HomeMy WebLinkAbout05-5731
ORiGINAL
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
David Kyle, as parent and legal
guardian of Chase Kyle, a minor
2U08 Dickinson Avenue
Camp Hill. Pa 170 II
No OS' - ("'7J (
Ct~,L ~ErL~
v.
Henry j Malis
2UU Pennsylvania Avenue
Camp Hill, Pa 17011
PETITION FOR LEA VE ALLOWING SETTLEMENT
AND COMPROMISE AND FOR DISTRiBUTION
The Petition of David Kyle, as parent and natural guardIan of Chase Kyle, a
1111 nor, I especttully represents
The Plaintiff, David Kyle, is an adult individual residing at 2008
Dickinson Avenue, Camp Hill, Pennsylvania.
2. The minor/Plaintiff, Chase Kyle, is ten (10) years of age, having heen born
on December 12, 1994. and is the son of Petitioner, David Kyle Minor!Plaintiff resides
with his father at 2008 Dickinson Avenue, Camp Hill, Pennsylvania
3 Detendant. Henry 1 Malis, IS an adult individual residing at 2UU
Pennsylvania Avenue, Camp Hill, Pennsylvania
4 On or about August 2, 20m, minor/I'\aintiff sustained personal injuries
when Defendant Henry 1 Malis' minor child threw a "pool ring", striking
minor/Plaintiffs mouth
5 The injuries sustained by minor!Plaintiff included a fracture of his lower
anterior teeth, #23 class II fracture and #24 class 1ll fracture with pulpal exposure
6. As a result of said injuries, minorlPlaintiffwas treated by Frederick M
Minium, DDS.
7. Dr. Minium opined that minor/Plaintiff will require additional dental
work. specifically, minor/Plaintiff will need a full coverage crown on both teeth and may
require root canal therapy. (See copy of correspondence and dental records received
from Dr. Minium attached as Exhibit "A")
8 Dr. Minium has indicated that the additional dental work cannot be
performed until minor/ PlaintifTis at least twelve (12) years of age.
9 The Defendant, Henry 1 Malis, through his counsel, Nadine C Bell.
Esquire, has ofTered Five Thousand Seven Hundred Forty-Six Dollars ($5.74600) as full
settlement of the present action.
lOIn the opinion of the Petitioner, this offer is fair and reasonable and would
serve the best interest of the minor child.
II Petitioner submits that there are no attorney's fees and/or costs f(lr the
minor child with regard to the instant action.
12. The sum of Five Thousand Seven Hundred Forty-Six Dollars ($:;' 746(0),
shall be made payable to minor/Plaintiff, Chase Kyle, be paid to the Petitioner herein
which will be placed in a federally insured savings account or federally insured savings
certificate in the name of the minor, or a Trust Account.
I j. Plaintiff shall be permitted to withdraw fimds, as necessary, to pay for the
minor child's additional dental work, with regard to the instant action. The minor, Chase
K vie, shall have full and exclusive control over the remaining funds in the savings
account
WHEREFORE, Petitioner, David Kyle, as parent and natural guardian ot"Chase
Kyle, a minor, prays your Honorable Court to enter an Order approving the proposed
compromise settlement and distribution of the proceeds of settlement.
Respectfully submitted,
-----
,
David K e, as Parent and Natural Guardian
of Chase Kyle, a minor
Date lC2:j'7' 6'S
tf~\hi+ A
Endodontics Associates
c 395 St. John's Church Road
Camp Hill, PA 17011-
(717) 545-7400
STATEMENT
Date Number
02/14/2005
Page 1 of 1
Make Checks Payable To: Endodontics Associates
Account: Mr Chase K Kyle
2008 Dickinson Ave
Camp Hil" PA 17011-
Credit Card Payment
_Visa _Master Card _AM EX_Discover
Card Number
Expiration Date ~_
Name
Signature
RETURN TOP PORTION WITH PA YMENT
Patient: Mr Chase K Kyle
Amount Enclosed $
---------------------------------~---~--------------------------------------~------
.
Date Description Charges Credits You Owe Insur. Estimated
Detail for: Chase K Kyle Previous Balance: $0.00 Next Appt: None
Last Statement: 01/01/1800
02/02/2005 SPECIALIST CONSUL 24 $65.00 $000 I
02/02/2005 INTRA-ORAL PER lAP 24 $20.00 $0.00
02/07/2005 Insurance Payment - Carrier #1 $0.00 $000
Treatment date: 02f02f2005; Procedure SPECIALIST CONSULTATION: Charge
$65.00
02/07/2005 Insurance Payment - Carrier #1 $0.00 $12.00
Treatment date 02f02f2005; Procedure INTRA-ORAL PERIAPICAL, Charge
$20.00
02/07/2005 UNITED CONCORDIA ADJUSTMENT $0.00 $8.00
Totals for: Chase K Kyle $85.00 $20.00
TOTALSW $85,00 .0 $20.00 . >$95:00 $0.00
.0
Retain this statement from Endodontics Associates issued 02/14/2005 for your records.
Please make checks payable to Endodontics Associates.
Regarding Insurance: Insur. Expected is calculated on informntion provided to us by your insurance company.
0-30
$65001
31-60
$0001
61-90
$0001
91+
$0.00
Messages
( Please Pay: $65.00
,Thank you for the opportunity to offer the highest quality dental care. Your balance is shown above, kindly return the top
portion of thiS bill along with your payment in the enclosed envelope PLEASE CAll THE BilLING DEPARTMENT WITH
ANY QUESTIONS: (717) 545-7400 Ext 122 or (717) 909-6863
ThiS is not a covered service
Copyright - Discus Dental Software. 1984 - 2005 - All rights reserved
STATEMENT OF ACCOUNT
(717)763-1676
CHART NO'1 PAGE NO.
