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JOHN N. WALTERS and MARGARET
T. WALTERS, individually and as Parents and
Natural Guardians of DANIEL WALTERS, a Minor,
Petitioners
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY,
: PENNSYLVANIA
v.
; NO. (), - (.,jbP
G()~(Y~
LISA E. MARTIN,
: CIVIL ACTION - LAW
Respondent
ENTRY OF APPEARANCE
TO THE PROTHONOTARY:
Kindly enter the appearance of the undersigned on behalf of the Petitioners, John N.
Walters and Margaret T. Walters, Individually and as Parents and Natural Guardians of Daniel
Walters, a Minor, with respect to the above-captioned matter.
Respectfully submitted,
JAMES, SMITH, DURKIN & CONNELLY, LLP
Dated: /I~j&f
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URKIN, ESQUIRE
_~y IU95~
JARAD W. HANDELMAN, ESQUIRE
Attorney J.D. #82629
P.O. Box 650
Hershey, P A 17033-0650
(717) 533-3280
Attorneys for Defendant
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JOHN N. WALTERS and MARGARET :IN THE COURT OF COMMON PLEAS
T. WALTERS, individually and as Parents and :CUMBERLAND COUNTY,
NaturalGuardians ofDANlEL WALTERS, a Minor, :PENNSYLVANIA
Petitioners
v.
~NO. O/~ lD?OP
eu~l ~~
LISA E. MARTIN,
:CIVIL ACTION - LAW
Respondent
ORDER
AND NOW, this/3 t/J day of fj, r ~ ~, 2001, upon presentation of a Petition
for Approval of Compromise Settlement and Distribution of Proceeds of a Minor's Compromise, it
is hereby directed that a hearing on the merits take place on the ~ day of
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JOHN N. WALTERS and MARGARET :IN THE COURT OF COMMON PLEAS
T. WALTERS, individually and as Parents and :CUMBERLAND COUNTY,
Natural Guardians of DANIEL WALTERS, a Minor, :PENNSYL VANIA
Petitioners
v.
~NO. 01 - 1J6P
C?tU~CY~
LISA E. MARTIN,
:CNIL ACTION - LAW
Respondent
ORDER
AND NOW, this a...J day of r;; -"a
WALTERS and MARGARET T. WALTERS, individually and as parents and natural guardians of
, 2001the Petition of JOHN N.
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DANIEL WALTERS, a Minor, is hereby GRANTED, with Minor's proceeds to be issued as
follows:
Settlement of $5,300.00, to be distributed as follows:
1. $4,250.00 to DANIEL WALTERS in a guardianship account insured by a Federal
governmental agency.
2. $1,050.00 to MARGARET T. WALTERS for unreirnbursed wage loss during the
Minor's convalescence.
3. No withdrawals can be made from such account without Court approval until the
minor reaches majority.
4. Proof of deposit shall be promptly filed of record.
Petitioners may execute a general release in favor of Nationwide Insurance Company and
LISA E. MARTIN.
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JOHN N. WALTERS and MARGARET :IN THE COURT OF COMMON PLEAS
T. WALTERS, individually and as Parents and :CUMBERLAND COUNTY,
NaturalGuardians of DANIEL WALTERS, a Minor, :PENNSYL VANIA
Petitioners
v.
~NO. 0 l- "~f>
C21(.)~l y~
LISA E. MARTIN,
:CIVIL ACTION - LAW
Respondent
PETITION FOR APPROVAL OF COMPROMISE SETTLEMENT
AND DISTRIBUTION OF PROCEEDS OF A MINOR'S COMPROMISE
AND NOW, come Petitioners, JOHN N. WALTERS. and MARGARET T. WALTERS,
individually and as parents and natural guardians of DANIEL WALTERS, a minor, and fIle this
Petition to Compromise Action and for approval and distribution of settlement proceeds and aver
the following in support thereof:
1. Petitioners JOHN N. WALTERS and MARGARET T. WALTERS (hereinafter
"Petitioners") are adult individuals who currently reside at 100 Byron Nelson
Circle, Etters, Pennsylvania, 17319.
