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HomeMy WebLinkAbout94-02520 '>-, ,-,.,., -,..........;":"""j' ~.:...'...'...!....... iF '; . {'c '~ " ~ 'A- VJ " ',f ~. ~ '~ ,1 ;~ '!~ -, i-~ ~ - '.. o n l() (Q . . C~:P'OnER II PlIELDI .. '_YlANDCOIXIV' '...."TLAW U I MAlIlCIIT.'ntDT po.- ... LDtOYf&,...VLVANlA 174M1 7~ 1./ J-.f J..( - ------_.- -"--.---.- _.,.-..._-'-'._.~._-- ZEDNA POLILLO, . IN THE COURT OF COMMON PLEAS . plaintiff CUMBERLAND COUNTY, PENNSYLVANIA v. . NO. 94-2520 . : STATE FARM INSURANCE COMPANY, . CIVIL ACTION - LAW . Defendant AMENDED NOTICE OF ARBITRATION HEARING TO: Rolf E. Kroll, Esquire REYNOLDS AND HAVAS 10l Pine Street Harrisburg, PA 17108 Richard F. Maffet, Jr., Esquire 2201 North 2nd Street Harrisburg, PA 17110 PLEASE TAKE NOTICE that the Arbitration Hearing in the above- captioned matter has been rescheduled for Thursday, December 21, 1995, at l2:30 p.m. in the Law Offices of COSTOPOULOS, FOSTER & FIELDS, 831 Market Street, Lemoyne, Cumberland County, Pennsylvania 17043. '- v Thomas M. Devlin, Esquire 1802 Market Street Camp Hill, PA l70ll Andrew C. Sheely, Esquire 5 West Main Street Shiremanstown, PA l701l Date: ~..,). 7. /990' ZEDN~ POLILLO, plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIa v. NO. 94-2520 ST~TE FARM INSURANCE COMPANY, Defendant CIVIL ~CTION - LAW AMENDED NOTICE OF ARBITRATION HEARING TOl Rolf E. Kroll, Esquire REYNOLDS AND HAVAS 10l Pine Street Harrisburg, PA 17108 Richard F. Maffet, Jr., Esquire 2201 North 2nd Street Harrisburg, PA 17110 PLEASE TAKE NOTICE that the Arbitration Hearing in the above- captioned matter has been rescheduled for Thursday, January 18, 1996, at 12130 p.m. in the Law Offices of COSTOPOULOS, FOSTER & FIELDS, 831 Market Street, Lemoyne, Cumberland County, Pennsylvania l7043. Thomas M. Devlin, Esquire 1802 Market Street Camp Hill, PA 17011 Andrew C. Sheely, Esquire 5 West Main Street Shiremanstown, PA 17011 Datel A~. .;lq, ICjClS ~ ,;, - " t ~ " ~ - ~= .-.... N ~ ~ U"l "" l>_ ~ JUH 19 4 11 rH '95 ~ ... ~ \ lilt L Offll~f or 1Ii< .' Hew: iAh'. CUMOChc(.tW (,',1Y PIHH~,\.~llIl. ~ ~ . i.' ~ } hi J ... ~,. :i" ' - /!' ':1 ~~ .,', 1. ;' '.\' . "",.., ,., " ':>- . }. ~ -, I ~-.. :r.:: '",- . 0-- Cl._ . , ,0 0 01 '-.I ~ P') I.) i:.J . <::' .,- ('o.,J .... ,~ ", "- ~. ~ .~ - ~ Ii) -1\ - .lr\ "1 , ~ ~ '" j ::,.: 't 't:: i .\'1' , (~ I ! ..: ..... z Vl": ..:> w...J . ...J>- >- D.~ z zE5 ..: ff ~D. 8 0 0 w~ ;fi: tl !z ~~ u..~ ...J Z 0::> ~ ..... Jo~ 0 ..: t:;:w ...... ::> ...J z 0.... Vl.... ff ::>0 0 ...J'~ z<: e~ z ~ : oz ..... ...J.... ..... m 0 w..: I- .....<: ~-g w q~!2 ~ w ...J'~ we;! ..: Om 1=w ...J D.~ rt~ ~ i!:~ f;' z~ ,~ ..:D. > w~ S~15~E z ....uO~ 0 to: zw w U Zo< N I- o-iil Vl VI 0111 ...- ...0< '" < J: . ZIDIA POLILLO, Plaintiff v , IN THI COURT OF COMMON PLIAS I CUMBERLAND COUNTY, PIHHSILVAlIA I I NO. Ill. (~.5J(' (", I 7U(Y1 I I CIVIL ACTION - LA" I STATI FARM INSURANCE COMPANI, Def.ndant NOTICE YOU RAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this Complaint and Notice are served, by entering a written appearance personally or by attorney and filing in writing with the Court your defenses or objections to the claims set forth against you. You are warned that, if you fail to do so, the case may proceed without you and a judgment may be entered against you by the Court without further notice for any money claimed in the Complaint or for any other claim or relief requested by the Plaintiff(s). You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LA~ER AT ONCI. IF IOU DOII'T RAVE A LA~IR OR CAlfHOT AFFORD ONI, GO TO OR TILEPHOIII THI OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAR OIT LEGAL HILP. COURT ADMINISTRATOR Fourth Floor Cuaberland County Court Hou.. One Courthou.. Square Carli.le, PA 17013-3387 717-260-6200 NOTICIA LE HAl DBMAHDADO A USTED EN LA CORTE. Si usted quiere defenderse de eatas demandaa expueatas en laa paginaa aiguientes, uated tiene veinte (20) dias de plazo al partir de la fecha de la demanda y la notificacion. Usted debe presentar una apariencia escrita 0 en persona 0 por abogado y archivar en la corte en forma escrita HUS defensas 0 sus objeciones alas demandaa en contra de su persona. Sea aviaado que ai uatad no se defiende, la corte tomaro medidas y puede entrar una orden contra uated ain previo aviso 0 notificacion y por cualquier queja 0 alivio que ea pedido en la peticion do demanda. Usted puede perder dinero 0 sus propiedadea 0 otros derechoa importantea para uated. IIDRA POLILLO, Plaintiff I IN THE COURT OF CONNOR PLIAS I CUMBIRLAlD COUNTY, PEHHSILVAlIA I I NO. 1/1. ,^.').) r I I CIVIL ACTION - LAW I y STATE FARM INSURANCE CONPAlY, Defendant fl'1. 'f I , 1994, comes the Plaintiff, ZEDNA POLILLO, by her attorney, Richard F. Maffett, Jr., Esquire, and avers the following: 1. Plaintiff is ZEONA POLILLO, an adult individual who resides at 226 Birch Lane, Carlisle, Cumberland County, Pennsylvania. 2. Defendant is an Illinois Corporation licensed to write insurance policies in the Commonwealth of Pennsylvania pursuant to the Pennsylvania Motor Vehicle Financial Responsibility Law, 75 Pa, C.B.A. 51701, et ~ Defendant has its principal place of business at 115 Limekiln Road, P.O. Box 257, New CUmberland, Cumberland County, Pennsylvania, and regularly conducts business in Cumberland County. 3. On or about August 9, 1992, Defendant issued to Plaintiff an automobile insurance policy, which, by its terms, provided payment for reasonable expenses incurred for necessary medical services because of bodily injury sustained by Plaintiff as a result of a motor vehicle accident involving the Plaintiff. 4. Said policy of automobile insurance was in full force and effect on September 25, 1992. 5. On September 25, 1992, Plaintiff, while operating the insured motor vehicle, was involved in an accident when the insured vehicle was struck by an automobile operated by Mark E. Skilton. 6. As a result of said collision, Plaintiff suffered injury to her neck and back which has been diagnosed as cervical hyperextension-hyperflexion sprain-strain, cervical-brachial syndrome of the right upper extremity, torsion injury of the lumbar spine and a neuropathy of the right lower extremity. 7. As a result of her injuries sustained in said accident, Plaintiff has been obliged to receive and undergo medical attention and care by Robert C. Zabinski, D.C., and to incur medical bills therefore, and she will be obliged to continue to incur such bills for treatment for an indefinite period of time in the future. B. Despite repeated demands by Plaintiff, on or about March 28, 1993, and continuing thereafter, Defendant has unilaterally, unreasonably, wantonly, without just cause, and unlawfully, refused payment of medical bills incurred by 2 Plaintiff for medical treatment rendered by Robert C. Zabinski, D.C. for treatment of her injuries suffered in the aforesaid automobile accident. 9. The aforesaid medical bills incurred by Plaintiff for treatment by Robert C. Zabineki, D.C. since March 28, 1993 total Two Thousand Four Hundred Eighty-Five ($2,485.00) Dollars as of March 23, 1994. 10. The aforesaid treatment and care of Plaintiff by Robert C. Zabinski, D.C. conforms to professional standards of performance and was medically reasonable and necesBary treatment rendered for the bodily injury sustained by Plaintiff as a result of the aforesaid accident. 11. The charges and expenses incurred by Plaintiff as a result of the aforesaid treatment and care by Robert C. Zabinski, D.C. are customary and usual and lawful. 12. Immediately following the aforesaid accident, Plaintiff gave notice thereof to Defendant, and haB submitted to Defendant, reasonable proof of the fact of her injuries and the amount of bills and expenses on the appropriate forms. Plaintiff has, from time to time thereafter, submitted to Defendant in writing the amounts of additional bills and expenses sustained and incurred 3 for reasonable and necessary medical treatment received from Robert C. Zabinski, D.C. 13. Defendant filed a challenge with a Peer Review organization (PRO), Consolidated Rehabilitation Company, 2616 North Broad street, P.O. Box 1719, Lansdale, PA 19446 for the purpose of evaluating the treatment and services provided to Plaintiff by Robert C. Zabinski, D.C. 14. The initial determination of the PRO which was rendered on August 19, 1993, was unreasonable, without just cause and unlawful in that it concluded no further chiropractic care should be rendered to Plaintiff after March 28, 1993. Defendant did not provide Plaintiff with notice of the PRO results until August 27, 1993. 15. The initial determination of the PRO rendered on August 19, 1993, is incompetent, invalid and unlawful because it was rendered by a reviewing individual, Kevin W. Emmons, D.C., who is not of the same specialty as Robert C. Zabinski, D.C., CCRP, a Board-Certified Chiropractic Rehabilitation Physician, the individual subject to review, in violation of 75 Pa, C.S.A. 51795(b) (2). 16. The PRO's initial determination is based solely upon spsculation. 4 17. Dr. Bmmons, the initial PRO reviewing individual, did not provide Dr. Zabinski with adequate opportunity to discuss Plaintiff's case with the reviewer, and did not have the Plaintiff's complete medical records, ae required by Section 6.952(c) of the Insurance Department Regulations. 18. Plaintiff filed a request for reconsideration of the PRO's initial determination within thirty (30) days of receipt of the PRO's initial determination, on September 16, 1993. 19. On September 17, 1994, the Defendant commissioned a reconsideration by the PRO, Consolidated Rehabilitation Company, of the PRO's initial determination. 20. The reconsideration determination of the PRO, rendered on October 19, 1993, is unreasonable, in error, without just cause and unlawful in that it concluded that no further chiropractic care should be rendered to Plaintiff after March 28, 1993. 21. The reconsideration determination of the PRO, rendered on October 19, 1993 is incompetent, invalid and unlawful because it was rendered by a reviewing individual, Mark Cavallo, D.C., CCSP, Diplomate American Academy of Pain Managemsnt, Certified Independent Chiropractic Examiner, who is not of the Bame 5 specialty as Robert C. Zabinski, D.C., CCRP, a Board-Certified Chiropractic Rehabilitation Physician, the individual subject to review, in violation of 75 Pa, C.S.A. 51795(b)(2). 22. Defendant's denial of Plaintiff's benefits is not baeed on proper evidence or due consideration of Plaintiff's personal condition, her medical records, and the opinions of her treating chiropractic phyeician. 23. Defendant has acted unreasonably, without just cause, and unlawfully by refusing payment of the aforementioned chiropractic bills. 24. As a result of Plaintiff's aforesaid refusal to pay reasonable and necessary chiropractic bills incurred for treatment of Plaintiff's injuries suffered in the aforesaid motor vehicle accident, Plaintiff is entitled to interest on the amount of the claim from the date the claim was made by Plaintiff in an amount equal to twelve (12%) percent per year. 25. Because of Defendant's failure to pay Plaintiff's chiropractic bills without reasonable foundation, and because the Defendant acted in an outrageous and unreasonable manner, 6 5. Admitted. 6. Admitted in part and denied in part. It is admitted that Plaintiff was diagnosed with a hypereKtension-hyperflexion sprain-strain injury. It is specifically denied that any of the bills at issue for said injury are reasonable, necessary or related to the motor vehicle accident in question and strict proof to the contrary is demanded at trial. 7. Admitted in part and denied in part. It is admitted that Plaintiff sought care from Robert C. Zabinski, D.C. It is specifically denied that the care at issue and any bills in association therewith are reasonable, necessary or related to the motor vehicle accident in question or that same are compensable under the terms of state Farm's policy and Pennsylvania Law and strict proof to the contrary is demanded at trial. 8. Admitted in part and denied in part. It is admitted that Plaintiff made demands for payment. However, state Farm paid all of Plaintiff's bills up through June 15, 1993. Accordingly, Plaintiff's reference to March 28, 1993, is inappropriate. 9. Admitted in part and denied in part. It is admitted that Robert c. Zabinski, D.C. has submitted bills for chiropractic treatment since March 28, 1993 which total in the aggregate Two Thousand Four Hundred Eighty-Five ($2,485.00) Dollars. It is specifically denied that under any circumstance, - 2 - that Dr. Zabinski is entitled to Two Thousand Four Hundred Eighty-Five ($2,485.00) Dollars as his bills are subject to the cost containment provisions of 75 Pa. C.S.A. 11797(a). By way of further answer, Dr. Zabinski was paid for his services rendered up through June 15, 1994, and accordingly, Plaintiff's reliance upon the date of March 28, 1993, is misplaced. 10. Denied. The allegations contained in this paragraph of plaintiff's Complaint constitute conclusions of law to which no further pleading is required and they are therefore, denied. By way of further answer, it is specifically denied that the treatment at issue was medically reasonable, necessary or related to the motor vehicle accident in question and strict proof to the contrary is demanded at trial. 11. Denied. The allegations contained in this paragraph of Plaintiff's Complaint constitute conclusions of law to which no further pleading is required and they are therefore, denied. By way of further answer, it is specifically denied that the treatment at issue was medically reasonable, necessary or related to the motor vehicle accident in question and strict proof to the contrary is demanded at trial. 12. Denied as stated. It is specifically denied that any of the care and treatment at issue and any of the bills submitted in association therewith were reasonable, necessary, or related - 3 - to the motor vehicle accident at issue and this allegation is therefore denied. 13. Admitted. 14. Admitted in part and denied in part. It is admitted that the initial determination of the PRO was contained in a report dated August 19, 1993. It is further admitted that the report concluded that Plaintiff's reasonable and necessary medical treatment should have concluded on or before March 28, 1993. The remaining allegations of this paragraph of Plaintiff's Complaint constitute conclusions of law to which no responsive pleading is required and they are therefore, denied. 