS. Erie Insurance Exchange • Defendant SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: Pinnacle Health System/Tristan Radiology Specialists,4518 Union Deposit Road,Harrisburg,PA 171 1 1 (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 radiology reports and radiology CD's pertaining to Mary Chambers, DOB: 12/04/1951; SSN: xxx-xx-2935 from January 1, 2001 to present at Johnson, Duffle, Stewart& Weidner, 301 Market Street, Lemoyne, PA 17043-0109 (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: John A.Stotler,Esquire ADDRESS: 301 Market Street,PO Box 109 Lemoyne,PA 17043-0109 TELEPHONE: 717-761-4540 SUPREME COURT ID#43812 ATTORNEY FOR: Defendant BY THE COURT. I #.L. . b Prothonotary,Civil Division Date: ( u V cl /�_, //. — - eal o the Court Deputy CERTIFICATE OF SERVICE I HEREBY CERTIFY that I served a true and correct copy of the foregoing Notice of Intent upon all parties or counsel of record by depositing a copy of same in the United States Mail at Lemoyne, Pennsylvania, with first-class postage prepaid on the 14th day of January, 2014 addressed to the following: Casey O. Srogoncik, Esquire Clearfield & Kofsky Suburban Station Building —Suite 355 1617 JFK Boulevard Philadelphia, PA 19103 JO ' ' : B UFFIE, STEWART & WEIDNER war By: John A. Statler, "lire Attorney I.D. No. 43812 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Attorneys for Defendant Erie Insurance Exchange • CERTIFICATE OF SERVICE I HEREBY CERTIFY that I served a true and correct copy of the foregoing Certificate Prerequisite upon all parties or counsel of record by depositing a copy of same in the United States Mail at Lemoyne, Pennsylvania, with first-class postage prepaid on the 12th day of February, 2014 addressed to the following: Casey O. Srogoncik, Esquire Clearfield & Kofsky Suburban Station Building — Suite 355 1617 JFK Boulevard Philadelphia, PA 19103 JOHNSON, DUFFIE, STEWART &WEIDNER By: John A. Statler, • ire Attorney I.D. No. 43812 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Attorneys for Defendant Erie Insurance Exchange CERTIFICATE "U, RE;-U.AND COUNT PENN MEtt (*ISITE TO SERVICE OF A SUBPOENA PURSUANT TO RULE 4009.22 IN THE MATTER OF: Court of Common Pleas - Cumberland County, PA MARY CHAMBERS vs. TERM: ERIE INSURANCE EXCHANGE CASE No: 13-5219 As a prerequisite to service of a subpoena for documents and things pursuant to Rule 4009.22. RecordTrak on behalf of JOHN STATLER Defendant certifies that (1) A notice of intent to serve the subpoena with a copy of the 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) No objection to the subpoena has been received or it has been waived, and (3) The subpoena which will be served is identical to the subpoena which is attached to the notice of intent to serve the subpoena. Date : 05/30/2014 RecordTrak on behalf of /S/ JOHN STATLER Attorney for Defendant RT#: 266374 RECORDS PERTAIN TO: MARY CHAMBERS MARY CHAMBERS vs. ERIE INSURANCE EXCHANGE NOTICE OF INTENT TO TO: CASEY SROGONCIK CLEARFIELD, KOFSKY & PENNEYS 1617 JOHN F KENNEDY BLVD SUITE 355 PHILADELPHIA, PA 19103 (215) 563-3580 May 12, 2014 COURT: Court Of Common Pleas - Cumberland County, Pa TERM: DOCKET: 13-5219 SERVE A