HomeMy WebLinkAbout09-8679THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY
In Re:
Paige N. Fowler, a minor, by and through her
parent and natural guardian, Carrie Fowler
and Carrie Fowler, in her own right.
No. 0 y'_ ?l, 7 9 Cc? T,-
Minor's Compromise
PETITION FOR LEAVE TO SETTLE OR COMPROMISE MINOR'S ACTION
To The Honorable, the Judges of the Said Court:
The Petition of Paige N. Fowler, a minor, by and through her parent and natural Guardian
Carrie Fowler, by her attorney, Thomas P. Gannon, Esquire respectfully requests that this
court approve the settlement of the within matter and the distribution of proceeds and in
support thereof avers the following:
1. Petitioner is Paige N. Fowler, a minor.
2. The minor was born on November 29, 1992, and her social security number is 174-74-
1378.
3. The minor resides with her mother at the following address: 32 Lismore Place,
Mechanicsburg, PA 17050.
4. The minor's mother is Carrie Fowler who resides at the above address.
5. The defendant is James P. White who resides or whose principal place of business at all
relevant times was 3 Mayfair Court, Camp Hill, PA 17011
6. Attached hereto is a statement, under oath, of the minor's parent and natural guardian
certifying the physical and mental condition of the minor and marked Exhibit "A".
7. On August 10, 2008 the minor sustained the following injuries at the following location
a) Cervical Strain and low back pain.
b) The accident and injury occurred in East Hanover Township, Dauphin County, PA.
8. This matter was settled without resort to litigation and this petition is being filed in the
minor's county of residence.
9. The following gross settlement has been proposed: $27,000.00 payable to the minor.
lo. Attached hereto marked Exhibit "B" is a final Outpatient Note by Dr. Mark Knaub dated
February 16, 2009, which sets forth that the minor had not structural injury, no fractures or
dislocations and may return to gym class and regular activities without limitations.
11. Attached hereto marked Exhibit "C" is the written approval of the proposed settlement and
distribution by the minor, who is sixteen (16) years of age or older, as well as the parent's
and natural guardian's approval of the proposed settlement and distribution.
12. Counsel is of the professional opinion that the proposed settlement is reasonable
inasmuch as the minor suffered soft tissue injury from which she is expected to fully
recover.
13. Counsel request a fee in the sum of $8,999.10, which is 33 1/3 percent of the net
settlement payable to the minor. A copy of the contingent fee agreement is attached as
Exhibit "D".
14. Counsel has incurred the following expenses for which reimbursement is sought in the
amount of $175.38. Attached hereto as Exhibit "E"is a detailed list of those expenses.
15. The Department of Public Welfare does not have a claim or lien against the plaintiff.
Petitioner is not aware of any claim or lien by any other entity.
16. Counsel has not and will not receive collateral payments as counsel fees for
representation involving the same matter from third parties. (I.e. subrogation).
17. The net settlement payable to the minor is $17,825.52.
WHEREFORE, Petitioner requests that she be permitted to enter into the settlement recited
above and that the Court enter an Order of Distribution as follows:
To Thomas P. Gannon, Esq. P.C. $175.38
Reimbursement for Costs
To Thomas P. Gannon, Esq. P.C.
Counsel Fee $8,999.10
To Paige N. Fowler, a minor, in a restricted account
not to be withdrawn before majority or upon prior $17,825.52
leave of Court. F.PO
h Gannon, sq.
Attorney for Petitioner
VERIFICATION
I hereby certify that I am counsel for Petitioner, Petitioner is not presently
available to take this Verification or which lacks sufficient knowledge or information
to verify the statements in the foregoing pleading in that the statements contained in
that pleading are predicated upon the results of investigations that I have personally
undertaken or commissioned and that have not been communicated to the client or
involve legal interpretation. Under the provisions of Pa. R.C.P. 1024(c), I hereby
verify that the statements made in the foregoing pleading and any attachment thereto
are true and correct to the best of my information and belief I understand that false
statements therein are made subject to the penalties of 18 Pa. C.S. Section 4904
relative to unsworn falsifications to authorities.
'A AAALAOI
Thomas P. Gannon, sq.
STATEMENT OF PARENT AND NATURAL
GUARDIAN CERTIFYING THE PHYSICAL AND
MENTAL CONDITION OF PAIGE FOWLER, A MINOR
1 certify that Paige Fowler has recovered from the injuries
suffered in the automobile accident of August 10, 2008.
