Our Client:XXX XXXX

SETTLEMENT DEMAND

PRIVILEGED/CONFIDENTIAL COMMUNICATION

DATE: ____

Addressee:

Our client:XXX XXXX

Your Insured:ABC

Claim Number:

Date of loss:May 23, YYYY

Dear _____:

This office represents XXX XXXX concerningthe injuries he suffered when he was involved in a motor vehicle collision that occurred because of the negligence of your insured on May 23, YYYY.

As particularly set forth below, please accept our client’s settlement demand in the amount of $______. If this amount exceeds your insured’s available policy limits, please consider this a policy limits demand. Acceptance of the policy limits is conditioned upon a receipt of a certified copy of the policy declarations page. Our client will be responsible for any and all liens that may attach to this settlement.This settlement offer shall remain open for 30 days from the date of this letter, through and including ______.

FACTS AND LIABILITY

On May 23, YYYY,XXX XXXX wasdriving northbound in his Dodge Wagon along with his wife, Margaret XXXXon ABC Highway, XYZ County, XXX,. Your insured, ABC, was in his Ford Truck right behind Mr. XXXX’s vehicle.When Mr. XXXX stopped at the red light, Mr. ABC lost control of his vehicle and rear-ended Mr. XXXX’s vehicle.After that, Mr. ABC changed lane and struck another vehicle as well. As a result of achain collision that was caused, Mr. XXXX’s vehicle hit the vehiclein front of him.

The XXX State Police prepared a Traffic Collision Report and determined that your insured, Mr. ABCwas the cause of collision through improper lane change and failure to give full time and attention.

PROPERTY DAMAGE

As a result of the collision onMay 23, YYYY, the Wagon,VIN: 1A4BC000000001that Mr. XXXXwas driving sustained significant damages all over. His vehicle was towed by Ted’s Towing.

FINANCIAL RESPONSIBILITY

On the date of the subject collision, Mr. XXXXwas in compliance with the financial responsibility laws of the State of XXXas he was insured by Allen & Allen Insurance Agency,policy number 4A300000.

SUMMARY OF PHYSICAL INJURIES

As a result of the collision, Mr. XXXXsustained the following injuries:

• Serious head injury resulting in an acute posttraumatic headache and loss of consciousness
• Scalp contusion and abrasion
• Ecchymoses in his neck, right chest, flank and abdomen
• Thoracolumbar strain
• Righttransverse T2-11 rib fractures needing conservative management
• Chronic incompletely united fracture of T12
• Right hip contusion and sprain
• Purple ecchymotic area across mid-lower abdomen suggestive of a severe seatbelt injury
• Perforated viscus with acute peritonitis due to blunt trauma needing 2 exploratory laparotomiesPolymicrobial abdominal infection requiring broad spectrum antibiotic treatment
• Systemic inflammatory response syndrome due to infectious process with acute organ dysfunction
• Bladder trauma requiring a surgery for the repair
• Acute deep vein thrombosis of left leg requiring anticoagulation therapy
• Abdominal abscess requiring an incision and drainage
• Incisional herniaadjacent to the colostomy site
• Neuropathic pain of unknown etiology requiring pain management and steroid injection

TREATMENT OF INJURIES

On May 23, YYYY, soon after the collision, Mr. XXXX was transported with complete spinal precautions to XYZ Hospital Center by an ambulance. He was evaluated by Ronnie XXXXX, M.D., at XYZ Hospital Center. He complained of headaches and pain in his right hip and right-side of his back. He sustained loss of consciousness soon after the collision. Hewas grimacing and groaning in pain. A physical examination revealed an abrasion on his scalp. There was moderate tenderness on his right mid-back and right hip. A CT scan of his mid-back revealed multiple nondisplaced fractures involving the right costovertebral junctions extending from T2 through T11 vertebrae. The fractures involved the posterior ends of the right ribs and the transverse processes. He was diagnosed to have thoracolumbar strain, acute posttraumatic headache, scalp contusion and abrasion, right hip contusion and sprainand right transverse T2-11 rib fractures. He was admitted to Dr. XXXXX’s service. He was administered 1 mg of Dilaudid, Zofran and Morphine for pain relief. He was recommended intensivist, physical therapy and neurosurgery consultations. He was instructed to apply ice to scalp, use incentive spirometry, and encouraged coughing and deep breathing. He was initiated on intravenous hydration with fluids. Frequent neurology evaluations and anticoagulation therapy were advised.

