Periventricular Leukomalacia (PVL) Lawyers in New York

New York PVL birth injury claims generally must be filed before the child's 10th birthday under CPLR §214-a and CPLR §208. Every settlement requires judicial approval at an infant compromise hearing under CPLR §1207 and §1208, and attorney fees follow the sliding scale in Judiciary Law §474-a. According to a 2017 peer-reviewed systematic review and meta-analysis in Medicine (PMC5607162) of 15 studies and 12,851 participants, periventricular leukomalacia (PVL) is the most common form of cerebral white matter injury in preterm infants, and the cited reviews report cerebral palsy in a wide range of 60% to 100% of survivors (the wide range reflects heterogeneous PVL severity criteria across the underlying studies) — making PVL one of the most consequential preventable preterm brain injuries in pediatric medicine. Porter Law Group represents New York families whose preterm infants suffered preventable PVL through inadequate prenatal monitoring, failure to prevent preterm birth where possible, failure to administer recommended neuroprotective interventions, or inadequate NICU care.

Why Choose Porter Law Group for PVL Cases in New York?

PVL cases turn on a complex chain of preventable failures: were the maternal preterm birth risk factors recognized; was preeclampsia or chorioamnionitis identified and managed; were antenatal corticosteroids administered when indicated; was magnesium sulfate offered for neuroprotection in eligible patients; was the preterm infant transferred to an appropriate level of neonatal care; were AAP-recommended cranial ultrasound screenings performed on the recommended schedule; and was the resulting cerebral palsy recognized and addressed early. Each of these is documented. Porter Law Group has recovered more than $500 million for seriously injured clients since 2009, including multiple pediatric recoveries exceeding $8 million for children with permanent birth-related disabilities including cerebral palsy.

Led by Harvard-educated attorney Michael S. Porter, a former U.S. Army JAG Corps Captain with over 20 years of trial experience, the firm retains maternal-fetal medicine specialists, neonatologists, pediatric neurologists, neuroradiologists, and life care planners to document the mechanism of injury and the lifetime cost of care. Seven of eight partner-level attorneys are recognized by Super Lawyers, a distinction earned by fewer than 5% of New York attorneys.

"PVL cases are won by reconstructing the prevention chain. Was the mother properly evaluated for preterm birth risk? Were corticosteroids and magnesium sulfate offered when indicated? Was the preterm infant cared for at the right level NICU? Were the cranial ultrasound screenings performed on schedule? When any of those links breaks and the result is white matter injury and spastic diplegia, the chart usually shows where the standard of care was missed."

— Michael S. Porter, J.D., Porter Law Group

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What Is Periventricular Leukomalacia?

Periventricular leukomalacia (PVL) is a form of brain injury — specifically, the death and softening (malacia) of white matter tissue in the periventricular region of the brain, near the fluid-filled lateral ventricles. The injury occurs almost exclusively in preterm infants, particularly those born before 32 weeks gestational age, because the periventricular white matter at that stage of development is uniquely vulnerable. Per peer-reviewed pediatric neurology literature, the periventricular white matter receives only approximately 25% of the cerebral blood flow that the cortical gray matter receives — making it especially susceptible to hypoxic-ischemic injury when blood pressure drops or oxygen delivery is compromised.

Per Volpe's neuropathological classification (2017), cited in peer-reviewed PMC review (PMC5745826), PVL has three pathological forms graded by lesion size and visibility:

Modern advances in NICU care have reduced the incidence of severe cystic PVL, but the more subtle non-cystic and diffuse forms remain common in very preterm survivors. Per peer-reviewed Pediatric Research (2020) and the American Academy of Pediatrics' recommendations on routine neuroimaging of the preterm brain, white matter injury is now recognized as the most frequent form of preterm brain injury overall.

The clinical consequence spastic diplegia (cerebral palsy primarily affecting the legs) — is the signature outcome. PVL is the leading cause of cerebral palsy in preterm infants per multiple peer-reviewed sources, including the Child Neurology Foundation summary and the 2017 systematic review in Medicine (PMC5607162) reporting cerebral palsy in 60% to 100% of PVL survivors.

What Causes PVL and Who Is at Risk?

