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HomeMy WebLinkAbout14-3401JENNIFER SLEAR AND MICHAEL SLEAR, as Parents and Natural Guardians : of ANDREW SLEAR, a Minor IN THE COURT OF COMMON PLEAS CUMBERLAND CO., PENNSYLAI4T CD C- V. V 1 V (t �C (.51No. ��(� 3 � 1 C � �. • -73 CD PETITION FOR COURT APPROVAL OF MINOR PLAINTIFF'S = — COMPROMISE SETTLEMENT AND DISTRIBUTION OF PROCEEDS - `n CARLISLE AREA SCHOOL DISTRICT : AND NOW, come the Petitioners, Andrew Slear, a minor, by Jennifer Slear and Michael Slear, his Parents and Natural Guardians, by and through their attorneys, Navitsky, Olson & Wisneski LLP and hereby aver as follows: 1. Petitioners, Jennifer Slear and Michael Slear, are the parents and natural guardians of Andrew Slear, a minor. 2. Minor Plaintiff Andrew Slear resides with his parents in Carlisle, Cumberland County, Pennsylvania. . 3. Minor Plaintiff, Andrew Slear, is currently 15 years old. He was born on November 15, 1998 4. Wilson Middle School where the incident occurred is part of the Carlisle Area School District. 5. On November 28, 2012 at the Wilson Middle School, in Carlisle, Pennsylvania, Andrew Slear sustained first and second degree burns on his forearm, face and ears as a result of a fire that occurred in science class. 6. The parties agreed to a mediation, which was held on March 14, 2013. ate- � g\o3•1Spa "� 2-4 fldtkoi3� 7. Defendant, although disputing liability for the damages incurred, has nonetheless agreed to compromise the disputed claims. A copy of the executed Release is attached hereto as Exhibit A. 8. Given the nature of Petitioners' claim, the defenses available to Defendant, and the nature of minor Plaintiff's injures, Petitioners consider Defendant's offer to be a fair, just, and equitable settlement and to be in the best interest of the minor Plaintiff. 9. Your Petitioner retained the firm of Navitsky, Olson & Wisneski LLP and entered into a Contingent Fee Agreement with said attorneys for their professional services, plus expenses. A copy of the Power of Attorney and Fee Agreement is attached hereto as Exhibit B. 10. Pursuant to the Pursuant to the Power of Attorney and Fee Agreement, Navitsky, Olson & Wisneski LLP is entitled to a fee of Thirty Percent (30%) of the settlement, but has voluntarily reduced the fee to Twenty Percent (20%). 11. Navitsky, Olson & Wisneski LLP has also incurred expenses for investigation, medical records, mediation expenses, and miscellaneous items totaling $743.50. An itemization of the expenses is attached hereto as Exhibit C. 12. The only known lien asserted against the Estate is by Troyer Solutions on behalf of Highmark Blue Shield for Thirteen Thousand One Hundred Twenty Dollars and Sixteen Cents ($13,120.16). A copy of the lien letter from Troyer Solutions is attached hereto as Exhibit D. 13. Your Petitioner believes that, in accordance with the terms of the Power of Attorney and Fee Agreement a fair, just and equitable distribution of all settlement proceeds would be as follows: 2 (a) Jennifer Slear and Michael Slear, on behalf of Andrew Slear, to be deposited in a restricted savings account at M&T Bank, which is FDIC insured. (b) Andrew Slear (to be placed into structured settlement) (c) Navitsky, Olson & Wisneski LLP legal fees (30% fee reduced to 20%) (d) Highmark Blue Shield lien ($13,120.16 to be escrowed) (d) Navitsky, Olson & Wisneski LLP reimbursement of expenses TOTAL $ 4,936.34 $50,000.00 $17, 200.00 $13,120.16 $ 743.50 $86,000.00 13. The sum of $50,000.00 will be utilized to fund a structured settlement annuity underwritten by Pacific Life Insurance Company (rated A+ Superior by A.M. Best Company) for the benefit of Andrew Slear, a minor. Said annuity will provide the following periodic payments: $5,0000.00 guaranteed lump sum payable November 15, 2016. $10,000.00 guaranteed lump sum payable November 15, 2019. $48,000.00 guaranteed lump sum payable November 15, 2023. Indemnity Insurance Company of North America and/or School Claims Service shall issue payment in the amount of $50,000.00 made payable to Pacific Life & Annuity Services, Inc. (PLASI). PLASI shall fund the "periodic payments" by purchasing a "qualified funding asset" within the meaning of Section 130(d) of the Internal Revenue Code of 1986 in the form of an annuity contract issued by Pacific Life Insurance Company. The parties to this settlement shall cooperate fully and execute any and all supplementary documents, including the Qualified 3 Assignment document, and to take all additional actions which may be necessary or appropriate to give full force and effect to the basic terms and intent of this settlement. 