15. Denied. The allegations contained in this paragraph of Plaintiff's Complaint constitute conclusions of law to which no further pleading is required and they are therefore, denied. 16. Denied. The allegations contained in this paragraph of Plaintiff's Complaint constitute conclusions of law to which no further pleading is required and they are therefore, denied. 17. Denied. It is specifically denied that Dr. Zabinski did not have adequate opportunity to discuss Plaintiff's case with the reviewer. By way of further answer, it is specifically denied that the PRO had insufficient documentation necessary to undertake its review. To the contrary, at all times relevant hereto, the PRO had the necessary documents to undertake its review and strict proof to the contrary is demanded at trial. - 4 - lB. Admitted. 19. Admitted. 20. Admitted in part and denied in part. It is admitted that a report of reconsideration was issued on or about October 19, 1993. The remaining allegations of this paragraph of Plaintiff's Complaint refer to a writing which speaks for itself and is the best evidence of all it contains and accordingly, no responsive pleading thereto is required and same is denied. 21. Denied. The allegations contained in this paragraph of Plaintiff's Complaint constitute conclusions of law to which no further pleading is required and they are therefore, denied. By way of further answer, it is specifically denied that Dr. Cavallo is not of the same specialty of Dr. Zabinski and strict proof to the contrary is demanded at trial. 22. Denied. It is specifically denied that state Farm's denial of benefits lacked a proper factual basis. To the contrary, state Farm's denial was rendered in accordance with the terms and conditions of A1797(b) and included all the appropriate considerations in association therewith. 23. Denied. The allegations contained in this paragraph of Plaintiff's Complaint constitute conclusions of law to which no further pleading is required and they are therefore, denied. - 5 - 24. Denied. The allegations contained in this paragraph of Plaintiff's Complaint constitute conclusions of law to which no further pleading is required and they are therefore, denied. 25. Denied. The allegations contained in this paragraph of Plaintiff's complaint constitute conclusions of law to which no further pleading is required and they are therefore, denied. WHEREFORE, Defendant, state Farm Insurance Company demands judgment in its favor and against Plaintiff, Zedna Polillo with costs of suit assessed to Plaintiff. NEW MATTER 1. This case arises from a rearend accident that occurred on September 25, 1992 involving damage to Plaintiff's vehicle. 2. Thereafter, Plaintiff engaged in extensive therapy with Robert C. Zabinski, D.C. 3. In accordance with the terms and conditions under 75 Pa, Cons. stat. state Farm issued payments under the policy issued to Plaintiff from the date of the accident through June 15, 1993, amounting to six Thousand Three Hundred Seventy Three and 37/100 ($6,373.37) Dollars. 4. A true and correct copy of state Farm's payout sheet reflecting its payments to Plaintiff up through and including June 15, 1993 is attached hereto and included herein by reference as Exhibit "A". - 6 - 5. On July 6, 1993, state Farm received a statement for services rendered by Dr. Zabinski for dates of treatment beginning on June 22, 1993, through the date of the statement. A true and correct copy of this statement for services rendered is attached hereto as Exhibit "B". 6. Thereafter, state Farm timely referred the matter to Consolidated Rehabilitation company, a Commonwealth approved Peer Review Organization, ("PRO") to assess the propriety of Plaintiff's continuing care and treatment. Notice of this referral was sent to Dr. Zabinski on July 21, 1993. A true and correct copy of this notice is attached hereto as Exhibit "C". 7. By report dated August 19, 1993, the PRO issued a report concluding that chiropractic care was no longer necessary after March 28, 1993. A true and correct copy of this report is attached hereto as Exhibit "D". 8. Plaintiff's requested reconsideration of the PRO's initial determination. state Farm requested reconsideration on September 17, 1994. A true and correct copy of State Farm's timely request for reconsideration is attached hereto as Exhibit "E". 9. The results of the reconsideration are contained in a report dated October 19, 1994. This reconsideration report affirmed the conclusions rendered in the initial Peer Review. A - 7 - true and correct copy of the report of reconsideration is attached hereto as Exhibit "F". 10. The claims of Plaintiff are limited by the terms of the MVFRL, 75 Pa. C.S.A. 01701 ~~. as amended by Act 6, April 15, 1990 ("Act 6"). 11. The bills in dispute were incurred after the effective date of Act 6. 12. Thereafter, based upon the totality of the circumstances, state Farm sought professional assistance in assessing the reasonableness, necessity and relatedness of Zedna Polillo's injuries. 13. The charges at issue in this case and for which insurance coverage is claimed from state Farm are unreasonable and unnecessary and/or are for injuries and/or conditions unrelated to the accident in question. The nature and extent of injuries, damages and other losses alleged by Plaintiffs are denied. 14. Plaintiff's claims for insurance benefits are barred by lack of consideration. 15. Any application of a legal rule so as to broaden defendant's liability under the insurance policy in question is barred as a matter of equity. 16. Plaintiff's are not entitled to recover attorney's fees incurred in obtaining any insurance benefits which may ultimately - 8 - exhibit A Exhibit B :.'.;:~~t~~~t:~ ~\; ~:i~;:.;~:~:~;~:;~ "/1 "<..,, ."...'1....:1.... .,;y ~.!~:~~;;.rd:. ;~~ ) :.:":',~' i:/r, )~::i;:~'~::/.::.;"':::: ',;'-.':: .:: ~...: '-; ," .., ; ::, ~~ ;ii:X:<.:.:'~' '..: ,'i . . .,' .....,. ~ . ,.' "";-": . ..., ~ ~TATtMfNr l.,''i3i. 'i.:t:t." '-l I 1.4 I -; "2- TEL: (71 n 737.6279 ROBERT c. ZABlNSKl. D,C. 3020 MAAKfT STRm CAMP HIli. PENNSYLVANIA 17011 TAX 10 1ZJ2248610 " r HARRISBURG Jill 06 1993 RECEIVED ~"" t'A'IVIHrI"ADC. ATTUt~aArr. IHOMIlwtu. ,.."",.. CW YOu" IllbT "'A1'Dfbn' KItS. ZEnnA POLIllO 226 Bircb Loane Carlisle, fA 17013 NF: Stat. Farm Insul:anc. DX' E812 0 847 0 "23 3 ~ """'''''D . . J , I . ~ rm. CRIllIT'S O~.c:IltI""'IOH ~.......,. ~NCa AD.J_ - ;ij ~!m\92~HlIrv~!~~1 97128 ee' vi~~ 'nn 6-29-Q 18X, l~P ~r !~5~".. rg~fW lllMh 52 00 : 7-2-93 ~~n~v(67) 99215 CY(40) 9i7,~~ ~:rv ,..cO! rpt(15) 97128 lumbar carvie< 1177 no '?Al Inn (-5-93 :~laim Submittad $281.00 .. -- . , -- 1 --- --. - --- c:. \:I-wn""'-" ~, w lanIINI_n lUUI1 1lO1'~aI""""'1I111J :::.. .u,j'f.o...." \111I\ 1.1I~1". "'-Otf.. .....,8SZ1~ rnl1V-J~"""'.""-:t.._... AHV-AJwtM-V~ .1IOic....~. '. DI.I'...~IA:OlXl l'\J.UI'AT t.l.lf AMOI.M :..lALtI.c:t: ~ ~ P:-"""",,_ 1110lCllhWi ~I'n",.." ""-'-- '::-:i:. rum..: UI .""ot.." tVia-.4IIw\UI rm..r.una., ~4'nrn- .W!lC~ ,-..,--u.""'.........,JOOIo.......-..n !.""111 C\'-CYW<I'mv ,;0 -_ a... lI!nn:n-_1I '1IU lie - """""" """-n aa. 1!lS07Il J...1-'-'1IlOl'Q"'" n-~ ~.ttT7~ ''1-0_ ~ '1101Ql N.J.-'~""", I!oIicri 11101OI "'r..I~1I!Gil CGctiaII\.o.\o1blII cu. .fI-c... """"',...."-!-n 1112041 1l!-~'tIl1'l " ,. ..... '. l " i.." !1~~{;~f:'\J.:i,:r::.;i}~:::',~':;. }!~;y.;:ii,rf.j~I~~~,;,j~~_Hl fT;~~'. h~.:.::.;! :'.; ~'.~:::;~ ., . , " .~ ~;:.}.': ..:~.T./ ;~::;::.~ - ~'. .'. ,. .,1 ""',I.,.",n,"l' '.':.i'.'" II'" """III>@ exhibit c . .".. ""'nlll 1:\ .,,".H"'~I"'''''''' ....'111". \IJ Exhibit 0 "~" .~~R0 COllsoliililte~i Hehahiliwrion COlllpany ~ i l/'\l\l\h.lwl.Jn.... AUG 2 7 1993 ~f::,~;:D{"~P CO~TIDENTIAL REPORT ATT: BECKY PASTOR. R.N. (1E....I:.p ,.-"", ""...:.. ';';-' i '.'~r Kt:\'i:\\ l>S:iJll~.lIjlJn ,mHi<<l by lh~ C)rnmoo\\~uhh IIr P~nl\~>'I\'aJ1i3 0/19/93 _..u ___ ._.~. ____ ______._ _'. -- ---- ---.------------.--...- RE: ZEDNA POLILLO CL: 38-6536-422 D/A: 9/25/92 AUG 2 3 1993 Dear Ms. Pastor: For the purpose of this review, I have ut111z~d the following records: C'1C 1. DR. ZABINSKI'S NARRATIVES ONLY (NO NOTES OR DtAGNOSTICS) A. 8/5/93, 9/29/92. 10/19/92. 11/9/92, 12/22/92, 1/15/93, 2/18/93, 3/5/93, 4/19/93, 5/21/93, 6/9/93, 7/15/93, 7/5/93, B. BILLING STATEMENT, 6/22/93-7/5/93 2. msc. A. ER RECORDS, HOLY SPIRIT HOSPITAL, 9/25/92 B. APPLICATION FOR BENEFITS, 9/28/92 According to the records, this at the t1~e 30 year old restrained female driver was at a stop sign when her vehicle was struck in the rear _ She was tranflported to an ER and released with muscle relazors. Two days later, she repot'ted to Dr. Zabinski with complaints of head, neck, shoulder, and low back pain, and also paresthesias in her mid-back. She ~as examined there and found to have positive findings indicative cf a cervical strain/sprain and torsion injury to the lumbar spine. Treatment cOlllDlenced on that day and has continued to this time. Presently, she is on a frequency of once per week. ','. ,- - - .. As per your request, I did cull Dr. Zabinski to discuss t;.Ws case on Tuesday, 8/17/93, at 11:45 AM. Ee was quite adamant about his form of documentation being su.fficlent. Namely, the regular narratives that he has supplled during the course of care. I disagree with that, as daily notes would be more helpfUl in determining tWI> patient I 5 illlprOVp.J1lellt. He also statel> that his treatment is documented ill jou.rnaIE: as being appropriate I'or the injury. He had treated I:ho pat1ent in the pnst, somer.ime 1U 1906 for a WOJ:'k related low back i"~"r;'. "'1" mnrp recently for U1igratne hnaaacoes. n!~"_olll hack lnjury was a cloBnd IIlr, :... .;tot~~, ~!!'l thn n~'~"!""~~.~,,,? t'rnFltlll(lnt- h;..(} "oth1n~ ~:ilatsoever ro {,'"' with her current cOIl.littun. She doe,s suffer suboccipital headaches. but theHG are different from her former problems. The problem here is that tho patient hr.s two past condit:lons that r:!r.....=?rf. . o. "'. L ,~... , : . '; I,' .1 r ';" ~ .r' .'j 9,': ;'. !.... .,~. ... CI~' ._ ._';~':';~ :l\;;'::r~:- '''',.. " '.i' ,TJ ;:r...;'~ .~:.. . , ~ , "," ~ ~ r , .::': '.t.' ."J. . ,\ -. "'" AU6 2 71993 RECEIVED ZEnNA POLILLO, CONTINUED. PAGE TWO. might be applicable to ber currentiltntus. Dr. Zabinski told be that both of thosa conditions are s'~parate, cloued fHea, and J[ I desired information from tham, I '",ould have to call him back 1n the afternoon. In my opinion, a pat.lent I s file is a complete record. It should not consist of indiv1dUAl closed files. That is not proper record' keeplng. Accordin!~ to the law, these rev1ewfr are to be done on the basis of writ~en documentation. I could not, becaUBe of time reatraints, wa:lt for copies of the past history. They should have beeu included in the fUe. Dr. Zabinski had nothing to add other then the fact that the patient is still improving, she does well at once pe= week, and that he is 'shooting for MMI in 60 days.. He also stated that there were no disc lesions and therefore, no MIU' is or EMG I S were necessary. After review. of these records, it ilS my opinion that treatment was initially ~easonable and necessnry for injuries sustained in the 9/25/92 MVA. It does appear that the patient sustained a moderate cervical and lumbar strain/sprain. The documentation format, although adequate for such an injury, does not substantiate this ertensiva I: rea tment . I did not mention prev10usly that Dr. Zabinski felt q1bez measurements were adequate documentation. I disagree lath that in this case as there is no baseline to go on. This patient has a h:1story of musculoskeletal problems, and as su(11. might have already had pe=l;lne'Jt impairment:. It so, there lire already scar tissue deposits that will prevp.nt he~ from ~eaching optimal measuremenl:s (ROM,atc.). Considering that, detonLtcing MMI from this (Cybex) method would be impossible without previous tesl:ing (prior to the accident.) . It is stated that the patient is cUJ:renUy under rehabilitative care at once por week. [1I my opinioll, that is maintauance. 1 can't really deternune when she went on that schedule, an there are references to increased frequou(~ due 1:0 cephalgia. Again, because of tile formal: (nanatives only), it is difficult to ascertain this patlent's improvement: lIr the cause of her complaints. .Ul per: your qu.'lst;lons, lhe l":lJITl1nt I:rl..!al-ment doe!,\ not seem reasonable or necessary, based on the document~t'c!l. T~ ~ opiniuu, LWl,.i dcc=::.'t C.ll-'I::'Uci..J. UJui.~ ~~lt:l! C1 ~U\.lll~rate inJury to the cerrrtcnl and lumbar ~pinlL PilAf;!lIl' trAl1tml'nt fnr rmr.h inj'lr:es lIoed not e.xceed ninet}. days. Active re.habil i tat ion is appropriate, and that appears to hao,;'e been started hO~e. A ninoty Exhibit E .uJII'IUt...,',_.,."....''''''\III...IU.'. '.......'FlllM"......'"P,.. ,) un' Exhibit F 'w w . ...~;? I'. ..t",'~r:U~f) 1 i\l \, \'...~ :e~ir;,; :'~~::.':C NOV 0 S ,~~3 rU:Ct.i\, '::'.J S":.:\tlnQ th.r.t thlB c:l...imant 8i1,JE,"1IOn':,IC ~.n~. los!! 01' ccr:~C:~'::Jl''!lnl'!~ll!, nor euata:ned any trac:tur~5 and O~ dl!loC~t~gna. I: rL.::: '.U I: :.;::;. ~ :..:,~:'~ SubBequantly, this claimant p~e~enten t~ th~ o"flce of Dr. Reb.rt !....binsLi, Chirer-r.c:tCl'", on 9/':1.9/9':., ."I'.lIrll lot was netec th...t uper endmination ::Jr. Z.bin/H,i cu-rl...ed at '~he tol ,c\"~I",CJ c~'.';nr:!!l!l!!l hy;]ere:ltension/hyp.rfle::tion lnjlJt-y, 1;.11U-'''l;:~1 t:1-...c~i..l s,'naromu, tortior. injury lumbllt' splnli ..nd -6.dlcli,~pClr.t1'''' 10;01 ooc:l, !'-I'..tf upon the above di~gn06~!! Dr. :.bin~I." impl.~lInt~d ~ t-~~tment r.\Iimen conslstinQ ef ultrasOlnc, nardO'.. ,n...nlp,_,latlcn CT ..,.. !!pine and r.h...bi!ltativli trIt4tmen~. F,-om t'. reView 01 th. m..cical ,"gc;oros. It is nct~;l ..n...t thle claim.ant .:.ni~i~tl'!c car~ under tne ~uidance or Dr, Zablni~.~ on 9/29/92 and continued through 8'93. Acccrdir~ tD the rQ~Qrd. t:his claimant c:ontlrlL;ed tc recei','E can? 'lMder ':he r.:.Ji:lar.ce cf Or. 4.b~n.k1 oeyond 8/93. In answer to yeur correspcndwnc:e d~teo 10/1:/93, th~ ~ol:cwirg ii ~y prote5sional opinion ~cnC~rni"g yc~r ~~'etlon~l 1. DC '(OU CONCUR THAT F'AT!ENT ;:;:EACHE!l !:ErJEFIT c;r- C:'IIRCJFfi,~CTlC CARE BY ZABINSKI CHIROPRACTIC ON O~ 8'0' :/20!9! AND THAT NO FURTHER CARE WOULD ~E NEEDED~ If thia claimant's compllllnt6, m.~hanlsm ot tn.:.Jri~9 6nd n~i~ory of the accident ~i pre!!ented ~re correct. thi~ =leimant inltl~:.t care undilr the ,"uldanc:. of Dr. Z.tHn..~.