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Home My WebLink About98-04525 , ; I i I I-Ji .0 j '"' ~\ ~l ~ ~i ~1 I ....... I I . I ~i ~I ~i 1 ' I ~ s: 'J '4 ,,>' \. U ~ ~ G) I i I j i I ! ! i ~I . I - I -: I <:)1 \r')i ~l ~I , 6.", ~ ~I /,r' / . " ....l, .. ~. ~ '.:.: ,,'_~' ,':. ".' ' . ,'. ':::'1.:. ';~:'.'>';-' "~,," ..", .< ;', ~..';:",';1~"I':\ '. :. IlIUANNA SANDERS, hy her Parents and Legal Guardians. TAMMY It SANDERS tlnd BLAKE SANDERS. PlainlilTs IN TilE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA v. CIVIL ACTION -LAW NO.9 S'. l.(( J., CLi...J -- J..(.~ DONEGAL COMPANIES Delcnda~ AND NOW, thisLI day of Compromise is granted and Dc!cndant is or( forth in the Pelition. . 199R, the Pelition for Approval of Minor's ed to pay all claims in the amount of$2.500.00 as set ~ "\~': :'~ t<,:,:. '-: "\'.'.",' .~r' , ';".1"",.,:,:.'.,' ":-::::,.., ....tt,,,\ ~.~:',,~::.".'.':-_~_:'.,.'I":,',:';"'. ,'" ~. ,_ _ ,', ~,,,.,..' ;l~,"," .,.t' ",,,~:~;'.;.;.'~''''''''''' . v. CIVIL ACTION - LA W NO. q r. '1.C;.7" C,....~ ( .T.'th i k I"~: I L \:., fi" !$) i : I. : \. ; I", . Ir ". I !\ . ,: ;". i I " " It. " ., ! I 1111' 11\1\1111 1M''''' "'I tMM "..I'IIIIA. l'fUf"l U~II''<I'I:'ll.''r'' 11(\1..,,1 lJ~ lI"" III ...}! 1'\1 111\11"" BRIANNA SANDERS. hy hcr Parcnts and Lcgal Guardians, TAMMY R. SANDERS and BLAKE SANDERS. Plaintins IN TilE COURT OF COMMON PI.EAS OF CUMBERLAND COUNTY. PENNSYLVANIA DONEGAL COMPANIES Dcfcndant PETITION FOR APPROVAL OF MINOR'S COMPROMISE I. Thc Pctitioncrs. Tammy R. Sandcrs and Blakc Sandcrs. arc adult individuals and thc parcnts and Icgal guardians of thc minor Pctitioncr. Brianna Sandcrs. born on May 21, 1995, rcsiding at 241 Ncil Road, Shippcnsburg, Pcnnsylvania 17257. 2. Thc Dcfcndant Doncgal Companics is an insurancc carricr Iiccnscd to do busincss in Pcnnsylvania with an addrcss of 1195 Rivcr Road, Marictta, Pcnnsylvania 17547-0302. 3. On or about May 29. 1998, thc minor Plaintiff, Brianna Sandcrs. was injurcd in a lwo- vehicle accidcnt while the vehicle in which she was a passengcr was rear-endcd by a vehicle driven by Mark A. Minnich. 4. Thc accident occurred on SR 174 in Shippensburg, Cumberland County, Pennsylvania. 5. As a rcsult of that accidcnt, the minor Plaintiff, Brianna Sandcrs, sustained a fractured clavicle and incurrcd mcdical bills inthc amount of $382.00. (Sce Wagc and Medical File Review Shcct attached hercto as Exhibit "A".) 6. At the time of the accidcnt, the respondcnt Doncgal Companics provided liability coverage for the vchiclc operatcd by Mark Minnich. 7. Respondent Donegal Companies has agreed to pay $2.500.00 to Plaintiffs. (See letter datcd July 22, 1998, confinning settlcment attachcd hcreto as Exhibit "B".) 8. A Relcasc of All Claims will be signed by Petitioners setting forth the tenns of settlcmcnt. (Scc proposcd Relcasc of All Claims attachcd hcrcto as Exhibit "C".) 9. The partics, thcrcfore, scek court approval of the settlcment as set forth above. ,..:. ."~:,~'r ,'" ,," 't'., "":;:."",1:" . 