2. Petitioners are the parents and natural guardians of DANIEL WALTERS, a
minor, (hereinafter "Minor") who currently resides with Petitioners at the above
address.
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3. Minor's date of birth is May 1,1986.
4. Respondent LISA E. MARTIN (hereinafter "Respondent") is an adult individual
who currently resides at 116 Bungalow Road, Enola, Pennsylvania, 17025.
5. This case arises from an automobile accident on November 15, 1998 wherein the
vehicle of Respondent collided with that in which the Minor was a passenger.
6. As a result of the accident, Minor was taken to Holy Spirit Hospital for evaluation
at which time he was diagnosed with a cervical strain. A copy of the Emergency
Room report is attached hereto as Exhibit "A".
7. Minor had conservative follow-up treatment consisting of pain medication and
rest.
8. Respondent was insured under an auto policy issued by Nationwide Insurance
Company (hereinafter "Nationwide"), an insurance company licensed to transact
business in the Commonwealth of Pennsylvania, with a principal place of
business at 1000 Nationwide Drive, Harrisburg, Pennsylvania, 17112.
9. To date, Minor's medical bills have been paid by USAA.
10. Petitioners have made a careful and diligent inquiry and investigation to ascertain
the facts surrounding the accident, the responsibility of therefore and the nature,
extent and seriousness of Minor's injuries.
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11. As evidenced by that attached hereto as exhibit "B", the 'Minor's treating
physician has opined that the Minor has obtained maximum medical improvement
without the need for further treatment.
12. Nationwide has offered to compromise this claim for the amount of Five
Thousand Three Hundred Dollars ($5,300.00) of which One Thousand Fifty
Dollars ($1,050.00) is to be paid to Margaret T. Walters for out-of-pocket
expenses incurred.
13. Petitioners believe that this compromise with Nationwide is fair and in the best
interest of Minor.
14. Nationwide requests that Petitioners give a release in the form attached hereto as
Exhibit "C".
15. Said compromise is in accordance with Pa.R.C.P. 2039.
16. Petitioners intend to deposit said proceeds of Minor's settlement in a trust account
at Members First Federal Credit Union, a banking institution insured by the FDIC.
17. Proof of deposit shall be filed with the Court.
WHEREFORE, Petitioners request that this Honorable Court enter an Order authorizing
settlement in accordance with the aforementioned terms, and that Petitioners, individually and as
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parents and natural guardians of Minor Petitioner, may execute a general release in favor of
Nationwide Insurance Company and its insured, USA E. MARTIN.
Respectfully submitted,
JAMES, SMITH, DURKIN & CONNELLY LLP
Dated: I~b'/H
B
URKIN, ESQUIRE
Attorney J.D. #29563
JARED W. RANDLEMAN, ESQUIRE
Attorney J.D. #82629
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P.O. Box 650
Hershey, P A 17033-0650
(717) 533-3280
Attorney for Petitioners
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JOHN N. WALTERS, Individually and
as Parent and Natural Guardian of
DANIEL WALTERS, a minor
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DATE
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ARET T. WALTERS, IndiVidually and
as Parent and Natural Guardian of
DANIEL WALTERS, a minor
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VERIFICATION
The undersigned, JOHN N. WALTERS, Individually and as Parent and Natural Guardian of
DANIEL WALTERS, a minor, hereby verifies that the facts set forth in the Petition for Approval of
Compromise Settlement and Distribution of Proceeds of a Minor's Compromise are true and correct
to the best of his knowledge, information and belief and further states that false statements herein
are made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unsworn falsification to
authorities.
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JOHNN. WALTERS
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VERIFICATION
The undersigned, MARGARET T. WALTERS, Individually and as Parent and Natural
Guardian of DANIEL WALTERS, a minor, hereby verifies that the facts set forth in the Petition for
Approval of Compromise Settlement and Distribution of Proceeds of a Minor's Compromise are
true and correct to the best of her knowledge, information and belief and further states that false
statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unsworn
falsification to authorities.