KY0001 .
'BILLlNG DATE'
02/08/2005
CREDIT CARD #_____._____. __EXP
Frederick M. Minium. D.D.S.
1509 Cedar Off Drive
Camp Hill, PA 17011
I" ,jGUA~~TOR NAME'AND MAILING ADDRIjSS . '
Mr. David Kyle
2008 Dickinson ave
Camp Hill, PA 17011
NAME
(AS it appears on c;ard)
SIGNATURE
TYPE OF CARD
AMOUNH;NCtdsED
i;~';:~~::;:l'; {,;,,',';</:-",::i,';':.' ,\. :i':f::';:;~l:'::
._.., _ . m _ ___.~._~______ __ _.__ __ ._.__,___~__,,_..___'__'__'__________
PLEASE RETAIN THIS PORTION OF THE STATEMENT FOR YOUR RECORDS
01/08/2005 Balance FOlWard 0.00
. 01/21/2005 DDS1 :D9440:0ffice visit-after regular hrs Chase 68.00
. 01/21/2005 DDS1 :D2335:Resin-4+ wlincis angle-anterior Chase 150.00
02/08/2005 Payment - PA Blue Shield Chase -100.00
. 02/02/2005 HYG2:D0274:Bltewings-four films Merideth 30.00
. 02/02/2005 DDS1 :D0120:Periodic oral evaluation Merideth 20.00
. 02/02/2005 HYG2:D1110:Prophylaxis-adult Merideth 47.00
02/08/2005 Payment - PA Blue Shield Merideth -82.00
02/08/2005 Write.Off Merideth .15.00
02/08/2005 Write.Off Chase -50.00
. Indicates that i surance has been billed for the procedure.
68.00
0.00
0.00
0.00
68.00
0.00
PLEASE PAY .......1
THIS AMOUNT"""- 68.00
@ Easy Dental 1997.99 DLSTM 2
Frederick M. Minium, D.D.S. - 1509 Cedar Cliff Drive Camp Hili, PA 17011 (717)763-1676
~
FREDERICI< MINIUI\\, DDS
1509 (eelJI Clltt 1.11 I\'('
Cllllp Hill.I'r\ 17Cill
fc'lephollc: (7171 Il, ;-1 (,~ I;
FdX: 1717'1 76;--':'(1(,<-1
flllilliullHlds(u dol.\ 011,
October It, 2004
Donegal Insurance Co.
1195 River Road
P.O.Box 302
Marietta, Pa. 17547-0302
Attention: Joel Shutt
Claim Representative
Dear ML Shutt;
Enclosed you will find a copy of your letter with a series of questions. This is in reply to
those questions as per your numbeL
(1) Chase Kyle fractured his lower anterior teeth,#23 class II fracture and #24 class
III fracture with pulpal exposure.
(2) Vitality tests and radio graphics indicate #23 and #24 still have vital pulps.
(3) Both #23 and #24 need full coverage crown. Either or both may at some point
require root canal therapy, but currently are vital pulps.
(4) No medication being taken.
(5) No.
(6) We plan to place Dorcelain crowns on #23.#24. Possibility of root canal theraDY
in future as with any traumatic injury.
Sinc~.
" J/J~
Fmd~~"Minium, D.D.S.
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REMARKS
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STATEMENT OF SERVICES eENDERED
c:::;~;>. !PA~NO.
BILUNGDATE
08/13/2003
Frederick M. Minium, D.D.S.
1509 Cedar Cliff Drive
Camp Hill. PA 17011
(717)763.1676
PROVIDERS: (ID,Name,Number)
DOS1-Frederick M Minium, Dentist #23-2264452
GUARANTOR NAME AND MAlUNG ADtlRE$S
Mr. David Kyle
3539 March Dr.
Camp Hill, PA 17011
PATIENT
'CREDIT
Chase
Chase
Chase
23
24
MIDLF DDS1 :02335:Resin-4+ w/incis angle.an
MIDLF DOS1:02335:Resin-4+ wflncis angle-an
Credit Card Payment .Thank You
150.00
150.00
-300.00
PRIOItBALANCE .CUPE!,.,t;~m;pi:fS;if~t#~~es
'l"'SllRANCEc'ESTIMA.TE PLEASE PAY
0.00
.300.00
+
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300.00
T
0.00
300.00
=
-300.00
DO Finance Charges: 0.00
YTD Late Charges: 0.00
YTO Guar Payments: 300.00
DO Ins Payments: 113.00
REASON
Merideth
Colton
Wed. - Sep. 24,
Wed. - Sep. 24.
3:10pm
3:10pm
px ex
px ex
lSY Dental 1997 .99 DLWlK 1
STATEMENT
ACCOUNT NO. PAGE NO.
1359100 1
<larns And Ashbyp.D.S.,P.C.
4836 E. Trindle Road
Mechanicsburg, PA17050
1 (717)737 -5834
BILLING DATE
Charges Or Payments After Billing
Date Will Appear On Next Statement
September 8, 2003
Mr. David Kyle
2008 Dickinson Ave.
Camp Hill, PA 17011
$
Amount Remitted
OM/C
oVISA oCHECK
TO ENSURE PROPER CREDIT PLEASE
OETACH AND RETURN THIS PORTION OF
THE STATEMENT WITH YOUR PAYMENT
Signature
Date
Exp. Date
>
<
REFERENCE
CHARGES
112.00
CREDITS
08/02/03 Office Visit After Hour
08/11/03 Statement Sent
08/11/03 Not A Covered Service B
09/08/03 Statement Sent
(elm 623671 Chase
Account
(elm 623671 Chase
Account
INS. PORTION REC I D
0.00
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CURRENT 30 DAYS 60 DAYS 90 DAYS NEW OUTSTANDING PLEASE PAY
BALANCE INSURANCE
112.00 0.00 0.00 0.00 112.00 0.00 112.00
Kearns And Ashby D.D.S., P.C., 4836 E. Trindle Road, Mechanicsburg, VA 17050
If you have any questions, please call our office.