14. The net balance of the settlement funds, pending negotiation of the lien with Healthcare Recoveries, will be deposited in a restricted savings account, which is FDIC insured at M&T Bank in Carlisle, Pennsylvania. No withdrawals will be permitted without Court Order until Andrew Slear's 18th birthday. 15. An Affidavit signed by the Petitioners requesting court approval in accordance with the terms of this Petition is attached hereto as Exhibit E. WHEREFORE, Petitioners pray that this Honorable Court enter an Order approving said compromise settlement, directing distribution of proceeds in accordance with the terms of this Petition, authorizing the Release signed by Petitioners, and to issue an Order approving same. Respectfully submitted, NAVITSKY, OLSON & WISNESKI LLP Michael J. itsky I.D. No. 58803 2040 Linglestown Road, uite 03 Harrisburg, Pennsylvania 171 0 717-541-9205 Counsel for Petitioners 4 EXHIBIT A SETTLEMENT AGREEMENT AND GENERAL RELEASE This Release and Settlement Agreement (hereinafter referred to as "Release") is made and entered into- between JENNIFER SLEAR and MICHAEL SLEAR, on behalf of themselves and on behalf of their minor son, ANDREW C. SLEAR, their heirs, executors, administrators, assigns, insureds, and legal representatives (collectively, the "Releasors") and THE CARLISLE AREA SCHOOL DISTRICT, its present and past officers, directors, stockholders, employees, teachers, agents, servants, attorneys, assigns, affiliates, subsidiaries, insurers, specifically Indemnity Insurance Company of North America and School Claims Service , and -any and all other persons, films, and/or corporations in which any or all of them might have an interest (collectively, the "Releasees"). WHEREAS, Andrew C. Slear was involved in a personal injury incident that occurred on November 28, 2012 at the Wilson Middle School in Carlisle, Pennsylvania as a result of which Andrew C. Slear, through his parents, Jennifer and Michael Slear, has asserted and/or could assert certain claims for damages arising from the November 28, 2012 incident at the Wilson Middle School in Carlisle, Pennsylvania; and WHEREAS, Jennifer Slear and Michael Slear, as parents of Andrew C. Slear, have asserted and/or could have asserted claims for money damages arising from the incident that occurred on November 28, 2012 at the Wilson Middle School in Carlisle, Pennsylvania; and WHEREAS, Releasors and Releasees desire to settle all claims that have and/or could have been asserted by Releasors individually, in their own behalf and with respect to Jennifer and Michael Slear-on behalf of their minorson, Andrew C. Slear, together with -any and all other matters pertaining to Releasors' claims that have been raised, might have been raised, could be 05/1188010.v1 1 raised, could have been raised, or that might be raised in the future under theories of negligence, Constitutional and/or other statutory based claims ancVor any and all other liability or damages claims or any kind or nature. Releasors and Releasees incotporate the foregoing into the following agreement. 