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HomeMy WebLinkAbout13-1842 Supreme fu nnsylvania Coleas For Prothonotary Use Only: Docket Na C County The information collected on this form is used solely for court administration purposes. This form does not supplement or replace the filing and service ofpleadings or other pupers as required by law or rules of court. Commencement of Action: 0 Complaint 0 Writ of Summons ll Petition 0 Transfer from Another Jurisdiction 0 Declaration of Taking Lead Plaintiff's Name: Lead Defendant's Name: MARSHA BIGLER, AS PNG OF NATASHA BIGLER SHARON ADAMS Dollar Amount Requested: Owithin arbitration limits Are money damages requested? El Yes 0 No ou (check one) 0 tside arbitration limits Is this a Class Action Suit? Yes F1 No Is this an MDJAppeal? 0 Yes ll No Name of Plaintiff/Appellant's Attorney: GERARD C. KRAMER, ESQ. © Check here if you have no attorney(are a Self-Represented [Pro Sel Litigant) Nature of the Case: Place an"X"to the left of the ONE case category that most accurately describes your PRIMARY CASE. If you are making more than one type of claim,check the one that Y you consider most important. TORT(do not include Mass Tort) CONTRACT(do not include Judgments) CIVIL APPEALS Intentional 0 Buyer Plaintiff Administrative Agencies Q Malicious Prosecution 0 Debt Collection:Credit Card ® Board of Assessment E] Motor Vehicle 0 Debt Collection:Other 0 Board of Elections Nuisance _ Dept,of Transportation 0 Premises Liability Statutory Appeal:Other © Product Liability(does not include mass tort) 0 Employment Dispute: Slander/Libel/Defamation Discrimination © Other: ® Employment Dispute:Other 0 Zoning Board 0 Other: 0 Other: MASS TORT f © Asbestos 0 Tobacco 0 Toxic Tort-DES Toxic Tort-Implant REAL PROPERTY MISCELLANEOUS 0 Toxic Waste 0 Other: 0 Ejectment 0 Common Law/Statutory Arbitration i 0 Eminent Domain/Condemnation 0 Declaratory Judgment 0 Ground Rent l Mandamus 0 Landlord/Tenant Dispute ® Non-Domestic Relations Mortgage Foreclosure: Residential Restraining Order PROFESSIONAL LIABILITY 0 Mortgage Foreclosure:Commercial 0 Quo Warranto Dental 0 Partition 0 Replevin Legal Quiet Title 0 Other: Medical 0 Other: rl Other Professional: Updated 1/1/2011 SCHMIDT KRAMER PC FILED-OFFICE: By: Gerard C. Kramer, Esquire OF THE PROTHONOTARY 209 State street 1013 APR —9 AM t1: 09 Harrisburg, PA 17101 (717) 232-6300 CUMBERLAND COUNTY (717) 232-6467 Fax PENNSYLVANIA gkramer@schmidtkramer.com Attorney for Petitioner IN RE: MARSHA BIGLER, AS : IN THE COURT OF COMMON PLEAS PARENT AND NATURAL : CUMBERLAND COUNTY, GUARDIAN OF NATASHA : PENNSYLVANIA BIGLER, A MINOR. : NO. PETITIONER. : PETITION FOR APPROVAL OF COMPROMISE SETTLEMENT AND DISTRIBUTION OF PROCEEDS FOR NATASHA BIGLER, A MINOR AND NOW, comes Petitioner MARSHA BIGLER, as Parent and Natural Guardian of NATASHA BIGLER, a Minor, by and through his attorneys, GERARD C. KRAMER, ESQ. and SCHMIDT KRAMER PC, and respectfully sets forth the following in accordance with Pennsylvania Rule of Civil Procedure 2039; 1. Petitioner is Marsha Bigler as the Parent and Natural Guardian of Natasha Bigler, a Minor. 2. Petitioner currently resides at 4 Buffalo Drive, Shippensburg, Cumberland County, Pennsylvania. 3. Petitioner is the natural birth mother of Natasha Bigler, whose date of birth is July 23, 1998. 4. At the time of the accident described below, Natasha Bigler resided wit rA- Petitioner. (/( (?mow 0 i Sb C-R7 �o 8 5. On October 26, 2011, Natasha Bigler was a back-seat passenger in her Petitioner's 2001 Suburban traveling west on Ridge Road in Hopewell Township, Cumberland County, Pennsylvania. 6. Defendant Sharon Adams failed to stop at a stop sign governing the intersection of Ridge Road and Jumper Road. As the Defendant proceeded into the intersection, she struck the Bigler vehicle. (See Police Report attached as Exhibit "A"). 7. Natasha Bigler was injured due to Sharon Adams' negligent operation of her vehicle. 8. Natasha Bigler was transported to Chambersburg Hospital by the Shippensburg Area EMS. As a result of the accident, she sustained a chest contusion and a right cervical strain. (See Chambersburg Hospital Medical Records attached as Exhibit "B"). 9. On October 28, 2011, Natasha Bigler followed up with her family physician, Dr. Carlos R. Sandoval-Martinez, M.D. at the Shippensburg Family Practice for her upper back and neck pain. A cervical spine x-ray as conducted at the Hershey Medical Center on November 2, 2011. Natasha Bigler was diagnosed with neck pain status post motor vehicle accident. (See Shippensburg Family Practice Medical Records attached as Exhibit -C-). 