~. en '/1'19/92. ~e'" 111- juril!l~ alleQ~dly .uetaingd in a ~va a~ 9/2~f9:. l~ ~pp.'re by th~ tile av.ail.ble tor my reV1E~ tn~t chlrepr~~t~c: care renderil~ to thi~ claim~nt by Dr. Zaoine~i was appr~pr!ate. rO~i=n~bl. one neCeS6C1ry in the init1.1 month. cf C4r~, It =.t".Quto bs nwt~d that t.he Lise r:": ;;o.ll:.~t:"d, ~.1lAri,D:'.. ~".eL.!d~;;I; Ir.a.nip~il...ticn ~or- ,:hii tr-eat.'T'ler.,; of '!~,,;': ~i~~'_!~ lr'1j'.I"'ie~ li'~I~t., !I.!J th:.!! ~lalmar.t ~lleCjedly '5iJStil:.:"'\~d ,~r. ';-/:'!'I.'C?:-: :.~ ';!;udl:', ~;_'~+-.i.:..ilt'" for up to a thr~1! month ~.r~od ct t~~~. Tr~."~~n: 'or ~~tt ~L~!!UE lnJurll!S which eac:w.dl! thio: l."qth H' ':,....~tl1."~ t.Uel'! Is L'I'~01iiil.l.v" it not do~ume,..ted by peliitlve o,";,f1c:p:rc,;,;:;.'nlt~\:-"..!'1g1~~1 COi16L\!t;",- tionl!, CT/MR tJ.ndi.l1g~1 0"- :nrJl!! ~.':'.'~I'C~'~ I_l~r;,n':'-'!t.~': G'.cli.,l.t:.!.dr,~ !!LICh a& f1"ltoll! E~IG, SSEf"/NC:V, ..t;. No ;:C';-.;It~lf I':',' "''!Iip-'-r.d" .fInd or any diGlgnoatlc t'eCj.': r~liutt~ .;:::~.!:': r~t- n-y ~~"!..~l...; ::':>n~~t"11ng ~llis :;&\5ri. L:p'Jn ~':-!"'J.G'w~I!Y '.~.l: ~,,_....I'. .,... ..~~r w''':':.. :;.;\J ;..., ....,. ..~"rt'..:j.~ ~~nc..:"''''''''; ..~:.; ",~~.1i;l ... ;,: ~'I5'~,.~'ht'~....,..,rl ~~, ~)..., ~:-"T\'.:J:15 .....,~ th1.e cl~1mant Ill',d re..ched c! po.t.nt lJ~ mA't1tf~l,''T\ Ql!ne..~.... .;1' ':'d~tnl!r .:11ir',,:- ;Jr...c:t~c: c!!rt!! by :':/26/93, " IOont,\.. ~I" ,~':<:1j t:cn ~ t ......Ii r,~.1I1'l t " !Cl'". Emmons that ti',/! c:ybl<1I t;,,~~:n~ !Ji'rhr;T1ac 0" tt1~lj o;;lll1.1101rr. l",' ~ 'W .,,,,,'I\!":}G \1' ":,... ..c"....r, ......1\...... :JCr.E. ='cl;. ::;.. t\O~ G 5 \~S3 ':':y= - ':=!:..-: ,\lO.: :,J~:.i :64 .:;:: ... :'''C~itJ'~~ .'\- Dr. Zabim.f.i Wilii not ..pprop..:.ate, ~,or- "'~~!!cr,..b~:e. ..1;:0::1 ~i"ls"in," thm do~umentation pre5ented ~rc~ tha t~eat!n~ ~hi"cp"'~:l~C ~hY~!- ~ian. Dr. Z~bin~ki. Alon~ ~ith ~i6cusslng thi. .~:~ ft~t~ ~h~ treatinQ chirapr~ctic ~hy!ici~n, 3m in ~~rwemant wtt1 t~Q ini~ial peer review performed by Cr. E~mona ~n tnac t~is ~la~mant had riiilchao II point. of ma;:lm"m ::in."i'~ tJt ft',rtr,e,r ,:h~rop"'!cUc treatment by 3/28/93. Ther!! !::1.!t5 n: 1'u,',:h~r Cb2ljc,:i'.'e eli-ni- cal documentation for my re\lEI. 6~~pg...tln," ~he neces5ity cr ~eed of continued cniropractlc ~..r'" b~yoncJ il '" ,n:;Jr,tt. pe;-ic1 of dr.e con earn ing thl!! ca!!e. I t ill 'W pr"o1'!!!!!!lOnoil I :.pin:an thil \: :;;:ryonc 3/26/93, ~ home rehabilitatlVQ type pragr~m ~Dn~iEtlnQ ~f th~r.- p"~lti::: st.retches and e':a;-~lees ':OCl ~e h~vll billlln l.11plai11lfrtl!d ':c increase strenQ1:ti. fla,:ibility "nd end:'H"e.I1C:e. ,!!.!5 L<el:' ~:!l to !~el;, prllvlfnt against any a\lllrllva"::ion/el:ac:erbetion of thO! !llle';led injuries sU5~e.ined due to t~e ~ve. in qU~Etion cf 91~5/92. Addi- tione.ll y, it is my professions 1 cpirllan tl"a t c,ny and aU cyoe:' testlnQ performed on this clalmant by Dr. Z"bins~l Has not appr~- priate, nor rel.onable at eithsr ~Qnitorln~ the ~rc~ress th~t thIS clAimant was making ~ith t~e ~a;-e ~elng pr=Yl~ed ~y Dr. Zabinski and or altere.ting a treat.men1: regimen. ~t is my ~rcf~~- sional opinion thet the initial e;;i\minaticn fol~c;..;ed by :-,c:;r,ar-Ou.. re-G1:;a.mil1at:10ns which were perforned en this c leim.?n t b', Dr. Zabinski. ccn5iating of activa/paaeiv~ r~ngeE of motion, orthope- dic m.neuvers, neurological testin~. at;., wClIld have bEqr. ~~?r~- pr!ate in and of iteelf at both objHctivaly mcn~tor~n; ~~~ prc~r&.. thi~ ~laimant W~K makin~ witn the care beinQ pr~vld~d by Dr. Zabin~~i alonQ with a!tar~tin~ a tre~tment reg~m~n if nece~- sary. Theretare, it is my pro1esslonal 0~i~1on that Inl "nd ~l: ~ybe" testinQ par formed on thia cl!limant by Dr, !~bin2ki Aa~ net ~pproprillte nor reasonilble ~cncarnin; thi6 case. Additionally, Cr. ZabinE~i request~d ~he ~~p~rtuni~~ ~a aisc~$s thlS case ~Iith me prior to my renderi~g a deci~ion. On ~C!!9/93, I di.cus~ed this ca~a with Dr. Za~~'16..i. It ~as statea ty 0-. ~abin5~1 ~h~t thi~ cla~m~nt ~aa b9i~g t-~~t~d through ~c !~e pres~nt, Th~re w~s ~o f~r~h~r daCl~ne~t~ticn for I~~' ~~view ~~n- cerninQ thia cese. rheretore~ upor reviewing the ert:re dccumEntatio~ ~re52ntea fo~ ~)' re"/iew concerning t;,~! case fro~ the tre~ting chircpr~ctic phywi~ian. Dr. Zabinski, Blcn; ~~tn =iecu~~~n~ ~hi~ file h:tn tha trebtlnQ chircpr~c1:i~ phy~i~~~n. ! ~m:r &gr~~m~nt ".t~ t~a ~n~tial peer review D~rtormeo by ~r. ~m~c~s ~~ t~at .~~~ ~~~~~e~~ ~IC\~ I WU.~~'ltC s. po1n t:. of m.:~ lmu:n med lea 1 imr.; rove.mer-. tel- ,-,~.: r.'.~,7 ben~flt 01 chircprcH:.tic care 0:1 ~,.'''':8:'-:'3'1 n':'.~ 1l~r.tl'1.. ~~ :-~ Jt.',' ~~=f~~~ion^l LpLnion that t~i~ ~:~;t~ ~~ t-~~t:~~~~ ~:~~..~e ~rr~ than ~uffici.,=nt to nii,,::h .!\ p011"'t ct r""'i'iio~I.'.t1cn, tCj- ~~.~.. ::!e.:'ln- ~nt6' !njuriae ~ust~ined d~e to the MVA in quee~ion. . VERIFICATION I, JOHN WILKOWSKI, hereby acknowledge that I am the Claim Supervisor of STATE FARM INSURANCE COMPANY, one of the Defendants in this action; that I have read the foregoing pleading; 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.e.S.A. Section 4904, relating to unsworn falsification to authorities. DATE I BYI ';i.4J.~II.IJL . OHl[ ILKOWSKI ,llA/iIl Sb/ltl!6lJQr.:. (Title) accurately reflects the Defendant's payments for medical bills through June 15, 1993. It is denied said payments were made to Plaintiff. Said payments were made to multiple health care providers on behalf of Plaintiff as required by Plaintiff"s auto insurance policy with the Defendant. S. Admitted. 6. Admitted. 7. Admitted. However, said report was unreasonable, in error, without just cause, and unlawful. Said report was based upon hearsay and speculation and was rendered without physical examination of Plaintiff. Said report was issued without providing Dr. Zabinski an adequate opportunity to discuss his treatment of Plaintiff with the reviewar and without Plaintiff's complete medical records, as required by Section 6.9s2(c) of the Insurance Department Regulations. Said initial PRO report was issued by a reviewing individual, Kevin W. Emmons, D.C., who is not the same specialty as Robert C. Zabinski, D.C., CCRP, who is a Board-Certified Chiropractic Rehabilitation Physician, in violation of 75 Pa, C.S.A. SI79s(b)(2l. B. Admitted. 9. Admitted. Nevertheless, said reconsideration determination was unreasonable, in error, without just cause, and unlawful. Said reconsideration determination was based upon hearsay and speculation and was also rendered without physical examination of Plaintiff. Said reconsideration determination was rendered by a reviewing individual, Mark Cavallo, D.C., CCRP, Diplomate American Academy of Pain Management, Certified Independant Chiropractic Examiner, who is not of the same speciality as Robert C. Zabinski, D.C., CCRP, a Board-Certified Chiropractic Rehabilitation Physician, in violation of 75 Pa, C.S.A. SI795(b)(2). 10. Denied. The allegations contained in this paragraph constitute conclusions of law to which no further pleading is required and they are denied. 11. Admitted. 12. Admitted in part, denied in part. It is denied the Defendant sought adequate professional assistance as is more fully set forth in Paragraphs 7 and 9 above. 13. Denied. The charges at issue are reasonable in amount and are the result of reasonable and necessary care rendered by Dr. Zabinski to Plaintiff for injuries related to the accident in question. The nature and extent of Plaintiff's injuries, damages and other losses are accurately set forth in Plaintiff's Complaint. 14. Denied. The allegations contained in this Paragraph constitute conclusions of law to which no further pleading is required and they are denied. 15. Denied. The allegations contained in this Paragraph constitute conclusions of law to which no further pleading is I ~ -"' ZABINSKI CHIROPRACTIC OFFICE Robert C. Zabinsk~ D.C., C.C.R.P. 3028 Market Stn,' Camp HiI~ PA 17011 (717) 737.6279 FAX (717) 737-1389 . September 29. 1992 HARRISBURG OCT 0 1. RECEIVED Ms. Nadine Alvianl State Farm Insurance P.O. Box 257 New Cumberland, PA 17070 Re: Zedna Polillo DOA: 9-25-92 Claim": 38-6536-422 Policyll: 685-77iOB0938 Dear Ms. Alviani: On Monday, September 28, 1992, at the approximate time of 3145 p.m., Mrs. Zedna Polillo, a 30 year old caucasian, female, did Willingly present herself to this office for her injuries as a sole and direct result of her motor vehicle collision. It was established In private consultation that on Friday, September 25, 1992, at the approximate time of 4130 p.m., Mrs. Polil10 was driving her 1974 green Chevrolet Malibu Sedan, on Williams Grove Road. She was in the Intersection, stationary, making a left hand turn. Seat belt, lap belt and shoulder harness were engaged. She did have her daughter sitting beside her as well as her son in the left rear portion of the car In a car seat. Road surfaces at time of collision were wet. Visibility was good. Mrs. Pollllo had both hands on the steering wheel. She was not forewarned that this accident was about to occur. Positioning of the head. neck and upper torso was of straight, forward flexion. Mrs. Polillo states that an individual, namely ~ark Skilton, was driving a late model Ford Taurus Sedan. rear ended her at the approximate speed of 40 m.p.h., This created an exceptional jolt which forced her forward and backward with the skull hitting her head rest. She, as well as both children, were obviously shaken but were not rendered unconscious. Mrs, Pollllo believes that ~r, Skilton's car was totaled as well as multiple .lamage .lone to her car which may very well be totaled also, ~rs, Pollllo developed_~EU1'.ed!a~e..pa!.!l after the!lJ!i!0!'.. the .1oweE back, neck and across the s rs. Police officers did arrive to the scene of ent shortly afterwards, She was placed In their squad car untll the ambulance arrived when they were taken to Holy Spirit Hospital for examination and x-ravs, This patient .lid see an Emergenc'l Room physician. 'Iultlple x-rays '.'HI! uken d the chest, cervic.ll spine and lumbar splne. 'p..-L.- " , I Ms. Nadine Alviani State Farm Insurance Septumber 29, 1992 Page two HARRISBUI OCT 0 1 & RECEIVE She was informed that there were no fractures, given a prescription for muscle relaxants as well as a collar and released. Within 48 hours her symptomatology progressively got worse where upon she developed a top of the skull cephalgia, difficulties turning her head and neck, experiencing severe right upper cervical-brachial problems with difficulty raising the arm, mid back burning and paresthesia sensation, lower back pain with referral pain pattern descending the right lower extremity, stopping at the popliteal fossa. After speaking with her insurance carrier, Mrs. Po1illo then called our office to be seen for professional care. She is having difficulty ambulating, trouble sleeping, extreme sensitivity to the anterior throat muscles and the feeling of light headiness in conjunction with her top of the skull cephalgias. Her symptomatology continues to progress as mentioned above. Our orthopedic examination does reveal the following tests to be positive: Jackson Compression test, Spurling's test on the right, Maximum Cervical Rotary Compression test, Foramina Compression test bilaterally, Shoulder Depression test on the right and Soto Hall test. Specific spinal percussion and palpation to the cervical spine reveals cervical spine facet joints to be positive from the C2 through C7 vertebral levels inclusively. The Dynamometer Grip Strength test does have an average reading of 20 points per upper extremity on the right and 40 points per upper extremity on the left. This patient is right handed. Circumferential Mensuration of the cervical spine was performed with a measurement being documented at 14 inches. This was taken at the landmark of the C7 spinous process. The lumbar spine examination revealed the following orthopedic test positive: Sitting Bechterew test, Kemp's test, Body Lateral Bending on the right, Bilateral Straight Leg Raising test at 30., Lasegue's test bilaterally at approximately 30. and the Farfan's Compression test. Descending the spinal column revealed sensitivity to the T2,T9,L4,L5 and right sacro-iliac joint levels. The neurological examination was performed to the cervical, thoracic and lumbar spinal dermatome patterns indicating no levels of hyperesthesia or hypoesthesia. However, the Cl2B tuning fork did reveal a hypoesthesia to the right brachial region. Testing of the upper and lower extremity deep tendon reflexes, namely the biceps, triceps, pronators, wrist, scapulohumeral, achilles and patella, were all recorded at a Grade II level, No signs of wrist or ankle clonus was present on neurological examination. The pupils were round and reactive to light. ~o nystagmus was found on ocular examination. The tympanic membranes were intact. No signs of injection were found bilaterally. The CYBLX examinations were performed to the cervical and lumbar spine regions to document this patient's specific flexibility, range of motion in conjunction with musclo testing. Tho f"llowing results have boen recorded ,lnd documented. .. " '. ~ ZABINSKI CHIROPRACTIC OFFICEHARRISBUR Robert C. Zablnsk~ D.C, CCR.P. APR 2 0 . 