PVL is caused by injury to oligodendrocytes — the white matter cells that produce myelin — in the periventricular region during the vulnerable preterm period. The recognized causes and risk factors are:

Prematurity itself. The single largest risk factor. Per peer-reviewed pediatric literature, the risk of PVL is highest in infants born before 32 weeks gestational age, and the younger the gestational age at birth, the greater the risk.

Hypoxic-ischemic events. Per a 2017 peer-reviewed systematic review and meta-analysis (n=12,851 across 15 studies, PMC5607162), the following hypoxic-ischemic-related risk factors are independently associated with elevated PVL risk:

(Note: these are pooled odds ratios from a meta-analysis with wide confidence intervals; the underlying studies were heterogeneous in design and population disclosed per v3 single-center cohort framing principle.)

Intrauterine infection and chorioamnionitis. Maternal infection during pregnancy, particularly chorioamnionitis (infection of the membranes and amniotic fluid) is a major recognized risk factor for PVL. The mechanism involves inflammatory cytokines crossing the placenta and damaging the developing white matter, sometimes independent of any oxygen-deprivation event.

Premature rupture of membranes (PROM). Per peer-reviewed pediatric sources including Cedars-Sinai, early rupture of membranes is associated with both the trigger for preterm delivery and the increased risk of intrauterine infection, both of which independently elevate PVL risk.

Intraventricular hemorrhage (IVH). Per MedlinePlus, preterm infants who experience IVH are at substantially increased risk of subsequently developing PVL.

Postnatal hemodynamic instability. Hypotension, bradycardia, and significant fluctuations in blood pressure during NICU care all contribute to the watershed-territory injury pattern characteristic of PVL.

Twin-to-twin transfusion syndrome and other twin-related complications. Twin gestations face elevated risk of preterm delivery and of asymmetric blood flow patterns that can produce PVL in one or both twins.

When Is PVL Considered Medical Malpractice in New York?

PVL itself, the brain injury is rarely caused directly by an obstetric or neonatal error in the way that, for example, shoulder dystocia injuries or vacuum extraction injuries can be. Most PVL is the consequence of preterm birth, intrauterine infection, or hemodynamic instability. The malpractice analysis turns on whether the team prevented preterm birth where possible, mitigated PVL risk where preterm birth was inevitable, and recognized and addressed the resulting injury promptly.

Six recurring failure patterns establish liability:

Failure 1 — Failure to identify and manage preterm birth risk factors. Per ACOG Practice Bulletin No. 234: Prediction and Prevention of Spontaneous Preterm Birth (August 2021, Obstetrics & Gynecology 138:e65-e90) — endorsed by the Society for Maternal-Fetal Medicine patients with prior spontaneous preterm birth, short cervix on transvaginal ultrasound, or other recognized risk factors warrant individualized risk assessment and may benefit from interventions including vaginal progesterone in selected cases and cervical cerclage in selected cases with prior spontaneous preterm birth and cervical length less than 25 mm. Failure to identify these risk factors or to offer the recommended interventions when followed by preterm birth and PVL is a recognized basis for malpractice.

Failure 2 — Failure to administer antenatal corticosteroids. Per ACOG Committee Opinion No. 713: Antenatal Corticosteroid Therapy for Fetal Maturation (August 2017, Obstetrics & Gynecology 130:e102-e109; subject to interim updates), a single course of corticosteroids is recommended for pregnant women between 24 0/7 weeks and 33 6/7 weeks gestational age who are at risk of preterm delivery within 7 days, including those with ruptured membranes and multiple gestations. The intervention reduces neonatal mortality, respiratory distress syndrome, and intraventricular hemorrhage all of which are linked to PVL risk. Failure to administer corticosteroids when indicated is a recognized basis for malpractice when the resulting preterm infant develops PVL.

Failure 3 — Failure to administer magnesium sulfate for fetal neuroprotection. Per ACOG Committee Opinion No. 455: Magnesium Sulfate Before Anticipated Preterm Birth for Neuroprotection (March 2010, Obstetrics & Gynecology 115:669-671), the available evidence suggests that magnesium sulfate given before anticipated early preterm birth reduces the risk of cerebral palsy in surviving infants. Physicians electing to use magnesium sulfate for fetal neuroprotection should develop specific guidelines regarding inclusion criteria, treatment regimens, concurrent tocolysis, and monitoring in accordance with one of the larger trials. Multiple peer-reviewed randomized controlled trials and meta-analyses have shown magnesium sulfate reduces cerebral palsy risk in preterm infants. Failure to offer or administer magnesium sulfate when indicated is a recognized basis for malpractice when the resulting preterm infant develops PVL and cerebral palsy.

