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LAW OFFICES
BENNETT, BAICKLIN & SALTZBUAO
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IN THE COURT OP COMMON PLEAS OP CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL DIVISION
CHRISTIAN C, ROT'l'MANI
as parent, natural and legal
guardian of CHRISTIAN J. ROTTMANN
Pro Se Plaintiffs
CUMBERLAND COUNTY
COURT OF COMMON PLEAS
CIVIL ACTION - LAW
vs.
No.1 91-
(i )" 4--- J- C^-v4.-L
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IAN C. STEVENSON and
JANET E. STEVENSON
Defendant
PRAECIPE POR WRIT OF SUMMONS
TO THE PROTHONOTARY OF SAID COURT:
Issue Summons in
Civil Action - Law
in the above case.
x Writ of Summons shall be issued and forwarded to the Pro
Se Plaintiffs.
(l~~~
Christian C. Rottmann (as
parent, natural and legal
guardian of Christian J.
Rottmann a minor
Date:
11/1/ I q y
213 Fox Drive
Mechanicsburq, PA 17055
(717) 737-9535
Supreme Court ID Number
*****
TO: Ian C. Stevenson and JanBt E. StevBnson
YOU ARE NOTIFIED THAT THE
AN ACTION AGAINST YOU.
ABOVE NAMED PLAINTIFF(S) HAVE COMMENCED
"CLL'\..tkC-L ~'-. Jhe LA.. L
proth notary!C'~.. civil DiviSion,)
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BENNETT, BAICKLlN & SALTZ8UAG
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LAW OFFICES
BENNETT, BRICKlIN & SALTZBURG
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IN THE COURT 01" COMMON PLEAS 01" CUMBBRLAND COUNTY, PENNSYLVANIA
CIVIL DIVISION
vs.
CUMBERLAND COUNTY
COURT OF COMMON PLEAS
CIVIL ACTION - LAW
NO.: 1'11-- as-t).- ~
CHRISTIAN C. ROTTMANN,
as parent, natural and legal
guardian of CHRISTIAN J. ROTTMANN,
Pro Se plaintiffs
IAN C. STEVENSON and
JANET E. STEVENSON
Defendant
CBRTI1"ICATION 01" ACCBPTANCB 01" SBRVICB
I, Gregory S. Hirtzel, attorney for Defendants, Ian C.
StevBnson and Janet E. StBvenson, hereby certify that I am the
attorney for Defendants rBlative to the abOVB matter and
acknowledge receipt of servicB of the Pro Se Plaintiff's Writ of
Summons and petition for Court approval and with respect to those
documents, waive any service requirements provided by thB rules of
civil procedure upon the Defendants.
BENNETT,
ZBURG
DATED: II }JOt). (~ft/
By:
Gregory S. Hirtz , Esquire
Attorney for Defendants
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u..W OFFICES
BENNlTT. AHICKll~1 & SAI.TLBUHG
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NOV 17 1994
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IN THE COURT OF COMMON PLBAS OF CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL DIVISION
CHRISTIAN C. ROTTMANN,
as parent, natural and legal
guardian of CHRISTIAN J. ROTTMANN,
Pro 5B Plaintiffs
CUMBERLAND COUNTY COURT
OF COMMON PLEAS
vs.
CIVIL ACTION - LAW .A
NO.: (j 4- ~J4 )-rY~0L.,
IAN C. STEVENSON and
JANET E. STEVENSON
Defendant
ORDER
AND NOW, this I/" day of
AJ (,.. v~_ b-c..r-
, 1994, upon
consideration of the foregoing Petition and after Hearing, it is
ORDERED that the minor's sBttlement for the gross sum of Fourteen
Thousand and No/100 Dollars ($14,000), pursuant to the terms of the
Release attached as Exhibit A to the foregoing petition, is hereby
approved, distribution directed as follows:
TO: Christian C. Rottmann. as parent. natural and
leaal auardian of Christian J. Rottmann. a
minor, to be placed in a federallv insured
savinas account or federally insured savinas
certificate in Christian J. Rottmann's name
marked "not to be withdrawn until said minor
reaches thB aqe of lB. or without the order of
a court of competent iurisdiction."
BY THE COURT:
J
01 /.ON
.