Name C11('<~ '?"II~
PROGRESS NOTES
DATE DR. TOOTH SURF. R.D. ANES. N,O TREATMENT BEH OH DATE TIME PRoe
2:-:\"Z1D'I Cl.{ IIJ "j,',00 9<' JlCJb./ t,....,...., ~, I.' "VY\J.ArhD,^.~ ~I
1.Y,' ~ fl.'-/.. (IV"-" 9.\- ~\..Ii:,."vW",," 'I:\, "Z.q-'.-~I
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FREDERICI< MINIUM, D.DS
I soq Cedi'!!" C!iff Chili'"
C,-lrnp 1111i, Pi\ 1 i'Cill
Telepl)(HH~: i7l!) ib.:-lh7(,
F,lX: i717i 76Tl0b4
till inILlrndd~(lld()l_l (Jill
December 7, 2004
Mr. David Kyle
2008 Dickinson Ave.
Camp Hill, Pa. 17011
Reference: Chase Kyle
Claim No: G 001 2624 (41)
Dear Mr. Kyle,
Enclosed are the fees at this present date you requested for possible future treatment of
tooth #23 and tooth #24:
Root Canal Treatment-Tooth #23 ADA Code: D3310
Root Canal Treatment-Tooth #24 ADA Code: D3310
Post and Core-Tooth #23 ADA Code: D2954
Post and Core-Tooth #24 ADA Code: D2954
Crown-Tooth #23 ADA Code: D2740
Crown-Tooth #24 ADA Code: D2740
$450.00
450.00
175.00
175.00
595.00
595.00
:::. :J Cf'iO
As stated previously stated, there is no way to predict the future treatment necessary for
these two teeth; therefore, it is impossible for me to give you a total for his treatment now
or the cost involved as fees are subiect to increase in the future if or when this treatment
becomes neCeSSal).
~y, p
VIP
Frederick M. Minium, DDS
1..
CERTIFICA TE OF SERVICE
I, David Kyle, as parent and natural guardian of Chase Kyle. a minor, hereby state
that the within documents have been served upon the tollowing on the date set t'lrth.
Nadine C Bell, Esquire
Nikolaus & Hohenadel, LLP
212 North Queen Street
Lancaste" I"A 17603
Al6;;;:::
u__u _,~__u
David Kyle
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OR/GINAI.
J useph G Muzic, Esquire
Atturney I.D. Nu 55919
Nadine C Bell, Esquire
Atturney I DNa. 89388
NIKOLAUS & HOHENADEL, LLP
212 North Queen Street
Lancaster, P A 17603
(717) 299-3726 FAX (717) 299-1811
E-mail. jl1J\J:Zj,c@nikolaushohenadeL!<om
E-mail nbell@nikolaushohenadel.com
____________,=-'.____........mm._mn__________________________________
A /f()/'IIey,,-f!'" I Jefenaanl
11\ THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
David Kyle, as parent and legal
~uardian of Chase Kyle
200S Dickinson Avenue
Camp Hill, Pa 170 II
C-
No ()~- S7]/ {!,-v~L 182-'[
v.
Henry J Malis
200 Pennsylvania Avenue
Camp Hill, Pa 170 II
ACCEPTANCE OF SERVICE
AND NOW un this ';' (.' day oC~,_S'G"!-,--,__, 2005, I, Nadine C Bell.
Esquire. attorney fur Defendant Henry 1. Malis, hereby accept service of the Writ uf
Summons by Plaintitf, David Kyle, as parent and natural guardian of Chase Kyle. a
minor, in reference to the above matter.
NIKOLAUS & HOHENADEL, LIP
BY
1 . ,":/-<
O"'--/(c/(~f(,______ CJ/: 'f'../-,' "---
- -------------
Nadine C Bell, Esquire
Attorney for Defendant
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DAVID KYLE, as parent
and legal guardian of
CHASE KYLE, a minor,
Plaintiff
v.
HENRY J. MALIS,
Defendant
',.
.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYL VANIA
CIVIL ACTION - LA W
NO. 05-5731 CIVIL TERM
ORDER OF COURT
AND NOW, this 9th day of November, 2005, upon consideration of Plaintiff's
Petition for Leave Allowing Settlement and Compromise and for Distribution, a hearing
is scheduled for Thursday, December 29, 2005, at 3:00 p.m., in Courtroom No. I,
Cumberland County Courthouse, Carlisle, Pennsylvania. Petitioner is referred to
Pennsylvania Rule of Civil Procedure 2039 for purposes of understanding what orders are
permissible in such cases.
~id Kyle, as parent and
Legal guardian of Chase Kyle
2008 Dickinson Avenue
Camp Hill, PA 17011
Plaintiff, pro se
~ine C. Bell, Esq. ~
212 North Queen Street
Lancaster, P A 17603
Attorney for Defendant
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BY THE COURT,
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DAVID KYLE, as parent
and legal guardian of
CHASE KYLE, a minor,
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYL VANIA
v.
CIVIL ACTION - LAW
HENRY J. MALIS,
Defendant
NO. 05-5731 CIVIL TERM
ORDER OF COURT
AND NOW, this 30th day of December, 2005, upon consideration of the attached
letter from Nadine C. Bell, Esq., attorney for Defendant, the hearing previously
scheduled for December 29, 2005, on Plaintiffs Petition for Leave Allowing Settlement
and Compromise and for Distribution, is rescheduled to Tuesday, February 14, 2006,
at 10:30 a.m., in Courtroom No.1, Cumberland County Courthouse, Carlisle,
Pennsylvania.
