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HomeMy WebLinkAbout02-5080 SAIDIS SHUFF, FLOWER & LINDSAY 26W. High Streel Carlisle, PA In Re: STEP~L~NIE ZOOK, A minor, by and through Her parent and guardian, Barry Zook : IN THE COURT OF COMMON PLEAS : CUMBERL~2qD COUNTY, PENNSYLVkNIA PETITION TO PERMIT COMPROMISE OF MINOR'S CLAIM AND NOW, minor, Shuff, comes Petitioner, Barry Zook on behalf of the Stephanie Zook, by and through their attorneys, Saidis, Flower & Lindsay, and requests this Honorable Court to permit compromise of a minor's claim and in support thereof avers as follows: 1. Petitioner is Barry Zook, the father and guardian of Stephanie Zook, a minor. 2. The Petitioner resides at 313H Shady Lane, Enola, Cumberland County, Pennsylvania 17025. 3. Stephanie Zook, a minor, resides at 313H Shady Lane, Enola, Cumberland County, Pennsylvania, 17025 with her father, Barry Zook, Zook. 4. who has physical and legal custody of Stephanie The minor, Stephanie Zook, was born on June 15, 1988 and is currently 14 years of age. 5. On November 22, 1995, Stephanie Zook, while standing along the westbound berm of Route 944 in East Pennsboro Township, was struck by an automobile owned by George M. SAIDIS SHUFF, FLOWER & LINDSAY 26W. High Streel Carlisle, PA Vasiloff, per hour. 6. Jr. and driven between approximately 25 and 35 miles Upon being struck by Mr. Vasiloff's vehicle, Stephanie Zook was thrown in the air and landed on the pavement. 7. She was transported by Life Lion to Hershey Medical Center where she was diagnosed with a closed head injury and a fractured right orbital bone. 8. Stephanie Zook was admitted to Hershey Medical Center on November 22, 1995 and remained their until discharge on November 28, 1995. While at Hershey Medical Center she was treated by Dr. George W. Blankenship, and had her right orbital fracture surgically repaired by Dr. Shapiro on November 26, 1995. 9. Stephanie Zook was discharged from Hershey Medical Center on November 28, 1995 to a pediatric rehabilitation facility where she underwent rehabilitation until being discharged from the facility on November 30, 1995. 10. After her discharge from the pediatric rehabilitation facility, Stephanie Zook was followed by Dr. James McManaway, a doctor of pediatric ophthalmology at Hershey Medical Center. 2 SAIDIS SHUFF, FLOWER & LINDSAY 26 W. High Street Carlisle, PA 11. marked as Exhibit December 4, 1996, Attached hereto incorporated by reference herein and ~'A" is a copy of Dr. McManaway's report of stating that Stephanie's prognosis for recovery is excellent and that she should not have any long term ocular problems related to her injury of November 22, 1995. 12. Stephanie Zook appears to have fully recovered from the head injury and has not undergone treatment for that injury in several years. 13. Stephanie Zook's medical expenses were paid by Capital Blue Cross, an agent for Pennsylvania Blue Shield, and they are not asserting any subrogation interests in this claim. 14. Attached hereto incorporated herein by reference and marked as Exhibit KB" is a copy of a letter from Ray N. Myers of Capital Blue Cross dated June 15, 2001. 15. Petitioner is unaware of any outstanding medical bills for treatment of Stephanie Zook's injuries arising out of the accident on November 22, 1995. 16. At the time of the accident, Mr. George M. Vasiloff, Jr. was insured by State Farm Insurance Company for liability for personal injury and property damage. SAIDIS SHUFE FLOWER & LINDSAY 26 W. High Street Carlisle, PA requirements of Pa.R.C.P. further directions 23. George M. 239 and comply with such other and as your Honorable Court may require. State Farm Insurance Company, as the insurer for Vasiloff, Jr. has requested that the Petitioner execute a Release, a copy of which is attached hereto incorporated herein by reference and marked as Exhibit "D'. WHEREFORE, Petitioner respectfully requests that Your Honorable Court enter an Order approving the settlement of claim of Stephanie Zook for $15,000.00 payment of attorneys fees of $4,995.00 Flower & Lindsay out of that sum, and to approve the execution of a Release in favor of George Vasiloff, State Farm Insurance Company. the and to authorize the to Saidis, Shuff, Respectfully submitted, SAIDIS, S , FLOWER & LINDSAY /'Robert/C. Saidis, Esquire ~-Attorney I.D. # 21458 26 West High Street Carlisle, PA 17013 (717) 243-6222 Attorney for Petitioner Dated: /O//~/0 ~- Jr. and his