To whom it may concern, Our firm has the pleasure of representing Glenn Zimmer who is our client in connection with the above referenced accident. The negotiation initiated by this demand package is for a bodily injury settlement. We are submitting this information solely for purposes of giving your company a limited opportunity to offer to resolve this claim. Any information or materials submitted herein are not to be utilized in a later trial or proceeding without our consent. In addition, no information should be considered a factual or legal admission by my client. Further, any materials submitted shall remain the property of my client and should be returned upon our request. Finally, unless otherwise specifically stated, all references to dollar amounts in this demand and during negotiations shall be in USD.The negotiation initiated by this demand package is for a bodily injury settlement. There are certain additional administrative claim considerations for future medical expenses, physical and economic losses and mileage drivers. In the event we reach a settlement of this claim, any release shall include the following language: This document demand package does not release any other parties except releasee's insured(s) and their insurance company. Furthermore, this document does not extinguish any rights for releasor's first party benefits. Finally, Page 1 06/23/2012 Client: Glenn Zimmer this document does not release releasor's rights or their insurance company's subrogation right for property damage. In the event the release fails to include this language, we will stamp the release exactly as stated above. If you have any objection to this language, please state your objection in writing so that we can stipulate to a mutually acceptable release. I. Medical History Documents 1.01 Medical Office records X Reviewed 1.04 From Client X Reviewed 1.05 Delay in Seeking Care X Reviewed II. Clinical Evaluation Documents 2.01 Physical Examination X Reviewed 2.02 Injuries ICD-9 codes X Reviewed 2.03 Symptoms documented X Reviewed 2.06 Diagnostic Procedures X Reviewed 2.08 Medical Validation X Reviewed III. Diagnoses 850.1: Concussion with no loss of consciousness (Mild TBI) 854.0: Closed Head Injury 339.20: Posttraumatic headache, unspecified 308.0: Predominant disturbance of emotions (Anxiety) 780.79: Other malaise and fatigue (Lethargy, Tiredness) 780.5: Sleep disturbance 780.4: Dizziness 739.1: nonallopathic lesion cervical 739.2: nonallopathic lesion thoracic 739.3: nonallopathic lesion lumbar 739.4: nonallopathic lesion sacral 739.5: nonallopathic lesion pelvic 847.0: Sprains and strains of cervical region 729.99: Soft tissue disorder contusion 920.0: Contusion of neck 922.3: Contusion of back 728.85: Spasm of muscle 728.4: Laxity of Ligament cervical region 723.1: Cervicalgia 723.9: Neck disorder/symptoms 729.1: Myalgia Page 2 06/23/2012 Client: Glenn Zimmer 729.1: Myofascitis 839.08: Multiple cervical vertebrae 839.20: Lumbar vertebrae, closed 839.21: Thoracic vertebrae 839.42: Sacrum, closed 719.46: Pain in joint; shoulder region 719.41: Pain in joint; shoulder region, Scapula 719.48: Pain in joint; other specified sites, Head, Neck, Ribs, Skull, Trunk, Ve IV. Complaints Demonstrable and Non-demonstrable/soft tissue complaints were documented as: Posttraumatic headache Intensity: 4-6 Moderate Frequency: Frequent, occurring 51-75% of the day Further effects: The pain is further aggravated upon awakening Any Movement Right Temporal Headache Intensity: 7-9 Intense Frequency: Constant, occurring 76-100% of the day Type: Shooting Further effects: Bending Right Occipital neuralgia Intensity: 7-9 Intense Frequency: Constant, occurring 76-100% of the day Type: Shooting Radiation: The pain suffered by the patient is noted to radiate bilaterally Shoulder Further effects: The pain is further aggravated upon awakening Any Movement Neck pain Intensity: 7-9 Intense Frequency: Frequent, occurring 51-75% of the day Type: Aching Radiation: The pain suffered by the patient is noted to radiate bilaterally Shoulder Further effects: The pain is brought on by Any Movement Thoracic spine pain Intensity: 4-6 Moderate Frequency: Frequent, occurring 51-75% of the day Type: Aching Page 3 06/23/2012 Client: Glenn Zimmer Lumbar spine pain Intensity: 4-6 Moderate Frequency: Intermittent, occurring 26-50% of the day Type: Aching Restricted range of motion of (six planes inthe cervical) Intensity: 7-9 Intense Frequency: Constant, occurring 76-100% of the day Pain on movement Intensity: 4-6 Moderate Frequency: Frequent, occurring 51-75% of the day Type: Shooting Radiation: The pain suffered by the patient is noted to radiate bilaterally Shoulder Further effects: The pain is brought on by Any Movement Soft tissue pain (contusion) Intensity: 7-9 Intense Frequency: Constant, occurring 76-100% of the day Type: Aching Radiation: The pain suffered by the patient is noted to radiate bilaterally