1. Settlement and Release Releasors, for and in exchange for good and valuable consideration , the consideration for which is the release of Releasorsclaims for personal physical injuries and/or attorney's fees, if and as applicable, payable by and/or behalf of Releasees hereby forever release and discharge Releasees of and from any and all past, present and future claims, demands, obligations, actions, causes of action, liens, rights, damages, costs, expenses, arid compensation of any nature whatsoever, which Releasors now have, or which may hereafter accrue or otherwise be acquired, on account of, or in any way growing out of the November 28, 2012 incident at the Wilson Middle School in Carlisle, Pennsylvania, whether known or unknown, including any claims for interest, costs and fees including attorneys' fees. This Release shall be a fully binding and complete Settlement Agreement between the parties hereto and is a General Release. Releasors further agree to submit promptly a Petition for Court approval of the Compromise of a Minor's cause of action and/or claims and shall provide a copy of the Court Order approving that Minor's Compromise to appropriate representatives of the Carlisle Area School District. 2. Full and Final Release It is fully undergood and agreed that this Release covers all asserted and potential claims against Releasees, it being the intent of the undersigned Releasors to extinguish fully and forever 05/1188010.v1 2 every and all claims against the Releasees for injuries and/or damages incurred and/or which may be incurred and/or which have been incurred as a direct or indirect result of the incident that occurred on November 28, 2012 at the Wilson Middle School in Carlisle, Pennsylvania. 3. Further or Future Damages Releasors hereby acknowledge, agree, and understand that after the date of this Release, their injuries and/or damages may turn out to be different than they, now believe them to be, and that by signing this Release they are accepting that risk and giving up any right to seek further money from, or otherwise to assert any and all claims or demands against the Releasees. 4. Warranty Releasors hereby represent and warrant that they will satisfy all claims and liens that can or may be asserted against the proceeds of this settlement. Releasors further represent, warrant and agree that if any lien or laim is asserted, they will satisfy. such lien or claim as asserted, they will satisfy such lien or claim promptly and will indenmify, hold harmless and defend the Releasees from any and all such lien(s) or claim(s). It is expressly warranted by Releasors that any and all medical liens, health care liens, Medicare liens, and any other liens asserted or to be asserted by any person, firm, corporation, or government entity as a result of the provision of any medical care, treatment, or services to Releasors in their lifetimes, will be satisfied by the Releasors out of the settlement proceeds. In no event shall Releasees or any of them bear any responsibility or liability whatsoever for any liens. Additionally; Releasors shall indemnify, defend, and hold harmless, the Releasees from any claims, demands, or suits of any kind from any liens asserted in connection with the 05/1188 10.v1 3 November 28, 2012 incident, which occurred at the Wilson Middle School in Carlisle, Pennsylvania. In accordance with the Medicare Secondary Payor Act, the interests of CMS (Centers for Medical Services) have been taken into account and in accordance with the SCHIP Law, no reporting is necessary with regard to this settlement. Further, Releasors agree to fully satisfy, indemnify, and hold Releasees harmless from any and all penalties, liens, conditional payments, fines, demands, and actions in law or in equity, or other payments that may be required if any of the Releasors' representations as to the entitlement or lack thereof of Medicare benefits are in any way misrepresented. 5. Attorney's Fees Each party hereto shall bear all attorneys' fees and costs arising from the actions of their own counsel in connection with the Complaint, this Settlement Agreement and the matters and documents referred to herein, and all related matters. 6. Warranty of Capacity to Execute Agreement Releasors represent and warrant that no person or entity other than the Releasors have and/or have had any interest in the claims, demands, obligations, or causes of action referred to in this Settlement Agreement and Release, and that they have not sold, assigned, transferred, conveyed, or otherwise disposed of any of the claimS, demands, obligations, or causes of action referred to in this Settlement Agreement and Release. 