insurer, PENNSTATE College of Medicine University Hospital. Children's Hospital The Milton S. Hershey Medical Center Department of Ophthalmology & The Pennsylvan Lions Vision and Research Center Scott D. Moore, Esquire 26 West High Street P.O. Box 560 Carlisle, PA 17013 Dear Atty. Moore: EXAMINATION REPORT December 4, 1996 RE: Stephanie M. Zook HMC#705607 RO. Box 850 Hershey, Pennsylvania 17033 Office: (717) 531-6053 Pt. Appts. (717) 531-6754 FAX: (717) 531-5475 I am dictating this letter regarding Stephanie Zook to you after receiving your letter with a written authorization for release of medical information. I will respond to your questions in the order that they are listed in your letter. I first examined Stephanie on 12/6/95. She was examined in the hospital by Dr. Blankenship (one of my associates) on 11/22/96. I examined Stephanie because of right orbital (eye socket) fractures that she suffered when she was struck by a car while crossing the street on 11/22/95. The orbital fractures were repaired by Dr. Shapiro on 11/26/95. My examination showed a small exophoria and right hyperphofia (tendency for the eyes to misalign which is controlled by the brain). The differential diagnosis for this included a pre-existing phoria, swelling of the right eye socket from the injury or subsequent fracture repair, or a subtle injury to the fight fourth cranial nerve. Fortunately, Stephanie had 20/20 visual acuity for each eye and no evidence of injury to either eye, although there was some mild subconjunctival hemorrhage of the fight eye and redness of the fight upper and lower eyelids. At this point, I recommended observation because the exo and fight hype.rphoria would like resolve spontaneously without treatment. Stephanie was then seen In follow-up on 2/8/96. Her exo and fight hyperphoria had resolved. She continued to have excellent visual acuity for each eye without glasses. Stephanie did have 1-2mm ptosis of the fight upper eyelid. At that point, ! felt that Stephanie was doing well and would not require any further ocular treatment. The ptosis of the fight upper eyelid was barely noticeable and I did not feel that it would require reconstructive surgery. Observation was recommended as described in the above paragraph. An Equal Opportunity Unive's y Oculoplastic and Orbital Surgery Stuart H. Goldberg. MD. Pediatric Ophthalmology and S rabtsraus James W McManaway, Ill. M.D, George W. Blankenship. M.D. Thomas W. Gardner, M.D. David A. Quillen, M.D Stephanie would have been unable to attend school between November 22 (the day of her injm-y) and November 30 (the day she was discharged from the hospital). It is reasonable that Stephanie would have been out of school for a few more days following her discharge from the hospital to mst. When I examined Stephan/e on December 6, there was no ocular reason to keep her out of school. Stephanie's prognosis for recovery is excellent. She has a barely noticeable ptosis (drooping) of the right upper eyelid, which I do not feel will require reconstructive surgery. Stephanie should not have any long term ocular problems related to her injury of November 22, 1995. ~,;incer~ly,.,, ~b The orbital fractures are clearly related to her automobile accident. The exophoria and fight hyperphoria may have been related to the accident, or the orbital fracture repair. The phofias have resolved completely at this time. Stephanie was seen by me on 12/6/95. The office charge was $165.00. Stephanie was seen by me in follow-up on 2/8/96. The office charge at that time Was $40.00. The charge for the hospital consult by Dr. Blankenship on 11/22/95 was $200.00. Please send a check in the amount of $50.00 payable to the Department of Ophthalmology to me at the address on the above letterhead. · Capital BlueCross Agent for Pennsylvania Blue Shield Independent Licensees of the Blue Cross and Blue Shield Association Harrisburg, PA 17177 (717) 541-7000 www.capbluecross.com Joseph L. Hitchings, Esq. 26 West High Street Carlisle, Pa. 17013 June 15, 2001 I.D.: 210521166 Patient: Stephanie Zook Date of Loss: 11-25-95 Dear Mr. Hitchings: This will serve to advise you that Capital Blue Cros does not have a subrogate interest in the above-referenced case. The group under which this patient is enrolled does not fall within ERISA guidelines. If you have any questions regarding this matter, please contact me at the number provided below. Very truly yours, Ray N. Myers Subrogation Other