Failure 4 — Failure to recognize and treat chorioamnionitis or other maternal infection. Per ACOG Committee Opinion No. 712: Intrapartum Management of Intraamniotic Infection (August 2017, Obstetrics & Gynecology 130:e95-e101) — note that intraamniotic infection is the more current term for what was historically called chorioamnionitis — recognition of intrapartum intraamniotic infection and implementation of treatment recommendations are essential steps that effectively can minimize morbidity and mortality for women and newborns. Empiric antibiotic treatment is indicated; ACOG specifically notes that intraamniotic infection alone is rarely, if ever, an indication for cesarean delivery. Failure to recognize maternal infection signs (fever, fetal tachycardia, elevated maternal white blood cell count, foul-smelling amniotic fluid) and to treat aggressively is a recognized basis for malpractice when the resulting preterm infant develops PVL through inflammatory mechanism.

Failure 5 — Inadequate NICU care including hemodynamic instability and inappropriate level of care. Per the AAP 2012 Policy Statement on Levels of Neonatal Care and the AAP 2023 Standards for Levels of Neonatal Care: II, III, and IV, preterm infants <32 weeks GA or <1,500 g require Level III or IV NICU care. Failure to transfer to an appropriate-level facility and failure to maintain hemodynamic stability through appropriate fluid management, vasopressor support, and ventilation — are recognized bases for malpractice. See our Neonatal Injury practice for more on level-of-care failures.

Failure 6 — Failure to perform AAP-recommended cranial ultrasound screening. Per AAP recommendations summarized in the 2021 Journal of Pediatrics review of routine neuroimaging of the preterm brain, cranial ultrasound is the recommended screening modality for preterm brain injury including PVL. Multiple peer-reviewed sources confirm that serial cranial ultrasound, typically twice weekly in the first week and weekly thereafter for at-risk preterm infants is the standard of care, with MRI offered at term-equivalent age for high-risk infants. Failure to perform recommended screening when subsequent diagnosis of PVL is delayed and early intervention is lost is a recognized basis for malpractice on a delayed-diagnosis theory.

What Compensation Can You Recover for PVL in New York?

New York places no statutory cap on damages in medical malpractice or birth injury cases. PVL cases that result in permanent spastic diplegia or other forms of cerebral palsy, cognitive impairment, sensory loss, or developmental disability are among the largest pediatric malpractice recoveries because the lifetime cost of care is substantial.

Future medical and custodial care is the largest category in catastrophic cases. Children with PVL-induced cerebral palsy typically require lifelong physical, occupational, and speech therapy, mobility equipment (including power wheelchairs in severe cases), orthotic devices, surgical interventions (selective dorsal rhizotomy, baclofen pumps, orthopedic surgeries), assistive technology, and special education support. TheCDC estimates the lifetime cost of care for an individual with cerebral palsy at approximately $1 million in 2003 dollars, with medical care costs running roughly 10 times higher than for children without CP. Adjusted for current medical inflation, life care plans in catastrophic PVL cases routinely run to seven and eight figures.

Lost future earning capacity. A child with PVL-induced cerebral palsy and cognitive impairment can recover the full projected lifetime earnings of a comparable uninjured peer.

Pain and suffering damages are not capped in New York. Juries consider the permanence of the injury, the child's life expectancy, and the loss of normal childhood, adolescent, and adult experiences.

Wrongful death. Severe PVL with multi-organ complications can result in neonatal or infant death; parents may pursue a wrongful death claim under EPTL §5-4.1 within two years of the death.

Parents' derivative claim. Parents can recover medical expenses they paid on the child's behalf and damages for loss of the child's services — but under their own 2.5-year CPLR §214-a statute, which is not tolled by the child's infancy.

What Settlements Has Porter Law Group Won in Birth Injury Cases?

