HomeMy WebLinkAbout97-02766
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4. The minor's father is Robert W. Shields, Sr., whose last known address is Box 76,
Back Street, Plainfield, PA 17081. He has never had custody of the minor noris he
providing support to her currently.
5. lltis claim arises out of a motor vehicle accident which occurred on September 19,
1995 when Tabitha M. Shields was riding as a back-scat passenger in a vehicle
operated by Tina M. Vaughn, with the pennission of the vehicle's owner, Woodrow
Vaughn.
6. Tina M. Vaughn is currently twenty five years of age, having been born on July 22,
1971.
7. On September 19,1995, at approximately 8:15 p.m. the vehicle occupied by Tabitha
M. Shields was operating in an Easterly direction on State Route 174 in Penn
Township, Cumberland County, Pennsylvania, when the vehicle left the roadway and
struck a telephone pole, fence post, and mail box; rolled over and continued to travel
approximately 100 feet before coming to a rest on the South benn of the roadway
facing North.
8. Tabitha M. Shields was ejected from the rear window of the vehicle and suffered
serious and pernlBnent injuries as a result of the accident including, but not limited to,
forehead and facial lacerations and contusions; contusions on left foot and sprained
ankle; dental injuries including missing and cracked teeth; headaches. and other aches
and pains.
9. No claim has been previously filed on behalf of Tabitha M. Shields in any court of
law concerning the above collision.
10. TIle parties have agreed to settle and compromise the claims of Tabitha M. Shields for
an amount equal to the limits of liability of the automotive insurer of Woodrow and
Tina Vaughn, said amount being $15,000. A true and correct copy of the applicable
declaration sheet of the Vaughns' is attached hereto as Exhibit "A."
II. Petitioner has been advised that the available first party medical coverage maintained
through her own motor vehicle insurance company is near exhaustion and understands
from Tabitha's physicians that further medical treatment will be required subsequent
to the exhaustion of available benefits.
12. Petitioner and Tabitha M. Shields intend to pursue an underinsured claim against
Petitioner's own policy ofinsurance, but anticipate the need to make payment for
medical treatment prior to reaching agreement on that claim.
13. Therefore, Petitioner requests that this COllrt approve the settlement proposed herein
in order to provide a fund out of which medical and living expenses may be paid on
Tabitha Shield's behalf.
14. A copy of the release is attached hereto as Exhibit "B."
15. Counsel is of the opinion that said settlement is reasonable because of the impending
need for the funds, as well as the anticipated availability of under insured motorists
benefits to further compensate Tabitha for her pain and sutTering, as well as any
additional expenses and in light of Tabitha's age and need to provide for her own
infant son.
16. Counsel has incurred or will ineur the following expenses for which reimbursement is
sought out of the settlement funds:
TWIN CITY FIRE INSURANCE CQM?ANY
PERSQNAL AU1Q PQLICY
AMENDED DECLARATIO
PQLICY NUMBER 79 EZ 269739 H
NAMED
WOODROW W IIAUGHN
164 BiG SPRING TERRACE
NF.WIIILLE PA 17241
JEFFREY BOUDER
PRODUCER 1'1 S HIGH- S1
NEWIIILLE PA 17241
INSURED
PDlICYPEA'OD FRqM TO
tlOtI.llSTMDARDT,"E 0 .107.195 07.107/96
AMEND/.'EI.T
EFFECTIVE 06.11 '.1
THE COKPLETE POLICY COHSISTS Of THE DECLARATIONS PACE, PERSONAL AUTO POLICY
IUCD EIlIlORlilHEIlTS. ALSO lEE F~rH CAr f8N-I,
THE PftEHIUK STATED IN tHE DECLARATIOH IS THE INITIAL PREHIUK fOR THIS POLICY.
OM EACH RElCDIAL. CO"TlHllATlCl" OR IUlNIV~R:;UY Of THE EfFECTIVE DATE OF THIS
POLICY THE PREHIUK SHALL BE CottPUTE!') BY US IN AcconDANCE WITH OUR KAHUALS THEM
IN USE.
AHY AUTO OR TPAILER DESCRIBED BELOW IS PRIHCIPALLY CARACEO AT THE H~ED
INSURED' S IUlDRESS SIi;'~i ABOVE UHLESS OT'lEJUlISE STATED.