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MAR~~. WALTERS
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ADM. DATE: 11115/98
CC
The panent IS a 12-year-01d whlte mwe who presents after a motor vehIcle aCCIdent.
BPI
The patIent was a restramed passenger 10 the front seat. Complams of pam ID his
nght and left claVIcle areas and nght and lefllllac crest and lower cervIcal, upper
thoraCIC verlebrae, cervIcal area at about the level of Tl, TZ. Demes any other
spec1fle complamts.
PMH
Nll.
ALLERGIES
Nil
SHlFH
Negative.
ROS
The patIent demes any head mjury, loss of conSCIOusness, blurred VISIOn or varnltrng
PHYSICAL EXAMINATION
CONSTITUITlONAL The patIent is a well-developed, well-nounshed while male 10 no acute dIStress.
Temperature 98.Z' FahrenheJt, pulse 69, respIratIons 18, blood pressure 130/68.
EYES ConjunctIvae WIthout dIscharge or IDjectlOn. LIds Wllhout lesIOns. PERRL.
ENT Ears. TympanIc membranes Wltbout perforation, mject:lOn or bulgmg.
Moutb _ LIpS, teetb and gums normal
Throat, Oropbarynx WIthout leslOos or exudate. AIrway patent.
N'ose - Nasal mucosa normal.
Suiuses - No smus tenderness.
NECK The patIent lS teoder on palpation over the level of about Tl, TZ, mostly parasplOous
area, but also 10 the mIdline.
LUNGS Normal respIratory effort. Breath sounds equal Na roles, rhonchI nr wheezes.
CHEST Nontender to palpation.
CARDIAC Regular rate and rhythm WIthout murmurs, ectopy, rubs or gallops.
GUABDOMEN Soft, nontender, normal bowel sounds, no masses. No bepatosplenomegaly.
SKIN Normal color and turgor. The patient has pamt on hIS left forearm from somethmg
unrelated to the aCCIdent.
Page 1
HOLY SPIRIT HOSPITAL
Camp H,I/, PA
17011
NAME: WALTERS, DANIEL
MR#: 403383
ROOM #: BCU
DR.: Rudnick
EMERGENCY ROOM llEl'OJ{T
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EXTREMITIES
SymmetTlcal. Full range of motion. Equal tone and strength. No jomt tenderness
or effusion. No clubbIng or cyanosIs.
NEUROLOGICAL
Alert and oriented to person, place and bme. CranIal nerves Intact. Sensory and
motor functlO,ns no.rmal Reflexes symmetru~al.
PSYCHIATRIC
OrIented to person, place and tIme Mood and affect approprIate.
LABORATORY ASSESSMENT
A unnalysls was negatIVe for blood. An x-ray of the pallent's
cervIcal spme, lumbosacral spme and T-spme were w.thm Dormal
hrolls.
ASSESSMENT
Muscle stram.
PLAN
Ibuprofen or Tylenol for pam, warm soaks to the pabent's tender areas on hIS
back/neck for half hour every four hours for 72 hours. No gym for one week
Fnllow up wIth hIS famIly doctnr wlthm nne week's lime.
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oward RudnIck M.D.
HR/sd
D: 11/15/1998
T 11/16/1998
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HOLY SP1RlT HOSPITAL
Camp Hill, PA
17011
NAME. WALTERS, DANIEL
MR#: 4()3383
ROOM # ECU
DR : RudnICk
EMERGENCYROOM REPORT
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!:Y'ORG5NCY CARE \:NlT
(717) 763-2316
l' AM!L Y !1EALTH CECiTER
(717) 76~i-2424
DISCHARGE INSTRUCTIONS
HOLY SPIRIT HOSPITAL
The examination and treatment you have received in the Emergency Care .unit (Eell) have been rendered on un emergency ba~is only, and are not intended lQ be a substitute for or an effort to provide
complete medical care. If you develop Dew problems or complications ~ontact your physici.an or the I?mergency Care Unit. FOLLOW THE INSTRUCTIONS CHECKED BELOW.