SUBPOENA TO PRODUCE DOCUMENTS Please take notice that on behalf of JOHN STATLER, attorney for Defendant, RecordTrak intends to serve a subpoena identical to the one(s) attached to this notice. You have until June 2, 2014 to file of record and serve upon the undersigned an objection to the subpoena(s). If no objection is made, the subpoena(s) will be served. IF PLAINTIFF'S COUNSEL AGREES TO WAIVE THE 20 DAY NOTICE PERIOD, PLEASE INDICATE BELOW AND FAX SAME TO THE UNDERSIGNED AT YOUR EARLIEST OPPORTUNITY. IF YOU WISH TO PURCHASE COPIES OF THE RECORDS, PLEASE CONTACT RECORDTRAK FOR PRICING AND FAX THIS CORRESPONDENCE BY June 2, 2014 TO (610) 992-1405. All records will be provided (including no record statements) as produced by each record location. Daniel Wake 610.354.8348 RECORDTRAK 651 Allendale Road P. O. Box 61591 King of Prussia, PA 19406 LIST OF RECORD CUSTODIANS AND SUBPOENAS TAG RECORD CUSTODIAN MATERIALS BEING OBTAINED 5 HARRISBURG HOSPITAL 1 . ALL ADMISSION AND DISCHARGE SUMMARIES, OPERATIVE REPORTS, HISTORY & PHYSICAL RECORDS, CONSULTATIONS, PROGRSS NOTES, INTRAOPERATIVE IMAGES, AND CORRESPONDENCE FROM 12/20/2013 TO PRESENT, INCLUDING RECORDS FROM PINNACLEHEALTH AT HARRISBURG HOSPITAL, COMMUNITY GENERAL OSTEOPATHIC HOSPITAL, AND/OR WEST SHORE SURGERY CENTER (MED) 6 HARRISBURG HOSPITAL 1 . FOR DATES OF SERVICE 02/01/2014 TO PRESENT ONLY: ALL X-RAYS, MRI SCANS, CT SCANS AND CORRESPONDING REPORTS. (RAD) Yes, I would like a copy of all of the records listed above. Yes, I would like specific records I have indicated above. SIGNATURE: FIRM: Date: YES, I AGREE TO WAIVE THE 20 DAY NOTICE PERIOD FOR ALL SUBPOENAS ON THIS NOTICE Signature of Plaintiff's Counsel: Date: MARY CHAMBERS COURT: Court Of Common Pleas - Cumberland County, Pa vs. TERM: ERIE INSURANCE EXCHANGE DOCKET: 13-5219 FIRM: EMAIL: Page 2 RT: 266374.5 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND MARY CHAMBERS V. ERIE INSURANCE EXCHANGE File No: 13-5219 SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: HARRISBURG HOSPITAL liteAf/LA (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: See attached rider. at 651 Allendale Road King of Prussia PA 19406 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 may have the right to seek in advance the reasonable cost of preparing copies or producing the things sought. If you fail to produce the documents or things required by this subpoena within twenty (20) days afte 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: RecordTrak, JOHN STATLER Address: 651 Allendale Road King of Prussia PA 19406 Telephone: (8001220-1291 Supreme Court ID# Attorney for: Defendant DATE: Seal of the Court BY THE COURT: S RE: MARY CHAMBERS vs. ERIE INSURANCE EXCHANGE CASE NO. 13-5219 RECORDTRAK FILE #: 266374; TAG 5 LOCATION: HARRISBURG HOSPITAL (MED) RECORDS PERTAIN TO: MARY CHAMBERS SS #: , DOB: X . ALL ADMISSION AND DISCHARGE SUMMARIES, OPERATIVE REPORTS, HISTORY & PHYSICAL RECORDS, CONSULTATIONS, PROGRSS NOTES, INTRAOPERATIVE IMAGES, AND CORRESPONDENCE FROM XX/XX/XXXX TO PRESENT, INCLUDING RECORDS FROM PINNACLEHEALTH AT HARRISBURG HOSPITAL, COMMUNITY GENERAL OSTEOPATHIC HOSPITAL, AND/OR WEST SHORE SURGERY CENTER RT: 