HomeMy WebLinkAbout12-1372
Robert F. Claraval, Esq. T ' E PF?0 , ! 1?0 4 6TA1t
Claraval & Claraval 2o'12 MAR _ I PM !
500 North Third Street, 2nd Floor
Harrisburg, PA 17101 CUMBERLAND COU?3 - Y
(717) 233-4780 PENNSYLVANIA
Supreme Court I.D. 19222
Attorneys for Petitioner
_
IN RE: PETITION FOR THE IN THE COURT OF COMMON PLEAS
APPROVAL OF SETTLEMENT OF CUMBERLAND COUNTY, PENNSYLVANIA
MINOR'S CLAIM by
TIFFANI GILLAUGH, a minor, NO. 1 Z - /,? 7?, ?[ v c L
by her Parents and Natural Guardians
STEVEN GILLAUGH and
KIM GILLAUGH,
Petitioner
PETITION FOR APPROVAL OF SETTLEMENT
OF MINOR'S CLAIM
AND NOW COMES Steven Gillaugh and Kim Gillaugh as parents and natural guardians
of Tiffani Gillaugh, a minor child, by and through their counsel, Robert F. Claraval, Esq., Claraval
& Claraval, respectfully representing the following:
1. Tiffani Gillaugh is a minor born April 25, 1995. Tiffani resides with her parents
Steven and Kim Gillaugh at 28 Cumberland Drive, Cumberland County, Mechanicsburg,
Pennsylvania.
2. On December 17, 2010 Tiffani Gillaugh was a passenger in a vehicle owned and
driven by Nathan Reh.
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3. At approximately 7:10 p.m. on December 17, 2010 the 1998 Volkswagen Golf
containing Tiffani Gillaugh and Nathan Reh was traveling West on West Winding Hill Road in
Mechanicsburg, Pennsylvania.
4. As the vehicle entered the apex of a slightly graduated curve on West Winding Hill
Road, operator, Nathan Reh, lost control of the vehicle.
5. As a result of lost control, the vehicle traveled in a sideways manner until it struck
a dirt embankment. The vehicle then went airborne and struck two trees.
6. Both Nathan Reh and Tiffani Gillaugh were seriously injured. Both were transported
from the scene to Hershey Medical Center by a combination of helicopters and ambulances.
7. As a result of the crash, Tiffani Gillaugh sustained a left femur fracture, left clavicle
fracture, left pelvic fracture, and a right ankle sprain. The Hershey Medical Center discharge
summary is Appendix A.
8. At the time of the crash the vehicle operated by Nathan Reh was insured by
Permanent General Assurance Corporation. The amount of liability coverage was only $15,000.00.
A copy of the Declarations Page is Appendix B.
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9. Kim Gillaugh and Steven Gillaugh retained Robert F. Claraval to represent Tiffani
Gillaugh regarding all possible claims relating to the crash of December 17, 2010.
10. Robert F. Claraval has investigated the crash, obtained medical records and other
relevant records, contacted Permanent General Assurance Corporation, negotiated with the
Permanent General Assurance Corporation adjustor, Venita Philmore, and carefully reviewed the
applicable documents from Allstate Insurance Company regarding under-insured coverage.
11. Tiffani's medical bills were paid by her parent's health insurance carrier CIGNA
Health Care. Those bills total at least $50,000.00. CIGNA Health Care has demanded subrogation
of those bills out of Tiffani's settlement proceeds.
12. It is recognized that the Gillaughs' health insurance carrier CIGNA Health care has
subrogation rights, however, it is unreasonable and inequitable for CIGNA Health Care to exercise
those rights in this case.
13. Steven and Kim Gillaugh did not purchase under-insured coverage with their
automobile insurance carrier Allstate Insurance Company due to the expense it imposed.
14. A proposed settlement has been reached between counsel for the guardians and
Permanent General Assurance Corporation which is the automobile insurance carrier for Nathan
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Reh. Permanent General Assurance Corporation has agreed to pay $15,000.00 with respect to all
claims involving Tiffani Gillaugh.
15. Additionally, Stephen and Kim Gillaugh would like to request reimbursement for
out-of-pocket expenses in which they will present to the Court. These expenses include medical,
pharmaceutical and loss of wages accrued from the December 17, 2010 crash.