Shoulder Soft tissue changes, i.e. spasm Intensity: 7-9 Intense Frequency: Constant, occurring 76-100% of the day Type: Stabbing Radiation: Neck Soft tissue changes, i.e. tenderness Intensity: 7-9 Intense Frequency: Frequent, occurring 51-75% of the day Dermatome Involvement Intensity: 7-9 Intense Frequency: Frequent, occurring 51-75% of the day Sclerotomal pain Intensity: 7-9 Intense Frequency: Frequent, occurring 51-75% of the day Cognitive, somatic, or psychological conditions Intensity: 4-6 Moderate Frequency: Frequent, occurring 51-75% of the day Sleep disturbance Intensity: 7-9 Intense Frequency: Frequent, occurring 51-75% of the day Page 4 06/23/2012 Client: Glenn Zimmer Fatigue, tiring more easily Intensity: 4-6 Moderate Frequency: Frequent, occurring 51-75% of the day Forgetfullness, poor memory Intensity: 4-6 Moderate Frequency: Frequent, occurring 51-75% of the day Anxiety Intensity: 4-6 Moderate Frequency: Frequent, occurring 51-75% of the day Sleep disturbances Intensity: 4-6 Moderate Frequency: Frequent, occurring 51-75% of the day Fatigue Intensity: 7-9 Intense Frequency: Frequent, occurring 51-75% of the day Dizziness Intensity: 4-6 Moderate Frequency: Frequent, occurring 51-75% of the day Lethargy Intensity: 4-6 Moderate Frequency: Frequent, occurring 51-75% of the day Fatigue Intensity: 4-6 Moderate Frequency: Frequent, occurring 51-75% of the day Tiredness Intensity: 4-6 Moderate Frequency: Frequent, occurring 51-75% of the day Change in sleeping patterns Intensity: 7-9 Intense Frequency: Frequent, occurring 51-75% of the day Inability to make decisions Intensity: 4-6 Moderate Frequency: Frequent, occurring 51-75% of the day Irritability with children Intensity: 4-6 Moderate Frequency: Frequent, occurring 51-75% of the day Irritability with co-workers Intensity: 4-6 Moderate Page 5 06/23/2012 Client: Glenn Zimmer Frequency: Frequent, occurring 51-75% of the day Interference of ADL: The determination of an impairment rating includes estimates that reflect the severity of the medical condition and the degree to which it decreases an individual's ability to perform common activities of daily living termed, ADL's, that are not work related. The patient experiences pain that interferes with activity V. Duties Under Duress The injured party has difficulty with Work Duties, Domestic Duties (inside the home), Household Duties (outside the home) and Educational/studies in School, and actually does one of the following activities while in pain and pain interferes in these activities causing duties to be performed under duress. The Duties Under Duress the patient attests to experiencing during Domestic Duties(Vacuuming, taking care of children, dishes, dusting, laundry, preparing meals) are due to difficulty with postural requirements anxiety/depression reduced concentration The Duties Under Duress the patient attests to experiencing during Household Duties(Mowing/Yard work, transporting family, shopping, taking out trash) are due to fatigue anxiety/depression The Duties Under Duress the patient attests to experiencing during Study/School are due to anxiety/depression reduced concentration These Duties Under Duress are experienced daily have been experienced since the incident VI. Loss of Enjoyment: The patient attests to suffering from a Loss of Enjoyment during Domestic activities as loss of interior cleaning vacuuming The patient attests to suffering from a Loss of Enjoyment during Study/School Page 6 06/23/2012 Client: Glenn Zimmer as a result of loss of attending class loss of Gym class Complaints Frequency of Pain Intensity of Pain Radiation of Pain Type of Pain The patient attests to suffering from a Loss of Enjoyment in SPORTS as prior to the accident the patient played socially The patient attests to suffering from a Loss of Enjoyment in SPORTS as since the accident the patient cannot play competitively cannot play any sport The patient attests to suffering from a Loss of Enjoyment during Hobbies as socializing These Loss of Life Enjoyment factors are are experienced daily have been experienced since the incident VII. Treatment Treatment to the patient included: 98942 Chiropractic Manipulation Treatment CMT 5 98943 Chiropractic Manipulation Treatment CMT Extra region 99204 Exam 97535 Education/ADL Patient Education: Self Exercise 97110 Therapeutic Exercises Referrals: The patient was referred for: CRMA. Immobility Devices: The patient was prescribed immobilization in the form of; Cervical pillow Page 7 06/23/2012 Client: Glenn Zimmer VIII. Stability of Medical Condition The patient's medical records reveal a documented showing of ongoing complaints and treatment with progressive improvement and the time period for stabilization ranges; 12 to 18 months IX. Medical Determination of Future Treatment It is determined that due to the nature of the injuries, future passive care must remain an option. X. Prognosis Overall The prognosis requires the need