HomeMy WebLinkAbout01-0347 FX~' a 4
MARGARET ROGUSKY and
VICTOR L. ROGUSKY, as Parents
and Natural Guardians of
MICHAEL ROGUSKY, a Minor,
Petitioners,
v.
VICTOR L. ROGUSKY,
Respondent
JAN 1. 8 Z[7(~~
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
No. O! - 3~7
CIVIL ACTION - LAW
ORDER
AND NOW, this ~Y ~ day of 2001, it is
HEREBY ORDERED AND DECREED that a he ring on the Petition of
Margaret Rogusky and Victor L. Rogusky, Guardians of Michael
Rogusky, a Minor, is hereby scheduled for ®~~S o'clock on
~_¢,plhc.c-C l~ 2001, in Courtroom No. ~ of the Cumberland
County Courthouse, 1 Courthouse Square, Carlisle, Pennsylvania,
at which time, all interested parties shall appear and be heard.
THE .Q`OId`R9~':
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MARGARET ROGUSKY and IN THE COURT OF COMMON PLEAS
VICTOR L. ROGUSKY, as Parents CUMBERLAND COUNTY, PENNSYLVANIA
and Natural Guardians of
MICHAEL ROGUSKY, a Minor,
Petitioners, NO.
CIVIL ACTION - LAW
v.
VICTOR L. ROGUSKY,
Respondent.
ORDER
AND NOW, this day of 2001, upon
consideration of the Petition of Petitioners, Margaret Rogusky
and Victor L. Rogusky, guardians of Michael Rogusky, a Minor, it
is HEREBY ORDERED AND DECREED that the Petition for Minor's
Compromise and Settlement in the amount of $10,000.00 shall be
paid to Petitioners, as Guardians of the aforesaid Minor.
Petitioners shall deposit the settlement monies in an interest
bearing savings account for the benefit of Minor, where it shall
remain until Minor obtains the age of majority. Petitioners are
authorized to execute a Release in favor of Victor L. Rogusky,
Daniel Rogusky and their insurance carrier, State Farm Mutual
Automobile Insurance Company. The Release shall be in the form
of the Release attached to Petitioners' Petition as Exhibit "C"
BY THE COURT:
~~
J.
MARGARET ROGUSKY and IN THE COURT OF COMMON PLEAS
VICTOR L. ROGUSKY, as Parents CUMBERLAND COUNTY, PENNSYLVANIA
and Natural Guardians of CIVIL ACTION - LAW
MICHAEL ROGUSKY, a Minor,
Petitioners,
v.
VICTOR L. ROGUSKY,
Respondent
:DOCKET NO . a i- 3 Y7 ~ ~~-~'"'
PETITION OF PETITIONERS, MARGARET ROGUSKY AND
VICTOR L. ROGUSKY. FOR MINOR'S COMPROMISE AND SETTLEMENT
AND NOW, comes Petitioners, Margaret Rogusky and Victor
L. Rogusky, ("Petitioners"), as Parents and Natural Guardians of
Michael Rogusky, a Minor ("Minor"), and file this Petition for
Minor's Compromise and Settlement, averring the following in
support thereof:
1. Petitioners are adult individuals currently
residing at 830 W. North Street, Carlisle, Pa 17103.
2. On January 24, 1999, Minor was a passenger in a
vehicle driven by Respondent's son, Daniel Rogusky. Minor was
injured in a single car accident in Carlisle, Pennsylvania.
3. As a result of the aforementioned motor vehicle
accident, Minor was hospitalized overnight at the Hershey Medical
Center for a closed head injury and fractured ankle. A copy of
the inpatient Hershey Medical Center records are attached hereto,
incorporated herein by reference and labeled Exhibit "A."
4. On February 16, 1999, the short leg cast was
removed. After ten days, Minor was permitted to return full
range of motion and was instructed to return to the orthopedic
office only as needed. Copies of outpatient medical records from
Hershey Medical Center are attached hereto, made a part hereof
and marked as Exhibit "B."
5. Since that time, Minor has had no complications,
problems or pain associated with any of the injuries sustained in
the accident or any other part of his body allegedly injured in
the accident.
6. Minor was born on June 25, 1984, and is currently
sixteen (16) years of age.
7. Petitioners have made a careful and diligent
search in investigating and ascertaining the facts surrounding
the accident, the responsibility therefor, and the nature and
extent of Minor's injuries.