.
on an icy patch of the roadway causing the vehicle to rotate into
the westbound lane of Wertzville Road when it was struck by an
oncoming vehicle owned by Rubin Brothers Co., Inc. and operated by
Debra A. GeorgB.
4. That said accident was, upon information and
belief, caused solely by the negligence of defendant, Ian C.
Stevenson and as a result of samB, Christian J. Rottmann, a minor,
was caused to lose consciousness for 30 - 60 seconds and suffered
a laceration above his left eye requiring sutures as well as a non-
displaced fracturB of the nasal bone, a non-displaced fracture to
the rib and a chip fracture of the radial head near the left elbow,
together with othBr contusions and abrasions about the minor
plaintiff's face.
5. That your petitioners have not retained counsel
although thBY are aware of their right to do so; and, this petition
has been prepared by Gregory S. Hirtzel, Esquire, an attorney
retained by State Farm Mutual AutomobilB InsurancB Company
(defendants' insurer), to present the settlement agreement with
defendants to this Honorable Court.
6. As a result of your petitioner's negotiations with
defBndants' insurer, a settlement in thB amount of Fourteen
Thousand and NollOO Dollars ($14,000.00) in favor of the minor
plaintiff, Christian J. Rottmann, pursuant to the ter.ms of the
indemnifying minor's general release attached hereto as Exhibit A,
has been obtained.
7. That your petitioners
sBttlement, with court approval, will
understand
be the full
that
and
this
final
.
recovery on bBhalf of the minor plaintiff, irrespective of whether
he may suffer from unforeseen complications in his condition
related to this accident; and, the full and binding effect of this
settlement has been explained to the petitioners by lBtter of
attorney Hirtzel dated October 25, 1994, which we have reviewed and
understand and is attached hereto as Exhibit B.
8. That as a result of his injuriBs, Christian J.
Rottmann, a minor, was admitted to Holy Spirit Hospital on the day
of the accident and was discharged the following day, on March 3,
1994.
Upon the minor's plaintiff's discharge from Holy Spirit
Hospital, he treated with Susquehanna Surgeons (Doctors Ronald M.
Grossman and Burton H. Kohn) for the non-displaced nasal fracture
and the eye laceration on two occasions. These physicians last saw
thB minor plaintiff on March 16, 1994. At that time, Dr. Grossman
noted:
"just a slight prominence of his nasal bone on the right
but no other significant or obvious deformity. The
diagnosis is that of an undisplaced nasal fracture (and
to the best of my knowledge), he has no sequelae and has
required no further trBatment or recommendations from us
since March 16, 1994. To the best of my knowledge, from
this problem, he has no disability."
A true and correct copy of Dr. Grossman's June 20, 1994 report
outlining his office's treatment of the minor plaintiff and the
records of Holy Spirit Hospital are attached hereto as Exhibit C.
9. That the minor treated with the Pennsylvania
Orthopedics (Thomas J. Yucha, M.D.) on March 17 and March 30, 1994.
Dr. Yucha's office note of March 30, 1994 remarks "Christian has an
BxcBllent range of motion lacking the last two degrees of
extension.
He has resumed his full activities and has no
.
mechanical symptoms. Return here as neBded." Further, according
to Dr. Yucha, x-rays taken on March 17, 1994 illustrated
satisfactory posi tion of the bone fragment. A true and correct
copy of the records pertaining to Dr. Yucha's trBatment dre
attached hereto as Exhibit D.
10. That pBr the recommendation of Dr. Yucha, the minor
plaintiff was unable to work from March 3, 1994 through March 30,
1994. The minor's waqB loss claim has been reimbursed in
accordance with requirements of the Pennsylvania Motor Vehicle
Financial Responsibility Law in the amount of $171.
11. That Christian J. Rottmann, a minor, has since
exhibited behavior consistent with his physicians' comments on
discharge; and, said minor's behavior is consistBnt with a full and
complBtB recovery form his injuries and petitioner respectfully
requests this Honorable Court to accept the attached medical
records in lieu of a personal appearance by the minor's physicians
in Court today.