3028 Marbt Str""rO.IVEJ Camp H11~ PA 17011" ~ (717) 737-6279 FAX (717) 737-1389 " April 19, 1993 Hs, Jackie Ravenel State Farm Insurance P.O. Box 257 New Cumberland, EA- ~070 ReI Zedna Polillo DOl.: 9-25-92 Claim": 38-6536-422 Policy": 685-7770B0938 Dear Hs. Ravenell On Honday, April 19, 1993, at the approximate time of 7100 a.m., Hrs. Zedna Polil1o did present herself to this office for her next scheduled comprehen- sive comparative re-evaluation and re-testing. My last medical report to you was dated Harch 5, 1993. As I have outlined to you through my previous medical reports, this individual continues to have difficulties with her accident related suboccipital cephalgias. She continues to have discomfort involving the cervical spine, moderate tension in the thoracic spinel however, is having lumbar spine dysfunction involving the lower vertebral levels and the right sacro-iliac joint. I am pleased to report with the frequency of care that we provided this patient we have been able to decompress the associated neurological irritation that was involving the right cervical-brachial region. The lower extremity' discomfort has been minimized with no true paresthesias into either lower extremity. It is my understanding that Hrs. Polillo continues to work her full time job responsibilities by working for a business in Harrisburg. Upon specific questioning, Hrs. Polillo states that her cephalgias are now at one time per week with an occasional two time per week episodes. She has discomfort upon turning her head and neck, especially while performing activities of daily living. There is no involvement neurologically of either upper extremity as previously noted. The mid back pain is more of a deep, dull ache sensation with no radiation into the rib cage or anterior chest wall region. The lumbar spine discomfort continues to give Mrs. Polillo most of her subjective complaints and does complain of difficulties while sitting, turning or even bending forward at times. Activities, such as putting Hs. Jackie Ravenel Stata Farm Insurance April 19, 1993 page two HARRISBURG APR 2 0 1993 RECEIVED on ny10~s or a pair of shoes, can cause her to wince due to sharp pain involving the right sacro-iliac joint. DeJerine's Triad, which does consist of coughing, sneezing or having a bowel movement, is negative to all spinal regions. The burning sensation that was part of her subjective complaints which we identified in our last medical report to you, at this time, seems to have resolved through conservative chiropractic care. " The orthopedic examination does reveal the Cervical Spine Hyperextension test to be positive with the Foramina Compression test being positive on the right and negative on the left. The Soto Hall test and Cervical --- - Distraction test are essentially negative. The Dynamometer Grip Strength test was recorded at 30 points per upper extremity on the right and 20 points per upper extremity on the left. Circumferential Mensuration was performed and documented at 14 inches with the landmark being the C7 spinous process vertebral level. .' The lumbar spine examination was performed with the following tests to De positive involving the lower lumbar spine region and right sacro-i1iac jointl Sitting Bechterew test, Lasegue's test, Kemp's test and Bilateral Straight Leg Raising test. Upon performing these tests there was no involvement of the left lumbar spine region or sacro-iliac joint. While performing all these orthopedic testings, there was no noticeable reproduction of paresthesias into either .10wer extremity. The neurological examination was performed with special testing to the spinal dermatome pattems. There were no indications of hyperesthesia or hypoesthesia. Testing of the upper and lower extremity deep tendon reflexes, namely the biceps, triceps, pronators, wrist, scapulohumeral, patella, were all recorded at a Grade II level. There were no signs of any wrist or ankle clonus on neurological examination. The CYBEX examinations were performed to the cervical and lumbar spine regions to specifically document this patient's spinal flexibility, range of motion in conjunction with paravertebral muscle strength testing. The following results were recorded and documented. Cervical spine forward flexion 57., extension 38., lateral bending left 22., lateral bending right 30.. While performing the tests in the lateral flexion mode, this patient was complaining of involvement of the left cervical spine and upper trapezius musculo-skeleta1 fibers. The lumbar spine CYBEX reveals forward flexion restricted.and painful at 48., extension reproducing discomfort at 9., lateral bending left 22. and lateral bending right 26.. This does show restriction in the forward flexion and extension mode. However, there has been improvement in the lateral flexion mode bilaterally. Due to the weakness and irritated lumbar spine facet joints, this correlates with this patient's subjective complaints of her lumbar spine dysfunction. Paravertebral muscle strength testing to these two specific regions remain adequate in strength and tonicity. . . .. I H.. Jackie Ravenel Stat. Farm Insurance April 19, 1993 Page three HARRISBURG APR 2 0 f993 "ICIIVIC Hrs. Poli110 has a blood pressure of 100/72 of the left upper extremity and a total body weight of 205 pounds. Since last evaluation, Hrs. Polillo has lost a total of nine pounds. " " . As I apprised you through my Harch 5, 1993 report. our goal continues to be corrective and rehabilitational in nature. Hrs. Polillo, in her own words, shares with me that she feels steady improvement from month to month with reduction of her symptomatology. As anticipated due to a motor vehicle accident, tissue healing .time can be slower than a simple musculo-skeletal sprain due to the fact of the traumatic forces occurring due to two auto. -- mobiles colliding. These traumatic forces are absorbed within the spine which creates a sharing force to the ligamentous structures, damaging them as in this case. There has been a multitude of times when Hrs. Polillo has requested to be seen for additional care because of her pain and discomfort and fear of inability to perform her work related duties. Therefore, to keep her gainfully employed and not result in any lost time from work, additional care was medically necessary. Our office will continue to provide rehabilita- tional services to Hrs. Polillo. We will gradually be working towards the level of maximum medical improvement in the next several months ahead. Upon receipt of our medical report and itemized statement, your continued prompt payment to this office within 30 days or less is graciously appreciated. If you have any questions concerning the rehabilitational process of Hrs. Polillo, please feel freA to contact this office and I will be more than happy to answer any of your questions. Thank you for working with me on the health and welfare of Zedna Poli11o. Encl. Statement for services rendered 3-19-93 through 4-19-93 $853.00. . . I I .. " , Mr. Bucher State Farm Insurance AU8ust 25, 1993 Pa8e Two HARRISBURG AUG 2 6 1993 RECEIVED an unrelentin8 suboccipital cephals.i!l..with..no knol4nreferr!l!i pain into either extremity. Iher~ lS crep1tAtion-of .h~ cervical with lnt~rmlttent neck patn durin8- thlr~Ourse of her activities of daily l!vin8. The mid-back tensiOi1r!-generlll-ly-woFllened--b- 'ec1ficactili t- .such as sittin for an ex ten e per 0 0 time. The lower back pain apparently ocuses on the ri8ht port10n of the lower lumbar spine re8ion with no true lower extrem- ity neuropathy. Dejerine's Triad which does consist of COU8hin8, sneezing, and having a bowel movement remains essentially ne8ative. The orthopedic examination does reveal the Cervical Spine Hyperextension test to be positive. The Foramina Compression test reproduces discomfort to the mid-portion of the cervical spine facet joints bilaterally. The Cervical Distraction test and Soto-Hall's test are essentially ne8ative. The Dynamometer Grip Stren8th test was performed and recorded at 40 points per upper extremity on the ri8ht and 20 points per upper extremity on the left. The lumbar spine examination was performed with Minor Si8n, Sitting Bech- terew's test, Le8 Drop Test, and Patrick-Fabere's test bein8 essentially ne8ative. Bilateral Le8 Raising, Kemp's test are both positive for repro- duction of pain into the lumbo-sacral junction. Specific spinal percussion and palpation reveals tenderness to the L5 and ri8ht sacral-iliac joint. Deep pressure does not reproduce any neurol08ical ramifications. The neurol08ical examination was performed via the Wartenbur8 Pinwheel instrument and there were no levels of hyperesthesia or hypoesthesia. Testing of the upper and lower extremity deep tendon reflexes remain completely intact. 7;,,, ;:',uUi examinations were performed to the ce~vical and lumbar spine re8ions to specifically document this patient's spinal ran8e of motion, joint flexibility and in conjunction with paravertebral muscle stren8th testin8. The cervical CYBEX reveals the followin8/ forward flexion 60., extension 27., lateral bendin8 left 21. and ri8ht 25.. The lumbar CYBEX reveals the followin8/ forward flexion 56., extension 13., lateral bendin8 left 34. and ri8ht 29.. Mrs. Polillo's paravertebral muscle stren8th testin8 remains adequate in stren8th and tonicity. Mrs. Polillo does have a blood pressure of 90/60 of the left upper extremity. Her total body wei8ht is reccrded at 173 pounds. Since onset of motor vehicle accident care Mrs. Polillo should be applauded for her hard work for 10sin8 40 pounds. At this time due to the positive remaining test results continued medical care is warranted and this shall be provided to Mrs. Polillo. rmmediately upon receipt of your Peer Review report please forward a copy of this report to our office for our medical records. Your com e and total cooperation is deeply appreciated. '..-' J -c....,~ C. Z~binskl..D.C., C.C.R,P, Cert~fled Chlrupractlc Rehabilitation - ZABINSKI !ft, R E C .E IV .E D t'AR 2 4 CHIROPRACTIC OFFICE 199~ , Robert C. Zabinski, D.C.. C.C.R.P. 3028 Market Street Camp HiI~ PA 17011 (717) 737-6279 FAX (717) 737-1389 Mat"ch 23, 1994 Richard F. Maffett, Jr., Esquire 2201 North Second Street Hat"risburg PA 17110 Re. Zedna Polillo DOI. Septembet" 25, 1992 Dear Attorney Maffett. Please be advised that on Tuesday, Mat"ch 22, 1994, at the approximate time of 7.00 a.m., Mrs. Zedna Pol1llo pt"esented herself to this office for out" final compt"ehensive comparative t"e- evaluation fot" injuries solely related to het" motot" vehicle accident collision of September 25, 1992. This office has continued to treat this individual for spinal difficulties as a result of this motor vehicle accident collision. Presently, this patient's primary subjective complaints consist of restricted range of motion within the cet"vical spine, ft"equency suboccipi tal cephalgias, occasional right at"m paresthesias descending the t"ight bt"achial region, mid back stiffness and sot"eness and lower lumbat" spine dysfunction wi thout any radiculopathy. This patient has remained on a constant schedule of cat"e, genet"ally at the frequency of evet"Y two weeks. Occasionally, due to an acute exacerbation and difficulties, additional appointments may have been scheduled due to the associated nerve root irt"itation that has incurred. This patient has t"eceived physical the~apy modalities consisting of ultt"asound to stimulate healing, inct"ease the blood flow supply to the surt"ounding tissue and penett"ate deeply to relax damaged tissues and associated pat"avertebt"al muscle spasms. OUt" ot"thopedic examination was perfot"med and t"evealed the following cet"vical spine tests to bs t"ecorded as positive. Cet"vical Spine Hypet"extension test, Foramina Compt"ession test, and So to Hall test reproducing discomfort to the tt"ansitional t"egion of the cervical spine. The Cervical Distt"action test and Jackson Compression test were essentially negative. The Circumferential Mensut"ation of the cet"vical spine was pet"fot"med with a measut"ement being t"ecot"ded at 14 inches with the landmat"k being the C7 spinous process vet"tebral level. The Dynamometer Gt"ip Stt"ength test was performed with an - Richard F. Maffett, Jr., Esquire March 23, 1994 Page two average reading of 30 points per upper extremity on the right and 20 points per upper extremity on the left. Palpable findings of the paravsrtebral musculature indicated taught and tender fibers involving the right upper trapezius musculo-skeletal fibers. The lumbar spine examination was performed with the following tests being recorded as negative. Sitting Bechterew, B1latera1 Leg Raising, Leg Drop, and Lasegue's test. Patrick Fabere's test and Kemp's test were positive on the right. DeJerine's Triad, which consists of coughing, sneezing or having a bowel movement, is essentially negative. The neurological examination was performed via usage of the Wartsnburg Pinwheel instrument. Testing to the cervical, thoracic and lumbar spinal patterns indicated no specific levels of hyperesthesia or hypoesthesia. Testing of the upper and lower extremity deep tendon reflexes, namely the biceps, triceps, pronator, wrist, scapu10humeral, patella and ach1l1es, were all recorded at a Grade II level. There were no signs or indications of wrist Jr ankle clonus on neurological examination. The CYBEX examinations were performed to the cervical and lumbar spine regions to specifically monitor and document this patient's spinal flexibility, range of motion and in conjunction with paravertebral muscle strength testing. The cervical CYBEX reveals forward flexion 68 degrees, extension 34 degrees, lateral bending left 24 degrees and lateral bending right 29 degrees. The lumbar CYBEX reveals forward flexion 53 degrees, extension 16 degrees, lateral bending left 34 degrees and lateral bending right 34 degrees. Paravertebral muscle strength testing to these two specific geographic regions remain adequate at time of examination. While stressing these musculature groups, this patient complained of right cervical spine pain and right lower back pain. Mrs. Polillo at time of examination has a blood pressure of 100/60 of the left upper extremity and a total body weight of 201 pounds. I have reviewed my physical examination findings with this patient and shared my clinical impressions. It is my professional opinion, having examined this patient and followed the course of her care, with a reasonable degree of chiropractic certainty, this patient suffers with a partial impairment syndrome involving the cervical and lumbar spine regions. Unfortunately, this will be life, long lasting and will result in acute exacerbations from time to time in the remaining portion of this patient's life. Mrs. Polillo never had these subjective complaints prior to her motor vehicle accident. Therefore, I am confident that these remaining residuals are solely related to her MVA of September 25, 1992. v I IN THE COURT OF COMMON PLEAS I CUMBERLAND COUNTY, PENNSYLVANIA I I NO. 94-2450 CIVIL TERM I ZEDNA POLILLO STATE FARM INSURANCE COMPANY PLAINTIFF'S EXIIIBITI CYBEX EXAMINATIONS BY ROBERT C. ZABINSKI. D.C. Cuv lcaL Lluabar Ldt: Right Ldt Right rorvard Latenl t..hnL Forward Lahul LahuL rl..10n !.tenlion Oendlnq 8endlnq rledon !'lthndon Bend 1n9 Oendlnq Normal 650 450 350 350 900 250 350 350 9/29/92 380 360 210 270 320 170 150 250 4/19/93 570 380 220 300 480 90 220 260 Change from +190 +20 +10 +30 +160 _80 +70 +10 9/29/92 8/25/93 600 270 210 250 560 130 340 290 Change from +220 -90 00 -20 +240 -40 +190 +40 9/29/92 Change from +30 -11 0 _10 -50 +Ro +40 +120 +30 4/19/93 3/23/94 680 340 240 290 530 160 340 340 Change from +300 -20 +30 +20 +21" -10 +190 +90 9/29/92 Change from +110 _40 +20 _10 +50 +70 +120 +80 4/19/93 . " 6TATEMENT ROBERT C. ZABINSKI, D,C, 3028 MARKET STREET CAMP HI~~, PENNSYLVANIA 17011 TE~, 17171 73706279 c....au a. '."".""'1 MADI A,n_ !.A" 0"'. ''''0'''" WIL.L. .H(~U ON "'OUI "'IllT ,TATI"C"' ~EDNA POLILLO 226 Birch Lane Carlisle, PA 17013 NFl State Farm 'A~.NC' 'O"W...lItD Id.:ydcO DATil TOT,.", e"IDIT' OI'C""TIO,., 1"'L.AHel :m\, '11 IPAVMIIHT. AD.I. . ~.U~ c.o''\''If' UIM,~~\I)J.,a~.' >) CY(~J" J~o 00 - - ~lJ~S ()) ~.lH~ C/lilm .!:>U b ""; rre.J. p~ ~ts. .