atient Information Patient Information sheets contain important information to review and keep.
aminal pain
( ) Alcohol reaction
( ) Allergic reaction
()Asthma
( ) Back pain
( ) Bites-HumanfAnima1l1nsect
()Surn
( ) Chest Pain
( ) Conjunctivitis
()COPD
( ) Corneal abrasion/foreign body
( ) Croup/bronchills
( ) Crutch walking
( ) Diarrhea and Vomiting/Pad. Vomiting
( ) Drug/Alcohol abuse/addiction
( ) Febrile Convulsion
WOUND CARE
( ) May gently wash over wound in 24 hours with soap and water or
peroxide. Do not soak in water.
) Change dressing _ times daily. Redress with Bacitracin/Neosporin
and sterile dressing.
) Keep wou ) Tetanus/Diptheria Booster given.
PRAINS, STRAINS, BRUISES, FR
evate the injured part for days to reduce swelling.
) Apply ice packs intermittently for _days to reduce swelling.
) Ace wrap for support for _ days.
) Wear splint () At all times until follow-up.
( ) For activity as needed.
) Use sling for support.
) Use crutches: () As needed, weight bearing as tolerated,
( ) At aU limes, NO WEIGHT BEARING
CKlBACK
ar cervical collar for support for _ days.
( ) Rest, avoid bending, lifting, strenuous activity for _days.
(V'Apply moist heat for gO minutes ~ -p times daily
(<09;"'109 In .."".,. -Ir'- 3 D/J-C;:S
ADDITIONAL INSTRUCTIONS
( ) Off work/school from to
( ) Light Duty until:
Restrictions: ; ~
M' No gym/sports until I (I ':'> 0 / t?
{}Follow instructions on W~r men's Compensation Form.
( ) Wear eye patch for hours,
{ ) If nose bleed recurs, pinch nose firmly for 5 minutes
continuously, relurn if bleeding not controlled.
) The prescribed antibiotic may reduce the effectiveness of
medication you are currently taking. Check package
instructions or consult with Pharmacist.
) The interpretation of your X-Rays are preliminary reading.
Your films will be reviewed by a radiologist. You or your
physician will be contacted if there is a change in the
diagnosis.
Additional Instructions:
( ) Fever/Ped. Fever ( ) Laceration
( ) Flu ( ) Neck Strain
( ) Fracture ( ) Nosebleed
( ) Headache ( ) Otitis Media
( ) Head Injury ( ) Pediatric Head Injury
( ) Hypertension ( ) Pediatric URl
( ) ImmunizationlTetanus ( ) PIDND
( ) Kidney Stones ( ) Rash
C:I"fOlCAT~
1 Continue present medications except:
( ) Seizure
( ) Sore Throat
5li Sprains and Strains
,() Threatened Mlscarriage
( ) Toothache
( ) U RI and Colds
( ) UTI and Pyelonephritis
( )Olher
Use Advil (Ibuprofen) or Tylenol as needed for pain, fever
ac ording to package instructions for age, weight.
( ) Use the following medicines according to package
instructions:
1:
2:
3:
) The following medicines may cause drowsiness:
DO NOT DRIVE OR OPERATE MACHINERY WHILE TAKING:
~ThjS is our recommendation for follow~up. If your
insurance (HMO) requires a physician referral for specialty
consultation, .IT IS YOUR RESPONSIBILITY TO OBTAIN THE
~~ESSARY APPROVAL,
~ollaw-up with: { ~ Return to hospital
;?<\Family Doctor-
2 ( ) WorkNet
in - / () days for: MFollow,up
f ) Suture removal
( ) Call as soon as possible for appointment
) Pick up your X-Rays from the Radiology Department prior to
your follow-up appointment. Call 763-2696 to have films
ready.