On the same day, James XXX, M.D., evaluated Mr. XXXX. On examination, he had decreased breath sounds at the bases of either side of his lungs. All his diagnostic reports were reviewed. He was prescribed Bacitracin ointment, Hydromorphone, Morphine and Ondansetron.He was recommended pain management and neurosurgery consultation. After discussing his condition with Dr. XXXXX, an admission to the intensive care unit for aggressive pulmonary therapy and close hemodynamic monitoring wassuggested.On the same day, AminullahXXXX, M.D., evaluated Mr. XXXX for a neurosurgical consultation. He had pain in his mid-back. All his diagnostic reports were reviewed. He was prescribed Lovenox for anticoagulation therapy.

On May 24, YYYY, KanwaljitXX, M.D., followed-up Mr. XXXX. He continued having pain in his mid-back. He was prescribed anticoagulants. On the same day, Dr.XXXX saw Mr. XXXX. He had pain in his back. Dr. XXXX stated that he was not in need of any neurosurgical intervention at that point of time. He was recommended physical therapy and pain management. On the same day, Dr. XXXXX saw Mr. XXXX. He had pain in his back when he was awake. He was advised to continue anticoagulation and physical therapy.

On May 25, YYYY, Dr. XXX saw Mr. XXXX. He was advised to continue incentive spirometry as well as aggressive pulmonary therapy.On the same day, Dr. XX saw Mr. XXXX. He complained of double vision with sideward gazing. He was advised to report if his breathing problems and double vision persisted or worsened further.

On May 26, YYYY, Dr. XXXX saw Mr. XXXX for a surgical consultation of his spinal fractures. He had significant pain in his back. All his diagnostic reports were reviewed. He was recommended conservative management of the fractures with pain management and physical therapy. He was advised to follow-up if there was any development of neurological complications.

On May 26, YYYY, and May 27, YYYY,Dr. XX saw Mr. XXXX. There was a slight increase in ecchymosis on his right posterior shoulder and back. He was advised to continue the same treatment.

OnMay 27, YYYY, Gabriel XXX, M.D., evaluated Mr. XXXX. He had severe pain and discomfort in his rib cage. He was breathing on 2 liters of supplemental oxygen through a nasal cannula. A physical examination revealed decreased breath sounds of either side of his lungs. He was advised to continue anticoagulation, physical therapy and pain management.On the same day, Shayla XX, P.T., saw Mr. XXXX for a physical therapy evaluation. He had pain and discomfort in his back that worsened with repositioning. He required moderate assistance to transfer himself from sit to stand and vice versa. He required minimal assistance for walking with a rolling walker. He was assessed to have deficits with ambulation, balancing, bed mobility, endurance, equipment training, strength and transfer. He was recommended to receive training for balance, bed mobility, caregiver, equipment posture/body mechanics, stair, transfer and gait. He was instructed on therapeutic exercises. The treatment was planned 5-7 times a week for 3-4 weeks.

On May 28, YYYY, Dr. XXXX saw Mr. XXXX. He developed a shooting numbness from the middle of his right buttock to the back of his leg to his right knee while receiving physical therapy. A physical examination revealed tenderness to palpation of his low back and right paraspinal muscles. There was a large contusion on the right side of his body. He was recommended to obtain an MRI of his mid-back and low back for an evaluation of his radiating leg pain. On the same day, Dr. XX saw Mr. XXXX. A physical examination revealed ecchymosis on his right shoulder and over the upper aspect of his right arm. He was advised to continue the same treatment.On the same day, Dr. XXX saw Mr. XXXX. He continued to have significant pain in his chest. There was ecchymosis on his right shoulder. Rhonchus was heard over his right upper lung field on auscultation. He was referred for inpatient rehabilitation. He was advised to continue anticoagulation, physical therapy and pain management.

