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Home My WebLink About99-05350MARTSON DEARDORFF WILLIAM' M 0TI11 ININIIN.,ILM.AINII! • AIM1IFA,., TEN EAST HIGH STREET CARLISIP, [PENNSYLVANIA 17013 CALL[ WISE, a Minor, D.O.B. 7/30/95, by her Legal Guardian, COLLEEN WISE, Petitioners V. JILLIAN M. FORREST and CGU INSURANCE COMPANY, Respondents SEP - 1 1999 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 99- t'311) e-,:.d '(cl- ORnEg AND NOW, this tf.??day of 1999, a hearing is hereby set to consider Co.?,troe , N?1 I for 1approval of the Minor's Compromise. The hearing will be held ere she-.......able N-re on 11 2Fi • 1999.- t7 3 : /Yt e-Y,6?- /V--" ?4? , ??L. CALLI WISE, a Minor, D.O.B. 7/30/95, by her Parent and Legal Guardian, COLLEEN WISE, Petitioners V. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO.99- JILLIAN M. FORREST and CGU INSURANCE COMPANY, Respondents AND NOW, this _ day of 1999, upon consideration of the foregoing Petition for Approval of Minor Settlement, Respondents are ordered to pay all claims in the amount of $30,000.00 as set forth in the Petition. Said funds shall be deposited in a federally insured account and shall not be removed until minor Petitioner reaches age 18 or upon further order of this Court, which shall retain continuing jurisdiction. Petitioners are authorized to execute a General Release to settle all claims as set forth above. BY THE COURT, ,J F IFILEV'DATAFII.I IGENW(w)%?xxLYIT In& 1. -b<mN IM:IN/YX 1111 11 AM X, i,W OY/DIW Ilx 11111 AM CALLI WISE, a Minor, D.O.B. 7/30/95, by her Parent and Legal Guardian, COLLEEN WISE, Petitioners V. JILLIAN M. FORREST and CGU INSURANCE COMPANY, Respondents IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO.99- 5350 &i JT- I. The minor Petitioner is Calli Wise who was bom on July 30, 1995. 2. Petitioner, Colleen Wise, is the minor Petitioner's mother, and has custody of the minor Petitioner. On or about June 27, 1998, Respondent, Jillian M. Forrest, was traveling on Longs Gap Road at its intersection with North Middleton Road in North Middleton Township, Cumberland County, when she rear-ended Petitioner's vehicle. 4. As a result of the accident, the minor Petitioner sustained personal injuries and was transported to the Emergency Room at Carlisle Hospital. She sustained a laceration to her right arm. The minor Petitioner was covered by a policy of motor vehicle insurance with Harleysville Insurance Company which has paid all of the medical bills associated with the treatment and care of the minor Petitioner. 5. The minor Petitioner was held in the hospital overnight for observation and was released the next day. 6. The minor Petitioner's injury did require further medical care with Dr. Lawrence Thompson who may need to perform two or three surgical procedures in the future to revise the scar from the laceration. 7. The parties desire to obtain Court approval of a settlement for the minor Petitioner, Calli Wise, and her parent and legal guardian, Colleen Wise, who have agreed to accept $30,000.00 in settlement. 8. Said settlement of $30,000.00 shall be paid as follows: r (a) $15,000.00 in cash, less expenses and attorney's fees of $7,500.00 to be deposited in a federally insured account; and (b) $15,000.00 to be placed into a structured settlement with Commercial Union Life Insurance Company of American which will pay minor Petitioner, or her estate, on July 30, 2017 the amount of $41,775.00. WHEREFORE, Petitioners request that this Honorable Court schedule a hearing to consider approval of the Minor's Compromise. MARTSON DEARDORFF WILLIAMS & OTTO By U- 6-, ? L4?? Daniel K. Deardorff, Esquire I.D. No. 17837 Ten East High Street Carlisle, PA 17013-3093 (717) 243-3341 Attorneys for Respondents Date: August 31, 1999 The foregoing Petition for Approval of Minor Settlement is based upon information which has been gathered by my counsel in the