10. The medical bills were paid by GMAC Insurance Company, the first party auto insurance carrier of Petitioner. 2 11. At the time of the accident, the vehicle operated by Sharon Adams was insured by Penn National Insurance. 12. Penn National Insurance has offered TWO THOUSAND FIVE HUNDRED DOLLARS ($2,500.00) under the policy of Sharon Adams. 13. In pursuing the claims against the tortfeasor, Petitioner engaged the law firm of Schmidt Kramer PC under a Contingency Fee Agreement, with an agreement of 25% attorneys' fees on any settlement in addition to reimbursement of costs advanced. (See Contingency Fee Agreement attached as Exhibit "D"). 14. To date, Schmidt Kramer PC has incurred costs relative to obtaining copies of the medical records and costs associated with the investigation and settlement of this matter in the amount of $207.03. (See Costs attached as Exhibit "E"). 15. Petitioner requests that the Court accept the amount of $2,500.00 as settlement for the third party claim with Penn National Insurance. 16. Petitioner requests that the Court distribute the total payments of claims in the amount of$2,500.00 as follows: SCHMIDT KRAMER PC $ 625.00 SCHMIDT KRAMER PC Attorna_fees (25% $ 207.03 Costs incurred to date To be deposited in an account on behalf of Natasha Bigler, a $ 1,66-7.97 Minor marked as follows: "This money shall be held in trust not to be redeemed, withdrawn, negotiated, or in any way alienated, except for renewal in its entirety, before July 23, 2016, except by Order of this Court." 3 TOTAL I $—T2,500.00 17. Petitioner requests that this account be authorized without the formal appointment of a Guardian of Estate of the Minor, or the entry of Security, with Petitioner being authorized and directed to invest funds belonging to Natasha Bigler, a Minor, as follows: a. to invest the funds in Certificates of Deposit to the extent possible, with an appropriate financial institution as described in Pa.R.C.P. 2039(b)(2), not to exceed such sums as are fully insured by F.D.I.C.; and b. to invest the balance of said sums, which cannot be invested in Certificates of Deposit, if any, in a Savings Account in an appropriate financial institution as described in Pa.R.C.P. 2039(b)(2), not to exceed such sums as is fully insured with F.D.I.C. Each account on behalf of Natasha Bigler, a Minor shall be marked as follows: "This money shall be held in trust not to be redeemed, withdrawn, negotiated, or in any way alienated, except for renewal in its entirety, before July 23, 2016, except by Order of this Court." 18. Petitioner's attorney shall file an Affidavit, evidencing the deposit of said monies within sixty (60) days of the Court's Order approving the settlement and the monies being deposited. 4 19. Petitioner, as Parent and Natural Guardian of Natasha Bigler, a Minor is satisfied that the offer of settlement of the aforementioned claim is just and reasonable, and that he is willing to accept said offer, if approved by the Court. (See Verification attached as Exhibit "F"). 20. Gary Bigler, as Parent and Natural Guardian of Natasha Bigler, a Minor, also believes this offer to be just and reasonable and joins in this Petition. (See Joinder attached as Exhibit "G"). 21. Petitioner respectfully requests that this Honorable Court grant him the authority to sign the proposed third-party Release from Penn National Insurance on behalf of Natasha Bigler, a Minor. WHEREFORE, Petitioner requests that this Honorable Court enter the Order attached hereto as Exhibit "H" approving the foregoing compromised settlement and directing the distribution of proceeds as set forth herein. Respectfully submitted, SCHMIDT KRAMER PC Date: By: erard C. Kramer, Esq. 209 State Street Harrisburg, PA 17101 (717) 232-6300 (717) 232-6467 Fax gkramer@schmidtkramer.com Attorney for Petitioner 5 POLICE REPORT AA-500 TX !ncideilt Number: H02-2071725 Commonwealth of Pennsylvania PAGE 1 Crash Involves: Police Crash Report REPORTABLE CRASH 0 DUI O Fatality a Hit and Run 0 Commercial Vehicle 0 State Police Vehicle O Local Police Vehicle *NIA 0 Work Zone O ATV 0 Snowmobile 0 Commonwealth Vehicle O Local Gov Vehicle Agency Name Case Closed Patrol Zone linvestigation Date a PA STATE POLICE-CARLISLE NO 21 10/26/2011 :., QC W Dispatch Time val rime Investigator Badge Number ¢ 10:47 hrs. 11:15 hrs. LONG,MATTHEW D 11173 u Approval Date Reviewer Reviewer Badge Number a 11/08/2011 RUDY,TODD J 06668 Date of Crash [rime of Crash Day of the Week Crash