-......-. --- --.--. _........ -.- -....-..... ...__..~ . .. .......... . '..lOw..O.III...... .'1".... h......... '-1'>>'11 ."a "L.I"" ,I." LAn ..".au,..r.N ..L..HCI COl.UMN J 111.11'"""",,,,,, ...."t'IIIf.... ..,. .,.." If "..,.... .. , "'M' ...."'un'... ........,....,... tH.""..u........".. .................... .....,.at... . """"1"'" ......."...,""'"""... '',In..,,..,,,..,.,,. I.',..,...,,,,, ,.".....,....."'..,.." ..',an...."....,.., ......n......,.'.,.,"'..." .., . ........utl"... ,'"..." ......"'.......u_.,. .........",. ...........-...'....r t.._ STATEMENT ROBERT C. ZABINSKI, D.C. 3028 MARKET STREET CAMP HILL. PENNSYLVANIA 17011 TAX 10 '232248610 r ZEDNA POLILLO 226 Birch Lane Carlisle PA 17013 TEL: 17171737.8278 CHAItOII Oil '.TIIl.Hfa MADC Ani" ulT CIA T& IHO_H WIU ......" ON YOU" ""In IU,..IIl.N' ..LANCI ,o".,uo I I DATI T~TAL C"IOITI :l:llo D I . C " , ~ T I D N II ..LANeI ~AYMIHT' AOJ. ,l:1J:.9 Total Fee Outstandi~~/;~5QA I ,1',0' . nn 1AOI nn: ........._.._~. I , ......-.~...._.. ..--.....- ---.-.. i , --- ...........-.......... .........."...-...~. ........................ 1 I .........,......,....... , ..........."....'u.... , , cc. CE -Ccwncwtr\tl'ltNt Conlultlllon. ....a (lIlfIlI\IllOft11lJ4ll !OF-"'.... ~ """"""111411 COV-~~..1I11111 0'/-0".. ".. 'iill~ 11MH-~ Ollc,~" IlOOlm .HV....l.ft. Hu'I ~1It 1100101 IU-1oroO _... tAlOOOl PI-Ph,I'Clll\erJOW 111010\ IHUPl PhoIO\NrWf' 1111111 Uf'll ~lIOthltlCN 1"UI1IUluuounOI ~Ihnrf Itl01&IIHYOl ~.....-h."tf\IDIkC.1lONl (awl" lt1nOt CY-CYIlX ,'mIl JIO_J"""Iad.O~tlfl'71UI IPf-Iooo-- !JoMo"""iill. '\.1'" ,... u.U I.UOUfIIIIH ,AUJrtCI COWWiI ~ IIC ....."""" IdUeI'" c... 1110111 OUI-Oft_ """" ,110701 os..O_cS.ooonIl101m NA..N.".IM ~ I'toIOI 1,lC-__C_,liOIOl CH, NPI-C... Hrstorl. Htw Plbtn' him liilO<l H! ..AH......"'" ,iill~ JAN 17 '96 14:17 ROBERT C ZABINSKI DC CCRP ,;~ ~ ALL CHARGES/PAYMENTS I T E M I ZED S TAT E " ! N T DATE I 12/29/95 IRSI. 23-2249619 PATIENT I ZtDNA POLILLO 199362 226 BIRCH LANE CARLILSC fin 17013 5S8171-02-5&86 POLl DATE/INJr 99/26/92 ~npo EMPLOYERr TOI RODERT C. ZADINSKI, O.C. 3920 MARKET STRUUT CAMP HILL PA 17911 717/737-G279 PaKI717/737-1309 DIAONOSIS: B47.9 SPRAIN AND STRAIN - NECK " 723.3 ceRVICAL OI~ORO!RS. OT~ER - CERVICOBnAC~I^L ~YNDnOMU (DIFFUSe) FCr CASH DATC Of' LAST BILL: / / PRt ZA052775 IDD 952775 ......................................................n.~.......~.~np.~r.~~Dr~."' DATE CPT DESCRIPTION .. POS TOS It AMOUNT ............................................................................... 12/lli/lI11 1I11:!13 OV..EST LO-MOD 11i MIN 11 1 1 21i.00 8Z/l6/lIS 97835 UL TIIASOUNO 11 1 1 5.U8 13/16/9& 99213 OVo.I!S, LCl-MOD 15 MIN 11 1 1 2!.eO 13/1G/96 97036 ULTRASOUND U 1 1 5.ee 94/21/95 99213 OV"EST LO-MOD 15. M I N 11 1 1 :!U. e0 14/21/95 97835 ULTRASOUND 11 1 1 50 ee 15/17/95 99213 DV-EST LO-i'\OD 15 IUN 11 1 1 2& I \)(I 1Ii/17/9S 97836 ULTIlASOUND 11 1 1 5.00 16/26/95 99213 OV-EST LO-MOD 15 MIN 11 1 1 25. eo ts/Z6/U 9703& ULTRA30UND 11 1 1 5.00 t7/17/95 99213 OV-EST LO-MOD 15 MIN 11 1 1 21i. ee 87/17/90 97D3S ULTRASOUND 11 1 1 Lee 87/19/95 95/213 OV-E5T LO-MOD 15 MIN 11 1 1 20. ee 17/1D/g5 971135 ULTRASOUNO 11 1. 1 L00 87/24/9'" 99213 OV-EST LO-I1DD 15 MIN 11 1 1 20.00 97/24/95 97113l> UL nlASOUNU 11 1 1 S.1I11 t7f31/9S 9!l213 OV-l!ST LO-I'tOD 16 I'tIN 11 1 1 25.00 17/31/95 97035 ULTRASOUND 11 1 1 :'.110 eO/e9/95 99213 QV-EST LD-MOO 1!l I1IN 11 1 1 20. 90 os/n/;!i 97035 UL "RASOUND 11 1 1 ~,0V. 10/24/95 99213 OVo-EST LO-MOO 15 1'11/1 11 1 1 2:'.00 10/.4/95 91035 ULTRASOUND 11 1 1 G.llt 19/13/9& 911213 OV-EST LO-I'tOD lS MIN U 1 1 ~0.0e 19/13/l/6 97835 ULTRASOUND 11 1 1 li.00 19/27/96 99213 OV-EST lO-MOD 15 I'\I N 11 1 1 :!c.ac. 09/27/96 9713& ULTRASOUND 11 1 1 G, 0 ~ 18/11/95 99213 OV-EST LO-I'tOD 16 I'tIN 11 1 1 2!ioa~ 10/11/95 97835 ULTRASOUND 11 1 1 50 9 ~ CONTINUED ..........--................................................................... SUBTOTAL I 3~0.9t J/lli 1T'" 1<' Ie ~"IE~' , E/lUli$~1 D': CC~~ ~/l~E e. .:.. ^LL CH^RGCs/P^VnCNT3 I T E " I ZED S TAT E MEN T . PATIENT I ZEDNA POLILLO 18.302 "" RIRCH LANG tARLILtt PA 17813 GS'171~G~~GGDO POLl DATE/INJI eD/~5/g2 Gnp. DATtl 12/20/9G lK~'1 lJ~~~~Ubl~ F.MPI,OVER I TO I RODeRT t. lAIlINSKl, D. c. 3Q39 HARKET STRE~T CAMP HILL PA 17011 717/737-0~7' 'a~1717/737-13a9 DIAONU~lSI 0~7.' 3PAAIN AND 'TRAIH - HeCK 1~3.~ tEKVICAL DISORDERS. OTlIeK - CERVICDsnACHIAL SYNDROME (DIP'USE) FC, CA~H DATt or LAST IlILL: .__M.______.__.__..__._.__..__.._._ft.."."."~~~~~"W~"~~~".-_...~."~"".~...~~"~.~ I I PRt IR80Z770 IOU .02770 DATE ....~..~..~..........._.......................u.._............................. 11/23/06 00213 OV~EST La-MOO 16 MIN 11 1 1 2..00 11/23/95 918n ULIKRSUUNO 11 1 1 ~.\l\l 18/25/11~ t921~ DV-CST LO-MOO IG MIN 11 1 1 ~G.OO lt/2~/D~ 97tH ULTRASOUND II , , n."" u/n/lls YIl~13 uv-~ST LO-MUU 15 HIN 11 1 1 25.\10 ll/U/9G 9703G ULTnAODUND 11 1 1 ~.6e U/17/Q6 00213 OV-EST La-MOD 16 MIN 11 1 1 2..18 11/17/90 97830 ULTRASOUND 11 1 I 0.110 ..I.........,-~." "'.-.-, ' ..,.,.... ...,. ..... .", - r.rM t ~,o. QD CPT DESCRIPTION . pas TOS . A"DUNT .j , , , A~~-./t .'UIIIJIIlIHT '.nIVi IIIn...I_I__OlltlLDcI1Jon;1.k;';''I'IIf) 9/..)\/Cf2- T~\'~~O CCL,~!vI' InVI,X"~ AOM u-r-("~.I~~ ,.SAM.~ PR~BLE~; d.'~' .1 YII. ~.I_no.OATEyA~~_.. ." .DUCRIPJION: CONSENT ~~ ,If bU+- : SKsNEO. I 'JlIl I lAST TETNlUS; h,q. W . .--~ ..~. ..- t .,..- --.-..- --'~-'- -.-......-:- . .- . . ,) , II~sr \ 11: ~ _._ +._._.__ .._ __.._ . H: :") ~ .-.--..- --.. ... _..- - ... IIJG 1,;' ,O'IUI (\C,uJ JII Lf.~:3.).JI', TEMP. ,,(;1. . I~' ~. Cll~ll ~'alC IU^Ol,\6L1 JUt; VEiUW" ~F.lii'J;' ''1'!J~ t-. ',,- -- -_.~- '':l' 9UQ I .... . t'. . .04>,~ lJ. A$aEO'IIfN!::l' l~d,'.1 D_"cp-r rUnre,pon.Nt ..'-rJ..-(L.-;..... ; - . ...-.- ......- . . I I' . "SIIlEi\AIl.lt . _.... -... '0' ,. .... . . I , " BPMQNITlJfl,1 nl'JI "E~~~~~l,.!n , VlSUA("re5T: .. os OD .. ..-.- ------ ----- --...-- NI'.J';~3; -;-Q -.. /J (J-' "",-~"i.- -~'fz.-- - .. L)/l "r-7 (-f;)../)f cr. ('_:-::'~ /Jr. rrft1p.-j-. . - . .'r-'%,- U--;-/~.;;.;- . ~,,'~~~: Iv t~i"HRS 13tH (. ~ iJp!r (C Ulr;)N (.~~'i;;': ~ (~.Y:__"_ ~ctt-~ "-.... :- _~t _,($~()..jillL'_H.CQ _.LJ!YL.I .I H!!IQ ._l .tUlO.REF _HAS ~TIIlR. _ ~-I'IOIC"-IIPIC '.-!:IW!t. 2~P~N 9 W r ~.~ \ , ,I, ciif~~'illS" .,,"~IiiiIoRT;'J ' "I: '.,:-h._ -'L ... ,~\' *:*'!:f1,L"';.;*~ tQ ~\:.1'E~~IlI~IIlLJ ~rr~'II:.rllll;" .~i'~O~O r.\J JJI-06Mtr"T1h.au ~ . .~:;rDICTAriDc'n:: c:o ~- i "Gun..!; l\I!J'f!lf,~eul (1~ ifl';':, -;;.... ':,oREPiiiri"'Oi ~\ Cot .G,~.",,"gl:J:).l:"~' \.-0- ~;~$.~~~( .cc,.,. . nll^ ~ II~:~'J' '~fot :JJJ ":::pjjYiicWl'_~."~I}I'" ?C.k~'" '. .' I .. .. I;'~ . .._- ,.. ---.'.--'''-.-- -. -.. .'FO,uI',rJj '"1" '':10, "".I.)U\l.ot.0-P..k A..t:b. % 0 ,,:~*'**-* .*'-':'*. ..1::'...... p!J J ~ (~"-. I.- I~- "-j- ,. .... u DISCH INSr V I DtAGIlOSIS: . ... ) 1..(. fZ<.- . . . >"- ~ /' ,CLTHNGDIS"H" DISCH~ ~.dL. ,?2- ~.f.....~-Hils-;XlPul,~,;~i-i,;;;"ecl-..I.I;,j~--- I I cnllcol-.I-I'"porlCl'--1 -I .A\l1l,c,w.eq'6"'; 'OISPOSIT1OO:-.t~Hom'--I-1 AMA. I. I Morgu~__l_l~ ;l-:.'~" HIlS 2- - .. , -.... . HAS' /.~ RE\'OR.TCALLED- !T',"'. AT'~ . .-''':~;Rol''- ,~~ ,!. ." HRS \, I ~ ., ~r...~...d. -" ..'. ...;._':'" y- . OOSERVAlOl SIG: .. SIO: __ ...' ._'.. ILDAI.O. . r'll. -7t1.~_. . ..... __L o,_vuVtLl----3o yu . -HARRISBURG - .-... --.-- ,.-. TO: :.I':R'" '":":':- ,. " . . ...;':;:'':'U . ~l ~...:J ':'" Jl.:'lt .. t,,'.'h.. 1 .' ".. :.;r.,J ijOL)'c~P'lij.l1d:10~PITAL ':"':cAM~HiLC~PA~ ~. ~~-.'NOY T3 .~ .. , '. I.....'. -' ~ :.1 'l:~EMERGENCY D~PARTMENT RECORIT -~ DE...,"",l.." ._" .~"' ,,~~, L _ ..:..._..:.________ .___. ..!tEe F' I V I!': ~ ...:,::"...." ... ED PH~~IC1AN;s..COPY\\.:':; \! I;::,. ,-..- .... -.-." '~"I.' -. -.-.---...-. CAIllllAC " LAIOlIA" . "- I I Mon.tor. ---..,.'( I ACL .N I leKk --.:.:... I IALCO I 1ll<1Ib I...... _ - I I AMIIOHlA 1 I CWMII " I 1 AMYL II ' ~ IIAI'TT,. , '.I' '." \ , 1II18UN ,. " .......TOllY i, - " , I, I.~ ,:' " I 102 1M - I Ic:ec I 1 He I I Malt , ~ I; I CK . ( I~ _ I ICPRO " I IReopR.t. ~. 1 ICIIEA ;:'" '. I 1 A8Q...~ . - . 1 1 CRPI I 102S11 . 1 IDIf.F . . I 1 SpulwnQlS' r 1'010 . I. 1 ''', L~~ _ 1 IDIWITlN l..~,l' , ' ( 1 ESA IV RAT! SIZE I I GLUC i ." . 1 1ll5W _ _ _ I IGLYCOSYlATEOHGB I INSS _ _ _ 1 IHCGS (ILA ___ IIUPA ./ I I D5I,491S .",./ 1 1 uvV ...-- _ _ 1 I LYTE I D5I.8NS f " t' . 1',-1 MONOSPOT .. .' ---I~""'.'" ,. I I OOINIliINE I 1 SACE 11,~TES I ' I ANPAlAENP I I APA I ITHEA 1 ITHYA I I TSH 1 1 UAIC ACID 1 1 BLOOllIAHK I 1 TIPf & Salon .. I IC--_ UnItI I ~T~ I J~!'I Blood I I Illgl,OIlOl ooY ( 18 SlrIpAG I I 8lllnp CIlIurt I 1 AIfobIc CuIIuI, III.It1UII.......... . I . r-r;--'-'-;77"'11 ." I IIlIoodClllurt "I' 1 ILunabn "1, I 1 Chlamjllil ." 1 I Bone Sean I IDCCullu" ~t.l IVonoi!;"" I I ThIOIIC!l1lurl ~ 1.1 . i 1 UrineCullutl . I .. I,.. &1 I'lll~l!l '. A\ .' J....... ACCIDENT I I SURGEIll' _ i ., ..,. ~ ,,\ \} i~ UPPUEI I "C" coIlIf _ I II MIS 14704 I ET Tu_ I Ace 4" MIS 14712 I I Ace e" MIS 18325 I FoIty Calh I 1An\l~ IOCL_ I IAngio IUI1na/yIlaQ PAOaDUIIU I I,NIhrocan_ I I Cardiac Monltortng I I CVP IV MIS 14011065 I I Eye Exam MIS 14121008 I I FoI1lgn Body - I 1 Eye . I I Eat I I Spinal Tap II!ll>l"t~, 'IIM"~" Langlh :. I, ~ ... Locallon .Lenglh Localion I Thoractnleeis MIS 14120174 I I I MEDICAL EMERGENCY I I MEDICAL NON-lIIEAGEHCY " WCElUHEOUS I EKG I EKG Petch" I Delill. Peds I Hands Off Peda IWHOI OOY ,/ I I AM'ObIl S<<toe , r I Flalpill.upnghl I 1 PtMeRm , II~ heel. RfN ~. . IIChfllPoi1allit( I." I I AIlf, .' ' d ,L, A 1'1 ~IVPRm IIAnklo ,L A . I I FOOl L A I ~~.., hL A I I KnM A 1 I TbfIl ~..v A liT.. -----=-P' L A :_::: ~L~ I I FoI1ann \ A I IHand A I I Wrlet L A 11_ L A I 1 FICiIl80nee I 1 SkuU I I 5p11jCarv/Lat 0I)Iy .,.. '~If\TNf', ~ ..., . l'IThcnoofRm' . . )4 4..~?, l) fv:~ . ,. . UL TAA BOUND II- I I Doppler I I Gal BlIdclel I 1 PeMc I 1 PATlENT CUIIIF1CAT1O/!, 1 I'~W' :r.....~. I 1 INTERMEDIATE i.' I 1 CC!MPREHENSIVE I I CAmCAl. CARE '. .." . '" I ~dl, CMCIle, PIT 23a04 ',I ..) I Pelt CM"'" PIT 23&12 I Mid. D....,"'l MIS 1410556 I SuIU" Set MIS 24220000 , .. IlOIAlII '" .,,' II~.. ........ , ,\.: ' "'l . -.J' 'I ~ .' r .-. I ....t_,. ... ( ,j ..... :A..-..' : .. . HOLY SPIRIT HOSPITAL CAMP HILL, PA EMERGENCY DEPARTlVlENT PHYSICIAN ORDER FORM .J -"----. ..;'\. ).. /.... . IITI " HAS HRS HRS I CUellW 141l1G02 1 CaWt EpIelulI l~dlW . 14OI1D6! 1 1& 0 lW 14120201 INGTubI I~ . " , I SpiromeIry' . , t, (1.04') 0' '. I, ." . , HARRISBURG NOV , 3 9J2 RECEIVEO ..,. ZABINSKI CHIROPRACTIC OFFICE !ft- . Robert C. Zablnsk~ D.C., C.C.R.P. 3028 Mark,t Stml Camp HII~ PA 17011 (717) 737.6279 FAX (717) 737.1389 November 9, 1992 Ms. Jackie Ravenel State Farm Insurance P.O. Box 257 New Cumberland, PA 17070 HARRISBURG NOY 1 0 !92 RECEIVED Rei Zedna Polillo DOAI 9-25-92 Cl~im"1 38-6536-422 PolicY"1 685-7770B0938 Dear Ms. Ravenell On Friday, November 6. 1992, Mrs. Zedna Polil10 did present herself to this office for her first comparative re-evaluation and re-testing. My two ~ medical reports to you were of September 29. 1992 and October 19, 1992 have~~' kept you completely apprised of the health and welfare of Zedna Polil10. At this time, her rimar subjective co consist 0 t the fre uency of three times per week, neck pain, paresthes~volving the ri on m ac ower back ai nd nurn ness and tin 11n d w g..at the poplitDol feees ,GAien. Ms. Polillo, upon specific questioning, clearly states that she does feel weakness with usage of the right upper extremity and having difficulty raising it from time to time. The lower extremity neuropathy has not developed into any weakness of the extremity. However, she continues to be plagued with these discomforts on a daily basis. She shares with me, her cephalgias are not of the severity or intensity nor is the pain that she is experiencing involving these spinal regions. She does feel improvement with these accident related spinal conditions. However, she is still concerned with the paresthesias of the right upper and lower extremity. The orthopedic examination does reveal a positive Cervical Spine Hyperextension test and Foramina Compression test bilaterally with special emphasis reproducing discomfort on the right. The Cervical Distraction test and Soto Hall test are essentially negative. The Dynamometer Grip Strength test was performed on three separate occasions with an average reading of 35 points per upper extremity on the right and 20 points per upper extremity on the left. This does show a 15 point improvement of the right upper extremity, showing us strength is returning to the injured extremity. The lumbar spine examination \D-L- - , '\ Hs. Jackie Ravenel State Farm Insurance November 9, 1992 Page two HARRISBURG "O~ \ \l - RECEl'JED does reveal a positive Sitting Bechterew test on the left, Farfan's Compression test, Bilateral Leg Raising test reproducing discomfort at approximately 70. and Kemp's test positive on the right and negative on the left. DeJerine's Triad is essentially negative to the cervical, thoracic and lumbar spine region. Specific spinal percussion and palpation does reproduce sensitivity to the C3,C4,C7,T4,L4,L5, and right sacro-iliac joint. The neurological examination was performed to the various spinal dermatome patterns. There were no levels of hyperesthesia or hypoesthesia. Deep tendon reflexes of the upper and lower extremity remain intact. There were no signs of any wrist or ankle clonus on neurological examination. The CYBEX examinations were performed to the cervical and lumbar spine regions to document this patient's specific spinal flexibility, range of motion and muscle testing of the specific geographic paravertebral structures. The cervical CYBEX revealed forward flexion has improved to 590, extension 34., lateral bending left 290 and lateral bending right 310. The cervical CYBEX revealed a lS. improvement in the forward flexion mode. The lumbar CYBEX reveals forward flexion greatly restricted at 370, extension painful at 100, lateral bending left 290 and lateral bending right 27.. Hs. Polillo shares with me during the course of the examination that her lower lumbar spine region is giving her considerable discomfort todaYl therefore, the forward flexion CYBEX does reveal considerable restriction. Testing to the paravertebral musculo-skeleta1 tissues indicated no signs of severe muscle spasms nor muscular deterioration upon testing. Due to the injury to the ligamentous system, this is resulting in a weaken area causing Hs. Polillo considerable discomfort, pain and instability while performing her activities of daily living. Hs, Polillo does have a blood pressure of 110/62 of the right upper extremity and a total body weight of 210 pounds. I have reviewed my physical examination findings with Hs. Polillo and have shared with her that I will be reducing the frequency of care for the next 30 days. She is aware of her home rehabilitational procedures which she is to be doing between scheduled office visits. If any acute idiopathic exacerbations do develop, she is to call this office for guidance. This patient is progressing as anticipated. Our therapy will continue to be corrective and rehabilitational in nature to strengthen the ligamentous and musculo-skeletal system as well as reduce the neurological insult that has been sustained as a direct result of the motor vehicle collision. Hs. Polillo is completely attentive, prompt and courteous at all schedule appointments and maintains a very serious attitude in regaining her health. ... ') Hs. Jackie Ravenol State Farm Insurance November 9. 