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Elizabeth A. Underwood

Portrait of Elizabeth A. Underwood

Elizabeth is a shareholder in the Health Care Department, where she delivers strategic defense counsel in medical and dental malpractice matters, as well as long-term care litigation. Elizabeth has successfully represented a wide range of health care professionals, including physicians, dentists, physician assistants, certified registered nurse practitioners and nurses, securing favorable outcomes in numerous complex malpractice cases, including at trial, binding arbitration, and in mediation. Additionally, she defends long-term and skilled care providers, such as assisted living, personal care, rehabilitation and skilled nursing facilities, against claims of negligence, malpractice, breach of contract and wrongful death. Elizabeth’s comprehensive understanding of health care law and dedication to client advocacy consistently result in successful outcomes for her clients.

Elizabeth also handles complex product liability cases, as well as catastrophic injury matters arising from construction and motor vehicle accidents. She has tried numerous cases to defense verdicts, and has secured dismissals for her clients on dispositive motions.

Elizabeth graduated cum laude from The George Washington University School of Law. She was awarded the American Bar Association/Bureau of National Affairs Award. She completed her undergraduate degree at the University of Pennsylvania, where she graduated cum laude and with distinction in her major of International Relations.

    • The George Washington University Law School (J.D., cum laude, 2004)
    • University of Pennsylvania (B.A., cum laude, 2001)
    • Pennsylvania, 2004
    • Getting the Most Out of Medical Experts, NBI webinar, March 20, 2025
    • Best Practices for Presenting Medical Records and Expert Testimony, NBI webinar, March 20, 2025
    • Creating a Trial Notebook, Institute for Paralegal Education, Philadelphia, Pennsylvania, June 18, 2015
    • “Waiving the Right to Seek Arbitration: New Court Ruling Limits Parties’ Ability to Seek to Enforce Arbitration Clause,” Defense Digest, January 2021, Vol. 27, No. 1
    • "Case Update: Secretary of Labor v. Summit Contractors, Inc.: A Revival of the Controlling Employer OSHA Citation Policy on Multi-Employer Worksites," Defense Digest, Vol. 15, No. 2, 2009
    • "The Summit Decision: Limiting General Contractor's Liability Under OSHA for Safety Violations of its Subcontractors at Multi-Employer Construction Sites," Defense Digest, Vol. 15, No. 1, 2009
    • "Show Me The Merit: Pennsylvania's Certificate of Merit Requirement And Substantial Compliance," Defense Digest, Vol. 13, No. 2, 2007

Thought Leadership

Defense Digest

On the Horns of a Trial Dilemma: Addressing a Prior Conviction on Direct Examination or Waiving the Right to Contest the Admissibility on Appeal