preparation of the lawsuit. The language of the document is that of counsel and not my own. I have read the document and to the extent that it is based upon information which 1 have given to my counsel, it is true and correct to the best of my knowledge, information and belief. To the extent that the content of the document is that of counsel, I have relied upon counsel in making this verification. This statement and verification are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unswom falsification to authorities, which provides that if 1 make knowingly false averments, I may be subject to criminal penalties. Colleen Wise, Parent and Legal Guardian of Calli Wise, a Minor r . 1M1 :: CALLI WISE, a Minor, D.O.B. 7/30/95, IN THE COURT OF COMMON PLEAS OF by her Parent and Legal Guardian, CUMBERLAND COUNTY, PENNSYLVANIA COLLEEN WISE, Petitioners V. : NO. 99- JILLIAN M. FOP-REST and CGU INSURANCE COMPANY, Respondents CONSENT OF PETITIONER AND LEGAL GUARDIAN The undersigned, Colleen Wise, Petitioner, in the above captioned action and mother of Calli Wise, a minor, has read the foregoing Petition for Approval of Minor Settlement, and has reviewed the terms of said Petition and settlement with our attorney and hereby consent to the Petition and agree to said settlement. Colleen Wise n M > C- L, ( 1 I .? U?l 4 Q1 CJ a ? v y n WISE, CALLI MARIE MR 0777796 C? o6/26/199a CHIEF COMPLAINT: Ann injury. HISTORY OF PRESENT ILLNESS: This is a 2-year-old female who was in a car seat in the backseat of a motor vehicle that was involved in a motor vehicle accident. My understanding is that the child was on the left side of the car. The car rolled on its left side. It did not completely roll over, however. Apparently the child was restrained. Mother and I believe the driver is a medic. What was found on ?---• '- ..? - - --- 9 buds not able secondary survey wa- i to specifically give m4 in partially immo- bilized. Her head we PAST MEDICAL HIS No o Mumbling MEDICATIONS: No. ALLERGIES: No knc 4 (? - REVIEW OF SYSTEM EXAMINATION: Bloc t Examination of the head reveals pupi 9 9 "5350 C( V) L_ ill. There is a small area on the righ . No other obvious facial lesions. deviation. Lungs are clear to auscultate To ° °r P011 " c I °, r ?a.n. and nontender. No ecchymosis there. 1 d' ?" y cm laceration which is gaping of the right anterior upper arm )and a small area, I believe, laceration of the proximal forearm. I do not seen any obvious evidence of, fracture. No obvious neurovascular involvement. She did have a distal radial pulse present. DATA BASE: X-ray, portable right arm, revealed per Emergency Department M.D., no fracture or dislocation. EMERGENCY ROOM COURSE: She had normal saline 50 cc an hour started IV, fentanyl 15 mcg to help sedate her slightly. Due to the significance of wound, 1 have asked or, Thompson, Plastic Sur- gery on call, to come perform the repair. He decided to take her to the Operating Room to have that performed. She was discharged from the Operating Room. FINAL DIAGNOSIS: Laceration, 6 cm, right arm. FPItt D: 07/02/1998 - 06:47 T: 07/05/1998 aV Page 1 of 1 ORIGINAL am EPETITIONER'S t h9 id, CARLISLE HOSPITAL EMERGENCY ROOM RECORD Paul Franke, M.D. 0j) UC" ha Up2aMO WISE, CALLI MARIE MR 0777798 C? 06/2811998 CHIEF COMPLAINT: Ann injury. HISTORY OF PRESENT ILLNESS: This is a 2-year-old female who was in a car seat in the backseat of a motor vehicle that was Involved in a motor vehicle accident My understanding Is that the child was on the left side of the car. The car rolled on its left side. It did not completely roll over, however. Apparently the child was restrained. Mother and I believe the driver is a medic. What was found on secondary survey was significant laceration of the right arm. The child presents crying but is not able to specifically give me a history. There was no loss of consciousness. Child comes in partially immo- bilized. Her