HomeMy WebLinkAbout03-2553JILLIAN R. SHAMBAUGH, a minor by
MICHAEL SHAMBAUGH and
PATRICIA SHAMBAUGH, parents
and natural guardians of
JILLIAN R. SHAMBAUGH,
Plaintiff/Petitioner
VS.
PHILLIP A. FREDERICK,
Defendant/Respondent.
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
: NO.
PETITION FOR MINOR'S COMPRISE
AND SETTLEMENT
PETITION TO OBTAIN COURT APPROVAL TO SETTLE THE
CLAIMS OF A MINOR
The Petitioner, Jillian R. Shambaugh, a minor, by Patricia and Michael Shambangh, the
parents and natural guardians of Jillian R. Shambangh, respectfully set forth the following
averments in support of their requests.
1. The Petitioners, Patricia and Michael Shambaugh, are adult individuals who are married
and reside at 19 Kingswood Drive, Mechanicsburg, Cumberland County, Pennsylvania,
17055.
2. The minor, Jillian Shambaugh, is currently 17 years of age, having been born on March
30, 1986.
3. The minor resides with her mother and father, the above-referenced Patricia and Michael
Shambaugh, at the address provided above.
4. The Respondent, Phillip A. Frederick, is an adult individual who currently resides at 5136
Ravenwood Road, Mechanicsburg, Cumberland County, Pennsylvania 17055.
5. The circumstances giving rise to the instant Petition occurred on December 16, 2000, on
Route 15 in Gettysburg, Adams County, Pennsylvania.
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11.
12.
13.
At the time and place, the minor Plaintiff was a passenger in a vehicle owned and
operated by the Defendant/Respondent, Phillip A. Frederick.
The single vehicle accident occurred when Mr. Frederick struck an ice patch and began to
slide. Mr. Frederick's vehicle slid off the roadway toward the westside of the road and
struck a guardrail with the right fender. The vehicle traveled through the guardrail and
came to rest on its wheels facing south in a drainage culvert.
Immediately following the accident, the minor Plaintiff was taken to the emergency room
of Gettysburg Hospital where she was diagnosed as having received a neck strain and
some abrasions.
The minor Plaintiff sought and received several months of chiropractic treatment to assist
in her recovery from the injuries she suffered.
To date, all medical bills have been paid.
The minor Plaintiff's final office visit with Richard Hallock, M.D. of the Orthopedic
Institute of Pennsylvania, occurred on October 1, 2002.. A true and correct copy of Dr.
Hallock's final report is attached hereto as Exhibit "A".
On the date of the accident, the Defendant/Respondent, Phillip A. Frederick, was insured
under an automobile policy issued by the GEICO Insurance Company.
In an effort to settle this case, the parties have agreed that the sum of Three Thousand
Seven Hundred Dollars ($3,700.00) will be paid on behalf of Jillian Shambaugh, a minor,
in exchange for a release of all claims. Insofar as execution of the Release requires the
Court's permission, attached as Exhibit "B" is an unsigned copy of the Release that has
been proposed.
14. The Petitioner believes that the settlement enumerated in the Petition is fair and equitable
and in the best interest of the minor Plaintiff, Jillian Shambaugh.
15. GEICO Insurance Company has offered to pay the sum set out in this Petition toward an
amicable resolution of the claims and in exchange for Court approval and a properly
executed release of claims.
16. GEICO shall also pay costs and legal fees incurred with respect to the instant Petition for
Court approval.
WHEREFORE, Petitioner, Jillian R. Shambaugh, a minor, by Patricia and Michael
Shambaugh, the parents and natural guardians of Jillian R. Shambaugh, respectfully requests that
this Honorable Court enter an Order approving the following compromise settlement, directing
the distribution of proceeds thereof as set forth above, and authorizing the Petitioner, upon
payment of the aforesaid sums, to discontinue the action brought and to execute a full and final
release.
Dated:
By:
CALDWELL & KEARNS
Jeffr'~y T~(/l~re, Esquire
Attorney I.D. #73617
Douglas E. Herman, Esquire
Attorney I.D. #86569
3631 North Front Street
Harrisburg, PA 17110
(717) 232-7661
Attorney for Defendant/Respondent
12/06/02 FRI 16:08 FAX 412 262 7508
STATE FAi~ INS.
002
ORTHOPEDIC II~%TITUTE OF PENNSYLVANIA
(717) 761-5530
PaEient~: Jillian K. Shambaugh Chart #: 20742428
DOB: 03/30/86 SSN: 202 66 7772 Page 9 1
10/01/2002
OFFICE VISIT
Trindle Road Office
CHIEP COMPLAINT: This 16 year old patient was in today for her Deck.
HISTORY OF COMPLAINT: She was ~nvolved in a motor vehicle accident on
12-16-00. She wa~ a p~9~r in a moving ve~Zcle w~ich was involveO in an
accident. Apparently the van she was in ultime=ely went over a guardrail and
was air born and went down into a ravine. She has had chiropractic treatment
for several months following the injury, She now has some intermittent
discomfort. She takes phys. ed. and a~ 5his point does not state she has any
specific restrictions.