On the same day, Joy XXXX, O.T., saw Mr. XXXX for an occupational therapy evaluation. He had pain in his right buttock that radiated down to his right leg and ankle which he relayed as 7-8/10. He required complete assistance for his upper and lower body dressing and contact guard assistance for toilet transfer. He was recommended to receive training for basic activities of daily living, mobility, patient education and safety education. The treatment was planned for3-4 times a week for 1-2 weeks. He was recommended inpatient rehabilitation.On the same day, an MRI of Mr. XXXX’s low back was obtained. The study revealed spondylotic changes, scoliosis and spinal stenosis at L3-4 and L4-5. There was a probable compression of left L4 nerve root. An MRI of his mid-back revealed bone marrow edema of the vertebral bodies of T4 and T12 with mild compression of the end plates. Findings were consistent with acute compression fractures.

On May 29, YYYY, Dr. XXXX saw Mr. XXXX. The MRI studies were reviewed. He was cleared for physical and occupational therapy. A discharge plan and follow-up in a month were proposed. On the same day, Ms. XX, P.T., saw Mr. XXXX. He had pain in his right calf. He was recommended acute inpatient rehabilitation.

On May 30, YYYY,Dr. XXX saw Mr. XXXX. He had pain in his chest with movements and was in distress. He was advised to continue anticoagulation, physical therapy and pain management. He was referred for inpatient rehabilitation.On the same day, Mr. XXXX was transferred to XYZ Institute for Rehabilitation for further rehabilitation. At the time of transfer, he continued to have significant ecchymosis surrounding his left shoulder and chest area. He had limitations with walking because of his pain and body habitus. He was prescribed Percocet for pain relief. He was advised to follow-up with his primary care physician, trauma surgery for the management of his multiple rib fractures and with Dr. XXXX in 4 weeks.

On the same day, Mr. XXXX was admitted to XYZ Institute for Rehabilitation. XXX, D.O., evaluated him. He had pain in his back which increased with movements. A physical examination revealed decreased breath sounds at the bases of his lungs on auscultation. There was laceration, contusion and abrasion on his scalp. He was recommended to receive physical, occupational as well as speech therapy and continue pain management with MS Contin and Percocet.

On May 31, YYYY, Leonora XXXXX, M.D., evaluated Mr. XXXX. He continued to have pain secondary to the multiple soft tissue injuries with significant ecchymoses on his right shoulder, both sides of his face, right neck, right trunk, sacral and gluteal areas.He had disorders with his activities of daily living and difficulty with walking. He was reported to have pseudo sciatica radiating down his right leg which was probably associated with muscle spasm and compression of his sciatic nerve. A physical examination revealed ecchymoses on his neck, both sides of his face with right worse than the left, right trunk, sacral and gluteal areas. His breath sounds were decreased on the bases. The motor strength in his hands and legs were 4/5. He was recommended to undergoa comprehensive rehabilitation such as speech therapy, psychology, physical therapy and occupational therapyto address his musculoskeletal and functional deficits. He was prescribed Antivert, Flexeril, Robaxin, Percocet and Tylenol.

On the same day,Mr. XXXX was evaluated by a physical therapist. He had pain in his low back which he relayed as 4-5/10. A physical examination revealed muscle strength of his legs of 4/5 with a slight limitation with the exertion of his right leg. There was numbness in his right thigh. He required contact guard assistance for walking using his rolling walker. He was recommended to receive skilled physical therapy such as gait training, therapeutic exercisesand patient education to address his impairments because of pain, decreased strength and functional deficits with balance, mobility, transfers, walking and climbing stairs. A pressure relieving cushion was provided to him for pain relief in his sacrococcygeal area.

On the same day, Mr. XXXX was evaluated by an occupational therapist. He had pain, fatigue, decreased endurance, overall soreness and decreased ability to perform his activities of daily living and functional transfers/mobility. He was observed to require supervision for dynamic sitting balance and minimal assistance for bed mobility and moving around. He required supervision for social interaction, problem solving and memory. He was recommended cold gel pack application to his mid-back and low back and therapeutic exercises for his hands and legs.

From June 1, YYYY, until June 8, YYYY, Dr. XXXXX saw Mr. XXXX. He was advised to continue the prescribed pain medications, physical therapy and occupational therapy.

On June 9, YYYY, Dr. XXXXX saw Mr. XXXX. Hehad developed discomfort in his abdomen. An X-ray of his chest was obtained which revealed a small amount of free air beneath his right hemidiaphragm.