head was turned very much to the right Infer and she was crying heavily. PAST MEDICAL HISTORY: None known. MEDICATIONS: No. ALLERGIES: No known allergies. REVIEW OF SYSTEMS: No loss of consciousness. She is guarding her right arm. EXAMINATION: Blood pressure 123/88. Pulse is 133. Respirations - child Is crying. Examination of the head reveals pupils are equal, round, and reactive. Extraoeular movements are full. There is a small area on the right forehead of ecchymosis present but there is no bony deformity. No other obvious facial lesions. As stated, pupils are equal, round, and reactive. No tracheal deviation. Lungs are clear to auscultation bilaterally. No obvious fracture of rib cage. Abdomen is soft and nontender. No ecchymosis there. Extremity exam reveals that the child has approximately a 6-8 cm laceration which is gaping of the right anterior upper arm and a small area, 1 believe, laceration of the proximal forearm. I do not seen any obvious evidence of. fracture. No obvious neurovascular involvement She did have a distal radial pulse present. DATA BASE: X-ray, portable right arm, revealed per Emergency Department M.D., no fracture or dislocation. EMERGENCY ROOM COURSE: She had normal saline 50 cc an hour started IV, fentanyl 15 Meg to help sedate her slightly. Due to the significance of wound, I have asked Dr, Thompson, Plastic Sur- gery on call, to come perform the repair. He decided to take her to the Operating Room to have that performed. She was discharged from the Operating Room. FINAL DIAGNOSIS: Laceration, 6 cm, right arts. FP/tt D: 07/02/1998 - 06:47 am T: 07/05/1998 aV Page 1 of 1 ORIGINAL 1 PETITIONER'S EXHIBIT o /8 kJC CARLISLE HOSPITAL EMERGENCY ROOM RECORD Paul Franke, M.D. J ijvo Uti;u 44 gEp 2 b M5 To: lsKSncm K. Thompson III, N.D. From: Carlisle Hospital 0-29-99 10:101. p. 1 of 2 4t 06/28/1998 WISE, CALLI MARIE OBS 102-W MRS 777796 DATE OF OPERATION: 06/27/98 SURGEON: Or. Lawrence K. Thompson III ASSISTANT SURGEON: OPERATION: Exploration, debridement, closure of wounds and abra- sions of right upper extremity. HISTORY: The above-captioned two year old little girl was seen at the request of the emergency physician for evaluation and treatment of a laceration sustained in an auto accident to the right arm. The mother states that the child is in gCod health. She has been followed closely by her pediatrician, all "shots" are current. General health has been good. No allergies, etc. The patient was seen in the Emergency Room and Emergency Room treatment was rendared. Due to the severity and size and loca- tion of the lacerations and abrasions and the amount of dirt it was felt that the child should be taken to the Operating Room. Permission was granted and after receiving this and preoperative evaluations she was taken to the operative suite. DESCRIPTION OF OPERATION: The patient was seen in consultation by anesthesia and under anesthesia standby supplemented with 4 Xylocains plain the arm was prepped and draped ae a sterile field. There was a moderate amount of gravel and dirt in the wounds. The wounds were carefully scrubbed with saline as well as Betadine. sharp dissection was also performed. It was neces- sary to do some debridement as the edges were quite irregular and friable. In addition, there were numerous abrasions an both sides, extensor and flexor, of the arm. The lacerations measured approximately 12 cm to 14 cm in length, the largest one, there were actually three, and the widest of this was approximately 4 cm to 5 cm. There was a small laceration at the base of the right little finger and numerous puncture wounds and gravel on the extensor surface. There were also abrasions of the entire upper extremity. Following prepping and draping the wounds were then closed with interrupted inverted 4-0 Vicryl subcutaneously and then multiple 5-0 Prolene was used for cutaneous approximation. Two tissue drains were placed in the depths of the wounds and secured with their own 5-0 Prolene. The wounds were then dressed with Adaptic and Betadine. As stated, the wounds had previously been debrided with Betadine and saline irrigation. 