8. State Farm, Respondent's insured, has agreed to
compromise Minor's claim for $10,000.00.
9. The aforementioned settlement has been explained
at length to Petitioners and Petitioners have indicated that they
understand same and have voluntarily agreed to enter into the
settlement.
10. The settlement is in no way to be construed as an
-2-
admission of liability of the part of Respondent or State Farm,
or any other persons or entities.
11. Petitioners believe that the settlement is fair
and in the best interest of Minor.
12. State Farm and Respondent hereby request
Petitioners to give them a release in the form that is attached
hereto, made a part hereof and marked as Exhibit "C."
13. Petitioners fully intend to invest the proceeds of
this settlement as provided by Chapter 73 of the Decedents,
Estates and Fiduciaries Code, and to make such distribution of
the income received by them in accordance with 28 Pa. Cons. Stat.
§5164 for the ongoing, necessary, and reasonable expenses for the
care, maintenance and education of Minor.
WHEREFORE, Petitioners, Margaret Rogusky and Victor L.
Rogusky, as Parents and Natural Guardians of Michael Rogusky, a
Minor, prays this Honorable Court enter an Order approving the
Minor's Compromise.
Date:. /~IO~p/
Dater/D~O/
By : a~t~he~7~ / SoO.(,to~cl~
MAR. A ~ T~ T ROGUSKY
~ ~ ~
By : ~~ ~,,
VICTOR L. ROGUS
Parents and Natural Guardians
of the Minor, MICHAEL ROGUSKY,
and Petitioners herein.
-3-
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- State FarmInsurance Compari~es(~)
INfYtANC~
State Ferm Inaurence
115 Limekiln Road
PO Box 257
March 3 , 1999 New Cumberland PA 17070-02'.
Hershey Medical Center H~~>~~:~S~iJ~y~a
500 University Drive
Hershey, PA 17033 M,l~ ~ 1 ~~~9
Attn: Medical Records Administrator
RE: Claim Number: 38-J163-263
Date of Loss: January 24, 1999
Our Insured: Victor L. Rogusky
Patient #~: SSN 162-68-7248 •
Dear Medical Provider:
Enclosed is an authorization for release of medical information
concerning Michael Rogusky who was treated on 1/24/99 and after.
We request the following:
~, Complete Medical Records
Admission History and Physical
Emergency Room Records
Discharge Summary
Other:
Please include your bill for this information and payment will
follow. Thank you for your assistance.
Sincerely,
Claim Specialist ~^~''~-
(717) 774-9015 ~
r.
State-Farm Mutual Automobile Insurance Company •.
Enclosure: Authorization
RECORpE
eq• #
~~ ~I; ~ _Initials_~
S-1.+_.
HOME OFFICES: BLOOMINGTON, ILLINOIS 89710-0009
Vii; ,:;
M'~ 2 21~9~
Recordex Services, Inc. has been retained by the Medical Record Department of
HERSHEY MEDICAL CENTER
to fulfill requests for copiss;of medical. records. We wish to, emphasize that-the
increasing demands for patient.data pose a rising threat to-the confidentiality of the-
. patient's medics! information: `Recordex Services strives to take every opportunity.
to safeguard patients' right to privacy as outlined in the AHA's Patient Bilf of Rights. ,.
$pecifcally, all patients Kaye the .right "to expect that all communications and
recocds pertaining to their care will-lie treated as' confidential by. ttie hospital :and. any
othec.part~o entitled to review certain information in such records," ~As one such party,
we ask that all information transmitted herewith be treated with utmost.respeCt and .
the dignity such personal. medical information warrants.
.Enclosed are the reproduced medical documents specifically authorized by the
patient orhis/her legal representative. Each medical record was carefully reviewed
to assure proper disclosure to, you, the .requestor. -Any re-.disclosure without the .
~.. express written consent of the person to whom the information pertains is prohibited. ,
.Please be .advised that ttie use:of. the information for other than .the stated purpose
- : is prohibited: Based upon guidelines provided by the.American Health Information
Management Assi?ciation; the information should also be.destroyed after thestated .-
need has been fulfilled.: ~ -
If you have any questions,.please do not hesitateao. contact:us'at 1-800-525-2922 .
and one. of our Customer Service Representatives will be happy to assist you.