1992 Page three H~"R'SBURG tlO~ , 0 . , '-l~'ED R~""r.. v Upon receipt of my medical report and itemized statement. your prompt payment to be received by this office within 30 days or less is deeply appreciated. If any questions or concerns with the pr08ress of this case to date, please feel free to contact this office at your earliest convenience. Thank you for working with me on the health and welfare of Zedna Polillo. <?o:- I Encl. Statement for services rendered 10-19-92 through 11-6-92 $593.00. " ZABINSKI CHIROPRACTIC OFFICE December 22, 1992 Robert C. Zabinsk~ D.C., C.C.R.P. 3028 Market Street Camp Hil' PA 17011 (717) 737-6279 FAX (717) 737-1389 HARRISBURG DEe 23 1992 R~CE'VED Hs. Jackie Ravenel State Farm Insurance P.O. Box 25i New Cumberland, Pa, 17070 RE: Zedna Poli11o DOA: 9-25-92 Claim": 38-6536-422 Po1icyd: 685-7770B0938 Dear Hs. Ravenel: On Honday December 21, 1992, HI's. Zedna Poli11o did present herself to this office for a comprehensive comparative re-evaluation and re-testing. Hy last complQte medical report to you identifying this patient's status as she proceeds thru her program of rehabilitation was on November 9, 1992. I am pleased to report to you at this time, this patient has had a reduction of her primary symptomatology which does consist of cephalgias, cervical- brachial paraesthesia's, right lower extremity paraesthesia's in conjunction with lumbar spine dysfunction. At this time, her 1 ias are at the fre uenc of 0 two ti week. They are no longer dai y an not at the frequency of three times per week. The neck pain is improving however this patient still experiences this on an intermittent bavs. The mid-back p'iR is tp.".p "". .1-1. t. mere-of a secondary ~nm~t ~Rd IL dues not refrain this individual from-performing her physical activities nf daffy living. Her primary dilemma at this time is the lumbar spine dysfunction which does have the tendency to shift from joint to joint and this patient is having more of a discomfort involving the left sacral-iliac joint. The biggest positive step has been the reduction of the right lower extremity neuropathy descending the posterior aspect of the leg stopping at the popiteal fossa. At this point and time, this condition has healeu thru con~ervative chiropractic care. She best describes her lower back pain as a deep dull nag8in9 ache shifting in nature from the lett sacral-iliac joint to the right sacral-iliac joint. The orthopedic ex~mination does reveal a positive Cervical Hyperextension test o -'3 ,. , Ms. Ravenel State .arm Insurance December 22. 1992 Page Two HA~~/SBURG DEe 23 1992 kt;:CE/VED as well as Foramina Compression test on the right and negative on the left. The Cervical Distraction test and Soto-Hall's test are essentially negative. The Dynsmometer Grip Strength test does reveal 30 points per upper extremity on the right and 25 points per upper extremity on the left. The thoracic spine examination indicated flexion. extension, and lateral bending with compression to be negative. Palpation to the T4-T5 vertebral levels did indicate tenderness. The lumbar spine examination was performed with the following tests being recorded as positive: Sitting Bechterew's, Bilateral Leg Raising at BO., Lasegue's, and Kemp's. All these tests reproduced discomfort as well as tension in the muscular fibers on the left. Oejerine's Triad which consists of coughing, sneezing. and having a bowel movement does not reproduce any cervical or lumbar spine pain. Specific spinal percussion to the spine indicated the following levels to be sensitive; C2-C5-C6, T4-T5, L4-L5 and left sacral- iliac joint. The neurological examination was performed via the Wartenburg Pinwheel instrument and testing of the upper and lower extremity deep tendon reflexes were found to be intact. There are no levels of neurological implication of any patterns of hyperesthesia or hypoesthesia. The CYBEX examinations were performed to the cervical and lumbar spine regions to document this patient's specific spinal flexibility, range of motion and in conjunction with muscle strength testing. The cervical CYBEX reveals the following: forward flexion 53., extension 36., lateral bending left 30. and right 2B.. The lumbar CYB~X reveals the following: forward flexion 39., extension 11., lateral bending left 22. and right 34.. This does show con- siderable restriction in the forward flexion mode. This patient's restricted range of motion to the left portion of the lumbar spine region does correlate with her subjective complaint's of pain and discomfort involVing the left sacral-iliac joint. Muscle testing to the cervical and lumbar spine paravertebral structures remain adequate in strength and tonicity. Mrs. Polill~ does have a blood pressure of 108/60 of the left upper extremity. Her total body weight is recordLu at 212 pounds. Due to this patient's continued positive improvement and reduction of neuro- logical implications we will be reducing this patient's frequency of care within the next two weeks to one visit per week. We will continue t~ apprize her with her interim and comprehensive re-testing to note her gainful improvement. To date, r am happy w;th-her results, [do believe she has a good to excellent prognosis for a complete and full recove~. ~s we continue on With her rehabili- tational care I "Ul asse.. her condition in- the near future. ( '" '\ H ~,.r:....... .. " ".\................1 'ZAl!INSKI CHIROPRACTIC OFFICE JA:ll 9 CJ . Robert C. Zabinsk~ D.C., C.CR.Po R E C E J V EO 3028 Marui Sm,1 Camp Hil4 PA 17011 (717) 737.6279 FAX (717) 737.1389 .' ~~ :)". ~.~' ~~.JooII. g~i~~!i ~',. ~.~ .. 1., January 15, 1993 Hs. Jackie Ravenel State Farm Insurance P.O. Box 257 New Cumberland, PA 17070 REI Zedna Polillo DOAI 9-25-92 Claim"1 38-6536-422 PolicY"1 685-7770B0938 Dear Hs. Ravenell On Thursday, January 14, 1993, Mrs. Zedna Polillo did present herself to this office for a follow-up interim comparative re-evaluation and re-testins. My last complete medical report to you, brinsing up to date this patient's current status concerning her spinal injuries directly related to her motor vehicle collision, was mailed on December 22, 1992. At this time, as I have previously apprised you, we have reduced this patient's current rehabi1itational program of care due t~ the improvements subjectively and objectively. However, this patient called our office on Wednesday, January 13, 1993, to be seen prior to her next scheduled appointment due to the fact that she was experiencing increased lower back pain and neck discomfort. Examination did reveal tenderness to the spinal process levels as well as paravertebral muscular tension. This patient denied of any slips, falls or re-aggr~vations to her present condition. At this time, this patient is experiencing continued difficulties with her cephalgias for the last seven days. This patient's neck pain is in the mid portion of the cervical spine involving the cervical spine facet joints, Hrs. polillo is not experiencing any paresthesias to either upper extremity nor into the distal digits. She is not complaining of any weakness with usage of either upper extremity. The mid back pain at times, depending on how she moves, is creating twinges of discomfort with occasional cramping sensation involving the paravertebral musculature. Ker lower back pain continues to give her difficulties with flexibility and range of motion but is of the deep, dull ache variety in description of pain. She is not experiencing any numbness and tingling as she was in the past involving the anterior or posterior aspect of the lower extremit~, She is not ~ -~ .\ l."'. - '11', . ,t'..t......... ..... Ms. Jackie Ravenel State Farm Insurance January 15, 1993 Page two J .1'/ 1 :1 ".'J 11. ;) ...... RECEIVED experiencing any weakness with either extremity nor difficulties with ambu1ation. DeJerine's Triad, which consists of coughing, sneezing or having a bowel movement, is negative for reproducing any increasing spinal duress. 1his patient continu~: ': h: :~~: :~ ~~p~npm mngt_of her physical activities of dail 1 v g n i e basis but is continualfy mindful 0 proper bendina and lifting. ,..- ,~ The orthopedic examination does reveal a positive Cervical Spine Hyperextension test to the mid portion of the facet joints. The Foramina Compression test is positive on the left and negative on the right. The Cervical Distraction test is essentially nogative. The Soto Hall test did produce the subjective complaint of a pulling and drawing sensation involving the left upper trapezius muscle. The Dynamometer Grip Strength test did record 40 points per upper extremity on the right and 25 points per upper extremity on the left. Circumferential mensuration of the cervical spine was documented at 14 1/2 inches with the landmark being the C7 spinous process vertebral level, The 1wnbar spine examination revealed involvement of the right sacro-iliac joint which reproduced pain and discomfort while performing the Sitting Bechterew test, Bilateral Leg Raising test and Kemp's test. Palpation to the lumbar spine region revealed sensitivity to the L4,L5 and right sacro. iliac joint, Mild paravertebral muscular tension was found on examination. The neurological examination remains intact. The CYB~X examinations were performed to the cervical and lumbar spine regions to specifically document this patient's spillal flexlbility, range of motion in conjunction with paravertebral muscle strength testing. Cervical CYBEX revealed forward flexion 52., extension 35., lateral bending left 23. and lateral bending right 31.. The restricted measurement of the left does correlate with this patient's subjective complaints of left cervical spine pain in conjunction with cephalgias. Lumbar CYB~X revealed forward flexion 57., extension 14. and painful, lateral bending left 28. and lateral bending right 32., Muscle strength testing seems adequate for this patient's current health statu~. At this time, due to this patient's increased suboccipital cephalgias and lumbar spine discomfort, we have added additional appointments to rehabilitate the area and decompress any associated neurological irritation. I do believe that with additional intensity ~f treatment scheduled for the next one to two weeks, we will be able to go back to the reduced frequency of care to one time per week and work towards a level of a full and complete recovery. "\ Robert C. Zabinski, D.C., C.C.R.P. 3028 Market Street Camp Hill, PA 17011 (717) 737-6279 FAX (717) 737-1389 HARRISBUR( FER 19 19: RICEWE ..... . , ZABINSKI CHIROPRACTIC OFFICE . . February 18. 1993 Ms. Jackie Ravenel State Farm Insurance P.O. Box 257 New Cumberland, PA 17070 ReI Zedna Polillo DOAI 9-25-92 Claim": 38-6536-422 Po1icY"1 685-7770B0938 Dear Ms. Ravenell On Thursday, February 18, 1993, Mrs. Zedna Polillo did present herself to this office for her comprehensive comparative re-evaluation. My last complete medical report to you identifying this patient's current subjective complaints and physical examination findings was January l5, 1993. Presently, this patient is responding to care as anticipated. She is now at the reduced freQuencv with her CPphAlgi~Q a~ne to two times per week. Neck pain is intermitt~nt. She is experiencing intermittent cerVical-brachial symptomatology. Mrs. Polillo denies of any coldness or loss of strength of the right upper extremity. However, she is experiencing paresthesias into the second and third digits. The mid back dlscomfort is best described as a mild, deep, dull ache sensation with no anterior chest wall pain. The lower back 1ii:;~~:~~~':'';. ..~..":;';':',." - ;t' -..-. --.. in nature with no right lower extremity neuropathy as previously noted. At this time. we have been able to successfully decompress the associated neurological insult. to this patient working on a daily basis as a secretary. we have prescribed an es ned to e ut ze ng In an automo i Q-itt-llomll nr s itUng eig . am confident that this will help enchance lumbar spine support and minimize some of the soft tissue residuals that continue to plague her. According to my records, this patient called for additional care on January 20, February 12 and February 13. 1993. this was due to a severe cephalgia, \j--( .' ,.