Loading...
HomeMy WebLinkAbout04-0914ELIZABETH BRANDLER, a minor, BY AND THROUGH HER PARENTS AND NATURAL GUARDIANS BRUCE BRANDLER and VIVIAN BRANDLER Plaintiffs EDWARD W. DIEHL and PATTI ANN DIEHL, Defendants 1N THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA AMICABLE ACTION NO. .IURY TRIAL DEMANDED PETITION FOR APPROVAL OF A MINOR'S COMPROMISED SETTLEMENT AND DISTRIBUTION OF PROCEEDS The Petition of Elizabeth Brandler, a minor, by and through her father and natural guardian, Bruce Brandler, respectfully represents: 1. Elizabeth Brandler is the daughter of Bruce Brandler and Vivian Brandler. Elizabeth is 17 years old, having been bom on August 7, 1986. 2. Elizabeth Brandler resides at 1053 Country Club Road, Camp Hill, PA, with her mother and father. 3. On June 26, 2002, while Elizabeth was a guest of the Defendants, their dog bit Elizabeth causing damage to her lip and mouth. 4. Elizabeth was taken to Holy Spirit Hospital where sutures were required and follow- up with a plastic surgeon. 5. Elizabeth was followed by Peter Giesswein, M.D., a plastic surgeon, in Carlisle, Pennsylvania. 6. On 1une 25, 2003, Elizabeth had surgery for the revision of the scar at Holy Spirit Hospital performed by Dr. Giesswein. See, Operative Report attached as Exhibit A. 7. Dr. Giesswein authored a report dated July 14, 2003 describing Elizabeth's progress. See, Report attached hereto as Exhibit B. 272580. I \CMG\CMG 8. Counsel for the Plaintiffs and the insurance company, Allstate Insurance Company entered into settlement negotiations and a settlement was reached in the amount of Thirty-Three Thousand Seven Hundred Fifty ($33,750.00) Dollars. See, Release attached hereto as Exhibit C. 9. In view of the uncertainty of securing a verdict, Your Petitioners consider the offer to be a fair, just and equitable settlement and to be in the best interest of Elizabeth Brandler. 10. Plaintiffs' counsel recommended that the Plaintiffs accept said offer, pending Court approval. 11. Plaintiffs retained the law finn of Angino & Rovner, P.C., to prosecute this action and entered into a contingency fee contract with said attorneys whereby said attorneys were to received, for professional services, 20% of the gross amount recovered if the case settled prior to suit. However, Plaintiffs' counsel has agreed to reduce its fee and accept a total of Three Thousand ($3,000) Dollars. See, Power of Attorney and Fee Agreement attached hereto as Exhibit D. 12. Angino & Rovner's out-of-pocket expenses total $298.16. _See, printout of expenses attached hereto as Exhibit E. 13. Accordingly, the net proceeds of the settlement, $30,451.84, is to be placed into the Wachovia Bank, a deposit which is insured by the federal government, in a money market account, number 101009263999 that provides no withdrawal will be made until Elizabeth Brandler reaches majority, except as authorized by Court Order. See, proposed Distribution Sheet attached hereto as Exhibit F. WHEREFORE, Plaintiffs request that Your Honorable Court approve the settlement and authorize payment of $3,000 for attorneys' fees; $298.16 for expenses; and direct payment of 272580.1\CMG\CMG $30.451.84 due to Elizabeth Brandler to be deposited into Wachovia Bank, money market account number 101009263999, restricted account that no withdrawal can be made prior to the age of majority without Court Approval. Date: s/ lc Respectfully submitted, ANGINO & ROVNE~R, P.C. '/ /;: Nell J. R,b :~, Es ire 4503 N. Front Street Harrisburg, PA 17110 (717) 238-6791 Counsel for Plaintiff(s) 272580.1\CMG\CMG VERIFICATION We, Bruce Brandler and Vivian Brandler, Plaintiff/Petitioners, hereby verify that the facts set forth in the foregoing document are true and correct to the best of our knowledge, information, mad belief. We understand that any false statements therein are made subject to the penalties