Thank you for your cooperation in maintaining the patient's right to, privacy.
RECORDEX SERVICES, INC.
17 Lee Boulevard • Suite D • Malvern, PA 19355 • (610) 640-0600 • I-800-525-2922 • Fax (610) 640-3844 • www.fyii.com
>,
EMERGENCY MEDICINE
~ PennState c.sisinger ~ CENTER
P.O. BOX 850
HOfllth $YStCiri HERSHEY, PA 17033.0850
717 531 8333 TEL
/ 4'~ r~ , ' % 'T
~:a~11Cic~:3.y, `~~~~
HAR 2 2 t99~
EMERGENCY DEPARTMENT NOTE
PATIBNT NANS: TRAUMA PATIENT
PATISNT NUI~BR: 0=3StY83~ti' DATE OF 3SRVICS: 01/24/99
ST$X: DATE OF BIRTH:
3ISTORY: The patient is a 14-year-old male who was the restrained
1@ft rear seat passenger involved in a motor vehicle accident where
the car ran off the road and hit a pole. There was-very ex~enaive
' v@hicle damage and there were two other very seriously injured
victims from the same accident brought by Life Lion to the hospital.
This patient was entrapped for approximately 45 minutes with his legs
wedged in the vehicle. He remained alert and did not have any loss
of consciousness prehospital. Hia main complaint was left lower
extremity pain. Initially prehospital his pulse was 130, but this
d@creased to 88. His prehospital blood pressure was 143/81 and he
was noted to be in a sinus rhythm. A peripheral IV was placed and
the patient was given 400 cc of IV fluid prehospital and after
extrication he was transported here eventually by Life Lion.
MEDICATIONS: None.
ALLERGIES: No known allergies.
PAST MEDICAL HISTORY: Unremarkable.
PERSONAL/SOCIAL HISTORY: Not obtainable due to the acuteness of the
patient's presentation.
FAMILY HISTORY: Not obtainable due to the acuteness of the patient's
presentation.
REVIEW OF,SYSTEMS: Not obtainable due to the acuteness of the
patient's presentation.
PHYSICAL fiXAMINATION:
General: On arrival to the Emergency Department showed the patient
to be alert and oriented. A cervical spine collar, long spine board,
left arm IV and face mask oxygen were in place.
Vital signs: Pulse 86, respiratory rate 20, blood pressure 151/82.
Oxygen saturation was 97~.
HEENT: Scalp was nontender without lesions. Face showed a small
abrasion over the left eyebrow. Eyes revealed pupils round and
reactive to light. Extraocular movements full. Nose and throat
normal.
Neck: No focal tenderness. Shoulders and chest wall nontender.
Lungs: Clear bilaterally.
Page 1 of 2
,. ~
PATISNT NAffi8: TRAUMA PATIENT
Cardiovascular: Regular rate and rhythm.
Abdomen: Flat, soft and nontender with normal bowel
Back: Lower back nontender.
Pelvis: Stable.
Extremities: Left leg showed tenderness and swelling
calf to just below the left ankle. Pedal pulses were
of motion and capillary refill were normal.
sounds.
from the mid
2+. Toe range
EMERGENCY DEPARTMENT COURSE: I was present at the patient's arrival
in the Emergency Department and supervised his initial exam.
Dr. Cilley was also present and further attending supervision of the
case was turned over to him. The patient will have further workup by
the Pediatric Trauma Surgery Team and then be admitted by the
Pediatric Trauma Surgery Service.
DIAGNOSIS: Ruie out multiple trauma.
1
DICTATING MD:
C. James Holliman, M.D.
Assoc Professor Director, International Emergency Med
Assoc Program Director, ED Residency Program
CJH/csb D: 01/24/99 T: 01/25/99 19:
~5,~~~~~~U~~
PATISNT NQMB q03 ~O~aO
Page 2 of 2
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Vital S Summary Comments
1Yme S s / Dia (Mean) HR/PR SpO2
HH:MM -- mmli (1VIBP) -- BPM °k
15:30 139 / 78 (95) 87 100
15:44 132 / 76 (89) 91 100
16:00 134 / 71 (90) 101 100 .