'j#":',:":-'. ~.....{.;.(..'" .I.-,~", :.' .~"":"';'_\""""l"'"'' -:' WIIEREFORE. Defendant requests that this Court approve the aforementioned Petition for Approval of Minor's Compromise. MAlnSON DEARDORFF WILLIAMS & OTTO lJY~~Cc. Daniel K. Deardorn. Esquire 1.0. Number 17837 Ten East High Street Carlisle. P A 17013-3093 (717) 243-3341 Attorneys for Defendant Date: '?/s/c;f , ':." ~ :~. :,i.' -'" '. ': ..&..' ,.' ~ ,..,.'. ".' ~f .... \.' :, ," ~. . I.' "4 " ",.'. -. .'.' ,.., (~ ." , ' , \, r. I ' . . ,_.,,' ".,"" t ,~ '.,' " . , .. . . "'. " , . ~ " .. ,_, ' . . ...J Exhibit A '. , ,'~ .', . ", .: ,",' '~'. ,'., "_"~' \c'': ~.":.': ',':.,', . ".:',,' '~~ '''~+, . " ( WAGE AND MEDICAL FILE REVIEW SHEET File No.: CAR Cl/tItJ7rF.f'///) D/A: J'29~f.r elmt. Name: 4,4,1,4,,"'-.4 .-f. J~"'Q~J M..{L) Marital Status: _M 4 _0 _Sep. DOB/Age: J' '21- 'JJ- Occupation: Diagnosis: /1--0- - /.J/f,,4,t/nJ1O h t r CLAV/t: Le Prognosis: Residuals: Disability Period: Total Lost Wages: Medical Specials: Doctor/Hospital Treatment Date Amount Total To Date t'. ;P Ir1/-~.f' II- " ;/7-11- ?' 00 ~ir;z. EXHIBIT "A" DM-5G8 (8-85) _ _ ,. .'. .' ,..,~. ' ,'. .. ' ., . ~, ' " ;' " . , . " " Exhibit B CAA 010 97 88 (55) RELEASE OF ALL CLAIMS KNOW ALL MEN IJf lliESe PRESENTS:. " ,n"***** Thal1lle UncIorslgned, being oflawlul age, tor the sole consklnl1on c:A ThO T1100SAND FIVE HUNDRED 00"",,,,",, ******* ******** *** * * ** * ****** *** * ************* * ************DoIl8lll ($2.500.00 ) III 1lIe undaralgnad In hand paid, receipt whareofls hereby ac~lod\IOd, doIdon horoby and lot mylour/lts hair.!, oxccutors, cdmlnbtta\Om, IU~Cl-''lI1I and as&lgna release, acquit IlI1d forever dlschll1le Mark A, Minnich, M & M Electric Associates and Atlantic States Insurance Co. and hla. her, lhelt, 01' Its llQents, s8Ml/lls, hol"" OlC8Culllrs, admlnlstralors and ell otnllt persons, ftrms, cmporalIons. associations 0( partn.... shlpl c:A and from SIf'/ and all clalms. actions, caUSGS of action, demands, rights, demages, cosls, loss 01 service, expenses and compensallon whaIsolMlr, which lhG undorSlgned now has/haYO 0( which may horealtar accn.ra on account 01 or In any way growlng out c:A SIf'/ and all Imwn and unlcoown, ~n and unloresoen bodily and pemnallnJur10s and prilperty damaa.e9and the consequence thereof reeuhlng 0( tn result from lha accIcIenI, cuually 0( lMII1t which occuned on 0( abouItha -Z I th day c:A May 19 98, at or near Shippensburq, PA It Is unclefStnOd and agreed thai this settlement Is the compromlsa c:A a doubtful and disputed claim, and that the payment made Is noi III be construed as an admIsSion of liability on the pari c:A the party 0( parties hereby released. and that said releases deny Hablllly tI1<mlO( and Inland merely III avoid litigation and buy their po.ace. The undal'5lgned hereby declaro(s) and represent(s) thai the lnIur1es sustained are or may be permanent and progresslvo and thai reco'/Ory therelrom 1:1 unc:eflaln and Indeflnlte and In making this Rele... It Is undorstnod and agreed, thai