) See your physician or specialist if not improved in
days.
) Return to ECU if you feel your condition is worsening,
especially if
) Your blood pressure was elevated, Please have it
rechecked by your physician.
) Test results have been given to you. Take them with you to
the follow.up appointment.
Test results given: DCBC DCPRO 0 EKG D X-RAY COpy
o RENAL PRO, 0 RECORDS COPY CHART 0 GLUC,
~TIENT VERBALIZES UNDERS:rANDING
/ J h~bY acknowledge receipt of these instructions and
. understand them. I understand that I have had emergency
treatment Ql!]y and that I may be rele~sed before all of my
medical problems are known or treated. I will arrange for
foHow~up care as I have been instructed,
StGNA TUR
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RUN DATl!: I 11/15/98 HOLY SPIRIT HOSPITAL, CAMP HILL, PA 17011 PAG!: 1
RUN TD:llI:. 1546 Dl!lPARTMmrr 0'1 LAllORATORY mDICINB
STl!:PEKNSON S.P. SWAXIIXlSS'X.D., DiRIICTOR
LOCATION
Name t W1IL1li:RSrPMIEL G ~./SeXi' 12/M Att!md I)",. ED GROUP
AC<ltlh 000012737128 unitt, 403382 Stll.tullll REG Ell. LooAtion. Ear ROW
a.g. U!15/Sa Dhelll
Spec #. 1115:UOO024S CollI 11/15/98-1531 Statu.. CaMP Req #. 00991856
Reed, 11/15/98-1533 sub Dr: ED GROUP
Ordered: URIliI
'rest Result 1":l.a9 Referenclll
Il&rN "
~ COLOR YELWW 11M, ST, YE
~ ClARITY CLEM CLBl\R
~ pH 7 0 4 5-8 0
~ SPJlC. GAA'V. 1.015 1.002 -1, 030
~ GLUe, NORMAL NORMAL MG./DL
~ Kll'XONES. UllIQAU.VE NEGATIVE MG ./ln..
~ EILI NEGATIVE NEGATIVE
~ Gee, Ji.tD. NEGATI1l1l ImGATIVE
~ PROTEIN NEGATIVE NEGATIVE
~ NITRITE NEQATIVE NEGATIVE
~ LEUK EST NEGATIVE NEGATIVE:
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RUN DATH. 11/17/98 HOLY SPIRIT,HOSPITAL, CAMP HILL, PA 170~1 PAGS 1
Rtm T:IMll. 0909 ' IlBPAR'rI<<llN'l' or t1iJI.OPA'r,ORY MED:ICIIIl!
STEPHlWSOll S.P. SWAM:IIlOSS lI.ll., DIRBCTOR
LOCATION
ll'_. WAx/rEllS,DANWL a Age./S""" 12i!lil Atte:lOl kl RlJDNIex,:ltOWARP L MP
Aec't:#, 000012737128 unitt. 403383 Stat;lI$, REG ER &oeat:l.on. BCD ROTJ'X
bgl 11/15/98 D:l.sch:
98:~0018603R COMP, ColI 11/15/98-1525 Reed 11/15/98-1537 (R#00991864) ED GROUP
Source: WMS DR
Ordered, URINE CULT
IGlU\M sf.UlAA/,,-N' S~IlEN I ..: ~.'
NO:l' PERt"OIOOlD - 1 .CREEN NEGATIVE
> \U11:INE CllLTORE I 1I'i1'1lLl
NO OR~I'sMS ISOLATED .'