16:14 127 / 76 (90) 105 100
16:30 130 / 84 (96) 111 100 t
16:46 131 / 77 (91) 111 100
SNAPSHOT 25 mm/sec Adult/Pediatric ,
Medical Ceater -
15:00 2 Hour Tabular Trend Adult/Pediatric
median (averaged) data
MdR 7 7 tene~age 1 er ~
~:~vhi:~i3s~al.~i`~',t^a 17:00
71Gne HR/PR PVCs Sp02 NIBP (mrnFlg) Comments
FIIi:MM BPM /min % S/D(M)
15:00 93 89 OFF
15:05 97 99 OFF
15:10 90 99 OFF
15:15 90 98 137/79 (96 )
15:20 86 100 OFF
15:25 88 100 OF.~
15:30 87 100 199/78 (95) /
15:35 92 100 OFF
15:40 95 100 OFF
15:45 91 100 I32/76(89)
15:50 98 100 OFF
15:55 97 100 OFF
16:00 101 100 134/71(90)
16:05 105 100 OFF
16:10 104 100 OFF
16:15 105 100 127/ 76 (90 )
I6:20 114 99 OFF
16:25 104 100 OFF
16:30 111 100 130/84(96)
16:35 112 100 OFF
16:37 111 0 100 OFF
16:40 111 0 100 ~ OFF
16:45 114 0 100 OFF
16:46 112 OfiF 100 131/77 (91) '
16:47 111 0 100 OFF
16:50 109 0 100 OFF
16:55
(3 i
17:00 ~3~' %
~ennState Geisinger
]Health System
DISCHARGE SUbII~lP.RY
-- Ha'
Health Information Servi~c~es 13~~Y~
M.C. HU24 M q ''AA
P.O. Box 850 ` ? u~9
Hershey, PA X7033-0850
PATIENT NAME: ROGUSKY, Michael P.
PATIENT NUI~IDER: 0969441 DATE ADMITTED: 01/24/99
LOCATION: DATE DISCHARGED: 01/25/99
SE%: DATB OF BIRTH: 06/25/84
ADMISSION DIAGNOSIS:
1. Status post motor vehicle collision. ~
2. Closed head injury.
3. Left ankle-talus avulsion fracture.
BRIEF HISTORY: This is a 14-year-old white male who was the
restrained back seat passenger involved in an auto versus pole motor
vehicle accident and was brought in by EMS complaining of left ankle
pain. The patient was amnestic to the event. ATLS protocol was
carried out and the patient was found on primary survey to be a 14-
year-old white male who was alert and oriented with a GCS score of
15. Airway was patent and he was breathing spontaneously. Initial
vital signs were as follows: Pulse 86, blood pressure 151/82,
respirations 16, oxygen saturation 97~ on room air. Last meal was
around 9-10 a.m. and last tetanus shot was approximately one year
ago.
Secondary survey showed that the patient had minor superficial
abrasions across the forehead and bilateral lower extremities. He
also had swelling noted in the left ankle/foot area. Otherwise his
secondary exam was unremarkable.
PAST MEDICAL HISTORY: AD/HD.
PAST SURGICAL HISTORY: None.
MEDICATIONS: None.
ALLERGIES: No known drug allergies.
LABORATORY DATA: CBC - white blood cell count 17.5, hemoglobin 14.4,
hematocrit 40.8, platelets 230. Creatinine 0.9, glucose 127, PT
12.9, PTT 38, INR 1.1, total bilirubin 0.6, ALT 26, myoglobin less
than 0.5, amylase 58, ionized calcium 1.24. ETOH level was less than
10. Urinalysis was negative. Drug screen was likewise negative.
Chest x-ray showed no pneumothorax. Pelvis showed on evidence of
fractures. C-spine series showed no fractures. Extremity films
showed the following: Right tibia/fib no fractures. Left ankle:
Small avulsion fracture of the talus. CT scan of the head was
unremarkable
Page 1 of 2
FEB 01199
c _ MARp?1~~9
PATIENT NAME: ROGUSKY, Michael P.
PATIENT NUMBER: 0969441
HOSPITAL COURSE: The patient was admitted to the pediatric trauma
surgery service for his closed head injury and left talus avulsion
fracture. He had his avulsion fracture evaluated by orthopaedic
surgery who then placed him in a splint overnight. The following day
they removed the splint and placed a left lower examination cast on.
Overnight, the patient did well and in the. morning he was begun on a
diet which he tolerated well. He reported adequate pain control.
His c-spine then was cleared radiographically and clinically. The
patient continued to do well and he was discharged to home.