7. No Admission of Liability It is understood and agreed by the Releasors and Releasees that this Release is not to be construed as an admission of liability on the part of the Releasees or any of them and that the 05/1188010.v1 4 Releasees expressly deny any liability for any negligence, breach of warranty, breach of contract, or other damage of any kind or nature whatsoever. 8. Payments In consideration of the Release set forth above, the Insurer on behalf of the Defendant agrees to pay the individuals named below the sums outlined in this Section 2 below. 8.1 Payments due at the time of settlement as follows: $50,000.00 of the overall settlement of this matter shall be used to fund the following "periodic payments" for the benefit of Andrew Slear, a minor. The remainder of the funds, $36,000.00, will be applied for the payment of attorneys' fees and expenses. Any leftover settlement funds will then be placed into a bank savings account or CD restricted account for the benefit of the minor, Andrew Slear. 8.2 Periodic payments made according to the schedule as follows (the "Periodic Payments"): Payable to Andrew Slear ("Payee" and/or "Claimant") $5,000.00 guaranteed lump sum payable at age 18 (on November 15, 2016). $10,000.00 guaranteed lump sum payment at age 21 (on November 15, 2019). $48,000.00 guaranteed lump sum payment at age 25 (on November 15, 2023). All sums set forth herein constitute damages on account of personal injuries or sickness, within the meaning of Section 104(a)(2) of the Internal Revenue Code of 1986, as amended. 9. Claimant's Right to Payments Claimant acknowledges that the Periodic Payments cannot be accelerated, deferred, increased or decreased by the Claimant or any payee; nor shall the Claimant or any Payee have 05/1188010.v1 5 the power to sell, mortgage, encumber, or anticipate the Periodic Payments, or any part thereof, by assignment or otherwise. 10. Claimant's Beneficiary Any payments to be made after the death of Payee pursuant to the turns of this Settlement Agreement shall be made to the Estate of said Payee or to such person or entity as shall be designated in writing to the Assignee by the guardian of said Payee with Court approval or from said Payee upon attaining the age of majority. If no person or entity is so designated by said Payee, or if the person designated is not living at the time of said Payee's death, such payments shall be made to the Estate of said Payee. No such designation, nor any revocation thereof, shall be effective unless it is in writing and delivered to the Assignee. The designation must be in a form acceptable to the Assignee before such payments are made. 11. Consent to Qualified Assignment 11.1 Claimant acknowledges and agrees that the Defendant and/or the Insurer may make a "qualified assignment," within the meaning of Section 130(c) of the Internal Revenue Code of 1986, as amended, of the Defendant's and/or the Insurer's liability to make the Periodic Payments set forth in Section 8.2 of to Pacific Life and Annuity Services, Inc. ("the Assignee"). The Assignee's obligation for payment of the Periodic Payments shall be no greater than that of Defendant and/or the Insurer (whether by judgment or agreement) immediately preceding the assignment of the Periodic Payments obligation. 11.2 Any such assignment, if made, shall be accepted by the Claimant without right of rejection and shall completely release and discharge the Defendant and the Insurer from the Periodic Payments obligation assigned to the Assignee. The Claimant recognizes that, in the 05/1188010.v' 6 event of such an assignment, the Assignee shall be the sole obligor with respect to the Periodic Payments obligation, and Claimant agrees that such assignment shall constitute a full release and discharge of all Defendant's and Insurer's obligations relative to the Periodic Payments set forth above. 