_ . REVIEW O1% SYST~I~=. _Ke~iam. af sVS~a~s,__P.a~t_ medical history, .~m~3y_b~R~O_ry_
and social history have been recorded and reviewed.
PHYSICAL EXAM: ~xam today reveals a very pleasant 16 year old patient. She
walks nortaally. She has no limo. She has full forward flexion of her spine.
She has no tenderness in her back. She has symmetrical strength and reflexes
in her lower extremities. She has full rotational ~ovements i~ her hips.
DIAGNOSTIC TESTS: X-rays of her LS spine today were normal.
DIAGNOSIS: LS strain, s~agus Dost MVA.
PLAN: At this point she is going to s~ar~ some home exercises for it. She
will be seen here prn. S~e does not have a/%y specific restrictions.
RHH/raf
~[ii~ AIRPOItT
JILLIAN R. SHAMBAUGH, a minor by
MICHAEL SHAMBAUGH and
PATRICIA SHAMBAUGH, parents
and natural guardians of
JILLIAN R. SHAMBAUGH,
Plaintiff/Petitioner
VS.
PHILLIP A. FREDERICK,
Defendant/Respondent.
· PETITION FOR MINOR'S COMPRISE
· AND SETTLEMENT
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
RELEASE OF CLAIMS
IN CONSIDERATION OF the payment to us of the sum of Three Thousand Seven
Hundred Dollars ($3,700.00) and other good and valuable consideration, Jillian R. Shambaugh, a
minor by Michael Shambaugh and Patricia Shambaugh, parents and natural guardians, of Jillian
R. Shambaugh, being of lawful age, have released and discharged, and by these presents do for
themselves, their heirs, executors, administrators and assigns, release, acquit and forever
discharge Phillip A. Frederick and any and all other persons, firms and corporations, of and from
any and all past, present and future actions, causes of action, claims, demands, damages, costs,
loss of services, expenses, compensation, third party actions, suits at law or in equity, including
claims or suits for contribution and/or indemnity, of whatever way growing out of any and all
personal, physical, mental, or emotional injuries and property damage resulting or to result from
an automobile accident that occurred on or about December 16, 2000 on Route 15 in Gettysburg,
Adams County, Pennsylvania.
We hereby declare and represent that the injuries sustained may be permanent and
progressive and that recovery therefrom is uncertain and indefinite, and in making this Release
and agreement, it is understood and agreed that we rely wholly upon our own judgment, belief
and knowledge of the nature, extent and duration of said injuries.
We understand that this settlement is the compromise of a doubtful and disputed claim,
and that the payment is not to be construed as an admission of liability on the part of the persons,
finns and corporations hereby released by whom liability is expressly denied.
It is understood and agreed that this Release is executed in connection with the settlement
of the claims of the undersigned as set forth in Civil Action No. in
the Court of Common Pleas of Cumberland County, Pennsylvania, which action is to be marked
as discontinued, settled and withdrawn.
IN WITNESS WHEREOF, we have hereunto set their hands and seals this __ day of
,2003, intending to be legally bound hereby.
WITNE S S:
(SEAL)
Michael Shambaugh, as parent and natural guardian
of Jillian R. Shambaugh
(SEAL)
Patricia Shambaugh, as parent and natural guardian
of Jillian R. Shambaugh
Jillian R. Shambaugh
(SEAL)
03-239/56609
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF '
SS:
On this day of ,2003, before me personally appeared Michael
Shambaugh, known to me to be the person whose name is subscribed to the foregoing General
Release and acknowledged that he executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
Notary Public
(SEAL)
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF '
SS:
On this __ day of ,2003, before me personally appeared Patricia
Shambaugh known to me to be the person whose name is subscribed to the foregoing General
Release and acknowledged that she executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
56609
Notary Public
(SEAL)
VERIFICATION
I verify that the averments in this document are true and correct. I understand that
false statements herein are made subject to the penalties of 18 Pa. C.S. 4904, relating
to unsworn falsification to authorities.
Date: ,.~'/g,,~/~ -~
By:
7~)~'~aturaI
Patricia Shambaugh, a parent an guardian of
Jillian R. Shambaugh, a minor
VERIFICATION
I verify that the averments in this document are true and correct. I understand that
false statements herein are made subject to the penalties of 18 Pa. C.S. 4904, relating
to unsworn falsification to authorities.
Date:
Michael Shambaugh, a parent and natural guardian
of Jillian R. Shambaugh, a minor
CERTIFICATE OF SERVICE_
ff ~, 2003, I hereby certify that I have
AND NOW, this~day of
served a copy of the within document on the following by depositing a true and correct copy of
the same in the U.S. Mails at Harrisburg, Pennsylvania, postage prepaid, addressed to:
Jillian R. Shambaugh
Michael Shambaugh
Patricia Shambaugh
19 Kingswood Drive
Mechanicsburg, PA 17055
CALDWELL & KEARNS
JILLIAN R. SHAMBAUGH, a minor by
MICHAEL SHAMBAUGH and
PATRICIA SHAMBAUGH, parents
and natural guardians of
JILLIAN R. SHAMBAUGH,
Plaintiff/Petitioner
VS.