for treatment due to ligamentous injuries. XI. Prognosis For each body area injured: Neck 26-50%/ Possible XII. Future Treatment Plan: Future treatment is determined necessary when there is the presence of moderate injuries; limitation of motion; ligamentous injury; neurological findings and by type and frequency of pain. According to the Croft Guidelines, this injury would fall into Grade III. Treatment is determined necessary due to ligamentous injury/laxity. Treatment is determined necessary due to limited range of motion. Future Treatment Duration/Time I estimate the patient will require future passive medical treatment to continue for 4 months XIII. MMI For Each Body Part (max.med.improv.) When the MMI of a body part has been determined as static, it indicates that a period of time has passed since treatment has stopped and the condition of the injury has not improved. The degree of capacity is static, not likely to increase in spite of continuing medical measures. When the MMI of a body part has been determined as stable, it indicates that the patient has stopped receiving treatment for the injury. A patient may stop receiving treatment for one injury, however, other body Page 8 06/23/2012 Client: Glenn Zimmer parts that have been injured as a direct result of accident will continue to require both active and/or passive care. The MMI has not yet been determined on this patient. Upper back Stable Mid back Stable Shoulder Stable XIV. % Impairment Rating This represents a permanent medical condition resulting from accident or work related trauma. Impairments are deviations from normal function of a body part, organ, system or function. The presence of Impairment represents that a function of the body part, organ, system or function can no longer be performed normally. The examinee must be at maximum medical improvement (MMI). The determination of a Permanent Impairment should only be made when the injured is at a Permanent and Stationary condition (P&S), and it has been determined that the examinee is stable, and that no further restoration of function is probable. The percentage of impairment in this patient is as follows: Head % Impairment 8% Cervical Diagnostic Related Estimate DRE Category 3: 15-18% Impairment - Radiculopathy at the time of the evaluation, surgery for radiculopaty, compression fracture between 25% and 50%. XV: % Whole Body Impairment (WPI) Total % Whole Body Impairment: 23 The medical impairment has had an impact on the client's Activities of Daily Living, Duties Under Duress (DUD - disability) and Loss Of Enjoyment (LOE). As a result of the impairment, there are preclusions from duties under duress and losses of life's enjoyment as continued within this report. The degree of impairment is not likely to change by more than 3% within the next year. XV. LIABILITY Also, as indicated on the accident report, the investigating officer concluded that my client did not contribute to the accident and thus was not negligent. Page 9 06/23/2012 Client: Glenn Zimmer XVI. PHYSICAL IMPACT The enclosed photographs which were taken of my client"s vehicle indicate that there was a significant impact between the vehicles with resulting property damage. XVII. Monetary Damages: Mileage Costs Mileage driver costs are allocated to the total number of miles the client has been required to drive in order to meet all appointment"s and requirements as directly related to and necessary as a result of the aforementioned accident and injuries as allowed by statute. Miles driven to/from: XVIII. Future Total Costs The Doctor estimates the patient will be required to be seen for a total of 16 visits. The Doctor estimates the charges for the primary treatment to be $ 131 per visit for a total of $ 2096. The Doctor estimates the charges for any therapies/modalities to be $ for a total of $ XIX. Future Expenses: It is determined that future treatments are recommended when there is a 51% or greater chance of medically probable clinical occurrence. XXII. DEMAND FOR SETTLEMENT Based upon the liability, impact, well documented objective medical findings inclusive of; Injuries, Diagnoses, Complaints by; intensity, frequency, type, radiation and further effects on the individual including the documented permanent impact and effect upon my clients Loss of Enjoyment of Life, Duties under Duress, and given consideration to the treatment, plan, prescriptive recommendations, stability of the medical condition, prognosis, future treatment, current and future medical costs, economic losses, MMI, percentage of whole person impairment and total monetary factors, please indicate your willingness to offer to tender $34,500.00 of your insured's policy limits by forwarding a release and settlement check made payable to our firm, August 2nd, 2012. Upon receipt of your offer to tender, I will review your offer with my client. Sincerely, Page 10 06/23/2012 Client: Glenn Zimmer Page 11 06/23/2012