of 18 Pa.C.S.A. §4904, relating to unswom falsification to authorities. WITNESS: Date: 2 / 2 WITNESS: Vivian Brandler Date: 272580,1 \CMG\CMG /BZ/B3 19:1~9:~ ,,' ~F~X-~ 717 249 4S34 Rig~,tF~ ~age 88! BRANDLER, ELIZABETH A SC 0~/25/2003 1022731 DATE OF OPERATION: 06/2512003 SURGEON: Peter Giesswein, M.D. ASSISTANT SURGEON: PREOPERATIVE DIAGNOSIS: Scar, upper lip. POSTOPERATIVE DIAGNOSIS: Scar, upper lip. oPERATIVE PROCEDURE: Revision of soar, upper lip, with realignment of the vermilion border and excision of scar tissue in a V shaped fashion. Ventricular dilatation ANE,~THESIA: MAC and 7.B cc of 1% lideceine with epinephrine infiltration. POST OP CONDITION: Poat-op condition was stabre. HISTORY: History as per office chart. The benefits, risks, and alternatives were e:,oplatned to the patient and her mother. All questions were answered before informed consent was obtained. PROCEDURE IN DETAIL: The alignment of the vermilion as well as the excision of the upper lip soar was outlined with a marking pen preoperatively. The patient ~;hen received MAC. The lip was prepped and =lraped in the usual manner and infiltrated with the above-mentioned local anesthetic. Under Icupe magnification, the scar was excised including part of the vermillion border. The underlying tissues ware elevated. The muscle bleeders were gently elsctrocauterized. The adjacent tissues were mobilized and rotated into the defect and secured with simple stitches of 5-0 Vicryl. This created a nice alignment of the vermilion borcler. A nice lip contour was accomplished. Tension wes taken off the repair by Stari-Stripe ever Maatisol. Bacitracin ointment was applied to the lip repair. The patient left the operating room in stable and satisfactory condition. She will spend some time in the post anesthesia recovery room before being discharged. [ reiterated instructions concerning follow-up, diet. activity and medication to the mother who was accompanying the patient. PG/sap D: 0612512003 07:51:D0 T: 07/02/2003 19:13:47 c: Peter Giesswein, M.D. Peter Giesswein, M.D. Page 1 of 1 DICTATING PHYSiCiAN COPY CARLISLE REGIONAL MEDICAL CENTER OPERATIVE REPORT 8216739 BRANDLER, ELIZABETH A SC 1022731 06/2512003 08/0711986 GIESSWEIN, PETER Giebswein Plastic Surgery Center for Cosmetic R Revonstructive Surgery Peter Giesswein, M.D. 5 Brookwood Avenue, Suite I · Carlisle, PA 17013 Phone: 717-249-2424 Fax: 717-249~4534 July 14, 2003 Attorney Neff J. Rovner Angino & Rovner, P.C. 4503 North Front Street Harrisburg, PA 17110-1708 RE: Elizabeth Brandler (DOB 08/07/86) Dear Attorney Rovner: This letter is in regard to your client and my patient, Ms. Elizabeth Brandler. Ms. Brandler is a very pleasant 16-year-old patient who on June 26, 2002 was seen by me for the first lime in the Emergency Room at Holy Spirit Hospital. She presented with a complex injury to the upper lip, which I was told was the result ora dog bite. The injury was repaired. Considering the sevexity of the soft tissue trauma the patient healed fairly well. After watchful waiting for about a year, the patiem and her parents consented to a touch-up procedure on the so-called vermilion border in which area the scar was still hypertrophic. This second procedure was done on June 25, 2003. So far the patient is doing very well. I would anticipate that we will know the final improvement in about eight to twelve months. Elizabeth and her parents are instructed in scar management and sun protection and to follow-up with me at regular intervals to make sure that her healing is uneventful. Enclosed you will find copies of the medical records, but also billing documents to give you insight into the care rendered and its costs. If you have uny fu~er questions, please do not hesitate to contact me. Certified by: The American Board o[ Surgery - The American Board o[ Plastic Surgery Member AMERICAN SOCIETY