12. Right to Purchase an Annuity The Defendant and/or the Insurer, itself or through Pacific Life and Annuity Services, Inc. ("Assignee") reserve the right to fund the liability and make the Periodic Payments in Section 8.2 through the purchase of an annuity policy from Pacific Life Insurance Company, an A.M. Best A+ rated insurance company. The Assignee shall be the sole owner of the annuity policy and shall have all rights of ownership. The Assignee may have Pacific Life Insurance Company mail payments directly to the Payee. The Claimant shall be responsible for maintaining a current mailing address for Payee with Pacific Life and Annuity Services, Inc. 13. Discharge of Obligation The obligation of the Assignee to make each Periodic Payment shall be discharged upon the mailing of a valid check in the amount of such payment to the designated address of the Payee named in Section 2 of this Settlement Agreement. 14. Informed Decision Releasors acknowledge that they have received the advice of independent counsel of their own choosing, specifically Michael J. Navitsky, Esquire of Navitsky, Olson & Wisneski, LLP and execute this Release as their own free act and deed. 05/1188010.v1 7 15. Non -Disclosure and Confidentiality Except to the extent required by applicable law, Court Order or subpoena and disclosure to legal tax advisers, Releasors and Releasees further understand and agree that neither they nor their attorneys, agents, servants or other representatives or individuals will in any way publicize or disclose or cause to he publicized or disclosed to any persons, QT in any news or communications media, including, but not limited to, legal publications, newspapers, magazines, radio, television and internet pages ancVor cites, the fact of and/or terms and/or conditions of this settlement or of the _claims from which this settlement arises. Except to the extent required applicable law, all parties to this Agreement expressly agree to decline comment on any aspect of this settlement, or the claims from which this settlement arises, to any and all individuals and/or members of the news media and/or refrain from engaging any individual or the news media in any such comment. The spirit and intention of this non -disclosure provision is to maintain confidentiality regarding the settlement itself and of the claims from which this settlement arises. This non -disclosure provision is intended to become part of the consideration to both Releasors and Releasees and is integral to the settlement reached between them concerning the claims that Releasors have or could have asserted as a result of and/or arising from the November 28, 2012 incident at the Wilson Middle School in Carlisle, Pennsylvania. Releasees and Releasors acknowledge that no portion of this settlement amount represents consideration for the mutual promise to maintain strict confidentiality of all of the terms of this Agreement. Rather, the Releasees and Releasors expressly have agreed that each- other's reciprocal confidentiality covenant is the sole consideration given in exchange for that of the other. 05/1188010.vl 8 16. Governing Law It is hereby agreed by the parties that this Agreement shall be governed by the Laws of the Commonwealth of Pennsylvania, regardless of any conflict of laws provision requiring reference to the Rules of, decision in and/or laws of another state or sovereign nature. 17. Entire Agreement and Successors In Interest The terms and conditions contained in this Agreement supersede all prior oral or written understandings between Releasors and Releasees and constitute the entire Agreement between them concerning the subject matter of this Agreement. This Agreement shall not be modified or amended except by a writing signed by all parties. Further, this Agreement shall be binding upon the executors, administrators, personal representatives, heirs, successors and assigns of each. IN WITNESS WHEREOF, this Agreement has been signed by Releasors, Jennifer Slear and Michael Slear on behalf of themselves and on behalf of their minor son, Andrew C. Siear. I FERIAR`' 441 iio . S- 9-/X MICHAEL SLEAR 05/1188010.v1 9 EXHIBIT B POWER OF ATTORNEY AND FEE AGREEMENT BY SIGNING THIS AGREEMENT, I (WE) ACKNOWLEDGE THAT I (WE) HAVE ENGAGED THE LAW FIRM