Porter Law Group's published catastrophic case results include three pediatric birth injury settlements that demonstrate the firm's track record in complex delivery-related injury cases. View all case results →

$8,300,000 Settlement: A premature infant suffered profound permanent disabilities, including cerebral palsy, after physicians failed to properly manage the mother's pre-gestational diabetes — the kind of preterm fact pattern in which inadequate prenatal management can lead to white matter injury and lifelong disability. The structured settlement provides lifetime care and therapy funding.

$8,250,000 Settlement: An infant sustained permanent physical and cognitive disabilities after delayed response to fetal distress during labor. Proceeds covered lifetime medical and educational needs.

$8,120,000 Settlement: An infant suffered permanent delivery-related injuries caused by mismanaged labor and delivery. The recovery funded a life-care plan built with the family's physicians and therapists.

Every case is different. Past results do not guarantee future outcomes.

How Long Do I Have to File a PVL Claim in New York?

PVL claims are medical malpractice cases, so the deadline is shorter than a general child injury claim and is subject to a hard 10-year cap that ordinary personal injury cases do not face.

PVL cases pose a particular timing risk because the diagnosis is often confirmed later — during developmental follow-up when spastic diplegia or cognitive sequelae become apparent. Public-hospital families whose preterm infant is eventually re-diagnosed with PVL-related cerebral palsy at age 12 to 18 months have almost certainly missed the 90-day Notice of Claim window and must seek leave to serve a late notice of claim under GML §50-e(5) — discretionary relief that is never guaranteed.

ACT NOW BEFORE YOUR PVL CLAIM DEADLINE EXPIRES →

What Should You Do If You Suspect a PVL Birth Injury?

1. Request the complete prenatal, labor-and-delivery, and NICU records. Under New York Public Health Law §18, you are entitled to your and your child's complete medical records within a reasonable time of a written request. Critical documents include all prenatal records (especially documentation of preterm birth risk factors, cervical length measurements, and any preterm labor evaluations), all maternal infection workups, the labor-and-delivery record (including documentation of antenatal corticosteroid and magnesium sulfate administration), the complete NICU record (daily flowsheets, hemodynamic data, all imaging), all cranial ultrasound reports, and brain MRI at term-equivalent age if performed.

2. Preserve all imaging. Cranial ultrasounds (serial), brain MRI, and any subsequent imaging are critical evidence. Request copies on disc and ensure indefinite preservation.

3. Document developmental milestones over time. Keep a dated log of every pediatric, neurology, developmental pediatrics, physical therapy, occupational therapy, and speech therapy visit. The trajectory of motor development, particularly leg strength and gait, is core evidence in PVL cases.

4. Verify whether antenatal corticosteroids and magnesium sulfate were administered. These are standard-of-care neuroprotective interventions for women at risk of preterm delivery before 32-34 weeks. The administration record (timing, dose, route) is core evidence in PVL malpractice cases.

5. Verify the NICU level of care. Per AAP 2012/2023 standards, very preterm infants <32 weeks GA or <1,500 g require Level III or IV NICU care. If your preterm infant was cared for at a lower-level facility, that mismatch is core evidence in level-of-care malpractice analysis.

6. Act immediately if your child was born at a public hospital. Births at NYC Health + Hospitals facilities, SUNY Upstate, SUNY Downstate, Stony Brook, or any county-run facility require a Notice of Claim within 90 days under GML §50-e. Missing this deadline can bar the claim entirely.

7. Contact a New York PVL birth injury attorney. Porter Law Group offers free consultations on a contingency-fee basis and handles every stage of the case, from record collection through expert review, litigation, infant compromise approval, and trial.

Was Your Baby Diagnosed with a PVL Birth Injury in New York?

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Where Can I Find PVL Birth Injury Lawyers Near You in New York?

Porter Law Group represents families in PVL and related birth injury malpractice cases throughout New York State, with a statewide practice reaching every county and jurisdiction. Our Syracuse headquarters serves Central and Upstate New York, while attorneys travel regularly to downstate courthouses for cases in the five boroughs, Westchester, and Long Island.

Serving Clients statewide, including  Maternal Medical Negligence Attorney in Syracuse, New York City, Manhattan, Buffalo, Rochester, Albany, Yonkers, White Plains, Utica, Binghamton, Long Island (Nassau and Suffolk Counties), Saratoga Springs, Ithaca.

Wherever you were injured in New York, call (833) PORTER-9 for a free consultation with an experienced maternal medical negligence attorney.