BY THE COURT,
David Kyle, as parent and
Legal guardian of Chase Kyle
2008 Dickinson Avenue
Camp Hill, PA 17011
Plaintiff, pro se
I I. f;L' ,';
, ()I/ Ire,'
; v ~ c/
J/Yifesley Olm:-, r.,' . J.
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,-1VUw..Cu.t.
,
12.300,
Nadine C. Bell, Esq.
212 North Queen Street
Lancaster, P A 17603
Attorney for Defendant
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---------
----~
DDNALD H. NIkOlAUS
JIJHN P. HoHENADEL.
MA~I;W.J. CREME. JR.
.JOt-4NF. MARKS..
PAULA C. MUNBON
A~ G. BAetNliR
~A.MJL.Ul:
M1eHAa. B. GRAB
MIOW;L A. VANA98E
.J0SEPJ.t liI:. MUZIC.....
USA.J. Ml:CtJY
NIKOLAUS & HOHENAOEL, tIP
ATTORNEYs AT LAW
:i:!:1~ NORTIoI OUf3iN STAI!~
LANCAsTER, PA. '7"""
lDJI\IlEI.
JOSSIH J. LOMIIAFIIXI
717/l:!aa..:,728
~AX 717/29901.11
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CXILUI\MIIA. FlA. 11&12
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_'*'ADImE M. HDHENADEL
ANTI<<lN., MARc HrJ!ItONB
Jc.tN c. ~El
WANDA B. WHARE
!\lAOI'M: C. SELL*
kRlS15N L. HARTMAN
. ALBc AaMITTB) Tn
NEW YDAK STA'tt BAR
December 29,2005
VIA FACSIMILE AND FIRST CLASS MAIL
Thc Honorable J. Wesley Oler. Jr.
Cumberland County Courthouse
1 Courthouse Square
Carlisle, P A 17013
Re: David Kvle. as Parent and Lee:al Guardian of Chase Kvle, a Minor v.
Henry Malis; No. 05-573 J
Dcar Judge Oler;
On this date, Mr. David Kyle, as parent and guardian for Chas Kyle, and I are
scheduled to appear before you at a hearing regarding the Compromisc and Settlement
for the above-referenced matter. Unfortunately, on this date a concern has been raised
between the parents of Chase Klye regarding the deposit of funds received and the
joinder of Ms. Meredith L. Kyle to this matter.
After discussing the situation, Mr. Kyle and I feel that it is most appropriate at
this time to continue the matter. None oOhe parties anticipate any difficulty in reaching
a resolution; however, time simply prevents us from doing so prior to appearing before
you. Accordingly, please reschedule this matter for a later datE:.
Thank you for your attention to this matter. Please do not hesitate to contact me
with any questions or concerns.
Very truly yours,
''/''1fi,:{...-~ CfJJl..ft
Nadine C. Bell
cc: David Kyle
Chris Noonan
81/-, /Ol/O-d ",-1
118168/LIl
l"peU"40H' 'nelo~IN-WOj,
80:vl ,0-6/-/1
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
David Kyle, parent and legal
guardian of Chase Kyle, a minor
2008 Dickinson Avenue
Camp Hill, Pa 1701 I
and
No: 05-5731 CIVIL TERM
Meredith Kyle, parent and legal
guardian of Chase Kyle, a minor
3539 March Drive
Camp Hill, Pa 17011
Petitioners
v.
Henry J. Malis
200 Pennsylvania Avenue
Camp Hill, Pa 17011
Respondent
AMENDED PETITION FOR LEAVE ALLOWING SETTLEMENT
AND COMPROMISE AND FOR DISTRIBUTION
Pursuant to Pa.R.C.P. 2039, Petitioners David Kyle and Meredith Kyle, Parents
and Natural Guardian of Chase Kyle, a minor, respectfully represents the following:
I. Petitioners are David Kyle and Meredith Kyle, adult individuals residing
at 2008 Dickinson Avenue, Camp Hill, Pennsylvania and 3539 March Drive, Camp Hill,
Pennsylvania, respectively.
2. The minor, Chase Kyle, is eleven (11) years of age, having been born on
December 12, 1994, and is the son of Petitioners David Kyle and Meredith Kyle By
No 05-5731 CIVIL TERM
Agreement, Petitioners have joint legal custody of the minor child and are authorized to
act on behalf of the minor child in the present legal action.
3. Respondent is Henry 1. Malis, an adult individual, residing at 200
Pennsylvania Avenue, Camp Hill, Pennsylvania and insured by Donegal Mutual
Insurance Company.
4. On or about August 2, 2003, Petitioner Chase Kyle sustained personal
injuries when Defendant Henry 1. Malis' minor child threw a "pool ring", striking
Petitioner Chase Kyle's mouth.
5. As a result of the incident, Petitioner Chase Kyle sustained injuries which
include a fracture of his lower anterior teeth, #23 class II fracture and #24 class III
fracture with pulpal exposure.
6. As a result of said injuries, Petitioner Chase Kyle was treated by Frederick
M. Minium, D.D.S.
7. Dr. Minium opined that Petitioner Chase Kyle will require additional
dental work; specifically, Petitioner Chase Kyle will need a full coverage crown on both
teeth and may require root canal therapy. (See copy of correspondence and dental
records received from Dr. Minium attached as Exhibit "A").
8. Dr. Minium has indicated that the additional dental work cannot be
performed until Petitioner Chase Kyle is at least twelve (12) years of age.
9. Respondent, through his insurance company, Donegal Mutual Insurance
Company, has offered to compromise the claim for injuries and damages sustained by
Petitioner Chase Kyle for the sum of Five Thousand Seven Hundred Forty-Six Dollars
($5,746.00), as full settlement of the present action.