June 1, 2023

Key Points: A recent Superior Court case found the filing of an unsuccessful motion in limine to preclude a prior conviction does not preserve the issue on appeal if the defendant strategically chooses to then introduce the evidence on direct.  A defendant must now choose whether to preserve the appellate right and allow the opponent to bring up the conviction, or seek to address it during direct, but lose the right to appeal. The recent Pennsylvania Superior Court case Commonwealth v. Stevenson, 287 A.3d 903 (Pa. Super. 2022), addressed the intersecting issues of how a party may preserve an adverse evidentiary ruling on a motion in limine for appellate review with the competing interests of the trial strategy that the party may seek to pursue as a result of the adverse ruling. Specifically, the Superior Court held that a criminal defendant who testified on direct examination regarding a prior conviction, after the trial court ruled the conviction was admissible pursuant to a motion in limine, waived the right to challenge that ruling because the defendant introduced the evidence himself. Raheem Stevenson, the defendant, was charged with robbery, burglary, and criminal conspiracy for events occurring on December 3, 2017. Stevenson had previously pled guilty to burglary in 2005. Pennsylvania Rule of Evidence 609 addresses the admissibility of prior criminal convictions for purposes of impeachment. While Pa. R.E. 609(a) allows for the impeachment of a witness with a prior crime involving dishonesty or false statements (crimen falsi) if that conviction or release from confinement is more than ten years old, as was the case in Stevenson, the court is required to conduct a balancing test weighing the probative versus the prejudicial value of admitting the prior conviction. Stevenson made an oral motion to preclude his prior conviction as too remote and, thus, too prejudicial. The court denied the motion. Stevenson was then faced with a common dilemma parties are faced with at trial: bring out the unfavorable evidence on direct examination in an attempt to lessen the impact, or wait to see if the opponent chooses to use the evidence on cross examination and risk appearing less than forthcoming to the jury. In this case, Stevenson chose to address the conviction on direct examination. He was subsequently convicted and, on appeal, claimed that the trial court improperly admitted the conviction without performing the appropriate balancing test.  On appeal, however, the Superior Court first addressed whether the issue of admissibility was appropriately preserved because defendant had introduced the evidence himself on direct. In holding that the defendant did, in fact, waive the right to appeal the initial ruling on the motion in limine by testifying on direct examination about his conviction, the court relied upon the general proposition that a defendant who introduces evidence at trial cannot subsequently claim on appeal that such evidence was improperly admitted. The court also cited to the United States Supreme Court case, Oher v. U.S., 529 U.S. 753 (2000), which interpreted the Federal Rules of Evidence related to impeachment by prior criminal conviction, wherein a 5-4 majority held that a criminal defendant, by choosing to testify and to address a prior conviction on direct examination, was executing a trial strategy and, thus, waived the right to complain on appeal as to the admissibility of the prior conviction.  The Stevenson ruling must now be taken into consideration for any witness with a prior criminal conviction a defendant intends to call on direct examination at trial. Strategically, a defendant can still file a motion in limine seeking to preclude the evidence. However, if that motion is denied, they will have to decide if the trial strategy of bringing the conviction out on direct overrides waiving the potential appellate issue. The ruling should also be taken into consideration when deciding whether or not to call a specific witness. Many case-specific factors will weigh into the decision, including how a jury may view the prior conviction, i.e., will the nature of the conviction likely prejudice the jury such that the appellate right is more importantly preserved, the likelihood of success on appeal, whether there are other facts that are admissible that will make testimony regarding the prior conviction more prejudicial or, conversely, that will cast a witness in a dishonest light if they do not bring the conviction out on direct?  Further, a defendant should also consider withholding filing a motion in limine at all if it is unclear whether the opposing side is aware of the conviction or whether, in fact, they will seek to use the conviction. In this instance, a defendant can seek to rely on Pennsylvania Rule of Evidence 609(b)(2), which requires that, prior to the use of a conviction more than ten years old, the party seeking to introduce the evidence give the adverse party “reasonable written notice of the intent to use it so that the party has a fair opportunity to contest its use.” If notice was not given prior to the attempt to impeach, in addition to the admissibility objection, the defendant also can raise the procedural objection pursuant to Pa. R.E. 609(b)(2) in an attempt to keep the evidence out while simultaneously preserving the appellate issue. Ultimately, this is a consideration that must now be weighed for any witness with a prior conviction which the defense would normally seek to preclude as either: (1) not a crime of dishonesty or false statement admissible under Pa. R.E. 609(a); or (2) a conviction of more than ten years old where the prejudicial value outweighs any probative effect. *Beth is a shareholder in our Philadelphia, Pennsylvania, office. She can be reached at 215.575.2599 or EAUnderwood@mdwcg.com.   Defense Digest, Vol. 29, No. 2, June 2023, is prepared by Marshall Dennehey to provide information on recent legal developments of interest to our readers. This publication is not intended to provide legal advice for a specific situation or to create an attorney-client relationship. ATTORNEY ADVERTISING pursuant to New York RPC 7.1. © 2023 Marshall Dennehey. All Rights Reserved. This article may not be reprinted without the express written permission of our firm. For reprints, contact tamontemuro@mdwcg.com.