4x4's, ABC, and OCL splint M. 0. Page 1 of 2 66-28-98 22:97 WISE, CALLI MARIE CBS 102-W MRu 777796 06/27/1998 07/30/1995 Thompson III, Lawrence K. CARLISLE HOSPITAL OPERATIVE REPORT NEO'?DC?O44 RECEIVED FROM: SE?'P? 1996 To: UKence K. Thompson III, M.D.? \ From: Carlisle Hospital 049-98 10:10" P. 2 of 2 I 06/28/1998 WISE, CALLI MARIE OBS 102-W MR# 777796 was incorporated. The wound on the hand was debrided and closed with several interrupted sutures of 5-0 Prolene as were several lacerations on the extensor surface of the forearm. OCL splint, as stated, as utilized and an Ace dressing. FINAL CLINICAL IMPRESSION: Multiple lacerations, abrasions, and foreign body of right upper arm and right little finger. LKT/vfn D: 06/28/1998 - 08:07 am T: 06/2911998 Lawrence K. Thompson III, M.D. cc Dr. Lawrence K. Thompson III WISE, CALLI MARIE CBS 102-W MR# 777796 06/27/1998 07/30/1995 Thompson III, Lawrence K. M. 0. Page 2 of 2 96-28-98 22:98 CARLISLE HOSPITAL OPERATIVE REPORT RECEIVED FROM: RECD DCO 44 SEP 2 4 1998 P.92 08/1L99 21:20 FAX Cosmetic & Plastic Surgery Center of Cenirat ftnnjytvania, RC. 19 Brookwood Avenue, Suite I OS CedWc, Penngivania 170133-9126 (1) 717-249-2244 • (F) 717-249-4534 August 11, 1999 Dan Deas+dorf, Attorney At Law RE. Calk wine Dear Mr. Dmrdorb Q01 Peter Gienwein, M.D. Lawrence K. Thompson, 1I1, M.D., F.A.C.S. Please Std enclosed a photograph, taken of Cblli on her recent visit to the office. The very thick scar directly above the elbow is of course tender and sensitive and itchy and this represents a hypertrophic or kehdd type sear. This am Is that wonldpp ? 3.o cm in length and about Ls cm in width. 'T'his is the one that this be of major concert. The others areas of coarse an also, but I think larger one will deWtely require surgical intervention or revision. This is a difficult area because of continuous bending and atercislug of the area, and therefore the child will always have a scar. ne other areas I believe will improve with some conservative management and/or the use of laser. It has beet well over a year now since her unfortunate Wary, and I think that the sears have reached ma)dmum maturity as far as the characteristics. Mother and Chi have been very good as far as following instmc ions regarding the use of various medications and message. You had requested my thoughts on this matter. In all probability, the area may require two b ore three procedures. It would be a rough estimate that each procedure In the neighborhood of ssoo.oo • $700.oo dollars. Ilia would be the surgeon's flee. None would use laser, of course there would be an additional charge for the facility as well as operating rooms. I hope that this information is of some help to you. if additional information is required, please give us a call. With regards, I remain. Yom, LKr/bds Lawrence I ompson, III, M.D., FAC.S. Enclosure 0 Membera?` A*VJWa VE CALLI WISE, a Minor, D.O.B. 7/30/95, by her Parent and Legal Guardian, COLLEEN WISE, Petitioners V. JILLIAN M. FORREST and CGU INSURANCE COMPANY, Respondents IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 99-5350 CIVIL TERM AND NOW, this 18th day of October, 1999, upon consideration of the foregoing Petition for Approval of Minor Settlement, Respondents are ordered to pay all claims in the amount of $30,000.00 as set forth in the Petition. $7,500.00 of said funds shall be deposited in a federally insured account and shall not be removed until minor Petitioner reaches age 18 or upon further order of this Court, which shall retain continuing jurisdiction. Attorneys fees of $7,500 are approved and to be paid from the settlement. $15,000.00 shall be placed in a structured