-"'. '''I '\ , , Ms. Jackie Ravenel State Farm Insurance February 18, 1993 Pase two . "'c;eURG FfB I 9 1993 RECEIVED The orthopedic examination does reveal a positive Cervical Spine Hyperextension test with a Foramina Compression test reproducins discomfort to the mid to lower portion of the cervical spine facet joints bilaterally. The So to Hall test does reproduce discomfort to the C7,Tt vertebral levels. The Dynamometer Grip Strensth test was recorded at 30 points per upper extremity on the right and 20 points per upper extremity on the left. Thoracic spine examination revealed palpation to the C4,Ts,T6 vertebral levels. Thoracic Lateral Bending, Extension and Flexion reproduce modest discomfort. The lumbar spine examination did reproduce discomfort across the 1umbo-sacra1 junction while performing the following orthopedic testsl Sittins Bechterew test, Lasesue's test and Kemp'& test. Palpation revealed sensitivity to L4,LS vertebral level. No true sacro-iliac joint involvement was noted on examination. The neurological examination was performed via the Wartenburg Pinwheel instrument and this was intact. Upper and lower extremity deep tendon reflexes were all recorded at a Grade II level. The CYBEX examinations were performed to the cervical and lumbar spine regions to specifically document this patient's spinal flexibility, range of motion in conjunction with paravertebral muscle strength testing. Cervical spine forward flexion has improved to 620, extension 42., lateral bending left 24" and lateral bending right 360. This does show improvement in all areas of CYBEX testing. The lumbar CYBEX reveals forward flexion 600, extension painful and restricted at 16", lateral bending left 230 and lateral bending right 2S". This once again shows modest improvement in areas that have been tested. Muscle strength testins seems adequate to the cervical and lumbar spine paravertebral musculature. Mrs. Po1i11~ does have a blood pressure of 100/72 of the left upper extremity and a total body weight of 211 1/2 pounds. .... .. .., -. --.. --, ..---- _.. _. ---- Taking into consideration this patient's current objective findings and subjective complaints involving the cervical and lumbar spine region, I am making the recommendation that this patient shall be at the reduced frequency of care of one time ewe for tH~ nex_ severa! we I wl11 ke you e e y appr sed of this patient's improvement through our interim and comprehensive evaluations. At this time, Mrq Polilto has not reached the level of maximum medical improvement. However do rem in co en a we w e a e to s a ze d any type of chronic imp a rment ifficul~ies. Upon receipt of my medical report and itemized statement, your continued prompt payment to this office within )0 days or less is graciously appreciated. ~ ~. ~ 'P<- / Robert . Zabi ski. D.C.. C.C.R.P. BOard/Certifi Chiropractic Rehabilitatl~n Physician Jl En<\l. S.Ji'3tement for services l-ls-9) through !-lll-9) 51002.ll0 '--" F"Io~qL' ! llJldna 1"01 ~Ilo FILE NO.: '8~5364:: ... ~,.. ~ I 1'''''"\ ht,~\. .,..;::1;:"",...... NOV 0 5 l;.~::l ~ t: c;:: i 1,' _ ..J s~<lting th<lt tr,is cl.aimant e:q,el"v3nc:ad .:In'/ loa'i nl nor sustalned any tracturas and or dlBlocilt10n~. I:,:~n':i":: li:)U~jneS5 ~ 5ubs~quently. t~is claimant present~d t~ the offlce ot O~. Robert Z.blns~l, Chiropractor, on ?129/9:. wher~ Lt w.s n0~OC th2t upon e:llIlII.inat.lon Dr. Zi\bins~'i l\rr.1Vt~d ,.t thl~ roll',)"'lnl) ,j.~aLJ"C1StlS: hypere:i temilon/hyperT 1 e:: til'l1 Hlll.WY. cer', lI:.:I J. bracr Ii' \ "YI1LJrtJme, tor'tlon lnJ ur'l lumbar '3p1ne rind ,-.rd 1'='.1 l.,p." 1:1\,/ 1 O.i eJ:\='" E'l1sad Llpon th.? above d HlgnO'l'lS Dr., ,: .lllln,; I. l J.,np 1 e.'me"\ h!d ,'. t ""'Ii. tmen t r.egllOen I.:onslstint] of Lllt".r.'-:\'-'iOlhl~~ 11I.\rll.\d.: :n~.nJ.pl\ldt:on :JT tl'"'13 '3p.i.ne and r'l!habi.\:t<ltive trl?atllwn~. Ff'lJIO il reVJ.8W of the IIIl'!dlCd! ,'(!I:f.lrI1!;. .t.!.s nClc~'~ th.lt tlu,," claimant initlated care under the guidance of Dr. Zabinski on Q/:9/9: arld continued ttlrOLtgtl ei9~. ,'ccording tel the records thi~ claimant cont1nued to r~C~lve ,=~re under ~he GUidance of Dr. Zablnski beyond 8/93. ln answer to your correspondence ~3ted It:I/13,~93. th,] ~cl~o\~i~g is ,ny profession...l opinion concenH~g YC'.'.r qL\9stlon5: 1. PO YOU CONCUR THA T F'AT! ENT F:::;'\\~HED t;,ENEF I T '::F CH [RIJPF ,~CT I C CARE BY ZABINSKI CHIROPRACTIC 8N rul B~ 3::8;9: ~ND THAT NO FURTHER CARE WOULD BE NLZEDL:O" If this c:laimc1nt'c; complaints, lIlec:h~ni~m (If In];Jr.!..~'.=i :one: Il.:1f:.:r.~. llf tile accident as presented i\re corn?I:t. I:ili~; .clall1l,r:t lIuti"':l1!c =ar~ under the gUldance af Dr. l.bLns~i, or q/:9/0~, for in- jUl'ies allegedly sustained i..1 :I ,(,va r;l~' '1/'2:5.'9:. 1 ': .lppeZlrs hy the flle aV.lilabl: for my n!VH'!W 1:11,.\t chlrrJprac:tcc c~"''! l"endered ta thiS claimant by Dr. .!lHJin=~ i. VI;\1Z ,.-\npropr13-:1::, :'"'(Jz.~scndbL:; dl1l~ ne':EHi!'idr'.' in tt,e 1,'Ltl.Jlnorlth~: ;:IT: l:-dl'"I? [: sriot..\lj be notzd that tr:8 l.lse cf:~,"1.l1.:.~\:.:.'/.= t"'i~l-,;;.pi=:i .":'~~:I::'Jdl.:'q --., ' -t' ..-.. +-C' t '':1'' I""~'--";'" '-~-:-=-r:-:-:--;-'-;.-:~;'.~-:~-;- '~"-l:'~--"-',,~ IT,~r!.'":.2:L\..:. _on ,,-,I __:.:.!,~_~!.:.=:.,?:._L.__:.'~~.' _ l. ;_. ~__ ,. __:.-:~_~r:...~.-_.,..-:,.\ ~I_. 1.:- '"h's C:;''''"'A'" .'.llQ""~.d"J '~u"t-,Tn-;'-~ "n ':I':"'i,i:,c,> 1" ,1",,'l"'L.........l.e~ '. _ .~~ "= _, ':J-- J.. _ ...-.::\_ \;;;'..J....., .......' ,.... ;J ....\...., .. .:.2'__, .... . far' up to _1 thr=" month per:ad GT j;~;llr.;. rr-e_\tnm.,~_ ..:::. '.,JI r. tl'3sL\~, -nJLtr'.leS wh.lch e::c:eecJs thL'3 lenrJth :.11 ~:f.lh\t,nt.:.'n... t:Il:~ 1.';: (::::~e:'3i"e r :la~ ,jCJC'LtmentEd b)o' .JO;,;lt.:.V>;;o ,.Jr-~;H.:I:lF.;ci,:"no?L~r=~.~lJ;' -:1.: =";l1l"iLtl La' :i.cnr:i. C-;'!'f'lf': f;.ndLrlgs, u',.. 'lIur.(.~ ,:\'.1',_\l--;C81.1 J....:.iq;hJ.:.::.. ~ ~"-:\ll...~~..i-.icn:s 'Jl:h r.'.~ !'\.ae1jle E~!G, SSEF..:'ICl,':, ~="'.'= 1':0 ~!I.\,:'" ~:FI;-::.,;, t'~.'" ~'~,;p.'".r?,t~~ 'lnll ,Jr. ~.\rl'" d i..MJnos tlC te'."i t: r.l"5U l t.'."'; .:: ~.~; I. r'J:. m'l .~. .I.,?...: ': :Hl\:at"'\ 111'1 :111.-'; l:,:\<;e. I I..'pr:'rl ;"F.I\i.'..r=~wLrg I:,~c? 11l,:.t1.:l1 ,!etcrn'.:',.:\t,:"1!1 ;:l'?r~.::'"',lll~: '~:., :1. ~~'II-H~'l .': '.:~n.-=-:(':j;"l~,'j t!1':'s .:.ase, :.:. ;,,0:; r.J'.:amlll~l-rl,::(j !:l'/ n~.. _.II:.:I:li~ .l-,:~' ':~~. ,;1.u,ndnt had r.'l!ached :I pOlnt IJr ~"\".;lILi'1I bel\L':.~':=. .'.'~:""~'- t:1~~I--:' 'Ji'.3C~:'C I:are b'/ :/~~/9:, = morlt:,~. ~... .:\t:,j1.~:.,:r', !,'.: I'H:~,3 I",..J+:'~.J t.. ~;r. Emlllons tl1,at the o.:yLJe:: +:::'::'-:.'..nl] r:)F~rt 'rni!~l on :-1-,1.:.. . l.~ '.,!\." t IJ" ........1'...'... I'. ..1"" ....,.:.,\..1 "1,'.,,\, ,.-'" .. 1:'~\CJI~ :- :li1dl'.' :"Ull', l:l 1711..E: l'lD.: ':8655642: tlO~ 05 ;::3 ,,:," ,:;~.t ~ _.J . - Dr. Zabinski was nut appropriat~. nor rua$cna~I~. 'Jpon r~\i?W1ng ':he uocL\mentation presented trom tho tn.at.l.l1lJ ch1rapr,1l:t',c ph'/Sl- .:h\n. Dr. Zi\bins~.l. along wlth disc\l\Jslrlg this fi:8 ,.,<,:h '.h'~ truat1ng ehlropr3ctic phYSlci3n, ! 4m ln agreement w_t~ the inLti.1 poer review performed by Dr. Emmons Ln tha~ :hj~ c'd:m~nt had reached a point of ma:llmv,m bene'fl": of fLlrt.her' ,:h",'opri\cl:ic tn:atment IJY 3/28/93. There i:!::i':it; no rUl":tll"r 'JIJJe-:':i',oe! ellni" ,:;\1 dOClunenti.\tion trJr my re\ Lt!\. 'illppu,-tlrl'j t11(. r:<~::c',,<,i l~ I'" nr~c~d III ,;:ontinL\ed chiraprac:t~c .:,1<'(1 IlL",'Jn" .\ .., Inl.lI',r.I" pE.,'""j ni lime concer'ning thl~ case. 1 t l'= lI,y pr'of(,(i~l .,'11 'JJln_t" I ....,yon.: 3/28/93 a hom 8 ram consis:lng ~r thera- peu.J.c c:tt""';':)t"{"'hes and e:-:er-c:.ses ,:oul.d ~)8'v'e been i:t' ~:..~ent..e t:c lnc.m!le strength, tle:dlJibly ~no c? ,ncPo i.\S \~"Il as to. hel;) pre'l~n t against any aggrava :i,1n; e::,~cerbi.\ tion of the alleged i.n..1u("'iF1S ~,L\5t.ained due to thellvi\ in qUl~stl[jn cr 9/'25/Q2. Addi- tionally, it. 1S my profession~l cpin'.lll1 ttli\t o?n,! ~nd ~,: 1 cybe:', tt:stlng pel-formed on thlS ;:1.111110,111: li'! 1),-, ~,lbLnsk L ";\'~ n'Jt ,]ppro" prlate, nor rei.\~oni.\ble at eith~r monltorlng the ~rograss that thlS claimant was making with the caru bD:ng pr~Ylded by Dr. l~blnski and or alterating i.\ treatment regimen. !t 1S 111'1 prof.s .lonal opinion that the lnitial e;.all1indticrl icl!=~2d ~y ~~mar~u~ n;,-e:.am1nations which were perfcJr'med nn ~11J.S \: l:1.lkUlt hV Dr'. Zabinski, consisting of actlvul pC\~j'2iv~ r ,;\i"H..jt!S 01' Ina':..LUn. ,:h" t.t\.:lpe!' d IC maneL\vers, neuro 10," ica I test.:.n';), etc., wCltld Mave b2-1r, apprc" ~rlate in ~nd of itself at both cbjectl~ely monlt.~rll1g the pr"ogres..:; thi'E cl",irnant ~li\(; m~1k~n~ \i1J.t:l t~~,~l .:\;\:"""2 ~)t~l;"\'J ;.1r-':"/id,;;'j by Iii.... ?:'\b.ll1~~~.l alurlq with .1ttl~l-at.in'1 ,;,' t.r"~~t".mf.il1t r.:~CJ'ilh?n 1'= nel:C~j ",dr y. Ttl..!re:ture.. It 1.~ lily prTJ'ful:;;,,:,.t,~JI1.:\.J '.Jr,L'l!.L!'\ L!'.d',"~,I\ .\Iltj .)'.' ::ybe:: testing fjt1rtorrned on this \:Ia~l"ant. ~J,I llr. :~.'\bl.'l'l~: riOtS ,"O~ BPpropri3te nor reascnabla \:oncurn:ng this case.. Addi~ianally. Dr. !Bbins~~ requustej ~h~ n~pcrcJn:~~ -. diseu~s tll~5 C:1..\5\3 \',itr me pl~l()r to :ny ,..,=r,derin~ ~'-:~I~Cl.S.l.':)I', On ,!.(J/19:'9:', j~scus~2d th~s case WIth Dr", !~bLnskl. It ~~s ~t~t~d ty D'. ..~~oJ:"il'~;~.l ':.hl\t Uai!S cl.;.im~r;t ~Ia=: beinrJ t"'E.ated':.~:r'Ql,\i;r. t~ t:l,",'! ~/'L"=~nt. rhet~E:- \~as nc fl'.r~ht:.I'- jtJCL'.ln~nt:.ti~tlh'1r In', .',:p1i=~J :011- ::,~rl~:"~~ thi3 case. :1.:r",:f\.1r:=. al;JQr~ r-.,:',':?\^Jlnq l:r.':1 =,':.~:,.,:: jl:'..I~;t,,-ll-':~\':.:._:n ::r-a<::.;I;ec far n': r-S'/:EW ~cn':'=f-'1inlJ t11:"S cane f....CHll t:-d~ ~r-t?..:.t:a:'G::t",l:-;.:ptaJC tic pt),.;;...c.:.:....-'\t1~ ~:r-, :::t..~L1Ln..jl,.l, ;;.\'.cnq "';.'..:;1 ,;.:.'.;C'-:;:...." '":..: "'.~,:.~ '-, t~ I:h.. 1:"-;:-l.\l:lIHJ l:tlJ...'.O!:Jr'\o.\\:;t..J.t" p;.lyl.i1.L:....:..;..'.. :\li~ ~r' -.;.,]t':":!lI.H'; 1,~t:t"'1 t',t>:o ~11;''':1.~1 !JGHH'" rt~'/i.ew pertr.JrrrHJd ", l'r'.. ~~,lllr.i:J:1~ LI! '::',11. .lo~'.:-:': ::._'~,fI-":~-'~: ld.ll 1"~~h:t1l::t: .3 pOLnt: or m...~:,1.I1lI.\.t1 ,nt~dl.l:,.\L t.nr;-".':)iE-,nE.'.-: ':I!.':ll1\'lll' ::~r~I1\:Jtlt. 'IT f:hlr.cpr',:\ct.ic ;:.l\"";~ rJr' :....~'g..-I;'.~:,' -,: n~I~r:'.~ .... .. if',' rl".t.l"'~~Sl."'lll.d CJpl.nl.Oll ~.h,1t t-'l'.: ~.~;\.;t:!.. :"'1 t_:!~:,rj'It:'!r~' .iI. '.':4 .flI'r~_~ ':tl.:irt .:i1.\rr..CL.JIlt: t= t-e;:\c:, -:\ j.II~~1.lit tJr r'--~I~IJ:~.~I'.1...:I~_ -:: ..~~. '::1.:\':'0\1 d~~:::' ~IlJU:"l:!':i ':ust~.1..lerj '::L\c': ~';: l:l-r: :'1'/" ;"1' 1'.'== ":.a,:r . .'" ~ Consolidated Rehabilitation Conlpany ') HARRISBURG AUG 2 7 1993 fi g,~A~,~P ., , CO:--;FIJ)E:"ITL\L REPORT ATT: BECKY PASTOR, R.N. I'~~r 1{~l'i~w Organilulillll .:~nili~d by lh~ C'\I11\1I"Il\\~allh of P~llns\'I\.lI\ia 8/19/q3 . ."":..... I' ~ . .' .. RE: CL: D/A: ZEDNA POLILLO 38-6536-422 9/25/92 ilUG 2 ,.' IC~' . "I} _:i',~' Dear Ms. Pastor: For the purpose of this review, I have utilized the following records: 1. DR. ZABINSKI'S N~~~\TIVES ONLY (NO NOTES OR DIAGNOSTICS) A. 8/5/93, 9/29/92, 10/19/92, 11/9/92, 12/22/92, 1/15/93, 2/18/93, 3/5/93, 4/19/93, 5/21/93. 6/9/93, 7/15/93, 7/5/93, B. BILLING STATEMENT, 6/22/93-7/5/93 2. MISC. A. ER RECORDS, HOLY SPIRIT HOSPITAL, 9/25/92 B. APPLICATION FOR BENEFITS, 9/28/92 According to the records, this at the time 30 year old restrained female driver was at a stop sign when her vehicle was struck in the rear. She was transported to an ER and released with muscle relaxors. Two days later, she reported to Dr. Zabinski with complaints of head, neck, shoulder, and low back pain, and alBo parestheBias in her mid-back. She was examined there and found to have positive findings indicative of a cervical strain/sprain and torsion injury to the lumbar spine. Treatment commenced on that day and has continued to this time. Presently, she is on a frequency of once per week. As per your request, I did call Dr. Zabinski to discuss this case on Tuesday, 8/17/93, at 11:45 AM. He was quite adamant about his form of documentation being sufficient. Namely, the regular narratives that he has supplied during the course of care. I disagree with that, as daily notes would be more helpful in determining this patient's improvement. He also states that his treatment is documented in journals as being appropriate for the injury. He had treated the patient in the past, sometime in 1986 for a work related low back injury, and more recently for migraine headaches. The low back injury was a closed file he states, and the migraine treatment had nothing whatsoever to do with her current condition. She does suffer suboccipital headaches, but these are different from her former problems. The problem here is that the patient has two past conditions that '11"', .lh-.hl \l , ':1.., "'. .\ 1111> }; '11 \L.ri. . ,.:n..' .1...1.;,..\ ,I~'l ~:11, . -..~ !l.ll'l.tl\,:lr.. ill\\1. 'ull\! :II \ ,'l ," ~ll ' . "ot.,'IU !It. l\ ',': \-:" ., , '. "",,"'. ," . '. ~ " HARFuSeURG AUG 2 7 1993 RECEIVED ZEDNA POLILLO, CONTINUED. PAGE TWO. might be applicable to her current status. Dr. Zabinski told be that both of those conditions are separate, closed files, and if I desired information from them, I would have to call him back in the afternoon. In my opinion, a patient's file is a complete record. It should not consist of individual closed files. That is not proper record keeping. According to the law, these reviews are to be done on the basis of written documentation. I could not, because of time restraints, wait for copies of the past history. They should have been included in the file. Dr. Zabinski had nothing to add other then the fact that the patient is still improving, she does well at once per week. and that he is "shooting for MHI in 60 days". He also stated that there were no disc lesions and therefore, no MRI's or EMG's were necessary. After review of these records, it is my opinion that treatment was initially reasonable and necessary for injuries sustained in the 9/25/92 MVA. It does appear that the patient sustained a moderate cervical and lumbar strain/sprain. The documentation format, although adequate for such an injury, does not substantiate this extensive treatment. I did not mention previously that Dr. Zabinski felt Cybex measurements were adequate documentation. I disagree with that in this case as there is no baseline to go on. This patient has a history of musculoskeletal problems, and as such, might have already had permanent impairment. If so, there are already scar tissue deposits that will prevent her from reaching optimal measurements (ROM,etc.). Considering that, determining MHI from this (Cybex) method would be impossible without previous testing (prior to the accident) . It is stated that the patient is currently under rehabilitative care at once per week. In my opinion, that is maintenance. I can't really determine when she went on that schedule, as there are references to increased frequency due to cephalgia. Again, because of the format (narratives only), it is difficult to ascertain this patient's improvement or the cause of her complaints. As per your questions, the current treatment does not seem reasonable or necessary, based on the documentation. In my opinion, this doesn't appear more then a moderate injury to the cervical and lumbar spine, Passive treatment for such injuries need not exceed ninety days. Active