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HOLY SBLRIT HOSPITAL
DEPARTMENT OF RADIOLOGY AND DIAGNOSTJ:C IllAGiNG
CAlIP HILL, PENNSYLVANIA 11011
(717) 763-2600
PATIENT: WALTERS, DANIEL G
IIR: 403383
SOC SEC: 999-05-0186
OHD DR.: ED GROUP,
PT TYPE, E~
ADlI DA~998 02,37PI1
LOCATION ECll
DICTATION DATE: 11/15/98 5:36pm
TRANSCRIPTION DATE 1111611998 07: 55AM
ARRIVAL DATE,
HOSP SERVICE: ECU
EXAMINATION: CERVICAL SPINE (8V)
COMMENTS,
Alignment is normal and the disc interspaces are preserved. No bony
abnorrnallt1es are seen. There 1S no encroachment on the neural foramina.
The atlanto-ax1al relatlonsh1ps appear normal.
CONCLUSION: Normal cervIcal spine.
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f'(. "Ii <; fE"\Jlewed bV
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DICTATED BY, K.R. Ha1det, M.D./lah
DATE O~ EXAM: 11/15/1998
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HOL~ SPIRIT HOSPITAL
DEPART!lEN'l' OF RAO!Ci!.bGt AND DIAGNOSTIC IllA~ING
CAMP HILL, PENNSYLVANIA 17011
(717) 763-2600
PATIENT. WALTERS, DANIEL G
MR. 403383
SOC SEC. 999-05-0186
ORD DR.. ED GROUP I
PT TYl'E~. E:
ADM DATE 1 5/1. 02.37PH
LOCATIO .
DICTATION DATE. 11/15/98 5.36pm
TRANSCRIPTION DATE 11/16/1998 07.56AM
ARRIVAL DATE.
HOSP SERVICE: E:CU
EXAMINATION. THORACIC SPINE (3V
COMMENTS:
Alignment i$ normal and the dlSC interspaces are preserved. The
vertebral bodies are normal in height. The bony architecture is normal and
there is no abno~mal wldening of the paraspinal stripe.
CONCLUSION, No~l thoracic spine.
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DICTATED l3Y: ICR. Haidet, M.D./lah
DATE OF EXAM. 11/15/1998
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1'I0LY SPIRIT HOSPITAL
DE!'ARTHENT Of' RADIOLOGY 1IND DIAGNOSTIC IHAGING
CAMP HILL. PENNSYLVANIA 17011
(717) 763-2600
PATIENT: WALTERS, DANIEL G
Hlh 403383
SOC SEe: 999-05-0186
ORC DR.: ED GROUP,
PT TYPE: E
ADM DATE 1~:37PM
LOCATIO~
DICTATION DATE. 11/15/98 5:36pm.
TRANSCRIPTION DATE 11/16/1998 07.57AM
ARRIVAL DATE:
HOSP SERVICE: ECU
EXAMINATION: LUMBAR SPINE (6V)
COMMENTS:
Alignment is normal and the disc interspaces are preserved. The bony
structures appear normal. The apophyseal and sacro-illacjolnts are
unremarkable.
CONCLUSION: Normal lumbar spine.
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pr~'l\tS re'J\
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DICTATED BY: K.R. Haidet, M.D./lah
DATE OF EXAM: 11/15/1998
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DAVID M. JOYNER,. M.D., f A.c.s.
RJCHARDJ. BOAL, M,D.
ROBER\' R. DAJ1MUS, M.D.
STEPHeN W. DAlLEY, M.D.
WILLIAM W. DEMtITtl, M.D., F .A.C.S.
JOHN R. FRANKENY IT, M.D., f'.A.C.S.
MARKR. GRUBB, M.D.
RICHARD H. tlALLOCK, M.D.
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JAMES R. HAMSHER, M.D" FA.C.S.
GREGORY A. liANJ.<.5, M.D.
ALEXANDER KALENAK, M.D., fAC.S.
ROBEKr R. KANEDA, D.O.
RONALD W. LIPPE, M.D., f A.C.S.
JASON J. LlTfON, M,D.
STEVEN B. WOLf, M.D.