Defense Digest

Waiving the Right to Seek Arbitration: New Court Ruling Limits Parties’ Ability to Seek to Enforce Arbitration Clause

January 29, 2021

Key Points: A recent ruling in the Pennsylvania Superior Court limits the time for a party to seek to enforce an arbitration provision. A party must seek to enforce an arbitration provision before it seeks to obtain other favorable rulings from the court to prevent waiver of the right to seek arbitration. Waiver can occur even if the pleadings remain open if the parties have sought other rulings from the court prior to requesting arbitration. As a matter of public policy, the Courts of the Commonwealth of Pennsylvania continue to strongly favor the settlement of disputes by arbitration. However, a party wishing to enforce an arbitration provision can waive its right to elect arbitration if it does not promptly seek to enforce such a contractual provision. In the recent case DiDonato v. Ski Shawnee, Inc., 2020 WL 6280080 (Pa. Super. Oct. 27, 2020), the Pennsylvania Superior Court further clarified and limited the circumstances under which a party may seek to enforce an agreement to arbitrate. Specifically, the Superior Court found that two defendants who sought to enforce an arbitration agreement contained within an enrollment contract for the defendant, Blair Academy, signed by the decedent’s mother, waived their right to assert arbitration because they participated in the judicial process, particularly by attempting to obtain favorable rulings from the court prior to seeking to enforce the arbitration agreement. Specifically, in DiDonato, the plaintiff, Ruth DiDonato, administratrix of the estate of J.D., a minor, initiated a lawsuit in the Court of Common Pleas of Philadelphia County against the defendant, Ski Shawnee, and defendants Blair Academy and John Padden (the Academy defendants), arising from a skiing accident that resulted in the death of a student at Blair Academy. In response to the complaint, the Academy defendants and Ski Shawnee filed preliminary objections as to venue, alleging that venue in Philadelphia County was improper and that the case should be transferred to the Monroe County Court of Common Pleas. The Academy defendants did not raise the existence of a contract requiring the arbitration of the plaintiffs’ claims in their preliminary objections. Thereafter, both the Academy defendants and Ski Shawnee entered into a stipulation with the plaintiff to strike certain paragraphs and claims from the complaint. Further, while the preliminary objections were pending, the Academy defendants filed a petition for removal to the United States District Court for the Eastern District of Pennsylvania. Ultimately, the District Court ruled that removal was improper and remanded the case to state court. Upon remand, the parties engaged in discovery limited to the issue of venue raised in both defendants’ preliminary objections. During this discovery period, the Academy defendants did not produce the enrollment contract in response to a request for “any document which refers, relates to or evidences any communication between you and [Decedent].” Approximately nine months after the complaint was filed, the Philadelphia Court of Common Pleas granted the preliminary objections as to venue and transferred the case to the Court of Common Pleas of Monroe County. Upon transfer to Monroe County, prior to filing an answer to the complaint, the Academy defendants filed a motion to sever and to compel arbitration. In their motion, for the first time, the Academy defendants produced and sought to enforce the enrollment contract which contained a clause requiring any and all claims against the Academy defendants to be resolved in arbitration. The Academy defendants also filed an answer, raising the arbitration clause in its new matter. The plaintiff opposed the motion to compel arbitration, arguing, among on other grounds, that the defendant waived the right to arbitration by waiting nearly a year to raise the issue. The trial court granted the motion, in part, compelling the estate’s survival claim and the mother’s wrongful death claim against the Academy defendants to arbitration. On appeal, the Pennsylvania Superior Court reversed, holding that the Academy defendants waived their right to assert the arbitration clause because of their delay in seeking arbitration. Despite the public policy in favor of arbitration, the court noted that when “a party avails itself of the judicial process,” including by attempting to win favorable rulings through the courts, that party waives the right to assert and enforce an arbitration provision. The court set forth the following factors to assess whether a party has availed itself of the judicial process such that the right to arbitration is waived, specifically, whether the party: (1) failed to raise the issue of arbitration promptly; (2) engaged in discovery; (3) filed pretrial motions that do not raise the issue of arbitration; (4) waited for adverse rulings on pre-trial motions before asserting arbitration; or (5) waited until the case is ready for trial before asserting arbitration. O’Donnell v. Hovanian Enterprises, Inc., 29 A.3d 1183, 1187 (Pa. Super. 2011).  Of significance for the court was the Academy defendants’ use of court proceedings in an apparent attempt to gain a strategic advantage in the case, specifically by: (1) filing preliminary objections as to venue; (2) seeking to remove the case to federal court; and (3) entering stipulations to dismiss various counts within the complaint prior to raising the issuing of arbitration. Further, the court was troubled by the fact that the Academy defendants had not produced, cited to, or in any way referenced the enrollment contract containing the arbitration provision for nearly a year, until they attached it to their motion to compel arbitration. Although the court rejected the plaintiff’s argument that the failure to raise the arbitration provision in preliminary objection, as a matter of law, waives the defendants’ right to assert arbitration, the Superior Court stressed that, in this case, the totality of the defendants’ actions as described above—requiring the plaintiff to extensively litigate the removal and venue issues prior to the defendant raising the claim for arbitration, prejudiced the plaintiff such that a waiver was warranted. Given the ruling in DiDonato, it is imperative to assess at the very beginning of the litigation whether an applicable arbitration provision exists and to make the strategic assessment whether to raise the provision or to proceed in court. The decision to assert an arbitration provision cannot be considered a “back-up” strategy prior to other legal maneuverings, as courts are likely to rule that the party has waived the right to assert the arbitration provision if it is not raised as the primary defense to a complaint. *Beth is a shareholder in our Philadelphia, Pennsylvania office. She can be reached at (215) 575-2599 or eapope@mdwcg.com. Defense Digest, Vol. 27, No. 1, January 2021 is prepared by Marshall Dennehey Warner Coleman & Goggin to provide information on recent legal developments of interest to our readers. This publication is not intended to provide legal advice for a specific situation or to create an attorney-client relationship. ATTORNEY ADVERTISING pursuant to New York RPC 7.1. © 2021 Marshall Dennehey Warner Coleman & Goggin. All Rights Reserved. This article may not be reprinted without the express written permission of our firm. For reprints, contact tamontemuro@mdwcg.com.