OF NAVITSKY, OLSON & WISNESKI LLP (HEREINAFTER NOW LLP), TO REPRESENT ME (US) UNDER THE FOLLOWING TERMS AND CONDITIONS: 1. NOW LLP may on my (our) behalf secure medical, work and other similar records, conduct an investigation, negotiate, and if nec sarys a ui ag inst nyone responsible for my (our) injuries and losses with respect to 1Q 11-19.43 -[02( +, Ah ith full power and authority to appear on behalf of the undersigned in any Court of record or in any. administrative oro her 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 all that said attorney shall lawfully do or cause to be done therein by virtue of this power of attorney. 2. I (we) understand that so long as the case is handled by a NOW LLP attorney, I (we) will not be responsible for any fees and/or expenses unless a recovery or benefit is obtained. 3. In the event that the client has been referred by another attorney or law firm, the client understands that NOW LLP may pay the forwarding attorney or law firm a fee. Any such fee would be paid out of NOW LLP's attorney fee, not out of the client's net proceeds. 4. If my (our) case is handled to a successful completion by a NOW LLP attorney, I (we) agree to pay NOW LLP all reasonable out-of- pocket expenses without the payment of interest, plus a fee for time expended as follows: ME NOW LLP a. 70% 30% SHl"I LEMENT PRIOR TO STARTING SUIT AND NO MEDIATION OR ARBITRATION b. SETTLEMENT FOLLOWING SUIT BUT PRIOR TO MEDIATION, TRIAL OR ARBITRATION 65% 35% c. SETTLEMENT OR VERDICT AT MEDIATION, TRIAL OR ARBITRATION, AFTER MEDIATION, TRIAL, ARBITRATION, OR APPEALS OR SHORTLY BEFORE MEDIATION, TRIAL OR ARBITRATION IF THE CASE HAS BEEN TOTALLY PREPARED 60% 40% d. OTHER CASES 5. If for any reason I (we) take (our) case to another attorney or law firm or handle it myself (ourselves), I (we) recognize that NOW LLP has, in good faith, expended money and time for my (our) benefit and I (we) therefore agree to pay, or have my (our) new attomey pay, immediately, upon severing the NOW LLP attorney/client relationship, all the out-of-pocket expenses incurred on my (our) case. In addition, when the case is successfully concluded, I (we) agree to pay or to direct my (our) new attorney to pay as a fee 20% of the gross recovery to NOW LLP. 6. In the event that any settlement is made on a structured or deferred payment basis, NOW LLP shall be entitled to receive their fee based on the present value of the structured settlement, as if paid as a lump sum at the time of settlement. NOW LLP does not structure or defer payment of their attorney fee or expenses. 7. Attorneys shall have power of attorney to endorse client and spouse's signature on settlement checks for deposit in attorney's escrow account and to sign medical and wage authorizations on behalf of client. t BY SIGNING THIS AGREEMENT, THIS I (4 DAY OF Fel) rtkCkr , 20 I ti I (WE) ACKNOWLEDGE THAT I (WE) HAVE READ, UNDERSTOOD, AND RECEIVED A COPY OF SAME AND -AGREE WITH ITS TERMS AND CONDITIONS. cLIE (S).f d (SEAL) EXHI8►r c 3:22 PM Navitsky, Olson & Wisneski LLP 05/14/14 Client Expense Report All Transactions Type Date Num Name Source Name Memo Amount Balance 1300 • Client Cost Advance 1300F • Miscellaneous Check 3/21/2014 15042 Slear, Andrew 13-038 Lehman Mediation Service ... Mediator's Fee - Invoice #14-2F:n 700.00 700.00 • Total 1300F • Miscellaneous Total 1300 • Client Cost Advance TOTAL 700.00 700.00 700.00 700.00 700.00 700.00 s1<«•SD Page 1 EXHIBIT Fax Server 6/3/2014 4:01:54 PM PAGE 2/002 Fax Server June 3 , LU14 Tr6i? Solutions, Inc. formerly Healthcare Recoveries, fnc. R 0. Box 34060 Louisville, KY 40232-4060 Fax: 877-309.0734 MICHAEL J. NAVITSKY, ESQUIRE NAVITSKY, OLSON & WISNESKI, LLP ATTORNEYS AT LAW 2040 LINGLESTOWN ROAD, SUITE 303 HARRISBURG PA 17110 - RE: Plan Member: Health Plan: Event Number: ANDREW SLEAR HIGHMARK BLUE SHIELD 8484720 - 8431930 Dear MICHAEL NAVITSKY: Troyer Solutions represents HIGHMARK BLUE SHIELD Health Plan in regard to subrogation and/or reimbursement matters. Please allow this letter to serve as written confirmation that the above referenced plan and Troyer