16. Accordingly, the guardians request the Court approve the following settlement
distribution:
(a) To Robert F. Claraval - Return of Costs $498.20
Advanced - Appendix C
(b) To Robert F. Claraval - Attorney Fees (15%) $0.00
(Waived)
(c) To CIGNA Health Care $0.00
(d) To Tiffani Gillaugh Amount to be
determined by the
Court
(e) To Stephen and Kim Gillaugh Amount to be
determined by the
Court
17. The guardians propose to the Court that Tiffani Gillaugh's distribution be invested
in an interest-bearing bank account. The funds will be FDIC insured.
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18. With the permission of Tiffani Gillaugh and the Court, Stephen and Kim Gillaugh
request that this account will contain a notation that no funds shall be withdrawn until Tiffani
Gillaugh becomes 23 years of age or until an Order of this Court is issued.
19. Counsel requests permission from the Court that a release for the benefit of
Permanent General Assurance Corporation be signed by Tiffani Gillaugh's parents. A copy of the
proposed release is attached as Appendix D.
20. It is specifically agreed between Kim Gillaugh, Steven Gillaugh and Permanent
General Assurance Corporation that this agreement and release in no way affects any claims or
possible claims between Steven Gillaugh, Kim Gillaugh, Tiffani Gillaugh, as to Allstate Insurance
Company and any malpractice claims.
WHEREFORE, it is respectfully requested the Court schedule a hearing to determine the
disbursement of the settlement proceeds received from Permanent General Assurance Corporation.
CLARAVAL & CLARAVAL
Date:
ROBERT F. CLWVAL, ESQ.
500 North Third treet, 2"d Floor
Harrisburg, PA 17101
(717) 233-4780
Supreme Court I.D. #19222
Attorneys for Petitioner
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VERIFICATION
The language in the foregoing document is that of counsel and not necessarily my own;
however, I have read the foregoing document and to the extent that it is based upon information that
I have given to counsel, it is true and correct to the best of my knowledge, information, and belief,
to the extent that the content of the foregoing document is that of counsel, I have relied upon counsel
in making this verification.
I understand that any false statements herein are made subject to the penalties of 18 Pa.
C.S.A. §4904, relating to unsworn falsification to authorities.
KIM GILLAUGH as Parent and NaturA i' 21v/o-
Guardian of TIFFANI GILLAUGH
ST EN GILLAUGH as Parent and Natur 1
Guardian of TIFFANI GILLAUGH
IN RE: PETITION FOR THE
APPROVAL OF SETTLEMENT OF
MINOR'S CLAIM by
TIFFANI GILLAUGH, a minor,
by her Parents and Natural Guardians
STEVEN GILLAUGH and
KIM GILLAUGH,
Petitioner
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 2012
CERTIFICATE OF SERVICE
I hereby certify that I have this day served a true and correct copy of the attached Petition for
Approval of Settlement of Minor's Claim by certified mail, postage prepaid, addressed to the
following persons:
Venita Philmore
Permanent General Companies
P.O. Box 305195
Nashville, TN 37230-5195
Roxanne Youndt
Travelers Insurance
P.O. Box 13485
Reading, PA 19612-3485
Kathy Rudzena
ACS Recovery Services
P.O. Box 4003
Schaumburg, IL 60168-4003
CLARAVAL & CLARAVAL
Date: -7 I (?, By:
DENISE I. WILLIAMS
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PENNSTATE HERSHEY
Milton S. Hershey
IV Medical Center
Patient Name: GILLAUGH, TIFFANI M
MRN: 7508861
Date of Birth: 4/25/1995
Patient Gender: Female
Penn State Hershey Tel: (717) 531-8055
Milton S. Hershey Medical Center
Health Information Services, HU24
500 University Drive
P.O. Box 850
Hershey, PA 17033-0850
Visit Number: 10508861
Visit Type: Inpatient
Patient Location: 7MBW; 7262; 01
Discharge Summary
RESULT STATUS:
DOCUMENT SUBJECT:
ELECTRONICALLY SIGNED BY:
Final
.D/C Summary
Simmons,Lynn G (12!23/2010 06:31 EST); Fagetman,Kerry
M (12/22/201016:57 EST)
DISCHARGE SUMMARY
Name: GILLAUGH, TIFFANI M
HMC Number: 7508861
DOB: 040/1995
Date of Admission: 121172010
Date of Discharge: 1221/2010
Reason for Discharge: Stable for Discharge
Physician: Fagelman, Kerry M
Service: Peds Surgery
Destination: 28 CUMBERLAND DRIVE, MECHANICSBURG, PA 17050
Discharge Diagnosis: Left femur fracture
Left clavicle fracture
Left pelvic fracture
Right ankle sprain
Surgical Procedures: L femur IM nail; 12/18/10; Lyons
Vaccinations Received This Hospital Stay:
No vaccinations were given this hospital-stay.
