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4. On September 28, 1995, Minor, who was a passenger
in a vehicle driven by her mother, Respondent, was injured when
Respondent's vehicle skidded into the rear of a vehicle being
driven by Shane T. Toombs on Gettysburg Road in Lower Allen
Township, Cumberland County, Pennsylvania. ~ Police Accident
Report, a copy of which is attached hereto, made a part hereof
and marked as Exhibit "A".
5. As a result of the aforementioned motor vehicle
accident, Minor sustained a strain/sprain of her cervical spine.
6. Minor was treated by Richard J. Boal, M.D., an
orthopedic surgeon, on November 6, 1995; December 4, 1995;
December 15, 1995; and December 11, 1996. Minor also received
physical therapy from December 26, 1995, to February 9, 1995, at
Healthsouth Rehab Hospital of Mechanicsburg. ~ medical records
from Dr. Boal and bills from Healthsouth, copies of which are
attached hereto, made a part hereof and marked as Exhibit "B".
7. On December 11, 1996, Minor was last seen by Dr.
Boal. At that time, her pain was limited and did not occur every
day. Also, an MRI of the cervical spine was normal. Lastly, Dr.
Boal concluded that Minor "will just slowly improve over time and
should not have any long term problems with respect to her neck."
8. At the time of the accident, Respondent's vehicle
was covered by an automobile insurance policy issued by State
Farm Mutual Automobile Insurance Company ("state Farm").
9. Minor was born on April 22, 1980, and is currently
17 years old. At the time of the accident, Minor was under the
care, custody and control of Petitioner.
10. Petitioner has made a careful and diligent inquiry
in investigating and ascertaining the facts surrounding the
accident, the responsibility therefor, and the nature and extent
of Minor's injuries.
11. state Farm, as Respondent's insurer, has agreed to
compromise Minor's claim for $5,500.00.
12. The aforementioned settlement has been explained
at length to Petitioner and he has indicated that he understands
same and has voluntarily agreed to enter into the settlement.
11. This settlement is in no way to be construed as an
admission of liability on the part of Respondent or state Farm,
or any other persons or entities.
12. Petitioner believes that the settlement is fair
and in the best interest of Minor.
13. state Farm and Respondent hereby request
Petitioner to give them a General Release in the form that is
attached hereto, made a part hereof and marked as Exhibit "C".
14. Petitioner fully intends to invest the proceeds of
this settlement as provided by Chapter 73 of the Decedents,
Estates and Fiduciaries Code, and to make such distribution of
the income received by them in accordance with 28 Pa. Cons. stat.
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Exhibit A
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COMMONWEALTH OF PENNSYLVANIA
POLICE ACCIDENT REPORT
REPORTABLE C!J NON. REPORTABLE 0
HARfU88URG
OCT 1 2 1995
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"'PATIENT NAME
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MARILVN MVERS
928 IbTH ST
NEW CUMBERLAND PA
17070
DESCRIPTIO" OF ttOSPlTAl SERVICE
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PHY5j~~L THERAPY
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CERl/lCAL PILLOIl
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HARRISBURG
FED 0 9 el6
PATIENT NUMBER
5'19645
MEDICAL RECORDS NO,
EI91602021
DATE OF BIRTH
04/22/80 1911002021
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OAL. RICHARD
ST~TE F~RI1
STFAAO 38-7142-799
GUARDIA I~SURANCE
GiJ~RDO 295709
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1911002021
20421091064
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ADDmONAL PAnEHT BIUJHO.....Y BI NEClSIARY FOR 'My OWlGU
HOT POSTtD WHEN TM5 BIlL WAS PRlJIARED. OR ., INSUAAHCE
C.lAAIEAS DO NOT PAY ANY PART ~ 1HI ~ SHOWN. , .
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YOUR PHYSICIAN WILL BilL YOU SEPARATELY FOR PROFfSSIOUAl SERVICES f1(flnfREO TO YOU
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INSURANCE
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Exhibit C
FULL AND FINAL RELEASE
FOR AND IN CONSIDERATION of the sum of Five Thousand
Five Hundred Dollars ($5J500.00) paid to the undersignedJ Robert
Myers, as parent and natural guardian of Mindy Myers, a Minor,
and other good and valuable consideration the receipt and
sufficiency of which is hereby acknowledged, the undersigned
,
agrees fully to release, discharge and hold harmless and
indemnify Marilyn Myers, State Farm Mutual Automobile Insurance
CompanYJ and all other personsJ associations and corporations
whether or not named herein, their heirsJ executors,
administratorsJ successors, assigns and insurers, and their
respective agentsJ attorneys, servants and employees, from any or
all causes of action, claims and demands of whatsoever kind on
account of all knownJ and unknown injuries, losses and damages
allegedly sustained by the Minor on September 28, 1995J and,
specifically from any claims or joindersJ for sole liability,
contribution, indemnity or otherwise as a result ofJ arising
from, or in any way connected with injuries sustained by the
MinorJ on account of which a Legal Action was instituted by the
undersigned in the Court of Common Pleas for Cumberland CountYJ
Pennsylvania, at Docket No.
, and the defense and
handling thereof from the inception of the claim until the date
of this Full and Final Release. The undersigned understands and
agrees that the acceptance of said sum is not an admission of
liability by any party named herein.
It is expressly understood and agreed that this Release
and settlement is intended to cover and does cover not only all
now known injuries, losses and damagesJ but any further injuriesJ
losses and damages which arise from or are related to the
occurrences set forth in the Legal Action noted above and the
handling and defense thereof.
It is further understood and agreed that this is the
complete Release agreement, and that there are no written or oral
understandings or agreementsJ directly or indirectly connected
with this Release and settlement that are not incorporated
herein. This agreement shall be binding upon and inure to the
successorsJ assigns, heirsJ executorsJ administrators and legal
representatives of the respective parties hereto.
The undersigned hereby declares that they are of legal
age; that the terms of this settlement have been completely read;
that they have discussed the terms of this settlement with legal
counsel of choice; and that said terms are fully understood and
voluntarily accepted for this purpose of making a full and final
compromise, adjustment and settlement of any and all claims on
account of the injuries and damages above-mentioned, and for the
express purpose of precluding forever any further or additional
suitsJ administrative proceedings or any other claims for relief
arising out of the aforesaid claim.
Page 2 of J
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