Description 10/26/2011 10:45 hrs. WEDNESDAY SIDESWIPE(OPPOSITE DIRECTION) County Municipality CUMBERLAND HOPEWELL TWP Weather Conditions Relation to Roadway a NO ADVERSE CONDITIONS ON TRAVEL LANES Illumination Road Surface Conditions v DAYLIGHT DRY #of Units of People I#ofinjured #19led EMS Agency Medical Facility 002 002 002 000 SHIPPENSBURG EMS CHAMBERSBURG HOSPITAL School Bus Related School Zone Reed 1PennDOT Notified ype of intersection Special Location NO NO NO 4 WAY INTERSECTION NOT APPLICABLE Work Zone Work Zone Type Where in Work Zone c NO 0 Speed Limit Workers Present Officer Present Work Zone Characteristics ❑Lane Closure Road Closed or k on Shoulder Intermittent or Flagger ❑ with Detour ❑ ❑ Moving Work ❑ Control ❑ Other a Route Signing Route Number Segment Number Travel Lanes Speed Limit Orientation STATE HIGHWAY 4004 40 MPH WEST n House Number Street Name St.Ending STATE HWY 4004 ROAD CL Route Signing Route Number Segment Number Travel Lanes Speed Limit Orientation Used in LOCAL ROAD OR STREET T360 02 30 MPH SOUTH Intersection m Crashes Street Name St.Ending JUMPER ROAD e Route Number Or Mile Post Tenths Or Segment Marker Ramp Use Only Feet E c 0 a Street Name Street Ending Or Miles enths J U C O J Q - H Route Number Or Mile Post Tenths Or Segment Marker Ramp Use Only U. E The above entry is the E distance from the Crash o P 9 Street Name Street Ending Scene to Landmark 1 p � J m Degrees Minutes Seconds Decimal Degrees Minutes Seconds. Decimal CL Latitude: 40 06 ; 35 ■ 223 Longitude: .. 77 30 55 465 Traffic Control Device Traffic Control Functioning 0 STOP SIGN DEVICE FUNCTIONING PROPERLY d Lane Closed Lane Closure direction Traffic Detoured Estimated Time Closed ---] C PARTIALLY EAST AND WEST YES <30 MIN. Environmental/Roadway Potential:Factors(E/R) Factor 1 F actor 2 Factor 3 NONE c First Harmful Event In the Crash Most Harmful Event in the Crash X Unit Number Harmful Event Unit Number Harmful Event 001 STRUCK BY UNIT 2 002 HIT UNIT 1 Indicated Prime Factor Unit Number Prime Factor Driver Action C DRIVER ACTION 001 RUNNING STOP SIGN Prime Factor ErniromenteURoadway Prime Factor Vehicle Failure Prime Factor Pedestrian Acton w Road Surface Type Special Jurisdiction Printed At:PA State Police-Carlisle 0111112012 09:31 AM Page 1 Form#:H02-2071725 AA-50 7X Ancidodt Number: H02-2071725 Commonwealth of Pennsylvania PAGE 2 Crash Involves: Police Crash Report REPORTABLE CRASH 0 DUI 0 Fatality 0 Hit and Run 0 commercial Vehicle 0 State Police Vehicle 0 Local Police Vehicle *N/A O.Work Zone 0 ATV 0 Snowmobile 0 Commonwealth Vehicle 0 Local Gov Vehicle Unit Number Fype Unit _ Commercial Vehicle 001 Motor Vehkle In Transport No First Name Ml Last Name Suffix DOB Telephone Number SHARON C ADAMS 04127/1952 (717)4234642 Street Address CRY State ip Code 16 PEEBLES ROAD NEWBURG (USA) I PA r 17240 Gender I License Number License State Class Expiration Date lOwner/Driver FEMALE 1 19514413 PA C 15 1 PRIVATE VEHICLE OWNEDILEASED BY DRIVER 0 :1 Driver Presence lPhysical Condition Primary Vehicle Code Violation ---- Person Charged E. DRIVER OPERATED VEHICLE I APPARENTLY NORMAL 3323 YES 2 E Alcohol/Drugs Suspected IA co hol Test Type Icohol Test Results C NO TEST NOT GIVEN F '9 Driver Action RUNNING STOP SIGN IL 41 IL Pedestrian Action Pedestrian Signals Pedestrian Clothing Pedestrian Location 1st Harmful Event Left or Right Side Most Harmful Utility Pole Number STRUCK BY UNIT 2 YES 2nd Harmful Event Left or Right Side Most Harmful Utility Pole Number HIT FENCE OR WALL LEFT NO 3rd Harmful Event Left or Right Side Most Harmful Utility Pole Number 4th Harmful Event Left or Right Side Most Harmful Utility Pole Number Owner First Name Owner MI Owner Last Name or Business Name suffix SHARON C ADAMS Street Address city State Zip Code 15 PEEBLES ROAD NEWBURG (USA) PA 17240 Vehicle Type Special Usage Government Equipment Number AUTOMOBILE NOT APPLICABLE Model Year lVehicle Make Vehicle Model Vehicle Color VIN 2000 INFINITI 030T SILVER JNKCA31AXYT126602 License Plate Reg.State Est Speed lVehicle Ta--wved Towed By RC04E9 I PA 046 YES CDC TOING Insurance Insurance Company Policy Number Expiration Date YES PA NATIONAL MUTUAL CASUALTY INSU 1290029913 0212812012 Direction of Travel Vehicle Position Vehicle Movement Initial Impact Point 0 SOUTH RIGHT LANE"CURB" GOING STRAIGHT 0 O'CLOCK Damage indicator Gradient Road Alignment Possible Vehicle Failures DISABLING LEVEL STRAIGHT NONE #of Units Type Unit 1 Tag Number Tag Year Tag State 0 Yi Unit Make Unit Owner Type Unit 2 Tag Number Year State Unit Make Unit Owner Fag 7 Engine Size Saddle Bag/Trunk? Trailer? Driver Education? cc Passenger? 