DISPOSITION: Discharged to home.
DISCHARGE MEDICATIONS:
1. Tylenol 650 mg p.o. q.4-6 hours prn pain or ibuprofen 200-600 mg
p.o. q.6-8 hours prn pain.
DIET; Patient may resume usual diet as tolerated.
f
ACTIVITIES: The patient may be weightbearing as tolerated on the
left lower extremity with the cast. He may refrain from any physical
education or sports activities until otherwise specified by a doctor.
He may call 531-8342 (pediatric surgery office) or 531-8521 (ask for
pediatric surgery resident) for dizziness, persistent vomiting,
altered mental status, slurred speech, vision problems, numbness or
tingling or any questions or concerns related to his injury. He
should call 531-8521 (pediatric orthopaedic resident on call)
regarding any questions or concerns of his left lower extremity
injury. He is to keep his cast clean and dry.
FOLLOWUP: He will follow up with Dr. Segal at Pediatric Orthopaedics
in three weeks' time. He will also follow up with Pediatric Surgery
in three weeks' time for his closed head injury.
DICTATING MD:
Zandra H. Cheng, M.D.
ATTENDING MD:
Robert E. Cilley
ZHC/eep D: 01/25/99
c: WP Clerk
T: 01/28/99 12:46
J. LYNN HOFFMAN, M.D.
804 BELVEDERE STREET
CARLISLE PA 17013
Page 2 of 2
FennState Geisinger
Health System
DISCHARGE SUNIId'ARY
~ M.C. HU24 rmation S MAC Z ? fne~
P.O. Box 850 ~7~7
Hershey, PA 17033-0850
PATIENT NAME: ROGUSKY, Michael P.
PATIENT NOMBER: 0360830 DATE ADMITTED: 01/24/99
LOCATION: /~ Gq~,(L(~DATS DISCHARGED: 01/25/99
3$%: DATE OF BIRTH: 06/25/84
ADMISSION DIAGNOSIS:
Status post MVA, closed head injury and left talus avulsion fracture.
DISCHARGE DIAGNOSIS:
Same.
OPERATIONS OR
None.
BRIEF HISTORY: The patient is a 14-year-old white male restrained
back seat passenger of an auto versus pole MCV with amnesia of
events, brought to Hershey Medical Center for trauma evaluation.
ATLS protocol was followed. The patient was found to have a closed
head injury and a left ankle talus avulsion fracture. The patient
was placed in a splint and tasted and admitted to the hospital for
observation.
HOSPITAL COURSE: The patient did well overnight, was started on a
clear diet in the morning, advanced to regular without difficulties
in the afternoon. The C-spine was cleared on hospital day one both
radiographically and clinically. On the day of discharge, the
patient was ambulating with crutches without difficulty and was
tolerating a regular diet.
Physical exam was within normal limits. There was a cast on the left
lower extremity. The patient was discharged on Tylenol every 4-6
hours p.r.n. or ibuprofen 200-600 mg every 6-8 hours p.r.n.
The patient was discharged with the following instructions - resume a
regular diet, may be weight bearing on the left lower extremity with
leg cast, crutches for assistance. The patient was instructed .to
call the pediatric surgery office or the pediatric surgery resident
L`or any problems. The numbers were provided. Problems included
dizziness, persistent vomiting, altered level of consciousness,
slurred speech or any other questions or concerns. The phone number
was provided for the orthopedic surgery resident on call for any
other problems regarding the left ankle injury and finally to keep
Page 1 of 2
FEB D1
' -- .- qR ~ ~ 19gg
. i_ ~
PATIENT NAME: ROGUSKY, Michael P. PATIENT NUMBER: 0360830
the cast clean and dry. The patient was made a follow up appointment
with Dr. Segal in orthopedic surgery in three weeks.
DICTAT2NG MD:
Christopher Wolfgang, M.D.