12. That your petitioner approves of the proposed
settlBment as embodied in the within petition and in the general
release because I consider it fair and reasonable and that it
adequately compBnsates Christian J. Rottmann, a minor, for the
injuriBs he sustained, and I do further approve of the proposed
distribution and terms of settlement in the form of the Order
attached hereto. Further, all medical bills incurred by Christian
J. Rottmann, for treatment of his injuries resulting from this
accident have been paid by his insurer for first party benefits,
Nationwide Insurance Company.
.
EXHIBIT A
INDEMNIFYING GENERAL RELEASE
FOR MINOR'S COMPROMISE
KNOW ALL PERSONS BY THESE PRESENTS THAT Christian C.
Rottmann and Joan M. Rottmann, as the parents and legal guardians
of Christian J. Rottmann, a minor and Christian J. Rottmann, in h;;'s
own right, for and in consideration of Fourteen Thousand and No/lOa
($14,000.00), do hereby remise, release and forever discharge Ian
C. Stevenson, Janet E. Stevenson, Rubin Brothers Co., Inc., Debra
A. George, their heirs, executors, administrators and insurers, and
all other persons, finns and corporations, and their heirs,
administrators, executors and assigns of and from all, and all
manner of actions and causes of action, suits, debts, dues,
damages, accounts, bonds covenants, contracts, agreements,
judgments, claims and demands whatsoever in law or equity which
Christian J. Rottmann, a minor, had, has or may in the future
develop as a result of a motor vehiclB accident occurring on March
2, 1994 on Wertzville Road, approximately 500 feet west of its
intersection with Lambs Gap Road, Hampden Township, Cumberland
County, Pennsylvania, which against the said Ian C. Stevenson,
Janet E. Stevenson, Rubin Brothers Co., Inc., Debra A. George,
their insurers and all other firms, persons, corporations and/or
entities, either we ever had, now have, or which our heirs,
executors, administrators, successors of assigns or a"y of them
hereafter can, shall or may have, for, or by reason of any cause,
matter or thing whatsoever, from the beginning of the world to the
date of these presents.
As further consideration for the payment of said sum, the
undersigned, Christian C. Rottmann and Joan M. Rottmann, as the
parents and legal guardians of Christian J. Rottmann, hereby agree
to indemnify Ian C. Stevenson, Janet E. Stevenson, Rubin Brothers
Co., Inc. and Debra A. George and State Farm Mutual Automobile
InsuranCB Company and hold them harmless against any and all claims
for damages, compensation or otherwise, on thB part of said minor
or his legal representatives growing out of said accident, and to
reimburse or make good any loss or damage or costs that either Ian
C. Stevenson, Janet E. Stevenson, Rubin Brothers Co., Inc., DBbra
A. George or State Farm Mutual Automobile Insurance Company may
sustain on account of any further claims made by said minor or by
anyone on his behalf and resulting from thB accident above
mentioned; and, the undersigned hereby waive any and all rights of
exemption, both as to real and personal property, to which we may
be entitled under the laws of this or any othBr state as against
such claims for reimbursement or indemnity by either Ian C.
Stevenson, Janet E. Stevenson, Rubin Brothers Co., Inc., Debra A.
George and/or State Farm Mutual Automobile Insurance Company.
The undersigned further warrant that this Release
represents a compromised and final settlement of a disputed claim
and that the payments being made on behalf of Ian C. StevBnson and
Janet E. Stevenson to Christian J. Rottmartn a minor, in a
restricted account in his name, do not constitute an admission of
liability or responsibility.
IN WITNBSS WHBRBOF, I have hereunto set our hands and
seals this :3/ day of oc.. r, in the year of our Lord one thousand
nine hundred and ninety !our.
SIGNED, SEALED AND DELIVERED
IN THE PRESENCE OF:
4"'-~ ~'~c-1.~~
W ess
d~0?4~
Christian C. RottmarY}
(as the parent and legal
guardian of Christian J.
Rottman)
Witness
~~.Q~~..J
~. RottmalY,l
(as the parent and legal
guardian of Christian J.
Rottman)
Sworn to and subscribed
before me this day
of ,1994.
~ _In.
Notary Public
'Wo'! ARI~L SEA\.