1 Driver Helmet Type Helmet Stayed On? DOT/Snell Designation? Eye Protection? Long Sleeves? Long Pants? Over Ankle Boots? * Passenger Helmet Type Helmet Stayed On? DOT/Snell Designation? Eye Pi5i"Sleeves? Long Pants? Over Ankle Boots? * Passenger? Helmet? o Head lights? Rear Reflectors? IL Printed At*PA State Police-Carlisle 0111112012 09:31 AM Page 2 Form#:H02-2071725 4A-5^C TX ..,Incideiit Number: H02-2071725 Commonwealth of Pennsylvania PAGE 3 Cr-ash Involves: Police Crash Report REPORTABLE CRASH 0 DUI 0 Fatality 0 Hit and Run 0 Commercial Vehicle 0 State Police Vehicle 0 Local Police Vehicle *I&A 0 Work Zone 0 ATV 0 Snowmobile 0 Commonwealth Vehicle 0 Local Go,,Vehicle Unit Number rype Unit Commercial Vehicle 002 1 Motor Vehicle in Transport No First Name MI Last Name Suffix DOB Telephone Number GARY R BIGLER Jr 03111611967 (717)446-4413 Street Address city State Zip Code 4 BUFFALO DRIVE SHIPPENSBURG PA 17257 Gender License Number License State Class Expiration Date jOwner/Driver MALE 22465420 PA C 0311712012 1 PRIVATE VEHICLE OWNED/LEASED BY DRIVER Driver Presence Physical Condition Primary Vehicle Code Violation Person Charged E UNKNOWN APPARENTLY NORMAL NONE NO .s Alcohol/Drugs Suspected Alcohol Test Type lcohol Test Results r- NO TEST NOT GIVEN Driver Action NO CONTRIBUTING ACTION V Pedestrian Action Pedestrian Signals Pedestrian Clothing Pedestrian Location 1st Harmful Event Left or Right Side Most Harmful Utility Pole Number HIT UNIT I YES 2nd Harmful Event Left or Right Side Most Harmful Utility Pole Number 3rd Harmful Event Left or Right Side Most Harmful Utility Pole Number 4th Harmful Event Left or Right Side Most Harmful Utility Pole Number Owner First Name Owner MI Owner Last Name or Business Name Suffix GARY R BIGLER Jr Street Address city State Zip Code 4 BUFFALO DRIVE City PA 17257 Vehicle Type Special Usage Government Equipment Number SLIV I NOT APPLICABLE Model Year [Vehicle Make etriele Model Vehicle Color VIN 2001 ICHEVROLET SUBURBAN GOLD 3GNGK26GBIG222671 License Plate Reg.State Wt Speed lVehicle Towed Towed By 12451PD PA 846 YES CDC TOWING Insurance Insurance Company Policy Number Expiration Date YES GMAC INSURANCE 100784658OA01 02AW2012 Direction of Travel Vehicle Position Vehicle Movement Initial, Impact Point 0 WEST RIGHT LANE"CURB" GOING STRAIGHT 12 O'CLOCK E Damage Indicator Gradient Road Alignment Possible Vehicle Failures -2 DISABLING LEVEL STRAIGHT NONE C #of Units Type Unit 1 Tag Number Tag Year Tag State z 0 Sl Unit Make unit Owner 3 .E Type Unit 2 Tag Number Tag Year Tag State Unit Make Unit Owner Engine Size Passenger? die Bag/Trunk? Trailer? Driver Education? cT So, Driver Helmet Type Helmet Stayed On? DOT/Snell Designation? Eye Protection? Long S ants? Over Ankle Boots? E! - leaves? Long P 0 0 o 2 Passenger Helmet Type Helmet Stayed On? DOT/Snell Designation? Eye Protection? Long Sleeves? Long Pants? Over Ankle Boots? .2 Passenger? HeIrnet? 0 .9�01 I Head Lights? Rear Reflectors? o. Printed At PA State Police-Carlisle 0111112012 09:31 AM Page 3 Form*H02-2071725 PA-500 TX Incident Number: H02-2071725 Commonwealth of Pennsylvania PAGE 4 Crash Involves: Police Crash Report REPORTABLE CRASH 0 DUI 0 Fatality 0 Hit and Run 0 Commercial Vehicle 0 State Police Vehicle 0 Local Police Vehicle WA 0 Work Zone 0 ATV 0 Snowmobile 0 Commonwealth Vehicle 0 Local Gov Vehicle Unit# Person No. First Name MI Last Name Suffix DOB 002 001 GARY R BIGLER JR 4311611967 Street Address City State Zip Code = 4 BUFFALO DRIVE SHIPPENSBURG PA 17257 Phone Number JEMS Transport Person Type Gender Injury Severity E (717)446-4413 YES DRIVER MALE MINOR INJURY 4 c Seat Position Safety Equipment 1 m DRIVER-ALL VEHICLES LAP AND SHOULDER BELT USED a IL Safety Equipment 2 Extrication FRONT AIR BAG DEPLOYED(FOR THIS SEAT) NOT EXTRICATED Ejection Ejection Path NOT EJECTED NOT EJECTEDINOT APPLICABLE Unit# Person No. First Name MI Last Name Suffix DOB 002 002 GARY R BIGLER JR 0311611967 Street Address City State Zip Code 4 BUFFALO DRIVE SHIPPENSBURG PA 17257 wPhone Number JEMS Transport Person Type Gender Injury Severity E (717)446-4413 YES DRIVER MALE MINOR INJURY c Seat Position Safety Equipment 1 m DRIVER-ALL VEHICLES LAP AND SHOULDER BELT USED a IL Safety Equipment 2 Extrication FRONT AIR BAG DEPLOYED(FOR THIS SEAT) NOT EXTRICATED Ejection Ejection Path NOT EJECTED NOT EJECTED/NOT APPLICABLE w Owners First Name Ml Last Name Suffix Phone Number E ALVIN M WEAVER (717)729-7757 o Street Address lCity State