COVERAGES, eoVERACE IS PROIUDED WHERE PIIDlllltlS
A PREMIUH OR LIMITS AHOUNT IS SHOWlI. LI"I'S VEH f VEH 2 VEH 3 VEH ~ TOTAL
LIABILITY EACH PERSON $15.000 Ilf fff
BODILY I"JURY EACH ACCIOENT $30.000
L1"InD TORT
Pr.OPERTY DAHACE EACH ACCIDZKT
$5.000
1!J 19
23 23
Ita Ita
1t: '8
REJECTED
REJ!O:Cn:O
DAHACE TO YOUR AUTO.
OTHER THAM COLLISION
COLLISION
H FIRST PARTY BIKEFITS
tlEDICAI. l1IPFI!<:!': 1l~!!~f'1T
J U~I"SURED KOTCRISTS
" UHDERI"SURED MOTORISTS
ACTlIAL CASH VALUE
LESS 4500
LESS $5Da
$5.81)0 I.IMlt
D1DORSDUHTSI
alai A 155 AP 5500 A
11355Z AP 591 ACC90'i5
TOTAL ~ftDlIUKS qOI
SURCHARCES I"CLUDED In POLICV PREHIUK=
(SEE LEC~D OH FOLLOWIHC PACE)
fq'lS A S'ISK
'IOf
$0
A'..lTOS IUID TRAILERS.
. EH YR HA."IE ttlSDEL VEH ID IIIl1'11lER
f "FORD HUSTAN grD2YlqO'~S
TOTAL AD~ITIOHAL PR~IUM $f18.00
TOTAL AMOUNT $qOI.OO
RATI"C SURCHARCE
SVH ACE DT He CD DI 10 CLASS PTS ~ TER ATD IDI
O~ , N N 0%" fA 00 000 27 V~ 001
CR. Y PRI O~ .'IB, IIX
DRIUER I"FORHATIO",
r!O.HAHE
I WOODROW W VAUGHN
LICENSE HUPtBF.R
nun'ls
BIRTHIiAtI: SEX "'5 flO VEH'
O'l,D1'3O H S 1
'100110171
t1flro!lNlD'-'M COrY
I'ACE
f
1390011
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EXHIBIT "A"
....---
---..-.'""....
RELEASE AND SETTLEMENT OF CLAIM
560 AL 05148
FOR THE SOLE CONSIDERATION oL...Fifte8n.Thousand..and..00ll00.~~..M...M.M..U~U~.M~U
...............................................Dollars ($..... 15. OOO..OO~u....).
I/we.... ............SHIELDS ...TABITHA.............
residing at.... ....... ..1697. .\Ialnu 1;. .Bol;l;om .Rd ..ApI;.. 1.,.. Newvi lIe... .PA...17.241....................... .......... .............................. .....
do hereby release. acquit and forever discharge ...........\I00dc<lw..Vaughn..Jr.............................................................................
...\I00drow..Vaughn..Jr.. ..&..Tina..V.lUghnThe..Hart.ford..lnsurance..Group..and..their..respective..agents
from any and all actions. causes of action. claims and demands. damages. costs. loss of services. expenses and compensa.
tion on account of or in any way gro"ing out of any and all known and unknown personal injuries and property damage
resulting or to result from an accident which occurred on or about....................Sepl;ember..19.,...1995 .................19...........
and do hereb}' agree to indemnify and save harmless the said............\I00dc<lw..Vaughn..Jr....................................................
. ...l1oodrow..V.aughn..Jr....&..Tina..VaughnThe..Ilart.ford...lnsurance..Group.and ..their..respective ..agents,
from all further claims or demands. cost or expense arising out of che injuries or damage sustained by me/us. It is furcher
agreed that in the event other parties are responsible to me/us for damages as a result of this accident. the execution
of this agreement shall operate as a satisfaction of my/our claim against such other parties to the extent of the pro rata
share of the parties herein released.
It is expressly warranted by me/us that no promise or inducement has been offered except as herein set forth; that
this release is executed without reliance upon any statement or representation of the person or parties released. or their
representatives. concerning the nature and extent of the injuries. damages and/or legal liability therefor; that a=pt.
ance of the consideration set forth herein is in full accord and satisfaction of a disputed claim for which liability is
expressly denied.
Signed and sealed this....................... .............. ...day of................... ........................................ ............................. .......... ..19.. ........
Witness
Address
x
.............................................................................................
Signature of Tabitha Shields
.........!~.~.7..Jf.~!.I.\!!~..~~~.9.!I!...~~...?\ll.U......................
Newville PA 17241
............................1.................................................................
STATE OF....................................................} ss.
COUNTY OF..................................................
