HomeMy WebLinkAbout01-1729 FX
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MAR 2 /) 20fJlfjP
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
TED A. GAYMAN, as parent and natural
guardian of CHAD M, GAYMAN, a minor,
Plaintiff
AMICABLE ACTION
v,
NO, 01 - /7::l.r
CL(.)~l 'J-~
ERIE INSURANCE EXCHANGE,
Defendant
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ORDER
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AND NOW, this
day of
,2001, upon presentation and due
consideration of the foregoing Petition for Approval of Minor Plaintiff's Compromise Settlement
ii,
and Distribution of Proceeds, it is hereby Ordered and Decreed in accordance with the provision of
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Pa,R.C.P. 2206 that the Petition is GRANTED,
Payment of fees and expenses as listed in the Petition is approved and payment of Ten
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Thousand Five Hundred Seventy-Five and 00/100 Dollars ($10,575.00) to Minor Plaintiff Chad M,
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Gayman is directed to be made and deposited in a Bank, a depository which is insured by the
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Federal Government, and no withdrawal will be made from such account until the Minor Plaintiff
attains majority, except as authorized by Order of Court,
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BY THE COURT:
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228326.1IRASIMLB
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IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
TED A. GAYMAN, as parent and natural
guardian of CHAD M, GAYMAN, a minor,
Plaintiff
AMICABLE ACTION
v,
NO,
ERIE INSURANCE EXCHANGE,
Defendant
ORDER
AND NOW, this
day of
,2001, upon consideration
of the within Petition, a hearing is scheduled on the
day of
2001, at
,m, at the Cumberland County Courthouse in Courtroom Number _'
BY THE COURT:
1.
228326.l\RASIMLB
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IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
TED A. GAYMAN, as parent and natural
guardian of CHAD M, GAYMAN, a minor,
Plaintiff
AMICABLE ACTION
v.
NO, bl-J7:J'l C.;;J ~
ERIE INSURANCE EXCHANGE,
Defendant
PETITION FOR APPROVAL OF MINOR PLAINTIFF'S
COMPROMISE SETTLEMENT AND DISTRIBUTION OF PROCEEDS
The Petition of Chad M. Gayman, by his parent and natural guardian, Ted A. Gayman,
respectfully represents:
1. Chad M, Gayman, the minor Plaintiff, is the son of Ted A. Gayman, Petitioner,
herein, Chad M, Gayman is 17 years old having been born on June 2, 1983.
2, On March 14,2000, Chad M, Gayman sustained a soft tissue neck injury as a result
of a motor vehicle accident.
3, Minor Plaintiff was operating his motor vehicle when he was rear-ended by the
vehicle being operated by Casey A. Swigert,
4, A copy of the Police Accident Report is attached hereto as Exhibit A.
5. Casey A. Swigert was not covered by an insurance policy at the time of the accident.
6. Minor Plaintiff presented a claim to his automobile insurer, Erie Insurance
Exchange, for uninsured motorist benefits,
228326.11RASIMLB
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7. Erie has agreed to pay and to compromise the claim arising from the injuries to Chad
M. Gayman for the sum of Seventeen Thousand Five Hundred and 00/100 Dollars ($17,500,00),
subject to the approval of your Honorable Court.
8. Minor Plaintiffs claim has been litigated through discovery and was scheduled for
arbitration on April 2, 2001.
9. Petitioner considers this to be a fair, just, and equitable settlement and to be in the
best interests of Chad M, Gayman,
10, Minor Plaintiff treated with John W. Rodgers, M,D, A copy of Dr. Rodger's
treatment note of May 30, 2000 is attached hereto as Exhibit B.
11, Should the Court deem it necessary to schedule a hearing to approve the settlement,
and if a hearing is scheduled, Minor Plaintiff, his father, and Plaintiff s counsel will be present at the
hearing.
12, Your Petitioner has retained the law firm of Angina & Rovner, P.C. to prosecute this
action and has entered into a contingency fee agreement with said attorney whereby said attorney is
to receive, for professional services, thirty-five percent (35%) of any amount recovered after filing
suit, plus reimbursement of expenses, Plaintiff's counsel's fee is Six Thousand One Hundred
Twenty-Five and 00/100 Dollars ($6,125.00), which is 35% less a fee concession ofTen and 98/1 00
Dollars ($10,98).
228326.1\RASIMLB
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13. To date, Plaintiff's counsel has incurred expenses totaling Eight Hundred Ten
Dollars and 98/100 Donars ($810,98) in pursuit of Plaintiff Chad M, Gayman's claim.
14, Petitioner understands that the remainder of the settlement, Ten Thousand Five
Hundred Seventy-Five and 00/100 ($10,575,00), is to be held in trust for Chad M, Gayman in an
account which is insured by the Federal Government and that no withdrawal be made therefrom
until Chad M, Gayman attains majority or authorized by Court Order,
WHEREFORE, Petitioner respectfully requests Your Honorable Court to approve the
minor's compromise settlement and authorize the payment of attorney's fees from the fund due the
minor and direct payment due to the minor to be deposited in a bank in trust for Chad M. Gayman,
ANGINO & ROVNER, P .