From June 1, YYYY, until June 10, YYYY, Mr. XXXX received therapeutic exercises, gait training, elevation training, wheelchair management, cold packs and neuromuscular reeducation for the physical therapy of his hands, legs, mid-back and low back.

From June 1, YYYY, until June 10, YYYY, Mr. XXXX received therapeutic exercises, transfer training and patient education as part of his occupational therapy.

On June 10, YYYY, Mr. XXXXwas transferred to ABC University Medical Center for further evaluation and management of the free air. A re-admission to the facility after stabilization was proposed.On the same day, XXXX, M.D., saw Mr. XXXX in the ER of ABC University Medical Center. He had non specific pain in his lower abdomen since a week. A physical examination revealed mild tenderness and ecchymoses over his lower abdomen.A CT scan of his abdomen and pelvis revealed the presence of a large amount of free air diffusely throughout his abdomen. He was diagnosed to have generalized abdominal pain with free intra-abdominal air and acute peritonitis.

On the same day,XXXX, M.D., stated that Mr. XXXX had a distended abdomen with purple ecchymotic area across his mid lower abdomen suggestive of a severe seatbelt injury. He was taken to the operating room on an emergency on suspicion of a perforated colon. An emergency exploratory laparotomy was performed along withthe extensive lysis of adhesions, exploration and resection of mesentric mass and a repair of colonic partial thickness laceration and bladder injury. He tolerated the procedure well and he was shifted to surgical intensive care unit with a wound vac.

On June 11, YYYY, Dr. XX saw Mr. XXXX. He remained intubated and sedated because of his comorbid conditions. A physical examination revealed multiple bruises throughout his body. His abdomen was distended with diminished bowel sounds. There was a large bruise on his right lateral chest and a large ecchymosis on his flank and right lower quadrant of his abdomen. He was diagnosed to have traumatic mesentric hematoma. He was prescribed 2 doses of Flagyl and 1 dose of Ciprofloxacin. His diet was withheld and it was to be resumed based on his bowel function.Extubationwas advised depending on his tolerance and response to weaning from the ventilator. He was recommended to obtain doppler studies of his legs. Incentive spirometry after extubation and pain management was recommended for the management of his multiple rib fractures.On the same day, XXXX, M.D., saw Mr. XXXX. Extubation was pending as he remained intubated. He was advised to continue care as per trauma team.

On the same day, \XXX, M.D., saw Mr. XXXX for a neurosurgery evaluation. He had pain in his back which was managed with a thoracic brace. All his diagnostic reports were reviewed. He was diagnosed to have an unstable T12 vertebral body fracture. He was advised bedrest and to continue using the TLSO (Thoracic Lumbo Sacral Orthosis) brace.On the same day, a CT scan of Mr. XXXX’s mid-back was obtained which revealed multiple right-sided predominant transverse process fractures. A CT scan of his low back revealed disc bulge at L1-2 with facet arthropathy. There was a mild displaced fracture along the anterior T12 vertebral body extending to the superior end plate. A venous doppler of Mr. XXXX’s legs was obtained on the same day to evaluate for the pain and swelling of his legs. The study revealed an acute deep vein thrombosis in his left leg.

On June 12, YYYY, Dr. XXXX saw Mr. XXXX. He was extubated and had a nasogastric tube for stomach decompression. His abdomen was tender. He was prescribed Coumadin for the treatment of his deep vein thrombosis. He was advised to continue the same treatment.On the same day, Kelly A. XX M.D., saw Mr. XXXX. He appeared to be distressed because of the pain. A physical examination revealed contusion beneath the right side of his chin extending along the right side of his body to his pelvis. His abdomen was diffusely tender and mildly distended. A large area of bruise on his right lateral chest and contusion in his right medial ankle were observed. He was prescribed Percocet and Morphine on an as needed basis for pain relief. He was advised to continue the same treatment.On the same day, Sarah XXXXXX, M.D., saw Mr. XXXX. He was advised to wear TLSO brace when out of bed. He was started on Heparin infusion for treating the deep vein thrombosis of his left leg. He was recommended to obtain X-rays of his mid-back and low back.