On this....................................................day of..........................................................19........... before me personally appeared
.............................................,............................................................................................................................................"...."......,...........
to me known to be the person described h..rein. and who executed the foregoing instrument. and....................acknowledged
that................... voluntarily executed the same.
(R) KMR (0400p)
.............................................................................................
Notary Public
Form LC-W7 R.n. PrUItt'll irr. U.s.A.
EXHIBIT "B"
POWER OF ATTORNEY AND CONTINGENT FEE AGREEMENT
We, the undersigned, hereby retain the law firm of McGRAW, HAlT &
DEITCJ:fMAN as attorneys for us i~ our names and to institute and maintain an
action against -r;1I~ ~ fl and/or any person, firm,
corporation, or other entity whicli may be res nsible to us for damages which
were sustained by m~ minor child, r;.b,' s;J , on or
abou,l} the J9~~ _ Ida of ,/ 19-Zt:. at
({t, /7'1 :;;;r ani;' Q. fl?".r.
as the result of , and
to negotiate an amicable settlement of the claim, in accordance with the terms
and conditions herein set forth:
1. We agree that in consideration for the services to be rendered by
McGraw, Hait & Deitchman, we will pay McGraw, Hait & Deitchman a sum of
thirty.three and one-third percent (33 1/3%) of whatever is recovered as a
result of settlement without suit, or of any recovery attained after suit is filed or a
trial is held as fees for professional services rendered. In the event that the
claim is not resolved until after an appeal has been filed, we agree to pay
McGraw, Hait & Deitchman the sum of forty percent (40%) of any recovery
attained.
2. We agree to be responsible for all costs and expenses due to
persons or entities outside of the firm of McGraw, Hait and Deitchman including,
but not limited to, filing fees, travel, professional photocopy, deposition
expenses, witness fees, medical reports, and investigation, which may be
necessary to pursue this claim. Although McGraw, Hait & Deitchman may, in
extreme circumstances, advance these costs for us, we understand that we are
responsible for prompt payment of them and our failure to reimburse the firm for
these advancements and/or costs may result in the firm's withdrawal from
representation of us. McGraw, Hait & Deitchman on their part agree to provide
us with as much advance notice and estimation of anticipated expenses as
possible so that we may budget for these expenses.
EXHIBIT "e"
3. We also agree to reimburse McGraw, Hait & Oeitchman for the
following types of costs which may be incurred in conjunction with our claim:
a) outgoing fax transmissions will be billed at the rate of $ .50 per
page for transmissions exceeding two pages;
b) long distance telephone calls in excess of ten minutes may be
charged for the time over ten minutes;
c) photocopy batches in excess of 20 pages per copy job will be
billed at the rate of $ .05 per page over 20
d) long distance travel for depositions, court appearances, etc.
outside of a 50 mile radius of Carlisle will be billed at the rate of $ .30 per mile.
4. We understand that McGraw, Hait & Deitchman may request that we
make advance payment(s) to be held in escrow for payment of costs such as
those found in Paragraphs 2 and 3 to be incurred, and we agree to make such
advance payment(s) as may be requested from time to time. We are hereby
informed that we will receive routine statements indicating the work done on our
case as well as any payments due for costs or funds which we may have in
escrow.
5. We understand that if our claim, or any part thereof, arises out of the
maintenance or use of a motor vehicle, and if there is a dispute with our own
insurance carrier for first party or underinsured or uninsured insurance benefits,
McGraw, Hait & Deitchman will attribute their time spent on this aspect of this
claim to an hourly fee for purposes of presenting a fee petition to be paid by our
insurer. McGraw, Hait & Oeitchman will calculate their fees for services
performed in thi~ respect in accordance with the firm's hourly rates in effect at
the time the work is performed. We are aware that these rates are currently
$100 per hour for partners and that these rates are subject to change at any
time.
5. McGraw, Hait & Deitchman agrees not to settle the claim without prior
consent which shall be documented in writing to the furthest extent possible.
6. We agree not to settle the claim without the prior written consent of
McGraw, Hait & Deitchman.
7. McGraw, Hait & Deitchman reserves the right to withdraw from
representation if in their professional opinion the claim is without merit. We, the
undersigned, reserve the right to terminate this agreement at any time. In the
event of termination by either party, we agree that we will remain liable for
payment of all costs or expenses as set forth in paragraphs 2 and 3 above.