OF PLASTIC SURGEONS Page 2 Elm~ ~ran~r July 14, 20~/ V~ry Irul~/~.,~urs,~. ~. Enclosures: Billing Summary Office Notes PARENTS RELEASE AND INDEMNITY AGREEMENT CLAIM # 5132000653B19 In consideration of the payment, to the undemigned, of the sum of $ 33,750.00 the receipt of which is hereby acknowledged, the undersigned parent s and guardian s of Elizabeth Brandler, a minor, do forever release, discharge and covenant to hold harmless Edward W. & Patti Diehl & Allstate Insurance Company, and any other person, firm or corporation charged or chargeable with responsibility or liability, their heirs, administrators, executors, successors and assigns, from any and all claims, demands, damages, costs, expenses, loss of services, actions and causes of action, belonging to the said minor or to the undersigned arising out of any act or occurrence up to the present time, and pafficularty on account of all personal injury, disability, preperty damage, loss or damages of any kind sustained or that may hereafter be sustained by the said minor or by the undersigned, in consequence of an accident that occurred on or about the 26th day of Jpne, 2002 at or near 923 Werlzville Rd, Enola, Pa. The undersigned do hereby bind ourselves. and our heirs, administrators, executors, successors and assigns to repay to the said __ and to any other person, firm or corporation cha~ged with responsibility or liability, their heirs, administrators, executors, successors and assigns, any additional sum of money that any of them may hereafter be compelled to pay on account of the injuries to said minor because of the said accident. To procure the paYment of the said sum, we hereby declare: that no representations about the nature and extent of the said injuries, disabilities or damages made by any physician, attorney or agent of any party released, nor any reepresentations regarding the nature and extent of legal liability or financial responsibility of any of the parties released, have induced us to make this release and indemnity agreement; that in determining the amount of the said sum there has been taken into consideration not only the ascertained injuries, disabilities and damages, but also the possibility that the injuries sustained may be permanent and progressive and recovery therefrom uncertain and indefinite, se that consequences not now anticipated may result from the said accident. The undersigned agree , , as a further consideration and inducement for this retease and indemnity agreement, that it shall apply to all unknown and unanticipated injures and damages directly and indirectly resulting from the said accident, as well as to those now disclosed. The undersigned understand __ that the parties hereby released admit no liability of any sort by reason of said accident and that said payment in compromise is made to terminate further controversy respecting all claims for damages that said minor or the undersigned have heretofore asserted or might personally or through personal representatives hereafter assert because of said accident. Signed and sealed this in the presence of STATE OF ~ COUNTY OF Onthis day ~ SS day of 20 (SEAL) (SEAL) foregoing instrument, and acknowledged that __ , before me personally appeared , to me known to be the person who executed the . executed the same as free act and deed. My commission expires NOTARY PUBLIC C1 or:>-~, Parents Release & Inctemnity rev. O~/16/01 POWER OF ATTORNEY AND FEE AGREEMENT BY SIGNING THIS AGREEMENT, I (WE) ACKNOWLEDGE THAT I (WE) HAVE ENGAGED THE LAW FIRM OF ANGIN0 & ROVNER, P.C. (HEREINAFTER A & R), TO REPRESENT ME (US) UNDER THE FOLLOWING TERMS AND CONDITIONS: A & R may on my (our) behalf secure medical, work and other similar records, conduct an investigation, negotiate, an~ if necqssary start suit against anyone responsible for my (our) injuries and losses with