'lliOMASJ, YUCiiA. M.D,
ORTHOPEDIC INSTITUTE
OF PENNSYLVANIA
TELEPI10NE: (717) 761-5530 ,
(800) 834-4020 FAX: (717) 737-7197
October 16, 2000
John McNally, Esquire
James, Smith, Durkln & Connelly LLP
P.Q, Box 650
Hershey, PA 17033
OCT 2 4 2000
RE: Daniel G. Walters
212 17 2461
Dear Mr. McNally:
The above patient was initially seen by me on December 16, 1998.
12-year-old boy, who had no history of neck or low back pain and
as a passenger in the front seat of a car on November 15, 1998,
stopped and was rear-ended by another vehicle that he said might
going 40 miles an hour. He noted the onset of neck and low back
seen at Holy Spirit Hospital the day of injury where radiographs
cervical spine, thoracic spine and lumbosacral spine were taken,
reportedly showed no abnormalities.
He was a
was seated
The car was
have been
pain and was
of his
They
When I saw Dan:Lel, he was taking Advil and was having intermittent neck and
low back pain. His orthopedic examination disclosed no objective findings of
neck or low back abnormalities, I felt that Dan had strained his neck and
low back in thl~ vehicle accident and because of continued pain was unable to
wrestle at that time, I felt that it was appropriate for him to continue
taking Advil and sent him to the Keystone Spine Center for a program of back
exercises, which he was to continue to do on his own, At that point I felt
that no other lnvestigative studies were indicated and expected his symptoms
to subside with the passage of time. I did not feel that surgery would be
necessary.
When I saw Daniel on December 16, 1998, he was still symptomatic and had not
L eaclled maximum llledlcal lmp.l'ovement. I do not K.now whell he will do so. AS
have stated I do not know if any additional medical treatment is needed or
prescribed because I have not seen him in nearly two years.
If I can be of other help to you, please call on me,
c~~~~
Jaso J. Lltt ,M,D.
JJL/Clv
CAMP lULL Of'FfCt;
3916 TRlNDLE RD.
0RT110PE:DIC SURGEONS. LTD.
ADDRESS ALL CORRESPONDENCE TO: 875 POPLAR CHURCH RoAD, CAMP HILL, PA 17011
IlARRISBUKG OFFIce CAMP HILL OFFICE HBRSHBY OFNeB
450 POWERS AVE. 890 POPLAR CHURCH RD., STE. 108 10 WEST CHOCOLATE AVE., STE. 105
CAMP BILL OFFICE
875 POPLAR CHURCH RD:
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FULL AND FINAL RELEASE
FOR AND IN CONSIDERATION of the sum of FIVE THOUSAND THREE HUNDRED
DOLLARS ($5,300.00) paid to the undersigned, JOHN N. WALTERS and MARGARET T.
WALTERS, individually and as Parents and Natural Guardians of DANIEL WALTERS, a Minor, the
receipt and sufficiency of which is hereby acknowledged, the undersigned agree to fully release,
discharge, hold harmless, and indemnify NATIONWIDE INSURANCE COMPANY, LISA E.
MARTIN, and all other persons, associations and corporations, whether or not named herein, their
heirs, executors, administrators, successors, assigns and insurers, and their respective agents, servants,
employees and attomeys, from any or all causes of action, claims and demands of whatsoever kind on
account of all known, and unknown injuries, losses and damages allegedly sustained by DANIEL
WALTERS on November 15, 1998, and, specifically, from any claims, or joinders, for sole liability,
contribution, indemnity or otherwise as a result of, arising from, or in any way connected with injuries
sustained by DANIEL WALTERS, and the defense and handling thereof from the inception of the
claim until the date of this Full and Final Release,
The undersigned understand and agree 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 known injuries, losses, and damages, but any
further injuries, 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. Nationwide Insurance Company will,
however, pay for all future treatment to the Minor which resulted from automobile accident of
November 15, 1998 to the extent not covered by other insurance, and such payments shall be made
directly to the Minor's healthcare providers,
It is further understood and agreed that this is the complete Release Agreement, and that there
are no written or oral understandings or agreements, directly or indirectly connected with this Release
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and settlement that are not incorporated herein. This Agreement shall be binding upon and inure to the
successors, assigns, heirs, executors, administrators, and legal representatives of the respective parties
hereto.