ATTCIRIlEV JAlESM, BAtA. H,tlr1 Nit
'1!kI 'CllntlfIrnl e'1Ul11 ~
~.., c-lulNl [)p~" Ml1 ~ '995 . "
October 25, 1994
Christian C. Rottman
Page -2-
2. the petition for court approval which makes
reference to the accident, Christian's
injuries and the fact that you believe the
proposed settlement fairly and adequately
compensates Christian for his injuries. You
will seB that the petit ion also states your
acknowlBdgement and understanding that
Christian will be able to recover no
additional monies from any sourCB whatsoever
for this accident;
3. a verification for you which must be attached
to the petition when it is filed; and,
4. an indemnifying general release for minor's
compromise. OnCB this document is signed and
approved by the court, it serves to formally
terminatB any and all past, present and future
claims which Christian might haVB and
obligates you, as his parent, to indemnify and
hold harmless Ian C. Stevenson, Janet E.
Stevenson and State Farm for any costs,
judgments or other expenses they might incur
in the defense of future litigation instituted
on behalf of Christian as a result of this
accident.
It is very important that you carefully read all of the enclosed
documents, particularly the petition and the indemnifying general
relBase for minor's compromise. As you know better than I, the
course of Christian's medial treatment and his current condition,
I ask that you pay particular attention to paragraphs 4, and 8-11
of the petition to make sure that the information is accurate.
Please feel free to add any additional information in the margin or
on a separate sheet of paper concerning any of thB averments in the
petition. If you are comfortable with the statements in the
petition and the indemnifying release, please sign the writ of
summons and the releas~ above the signature linBs for your name;
please also sign the "verification" at the back of the pBtition.
The terms of the release shall not be binding until the court
approves the settlement and distribution is madB.
Once I have all of the executed documents, I shall file them with
the court and request that it schedule a hearing date. At the
hearing, both Christian and you will be required to appear. I
shall also be present as will a judge from the Cumberland County
Court of Common Pleas. With your approval, I shall call both of
you as witnesses and inquire as to the nature of your relationship,
...
.
COpy
LABORATORY DATA:
Remainder of the
nasal fracture as
White count 29,000, normal hematocrit.
labs were normal. X-rays were positive for a
well as a left olecranon fracture.
IMPRESSION:
Fractured arm and nose.
PLAN:
Pain control. Advance diet as tolerated.
JOSEPH ESPOSITO, M.D.
JE/bh
D: 03/02/1994
T: 03/03/1994
HARRISBURG
JUN 23 1994
RECEIVED
Page 2
HOLY SPIRIT HOSPITAL
Camp Hill, PA
17011
N~~E: ROTTMAN, CHRISTIAN
MRII: 312803
ROOM II: 431-1
DR.: ESPOSITO,
HISTORY AND PHYSICAL
EXAMINATION
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CONSULTpTllJN REPORT3S
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CAMP HILL PA 17011
717-763-eI41
39-0004
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MECHANICSBUR' PA 17055
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ROTTMAN .CHRISTIAN
a13 FOX DR
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PHARMACY 250 3 """
IV THERAPY . a60 4 6150
MED-SUR SUPPLIES 270 7 9700
LABORATORY JOO 16 J2aOO
DX X-RAY 320 6 6'1600
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HOLY SPIRIT HOSPITAL
503 NORTH 21ST STREET 8IRTH-DATE
23"1 512'i~'r Hill, PENNSYLVANIA 17011.2266 09/22/77
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0302'4 837C07267t
SUSQUEHANNA SURGEONS
PLEASE RETURN THIS PORTION WITH YOUR PAYMENT 7~ ~(Ut I '~.:'v':.:'lN~' 1$
OESCRIPTIONS OF
HOSPITAl. SERIJlCE5
SERVICE