2
No: 05-5731 CIVIL TERM
10. In the opinion of Petitioners, the settlement offer concerning Petitioner
Chase Kyle is fair and reasonable and would serve the best interest of the minor child.
II. Petitioners submit that there are no attorney's fees and/or costs tor the
minor child with regard to the instant action.
12. Petitioners propose and request this Court to approve a settlement of the
claims of Petitioner Chase Kyle with the following payments:
a. The sum of Five Thousand Seven Hundred Forty-Six Dollars
($5,746.00), shall be made payable to Petitioner Chase Kyle, be paid to
Petitioners herein which will be placed in a federally insured account or certiticate
of deposit in a bank or savings and loan institution.
b. Petitioners David Kyle and Meredith Kyle, by joint agreement,
shall be permitted to withdraw funds, as necessary, to pay for the minor child's
additional dental work with regard to the instant action. The minor, Chase Kyle,
shall have full and exclusive control over the remaining funds.
WHEREFORE, Petitioners David Kyle and Meredith Kyle, Parents and Natural
Guardians of Chase Kyle, a minor, respectfully pray your Honorable Court to enter an
Order approving the proposed compromise settlement and distribution of the proceeds of
settlement.
Respectfully submitted,
/~../~
David Kyle, Pttfent and Natural Guardian of
Chase Kyle, a minor
Date ~ I 11/0&
I
Mer ith Kyle, Parent and.
of Chase Kyle, a minor
3
I~ >< h;brt A
EndodOllllCS Associates
395 SI. John's Church Road
Camp Hill, PA 17011-
(717) 545-7400
STATEMENT
~Date
I 02/14/2005
L-
Number
~
Page 1 of 1
Account: Mr Chase K Kyle
200B Dickinson A\Je
Camp Hill, PA 17011-
Credit Card Payments
_Visa _Master Card _AMEX_Disco\Jer
Card Number
Expiration Date ~/~
Name
Make Checks Payable To: Endodontics Associates
Rf1URN -m? PORTION W\TH l'AYMEN1
\ Signature
)
Patient: Mr Chase K Kyle
Amount Enclosed $
_____.._ ____________u____________nn____n_______________..___ __________~________n___________ __________n__n__________~________n____ ____n_____________________
",', ,
Date Description Charges Credits You 'Owe (nSur.Estimated
Detail for: Chase K Kyle Previous Balance: $0.00 Next Appt: None
last Statement: 0110111800
24 $65,00 ~
0210212005 SPECIALIST CONSUL $000
G2f02f200S INTRA-ORAL PER\AP 24 $20.00 $0.00
0210712005 Insurance Payment - Carrier #1 $000 $0.00
Treatment date: 02/02/2005: Procedure: SPECIALIST CONSULTATION: Charge
$65_00
0210712005 Insurance Payment. Carrier #1 $0.00 $12.00
Treatme0t date_ G2/Cl212005', Procedure'_ INTRA-ORAL PERIAPICAL, Charge
$20,00
02107/2005 UNITED CONCORDIA ADJUSTMENT $000 $8.00
Totals for: Chase K Kyle $85.00 $20.00
, TOTALS ,'~ $85.P9 i" i< , :"'C:'2,L, .,.[~,;:.
." '.,' " ~i ni,.,
Retain this statement from EndodontiCS Associates issued 0211412005 for your records.
Please make checks payable to Endodontics Associates
Regarding Insurance: lnsur_ Expected is cCilculated on inform.stlon prQ',:ided to us by your insurance company.
0.30
$65001
31.60
$OOO!
61.90
$OOO!
91+ I
$0001
( P/ea~e Pay: $65.00 .
~
J
Messages
,Thank you for the opportunity to offer the highest qualily dental care. Your balaflce \S showfl above, kindly return the top
portion of thiS bill along with your payment In the enclosed envelope PLEASE CALL THE BilLING DEPARTMENT WITH
i'\NY QUESTIONS (717) 545.7400 Ex! 122 or (717) 909.6863
!ThiS is not a covered service
Copyrighl - Discus Dental Soflware. 1984 - 2005 - All lights reserved
STATEMENT OF ACCOUNT
(717)763-1676
L:~~~:'O'I PA::J
c-SlllINGDATE- ,
-',:~;'_'>-'~'_l7.:'..>" --.. .. H' ..
02/06/2005
Frederick M. Minium, D.D.S.
1509 Cedar Cliff Drive
Camp Hill. PA 17011
CREDIT CARD #______~~_.__EXP
NAME_
'"' 'iGUARANTORNAMEiAND:MAItING'ADDRESS, \
".J,:;. ,"-"_.,,,~"~_,,"""_",:,._,__,_..., "C'" .;,i."';',_:'_"_',u:_" ..':.-~.'" ..-,'".". ',' _,,'._'.' C.-, -,.:,- -' .....,-'-_...~. " -.
