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Home My WebLink About06-4124 . Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUN1Y, PENNSYLVANIA Christopher Shultz, v. Civil Action - Law No. Dl:.-l./IJl/ (3~I..!-'~~ Tim Wilbur Mechanical Contracting, Defendant PRAECIPE FOR ENTRY OF DEFAULT JUDGMENT PURSUANT TO SECTION 428 OF THE WORKERS' COMPENSATION ACT, 77 P.S. ~921 Pursuant to section 428 of the Workers' Compensation Act, 77 P.S. 921, enter judgment against Defendant in the amount of $2,040.93, interest at the rate of 10% per annum from 4/17/2006, as specified by section 406.1 of the Workers' Compensation Act, based upon the following: 1. 4/17/2006 Workers' Compensation Judge Francis Williamson entered a decision granting a Claim Petition for Workers' Compensation and ordering Defendant to pay Plaintiff the sum of $2,540.93 in Workers' Compensation benefits and counsel fees due to a work related injury that Plaintiff had suffered in the course and scope of his employment with Defendant. A certified copy of that decision is being filed currently with this Praecipe. 2. Defendant paid one monthly installment of $500.00 toward the sum awarded but has not mad any further payments. 3. By operation of section 428 of the Workers' Compensation Act, Defendant is in default for failing comply with the order of Workers' Compensation Judge. Respectfully submitted, B~~ ~;;~~ Smigel, Anderson & Sacks, LLP River Chase Office Center 4431 North Front Street Harrisburg, PA 17110 (717) 234-2401 . ~ Plaintiff : IN THE COURT OF COMMON PLEAS i OF CUMBERLAND COUNTY, PENNSYLVANIA Christopher Shultz, v. Civil Action - Law Tim Wilbur Mechanical Contracting, Defendant No. AFFIDAVIT I verify that I have personal knowledge of all facts not of record set forth in the foregoing Praecipe, and that such facts are true and correct, to the best of my knowledge, information, and belief. I acknowledge that any false statements herein are made subject to the penalties of 18 Pa.C.S. 4904, relating to unsworn falsification to authorities. Date 7/.;z/u c::~ Fred H. Hait t ~1~ 8 ~ ~ () ) ~ ~ &J ~ ~ "'v r- r 1 " . ~., c;:::..::> ~:.i:'; ::on c_ ~ r-: ;c'-;; c- ,.i ", o ' c:' c." G') Received Bwe 04/19/2006 LTR-OOS'REV 09/05/00 1 ClrculadDll Date; 04/17/2006 COMMONWllALTIl OF PENNSYLVANIA DEPARTMENT OF LABOR AND INDUSTRY WORKERS' COMPENSATION OFfICE OF ADJUllICATION 717-713-1419 FRANCIS WILLIl\MSON HARRISBURG JUDGES OFFICE EAST GATE CENTER 1010 NORTH SBVENTH STREET HARRISBURG PA 17102-1400 DECISION RENDERED COVEll LETTEll Bureau Clalm NlUIlber: 2862078 lasurei' Claim Number: bJury Dale: 0511212005 PedtloD.: CIaim.Pel Penalty.Pet CHRISTOPHER SHm.-TZ 35 GARDEN PKWY CARLISLE, PA 17013 FRED H. HAIT, ESQUIRE SMIGEL ANDERSON &: SACKS LLP RIVER CHASE OfFICE CTR 3RD FL 443\ N FRONT 5T HARRISBURG, FA 17110 Juclae: Fralll:is Wmiamson East Gale Cel1ter 1010 North SeveDth Stmt HmiBburJ, PA 17102-1400 The attached Decision of the lullae ia fiIlII un1eas Illappetl is takn to the Wadlmt CompeIIfIltiOll Appe8l Board If provided by law. Vs If you do 1101 ~ with this Decision, 8lI appee1 musl be filed with the Worl<ets' COmpenllltion Appea1 Board witbiD 20 days tom but DOl iDcludiDg !be dale of this IIOtice. fOl1llS for Ul tppeallU}' be oblained flolll !be Workcis' COlllPCIIIIlioa Appeal Boerd. Capital Auaciater. BuikliD& 901 NoJth Seventh S_ Thin! floor South Hmisburg, P A 17102 TIM WILBUR MECHANICAL CONTRACJlNG 507 N YORK ST MECHANlCSBURG, PA l70SS COMMONWEALTH OF PENNSYLVANIA. BWC LEGAL DlV 1171 S. CAMERON STREET ROOM 327 HARRISBURG, PA 17104.2501 o OPEN' ~ CLOSED o SUSPEl'lDED o UNKNOWN TO WCJ Awdlialy aids 8lId services are available upon reIl- to illdividuala with disabilities. E\\ual Oppott1mity EmployaIPtopam Paae t of 2 Received Bwe 04119/2006 21, CHRISTOPHER SHULTZ - 2862078 EmDlovee Wltn__ It ~.Ihlh: C-I Fee Agreement EmnloVl!r \\I;ifJ- '* ~,."ihlh; None Haal'ln.8: 4/1012006 09:20:00 Held 3/1/2006 09:30:00 Held 1/30/200610:15:00 Held 11/2812005 10:35:00 Held Auxiliuy aida IIId aemcea .... a~1e 1IpClIl....1O iadividulls with ttiIabiIili... EqIIII Opport\lllityl!mpi~ p.... 2 of 2 ;.f"'<""t' Received Bwe 04/19/2006 3 , Christopher Shultz Bureau Claim #2862078 Penalty and Claim Petitions Page 1 of I