Firm Highlights

Thought Leadership

Employer/Carriers Must Explicitly Invoke Right to Deny Claim Under “Pay and Investigate” Statutory Provision; Employes Must Always Prove Medical Necessity of Treatment

Koren v. City of Kissimmee/PGCS, ___So.3d___(Fla 1st DCA 6/10/26) The majority opinion in Koren holds that the Judge of Compensation Claims (JCC) properly denied psychiatric treatment because the claimant did not challenge on appeal the JCC’s finding that the requested treatment was not medically necessary. However, Judge K. Thomas authored a detailed concurrence agreeing with the result on the ground that the claimant failed to meet his burden of proving medical necessity. In doing so, Judge K. Thomas also emphasized an important principle: employer/carriers must expressly invoke the 120-day pay-and-investigate provision under Florida’s Workers’ Compensation Act if they intend to preserve their right to deny compensability. Merely authorizing evaluations, without explicitly invoking the 120-day rule, may be insufficient to preserve the right to deny compensability of specific injuries. In Koren, the claimant sustained injuries to his upper lip, tooth, right knee, and right foot when a board gave way on a deck he was repairing for the employer/carrier. The accident was accepted as compensable, and multiple specialists were authorized to treat his physical injuries, including an ear, nose, and throat physician, dentist, orthopedist, and plastic surgeon. The claimant later sought psychiatric treatment and attended an independent medical examination (IME) with a psychiatrist. The IME diagnosed adjustment disorder with mixed anxiety and depressed mood, opining that the condition was caused by “the actual appearance of the scar” resulting from the industrial accident. The IME recommended continued medication, including an antidepressant, as well as follow-up care with a psychiatrist and psychologist. Critically, however, the IME did not offer an opinion regarding the medical necessity of this treatment. The claimant then filed a petition for benefits attaching the IME report and requesting authorization of psychiatric care. The employer/carrier responded by authorizing a psychiatrist, whom the claimant did, in fact, see. However, the employer/carrier neither denied the claim nor issued written notice invoking the 120-day pay-and-investigate provision. The authorized psychiatrist subsequently opined that the claimant’s psychiatric condition was unrelated to the industrial accident and instead attributable to prior employment as a law enforcement officer and volunteer firefighter. The psychiatrist further concluded that the work accident was not the major contributing cause of the condition. Although the employer/carrier stipulated to the authorization of the psychiatrist, it ultimately denied the claimant’s entitlement to psychiatric treatment. The JCC denied the requested benefit. The majority opinion affirmed on the narrow ground that medical necessity had not been established. Judge K. Thomas’s concurrence, however, expands on the legal framework. Under Florida law, an employer/carrier presented with a claim must “pay, pay and investigate, or deny.” To avail itself of the 120-day pay-and-investigate protection, the employer/carrier must affirmatively and explicitly invoke that option, typically through a written 120-day letter. The statutory investigative period does not arise automatically upon the provision of care. Furthermore, an attempt to characterize authorization as a “one-time evaluation” does not avoid waiver, as even a single evaluation may constitute the provision of a compensable benefit. By authorizing psychiatric care without invoking the 120-day provision, the employer/carrier in Koren effectively accepted compensability of the claimant’s PTSD condition. Nonetheless, it retained the ability to contest entitlement to ongoing treatment. While the employer/carrier failed to demonstrate a break in the causal chain, the claimant still bore the burden of proving that the requested treatment was medically necessary. Because the JCC found that the claimant failed to meet this burden, and the claimant did not challenge that finding either below or on appeal, the denial of psychiatric benefits was ultimately affirmed.