266374.6 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND MARY CHAMBERS V. ERIE INSURANCE EXCHANGE File No:13-5219 SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: HARRISBURG HOSPITAL or En ' y) Within twenty (20) days after service of this subpoena, you are ordered by the Court to produce the following documents or things: See attached rider. at 651 Allendale Road King of Prussia PA 19406 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 may have the right to seek in advance the reasonable cost of preparing 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: RecordTrak, JOHN STATLER Address: 651 Allendale Road King of Prussia PA 19406 Telephone: (800)220-1291 Supreme Court ID# Attorney for: Defendant DATE: Seal of the Court BY THE COURT: RE: MARY CHAMBERS vs. ERIE INSURANCE EXCHANGE CASE NO. 13-5219 RECORDTRAK FILE #: 266374; TAG 6 LOCATION: HARRISBURG HOSPITAL (RAD) RECORDS PERTAIN TO: MARY CHAMBERS SS #: , DOB: X . FOR DATES OF SERVICE XX/XX/XXXX TO PRESENT ONLY: ALL X-RAYS, MRI SCANS, CT SCANS AND CORRESPONDING REPORTS. N1H4 CERTIFICATE 25111CIG OUMBERL AND CCAlaREQUISITE TO SERVICE OF A SUBPOENA P ENNS)' PURSUANT TO RULE 4009.22 IN THE MATTER OF: MARY CHAMBERS vs. ERIE INSURANCE EXCHANGE Court of Common Pleas - Cumberland County, PA TERM: CASE No: 13-5219 As a prerequisite to service of a subpoena for documents and things pursuant to Rule 4009.22. RecordTrak on behalf of JOHN STATLER Defendant certifies that (1) A notice of intent to serve the subpoena with a copy of the 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) No objection to the subpoena has been received or it has been waived, and (3) The subpoena which will be served is identical to the subpoena which is attached to the notice of intent to serve the subpoena. Date : 05/30/2014 RecordTrak on behalf of /S/ JOHN STATLER Attorney for Defendant RT#: 266374 RECORDS PERTAIN TO: MARY CHAMBERS MARY CHAMBERS COURT: Court Of Common Pleas - Cumberland County, Pa vs. TERM: ERIE INSURANCE EXCHANGE : DOCKET: 13-5219 NOTICE OF INTENT TO SERVE A SUBPOENA TO PRODUCE DOCUMENTS TO: CASEY SROGONCIK CLEARFIELD, KOFSKY & PENNEYS 1617 JOHN F KENNEDY BLVD SUITE 355 PHILADELPHIA, PA 19103 (215) 563-3580 May 9, 2014 Please take notice that on behalf of JOHN STATLER, attorney for Defendant, RecordTrak intends to serve a subpoena identical to the one(s) attached to this notice. You have until May 29, 2014 to file of record and serve upon the undersigned an objection to the subpoena(s). If no objection is made, the subpoena(s) will be served. IF PLAINTIFF'S COUNSEL AGREES TO WAIVE THE 20 DAY NOTICE PERIOD, PLEASE INDICATE BELOW AND FAX SAME TO THE UNDERSIGNED AT YOUR EARLIEST OPPORTUNITY. IF YOU WISH TO PURCHASE COPIES OF THE RECORDS, PLEASE CONTACT RECORDTRAK FOR PRICING AND FAX THIS CORRESPONDENCE BY May 29, 2014 TO (610) 992-1405. All records will be provided (including no record statements) as produced by each record location. Daniel Wake 610.354.8348 RECORDTRAK 651 Allendale Road P. O. Box 61591 King of Prussia, PA 19406 LIST OF RECORD CUSTODIANS AND SUBPOENAS TAG RECORD CUSTODIAN MATERIALS BEING OBTAINED 1 ARLINGTON ORTHOPAEDICS 1 . ALL MEDICAL RECORDS DATED 