Solutions have agreed to $13,120.16 as satisfaction of the plan's right to be reimbursed from your client's $86K COMMERICIAL LIABILITY recovery. Note that the plan may retain its right to be reimbursed from any additional sources of recovery that may become available to your client. Please make every effort to forward the settlement funds as soon as possible. The check should be made payable to the order of Troyer Solutions (Federal Tax ID # 61-1141758), subrogation agent for the above health plan. Please include the event number on the check. Thank you. Sincerely, 60.4hia. Valarie K. Brown Signature of Agreement 8484720 - 8431930/SXFULLCoverage E AFFIDAVIT We, Jennifer Slear and Michael Slear, do hereby affirm, certify and warrant that we approve of the settlement and distribution of proceeds proposed in the Petition for Approval of Minor Plaintiff's Compromise Settlement and Distribution of Proceeds, and we request that the Court approve such settlement and distribution. Date: O // Date: 510 1) 6P4A-t-.Age Jennifer Slear Michael Slear JENNIFER SLEAR AND MICHAEL SLEAR, as Parents and Natural Guardians : of ANDREW SLEAR, a Minor v. CARLISLE AREA SCHOOL DISTRICT : IN THE COURT OF COMMON PLEAS CUMBERLAND CO., PENNSYLVANIA ORDER APPROVING COMPROMISE, SETTLEMENT AND DISTRIBUTION AND NOW, thisday of , 2014, upon consideration of the Petition to Approve the ettlement and Di ribution of the Proceeds, it is Hereby Ordered that Petitioners are authorized to enter into a settlement with the Defendant in the gross amount of $86,000.00 on behalf of their minor son, Andrew Slear. If it has not done so already, Defendant shall forward all settlement drafts or checks to Petitioners' counsel for proper distribution with the exception of those funds used to purchase a structured settlement for the child. The settlement proceeds shall be allocated as follows: a) Jennifer Slear and Michael Slear, on behalf of Andrew Slear, to be deposited in a restricted savings account at M&T Bank, which is FDIC insured. $ 4,936.34 b) Andrew Slear (to be placed into structured $50,000.00 settlement) c) Navitsky, Olson & Wisneski LLP legal fees $17,200.00 (30% fee reduced to 20%) (d) Highrnark Blue Shield lien ($13,120.16 to be $13,120.16 escrowed) d) Navitsky, Olson & Wisneski LLP $ 743.50 reimbursement of expenses TOTAL $86,000.00 Petitioner is authorized to accept the structured settlement on behalf of their son, Andrew Slear, in the amount of $50,000.00. The Court approves of the selection of Pacific Life Insurance Company, which has been represented to the Court to be a A+ rated company by AM Best. The balance of $4,936.34 will be deposited in an FDIC insured bank savings account or • certificate of deposit for which there will be no withdrawal permitted until the child obtains 18 years of age without prior Court Approval. BY THE COURT: '/O6t6C J. 1icL i3l.� Pt . uur4s/:y rz� r— (72, = ( i ▪ (TY - -q _q '1 T? ` r•1 JENNIFER SLEAR AND MICHAEL IN THE COURT OF COMMON PLEAS SLEAR, as Parents and Natural Guardians : CUMBERLAND CO., PENNSYLVANIA of ANDREW SLEAR, a Minor NO. 14-3401 CIVIL v. CARLISLE AREA SCHOOL DISTRICT : r_' r7; t;i PROOF OF DEPOSIT s; _. co --<'' In accordance with Pennsylvania Rule of Civil Procedure 2039, attached ira_ph000copyi: of the deposit receipt issued on September 18, 2014, from M&T Bank in Carlisle ulsy. vaiiik, to Andrew Slear, a Minor, as proof of deposit of the settlement proceeds. ..< ca No withdrawal can be made from the account until the Minor attains majority, except as authorized by a prior Order of Court. Date: December 12, 2014 Respectfully submitted, NAVITSKY, OLSON 8. WISNESKI LLP Michael J. I a tsky, Esq I.D. No. 58:Q 2040 Linglestown Road, S ; to 303 Harrisburg, PA 17110 717/541-9205 Counsel for Plaintiffs M8E['Bank Understanding what important' High Street Carlisle Office If you have any questions, please call our Telephone.Banking Center at 1-800-724-2440 Today's Date: Business Date: 09/18/2014 09/18/2014 Time: 02:14 PM Savings Deposit $4,936.90 ****3159 4319 /05 35 Thanks for visiting us today. We are happy to assist you! $$$$$$$$$$$$$$$$$mgm