the undersigned rely(laa) wh:lIly upon tho underslgned's judgment, bellel and knowledge of the nature, extent, affect and duration 01 sold Injurles and liability therelot and Is made without reliance upon arry statement or representation 01 the party or partlOll horoby released or their reprosontallves or by arry physician or surgeon by them employed. . The undsrslgnod further docIaro(s) and reprosont(s) that thera may ba unknown or unantfclpaled Injurles resuhlng from the above stated accident, casualty or oven! and In making this Release It Is undBllllOOd and agtood that this Rsleasa Is Intended to Include such Injurlos. The undersigned further declare(s) and roprasoot(s) thai no promise. Inducame.nt or agreement not herein oxprassed has been made to the undersigned, and thalthls Rele""e contains the entlra egraoment belwesn the parties herolD, and that the terms 01 this Role... are contractual and not a mere recital. . this Rele/lSO ..prossly reserves all rlghl:l of the por.IOn, or persons, on whose bahalltho payment Is made and the rlghlll 01 aD persons In privily or connected with them. and reservas to them thslr right to pUJSUe thslr legal remedlos. n any, Including but not limited to claims lor contrlbution. property damage and personal Injury against the undersigned 0( those In privity or connected with the undsrslgned. THE UNDERSIGNED HAS READ THE FOREGOING RELEASE AND FULLY UNDERSTANDS IT. Witness day of CAlITlON: READ BEFORE SIGNING BELOW X ~ ~ako?fu.I1f~ ~~aJlfent and Legal X ~ Blake Sanders, as Parent and Legal Guardian of Brianna sanders 19~ Signed, sealed and delivered this X Witness X ~ Witness STATE OF COUNTY OF ss. On the day 01 19_ before me personally appeared III ma known 10 be the person(s) named herein and who executed the foregoing Release and acknowledged to me that voluntarily executed the samo. My term explras .19_ Notary Public EXHIBIT "e" In accordanc:e with p&rmytvanla /V;t. 165. 1M IoIIowlng notice Is being pnMded: Arri person who knowingly and with Inlenllo defraud any Insurance company or other person Illes an applleatlon for Insurance or statement of claim containing ant malerialty false Information or conc:eab for tho purpose 01 misleadlflg, information concerning My fact maJeriat thereto commits a fraudulent insur. ance act, which Is a crime and subiects such person,to criminal and civil penalties. '",:l".,'" 'c' "'_" ...::,~d' "'1"~; "'..:.. I,.,': , '1.';.~,.':......'....1 ~. '.:: '~',: ... CEHTIFICATE OF SElWIn: I, Lori A. Sullivan. an authorized agenl of Martson Deardorff Williams & OliO, hereby eertify tlml a eopy of the fiJregoing Petition fl1r Approval of Minor's Compromise was served this date by depositing same in the Posl Ofliee at Carlisle, PA. tirsl class mail. postage prepaid, addressed as follows: Mr. and Mrs. Blake Sanders 241 Neil Road Shippensburg, P A 17257 MARTSON DEARDORFF WILLIAMS & OTTO , , 1.-/ .' 1" ' By ,,-!Jt<-" J.. <,!' ~ Lor' A. Sullivan I Ten Easl High Street Carlisle, PA 17013 (717) 243-3341 Daled: 0/511f