Thought Leadership

Appellate Division Affirmed Workers’ Compensation Order Striking Defenses and Ordering Treatment

Kneezel v. Lambertville House, No. A-2729-24 (June 1, 2026) In Kneezel v. Lambertville House, Lambertville House appealed from a workers’ compensation order to strike its defenses and directing it to authorize knee replacement surgery. By way of background, the petitioner worked as a property manager for Lambertville and injured his back and knee in December 2019. A workers’ compensation claim was filed and the petitioner treated at Rothman Institute. He underwent four injections to his low back and was recommended for surgery. The day before, Lambertville canceled and set up a second opinion exam with Dr. Lawrence Barr. The petitioner filed a motion for medical and temporary benefits (MMT), which was ultimately granted by the workers’ compensation judge. As such, he received authorized treatment for his back. The petitioner was then referred for his left knee pain and treatment was provided by Lambertville. He was recommended for a knee replacement, but the petitioner declined at that time. Approximately two years later, he sought additional treatment, which was denied. After obtaining a report from Dr. Dhimant Balar, the petitioner filed another MMT. In response, Lambertville submitted Dr. Zachwieja’s report and surveillance reports. Dr. Balar opined the left knee injury was related to the work accident, whereas Dr. Zachwieja believed it was due to his advanced degeneration as there was no evidence of acute trauma. A hearing on the MMT began in November 2024, with the petitioner testifying his knee pain never went away and he had a lot of trouble walking, especially for more than five to ten minutes. The surveillance investigators were scheduled to testify after, but had to be rescheduled a couple of times. During a conference in early February 2025, prior to when the investigators were to testify, it was discovered that Lambertville did not provide discovery to the petitioner, including the investigators’ information and surveillance footage. The petitioner moved to strike Lambertville’s defenses and sought an order to authorize the left knee treatment. Petitioner’s counsel pointed to Lambertville’s unreasonable delay in providing the necessary information and Lambertville did not file an opposition. In March 2025, the investigators’ testimonies were set for mid-March. On March 14, 2025, petitioner’s counsel advised she was still waiting for discovery and the judge directed Lambertville’s counsel to provide any missing information by March 17, 2025. Lambertville provided video clips after the petitioner had testified so the judge indicated that if everything was not provided to petitioner’s counsel by the end of March 19, 2025, the judge would sign the order granting the MMT. The next day, the judge entered the order striking Lambertville’s defenses and ordering left knee treatment. Lambertville moved for reconsideration of stay of the order pending appeal. Following oral arguments, the judge denied Lambertville’s motion, citing N.J.A.C. 12:235-3.11 (a)(4)(i) that Lambertville was required to provide surveillance after the petitioner’s testimony and that it had failed to do so even after he testified in November 2024. The judge also noted the investigators’ testimonies were rescheduled multiple times and Lambertville had more than enough time to provide the requested information and failed to do so. The judge also noted Lambertville failed to file a response to the petitioner’s motion to strike. In addition, the judge pointed to the petitioner’s testimony, finding him to be credible and observing him to have to stand and move multiple times during testimony. Lambertville appealed, arguing its due process rights were violated as there was no opportunity to be heard and the order was procedurally and factually defective. However, the Appellate Division disagreed, noting Lambertville had sufficient notice and many opportunities to be heard. It was noted Lambertville’s failure to comply with the judge’s requests led to the order. As for the motion to strike, the Appellate Division indicated Lambertville failed to oppose the motion, which provided the judge with the ability to decide without a hearing for an uncontested motion. Ultimately, the Appellate Division found no abuse of discretion and affirmed the judge’s rulings and order.