. ard A. lock, Esquire
,D, N , 7281
North Front Street
Harrisburg, P A 1711 0
(717) 238-6791
Counsel for Petitioner
Date: March 22,2001
228326.l1RASIMLB
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COMMONWEAL TH d'F PENNSYLVANIA
POUCE ACODENT REPORT
," PORTABlE ~L""N~ ~ REPORTABlE I I
ACCIDENT.LOCATION
20. COUNtY CODE
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POLICE INFORMATION
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: DATE 03 l'-\ 00 I TIME I;:.Z I
CCIDENT INFORMATION
9. ACCIDENT f I ! 10. DAY Of WEEK
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COMMONWEAL TH OF PENNSYLVANIA
POUCE ACCIDENT REPORT
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INCIDENT II;
C/OENT DATE:
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85. DESCRIPTION OF ().WA(;EDPROPERTY
OWNER
. ADDRESS--
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a1. NARRATIVE - SFY PAECIPIfAT EVENTS. CAUSA'OOM F .SEQUENCE WIt
DET~~UKE INSURANCE INFORIMTIDN, AND LOCATION OF TOWED \O-.ct~, JFICNOWN.
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s: Chad returns for a recheck of his neck. He does report definite improvement although still
is occasionally symptomatic.
0: He has forward flexion & back bending limited secondary to some discomfort. He's
minimally tender to palpation around the posterior aspect of the neck. Passive ROM of
the neck is limited.
A: Improving cervical strain or whiplash.
P: Chad has discontinued physical therapy & will continue to do exercises on his own. I do
not feel he needs anyformaJ intervention at this time & should continue to improve. He
will progress to activities as tolerated & follow-up in the office on a p.r.n. basis.(JCR/dmg)
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VERIFICATION
I, Ted A. Gayman, as parent and natural guardian of Chad A. Gayman, a minor, have read
the foregoing PETITION FOR APPROVAL OF MINOR PLAINTIFF'S COMPROMISE
SETTLEMENT AND DISTRIBUTION OF PROCEEDS and do swear or affirm that the facts
set forth in the foregoing are true and correct to the best of my knowledge, information and belief. I
understand that this Verification is made subject to the penalties of 18 Pa.C,S,A., Section 4904,
relating to unsworn falsification to authorities,
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Ted A. Gayman . .
Date: 3//1/ti /
228557.IIRASIMLB
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CERTIFICATE OF SERVICE
I, Marcy L Brymesser, an employee of the law firm of Angino & Rovner, p,c., do hereby
certify that I am this day serving a true and correct copy of PETITION FOR APPROVAL OF
MINOR PLAINTIFF'S COMPROMISE SETTLEMENT AND DISTRIBUTION OF
PROCEEDS on the following via postage prepaid, first class United States mail, requested
addressed as follows:
John A. Statler, Esquire
Goldberg, Katzman & Shipman
320E Market Street
p, 0, Box 1268
Harrisburg, P A 17108
C'r!I~J(?~(fI@tr~A-
Mar y L B ymesse
Date: March 22,2001
228326.IIRASIMLB
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TED A. GAYMAN, as parent and
natural guardian of CHAD M,
GAYMAN, a minor,
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
01-1729 CIVIL
vs,
CIVIL ACTION - LAW
ERIE INSURANCE EXCHANGE,
Defendant
IN RE: PETITION FOR APPROVAL OF MINOR PLAINTIFF'S
COMPROMISE SETTLEMENT
ORDER
AND NOW, this 2. t.... day of March, 2001, a brief hearing on the within petition is
set for Wednesday, April 25, 2001, at 1:30 p,m, in Courtroom Number4, Cumberland County
Courthouse, Carlisle, P A.
BY THE COURT,
Richard Sadlock, Esquire
For the Plaintiff
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John A. Statler, Esquire
For the Defendant
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TED A. GAYMAN, as parent
and natural guardian of
CHAD M. GAYMAN, a minor,
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
V
NO. 01-1729 CIVIL TERM
ERIE INSURANCE EXCHANGE,
Defendant
IN RE: PETITION FOR APPROVAL OF MINOR PLAINTIFF'S
COMPROMISE SETTLEMENT
ORDER OF COURT
AND NOW, this 25th day of April, 2001, upon
presentation and hearing on a petition for approval of a minor
plaintiff's compromise settlement and distribution of proceeds,
settlement of this case in the total amount of $17,500.00 is
approved. Following payment of counsel fees in the amount of
$5,250.00, and expenses in the amount of $810.98, the balance of
the proceeds due the minor plaintiff, Chad M. Gayman, is
directed to be made and deposited in a bank, a depository which
is insured by the Federal Government, and no withdrawal will be
made from such account until the minor plaintiff attains
majority, except as authorized by order of court.