settlement as set forth in the Petition. Petitioners are authorized to execute a General Release to settle all claims as set forth above. BY THE COURT, J G _ J s r. a. co v `r ~ ?c F p c cm ON V W 2 ?QT V MARTSON DEARDORFF WILLIAMS & OTTO MDW&O ,IxroMNnlum.AI- TEN EAST HiG11 STREET CARLISLE, PENNSYLVANIA 17013 CALL[ WISE, a Minor, D.O.B. 7/30/95, IN THE COURT OF COMMON PLEAS OF by her Legal Guardian, COLLEEN WISE, CUMBERLAND COUNTY, PENNSYLVANIA Petitioners V. : NO. 99-5350 CIVIL TERM JILLIAN M. FORREST and CGU INSURANCE COMPANY, Respondents PRAECIPE TO THE CUMBERLAND COUNTY PROTHONOTARY: You are hereby directed to file the attached signature card and deposit slip pursuant to the Order of Judge Oler dated October 18, 1999. MARTSON DEARDDORFF WILLIAMS & OTTO By?? ? D=k6 Daniel K. Deardorff, Esqui e I.D. No. 17837 Ten East High Street Carlisle, PA 17013-3093 (717) 243-3341 Attorneys for Petitioners Date: October 25, 1999 Keystone Financial y DEPOSIT CREDIT HF4120W3AA1 CASH DATE / J NMIE?O//2l/l: /H u.!?SL.Las.?.kt_SQlIi. 1.?.1'tt?l:inm..? c ACCOUNT NUMBER " LESS CASH olram.vn Tar revunr, cal croon v,maluvw. /`TOTAL nr v,wr r rsu•w w,cr Jo .wvmr M \ /? $ DEPOSIT I,glll TM ApYIVr tl M IIrIl1Y COtY01fJK f811?' .MMr.u, nowan,JOrvrwwn ?Gl 1:5 18 11e1 26001: M.unOr DLUO pyhu Yl if Om MDW?O I.mp•MO•,lo?or.cr TpFUtNW Sllipl G.wa.Ilwnnrwu 1JOu TuplPr I717I241dH1 60.472 871.9 313 October 25, 19 99 PAY TO THE 11-71 ORDER OF Calli Wise, a minor, by her mother/ guardian Colleen Wise I $ 7,500.00 t am+• - t 6 avi :wt '? • DOLLARS e FlVj TRUSTACCOUNT MAMD SPl' f' 1 PmPn4' Pro ppda x'00871911' 1:0313047201: I C ?' y - R k AV 26720 20332u' 1. KEYSTONE FINANCIAL BANK, N.A. The signer(s) of this card agree(s) to be bound by the Deposit Accts. Agreement & an) other rules, regulations, or disdosures now in fora &lor hereafter adopted applicable tc the acct. & acknowledge receipt of such Deposit Acct. Agreement, rules & regulations, & disclosures as well as pricing information covering this acct If the depositors are husband & wife, they hold the acct. as joint Tenants with Right of Survivorship & not as Tenants in Common. Upon death of any of the owner, the balance shag become the absolute property of the survivor(s) subject to the rules relating to inheritance and estate tax. If the acct. is corporation, partnership or unincorporated association or other non-personal acct., a separate resolution is on Me. CERTIFICATION-Under penalties of perjury, I artily that (1) The number shown on this form is my correct taxpayer m I (or I am waiting for a number to be Issued to me), & (2) 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding. CERTffICATION INSTRUCTION - You most sou out Item (2) above If you have been notified by IRS that you are currently subject to backup withholding because of underreporting interest or c ividendan your tax return. Signature: )o COLLEEN R WISE COST FOR GLLI M19E P]O3TNa1 NO MITImRAM9 PEA COURT ORDER UNrrL 1/30/13 OR UNTIL THRU COURT ORDER 160 DORMOOD DR CARLISLE PA 17013-2171 -782-227- --174-76-5127 IMPORTANT SERVICE NAME BANK-OFFICE/INITIAL SIGNER(S) BELOW savings Account II )Qf o19-aO1 ACKNONLEDGE READING IDENTIFICATION FOR SIGNER NO.t OF STATEMENTS OW IDkoaT rnaTO.na THE TOP OF THIS CARD S PRINT 11. SIGNATURE - LC'L TITLES N 2. E3' R S L. Thin account is 9overuad by PA Dapoalt ACCOUer 4aw. CERTIFICATE OF SERVICE I, Lori A. Sullivan, an authorized agent for Martson Deardorff Williams & Otto, hereby certify that a copy of the foregoing Praecipe was served this date by depositing same in the Post Office at Carlisle, PA, first class mail, postage prepaid, addressed as follows: Ms. Mercene Kennedy Claims Representative CGU Insurance P.O. Box 8851 Camp Hill, PA 17001 MARTSON DEARDORFF WILLIAMS & OTTO By Lori 'A. Sullivan' Ten East High Street Carlisle, PA 17013 (717) 243-3341 Dated: October 25, 1999 c: Cn N r F? G i4? m =i cn U