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DETAIL'OF CURRENT CHARGES, PA
03/03 MEP 7SKG INJ VI014402120
03/03 ' EP '15"1: INJ V I 0 I 440?120
03/03 YDROXY 50"G/KL0144280691
03/02 AS 1000 011613068
03/02 RS 1000 011613068
03/02 N~STHESJA SET 011613103
03/02 AVI SET 230 011613370
03/02 CANNULA TUSINI: 0114105001
03/02 COLLAR SHORT 011460522
03/04 SUTURE TRAY 01111?000
03/04 CAST OCL 4 011720930
03/0S SLING AA" 8"L Oll41?332'
03/051'FOREAR" SPL ADT011412587
03/0S SLIPPERS PEDS 01141?682
03/02 GLUCOSE 01~520109
OJ/02,IRENAL PROFILE 012520155
03/02 A"YLASE, BLOOD 012520340
03/02 URIN. (NO "ICR0012522110
03/02 "ICROSCOPIC. UR012522190
03/02 cse U/5 PART DIOI25301201
03/02 DJF~ERENTIAL 012530180
03/03 CSC U/5 PART 010125301201
03/02 SPEC COLLECT FEOl251010JI
03/02 ,STAT HANDLING FOl2510368
03/02 I~TAT HANDLING FOl2510J68
03/02 STAT HANDLING F012510371~
OJ/02 !ISTAT HANDLING FOl2510J73
03/02 ~TAT HANDLING FOl2510374
03/03 ~P~C COLLECT FEOle5101031
03/03.'AT HANDLING FOl2510368
OJ/O? :CHESr 013610100
03/02 LEFT ELSOY 013610128
OJ/O? PELVIS 0'36101~a
'EOER"L 'CENT "10 J].t1'21H
PATlINT NUMBER REFER ALL aUESTIONS TO THE
BUSINESS OFFICE
.117) 76J.2t;]B
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JR OA '" OF SERVICE
fOUL
CHARae~
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1.72
1,72
1.00
9.50
9.50
16.50
26.00
1.25
44.75
3.75
21.25
5.50
15.50
5.00
21.00
66.00
57.00
12.00
12.00
31.00
12.00
31.00
7.00
11.00
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11.00
11.00
11 .00
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102.00
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INS co NO , IN9. CO. NO 2
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'AflENT
AMOUNT
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44.75
3.15
21.25
5.50
15.50
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21.00
66.00
57.00
12.00
12.00
31.00
12.00
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11 .00
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102.00
78.00
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PLEASE SEND PAYMENT TO:
HOLY SPIRIT HOSPITAL
503 NORTH 21 ST STREET
CAMP Hill, PA, 17011.2266
\OeIT OI"L ....TIE~.r OILLING o.AU ~e ~IC.5SAR'" FOA .
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HOLY SPIRIT HOSPITAL '
503 NORTH 21ST STREET 8 IRTH-DATE' '11<0" "C
. 23-1 S 12'i~'f' Hill, PENNSYLVANIA 17011.22BB 09122/77
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HAM.
C ROTT"A"
213 FOX DR
"~CHANICS8URQ,PA 170S5
1 AUTO INS
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SUSQUEHANNA SUR;F.ONS
DATI DeSCRIPTIONS 0' SERViCE TOTAl. esT COIJERAGE
lHJsnD HOSPITAL SlAVICI!! CODE CHARGes ,'j5. CO riO'
CERVICAL SPINE o l:!61 0208 141.00 ''''.00
NASAL BONES 013610232 83.00 83.00
01/02 ollsns 013610247 12".00 124.00
03/0" ED VISIT LEVEL 011710"01 218.00 218.00
OlIO" RHYTH" ECQ 1-3 011730735 37.00 37.00
03/02 EK' 012711100 "9.00 "9.00
OJ/O? ROO" ..31 0190113101 ":l0.00 4'30.00
PLEASE RETURN THIS PORTION WITH YOUR PAYMENT 7~ ~1Ut I .~'I.."JN~' I S
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.7171 783.2138
186".94
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'JR DATE OF SERVICE
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PLEASE SEND PAYMENT TO:
HOLY SPIRIT HOSPITAL
503 NORTH 21ST STREET
CAMP HilL, PA, 17011.228B
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213 FOX DR
"ECHANICS8URG,PA 170S5
I AUTO IN8
030294 5837C07267t
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SUSQUEHANNA SUR;eONS
PLEASE R~URN THIS PORTION WITH YOU~ PAYMENT 7~ ~(Ut I A~1',".:','~'_.~ $
OAT! OesCRIPTlONS all SERVICE TOTAL EST coveRAoe eST COVERAQe eST CovERAQI! 1ST. COVEAAoa
.osreD HOSPITAL SERvICES coel! CHARGES INS CO NO , ;~lS co, NOZ INS. CO. ~IO J INS. CO. NO .