Zip Code 980 BRITTON ROAD SHIPPENSBURG PA 17257 1 Property Description a` 50 FEET OF FENCE AND WIRE Person\Business Notified Phone Number Date Notified r11:00 me Notified ALVIN WEAVER {717)729-7757 1012812011 hrs o Reason for Notification Z DAMANGED FENCE POLES AND WIRE Printed At:PA State Police-Carlisle 01/1 112012 09:31 AM Page 4 Form#:H02-2071725 n lafi-firm?'Y Incidetit Number: H02-2071725 Commonwealth of Pennsylvania PAGE 5 Crash involves: Police Crash Report REPORTABLE CRASH 0 DUl 0 Fatality Q Hit and Run O Commercial Vehicle O State Police Vehicle O Local Police Vehicle Q NIA O Work Zone 0 ATV 0 Snowmobile 0 Commonwealth Vehicle d Local Gov Vehicle j 20 Nor ro --A=^LC c a 1 LK2 rV CIS! 0 nit2 Final RiMlfirta Pant a �G� I 3 Mies to Shippensbtirg TAP. ` 1 I NARRATIVE Crash Syno{mis This incident'occurred as Unit#1 was traveling south on Jumper Road and failed to completely stop and clear the intersection before continuing.Unit#2 was traveling west bound on Ridge Road when Unit#1 pulled out in front of Unit#2. Unit 02 struck the rear door of Unit#1 causing the vehicle to be pushed off the southwest corner of the roadway into a small fence knocking down approximately 50 feet of the fence. The drivers of both vehicles were transported to Chambersburg Hospital by Shippensburg EMS with minor injuries. Crash Details This incident occurred as Unit#1 was traveling south on Jumper Road and failed to completely stop and clear the intersection before continuing.Unit#2 was traveling west bound on Ridge Road when Unit#1 pulled out in front of Unit 92. Unit#2 struck the rear door of Unit#1 causing the vehicle to be pushed off the southwest corner of the roadway into a small fence knocking down approximately 50 feet of the fence. The drivers of both vehicles were transported to Chambersburg Hospital by Printed At PA State Police-Carlisle 0111112012 09:31 AM Page 5 Form#-H02-2071725 AA-5!'R TX incident number: H02-2071726 Commonwealth of Pennsylvania PAGE 6 Crash involves: Police Crash Report REPORTABLE CRASH 0 DUl O Fatality O Hit and Run O Commercial Vehicle O State Police Vehicle O Local Police Vehicle *N/A O Work Zone O ATV O Snowmobile O Commonwealth Vehicle O Local Gov Vehicle Shippensburg EMS with minor injuries. On 10126/11 at 1145 hours I spoke with the operator of Unit#1 at the Hospital. She stated that she didn't come to a complete stop at the intersection.Then she thought the intersection was clear so she proceeded to enter the Intersection when at the last minute she saw the vehicle coming from her left hand side and then it was to late. On 10126111 at 1280 hours I spoke with the operator of Unit#2 at the Hospital. He related that he was traveling west on Ridge Road when he saw a passenger car dart out into the roadway and he tried swerve to avoid hitting her directly on her drivers door. Both vehicles were transported by CDC Towing to his Impound lot for safekeeping.Unit#1 had serve damage to the rear driver side door. Unit#2 also had serve front end damage to his vehicle. Both Units were provided with a notice of crash investigation report. Unit#1 was cited for causing the crash T0844916-6). Printed At PA Stabs Police-Carlisle 01111/2012 09:31 AM Page 6 Form# H02-2071725 CHAMBERSBURG HOSPITAL MEDICAL RECORDS CHAMBERSBURG HOSPITAL EMERGENCY DEPARTMENT � Chanrbarallr,urg. CHAMSERSBURG, PA 17201 Chart Copy N L . �`R AMME TKMARTIN H00M41)73534 Ep H$7762$ AWAVWX TEL PATIWf WA HAMS AMDA ESS VWAAEY 1lLMONEN0. a BiGLER,NATASHA A 1717)466.4414 STUDEMT A BUFFALO DA SHIPMNS8URG.PA 17257 " $68-03-7336 S CI.Al3_ju&TWOfSWV0j T/1E6 PA CS lAE (41TE Of SINTN SiX UA}4TA1 STA TEXT S 10126111 1164 CA 13 4712311998 F S BIGLER.MAR3HA MC+ 17171201.8856 Pe AWI UWnW* 06C COOS US OP OCC OaTE OF OCC TZER,KARIN 10126111 (717)262.8866 NMM AM AOONyt, AIELATIQFI TO PAilEP1Y QAVAMIT011 EMPLOwEA INPOgM�1i0N t $itiLER,MARBHA DISABLED 4 BUFFALO DR Th NO. SHIPPENSSUAG,PA 17257 erl 194.60,7636 SiU4TMCS COGPUMY PD17CY MOLDS(! A5AT'ONWIPIlA4Y CE6TiPICATS7S1e:WP W8WAARI B.S.PPO PLUi IC 91GLER,NATASHA A SP ZAR11926464900102531700 .q MGHMARK B.S.PPO PLUS(C x y(£ •: r. rr,Atpu rW vIStY1{aN•�IOSrs WA 8ayier MA„Lawra»oi J Paleda M.D.,Adellto L (717)532-+)149 Pabde M,D.,Adelina L (717)832-414$ Other Doctor Inlormatiorr MR.F$ THE CKAM&P,31SUEU; HOSPITAL 112 North Seventh Street Charnbersturg, PA 17201 (717) 267-3000 PATIENT NAME:BIGLER,NATASHA A MEDICAL RECORD 0:H577529 ACCOUNT V. H00043573534 ADMISSION DATE: PATIENT TYPE: DEP ER H: DISCHARGE DATE: 10126111 ROOMIBED: REPORT#: 1027-0086 SERVICE DATE: 10126111 006:07/23/1998 