On March 26, 2019 a
Miscellaneous
was filed
involving a dispute between
Oliveira, Britni L.,
and
Vermont Mutual Insurance Company,
for Administrative Civil Actions
in the District Court of Bristol County.
Preview
oo.
Nl
CIVIL ACTION COVER SHEET = rel our of Massachusetts
(9130 V0028) P
PLAINTFFS Brith’ L, Oliveira caunty
ADDRESS: “BRISTOL SS SUPERIOR COURT Bristol
$$
DEFENDANT(S): ~~ Vermont Mutual Insurance Compan
MARZ 6 2019
ATTORNEY: Matthew M. Aspden, Esquire MARC J. SANTOS. ESO.
aooress: SABRA & ASPDEN, P.A. GLERKIMAGISTRAREoRess: 89 State Street
1026 County Street Montpelier, VT 05602
Somerset, MA 02726
B80: 548390
TYPE OF ACTION AND TRACK DESIGNATION (see reverse side)
CODE NO, TYPE OF ACTION (spocity) TRACK HAS A JURY CLAIM BEEN MADE?
E06 Mass. Antitrust Act, G.L. c. 93A, sec 9 A [x] Yes [no
*If "Othor" please describe;
STATEMENT OF DAMAGES PURSUANT TO GLL. c. 212, § 3A
|The following Is a full, Itemized and detailed statement of the facts on which the undersigned plaintiff or plaintiff counsel relies to determine money damages. For
this form, disregard double or treble damage claims; indicate single damages only.
TORT CLAIMS
{attach additional sheets as necessary)
|A. Documented medical expenses to date:
1. Total hospital expenses
2, Total doctor expense:
3. Total chiropractic expenses .,
4, Total physical therapy expenses ..
5, Total other expenses (describe below)
‘Subtotal (A):
1B. Documented lost wages and compensation to date
IC. Documented property damages to dated
ID. Reasonably anticipated future medical ant
IE, Reasonably anticipated lost WagES .......eseusersinne
IF. Other documented items of damages (describe below)
APRDD ROHHHE
IG. Briefly descrlbe plaintiff's Injury, Including the nature and extent of injury:
TOTAL (A-F):$
GONTRACT CLAIMS
(attach additional sheets as necessary)
Provide a detailed description of claims(s);
fescription of claims(s): yoral:$ 360,000.00
Plaintiffs claim for damages pursuant to M.G.L. c. 93A.
Signature of Attorney/Pro Se Plaintiff: X Date: 03/19/19
RELATED ACTIONS: Please provide the case nungber, case name, and county of any related actions pending in the Superior Court.
CERTIFICATION PURSUANT TO SJC RULE 1:18 . .
|| hereby certify that | have complied with requirements of Rule 5 of the Supreme Judicial Court Uniform Rules on Dispute Resolution (suc
Rule 1:18) requiring that | provide my clients with information about court-connected dispute resolution services and discuss with them the
advantages and disadvantages of the various methods of dispute resolution.
Date: 03/19/19
Signature of Attorney of Record: X
Document Filed Date
March 26, 2019
Case Filing Date
March 26, 2019
Category
Administrative Civil Actions
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oo. Nl CIVIL ACTION COVER SHEET = rel our of Massachusetts (9130 V0028) P PLAINTFFS Brith’ L, Oliveira caunty ADDRESS: “BRISTOL SS SUPERIOR COURT Bristol $$ DEFENDANT(S): ~~ Vermont Mutual Insurance Compan MARZ 6 2019 ATTORNEY: Matthew M. Aspden, Esquire MARC J. SANTOS. ESO. aooress: SABRA & ASPDEN, P.A. GLERKIMAGISTRAREoRess: 89 State Street 1026 County Street Montpelier, VT 05602 Somerset, MA 02726 B80: 548390 TYPE OF ACTION AND TRACK DESIGNATION (see reverse side) CODE NO, TYPE OF ACTION (spocity) TRACK HAS A JURY CLAIM BEEN MADE? E06 Mass. Antitrust Act, G.L. c. 93A, sec 9 A [x] Yes [no *If "Othor" please describe; STATEMENT OF DAMAGES PURSUANT TO GLL. c. 212, § 3A |The following Is a full, Itemized and detailed statement of the facts on which the undersigned plaintiff or plaintiff counsel relies to determine money damages. For this form, disregard double or treble damage claims; indicate single damages only. TORT CLAIMS {attach additional sheets as necessary) |A. Documented medical expenses to date: 1. Total hospital expenses 2, Total doctor expense: 3. Total chiropractic expenses ., 4, Total physical therapy expenses .. 5, Total other expenses (describe below) ‘Subtotal (A): 1B. Documented lost wages and compensation to date IC. Documented property damages to dated ID. Reasonably anticipated future medical ant IE, Reasonably anticipated lost WagES .......eseusersinne IF. Other documented items of damages (describe below) APRDD ROHHHE IG. Briefly descrlbe plaintiff's Injury, Including the nature and extent of injury: TOTAL (A-F):$ GONTRACT CLAIMS (attach additional sheets as necessary) Provide a detailed description of claims(s); fescription of claims(s): yoral:$ 360,000.00 Plaintiffs claim for damages pursuant to M.G.L. c. 93A. Signature of Attorney/Pro Se Plaintiff: X Date: 03/19/19 RELATED ACTIONS: Please provide the case nungber, case name, and county of any related actions pending in the Superior Court. CERTIFICATION PURSUANT TO SJC RULE 1:18 . . || hereby certify that | have complied with requirements of Rule 5 of the Supreme Judicial Court Uniform Rules on Dispute Resolution (suc Rule 1:18) requiring that | provide my clients with information about court-connected dispute resolution services and discuss with them the advantages and disadvantages of the various methods of dispute resolution. Date: 03/19/19 Signature of Attorney of Record: X