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SU""ARY OF CURRENT CHARGES
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I PHAR"ACY 250 ".44 4.44
IV THERAPY 260 61 . SO 61.50
"IS SUPPLIES 270 97.00 91.00
LABORATORY 300 322.00 322.00
OX X-RAY 320 646.00 6"'6.00
E"ERGENCY ROO" 450 255.00 255.00
EKG/ECG 730 49.00 "".00
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SUB-tOTAL OF CURRo CHARGES
GUAJ RELATIONSHIP: F
ACC-DATE: 03/02/94 TYPE:
DSCH/FINAL DIAGNOSIS. 802.0
PROCEOURE: 08.81 03/02/94
1864'94J 1864.94
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:~~~~E~~1.0~~~cSJIONS TO 'I'HE PI.EASE SEND PAYMENT TO:
,1l1J:8J.2'J8 HOLY SPIRIT HOSPITAL
503 NORTH 2' ST STREET
CAMP HILL. PA. 1;'011.2298
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ROTTMAN, Christian
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REG;.. .J
Christian Rottman ie doing fine. X-ray shows' satisfactory position of the fragment.
Nothing is floating about the joint. His motion is from 20 to 125 degrees. I would
like him to push with his elferc1ses and see me back here in a couple weeks. If he has
significant limitation, we will then get him formal physical therapy.
TJY
tlAR 3.0 1994
Chrietian has an elfcellent range of motion lacking the last 2 degrees of extension. He has
reeumed his full ectivitiee and has no mechanical symptoms. Return here ae needed.
TJY
~ . ~ ...
.
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.
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V E R I F I CAT ION
I, Joan M. Rottmann verify that I am the plaintiff pro se
in this action and that I am authorized to make this verification
to the foregoing petition for Leave to Compromise Minor's Action,
the facts set forth therein are true and correct to the best of my
recollection, knowledge, information and belief.
I further state that I am signing this verification on
the recommendation of my attorney who has advised that the language
in the foregoing document is required legally to raise issues for
resolution by the Court at trial. Further, I understand that some
of these allegations may prove inappropriate after investigation
and trial preparation are complete and I leave determination of
these matters to my attorney on his advice.
I understand that false statements herein are made
subject to the penalties of 18 Pa. C.S. Section 4904 relating to
unsworn falsifications to authorities.
DA'l'ED: ID/ at /9'-1
.
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~ M. Rottman (as
parent, natural ana legal
guardian of Christian J.
Rottmann a minor
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Girl/H. r T. f1I1ILt<UrJ f. SAll/lllJlll,
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NOV 1 7 19~34
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IN THB COURT OF COMMON PLBAS OF CUMBBRLAND COUNTY, PBNNSYLVANIA
CIVIL DIVIS lOll
CHRISTIAN C. ROTTMANN,
as parent, natural and legal
guardian of CHRISTIAN J. ROTTMANN,
Pro Se Plaintiffs
CUMBERLAND COUNTY
COURT OF COMMON PLEAS
vs.
CIVIL ACTION - LAW
NO.: qlf- ur-4J-. (!~
IAN C. STEVENSON and
JANET E. STEVENSON
Defendant
PRABCIPB
TO THE PROTHONOTARY:
Kindly list the pro se plaintiff's petition for court
approval of the minor's compromise in the above captioned matter
for disposition.
DATED: (t jJav !lit(
By:
Grego
Attorney
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U.W OFFICES
BENNETT. BRICKLlN & SALTZ BURG
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LAW OFFICES
BENNETT. BAICKLlN & SALTZBUAG
IN TUB COURT or COMMON PLBAS or COHBBRLAND COUNTY, PBNNSYLVANIA
CIVIL DIVISION
CHRISTIAN C. ROTTMANN,
as parent, natural and legal
guardian of CHRISTIAN J. ROTTMANN,
Pro Se Plaintiffs
CUMBERLAND COUNTY
COURT OF COMMON PLEAS
vs.
CIVIL ACTION - LAW
NO.: Cj L./.. It, 5 L{ 2. - Cj'v,'l
IAN C. STEVENSON and
JANET E. STEVENSON
Defendant
CBRTIrICATB or DBPOSIT
TO THE PROTHONOTARY:
Kindly file the attached certificate of deposit.
DATED:
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LTZBURG
By:
Grego . Hirtzel, Esquire
Attorney for Defendant
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