PHILLIP A. FREDERICK,
Defendant/Respondent.
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
PETITION FOR MINOR'S COMPRISE
AND SETTLEMENT
AND NOW, this
ORDER
,2003, it is
hereby Ordered that a hearing be held on ~'1~.. I ~" J ~0~ ~1~ at
~''~' °o clock in Courtroom ~ for the Court to consider the Petition to Settle
the Claims of a Minor which has been filed in the above-captioned matter.
Distribution:
~atricia Shambaugh
19 Kingswood Drive
Mechanicsburg, PA 17055
~uglas E. Herman, Esquire
CALDWELL & KEARNS
3631 North Front Street
Harrisburg, PA 17110
JILLIAN R. SHAMBAUGH, a
minor, by MICHAEL SHAMBAUGH
and PATRICIA SHAMBAUGH,
parents and natural
guardians of JILLIAN R.
SHAMBAUGH,
Plaintiff
Vo
PHILLIP A. FREDERICK,
Defendant
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 03-2553 CIVIL TERM
RDER F RT
AND NOW, this 12th day of June, 2003, upon
consideration of the Petition to Settle the Claims of a Minor,
it is hereby ordered and directed that the settlement is
approved. GEIG0 Insurance Company is directed to make payment
into a federally insured account in the name of Jillian R.
Shambaugh. Said account to be restricted such that no sums may
be withdrawn therefrom prior to March 30, 2004, without Order of
Court. The parents and natural guardians of the said Jillian R.
Shambaugh are hereby authorized to execute a full and final
release on behalf of the minor Plaintiff, Jillian R. Shambaugh,
and to discontinue the instant action.
GEIGO, or its representative,
file proof at this
opened.
is directed to
term and number that said account has been
Edward E. Guido, J.
Patricia and Michael Shambaugh
19 Kingswood Drive
Mechanicsburg, PA 17055
Brett M. Woodburn, Esquire
Attorney for Defendant
srs
¥1N~tA-1,LSNN~cl
JILLIAN R. SHAMBAUGH, a minor by
MICHAEL SHAMBAUGH and
PATRICIA SHAMBAUGH, parents:
and natural guardians of
JILLIAN R. SHAMBAUGH,
Plaintiff/Petitioner
VS.
PHILLIP A. FREDERICK,
Defendant/Respondent.
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
: NO. 03-2553 - Civil Term
:
: PETITION FOR MiNOR'S COMPRISE
: AND SETTLEMENT
AFFIDAVIT OF DEPOSIT
OF MINOR'S FUNDS
The undersigned, Brett M. Woodburn, Esquire, counsel for the Defendant, hereby
certifies that the net settlement amount of $3,700.00 as set forth in this Court's Order of June 12,
2003, was deposited into a restricted, federally insured account at Fulton Bank, entitled: "Jill R.
Shambaugh Court Order" and marked, "No WD TILL MAJ 03/30/04" on June 20, 2003. Said
account is numbered as 1370-91092.
Proof of deposit is attached hereto as Exhibit A.
Respectfully submitted,
03-239/58246
~LL & KEARNS
t..~.~-~[ ~w. vv u , squire
Attorney I.D. No. 81786
3631 North Front Street
Harrisburg, PA 17110
(717) 232-7661
Counsel for Defendant
Retail Account
FULTON BANK CUi~IB PKWY
1370-91092 ~D: D601 j ]~ranch C"~umberland Parkwa_.~
05/17/2OO3
002/002
]NO WD TILL MAJ 03/30/04
t ~S°~ NO 032553 CIVIL TERM
]
333 LORIA.~=_NN LEITCH
202-66-7772
Address
J~D DR
~I~ECHANIOSBURG PA 17055
19 KII~GSWOOD DR
Emplo~yment
717-697-9214 ~
Mirfimum Balance $
New Checking
~ I -trax (3) ~
OFAC Verification
IOthcr
I Othor
- IOrher
$50,00 Multiples
% P,~tflccd on OFAC
Savings
O~cr
SAVINGS/FULTON FUND DEPOSIT .......
THIS DEPOSIT IS ACCEDED SU~ECT TO VER~FICAT~E~ THE ~)~ I '
PROVISIONS OF THE UNIFORM ~MERClAL CODE AND T ~S AND
REGULATION5 OF THIS BANK ND T~.
CERTIFICATE OF SERVICE
AND NOW, this ~_ day of ~ ,2003, I hereby certify that I have
served a copy of the within document on the following by depositing a tree and correct copy of
the same in the U.S. Mails at Harrisburg, Pennsylvania, postage prepaid, addressed to:
Jillian R. Shambaugh
Michael Shambaugh
Patricia Shambaugh
19 Kingswood Drive
Mechanicsburg, PA 17055
CALDWELL & KEARNS
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