Discharge Medications:
1. Bisacodyl (Dulcolax Laxative) 5 rng by mouth once daily.
2. Docusate-senna (Senna S oral tablet) 1 tab by mouth 2 times daily.
3. EnoxaWn (Lovenox) 40 mg subcutaneously once daily.
4. HyDROMorphone (Dilaudid) 2 mg by mouth every 6 hours, as needed for Pain.
5. HyDROMorphone (hyDROMorphone 2 mg tablet) TAKE 1 TABLET BY MOUTH EVERY SIX HOURS AS NEEDED FOR
PAIN .
6. Enoxaparin (enoxapadn 40 mg10A mL inj.soln) INJECT 0.4 ML SUBCUTANEOUSLY (DOSE=40MG) EVERY DAY .
Date/Time Printed: 1/20/2011 09:55 EST Page 1 of 78
Printed By: TIce,Cindy L
PENNSTATE HERSHEY
Milton S. Hershey
qF Medical Center
Patient Name: GILLAUGH, TIFFANI M MRN 7508861
Discharge Summary
Brief History of Present Illness:
12/17/10 - Patient is a 15 yr old, presented to PSHCH via EMS s/p MVC. She was a restrained front seat passenger, car
vs tree. She was entrapped. No LOC appreciated. EMS placed left leg in traction due to primary complaint of left leg
pain with deformity.
Hospital Course:
12/17/10 - A level 2 pediatric trauma was called for her arrival, and ATLS procotols were established/followed. GCS 15
noted. She demonstrated hemodynamic stability, with no respiratory distress. She underwent imaging, and was
diagnosed with the following injuries:
Left femur fracture, left clavicle fracture, left superior pubic rami fracture, right ankle strain. She was admitted to the
pediatric floor, with orthpedic consultation. She underwent the following procedures:
12/18/2010 - SURGEON: Robert P Lyons, M.D.OPERATIVE PROCEDURE: Left transverse femur diaphysis fracture,
insertion of IM nail. She tolerated the procedure well and was admitted post op to the 7th floor. Fragmin was started per
the Orthopedic service. Foley was discontinued and she was able to void. Swelling was noted post op, day one of her
right ankle, xray was negative. air cast applied for comfort. Pain medication was transitioned from IV to po.
The challenge for Tiffant was mobility. Both PT and OT were consulted. By post op day 3 she was getting more mobile
with less discomfort. She continued to work with therapies. Post op day 4 we awaited recommendations for both therapies
for home. She did very well with therapies and completed step work. She will continue outpatient PT at home. Lovenox
was written and given to family. Dilaudid also prescribed for home. She was discharged to home the afternoon of post
trauma day 4.
Exam on Discharge:
NAD
RRR, no m/r/g
LCTAB
Abd soft, NTND, +BS
Left arm in sling, R ankle in air cast, 2+DP/PT pulses bilaterally, 2+ radial pulses bilaterally
Left leg incision c/dfi
Care Instructions:
1. You may remove your left leg bandages in 5 days. You may shower in 5 days. Do not submerge your incision in water or
bath tub.
2. Take lovenox 40 mg once per day subcutaneously for three weeks followed by aspirin 325mg po daily for three weeks
for DVT propyfaxis. Routine precautions, as you may bleed more easily/heavily.
3. Weight bear as tolerated as shown on left leg. Air cast to right ankle, and may stand/weight bear as tolerated.
4. Non weight bearing on left arm. Sling for comfort.
5. Pain medications can cause constipation. Drink plenty of fluids, eat foods rich in fiber, and take an over-the-counter
laxative (like Senekot or Miralax) if no stools every 2-3 days.
6. Please continue to use the ISB at home during the day.
Diet Guidelines:
Regular diet. Drink plenty of fluids, eat foods rich in fiber
Date/Time Printed: 1/20/2011 09:55 EST Page 2 of 78
Printed By: TIce,Cindy L
PENNSTATE HERSHEY
Milton S. Hershey
Medical. Center
Patient Name: GILLAUGH, TIFFANI M
MRN 7508861
Discharge Summary
Activity Guidelines:
Weight bearing as tolerated on left leg.
Non weight bearing on left arm.
Avoid activities that may lead to falls/impact until cleared by your surgeons at follow-up.
Return to school - homebound education required, to start upon discharge date, for an estimated duration of 3-4 weeks. .
No sports/PE until cleared by your surgeons at folbw-up.