Party Liability (800)417-7839 (717)541-3727 Fax: (717)651-8399 CC: Jodi Johnson, Paralegal, CBC SAID/S, GUIDO SHUFF & MASLAND 26 W. High Sheet Carlisle, PA POWER OF ATTORNEY CONTINGENCY FEE AOREEMENT KNOW ALL MEN BY THESE PRESENTS that I, the undersigned: 1. Do hereby nominate, constitute and appoint SAIDIS, GUIDO, SHUFF & MASLAND, as my true and lawful attorneys in the matter of personal injury claims for any and all damages arising from an accident involving Stephanie Zook which occurred on or about November 22, 1995, against any person, firm corporation or other entity who or which may be legally responsible therefor, and I do hereby authorize said attorneys to bring suit or to settle and compromise the said claims. NO SETTLEMENT SHALL BE MADE WITHOUT MY PRIOR APPROVAL. 2. Agree that the compensation of said attorneys for services rendered in the investigation and prosecution of said claims shall be one-third (33 1/3%) of any sums recovered by way of settlement or verdict plus reimbursement of all costs expended by them incident to the investigation, institution, prosecution and trial, if any, of the case, The remainder of the balance of any sum recovered after deduction of said counsel fees and expenses shall be paid to Stephanie Zook or her parents and natural guardians Barry and Debra Zook to be held in trust until she reaches majority. SAIDIS~ GUIDO SHUFF & MASLAND 26 W. H~gh Street Cadisl~, PA 3. Understand(s) that should no sums be recovered by suit or settlement, said attorneys will have no claim against Stephanie Zook for any fee for services rendered. However, I acknowledge that I will be responsible to reimburse my said attorneys for all costs expended and expenses incurred by them, incident to the investigation, institution, prosecution and trial, if any, in this case. 4. Represent(s) that no other person has been retained to represent Stephanie Zook in connection with this matter. 5. Acknowledge(s) receipt of a copy of this Agreement. IN WITNESS WHEREOF, intending to be legally bound hereby, we have hereunto set our hands and seals. DATED: Barry Z~ok, as Parent and Natural Guardian of Stephanie Zook De~r-a~ook, as Parent and Natural Guardian of Stephanie Zook SAIDI~FF & MASLAND RELEASE For the Sole Consideration of ti Fi ee Tho and and 00/100~ - Dollars. the receipt and sufficiency whereof is hereby acknowledged, the undersigned hereby releases and forever discharges _George Vasiloff __hiS__ heirs, executors, administrators, agents and assigns and all other persons, firms or corporations liable or, who might be claimed to be liable, none of whom admit any liability to the undersigned but all expressly deny any liability, from any and all claims, demands, damages, actions, causes of action or suits of any kind or nature whatsoever, and particularly on account of all injuries, known and unknown, both to person and property, which have resulted or may in the future develop from an accident which occurred on or about the 22nd day of November ,(year) ~1995 at or near___Wertzville Road, Enola, Cumberland Count_, Pennsylvania This release expressly reserves all dghts of the parties released to pursue their legal remedies, if any, against the undersigned, their heirs, executors, agents and assigns. Undersigned hereby declares that the terms of this settlement have been completely read and are fully understood and voluntarily accepted for the purpose of making a full and final compromise adjustment and settlement of any and all claims, disputed or otherwise, on account of the injudes and damages above mentioned, and for the express purpose of precluding forever any further or additional claims arising out of the aforesaid accident. Undersigned hereby accepts draff or draffs as final payment of the consideration set forth above. Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or a statement of claim containing any materially false information or any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminaJ and civil penalties, conceals for the purpose of misleading, information concerning In Witness Whereof, have hereunto set hand(s) and seal(s) this day of .