12/20/2013 TO PRESENT ONLY. INCLUDE OFFICE AND HAND WRITTEN NOTES, OPERATIVE REPORTS, TEST RESULTS, HOSPITAL RECORDS, CORRESPONDENCE, QUESTIONNAIRES/HISTORY, RECORDS RECEIVED BY OTHER PHYSICIANS, AND ANY OTHER MEDICAL RECORDS PERTAINING TO MARY CHAMBERS 2 GOOD SAMARITAN 1 . ALL MEDICAL RECORDS IN YOUR POSSESSION FROM ANY GOOD SAMARITAN HEALTH FACILITY, INCLUDING BUT NOT LIMITED TO GSH IMAGING CENTER, FOR DATES OF TREATMENT 11/11/2011 TO PRESENT. INCLUDE OFFICE AND HAND WRITTEN NOTES, TEST RESULTS, CORRESPONDENCE, RADIOLOGY REPORTS, PATHOLOGY REPORTS, QUESTIONNA RES/HISTORY & RECORDS RECEIVED BY OTHER PHYSICIANS. PLEASE ALSO INCLUDE THE PAIIhNTS INFORMATION SHEET. PLEASE BE SURE TO INCLUDE ALL ARCHIVED RECORDS AND ALL RECORDS LOCATED IN STORAGE. * * * * * * * * * * * *PLEASE SIGN THE ATTACHED CERTIFICATION AND RETURN WITH THE RECORDS.************** HOSPITAL * PA (MED) 3 GOOD SAMARITAN 1 . ALL RADIOLOGY CD'S/FILMS (X-RAYS, MRI SCANS, CT SCANS, EXCEPT MAMMOGRAMS) AND CORRESPONDING REPORTS FROM ANY GOOD SAMARITAN HEALTH FACILITY, INCLUDING BUT NOT LIMITED TO GSH IMAGING CENTER, FOR DATES OF SERVICE 11/11/2011 TO THE PRESENT. **PLEASE INCLUDE THE FORMAT FOR THE COPIES; CD OR FILMS AND THE FEE FOR EACH. PLEASE PROVIDE AN INVENTORY OF ALL FILMS, INCLUDING DATES OF STUDY PRIOR TO COPYING. * * HOSPITAL * PA (RAD) MARY CHAMBERS COURT: Court Of Common Pleas - Cumberland County, Pa vs. ERIE INSURANCE EXCHANGE 4 CYPRESS ORTHOPEDIC PAIN AGEMENT TERM: DOCKET: 13-5219 1 . ALL MEDICAL RECORDS IN YOUR POSSESSION FROM 11/11/2011 TO RESENT. INCLUDE OFFICE AND HAND WRITTEN NOTES, TEST RESULTS, ORRESPONDENCE, RADIOLOGY REPORTS, PATHOLOGY REPORTS, UESTIONNAIRES/HISTORY & RECORDS RECEIVED BY OTHER PHYSICIANS. LEASE ALSO INCLUDE THE PA EIENT'S INFORMATION SHEET. PLEASE BE SURE TO INCLUDE ALL ARCHIVED RECORDS AND ALL RECORDS LOCATED IN STORAGE. ************PLEASE SIGN THE ATTACHED CERTIFICATION AND TURN WITH THE RECORDS.************** 2 . ALL RADIOLOGY CD'S/FILMS ( -RAYS, MRI SCANS, CT SCANS) AND CORRESPONDING REPORTS FROM 11/11/2011 TO PRESENT. INCLUDING BUT NOT LIMITED TO RECORDS FROM GIONAL ORTHOPEDICS ** Yes, I would like a copy of all of the records listed above. Yes, I would like specific records I have indicated above. SIGNATURE: Date: FIRM: YES, I AGREE TO WAIVE THE 20 DAY NOTICE PERIOD FOR ALL SUBPOENAS ON THIS NOTICE Signature of Plaintiff's Counsel: Date: FIRM: EMAIL: Page 2 RT: 266374.1 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND MARY CHAMBERS V. ERIE INSURANCE EXCHANGE File No: 13-5219 SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: ARLINGTON ORTHOPAEDICS (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: See attached rider. at 651 Allendale Road King of Prussia PA 19406 You may deliver or mail legible copies of the documents or produce things requested by this subpoent together with the certificate of compliance, to the party making this request at the address listed above. You may have the right to seek in advance the reasonable cost of preparing 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: RecordTrak, JOHN STATLER Address: 651 Allendale Road King of Prussia PA 19406 Telephone: (800) 220-1291 BY THE CO Supreme