ATTENDING PHYSICIAN., PHYSICIAN: Lawrarce J Boyler M.D. EMERGENCY ROOM REPORT REPORT STATUS: Signed CHIEF COMPLAINT Automobile accident. HISTORY: This 13-year-old vms routine passenger of a carthat T-toned another car, then spun. She was at the asok seat with her mother who is not injured. The patient complained of right neck pain and chest pain at the scene. Was backboarded and is C-collared by the ambulance brought here. The patient did not bump her head as far as she can remember, The DVD player in front of her popped off the seat and nay have struck her In the chest which she thinks Is the mechanism of Injury. Has not ambulated prior to arrival. PAST MEDICAL HIS-ORY: Asthma. ALLERGIES: None. MEDICATIONS: Albuterol. PHYSICAL EXAMINATION: Vital Signs: Temperature 98.2, pulse 67, respirations 18, BP of 160174, and pulse o)(ime-ry 100%. General: The patient an a backboa-d. No visible facial or extremity Injuries. No tenderness over the cervical spine. Some diffuse posterior thoracic tenderness not local zed to the T-spins. Heart: Sounds are regula•. Lung sounds are clear. Tenderness over the upper sternum. Abdomen: Soft and nontender. Extremities: Moves all eArernitles. No tenderness. There is no drill. Finger-nose-finger and rapid eye movements normal. The patient does report having some transient paralysis of the left hand which the nurse witnessed and thought it was hyperventilation. It is completely cleared now. ASSESSMENT: Automobile accident with contusion of the chest, right cervical muscle strain. We wil proceed with a chest x-ray. The patient declines Tylenol for the pain. 4546801423341 <lectrunically signed by Lawrence J Sayler M.D.>10127111 0657 Transerphonist:A Dictated:1012811 1155 Transcribed:10127111 0313 CC; Additional copy: Other Wedical Record W%D082089 Page I of I DEPARTMENT: CHAMBRRSBURG HIM THE CHAMBERSBURG HOSPITAL SLM17 HEALTH CENTER. 112 north Seventh Street Rhonda Brake Shreiner Women's Ceater Chambersburg, PA 17251 Summit Diagnostics Services Departments of Chambersburg Hospital (717) 267-7149 PATIENT NAME:BIGLER,NATASHA A MEDICAL RECORD 0: H577529 ACCOUNT 0: H00043573534 PATIENT LOC: CER DOB:0712311998 PATIENT TYPE:DEP ER H: ORDER#: 1026-0144 ROOMIBED: REPORT#: 1026-0262 PRONE#, (717)466-4414 ADMITTING DIAGNOSIS: MVA RADIOLOGIST: Peter J Fang M.D. ORDERING PHYSICIAN: Boyler, Lawrence J M.D. DIAGNOSTIC IMAGING REPORT STATUS: Signed DATE OF SERVICE: 10/26/11 HISTORY: 13 year-old female with history of asthma. PA AND LATERAL CHEST: Comparison made with prior study of 11116/10. The lungs are well expanded and clear. The heart, pleural spaces, diaphragm, and mediastinum are free of any abnormality. No significant bony abnormalities are appreciated. Overall appearance of the chest is similar to prior study of 11/16110. IMPRESSION: No radiographic abnormalities. IC09 Cade: 492.90 922.1 <pectrodcaly sipped by Peter J Fang M.D>10/201i1 1707 Trans"pNoNst:NU-1 Dictated:1=&I1 1230 Transcribed:10120!11 1240 CC:Adellne L Pakde.NLD,;Lawrence J Sayler M.D. Additional copy: Other Nedlcai Record We:D092089 Fage 1 of 1 DEPARTMENT: DIAGNOSTIC IMAGING 71020 SHIPPENSBURG FAMILY PRACTICE MEDICAL RECORDS THE C14AMBERSBURG HOSPITAL SUMMIT HEALTH CENTER 112 North Seventh street Rhonda Brake Shreiner women's Center Chambersburg, PA 17201 Summit Diagnostics services Departments of Chambersburg Hospital (717) 267-7149 PATIENT NAME: BIGLER,NATASHA A MEDICAL RECORD#: H577529 ACCOUNT#: H00043573534 PATIENT LOC: CER DOB: 07/23/1998 PATIENT TYPE: DEP ER H: ORDER#: 1026-0144 ROOM/BED: REPORT#: 102 6-02 62 PHONE #: (717)466-4414 ADMITTING DIAGNOSIS: MVA RADIOLOGIST: Peter) Fang M.D. ORDERING PHYSICIAN: Boyler, Lawrence J M.D, - DIAGNOSTIC IMAGING REPORT STATUS: Signed DATE OF SERVICE: 10/26/11 PISTORY: 13 year-old female with history of asthma. PA AND LATERAL CHEST: Comparison made with prior study of 11/16/10. The lungs are well expanded and clear. The heart, pleural spaces, diaphragm, and mediaslinum are free of any abnormality. No significant bony abnormalities are appreciated_ Overall appearance of the chest is similar to pr study of 11/16a/10. IMPRESSIONradiographicabnormalities. ICD9 Code: 492790--9-22.1 <Electronically signed by Peter J Fang M.D.> 10/26/111707 Transcriplionist:MLH Dictated: 10/26/11 1230 Transcribed: 10/26/11 1240 r CC:Adelina L Palade M.D.;Lawrence J Boyler M.D. Family Physician's copy; Palade M.D.,Adelina L Valley Family Care,411 5 Fayette Street Shlppensburg,PA 17257 Other Medical Record#'s:D092089 Page 1 of I DEPARTMENT: DIAGNOSTIC IMAGING 71020 PENNSTATE VMWn S.Herstiq *did Center MRN-. 