respect to FJ/~. ~o'~ ~ , with full power and authority to appear on behalf of the tm/dersigned in any Court of record or in any admirfisu-ative or other proceeding, to do and perform all and every act and thing whatsoever that may be requisite and necessary to be done in connection with the above claim as fully as the undersigned might or could do if personally present; hereby ratifying and confirming ail that said attorneys shall lawfully do or cause to be done therein by virtue of this power of attorney. I (we) understand that so long as the case is handled by an A & R attorney, I (we) will not be responsible for any fees and/or expenses unless a recovery or benefit is obtained. If my (our) case is handled to a successful completion by an A & R attorney, I (we) agree to pay A & R ail reasonable out-of-pocket expenses without the payment of interest, plus a fee for time expended as follows: a. SETTLEMENT PRIOR TO STARTING SUIT b. SETTLEMENT FOLLOWING SUIT BUT PRIOR TO TRIAL OR ARBITRATION c. SETTLEMENT OR YERDICT AT TRIAL OR ARBITRATION, A & R ME (Us) AFTER TRIAL, ARBITRATION, OR APPEALS OR SHORTLY - ,~ -- ~ BEFORE TRIAL AND AFTER CASE HAS BEEN TOTALLY 4~ ~.,'~[Y ~}°'~o 7f-') ~ .f/// PREPARED g ~ P UR TOTAL COVERY VALUE ENmT { If for any reason I (we) take my (our) case to another attorney or law firm including a former A & R attorney or handle it myself (ourselves), I (we) recognize that A & R has, in good faith, expended money and time for my (our) benefit and I (we) therefore agree to pay, or have my (our) new attorney pay immediately, upon severing the A & R attorney/client relationship, all the out-of-pocket expenses incurre¢ on my (our) case plus interest at the rate of 6°,/0 per annum from the date of each expenditure. In additior when the case is successfully concluded, I(we) agree to pay or to direct my (our) new attorney to pay as fee ~A of the gross recovery to A & R. 20$219.1\CMO\MLB (OVER) revised 1/02 In the event that any settlement is made on a structured or deferred payment basis, A & R shall be entitled to receive their percentage based on the present value of the shmctured settlement, if paid as a lump stm~ at the time of settlement. If by settlement or operation of law, benefits are to be paid periodically in the future, the attorneys' fee due to Angino & Rovner, P.C., on such benefits will be calculated by taking the present value of such future payments at the time of the award based upon the then existing federal funds discount rate and will be paid in a lump sum to the attorneys at the time of settlement or verdict. I (we) agree not to settle or discuss settlement of my (our) case without the written consent ofA & R. PLEASE COMPLETE SECTION BELOW Receiving Support from Dept of Welfare or Public Assistance (Including Cash) Receiving Medicare/Medicaid Injured's Name Injured's Social Security Number lnjured's Date of Birth Address Street City, State, Zip Telephone Home PERSONAL INFORMATION Yes ~(eircle one) Yes ~No? (cirele one) Work BY SIGNING THIS AGREEMENT, THIS''[[4D' DAY OF~/~0T~-t/, 20tO.Z', I (WE) ACKNOWLEDGE THAT I (WE) HAVE READ, UNDERSTOOD, AND RECEIVED A COPY OF SAME AND AGREE WITH/TS TERMS AND CONDITIONS. WITNESS(ES): (SEAL) (SEAL) 2/25/2004 11/11/2003 .75 70.00 52.50 11/21/2003 .75 70.00 52.50 105.00 2.00 2.00 * 2/25/2004 5.00 5.00 * POST~E 2/25/2004 17.96 FIL~ ~ ............ ~ 02203 55414 30.80 55735 25.00 57333 20.90 58839 100.00 58840 55.50 58835 100.00- 50840 55.50- ANGINO & ROVNER, P.C. 4503 NORTH FRONT STRF~T ~x~RISBURG, PA 17110-1708 717/238-6791 FAX 717/238-5610 i~I C HARD C. ANGINO NEIL J, ROVNER JOSEPH M. I~IELILLO TERRY S. HYMAN DAVID L, LUTZ MICHAEL E, KOSIK RICHARD A, SADLOCK JAMES DECINTI JOAN L. STEHUI~lg LISA M, BENZIE ELIZABETH BRANDLER, A MINOR AND BRUCE BRANDLER AS FIDUCIARY v. EDWARD DIEHL DISTRIBUTION SHEET $33,750.00 $ 6,750.00 $27,000.00 $ 298,16 $26,701,84 $ 3~750,00 TOTAL AMOUNT OF SETTLEMENT DEDUCTIONS: Attorney's Fee (Normal Fee 30%) Special Fee Agreement 20% Balance Reimbursement of expenses paid by attorneys to others for records, experts, etc. Balance PLUS: FEE CONCESSION TO REDUCE FEE TQUNDER 10% BALANCE TO CLIENT PLUS ANY 1NTEREST EARNED WHILE HELD 1N BANK ESCROW FINAL DIVISION: Attorney's Fee $ 3,000.00 Client's Balance $30,451.84 Reimbursement of Expenses $ 298.16 $30,451.84 WARRANTY AND NOW, this 7~f__~ay of ~. 