Frequently Asked Questions About PVL Birth Injury Cases in New York

What is the difference between PVL, HIE, and cerebral palsy?

These three conditions are related but distinct. Periventricular leukomalacia (PVL) is a specific type of white matter brain injury near the lateral ventricles, occurring almost exclusively in preterm infants — particularly those born before 32 weeks gestational age. Hypoxic-ischemic encephalopathy (HIE) is a different brain injury syndrome gray matter injury from oxygen and blood flow deprivation, occurring primarily in term infants. Cerebral palsy (CP) is a clinical outcome a non-progressive motor disorder caused by injury to the developing brain. PVL is the leading cause of cerebral palsy in preterm infants per multiple peer-reviewed sources, and the specific form it produces is typically spastic diplegia (CP primarily affecting the legs). HIE in term infants typically produces a different CP pattern (often spastic quadriparesis or dyskinetic CP).

How is PVL diagnosed?

PVL is diagnosed through neuroimaging, primarily cranial ultrasound (cUS), with MRI offered at term-equivalent age for confirmation in high-risk infants. Per American Academy of Pediatrics recommendations summarized in the 2021 Journal of Pediatrics review, cranial ultrasound is the standard-of-care screening modality for preterm brain injury including PVL. In NICU practice, cranial ultrasound is typically performed twice weekly during the first week and weekly thereafter for at-risk preterm infants per multiple peer-reviewed sources. Cystic PVL (lesions >5 mm) is reliably detected on cranial ultrasound. Non-cystic and diffuse forms, which are increasingly common as cystic PVL has decreased with improved NICU care, often require MRI for full characterization. Failure to perform recommended serial screening when an infant has risk factors is a recognized basis for malpractice on a delayed-diagnosis theory.

Could my preterm infant's PVL have been prevented?

Possibly. While preterm birth itself is sometimes unavoidable, several recognized interventions reduce PVL risk in patients identified as at risk of preterm delivery. Antenatal corticosteroids (typically betamethasone) administered to women between 24 and 34 weeks gestational age at risk of preterm delivery within 7 days reduce neonatal mortality, respiratory distress syndrome, and intraventricular hemorrhage, all of which are linked to PVL risk. Magnesium sulfate for fetal neuroprotection, administered to women at imminent risk of preterm delivery before 32 weeks gestational age, has been shown in multiple peer-reviewed randomized controlled trials and meta-analyses to reduce cerebral palsy risk in preterm infants. Prompt recognition and treatment of chorioamnionitis reduces the inflammatory cascade that contributes to PVL. Appropriate-level NICU care maintains hemodynamic stability and avoids the watershed-territory injury characteristic of PVL. When any of these standard interventions was indicated and not administered, the resulting PVL may be actionable.

What is the prognosis for a baby with PVL?

The prognosis depends on the type and severity of PVL. Per the 2017 peer-reviewed systematic review and meta-analysis (PMC5607162), 60% to 100% of PVL survivors develop cerebral palsy. The most common form is spastic diplegia — cerebral palsy primarily affecting the legs, with relatively preserved arm and hand function. Children with cystic PVL (the most severe form) typically have more pronounced motor deficits and may also have epilepsy, visual impairment (including cortical visual impairment), and hearing loss. Children with non-cystic PVL may have milder motor symptoms but often have cognitive and learning disabilities. Per peer-reviewed pediatric sources, cognitive outcomes in PVL survivors range from normal intelligence with isolated learning challenges to significant intellectual disability. Early intervention, intensive physical and occupational therapy, and orthopedic management can substantially improve functional outcomes but cannot reverse the underlying brain injury.

How long do I have to file a PVL lawsuit in New York?

PVL claims are medical malpractice actions under CPLR §214-a, which imposes a 2.5-year statute of limitations. CPLR §208 tolls the deadline during the child's minority but caps the toll at 10 years from the malpractice meaning most PVL cases must be filed before the child's 10th birthday. Deliveries at public hospitals (NYC Health + Hospitals, SUNY Upstate, SUNY Downstate) require a Notice of Claim within 90 days of the injury under General Municipal Law §50-e, and the infancy toll does not extend the 90-day deadline. Because PVL is often diagnosed only when developmental sequelae become apparent at 12 to 18 months, public-hospital families face a particular timing risk and may need to move for leave to serve a late notice of claim under GML §50-e(5).