Date:
C-rri M. wler, parent and
natura dian of Paige N.
Fowler, a minor.
Subsc d sworn to before me this day
N' ? 2009.
NotarhPalic
COdb1:1 ONvytALrri OF PENNSYLVANIA
::?t+ies9 Sea!
?rrd ;r' t` rox ::teary Public
Sitverti^??^ ? 1,outailand County
13, 2013
fuln t ,ar -:.r -- izaJon of Notaries
CXt-f1 7 A
1_ O u t p a t I e n t N c t e D o c u m e n t 1
Final
Document Electronically Signed by: Ifnaub, Marls A
OUTPATIENT NOTE
Name; FOWLER, PAIGE N
HMO Number; 0665019
DOB-. 11/2511992
Date of Service: 02/12/2009
2/16/2009 8:08:51 AM
Paige is a 16-year-old female. who I saw back in the hospital in August of 2008. She was subsequently seen in the office few days
later. She was involved in a nmtorcycle accident, sustained neck injury, which resorted in neck pain. She was placed in a Miami J
collar and followed up few days later with flexion extension views, which showed no structural injury, no fractures, or dislocations.
She had no evidc= of instability. Her Miami J was discontinued and she was set free to do activities as tolerated.
She now returns with complaints of significant neck pain radiating down her entire back the whole way to her lumbar spine. She
reports pain that radiates into her bilateral upper extremities, numbness that goes into her right arm including her entire hand.
Symptoms are intermittent. She reports 0110 pain today. She has no bowel or bladder incontinence. She has no problems with her
balance. She denies any numbness, tingling, pins and needles in her lower extremities.
Treatment has included no formal treatment. She has not had any physical therapy. In terms of medications, she has taken over-the-
counter Tylenol, over-the-counter antiinflammatory medications. Her mother has given her some of her own Vicodin and Percocet
whom she reports that the symptoms were very bad. Patient reports that these medications improved her pain siguificandy. The
mother reports that after snowboarding for 3 hours a few weeks ago the patient was unable to get out of bed for the next few days.
There has been no change to her medical history since the summer.
PHYSICAL EXAM: Paige is a well-appearing young white female in no acute distress. Stance: No sagittal or coronal plane
imbahu=. She can stand on heels and toes without difficulty, has normal heel toe gait. Shc has mild limitation of range of motion of
her cervical spine specifically right and left axial rotation. She has 515 strength in her deltoid, biceps, triceps, wrist extensors, wrist
flexors, finger flexors, intrinsics. Her sensation to light touch is intact and symmetric in all nerve root distributions. She has 2+ sleep
tendon reflexes, biceps, triceps, brnchioradialis, patella, and Achilles. She has a negative Hoffmann sign. She has noclonus andher
toes arc downgoing. She has diffuse tenderness to palpation both along with spinous processes as well as in the paraspinal muscles
from her lower cervical spine to her lumbar spine.
IMAGING: Flexion extension lateral x-rays of her cervical spine were obtained in the office today and these document no
instability an flexion extension views.
ASSESSMENT AND PLAN: Paige has diffuse back pain and nondermaiamal extremity symptoms. I don't suspect any
structural pathology to explain her arm symptoms. Certainly, I doubt will find any structural etiology for her diffuse back
pain. I would like to get a SPECT scan of her spine to prove that we are not missing any occult injuries or processes.
Data Prbitsd• 41412009 Trine Printer/. 4:34 AM
E-/I- H- Iall 13
Patient Name: FOWLER, PAIGE N PSUHMC MRN: 0665019
1 O u t p a t i e n t N o t e D o c u m e n t
Final
Document Electronically Signed by: Knaub, Mark A 2116(2009 8:48:51 AM
Paige may return to gym class and regular activities without any limitations. I did give her a script for Lodine 400 mg 1 p.o. b.i.d. to
take with food.. I warned her of the potential G1 side effects of the medication. I will see Paige back after the bone scan is completed.