rehabilitation is appropriate. and that appears to have been started here. A ninety rEe 01 '% m:~{'ffol P.3'4 polillo v. statu Farm February 1, 1996 Palla 2 ---------------------- pllychuloqical, social, and vocational functioning of a viotim. Such services may includl.!, but are not limited to, lIedical oare, dIu9no~Llc and evaluation procedures, physical and occupational therapy, other ncolls&lIry therapies, upeo(;h patho loqy and audiology, optometric lIorvioo&, nursing care under the supervi.ion of a reqiutorod nurse, lIedioal social ..rv.l.ceu, vucatiullal rehabilitation and traIning aervicos, ocoupational license. IInd toulu, ,UIl) transportation where noceuu4ry tu secure medical and vocational rehabilitation services. Baud upon tho aforomentioned de!inition, tho Pennsylvania Superior Court thon held that a no- fault inourar wal not required to pay ror custodial or maintenance treatments, In other words, "oervioos which do not reduce t.ho disability of the victim or restore funotioning, being custodial in nature, would not be recoverllble undor the No- f'Bul tAct. ,. " 1Jl. 555 A. 2d at 209. It is lIc)mowlodged that the f1tllg CilSO 10'411 subsequently overruled in Drake v. PennJvlvania National Mut.ual lhAUranca ComDany, 529 Pa, 44, 60 A.2d 797 (1992). However, it wa. overrule~ on a tactual, not legal, basis. Specifically, in Drake, th. PenngYlvania suprame Court overruled the lower court by holding that Hr. Fertig needed continuing care in ord.r to prevent his condition from worsening. Therefore, the medical tre.tlllontB rllndered wIre "necenary" and as such, were to be paid for by the insurer. The principal or law, however, remains intact, that is, an insurer is not requirld to pay for custodial or maintenance medical carl thatl (1) would not improve the pereon'B condition lind/or (2) would not prevent the person's condition frcm wor.lning. QI& American Motorists_Ins. CO. V. amen Bank and Tl':I,IBt Co. of IlllnovlJr, Pa, super. , 644 A.3d 1332, 1234 (1994) (" ('1')her8 is no ;iI-it excluB10n tor- expln.e. related to medioal and nursing oarl which i. cu.todial . . so long eB it was neol.lar~ due to accident related injuries.") (BlIIphafllll added). Under Section 1'/12 of the I'Rllnsylvllllia Motor Vehiole Financial Re.ponlibUity Law, 7~ I'a. Cons. Stat. 51701, J.tt. url. ("MVFRL"), a. undlr the NO-!'ault A~'t, an insurer is only liable RICHARD F. MAFFElT, JR. Attornev at Law 2201 North Secona SlrI.t Hamsburg, P.nnsylvanla 17110 T .I.phon. (117) 233..180 Fill (7171 23H342 February 9, 1996 vi David J. Foster, Bsquire Costopoulos, Foster & Fields 831 Market street P.O. Box 222 Lemoyne, PA 17043 Thomas M. Devlin, Eequire "/ J" ~I 71 1802 Market street Camp Hill, PA 17011 Andrew C. Sheely, Esquire Five West Main street Shiremanstown, PA 17011 RBI polillo v State Farm Cumberland County Court of Common Pleas No. 94-2520 ., Gentlemen: This letter is in regard to the issue of the Dsfendant's responsibility to pay Plaintiff, Zedna Polillo's chiropractic bills incurred after March 23, 1994. Initially, at issue is the definition of "maintenance". The Defendant contende that Plaintiff and Dr. Zabinski conceded that said chiropractic treatments were maintenance. However, the Defendant defines "maintenance" as treatments that are of no value whateoever. The arbitration testimony of Dr. Zabinski, and his reports, reflect that, by March 23, 1994, Plaintiff had reached maximum medical improvement, but continued to suffer with pain and partial disability which was permanent in nature. Thereafter, Dr. Zabinski testified, his treatments were not intended to heal Plaintiff and cause her complete recovery, but were necessary to maintain Plaintiff's ability to function at her present level of physical activity and to prevent further disability. Both Dr. Zabinski and Zedna Polillo testified that the chiropractic treatmente after March 23, 1994 were beneficial to her in that 1.- . ,. , David J. Foster, Esquire Thomas M. Devlin, Esquire Andrew C. Sheely, Esquire Page 2 February 9, 1996 theYl allowed her to continue working, reduced her pain and discomfort, and caused her to be able to continue with activities of daily life. Therefore, the evidentiary record does not support the Defendant's aesertion that Plaintiff and Dr. Zabinski admitted that said chiropractic treatments were maintenance, i.e., treatments of no value whatsoever. The applicable No-Fault statute, 75 Pa. C.S.A. 51712(1) requires an insurer to provide firet party medical benefits coverage for reasonable and necessary medical treatment and rehabilitative services, including chiropractic. The statute's express language doos not exclude from coverage medical treatment which is not intended to improve the pationt's condition and cause recovery, but rather maintains ability to function and prevents further disability after reaching maximum medical improvement. The only statutory limitation on coverage is that the medi.cal treatment must be reasonable and necessary. See Drake v Pennsylvania National Mutual Casualtv Ins. Co., 529 Pa. 44,601 A.2d 797, BOl (1992) (copy attached). The purpose of the No-Fault Act was to establish a system of prompt and adequate basic loss benefits for motor vehicle accident victims. Moreover, it was the intent of the legielature to guarantee that accident victims receive prompt and comprehensive medical treatment. Id., at BOO-B01. The Pennsylvania Supreme Court has consistently held that in interpreting the No-Fault Act, it must be liberally construed to effectuate its purposes, erring in favor of coverage for the insured in close or doubtful cases. Id., at BOO. There does not appear to be any case on point as to what constitutes reasonable and necessary medical treatment under the current No-Fault law, 75 Pa. C.S.A. 51701, et sea. However, the Pennsylvania Suprems Court, while interpreting the now repealed predecessor No-Fault Act ruled that expenses related to custodial care involving a patient confined to a nursing home, including room charges, constituted professional msdical treatment and care and was an allowable expense under the Act. Drake v Pennsvlvania National Mutual Casualtv Ine. Co., supra. at B01. The Defendant cites Pennsylvania National Mutual Casualty Ins. Co. v Fertia, 3B2 Pa. Super. 335, 555 A.2d 20B (19B9) as its only authority for its claim that a no-fault insurer is not required to pay for custodial or maintenance treatments as services which do not reduce the disability of the victim or restore functioning. Id., at 209. However, Drake and Fertia involve the same case. Millard Fertig was rendered a David J. Foster, Esquire Thomas M. Devlin, Esquire Andrew C. Sheely, Esquire Page J February 9, 1996 quadriplegic in an automobile accident. He received inpatient hospital care, but within a year of the accident was admitted to a nursing home where he remained until his death some five (5) years later. The trial testimony established that Fertiq had reached the point in his rehabilitation where he was no ionger a candidate for physical therapy and was receiving only maintenance and supportive care. One physician testified that Fertig needed periodic review of his bladder and bowel functions, that he required skilled nursing care or his condition could regress, and that even though he was not a candidate for rehabilitation he needed medical and nursing care because of his condition. Drake v pennsvlvania National Mutual Casualtv Ins. Co., supra., at 799. The No-Fault Act in effect at the time, 40 P.S. 51009.l03(A), included coverage for professional medical treatment and care. The Superior Court in PennsYlvania National Mutual Ins. Co. v Fertia, supra., as noted above, denied coverage, ruling Fertia was receiving custodial care in the nursing home and not medical treatment. Id., at 210. Fertig died and, therefore, the appeal to the Pennsylvania Supreme Court was taken in the name of William L. Drake, Executor of his Estate. Drake v pennsvlvania National Mutual Casualtv Ins. Co., supra., at 797. The Pennsylvania Supreme Court in Drake reversed the Superior Court's decision not on factual grounds as the Defendant contends, but on legal grounds. Id. Under Drake, custodial services that are administered as part of professional medical treatment and care were ruled to be an allowable expense under the No-Fault Act as long as they were required because of accident-related injuries. Id., at BOl. As a result, the principal of law the Defendant cites from Fertig haD been overruled, and cannot be relied upon to resolve the instant matter. In American Motorists Insurance Company v Farmers Bank and Trust Co. of Hanover, Pa. Super. 644 A.2d l232, l234 (1994) (copy attached) which also interpreted the repealed previous No-Fault Act, the Superior Court ruled that the fact that an insured was receiving custodial care does not, of itself, relieve the insuror of the responsibility for payment, and that, for an insurer to be relieved of financial responsibility, the care must be unrelated to the accident. Id. The previous repealed No-Fault Act was again considered in Travelers Insurance Company v Obusek, ___ F.2d ___, No. 94-3666, U.S. Court of Appeals, Jrd Circuit (1995) (copy attached). In . David J. Foster, Esquire Thomas M. Devlin, Esquire Andrew C. Sheely, Esquire Page 4 February 9, 1996 that case, Lisa Obusek became paralyzed as a result of an automobile accident. The evidence established she needed twenty- four (24) hours attendant care for all activities of daily living including, but not limited tOl bowel and bladder routines, bathing, dressing, weight shifts and transfers, hygiene care, range of motion, house cleaning, exercise routines, leisure time activities and wheelchair maintenance. Id., at 3-4. In Travelers the evidence also established that daily attendant care of quadriplegics usually is provided by unskilled lay persons, having only a high school diploma and a driver's license and being over age lB, with a licensed practical nurse available for periodic supervision and review. Id., at 4-5. The Third Circuit Court of Appeals, citing Drake v PennsYlvania National Mutual Casualty Insurance Company, supra., ruled that the attendant care needed was because of accident- related injuries and constituted professional medical treatment and care which was an allowable expense. Travelers Insurance Companv v Obusek, supra., at 15-16. As noted above, custodial services involving nursing home care, including room charges, and attendant care, inyolving all activities of daily living, have been ruled to constitute medical treatment covered by first party No-Fault medical benefits. In the instant case, the treatment provided to Zedna Polillo by Dr. Zabinski after March 23, 1994, to maintain Plaintiff's ability to function at her present level of physical activity and prevent further disability, was a higher level of care, actually provided by a licensed chiropractor. As a result, it is clear that Dr. Zabinski's care of Plaintiff constitutes reasonable and necessary medical treatment under the present No-Fault statute, 75 Pa. C.S.A. 517l2(l), for which the Defendant must provide payment. ilSP ctfully sll.bmitted, .A_iJi ). p,'U)1J J/' ichard F. Maffett, Jr. RFMlcjs Attachments CCl Barry A. Kronthol, Esquire (wIatt) Zedna Polillo (wIatt) Robert C. Zabinski, D.C. (wIatt) SIIERIFF'S RETURN COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND In the Court of Common PleaD of Cumberland County, Pennsylvnaia No. 94-2520 Civil Complaint in Civil Action Law and Notice Zedna polillo VS State Farm Insurance Company R. THOMAS KLINE, Sheriff, who being duly sworn according to law, says, that he made diligent search and inquiry for the within named defendant, to witl State Farm Insurance Company but was unable to locate them in his bailiwick. He therefore deputized the sheriff of York County, Pennsylvania, to serve the within Complaint in Civil Action Law and Notice On May 20, 1994 , this office was in receipt of the attached return from York County, Pennsylvania. Sheriff's COStSI So answers I Docketing 14.00 Out of County 5.00 . ~./ . .., ( Surcharge 2.00 York Co. 29.44 R. THOMAS KLINE, Sheriff 50.44 Pd. by Atty Sworn and subscribed to before me 5-20-94 this Jd- d fn . ~ - ay 0 (~ "If ,A.D. Clot Lt- C. )} ld~<_. 1.1!/.Jr.; .... I I . . Prothonotary 19 . 1M The Court or C.:mmo:i Ple::s or C:.Jr.::"-:~It'l:nd C':'U:-;~'YI Panr:syl'lc::r:i= Zedna Pol illo 'IS. State Farm Insurance Company :-roo 94-2520 CJvil Term ---. ::..- :-low, May 16 :92.L.. !. S~'::::' 0: C~GE?.!..A1ID COt,;{'!'y. ?A~ co !l=-..by ci..;:u= t!:.: S~~ oi York . . CAu:ty to :'-.=".1tC ::is ',V:::, ... .. . .. . '-l. f . ~,. .- :.:::s ~'1'uc.:cn ::t::li -.. .... It == :-:qu=t ::Q ::a (l :.:::: ~ .:t:::::r. r~~ SlIe.~ ct C:::::!:er'..1Cd C~Wlty. :':1. . A'sdavit or Semc.= ~ow, May 18 !9 94 .. 3:15 o'dc~ . P. ~L 1:".-= . .. . . t. Corrplaint & Notice :.:= W1t::D State Farm 'Insurance Company - . , . tJpaQ , , .' :It 115 Limekiln Rd., New Currberland, PA " , by :::U:cili1i:o Mark Pau 1, Claims Supvr. . . ,." J. True & Attested c::py oi == :] "':-l:::U C'ol1ll1aint & Notice h~ r. ,. 3nd -~":. k::owa :0 Mark Paul ::.e .:::u:=:s '~~:::=i. So =w~ ~~~,~~, Shc::i' .f York CoWlt)". !':I. 5WCQ :md l'J!:sc-:i:d bCorc ~v:?if Mav 1. IgiL corn Sll'Y1CE ~a:u..l,GE s A'VTI r_'~ NOTARIAl SEAL 19 W. nHINE, t':~;ll" 1.".r~l!c '^"'" YQlk Counlv, r\li~.l ",,;,,, My Oonvri,wn EJcpllCO I.: ... 25. UO~ __010...-___. s Dav,'d r-o'sJ-e ( -(4'(.i....'~., 1,r('~j jut~l., 1-GI~}.I~) Il._kill.... LU C. ~ t.." c;{ '{ - (f It,,, 1JJ''-'' /hon1iJ" 111.Vrul,v - I j ({. 111f',. 11.. J. .I'll.. /- G.....,..~u.... 'i,' '(j 'L~ " r::: G~ .., :.: -,' iijw r~l --. ; I" 1,::; ." [:;~:;..' , .;;;,. ['\.'} ".;'!1 Cl :'y .. ~-, -;0 ['I' :~~ - "J ;i::r., i :. t~": I.": - ~ (;1 ~;:, -"m ...l'r' C.) .. ,,' :_j (II .~.j -. --', --. ~~ ~ .-.. n jI"1 ......... ...:....:::.a '.".~ . "'. r-'" I'" C), i;;rl f:.. I lu () I I --, c:c :--G If' IIDatA POLILLO, Plaintiff v 1 IN THE COURT OF CONNON PLBAI 1 CUMBERLAND COUNTY, PEHHSYLVANIA 1 1 NO. 9.-2520 1 1 CIVIL ACTION - LAW 1 STATE rARM IHSURAHCE COMPANY, Defendant PRAECIPE TO THB PROTHONOTARYl Please mark the above-captioned matter settled and discontinued with prejudice. Datedl 6/7 )% RiL.A;} !'~.t:11!: 1:.. 2201 North Second Street Harrisburg, PA 17110 (717) 233-4160 Attorney for Plaintiff . , ,I , ~ .3 '.. LJ~ I" P. .. (.: (t-: .l~ ,')-' t .. ...,., ~. .:. u~ F:- L._ )~ , " r': :'; ~ h ,,1~ ::J III ,. [1:., " -11 t r: :-'.J tOo. lJ.. \i' 3 0 c'