1~3i bt~( i;C~L'- , 2004, we acknowledge that we have read, understood, approved and obtained a copy of this Distxibntion She~. We further acknowledge that the above balance constitutes nly total reimbursement for medical expenses, wage losses, pain and suffering and any other losses sustained or claims resulting from our accident. We warrant that if there are any outstanding medical bills or claims other than as set forth above, they will be our responsibility; we further warrant that we will pay any outstanding Blue Cross, Blue Shield, Public Assistance, Medicare/Medicaid, medical subrogation liens or any other liens and expenses not noted above. WITNESS BRUCE BRANDLER, Parent and Natural Guardian of Elizabeth Brandler, a Minor CERTIFICATE OF SERVICE I, Christine M. Gallagher, an employee of the law firm of Angino & Rovner, P.C., do hereby certify that I am this day serving a hue and correct copy of the foregoing upon ail counsel of record via postage prepaid first class United States mail addressed as follows: Dana L. Phillips Allstate Insurance Company Market Claim Office 1655 Valley Center Parkway Suite 200 Bethlehem, PA 18017 Christine M.~allagher ~ _.2 ELIZABETH BRANDLER, a minor, BY AND THROUGH HER PARENTS AND NATURAL GUARDIANS BRUCE BRANDLER and VIVIAN BRANDLER Plaintiffs EDWARD W. DIEHL and PATTI ANN DIEHL, Defendants IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA AMICABLE ACTION NO. 0% I JURY TRIAL DEMANDED ORDER FOR MINOR SETTLEMENT AND NOW, this /g' day of r~,~c~ ,2004, upon consideration of the Petition for Approval of a Minor's Compromised Settlement of $33,750.00 and Distribution of Proceeds, IT IS HEREBY ORDERED AND DECREED that the Petition is granted and payment of $30,451.84 due to the minor is directed to be made and deposited into Wachovia Bank, Money Market Account Number 101009263999 a deposit which is insured by the Federal Government, and no withdrawal will be made fi.om such account until Elizabeth Brandler attains majority, except as authorized by Court Order. Additionally, IT IS HEREBY ORDERED AND DECREED that there will be a payment of attorney's fees ~n the amount of $3,000.00 and expenses ~n the amount of $298.16. Petitioners are hereby authorized to enter into a settlement and release on behalf of Elizabeth Brandler, their daughter, and mark the cause of action settled and discontinued. Petitioners' counsel shall provide the Court with an Affidavit of Deposit within twenty (20) days of this Order. BY THE COURT: 272580.1 ~CMG\CMG ELIZABETH BRANDLER, a minor, BY AND THROUGH HER PARENTS AND NATURAL GUARDIANS BRUCE BRANDLER and VIVIAN BRANDLER Plaintiffs EDWARD W. DIEHL and PATTI ANN DIEHL, Defendants IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA AMICABLE ACTION NO. 04-914 JURY TRIAL DEMANDED PROOF OF DEPOSIT Date: s/z loci In accordance with Pennsylvania Rule of Civil Procedure 2039, attached hereto as Exhibit A is a photocopy of a Deposit Slip fi.om Wachovia Bank issuo:l on March 25, 2004, as proof of deposit of settlement proceeds of the above captioned case. No withdraw can be made fi.om any such account until Ehzabeth Brandler, minor attains majority, except as authorized by a prior Court Order. Respectfully submitted, ANGINO & RO VNff[,~. I.D. No. ~2108 4503 N. Front Speet Harrisburg, p~/17110 (717) 238-6'791 Counsel for Plaintiff(s) 272580.1\CMG\CMG Exhibit A