20209
CC. DcArmitt, Don A, MD
2310 Patton Road
Harrisburg, PA 17112
Rcvicw(Sign: Knaub, Mark A, MD
MAK /CO DD: 02113/09 DT: 02114!49 11:15
Date Printed, 414)2009 Tura Printed., 4:34 AM
Patient Name: FOWLER, PAIGE N PSUHMC MRN: 0665019
THOMAS P. GANNON, ESQ. PC
PROFESSIONAL LEGAL SERVICES
552 Kelly Avenue
Woodlyn, PA 19094
Phone: 610-532-8445
Fax: 610-548-7177
November 16, 2009
Paige Fowler
32 Lismore Place
Mechanicsburg, PA 17050
SCHEDULE OF DISTRIBUTION
Re: Fowler v. White
File No: 8888
Gross Recovery ............. 27,000.00
Less: Attorney Fee (33 113%) ............. 8,999.10
Less: Costs (See Summary) ............. 175.38
Net Distribution To Client ............. 17,825.52
I HEREBY APPROVE OF THE ABOVE SETTLEMENT AND DISTRIBUTION
THEREOF. I ACKNOWLEDGE RECEIPT OF A COPY HEREOF AND AUTHORIZE
PAYMENT OF ALL LISTED EXPENSES, IF ANY. I CERTIFY THAT I HAVE REVIEWED
ALL MEDICAL BILLS WHICH MAY HAVE FORMED A BASIS OF MY CLAIM AND
SUCH SERVICES WERE ACTUALLY RENDERED TO ME. ANY MEDICAL EXPENSES
NOT PAID TO MEDICAL PROVIDERS AND MEDICAL INSURANCE REIMBURSEMENT
REQUEST, WHICH MAY HAVE BEEN OMITTED FROM THIS DISTRIBUTION, SHALL
BE PAID PROMPTLY BY ME.
I HEREBY AUTHORIZE MY ATTORNEY TO ENDORSE MY SIGNATURE UPON
ALL DOCUMENTS NECESSARY TO EFFECTUATE THIS SETTLEMENT.
I UNDERSTAND THAT DISTRIBUTION OF THE PROCEEDS OF THIS
Page 1 of')
SETTLEMENT SHALL BE MADE FROM MY ATTORNEY'S ACCOUNT AS SOON AS
THE SETTLEMENT CHECKS ARE CLEARED FOR WITHDRAWAL BY THE
DEPOSITORY BANK.
DATE:
Page 2 of 3
Standard Fee/Retainer Agreement
Date:
wi°sh? or etain Thomas. P. Gannon,
Esq. ("my attorney"), to represent me in connection with any and all claims that I may
have against any and all persons, arising out of an accident that occurred on. A t1G Li ? i /(,,/,
C;C
1 agree to pay my attorney a fee of thirty-three and one-third percent (33 113%) of any
sum recovered on my behalf. This amount is exclusive of any appeal fees. In the event
of any appeal, I agree that my attorney's fee will be increased by an amount of three
and one-third percent (3 113%). Furthermore, if a second or subsequent trial is
necessary, I agree the fee will be increased by three and one-third percent (3 1/3%).
I understand that I remain at all times responsible for all reasonable disbursements
incurred by my attorney, including court costs, expert witness fees, subpoena fees,
deposition fees, transcript fees, fees for computerized legal research or computerized
retrieval systems, and any other out-of-pocket expenses incurred by my attorney in his
investigation and prosecution of any claims I might have.
I understand that I am responsible for these disbursements or out-of-pocket fees
regardless of the success of my claim. There will be no Attorney's fees unless I recover
from the responsible person or persons.
My attorney is authorized to investigate fully any claims I may have. If my attorney
decides that it is in my best interest to file a lawsuit, a workers' compensation claim or a
legal proceeding on my behalf, my attorney has the authority to prepare and prosecute
these proceedings. If, at any time, having made reasonable investigation and inquiry of
my claims, my attorney determines that it is not feasible or proper for my attorney to
prosecute my claims, he shall notify me of these facts in a timely fashion and may
withdraw from representation under this agreement consistent with any court rules and
ethical requirements.
I further agree that any proceeds of any recovery, whether they be by settlement,
judgment, arbitration award, levy and execution or otherwise, are to be used to satisfy
my attorney's fees to which he is entitled; all costs and expenses of litigation which
remain unpaid; and any and all unpaid bills for medical providers, hospitals, expert
witness fees, and other related items and expenses.
Additionally, if all or part of the prior costs has been paid by another source (e.g.,
insurance or medical coverage), I agree that such source will be reimbursed out of any
such proceeds. My attorney has the authority and authorization to make such
disbursements of those funds directly to medical providers, insurance carriers or other
persons concerned, as it is necessary and required by law.
I further agree that, to the extent allowed by law, my attorney shall have a lien upon all
monies, things of value and other consideration recovered in any claim he prosecutes
on my behalf.