2
McGraw, Hait & Deitchman shall have no obligation to release the file to us or
any other attorney until such expenses have been paid.
a) In the event of a settlement or award after termination, McGraw,
Hait & Deitchman shall be entitled to payment in proportion to the time which the
firm spent working on the claim in relation to the total time spent on the claim by .
each attorney or law firm involved. This clause may be modified by written
agreement of the parties hereto or subsequent counsel.
8. We agree that McGraw, Hait & Oeitchman may employ associate
counselor special trial counsel at their discretion, and that any counsel so
employed may be designated to appear on my behalf and/or undertake to
represent us in this matter. The employment of any associate counselor special
trial counsel, however, shall not increase the total attorney's fee, if any, to be
paid.
9. We authorize McGraw, Hait & Oeitchman to deduct from our share of
any recovery and pay directly to any doctor, hospital, or other health care
provider any unpaid balance due for treatment of injuries related to this claim.
We also agree that the applicable attorney fee as discussed in paragraph 1 and
any outstanding costs such as those in paragraphs 2 and 3 are to be deducted
directly from any recovery obtained in this matter.
10. If payment of this claim is to be made by a structured settlement, with
or without trial, attorney's fees will be computed by taking the applicable
percentage agreed upon, multiplied by the present cash value of the settlement,
as determined by actuarial experts; said payment to be made out of any initial
lump sum payment.
11. We acknowledge that we have read this Agreement, have had an
opportunity to ask questions concerning its terms, and agree to its terms. We
also acknowledge receipt of a copy of this Agreement.
We agree to be legally bound by this agreement:
p~~ 'n; ~~
Date: 9-";;7- 95
Date:
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GLENDA M. MARTIN, parent and
natural guardian of
TABITHA M. SHIELDS, a minor,
PLAINTIFF
V.
TINA M. VAUGHN,
DEFENDANT
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNlY, PENNSYLVANIA
97-2766 CIVIL TERM
ORDER OF COURT
AND NOW, this 11th day of June, 1997, following a hearing pursuant to
Pennsylvania Rule of Civil Procedure 2039, IT IS ORDERED:
(1) Approval Is granted for plaintiff to settle the within minor's claim against
defendant, Tina M. Vaughn, in the amount of $15,000.
(2) Plaintiff Is authorized to enter Into all documents necessary to effectuate
this settlement.
(3) Payment of an attorney fee to McGraw, Hait & Deitchman in the amount of
$3,726.13 and costs of $95.50, IS APPROVED.
(4) Counsel for plaintiff shall deposit the net proceeds of $11,178.37 In a
federally insured Interest bearing account at York Federal In the name of "Tabitha M.
Shields, born August 14, 1979." The account shall contain the following notation:
NO WITHDRAWAL CAN BE MADE FROM THIS ACCOUNT UNTIL THE MINOR
ATTAINS MAJORITY, EXCEPT AS AUTHORIZED BY A PRIOR ORDER OF A
COURT OF COMPETENT JURISDICTION.
(5) Counsel for plaintiff shall promptly file of record with the Prothonotary proof
of said deposit, and forward a copy to this chambers.
JI
o N.m" Md"d
o Chaullc UrO\l,ncohil'
o NillTle ChlnJ;c l'n:vioUJ NJmc:
o U"k'" N.mo: I)u" TlIU",th
Chanl,'C I)atc:
AnnUIll Numhcl
/'IiRSONAL ACCOUNT SIGNATURE CARD
Emp. No.
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T^IIII'11^ M SIIIEI.IlS III
N~lIte and C '\lo'l'M:uhill Cndc:
CIO JENNII'I'R C UI'II'CIIM^N
Name
Nante
4l.lIl1;Rry ^V
SlIccl Addn:',
C^RIJSI.E I'^ 17013
1'0 11m, I Cil)' I Slale I Zip
Nil. ur Si~lIalun:J Rc:quin:d
020-72678
06/1 6/97
o Twinllilll: 0 O\'erdran Protcclion / Sweep
Chcd;ing Accl Nil
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o Transf", MunOlly 'n:
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fly luue Dale
o Semi-Annually
o ^nn".lIy hy
Issue: Dale
o ^nn".lIy
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184.66,3320 IRl
TIN TIU
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TIN TIU
717.249-4500
lIome MIone
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Work l'honc
GU^RANTEEO MONEY I'U
attains m jor
Otllcr Ac:cl No(s)
lITMA Accounts:
^~" orM.jo'~y
Successor Cuslodian:
Wilness:
IRA Acc:ounls:
Rill Nn,
0811411997
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