Court ID# Attorney for: Defendant DATE: 41.PiC�' Seal of the Court Prothonotary RE: MARY CHAMBERS vs. ERIE INSURANCE EXCHANGE CASE NO. 13-5219 RECORDTRAK FILE #: 266374; TAG 1 LOCATION: ARLINGTON ORTHOPAEDICS RECORDS PERTAIN TO: MARY CHAMBERS SS #: , DOB: X . ALL MEDICAL RECORDS DATED XX/XX/XXXX TO PRESENT ONLY. INCLUDE OFFICE AND HAND WRITTEN NOTES, OPERATIVE REPORTS, TEST RESULTS, HOSPITAL RECORDS, CORRESPONDENCE, QUESTIONNAIRES/HISTORY, RECORDS RECEIVED BY OTHER PHYSICIANS, AND ANY OTHER MEDICAL RECORDS PERTAINING TO MARY CHAMBERS RT: 266374.2 z COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND MARY CHAMBERS V. ERIE INSURANCE EXCHANGE File No: 13-5219 SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: GOOD SAMARITAN HOSPITAL * PA A0(44 (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: See attached rider. at 651 Allendale Road King of Prussia PA 19406 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 may have the right to seek in advance the reasonable cost of preparing 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: RecordTrak, JOHN' STATLER Address: 651 Allendale Road King of Prussia PA 19406 Telephone: (800) 220-1291 Supreme Court ID# Attorney for: Defendant DATE; Seal of the Court BY THE COURT; RE: MARY CHAMBERS vs. ERIE INSURANCE EXCHANGE CASE NO. 13-5219 RECORDTRAK FILE #: 266374; TAG 2 LOCATION: GOOD SAMARITAN HOSPITAL * PA (MED) RECORDS PERTAIN TO: MARY CHAMBERS SS #: , DOB: X . ALL MEDICAL RECORDS IN YOUR POSSESSION FROM ANY GOOD SAMARITAN HEALTH FACILITY, INCLUDING BUT NOT LIMITED TO GSH IMAGING CENTER, FOR DATES OF TREATMENT XX/XX/XXXX TO PRESENT. INCLUDE OFFICE AND HAND WRITTEN NOTES, TEST RESULTS, CORRESPONDENCE, RADIOLOGY REPORTS, PATHOLOGY REPORTS, QUESTIONNAIRES/HISTORY & RECORDS RECEIVED BY OTHER PHYSICIANS. PLEASE ALSO INCLUDE THE PATIENTS INFORMATION SHEET. PLEASE BE SURE TO INCLUDE ALL ARCHIVED RECORDS AND ALL RECORDS LOCATED IN STORAGE. ************PLEASE SIGN THE ATTACHED CERI'IrICATION AND RETURN WITH THE RECORDS.************** RT: 266374.3 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND MARY CHAMBERS V. ERIE INSURANCE EXCHANGE File No: 13-5219 SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: GOOD SAMARITAN HOSPITAL * PA (Name of Person or End Within twenty (20) days after service of this subpoena, you are ordered by the Court to produce the following documents or things: See attached rider. at 651 Allendale Road King of Prussia PA 19406 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 may have the right to seek in advance the reasonable cost of preparing 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: RecordTrak, JOHN STATLER Address: 651 Allendale Road King of Prussia PA 19406 Telephone: (800) 220-1291 Supreme Court ID# Attorney for: Defendant DATE: Seal of the Court BY THE COURT: RE: MARY CHAMBERS vs. ERIE INSURANCE EXCHANGE CASE NO. 13-5219 RECORDTRAK FILE #: 266374; TAG 3 LOCATION: GOOD SAMARITAN HOSPITAL * PA (RAD) RECORDS PERTAIN TO: MARY CHAMBERS SS #: , DOB: X . ALL RADIOLOGY CD'S/FILMS (X-RAYS, MRI SCANS, CT SCANS, EXCEPT MAMMOGRAMS) AND CORRESPONDING REPORTS FROM ANY GOOD SAMARITAN HEALTH FACILITY, INCLUDING BUT NOT LIMITED TO GSH