Page 1 of 2
It is further understood and agreed by me and my attorney that neither will settle any
claim arising out of this (incident/accident) without first having obtained the express
written consent of the other. It is understood and agreed that if either party receives a
settlement offer, the offer will be immediately forwarded to the other.
It is further agreed that if my attorney negotiates and recommends acceptance of a
particular settlement, as offered by the defendant or his agent or carrier, and if I refuse
to accept the settlement, such refusal shall constitute sufficient grounds for my attorney
to withdraw from representation of me and I agree to be indebted to my attorney for any
amount of attorneys' fees and costs and expenses reasonably incurred based upon the
offer as recommended.
If at any time I am deemed to be an incompetent and if any court rule, statute or other
law requires an amendment or a novation of this agreement or of the fee arrangement,
then the fee shall be such as may be approved by court or as set by statute or rule of
law.
My attorney has my authorization and consent to employ any other lawyer as co
counsel, if, in his discretion, he deems such appointment necessary or beneficial to my
case. I agree that co-counsel will also have the right to represent me in the prosecution
of my claims. My attorney, however, will have the responsibility of notifying me promptly
of his intent to employ co-counsel and my attorney shall have responsibility for paying
co-counsel out of his fee. It is understood that I have no other obligation to pay co-
counsel, but that any out-of-pocket expenses or disbursements reasonably incurred by
co-counsel shall be considered costs of litigation for which 1 am responsible. It is
understood that co-counsel will be available to me for consultation in this matter should
so desire.
Should this agreement be breached or otherwise terminated, my attorney shall be
entitled to immediate reimbursement of costs, disbursements, and expanses and any
payment of his fee according to the herein agreed percentage of whatever offer of
settlement he may have negotiated to the date of breach or termination, or to payment
of his fee based upon time actually expended at his prevaili whichever is
greater. /'?
Agreed and Consented To:
Date:'}? j
Page 2 of 2
SUMMARY OF EXPENSES
DATE DESCRIPTION
09/17/08 PA State Police Report
10/07/08 Hershey Hospital Record
05/06/09 Hershey Medical Records
Total Expenses
Page 3 of 3
AMOUNT
8.00
132.46
34.92
175.38
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DEC 212009
THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY
In Re:
Paige N. Fowler, a minor, by and through her
parent and natural guardian, Carrie Fowler
and Carrie Fowler, in her own right.
No. 69 - 86179
Minor's Compromise
ivit iernn
ORDER APPROVING SETTLEMENT AND ORDER FOR DISTRIBUTION
Now, this 2-q t? day of I f'_LQ -,Lc?- 2009,
u son consideration of the Petition For Leave to Compromise A Minor's Claim, filed
e- C-, l j? Z o ? , it is hereby ORDERED and DECREED that Petitioner is
authorized to enter into a settlement with Defendant James P. White in the gross sum
of Twenty-Seven Thousand Dollars ($27,000.00).
It is further ORDERED and DECREED that the settlement proceeds be
distributed as follows:
To Thomas P. Gannon, Esq. P.C.
a' Reimbursement for Costs
b To Thomas P. Gannon, Esq. P.C.
Counsel Fee
To Paige N. Fowler, a minor, in a restricted
c. account not to be withdrawn beforepajopty
or upon prior leave of Court. 1; (0 0 1
r fie b. '? t
LO l? l e- C- cC?l, w? ?p `l
$175.38
$8,999.10
$17,825.52
2 0019 0IEC 29 1 .6
COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
ORPHANS' COURT DIVISION
? =
K ,f
M
No:09-8679 Cl- i
co
In Re: Paige N Fowler, r- c-
A minor Minors Compromise y, 4
Q -Ln
%a
AFFIDAVIT OF DEPOSIT OF MINOR'S FUNDS
The undersigned, counsel for Carrie Fowler, parent and natural guardian of Paige N.
Fowler, a minor, hereby certifies that the net settlement amount of $ 17,825.52 as set
forth in this Court's order dated December 29, 2009 was deposited by me on January 28,
2010 into a restricted, federally insured account, marked
"NOT TO BE WITHDRAWN BEFORE MAJORITY OR UPON PRIOR LEAVE OF
COURT"
Account No. 7760439891 is entitled: Paige N. Fowler, a minor. Proof of deposit is
attached hereto as Exhibit A.
unsel for Parents and atural Guardians
of Paige N. Fowler, a minor
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