-. in presence of: , (year) - (Witness) (A~/dress) Signed X-- Signed X- 160-57 PA,3 Rev. 10-97 Pdnted in U.S.A. VERIFI__CATION I for Compromise understand that penalties of 18 Pa. C.S. § 4904, falsification to authorities. verify that the statements made in the foregoing Petition of Minor's Claim are true and correct. I false statements herein are made subject to the relating to unsworn DATED: Bar~Z~ok SAIDIS SHUFF, FLOWER & LINDSAY 26 W. High Street Carlisle, PA SAIDIS SHIJFF, FLOWER & LINDSAY 26 W. High Street Carlisle, PA In Re: STEPF~%NIE ZOOK, A minor, by and through Her parent and guardian, Barry Zook : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : No.: CERTIFICATE OF SERVICE ~%day n On this /~ of ~/~b~/~ , 2002, I, Adele Group, hereby certify that I served a true and correct copy of the foregoing PETITION TO PERMIT COMPROMISE OF MINOR'S CLAIM via United States Mail, postage prepaid, addressed as follows: James j. Ramsey Claims Specialist State Farm Insurance 115 Limekiln Road PO Box 257 New Cumberland PA 17070-0257 SAIDIS, SHUFF, FLOWER & LINDSAY Adele Group SAIDIS SHUFF, FLOWER & LINDSAY ATI*ORI~YS*AT*LAW 26 W. High Street Carlisle, PA in Re: STEPHANIE ZOOK, A minor, by and through Her parent and guardian, Barry Zook : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA AND NOW, this day of , 2002, upon consideration of the foregoing Petition, it is hereby Ordered that Petitioner be authorized to settle the claim of Stephanie Zook against George M. Vasiloff, Jr. and State Farm Insurance Company for the sum of $15,000.00 less attorneys fees of $4,995.00 and execute a Release in favor of George Vasiloff, Jr. and State Farm Insurance Company. The net proceeds of settlement shall be deposited in a bank account pursuant to the requirements of Pa.R.C.P. No. 2039(b) (2), with no withdrawal to be made therefrom until Stephanie Zook attains her majority, except as authorized by prior Order of Court. BY THE COURT: L, SAIDIS SHUFF, FLOWER & LINDSAY A~roRh~YS~ATq~W 26 W. High Street Carlisle, PA In Re: STEPHANIE ZOOK, A minor, by and through Her parent and guardian, Barry Zook · IN THE COURT OF COMMON PLEAS · CUMBERLAND COUNTY, PENNSYLVANIA · No.: 02-5080 Civil Term PROOF OF DEPOSIT TO THE PROTHONOTARY: Attached is proof of deposit made in the above-captioned case, on behalf of a minor. Said deposit was made on November 22, 2002, in the amount of $10,005.00. Bank America's Most Convenient Bank ® commercepc.com This is your receipt. Checks and othercollectionitemSagreement.are receivedDepositsfOr deposit subjeCtnot to the provisions of the Uniform Commercial Code or an y a pplicable may be available for immediate withdrawal 24-Hour Customer Service & Telephone Banking Telephone Banking 1-800-YES-2003 Customer Service 1-888-YES-0004 0082.1i 11/22/02 0004 ~IISC C~EDiT carlisle E;2B!O41ESD ~lu,0,35.UO BR-17-HB (Rev 3/00) COMMERCE BANK / HARRISBURG, N.A. Date: SAIDIS, SHUFF, FLOWER & LINDSAY Robert C,~aidis, Esquire Supreme Court I.D. # 21458 26 West High Street Carlisle, PA 17013 (717) 243-6222 Attomey for Petitioner In Re: STEPHANIE ZOOK, A minor, by and through Her parent and guardian, Barry Zook : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANia : No.: 02-5080 Civil Term CERTIFICATE OF SERVICE On this ~"~'~ day of November, 2002, I hereby certify that I served a true and correct copy of the foregoing Proof of Deposit, upon all parties of record via U.S. Mail, postage prepaid, addressed as follows: James J. Ramsey Claims Specialist State Farm Insurance 115 Limekiln Road P.O. Box 257 New Cumberland, PA 17070-0257 DATED: ////~/~ F~llis McCoy SAIDIS SHUFF, FLOWER & LINDSAY ATrORb~S.AT.LAW 26 W. High Street Carlisle, PA In Re: STEPHANIE ZOOK, A minor, by and through Her parent and guardian, Barry Zook · IN THE COURT OF COMMON PLEAS · CUMBERLAND COUNTY, PENNSYLVANIA · No.: 02-5080 Civil Term PRAECIPE TO SETTLE, DISCONTINUE AND END TO THE PROTHONOTARY: Please mark the above-captioned matter settled, discontinued and ended. Date: Respectfully submitted, SAIDIS, SHUFF, FLOWER & LINDSAY /..,/ ............. /~,~~ F~bert C. Saidis, Esquire Supreme Court I.D. # 21458 26 West High Street Carlisle, PA 17013 (717) 243-6222 Attorney for Petitioner In Re: STEPHANIE ZOOK, A minor, by and through Her parent and guardian, Barry Zook · IN THE COURT OF COMMON PLEAS · CUMBERLAND COUNTY, PENNSYLVANIA · No.: 02-5080 Civil Term CERTIFICATE OF SERVICE On this ~'~'~ day of November, 2002, I hereby certify that I served a true and correct copy of the foregoing Praecipe to Settle, Discontinue and End, upon all parties of record via U.S. Mail, postage prepaid, addressed as follows: James J. Ramsey Claims Specialist State Farm Insurance 115 Limekiln Road P.O. Box 257 New Cumberland, PA 17070-0257 DATED: Z '