(Asi! appears on carLl)
Mr. David Kyle
2008 Dickinson ave
Camp Hill, PA 17011
SIGNATURE
TYPE OF CARD
"r~PH~}\Ek~f~~~~P
.:;;:~~_qiRr~:~1~~;~jli;~i{$~~~~it~~f~~f:i~'$~llfj~~k~%',WM;f_~(~iY~~~IJ?:~~i;t~r:t!Js~:ijf,~1f..~1~~J~-Wi~1iit~~~~t:~~~1ik~f~'lW~.i~}.~]i~~fI~~~~ff~~;'t11i~~{t'f'i/i
" ;:~"f._ ',,"'~,:ro!lNSLJR13F1RSeER,GREDI;r<p.~EASEiD~TAGt:I:AJ:lD'RETl!RN,THI$P.0RTION[OF\THEiS;TATEMENTiWJ:fH3YQUR,P AYcMENr)~,,,,.'r6,i,ijil~}
,'.';"7~~i,~~~i"'t,h~":~;'_~;';;;G;j:,:'_<I":\--cl[;::1N~'cc{)'J:',;':'-t:'",_,~",~,,,,;,.t';r;\''i<'''ii'~''i'"''',''''''1:A''''''';'~f"'':(<Ji.-..,~,;,,,,,,,,.~-'-'i>i';:i!ir~'~'.,~,'~_':"~'~,>'!~f~'1~(.<,i,~-;:-"~';('ii>?I"<*'t!::t.,.",,;g"t~~:f<:'--'-I~i-:,':;,i1~rW;'jt""'''N'''''"'';~-i,~"i""i"'t,-<"':{,,:....:,-,,,:,:,~t>::':-"':Y~:dS':~,;"';~ic:::.'
--------..-----...----------.---------- ----_.._---~----~--- ~---~------~----_._----._---,--------- --,-.-.-
PLEASE RETAIN THIS PORTION OF THE STATEMENT FOR YOUR RECORDS
01/08/2005 Balance Forward 0.00
01/21/2005 DDS1 :D9440:0ffice visit.after regular hrs Chase 68.00
01/21/2005 DDSl :D2335:Resin-4+ w/incis angle-anterior Chase 150.00
02ID8/2005 Payment - PA Blue Shield Chase -100.00
02ID212005 HYG2:D0274:Bitewings-four films Merideth 30.00
02/02/2005 DDS1:D0120:Periodic oral evaluation Merideth 20.00
0210212005 HYG2:D1110'.Prophylaxis-adult Merideth 47.00
02/08/2005 Payment - PA Blue Shield Merideth -82.00
02/08/2005 Write-Off Merideth -15.00
02ID8/2005 Write-Off Chase -50.00
... Indicates that i surance has been billed for the procedure.
0.00
d)R~EN'ifj3~!i>.~(:E:J
68.00
0,00
0.00
L--~
PLEASE PAY
THIS AMOUNT" . 6800
@EasYDentaI1997-99 DI-STM2
Frederick M. Minium, D.D.S. - 1509 Cedar Cliff Drive Camp Hill, PA 17011 (717)763-1676
.J!
,....
FREDERICi< HI~~tUlv"t, DDS
1509 Cecl,ll ellt1 Uli\t'
ClIlif} Hili [lil, )-Cl:
Telephone _ : ~ i ~ I ;; b~',- I \-,~ i-
F ~l\ 1;C I -:-1 - (~i !i I(-,...j
illllll:umdcl,,'u ,1(,1\1)'-;,
October It, 2004
Donegal Insurance Co.
11 :)5 River Rond
P.O.Box 302
Marietta, Pa. 17547-0302
Attention: Joel Shutt
Claim Representative
Dear Mr. Shutt;
Enclosed yeu will find a copy of your letter with a series of questions. This is in reply to
those questions as per your number.
(I) Chase Kyle fractured his lower anterior teeth,#23 class II fracture and #24 class
III fracture with pulpal exposure.
(2) Vitality tests and radiographies indicate #23 and #24 still have vital pulps.
(3) Both #23 and #24 need full coverage crown. Either or both may at some point
require root canal therapy, but currently are vital pulps.
(4) No medication being taken.
(5) No.
(6\ We plan to place norcelain crowns on #23.#24. Possibility of root canal theranv
in future as with any traumatic injury.
Sine
'" .
;
~
Fr M. Minium, D.D.S.
01"_"
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[.
STATEMENT OFSERVICES RENDERED
Frederick M. Minium, D.D.S.
1509 Cedar Cliff Drive
Camp Hill. PA 17011
c~=:o. \ PAG~NO. 1
BILLING DATE
08113/2003
(717)763-1676
PROVIDERS: (IO,Name,Number)
DDS1-Frederick M Minium, Dentist #23-2264452
GUARANTOR. NAME AND MAIlING'ADDRESS
Me. David Kyle
3539 March Dr.
Camp Hill, PA 17011
PATIENT
Chase
Chase
Chase
MIDLF DDSl :02335: Resill4t wfinds angle-an
MIDlF DDS1 :02335:Resin-4+ wlincis angle-an
Credit Card Payment-Thank You
-300.00
23
24
150.00
150.00
0.00
-300.00
+
I
=
.300.00
30000
0.00
300.00
,
YfD Finance Charges: 0.00
YfD late Charges: 0.00
YfD Guar Payments: 300.00
YTD Ins Payments: 113 00
REASON
Merideth
Colton
'-Ned. - Sep. '24,
Wed. - Sep. 24,
px ex
px ex
3:10pm
3:10pm
lSY Oenta11997~99 DLWLKl
darns And AshbyD.O.S., P.C.
4836 E. TrindleRoad
Mechanicsburg,PA 17050
1 (717)737 -5834
Mr. David Kyle
2008 Dickinson Ave.
Camp Hill, PA 17011
TO ENSURE PROPER CREDIT PLEASE
DETACH AND RETURN THIS PORTION OF
THE STATFMENTWITH YOUR PAYMENT
08/02/03 Office Visit After Hour
08/11/03 Statement Sent
08/11/03 Not A Covered Service B
09/08/03 Statement Sent
IY (\ ~\
/ ~
\
//
oM/C
STATEMENT
ACcou~n NO. PAGE NO.