How much are PVL settlements worth in New York?

PVL settlements vary based on the severity and permanence of the resulting injury. Most PVL cases involve permanent cerebral palsy (typically spastic diplegia), and the lifetime cost of care typically runs to seven and eight figures. The CDC estimates the lifetime cost of care for an individual with cerebral palsy at approximately $1 million in 2003 dollars, with medical costs running roughly 10 times higher than for children without CP. Adjusted for current medical inflation and the multiple sensory, cognitive, and orthopedic comorbidities typical of PVL, life care plans in catastrophic cases routinely project tens of millions of dollars across the child's lifetime. New York places no statutory cap on damages in medical malpractice cases. Every settlement of a minor's claim must be approved by a judge at an infant compromise hearing under CPLR §1207, and attorney fees follow the sliding scale in Judiciary Law §474-a: 30% of the first $250,000, 25% of the next $250,000, 20% of the next $500,000, 15% of the next $250,000, and 10% of any amount over $1,250,000.

What are the AAP recommendations for cranial ultrasound screening in preterm infants?

Per AAP recommendations summarized in the 2021 Journal of Pediatrics review of routine neuroimaging of the preterm brain, cranial ultrasound (cUS) is the recommended screening modality for preterm brain injury — including periventricular leukomalacia (PVL) and germinal matrix-intraventricular hemorrhage (GMH-IVH). The AAP does not recommend routine MRI for screening, but offers MRI to high-risk infants at term-equivalent age (TEA) after a conversation with the family. In NICU practice, cranial ultrasound is typically performed serially during the preterm hospitalization — twice weekly during the first week and weekly thereafter for at-risk preterm infants per peer-reviewed sources. Failure to perform AAP-recommended serial screening when subsequent diagnosis of PVL is delayed and early intervention is lost is a recognized basis for malpractice. The screening trail is documented and can be reconstructed in litigation.

Was magnesium sulfate offered to my mother during preterm labor?

If your mother was at imminent risk of preterm delivery before 32 weeks gestational age, magnesium sulfate should have been offered for fetal neuroprotection per ACOG Committee Opinion No. 455 (March 2010, reaffirmed) and the 2020 ACOG/SMFM Consult Series. Magnesium sulfate has been shown in multiple peer-reviewed randomized controlled trials and meta-analyses to reduce cerebral palsy risk in preterm infants — with the protective effect specifically attributed to neuroprotection of the developing fetal brain rather than to delaying preterm delivery itself. Review your mother's labor-and-delivery record for documentation of magnesium sulfate administration (timing, dose, route). If magnesium sulfate was indicated but not administered or offered, that omission is a recognized basis for malpractice when the resulting preterm infant develops PVL and cerebral palsy. The relevant evidence is in the medication administration record, the consent discussions documented in the chart, and the maternal-fetal medicine consultation note (if any).

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Michael S. Porter, J.D.

Michael S. Porter is the founder and managing partner of Porter Law Group, representing New York families in periventricular leukomalacia, birth injury, medical malpractice, and catastrophic injury cases. A graduate of Harvard University (B.A., 1994) and Syracuse University College of Law (J.D., 1997), Porter served four years as a Captain in the U.S. Army Judge Advocate General's Corps. Selected to Super Lawyers for 14 consecutive years (2012–2025), he holds a 10.0 Superb rating on Avvo and a Distinguished rating from Martindale-Hubbell.

Bar Admissions: New York State Bar | U.S. District Court, Northern and Western Districts of New York

Memberships: New York State Bar Association, Onondaga County Bar Association, New York State Academy of Trial Lawyers, Multi-Million Dollar Advocates Forum

Contact Porter Law Group Today

If your preterm infant suffered PVL in New York due to medical negligence, critical deadlines may run faster than you expect: public-hospital cases require a Notice of Claim within 90 days, parents' derivative claims are not tolled by the child's infancy, and the 10-year cap under CPLR §208 closes most birth injury windows before a child's 10th birthday.

Contact Porter Law Group today at (833) PORTER-9 for a free, no-obligation consultation. We operate on a contingency-fee basis under Judiciary Law §474-a, so you pay nothing unless you win.

Phone: +1 833-767-8379

Email: info@porterlawteam.com

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