By the Court,
Richard A. Sadlock, Esquire
For the Plaintiffs
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John A. Statler, Esquire
For the Defendant
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IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
TED A. GAYMAN, as parent and natural
guardian of CHAD M, GAYMAN, a minor,
Plaintiff
AMICABLE ACTION
v,
NO. 01-1729 CIVIL
ERIE INSURANCE EXCHANGE,
Defendant
PROOF OF DEPOSIT
In accordance with Pennsylvania Rule of Civil Procedure 2039, attached is a photocopy of
the Certificate of Deposit issued on May 11, 2001 from the Orrstown Bank to Chad M. Gayman, a
Minor, as proof of deposit of the settlement proceeds.
No withdrawal can be made from any such account until the Minor attains majority, except
/-
as authorized by a prior Order of Court.
ANGINO & RO
Richard A. Sadlock, Esquire
I.D. No. 47281
4503 North Front Street
Harrisburg, PA 17110
(717) 238-6791
Counsel for Plaintiff
Date: May 21, 2001
228326.1 \RAS\MLB
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NON.NEGOllABLE/NON TRANSFERABLE
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ORRSTOWN BANK
P.o. BOX 60
SHIPPENSBURG, PA 17257
717-532-6114
No. 506 - 6 6 6 8 6 TIME CERTIFICATE OF DEPOSIT
OWNERSHIP OF ACCOUNT. CONSUMER PURPOSE
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DMOR DFI09 SPRINGVIEW ROAD ""'fl<YERIONUM&H DJOINT.NOSlJFMVORSHIP 11F~~~l
CARLISLE:. FA 17013 0 ICCM6INEOSTATEMENT)
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HAS DEPOSITED IN THIS BANK . i 'j ~,::. ....l U I ,_.11.. .L .1":1" 1:::/ 111111 .~,,' "" -"'''~ 'lIIUi 't!ti~r <.
PAYBLE TO SAID DEPOSITOR(S), SUBJECT' TO THE CONDITIONS PRINTED ON THE REVERSE SIDE OF CERTIACATE.
ISSUE TERM OF MATURITY PERCENTAGE RATE INTEREST PAYABLE
DATE CERTIFICATE DATE PER ANN'JM l 0 MONTHt.:'I' 0 SEMIMANNUALLY
o QUARTERLY 0 ANNUALLY
5 11 01 6 MONTHS 11 11-01 0 WJ!~~, '(It XIlADO-ON
g UNDER PENALTIES OF PERJURY I CERTIFY THAT THE ABOVE NUMBER IS MY CORRECT TAXPAYER IDENTIFICATION 0
NUMBER.
UNDER PENALTIES OF PERJURY I CERTIFY THAT I AM NOT SUBJECT TO BACKUP WITHHOLDING, EITHER BeCAUSE
IHAVE NOi BEEN NOTiFIED iHAi I AM SUBJECT TO BACKUP WITHHOLDING PS A RESULT OF A FAILURE TO REPORT
ALL INTEREST OR DIVIDENDS. OR THE INTERNAL REVENUE SERVICE HAS NOTIAED ME THAT I AM NO LONGER
SUBJECT -r;a~KUP WITHHOLD~' .
OEPOSITOR'S \ I l'\,\
SIGNATURE OJ)~ I " A.-o-
$1*$11,450.00*
o MAIL CHECK
il!XOMPOUNOING GROTolTR'
o CREDIT ACCT, NO~
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CERTIFICATE OF SERVICE
I, Marcy 1. Brymesser, an employee of the law firm of Angino & Rovner, P.c., do hereby
certify that I am this day serving a true and correct copy of PROOF OF DEPOSIT on the
following via postage prepaid, first class United States mail, requested addressed as follows:
John A. Statler, Esquire
Goldberg, Katzman & Shipman
320E Market Street
p, 0, Box 1268
Harrisburg, P A 17108
~~AA~tLIlnIrJ~ /
~ 1. rymess r
Date: May 21,2001
228326.11RASIMLB
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IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
TED A. GAYMAN, as parent and natural
guardian of CHAD M. GAYMAN, a minor,
Plaintiff
AMICABLE ACTION
v,
NO. 01-1729 CIVIL
ERIE INSURANCE EXCHANGE,
Defendant
PRAECIPE
TO THE PROTHONOTARY:
Please mark the above-captioned action as settled, satisfied, and discontinued,
ANGINO & ROVNER P,C,
ra A, adlock, Esquire
LD, No. 47281
4503 N. Front Street
Harrisburg, PA 17110
(717) 238-6791
Counsel for Plaintiff
Date: May 21,2001
cc: John A. Statler, Esquire
Goldberg, Katzman & Shipman
320E Market Street
p, 0, Box 1268
Harrisburg, P A 17108
231315.1IRAS\MLB
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