IMAGING CENTER, FOR DATES OF SERVICE XX/XX/XXXX TO THE PRESENT. **PLEASE INCLUDE THE FORMAT FOR THE COPIES; CD OR FILMS AND THE FEE FOR EACH. PLEASE PROVIDE AN INVENTORY OF ALL FILMS, INCLUDING DATES OF STUDY PRIOR TO COPYING. * * RT; 266374.4 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND MARY CHAMBERS V. ERIE INSURANCE EXCHANGE File No:13-5219 SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: CYPRESS ORTHOPEDIC PAIN MANAGEMENT (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: See attached rider. 651 Allendale Road Kind of Prussia PA 19406 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 may have the right to seek to advance the reasonable cost of preparing copies or producing the things sought. If you fail to produce the documents or things required by this subpoena within twenty (20) days afte 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: RecordTrak, JOHN STATLER Address: 651 Allendale Road King of Prussia PA 19406 Telephone: (800) 220-1291 Supreme Court ID# Attorney for: Defendant DATE: Seal of the Court BY THE COURT: RE: MARY CHAMBERS vs. ERIE INSURANCE EXCHANGE CASE NO. 13-5219 RECORDTRAK FILE #: 266374; TAG 4 LOCATION: CYPRESS ORTHOPEDIC PAIN MANAGEMENT RECORDS PERTAIN TO: MARY CHAMBERS SS #: , DOB: X . ALL MEDICAL RECORDS IN YOUR POSSESSION FROM XX/XX/XXXX TO PRESENT. INCLUDE OFFICE AND HAND WRITTEN NOTES, TEST RESULTS, CORRESPONDENCE, RADIOLOGY REPORTS, PATHOLOGY REPORTS, QUESTIONNAIRES/HISTORY & RECORDS RECEIVED BY OTHER PHYSICIANS. PLEASE ALSO INCLUDE THE PATIENT'S INFORMATION SHEET. PLEASE BE SURE TO INCLUDE ALL ARCHIVED RECORDS AND ALL RECORDS LOCATED IN STORAGE. ************PLEASE SIGN THE ATTACHED CER I IHCATION AND RETURN WITH THE RECORDS.************** X . ALL RADIOLOGY CD'S/FILMS (X-RAYS, MRI SCANS, CT SCANS) AND CORRESPONDING REPORTS FROM XX/XX/XXXX TO PRESENT. INCLUDING BUT NOT LIMITED TO RECORDS FROM REGIONAL ORTHOPEDICS ** CLEARFIELD & KOFSKY By: Casey 0. Srogoncik, Esquire Identification No. 204395 One Penn Center at Suburban Station Suite 355, 1617 J.F.K. Boulevard Philadelphia, PA 19103 (215) 563-6333 MARY CHAMBERS V. ERIE INSURANCE EXHANGE Attorney for Plaintiff '7L L[ Pi?07-1101-;07-/li' ;- 2014 403 -4 2: ',59 CUNBEF;LAND COIJAITy PENIVSYLVANIA COURT OF COMMON PLEAS OF CUMBERLAND COUNTY NO. 13-5219 ORDER TO SETTLE, DISCONTINUE AND END TO THE PROTHONOTARY: Kindly mark the above captioned matter Settled, Discontinued and Ended upon payment of your costs only. CLEARFTE6- KOFSICY CASEY 0. SROGONCIK, ESQUIRE Attorney for Plaintiff CERTIFICATE OF SERVICE I HEREBY CERTIFY that I served a true and correct copy of the foregoing ORDER TO SETTLE, DISCONTINUE AND END upon all parties or counsel of record by depositing a copy of same in the United States Mail at Lemoyne, Pennsylvania, with first-class postage prepaid on the 1st day of August, 2014 addressed to the following: Casey O. Srogoncik, Esquire Clearfield & Kofsky Suburban Station Building — Suite 355 1617 JFK Boulevard Philadelphia, PA 19103 JOHN._ ON, DUFFIE, STEWART & WEIDNER B John A. Statler, EsgQir Attorney I.D. No. 43812 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Attorneys for Defendant Erie Insurance Exchange