1359100
1
BilLING DATE
Charges Or Payments After Billing
Date Will Appear On Next Statement
September 8, 2003
$
Amount Remitted
o VISA 0 CHECK
Signature
REFERENCE
(Clm 623671 Chase
Account
(Clm 62367) Chase
Account
Date
Exp_ Date
<
112.00
INS. PORTION REC'D
0.00
<
L~
CURRENT 30 DAYS T 60 DAYS I 90 DAYS I NEW OUTSTANDING PLEASE PAY I
BALANCE INSURANCE
112.00 0.00 0.00 0.00 112.00 0.00 ..~~
Ke.arns And Ashby D.D.S., P,C., 4836 E. Trindle Road, Mechanicsburg, PA 17050
If you have any questions, please call our office.
PROGRESS NOTES
( \'c'" 't-- I' '
Name / 1\ < iC "} '(
--_._-,.----------~-_._.~--
O~TE lOR, ,GOTH \ SURF. IRD, ~NES, I N,O I TREATMENT ~HI OH l DATE I TIME I PROC
:hJD' ci Ii , "]..',00 p-v J\\1-W' 'vvv", ~i.-,. -r"'v>{""OIv>-(~1 ~-Lj--! I
1.Y~ ~ *'-.'IJA/'-'o 9'" ~'- <;;:,^[..~W""" l\. Zq'.-LI T I I
C\.t ")W;~-M:"'\{)bO\ fA\: \."" ^""'- 1:>?-4 F-Tl-
eLl). b.vJ1",U h <'"L<:; ~~;~ ~'(
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,
r?\ ; '-> rJ 0\ cl 10r. '(-'" A !Vi \",'
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I( V,,,1-VLn ~v 1 1-,.
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~
FREDERICK MINIUM, DDS
December 7, 2004
150Q CecJJI Clit1 Drive
C;'1rnp Hili, Pi\ I in I i
TelephonE': i:: 1 /' ) ,~b_-: 167[,
F'-Ix' (~171 :C<::-]CHi..:J
iminiLlmcJd~lIl;jul ,l on I
Mr. David Kyle
2008 Dickinson Ave.
Camp Hill, Pa. 170 t 1
Reference: Chase Kyle
Claim No: G 0012624 (41)
Dear Mr. Kyle,
Enclosed are the fees at this present date you requested for possible future treatment of
tooth #23 and tooth #24:
Root Canal Treatment-Tooth #23 ADA Code: D3310
Root Canal Treatment-Tooth #24 ADA Code: D3310
Post and Core-Tooth #23 ADA Code: D2954
Post and Core-Tooth #24 ADA Code: D2954
Crown-Tooth #23 ADA Code: D2740
Crown-Tooth #24 ADA Code: D2740
$450.00
450.00
175.00
175.00
595.00
595.00
::;. ;;><1'-/0
As stated previously stated, there is no way to predict the future treatment necessary for
these two teeth; therefore, it is impossible for me to give you a total for his treatment now
or the cost involved as fees are suhject to increase in the future if or when this treatment
becomes necessary.
~y,
04
Frederick M
"" .
~
Minium, DDS
No: 05-5731 CIVIL TERM
CERTIFICATE OF SERVICE
We, David Kyle and Meredith Kyle, Parents and Natural Guardian of Chase Kyle,
a minor, hereby state that the within documents have been served upon the following on
the date set forth:
Nadine C. Bell, Esquire
Nikolaus & Hohenadel, LLP
212 North Queen Street
Lancaster, P A 17603
~"Z
,/' --
,f . ,/ ///"
David Kyle, Parent4!nd Natural Guardian of
Chase Kyle, a minor
-'
Date ,.} IIfi /OC,)
I '
Meredit Kyle, Parent a
of Chase Kyle, a minor
4
("
j~^~
C.J
'-li
..-.\
-;\
r-:-'
\-,,'.~;
,
RECEIVED FEB 1~ ZtJRIGINM
y
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
David Kyle, parent and legal
guardian of Chase Kyle, a minor
2008 Dickinson Avenue i
Camp Hill, Pa ] 70 II
and
No: 05-573] CIVIL TERM
Meredith Kyle, parent a d legal
guardian of Chase Kyle, minor
3539 March Drive
Camp Hill, Pa 170] I
Pe itioners
v.
Henry 1. Malis
200 Pennsylvania A venu
Camp Hill, Pa 17011
Re pondent
AND NOW, this
ORDER OF COURT
+,L.
, 2006, upon
day of
consideration of the Petifon allowing settlement and compromise and for distribution, it
is hereby ORDERED and DECREED that the said Petition is APPROVED and
distributed is directed as Haws:
I. The Partie to the action are hereby authorized to compromise the above
claim upon the terms set rth in the attached Petition.
2. The Paym nt of Five Thousand Seven Hundred Forty-Six Dollars
($5,746.00) to be made b Donegal Mutual Insurance Company shall be in full settlement
of the liabilities of Henry r Malis for all causes of action of Petitioners David Kyle and
.\~\h\J
1'-.'
; ,
;,
,------
No.: 05-5731 CIVIL TERM
Meredith Kyle, Parents and Natural Guardians of Chase Kyle, a minor, regarding a
personal injury action of August 2, 2003.
3. This courtl approves a settlement of the claim of Petitioners with the
following Payments:
a To!Petitioners David Kyle and Meredith Kyle, Parents and Natural
Guardians ofCha e Kyle, is to be deposited in a federally insured account or
certificate of dep sit in a bank or savings and loan institution in the name of the
minor, until the nor child Chase Kyle obtain the age of eighteen (18), Five
Thousand Seven undred Forty-Six Dollars ($5,746.00).
b. Pe itioners David Kyle and Meredith Kyle, by their joint
agreement, shall e permitted to withdraw funds, as necessary, to pay for Chase
Kyle's additional dental work as related to the instant action. The minor, Chase
Kyle, shall have II and exclusive control over the remaining funds. at :> 0 '- lb.