Result

No-Cause Jury Verdict Secured in Wrongful Death Trial

We successfully obtained a no-cause jury verdict in a 13-day wrongful death trial. The decedent, a 59-year-old man, was admitted to the emergency room on February 15, 2019, with complaints of abdominal pain, decreased appetite, and constipation, despite the use of laxatives. The patient did not complain of any nausea, vomiting, or diarrhea. He had a significant medical history including diabetes, hypertension, prior coronary artery stenting, morbid obesity (with past gastric bypass surgery), longstanding ventral hernia, and back pain. A CT scan revealed multiple hernias and a potential closed-loop bowel obstruction, leading to a surgery consultation. Our client, an emergency general surgeon, interpreted that the patient did not have a closed loop or any significant obstruction and recommended non-surgical management. The patient was approved to have clear liquids, and had a vomiting incident shortly after, but our client was not notified. The patient was returned to NPO status, and after improving overnight, he was returned to “clears” and additional medical and renal consults were ordered. Our client did not receive any communications from the residents/nurses of any changes in the patient’s condition. On February 18, 2019, two rapid responses were called due to increased heart rate and vomiting. It is believed that the vomiting resulted in aspiration, causing sepsis, ultimately leading to the patient’s death. During the trial, the plaintiff’s sole medical expert highlighted imaging on the wrong hernia, which called into question all of his opinions in the case. We made key objections related to the expert testimony, limiting what the allegations were, and preventing new allegations from being made. After approximately two and a half hours of deliberating, the jury returned a no-cause verdict. 

Thought Leadership

Mitigating Long-Tail Liability: Delaware Court Reaffirms Five-Year Workers’ Compensation Deadline

Williamson v. Donald F. Deaven, Inc., No. N25A-07-004 FWW, 2026 LX 252526 (Del. Super. Ct. June 2, 2026) Claimant was involved in a compensable industrial work accident on May 12, 1995, for a low back injury.  Following this, he received compensation for temporary total disability benefits from July 1996 to September 1996 and for sustaining a permanent impairment in 1997 and 1998.  For the next 23 years, the claimant continued treatment and paid his own medical bills without submitting them to the employer’s insurer.  In November 2021, the claimant filed a petition seeking payment for medical expenses, including prospective surgery and a resulting period of total disability.  The employer moved to dismiss the petition, arguing it was barred by Delaware’s five-year statute of limitations (19 Del. C. § 2361(b)). Pursuant to 18 Del. C. § 3914, insurers must provide prompt written notice of the applicable statute of limitations to invoke the five-year deadline.  Due to the age of the case, neither party had a comprehensive file of the claim and the Board had archived its file of the matter.  The carrier’s computer system retained only bare information indicating that payments occurred and agreements and receipts were filed with the Board in 1997. While the claimant argued that the employer could not prove it provided the mandatory statutory notice, the Hearing Officer recovered the archived file, which contained two “Receipts for Compensation Paid” signed by the claimant.  The receipts explicitly contained the required five-year limitation language, which the claimant testified to signing at the hearing.  The claimant also attempted to introduce evidence of payments he claimed the employer made, which would have extended the statute of limitations.  As a preliminary matter, the hearing officer excluded the testimony about the payments because the claimant did not produce them to the employer.  The Board found in favor of the employer and dismissed the claimant’s petition as time-barred. The claimant appealed the Board’s decision, arguing that he never received adequate notice of the statute of limitations and that the hearing officer’s evidentiary ruling was an abuse of discretion. The Court held that the archived, signed receipts constituted substantial evidence that the insurer fulfilled its statutory notice requirements.  Therefore,  the claimant’s petition was time-barred under the statute of limitations provisions of 19 Del. C. § 2361(b).  Furthermore, the Court reinforced strict procedural compliance: it rejected the claimant’s attempts to introduce evidence of payment on appeal, ruling the argument was waived for failure to preserve it while the matter was still before the Board. This recent ruling by the Court underscores the importance and necessity of robust data preservation and precise compliance with notice requirements.  For risk managers, employers, and insurers, the decision highlights how tight administrative execution protects against catastrophic long-tail liability.