RECORD: The Claimant filed a Penalty Petition on October 7,2005, and a Claim Petition on October 18, 2005. The Parties entered into and executed a Stipulation of Facts, the same being approved by the Judge and incorporated herein as the Judge's findings of fact, a copy of which is attached hereto and made a part of the within decision. CONCLUSIONS OF LAW: All parties are bound by the provisions of the Pennsylvania Workers' Compensation Act, as amended. ORDER: The Penalty Petition filed on October 7, 2005, and the Claim Petition filed on October 18, 2005, is GRANTED. The Defendant and/or its' insurer is directed to pay compensation per the adopted Stipulation of Facts. Claimant was represented by an attorney in the within proceedings under a fee agreement which provides that Eight Hundred Dollars ($800.00) of any award of compensation shall be paid to Claimant's attorney. Defendant andlor it's insurer is ORDERED and DIRECTED to deduct Eight Hundred Dollars ($800.00) of the compensation payable to Claimant and pay same to Fred H. Hait, Esquire, with the balance payable to the Claimant. ~ Francis R. Williamson, Jr. Workers' Compensation Judge Harrisburg Judges Office FR Wjr/wd Received Bwe 04/19/2006 . .. .~ . 4 COMMONWEALTH OF PENNSYLVANIA I:>EPARTMENT OF LABOR ANI:> INI)lJSTRY BUREAU OF WORJ(EAS' COMPENSATION I~@g .~I\Iij~J BY:...__ -.......... ., CHRISTOPHER SHULTZ, Claimant Burcew Claim No. 2862078 VS. ClaimIPenalty nM WILBUR MECHANICAL C~ l)efertdant Nolnsurance STIPULA TION Christopher Shultz, Cloimant, and Tim Wilbur, Defenclant hereby agrM as follows: 1. Christopher Shultz, while ellIployed by Tim WillKlr Med1anicol Contl'ClCting, suffered a work related injury consisting of a lacerotedleft forearm in the COIII'se and scope of his employment on 5/12/05. 2. In order to resolve thu. petitions, Tim Wilbur agrees to pay the following sums to Christopher Shultz: $811.00 for medical expenses $300.00 for lost earnings $800.00 for attorney fees $90.93 for litigation costs. 3. Payment shall be made In monthly instalhnents of not less than $!500.00, with the first installment ~ing due on or before 4/1106, and continuing on the first day of each month thel"CClfter until the entire SlIIII of $2,5'40.93 Is pald In full. Payments shall be I\\4ilad or delivered to CklilllClllt's counsel: Fred H. Halt Smigel, Anderson & Sackr, I.LP River Chase Office Center 4431 North Front St....t Harrisburg, PA 17110 r/ 5 R'eceived Bwe 04/19/2006 .. .;'" . 'rl,'iI.- 4. Artt paymmt that is more than 30 days overdue shall bear interest at the statutory rate of 10% per annum. Tim Wilbur Mechanical Contracting Date: 3-.:;q~ob By (j) ~ Dote: 1./~ ,- ~t. ~/- ~17~~ r -..5- /2,~ Christopher Shultz , g s~ ~, .- .- 'd ~ a'i If !I .,. lo<~? ~ ~%%% '" , ~~\ ~ 'i'\ , ie 11< 0 ~ e = ? ~ U ~ \ '''is "i '"J .II! ~ ,~~ '1 \ 8% '" Itl \!. % ~ ,= lil % ~ ... \iro % ! ... ~ ~ Q ~ i ... }\ '" % % !~ ao ... '" ... ... % Q Q ... ... ~ ! ~ r- ~ ~ s ~ t/') "'- ~ oclg ~ < lClo<Clo< t-.b~ ~~ <::>t-~ ~~.... \\\ oct-li'l ~ ~ .... <::> \ .. .. ~ ~~i , ! '0 atTJ,! t '0 P;o g "" f) ! '''is "'- Va .~ '6' , , ~ 1 11 "ia ,,; ~ l .s i1 u U I'< .' . " .. ' .' UBC-475 REV 6-01 ~ Harrisburg. PA t 71 04 lABoR&iNb'VSTID' <;""'U.N""~ALT" OF PE~~HlVANr" www.d1i.state.pa.us BUREAU OF WORKERS' COMPENSATION July 17, 2006 The foregoing is hereby certified to be a true and and correct copy of Judge Francis Williamson's Decision Circulated April 17, 2006 Christopher Shultz v. Tim Wilbur Mechanical Contracting, BWC #2862078, D/I 5/12/05 in the case of as full, entire, and complete as the same remains on file in the Bureau of Workers' Compensation of the Department of Labor and Industry. Certified this 17th day of July 2006 -~/ ~. . Chief Claims Management Division ATIFSf: I hereby certify that Thomas L. Dinsmore , who signed the foregoing, was at the time of signing, Chief, Claims Management Division, Bureau of Workers' Compensation, and as such, was the legal custodian of the above-described records. IN TESTIMONY WHEREOF, I have hereunto set my hand and caused the seal of the Department of Labor and Industry to be affixed on this 17th day of July ,2006 Seal of the Department of Labor and Industry xi.,;/".. ~1.1. J ,- Sandra . Ne 1