ATTENDING MD:
Robert E. Cilley, M.D. ,
CW/psc D: 01/25/99 T: 01/28/99 15:24
c: WP Clerk
J. LYNN HOFFMAN, M.D. #
804 BELVEDERE STREET
CARLISLE PA 17013
Page 2 of 2
PennState Geisinger
Health System
Date of Exam: 25-Jan-99
ROBERT CILLEY MD
PEDIATRIC SURGERY
HMC, ** *****
Mq -~L,~
R
~12,~ Radiology Services 2
~~Q a ~v M.C. H066 Z 19,Q9
eo. Box sso
00969441 Hershey, PA 17033-08s0
545A-012599
ROGUSKY,MICHAEL P
25-Jun-84
7MBS
724302
Exam: DX FOOT 1-2 VIEWS - LT WGTBEAR, AP LAT,
AP AND LATERAL FILMS OF THE LEFT FOOT TAKEN STANDING
CLINICAL HISTORY: This patient was in a motor vehicle accident and
had an injury to the foot.
DISCUSSION: Poorly seen through the fiberglass is the avulsed ~
dorsodistal aspect of the talus at the talonavicular articulation,
result of an avulsion fracture. There is no other abnormality.
Reviewed & Signed: KATHLEEN D. EGGLI, M.D.
KDE/jgh
DICTATED: 25-Jan-99 TRANSCRIBED: 26-Jan-99 SIGNED: 02-Feb-99
_ College of Met
University Hospital •Chilm-a._ .iospi[al
The Milton S. Hershey Medical Center
PROGRESS REPORT
._.
4~ .~ ~7.4e~~19~rt'
.J79
PEDIATRIC ORTHOPAEDIC CLINIC
TAE PENN STATE GEISINGER HEAi,TH SYSTEM
ROGUSITY, MICHAEL P. MSffiKC# 0969441 February 16,1999
TORY: Michael returns for a follow up. He was involved in a motor vehicle accident three
weeks ago. He sustained an avulsion &at~ure of his left talus. He was treated with a ahortdeg cast.
Weightbearing a13 tolerated. For the past three weeks, he has had no problems. He has been quite
active in the cast. The cast is removed today.
PHYSICAL E%ANIINATION: He is nonteader. Range of motion is 5 degrees dorsiflesion and 20
degrees plantar fle>non. Neurovascular status is intact.
RADIOGRAPHS: Radiograph was not obtained today. ~
CR~F _ONIlVVIENIDATIONB: I have asked that Michael maintain a limited decreased activity for the
nest tend days. Rettua to clinic on a p.r.n. basis. Physical therapy for full range of motion,
strengthening, and proprioception, and weightbearing as tolerated.
I}ictated by:
Lee S. Segal, M.D
Associate Profess
Department of Orthopaedics and Rehabilitation
Pediatric Orthopaedics
LSS/ebt
D: 02/16/1999 T: 02/19/99
tx: Medicalrecorda
File copy
MR 8.1.Rev. ales PROGRESS REPORT
FULL AND FINAL RELEASE
FOR AND IN CONSIDERATION of the sum of Ten Thousand Dollars
($10,000.00) paid to the undersigned, Margaret Rogusky and Victor
L. Rogusky, as Parents and Natural Guardians of Michael Rogusky,
Minor, and other good and valuable consideration the receipt and
sufficiency of which is hereby acknowledged, the undersigned
agree fully to release, discharge and hold harmless and indemnify
Victor L. Rogusky, Daniel Rogusky, State Farm Mutual Automobile
Insurance Company, and all other persons, associations and
corporations whether or not named herein, their heirs, executors,
administrators, successors, assigns and insurers, and their
respective agents, attorneys, servants and employees, 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 the Minor on January 24, 1999, 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 the
Minor, on account of which a Legal Action was instituted by the
undersigned in the Court of Common Pleas for Cumberland County,
Pennsylvania, at Docket No.
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 now
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.
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 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 that they are of legal age;
that the terms of this settlement have been completely read; that
they have discussed the terms of this settlement with legal
counsel of choice; and that said terms are fully understood and
voluntarily accepted for this purpose of making a full and final
compromise, adjustment and settlement 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
-2-
suits, administrative proceedings or any other claims for relief
arising out of the aforesaid claim.
IN WITNESS WHEREOF, and intending to be legally bound
hereby, we have hereunto set my hand and seal this day
of
WITNESS:
2001.
MARGARET ROGUSKY
VICTOR L. ROGUSKY
As Parents and Natural
Guardians of Michael Rogusky,
a Minor
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MARGARET ROGUSKY and IN THE COURT OF COMMON PLEAS OF
VICTOR L. ROGUSKY, as Parents :CUMBERLAND COUNTY, PENNSYLVANIA
and Natural Guardians of :CIVIL ACTION-LAW
MICHAEL ROGUSKY, a Minor,
PETITIONERS
V.