01954615 Name: BIGLER,NKI'AS14A A DOB: 07/2311998 SOX: F SS#: 7336 Attending: SANDOVAL,CARLOS Requesting:SANDOVAL,CARLOS R Copy to: SANDOVAL,CARLOS R 411 SOUTH FAYETTE STREET SHIPPENSBURG,PA 17257 Exam: (HMC) XCSPLTDPOP-X-RAY CERVICAL SWINE LIMITLD 2.3 VIEWS-PEDS Date ofSarVICQ: 11/02201 l IWAMINATION- X-RAY CERVICAL SPINE LIMITED 2-3 VIEWS-PEDS/OP CLINICAL HISTORY: pain s/p MVA COMPARISON: None FINDINGS: The Vertebral body and intervertebral discs are of normal height and density.Normal alignment is maintained.There is no evidence eacture ordislocation.Them is no prevertebral soft tissue swelling.The C I-C2 alignment is also normal. a3l onnal!tudy of the cm-vical spine with no evidence of trauma. End of diagnostic Dictated and Reviewed By: CHOUDHARY,ARABINDA 11/02/2011 12:07 PM EDT Reviewed and Signed By: CHOUDHARY,ARABINDA 11/02/2011 12:07 PM EDT CP NOV 11/03/2011 5:30AM MHMC—DiaposlicReportBatch.rpt Page 1 of I CONTINGENCY FEE AGREEMENT ,ONTINGENT FEE A(;RMMNT THIS AGREEMENT entered into the 11 6-of November, 2011, by and between SCHMIDT KRAMER PC and Gary and Marshaligler on their own behalf, and on behalf of their minor daughter, Natasha�igler, as her parents and natural guardians of Shippensburg, PA, hereinafter referred to as "Client." WITNESSETH: The law firm of SCHMIDT KRAMER PC, will act as Client's attorney in negotiating for a settlement, and in bringing a claim against Sharon Adams arising out of an accident which occurred on October 26, 2011, in Shippensburg. In addition, SCHMIDT KRAMER PC, will pursue all claims for underinsured or uninsured motorist benefits to which the Client may be entitled under his/her insurance policy. In return,, the Client will: 1. Promptly supply accurate information, as requested by SCHMIDT KRAMER PC, and cooperate fully, including making myself available for meetings with attorneys and for legal proceedings. Client promises all information supplied will be truthful and accurate. 2. (a) In any claim brought on Client's behalf, to pay to SCHMIDT KRAMER PC, for its services an amount equal to thirty percent (30%) of all funds or property accruing to Client as a result of SCHMIDT KRAMER PC's services in securing a settlement of these claims without litigation; an amount equal to thirty- three-and-one-third percent (33-1/3%) of all funds or property accruing to Client as a result of SCHMIDT KRAMER PCs services in securing a settlement of these claims after a suit has been filed; and an amount equal to forty percent (40%) if such funds or property are secured after start of trial or as a result of verdict or judgment. Trial begins at the Pre-Trial Conference, or when testimony is taken for trial, whichever occurs first. In any matter submitted to arbitration, suit is filed when the arbitrators are appointed or when a Petition to Appoint Arbitrators is filed, whichever first occurs. In any matter submitted to arbitration, trial starts the first day the arbitrators have convened to hear testimony. (b) Client agrees not to settle or negotiate the above claim or any proceedings based thereon. (c) If Client terminates this Agreement before recovery, Client agrees that SCHMIDT KRAMER PC, shall be entitled to a fee based upon work done and benefit conferred. (d) Client agrees to read and follow SCHMIDT KRAMER PCs "Client Instruction Manual". 3. Client agrees to reimburse SCHMIDT KRAMER PC, out of any recovery, in addition to attorneys' fees, all costs and expenses incurred on Client's behalf in order to make the claim. All such costs and expenses will be advanced by SCHMIDT KRAMER PC as they are incurred. Such costs and expenses include, but are not limited to, filing fees, cost of medical records, copying costs, fax costs, long distance telephone costs, expert witness fees and sheriffs service costs. In the event there is no recovery, the Client will not be responsible for any costs or interest charges. Costs will be repaid to SCHMIDT KRAMER PC, out of any funds or property collected either by settlement or judgment. 