The undersigned hereby declare and warrant that they are of legal age, the terms of this
settlement have been completely read, and that they have discussed the terms of this settlement with
legal counsel of choice; and said terms are fully understood and voluntarily accepted for this purpose 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 suits arising out of the aforesaid claims.
WITNESS:
JOHN N. WALTERS, Individually and as
Parent and Natural Guardian of DANIEL
WALTERS, a Minor
DATE
WITNESS:
MARGARETT. WALTERS, Individually
and as Parent and Natural Guardian of
DANIEL WALTERS, a Minor
DATE
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JOHN N. WALTERS and MARGARET : IN THE COURT OF COMMON PLEAS
T. WALTERS, individually and as Parents and : CUMBERLAND COUNTY
NaturalGuardians of DANIEL WALTERS, a Minor, : PENNSYLVANIA
Petitioners
v.
: NO. 01-6808
LISAE. MARTIN,
: CIVIL ACTION - LAW
Respondent
PRAECIPE TO SETTLE AND DISCONTINUE
TO THE PROTHONOTARY OF YORK COUNTY:
Kindly mark the above docket as settled, satisfied and discontinued as to. all parties in this
action.
JAMES, SMITH, DURKIN & CONNELLY, LLP
Dated: i;/;o/&;r
. /
By:
,ESQUIRE
ttorney I.D. #29563
/ JARAD W. HANDELMAN, ESQUIRE
Attorney LD. #82629
P.O. Box 650
Hershey, P A 17033-0650
(717) 533-3280
Attorneys for Petitioners
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JOHNN. WALTERS and MARGARET : IN THE COURT OF COMMON PLEAS
T. WALTERS, individually and as Parents and : CUMBERLAND COUNTY,
NaturalGuardians of DANIEL WALTERS, a Minor, : PENNSYLVANIA
Petitioners
v.
: NO. 01-6808
1
LISA E. MARTIN,
: CNIL ACTION - LAW
Respondent
PRAECIPE TO FILE PROOF OF DEPOSIT
OF MINOR'S SETTLEMENT
TO THE PROTHONOTARY OF YORK COUNTY:
Please file, and make part ofthe record, the attached proof of deposit of Minor's
settlement proceeds in accordance with the Order of Court dated January 2, 2002.
JAMES, SMITH, DURKIN & CONNELLY, LLP
Dated: ~/;d/O"'~
,ESQUIRE
Attorney I.D. #29563
JARAD W. HANDELMAN, ESQUIRE
Attorney 1.0. #82629
P.O. Box 650
Hershey, P A 17033-0650
(717) 533-3280
Attorneys for Petitioners
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P.O. Box 40 . Mechallipsburg, P.A 17055-0040
(717) 697-1161
TOLL FREE (800) 283-2328
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Memberslsr
FEDERAL CREDIT UNION
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February 19, 2002
Re: Daniel G Walters
Karen Durkin
PO Box 50
Hershey, PA 17033
Dear Karen:
<:
Members 1 st FCU has established an account for Daniel G Walters. The funds
in the account have been placed in a Certificate of Deposit and frozen until May
1, 2004 pursuant to the Order of the Court of Common Pleas of Cumberland
County. The enclosed document shows the account name and the restriction
placed on those funds.
Please contact us for any additional assistance. Any questions or further
communications should be directed to Gregory P Schank, A VP Branch
Operations at 717-795-6003 or 1-800-283-2328 ext 6003.
Respecfully,
QOC"h~ yYT ~(Y4
/
Isodean M Worley
Assistant Branch Manager
Enclosure
FEB 2 r< 2002
5000LouiseDrive. P.O.Box40 . Mechanicsburg, Pennsylvania 17055 . (717)697-1161. Fax(717)795-6024
www.memberslst.org
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