Call your doctor if:
Please call 717-531-8521 (operator - ask for the pediatric surgery resident on-call): fever greater than 101 F, increased
severe pain, persistent vomiting, Increased swelling/pain/numbness to any extremity, coior•changes to left toes
(Grey/white/blue), increased redness/drainage from surgical wounds.
For routine questions during the weekdays, please call the pediatric surgery office at 717-531-8342.
Other Instructions:
When children are seriously. III or injured, they and their families may feel upsellworded. These feelings are common,
normal and can continue after returning home. Visit aftertheinjurycom for interactive tools and quick tips to help
recovery.
Penn State Children's Hospital Injury Prevention Tips - Teen Driver Safety
1. ALWAYS travel with your lap and shoulder seat belt, snugly fastened.
2. Never ride or drive under the Influence of alcohol or drugs.
3. Obey posted speed Omits.
4. Avoid distracted driving - using cell phone or texting, eating, adjusting the climate or music controls.
Follow-Up Appointments:
Scheduled Penn State - Hershey Appointments Within the Next 80 Days.
1. Follow-Up with Lyons, Robert at Orthopaedics East Campus on 01/04/2011 at 11:30 am
None
458848
DataMme Printed: 1120/2011 09:55 EST Page 3 of 78
Printed By: Tice,Cindy L
PENNSTATE HERSHEY
. ton S. Hershey
40 Me&cal Center
Patient Name: GILLAUGH, TIFFANI M MRN 7508861
Discharge Summary
Electronic Signature on File
Electronkally Reviewed/Signed by. Lynn G Simmons, MSN, CRNP Author Signature DtlTm23.12.2010 06.31 AM
Pediatric Surgery: Drs. Robert Cliley, Peter Dillon, Brett Engbrecht,
Kerry Fagelman, Dorothy Rocourt, Mary Santos
Coleen Greecher MS RD CNSD, Janet Shields MSN CRNP, PNP-SC
Lynn Simmons MSN CRNP
Electronically ReviewedOgned by. Kerry M Fagelman, MDCoslgner Signature DVTm: 22.12.2010 04:57 PM
LGS /CR DD: 12121110 DT.' 12122110 14:36
Date/Time Printed: 1/20/2011 09:55 EST Page 4 of 78
Printed By: Tice,Cindy L
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ORIGINAL POLICY DECLARATIONS
PIBSONAL AVTO
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NASA 372304W
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Tiffani Gillaugh - Costs Advanced
1/10/11 Upper Allen Township Police Department $15.00
-Police Report
2/3/11 Hershey Medical Center $229.45
-Medical Records
3/8/11 Information Network Associates $150.00
-Investigation Charges
2/22/12 Cumberland County Prothonotary $103.75
-Petition for Approval of Settlement
of Minor's Claim
TOTAL $498.20
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GENERAL RELEASE - INDI'V'IDUAL (NaNOR)
MVO WALL AIENBYTHESE PRESENTS-
That We, Steven and Kimberly Gillaugh, BEING of lawful age, on behalf of our minor child Tiffaul
Gillaugh'for sole consideration of $15,000.00 (FnF EEN THOUSAND Dollars and NO CENTS), to
me in hand paid, receipt whereof is hereby acknowledged, have remised, released and forever discharged
and for my heirs, executors, administrators, and assigns do hmby remiss, release and forever discharge
Nathan Reh and Permanent General Assurance Corporation and its successors and assigns, heirs,
executors, administrators, of and from any and all claims, demands, rights, costs and causes of action
whatsoever kind and nature, arising from, and by reason of any and all known and unknown, foreseen
and unforeseen bodily and personal igjuries, damage to property, and the consequences thereon resulting
and to result from a certain incident which happened on or about the 17`* day of December, 2010, at or
near Mechanicsburg, PA for which I have claimed the said Nathan Reh and Permanent General
Assurance Corporation to be legally liable, which liability is hereby expressly denied.
It is specifically acknowledged and agreed that this Release shall not in any way effect Steven Gillaugh,
Kimberly Gillaugh, and Tiffani Gillaugh's right or ability to bring any medical malpractice claim for any
care received from December 17, 2010 to.the present or any claim against Allstate Insurance Company.
Kimberly G1llaugh Steven Gillaugh
ZN WITNBSS WRBREOP, I have hereunto set my hand and seal this day
of , in the year TWO THOUSAND AND Eleven.