4. That the ove captioned matter is marked settled, discontinued and
ended.
Petitioners shall lie of record proof of the deposit ofthe funds into a restricted
account within thirty (30 days of this Order.
1/H. \Hl\4.I (j .sc.Lcdvl,.J !Q.) f~!.. 1'"1. 2-ot>c' I l!. t.v.,,,!leJ
I
BY THE COURT
Attest
)- i-f.. Me
(' .
. "'I-,,-<,~
I
~~l'-"-t(.1. ,(.
w;
2
. .
.
uhiGINAL
rN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
David Kyle, parent and legal
guardian of Chase Kyle, a minor
and
No: 05-5731 CIVIL TERM
Meredith Kyle, parent and legal
guardian of Chase Kyle, a minor
Petitioners
v.
Henry J. Malis
Respondent
PRAECIPE TO DISCONTINUE AND END
TO: CLERK OF COURTS - CIVIL DIVISION
PLEASE MARK THIS ACTION AS DIRECTED BELOW
J_ This suit is settled, discontinued, ended and costs paid.
This suit is settled, discontinued, ended with prejudice and costs paid.
This suit is settled, discontinued, ended without prejudice with costs paid.
Satisfaction of the award in the within suit is acknowledged.
Satisfaction of the judgment, with interest and costs in the within matter is
acknowledged.
Other.
/' ---
4V?'" J! .,YO: ~ ...,"'------
~l' ....?--
. . .,- / ~,.~
-.,'
/' /'
D~~id KYi~, Parent and Natural Gnardia;, of
Chase Kyle, a minor
Me edith Kyle, Parent
Gua dian of Chase Kyl
DISCONTINUANCE CERTIFICATE
AND NOW. this
day of
,2005. SUIT HAS BEEN
MARKED AS ABOVE DIRECTED.
PROTHONOTARY
-. ....
CERTlFICA TE OF SERVICE
We, David Kyle and Meredith Kyle, Parents and Natural Guardian of Chase Kyle,
a minor, hereby state that the within documents have been served upon the following on
the date set forth:
Nadine C. Bell, Esquire
Nikolaus & Hohenadel, LLP
212 North Queen Street
Lancaster, P A 17603
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David J€Y1e, Parent and Natural Guardian of
Chase Kyle, a minor
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Date ~ \ \ \tl.,
Mere ith Kyle, Parent an
of Chase Kyle, a minor
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ORIGINM
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLV ANIA
CIVIL ACTION - LAW
David Kyle, parent and legal
guaIdian of Chase Kyle, a minor
and
No: 05-5731 CIVIL TERM
Meredith Kyle, parent and legal
guardian of Chase Kyle, a minor
Plaintiffs
v.
Henry J. Malis
Defendant
PRAECIPE
TO THE PROTHONOTARY:
Attached hereto please find proof of a deposit of the funds into a restricted
account for the above-referenced matter, pursuant to Order of Court, dated February 13,
2006, as issued by Judge J. Wesley Oler, Jr.
Respectfully submitted,
NIKOLAUS & HOHENADEL, LLP
By: ; 7.t,-,,~, cP:,U(____~~_
Nadine C. Bell, Esquire
Attorney J.D. # 89388
212 N. Queen Street
Lancaster, P A 17603
(717) 299-3726
Attorney for Petitioners
..
CERTIFICATE OF SERVICE
I hereby certify that I have this day served a true and correct copy of the foregoing
document upon the following person(s) and in the manner listed below, which service
satisfies the requirements of the Pennsylvania Rules of Civil Procedure.
David Kyle
2008 Dickinson Avenue
Camp Hill, P A 17011
Meredith Kyle
3539 March Drive
Camp Hill, P A 17011
NIKOLAUS & HOHENADEL, LLP
Date:-;-I~t;.. Ii. ( \ ,.J;: )..((1(."
By: /}1 F't-A/l. CA.,:-<-'
Nadine C. Bell
LD. No. #89388
212 N. Queen Street
Lancaster, P A 17603
(717) 299-3726
Attorneys for the Plaintiffs
MEMBERS l't
l>~nEJt~\L- {';J{ kit}lf UN1U~
Camp Hill
3512 Market Street
Camp Hill PA 17011
Inquiries Call:
st
717-737-1041
Acct XXXXX}{X424
Eff' 03/11/06
Tlr: 0366
KYLE, CHASE K
Date: 03/11/06
Time: 10:14am
Deposit to
PreY Ba1:
Amount:
New Bal:
Seq:
REGULAR SAVINGS 00
0.00
5,146.00
5,746.00
#225732
Check Received
5,746.00
Authorized by
10 Source:
o Drv Lie
o SigCard
o Known
o Other
CHASE K KYLE
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MEMBERS 1"
fi'J.lf.Jiti\[. (;J'{ bt}'l'f\J!\l:lO:-:
Camp Hill
3512 Market Street
Camp Hill PA 17011
Inquiries Call:
st
717-737-1041
Acct XXXXXXX.424
Eff, 03/11/06
TIr; 0.:366
KYLE/CHASE K
Date: 03/11106
Time: lO:26am
00
5,746.00
5.00
5,751.00
#228418
SAVINGS 00
5,751.00
5,746.00
5.00
4f228419
Deposit to REGULAR SAVINGS
Prev Bal:
Amount:
New BaI:
Seq:
Withclrwl from REGULAR
Prev Bal:
Amount:
New Bal:
Seq:
Deposit to 6 MONTH CERT 46
Prev Ba1:
Maturi ty date:
Amount:
New Bal:
Seq:
0.00
09109/06
5,746.00
5,746.00
#228420
Cash Received
Fives Received
5.00
5.00
Authorized by
ID Source:
o Drv Lie
o SigCard
o Known
o other
CHASE K KYLE
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