VICTOR L. ROGUSKY, 3~~
DEFENDANT 09-~3~-7 CIVIL TERM
ORDER OF COURT
AND NOW, this ',~ day of February, 2001, following a hearing, IT IS
ORDERED:
(1) Approval of the settlement of this minor's claim for $10,000 for Michael
Rogusky, born June 25, 1984, IS GRANTED.
(2) The gross proceeds of $10,000 shall be placed in an interest bearing
account at the AIIFirst, Carlisle, Pennsylvania in the name of Michael Rogusky, born
June 25, 7984.
(3) The account shall contain the following notation: "NO WITHDRAWAL CAN
BE MADE PRIOR TO MICHAEL ROGUSKY OBTAINING HIS MAJORITY EXCEPT
BY AN ORDER OF COURT OF COMPETENT JURISDICTION."
(4) Counsel for defendant shall file with the Prothonotary and forward a copy to
the chambers of this judge proof of compliance with this order.
By the rt, ~ ~ O ~
Cww11~
C~"_~
~~f7
Edgar B. Bayley,
~ _ a
Margaret Rogusky and
Victor L. Rogusky, Pro se
Petitioners
Michael M. Badowski, Esquire
For State Farm Insurance Company
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MARGARET ROGUSKY and IN THE COURT OF COMMON PLEAS OF
VICTOR L. ROGUSKY, as Parents :CUMBERLAND COUNTY, PENNSYLVANIA
and Natural Guardians of :CIVIL ACTION-LAW
MICHAEL ROGUSKY, a Minor,
PETITIONERS
V.
VICTOR L. ROGUSKY,
DEFENDANT 01-0347 CIVIL TERM
ORDER OF COURT
AND NOW, this ~v~.. day of March, 2001, IT IS ORDERED that the order
of approval of the settlement of a minor's claim entered on February 14, 2001, is
amended to replace Allfirst, Carlisle, Pennsylvania, with Orrstown Bank. All other
provisions of the order shall remain in full force and effect.
By the
Edgar B. Bayley,
Margaret Rogusky and
Victor L. Rogusky, Pro se
Petitioners
Michael M. Sadowski, Esquire
For State Farm Insurance Company
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MARGARET ROGUSKY and
VICTOR L. ROGUSKY, as Parents
and Natural Guardians of
MICHAEL ROGUSKY, a Minor,
PETITIONERS
V.
VICTOR L. ROGUSKY,
DEFENDANT
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION-LAW
01-0347 CIVIL TERM
ORDER OF COURT
AND NOW, this day of March, 2001, IT IS ORDERED-that the order
of approval of the settlement of a minor's claim entered on February 14, 2001, is
amended to replace Allfirst, Carlisle, Pennsylvania, with Orrstown Bank. All other
provisions of the order shall remain in full force and effect.
By the Ca
Edgar B. Bayley,
Margaret Rogusky and
Victor L. Rogusky, Pro se
Petitioners
Michael M. Sadowski, Esquire
For State Farm Insurance Company
- NON NEGOTIABLE/NON TRANSFERABLE
-. ._ `_
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NO~506Q~ 6 661 '- .. TIME CERTIFICATE OF DEPOSIT- " ~ _' ; ORR,S~LOWN BANK
_ MICHAEL P ROGOSRY =162-68=7248 oawxmepsxPOCACwu~xr coxsulBiRWSPOBE _P.o:BOXBO--
_;- ..,.__ .. __ d0lpV-]IML ~._;- ' I _~:- -~,SHIPPENSBURG PA~t7257
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-MEMBERFDIC,I ^ } li i- "~' ~} ,r~'.~r ~~pt~ ~~~•`^~y n dp~ ~'+ 1 , -_ fl II ' -
..HAS DEPOSDEDIN THIS BANK ' ' J~~i! ` '~-`" II~'~, ~~ 1,•^° ~_1~ -~ .~EJ ~-a7 Idv~„~{: )F''~~' _ I •~ 1 _ _ _ __
PAYBLE TO,. ,, 0. f;POSISOR(S)';.SUBJECi TO:THE CON~fIIONS PRINTED ON THE REVERSE SIDE OF'CERTIFlCATE I ~ ' I ~ - --- ~ : - i =`I I - !'' _:
MAIL CHECK= ~ . ~ ~ ~ ..