SEALED and DEUVBRED in the presence of
WITNESS
ADDRESS
ONTBLS
STATE OF
COUNTY OF
DAY OF , 2
BEFORE ME PERSONALLY APPEARED
TO ME KNOWN, AND KNOWN TO ME TO BE THE SAME PERSON DESCRIBED IN AND WHO
EXECUTED TIRE ABOVE INSTRUMENT AND IMHE ACKNOWLEDGED TO ME THAT
HE/SHE EXECUTBD THE SAME.
OFFICIAL TITLE
IN RE: PETITION FOR THE
APPROVAL OF SETTLEMENT OF
MINOR'S CLAIM by
TIFFANI GILLAUGH, a minor,
by her Parents and Natural Guardians
STEVEN GILLAUGH and
KIM GILLAUGH,
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO.
Petitioner
ORDER
AND NOW, this -5 day of 2012, upon consideration of the
Petition for Approval of Settlement of Minor's Claim, a hearing is hereby scheduled for
a 9
BY THE COURT:
Judge
Distribution:
/Robert F. Claraval, Esq., 500 North Third Street, 2"d Floor, Harrisburg, PA 17101
?/Venita Philmore, Permanent General Companies, P.O. Box 305195, Nashville, TN 37230-5195
Roxanne Youndt, Travelers Insurance, P.O. Box 13485, Reading, PA 19612-3485
Kathy Rudzena, ACS Recovery Services, P.O. Box 4003, Schaumburg, IL 60168-4003
eor',
, 2012 at /- 30 _.m. in O aar,. `rto. 1
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IN RE: PETITION FOR THE
APPROVAL OF SETTLEMENT OF
MINOR'S CLAIM by
TIFFANI GILLAUGH, a minor,
By her Parents and Natural Guardians
STEVEN GILLAUGH and
KIM GILLAUGH,
Petitioner
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 12-1372 Civil
ORDER
AND NOW, this day of 2012, pursuant to Petitioner's
Motion for Continuance, the hearing scheduled for March 29, 2012 is hereby rescheduled for
2012 at30 ?O.m in Courtroom
BY THE COURT:
ALBE T H. MASLAN , Judge
Distribution:
Robert F. Claraval, Esq., 500 North Third Street, 2nd Floor, Harrisburg, PA 17101
?Venita Philmore, Permanent General Companies, P.O. Box 305195, Nashville, TN 37230-5195
V Roxanne Youndt, Travelers Insurance, P.O. Box 13485, Reading, PA 19612-3485
? Kathy Rudzena, ACS Recovery Services, P.O. Box 4003, Schaumburg, IL 60168-4003
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IN RE: PETITION FOR THE
APPROVAL OF SETTLEMENT OF
MINOR'S CLAIM BY TIFFANI
GILLAUGH, a minor, By her parents
and Natural Guardians STEVEN
GILLAUGH and KIM GILLAUGH,
PETITIONERS
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
12-1372 CIVIL TERM
ORDER OF COURT
AND NOW, this day of April, 2012, upon consideration of the
Petition for Approval of Settlement of Minor's Claim, and after a hearing thereon, IT IS
HEREBY ORDERED that a compromise settlement of the claim of Tiffani Gillaugh, a
minor, by her parents Steven Gillaugh and Kim Gillaugh, for the sum of $15,000 is
hereby APPROVED. The terms of settlement are as follows:
a. Litigation costs of $498.20 are ordered reimbursed to Robert F. Claraval,
Esquire.
b. The amount of $4,000.00 is ordered reimbursed to Steven Gillaugh and Kim
Gillaugh for past medical expenses.
c. The balance of the settlement, $10,501.80 shall be invested in an interest-
bearing, FDIC insured account with an appropriate institution for the benefit of
Tiffani Gillaugh. The account will contain a notation that no funds shall be
withdrawn until the minor becomes 18 years of age or until further order of
court.
d. Permission is given to Steven Gillaugh and Kim Gillaugh to sign a release to
Permanent General Insurance on behalf of Tiffani Gillaugh. The release will
not release any underinsured or medical malpractice claims.
e. Any and all liens claimed against the settlement proceeds are hereby
DISCHARGED in full.
Robert F. Claraval, Esquire
For Petitioners
?/Venita Philmore
Permanent General Companies
P.O. Box 305195
Nashville, TN 37230-5195
`Roxanne Youndt
Travelers Insurance
P.O. Box 13485
Reading, PA 19612-3485
Kathy Rudzena
ACS Recovery Services
P.O. Box 4003
Schaumburg, IL 60168-4003
saa
By the Court,
Albert H. Maslan , J.
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