4. Claims for first party medical benefits and income loss benefits are separate items. SCHMIDT KRAMER PC will help you process these claims. A separate agreement will have to be entered into for fees if a major dispute occurs requiring the filing of suit for these benefits. The Client has read and does understand this Agreement. Signed the day and year set forth above. WITNESS: Client: �Frlrypijjerl k-J-- Marsha gle r Approved: SCHUNIMIDWT BRAMER By I have received a copy of this Contingent Fee Agreement. Initials COSTS 9:47 AM SCHMIDT KRAMER PC 03/27/13 Client Cost Report Accrual Basis All Transactions Type Date Num Source Name Memo Amount Bigler, Natasha 225263 Check 8/13/2012 S21376 Stratos Legal Record Services,LP 225263/Natasha Biglerlinv.no 605953 Check 10/9/2012 S21814 Stratos Legal Record Services,LP 225263/Natasha Bigler/611705 84.48 Check 10/23/2012 S21898 Stratos Legal Record Services,LP 29.95 225263/Natasha Bigler/618014 Check 10/23/2012 S21898 Stratos Legal Record Services,LP 225263/Natasha Bigler/618037 29.95 Check 11/6/2012 S22013 Stratos Legal Record Services,LP 225263/Natasha Bigler/618037 2995 Total 225263 32.70 207.03 Total Bigler,Natasha 207.03 TOTAL 207.03 Pane 1 VERIFICATION VERIFICATION I, MARSHA BIGLER, as Petitioner and Parent and Natural Guardian of NATASHA BIGLER, a Minor, hereby state that I have read the foregoing Petition for Approval of Compromise Settlement and Distribution of Proceeds for Natasha Bigler, a Minor, and reviewed it with my attorney, Gerard C. Kramer, Esquire, and that I understand, agree, and approve the contents thereof and join in the Petition. OqaAr)hQ�, A)��� MARS BIGLER, Petits r and Parent and Natural Guardian of NATASHA BIGLER, a Minor. JOINDER JOINDER I, GARY BIGLER, as Parent and Natural Guardian of Natasha Bigler, a Minor, hereby state that I have read the foregoing Petition for Approval of Compromise Settlement and Distribution of Proceeds for Natasha Bigler, a Minor, and that I understand, agree, and approve the contents thereof and join in the Petition. ARY GLE a atural Guardia of BIGLER, a Minor ORDER IN RE: MARSHA BIGLER, AS : IN THE COURT OF COMMON PLEAS PARENT AND NATURAL : CUMBERLAND COUNTY, GUARDIAN OF NATASHA : PENNSYLVANIA BIGLER, A MINOR. . NO. PETITIONER. : ORDER AND NOW THIS day of , 2013, upon consideration of the Petition for Approval of Minor's Settlement, it is hereby ordered that Petitioner is authorized to enter into a settlement in the gross sum of TWO THOUSAND FIVE HUNDRED DOLLARS ($2,500.00). Petitioner is authorized to sign a Release and to mark the matter settled, discontinued, and ended. The settlement amount shall be distributed as follows: To: Schmidt Kramer PC, $625.00 for counsel fees; To: Schmidt Kramer PC, $207.03 for reimbursement of costs; To: Marsha Bigler, as Parent and Natural Guardian of Natasha Bigler, a Minor, $1,667.97 to be deposited into a restricted, federally insured account marked: "This money shall be held in trust not to be redeemed, withdrawn, negotiated, or in any way alienated, except for renewal in its entirety, before July 23, 2016, except by Order of this Court." TOTAL AMOUNT OF DISTRIBUTION: $2,500.00. Counsel shall provide to the Court, within sixty (60) days from the date of this order proof of such deposit. BY THE COURT: J. F IN RE: MARSHA BIGLER, AS : IN THE COURT OF COMMON PLEAS PARENT AND NATURAL : CUMBERLAND COUNTY, GUARDIAN OF NATASHA : PENNSYLVANIA BIGLER, A MINOR. , : NO. 13-1842 Civil PETITIONER. : co �r (= e j': PROOF OF COMPLIANCE WITH COURT ORDER r-- - AND NOW, this , ray of , 2013, atted=or filing is the Share/Loan List verifying that a restricted account has been `�; ' opened for Natasha Bigler, a minor, in accordance with the Order signed by Thomas A. Placey,,Judge on April 18, 2013. Respectfully submitted, SCHMIDT KRAMER PC 'ze BY G rard C. Kramer ttorney at Law Attorney I.D. No. 44715 209 State Street Harrisburg, PA 17101 (717) 232-6300 2013107110 11:09:01 2 12 A MEMBERS V FEDERAL CREDIT UNION July 10,2013 Schmidt Kramer 209 State St Harrisburg,Pa 17101 Dear Schmidt Kramer: Re: Natasha Bigler Members I"Federal Credit Union has established an account for Natasha Bigler. The funds in the account have been placed in a Certificate of Deposit and frozen until July 23, 2016. The enclosed document shows the account name and the restriction placed on those funds. Please contact us for any additional assistance. Any questions or further communications should be directed to Gregory P. Sehank,VP of Branch Operations at 1-800-283-2328, extension 6003. Respectfully, rinisfit., ' trative hey Assistant enclosure REV.6/30/08 Page I of 1 rV1St MEMBERS V ,FEDERAL CREDIT UNION Share/Loan List For Account: 0000613878 NATASHA A BIGLER Account Type: Court Member Ordered Member Type SSN Home Number NATASHA A BIGLER Primary 7336 717446-4414 4 BUFFALO DR SHIPPENBURG, PA 17257 Share Description Rate Maturity Date Available Balance S0000 REGULAR SAVINGS -$10.00 $5.00 S0040 36 MONTH CERT 0.50% 0712312016 -$2,162.97 $1,662.97 DEPOSIT TOTAL $1,667.97 LOAN TOTAL $0.00 7/3/2013