O MONTHLY . ___ ^SEMl-ANNUALLY - -~
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3-I.~-~l MONTHS 7-1]-02 -J. Vl tesaiHN+I rR ~iDD-0N - Q CREDIT ACCT.-NO.
UNDER PENALTIES OF PERJURY 1 CERTIFY THAT THE ABOVE NUMBER LS MY CORRECT TAKPAYER IOENRFlCATION ~ : -
NUMBER - --~^~SINGLE MANBRY CEpTIFlCATE (IIEY30N BACK) --'~ -~
UNDER PENALTIES OF PERJURY 1 CERTIFY THAT I AM NOT SUBJECT TO BACKUP VlRHHOLTNNG. EffHEA BECAUSE
TNAVE NOT BEEN NOTIFIED THAT I AM SUBJECT TO BACKUP WTTHHOLOING AS A RESULT OF A FAIWRE TO REPORT L3°AU IUMATICALLY RENENti1BLE CE CATS (REM I ON BACK)
ALL-NIIEREST aA DNIOENDS, OA THE WI'EANAL REVENUE SERVICE HAS NOTIFIED ME THAT 1 AM NO LONGER - /~
9UBJECI'c10/BIACKUP WITHNOLDNG..y~ ~ 1 ~ L / / - ~ i / '
DEPOSITOR'T-A.I ~'I'11/JMn'00 /iD7Aih A/4~ A „~~YYvv"" c~~D ~~/ (//~~/ \~l4yf/ /i in
MARGOLIS EDELSTEIN
PHILADELPHIA OFFICE
THE CURTIS CENTER
FOURTH FLOOR
INDEPENDENCE SQUARE WEST
PHILADELPHIA, PA 19106-3304
215-922-1100
FAX 215-922-1772
PITTSBURGH OFFICE
1500 GRANT BUILDING
PITTSBURGH, PA 15219-2203
412-281-4256
FAX 412-642-2380
WRITER:
MICHAEL M. BADOWSKI'
DIRECT E-N1AIL: mbadowski@margolisedelstein.com
ATTORNEYS AT LAW
POST OFFICE BOX 832
HARRISBURG, PA 17108-0932
STREET ADDRESS:
3510 TRINDLE ROAD
CAMP HILL, PA 17011
717.975.8114
FAX 717-975-8124
Honorable Edgar B. Bayley
Judge
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013
April 1G, 20P01
1~
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DELAWARE COUNTY OFFICE
21fi SOUTH ORANGE STREET
MEDIA, PA 19063
610-565-8311
FAX 610505-8318
NEW JERSEY OFFICE
P.O. BOX 2222
216 HADDON AVENUE
WESTMONT, NJ 08108-2888
856-858-7200
FAX 856-858-1017
SCRANTON OFFICE
THE OPPENHEIM BUILDING
409 LACKAWANNA AVENUE
SUITE 3C
SCRANTON, PA 18503
570-342231
FAX 570-342-0841
Re: Margaret Rogusky and Victor L. Rogusky
as Parents and Natural Guardians of
Michael Rogusky, A Minor, Petitioners, vs.
Victor L. Rogusky, Respondent
Petition for Minor's Com romise and Settlement
Docket No. 01-0347 Civil Term ~
Dear Judge Bayley:
7n fulfillment of your Order referable
settlement in this matter, please find enclosed a
received from Mrs. Rogusky along with a photocopy
Bank C.D. containing your or
MMB/na
Enclosures
cc: Ms. Linda
Koch (SF#38-J163-263, w/encls.)
*Certifed as a Civil Trial Advocate by the National Board of Trial Advocacy
A Pennsylvania Supreme Court Accredited Agency
to the minor's
letter I
of the Orrstown
endorsement-
830 W. North Street
Carlisle, PA 17013
April 6, 2001
Mr. Michael Badowski
Margolis Edelstein
3510 Trindle Road
Camp Hill, PA 17011
Dear Mr. Badowski:
Enclosed is a copy of the order of the court
we received concerning Michael's settlement money
and verification of its investment in Orrstown
Bank. I have also enclosed a copy for you to for-
ward to Judge Bayley.
Thank you for your help in the settlement
process. We appreciate your time and effort.
Sincerely,
Margaret Rogusky