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Home My WebLink About95-01430 VI ,.< "~' ,i, .J, ,t 'Ii " /"'~ ~::s. ," '" .~:.~ .~~ " . ,,~ ". !.: ,," :<~.l' .:(t;, .j,(. '~~., aJ C ,- U . '" 7 .;, . -!~ ~ ~ J ,\" ,',. ;~Io' a. iifriJ ;'~TI '03 .:-/~ ".~ '''~~ ""~ ',,..< ,,.),~ !'A~ ;h~ "~i;.t1 .):~~ ,:.~ ~J;]t~ ,\\{~ <'t\~ :h~~ ~~, ,:.,~., ~, ':';t. ..~ -t(."~ "-~~';1 ..".d ',,~,., . _.~~~~J , ,~ti :~',~~ ~:l ,. ~~,~~, . oJ l.. ~ o "I; .' ,;~. ' ,;t '" o ("f) :t- ,. :..: .~. ; :i - " ',,_.~;,.c;,~,~,_;,,~::.,,:,:' >, I',,~: . ~ If) ~ N I-" .. wq -,,) - (.:')~~ fE~ :c I...J;i~ ~F .:.... ~':);2 <" ~ , r:: .:r . ' C./) ,u" J ::1"/ --'\11 (,0; f":':;O l"- 0:: I" ::. 'jV,J f"- ... ~..o.. -: Lt. ,... :::l 0 a- U ~ o ~~ ~>l p.,lJ) Z~ ~ O~. i:>:: ~11< ~ o a,," u~3~ ~z > O~ I H o U E-<UZ r:.: 00 ::>QHM O~ E-<-:t U U.... <, ~~~~ e> ' ZSHO HUUZ , .... III ~ QJ III -ll-l lJ)ll-l ~~ O'...! III ..... ~11< lJ) ~ I"",.. _ .... .-Ii ~ d -Ill ~'8 HQJ ..:Ill-l , U QJ > Q , ~ ~ .' ~ Z o H ~ H ~ ~ ~ ~ ~~ HH E-<U H< ~~ .. '.' '. .. AUb 0 4 1997 ~ .., III i ~ ~ ~ i I r&i ~~~ ! ~ ~ ~ lri ~ u " , . . . . . . .. .' , , JAMES E. ORRIS and CHARLOTTE R. ORRIS, as parents and natural guardians of REBECCA A. ORRIS, a Minor, Plaintiffs . . IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW . . NO. 95-1430 CIVIL TERM v. AMY K. CLINE, Defendant PETITION FOR ADJUDICATION OF CAPACITY TO THE HONORABLE, THE JUDGES OF SAID COURT: The Petition of JAMES E. ORRIS, CHARLOTTE R. ORRIS and REBECCA A. ORRIS, by their attorney, Wayne F. Shade, Esquire, respectfully represents, as follows: 1, Petitioners JAMES E. ORRIS and CHARLOTTE R. ORRIS are adult individuals and parents and natural guardians of their daughter, REBECCA A. ORRIS, with whom they reside at 7320 wertzville Road, Carlisle, Cumberland County, Pennsylvania 17013. 2. Petitioner REBECCA A. ORRIS, was born on August 22, 1979, and will, accordingly, reach adulthood on August 22, 1997. 3. On November 18, 1994, Rebecca A, Orris was a passenger in a motor vehicle which was being operated by Amy K. Cline in a northerly direction on Locust Point Road in Silver Spring Township, Cumberland County, Pennsylvania, as it approached the W^YNI! F, SHADE intersection with U. S. Route 11. hllomcy at Law 53 Wul Pomf'rtt Street C.rli.lc. PmtlIylvanla 17013 WAYNE F. SHADE ^1tOm()I1'Law '3 Wut Pomfrtt sum Carli.le. Pmruylvania 11013 4. As the vehicle attempted to cross u.s. Route 11, it entered into the path of a Ford Ranger pick-up which was being driven by Russell White, Jr. 5. As a result of the collision between the two vehicles, the said Rebecca A. Orris sustained the following injuries: (a) Severe closed head injury including right cerebellar, right thalamic and right occipital hemorrhages; (b) Right rib fractures; (c) Right hip abrasion; and (d) Aspiration pneumonia. 6. As a result of her injuries, Erie Insurance Company is in the process of offering a large under insured motorist settlement. 7. In view of the severe brain injuries in this case, Erie Insurance company will need an adjudication, before concluding the settlement, that Rebecca A. Orris is not incapacitated in her ability to make and communicate decisions for the management of her financial affairs; or, in the alternative, the company will require Court approval of the settlement. 8. Petitioners believe and therefore aver that, in spite of her severe injuries, Rebecca A. orris will not be incapacitated in her ability to make and communicate decisions for the management 2 JAMES E. ORRIS and CHARLOTTE R. ORRIS, as parents and natural guardians of REBECCA A. ORRIS, a Minor, Plaintiffs . . IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA . . . . . . . . . . . . v. . . . . . . CIVIL ACTION - LAW AMY K. CLINE, Defendant . . : NO. 95- 14-?l (I CIVIL TERM AND NOW, ORDER OF COURT this l'liL day of March, 1995, upon consideration of the within Petition for Court Approval of Compromise Settlement and Distribution of Proceeds, a hearing is SCHEDULED for Wednesday, March 29, 1995, at 11:00 a.m., in Courtroom No.5, Cumberland County Courthouse, Carlisle, Pennsylvania. BY THE COURT, J Wayne F. Shade, Esq. 53 West Pomfret Street Carlisle, PA 17013 Attorney for Plaintiffs :rc .---. ,1 , n' ~ {: '>? '... ...~ ~i IE ~..... /4, ....:r. . ""t..~l'" ~ ~ ... !:?:t:.....;: ~ ., 1.A".C)c.>..... l'l u..:J:.Q->> C") c:u-z...... ;.t .~ l.:::.-.....~ .....O::-Jvt ~:f....tr~ ~ ...IUWZ ~\ I~ ... ...~I;clU I Jj, ;:%Q,. ....=> ~ 0'" . It) Q ~ <k r..< 01-1 3~ . ~~ ~I~ '" ;~ I - - III ~ ~ ~ J i . .-l IJA< III ~ U 8~~~ .j.J ~~~ ~ to i ~ G/ r.. ~ 1II ~ I ~ ! -'H .j.J o~r.. 011-1 ~'H d U 0 ~ < ~ ~ o U i~ -Ill ril E-<UZ !fa P::~Z ~r~ 01-10 ~ ~; 0'001 I-IG/ r..:E:1-I 8 t:.... III ~'H zl5!~ ..-l . u2l U <I rilA< > O~lQ ~ ~~ . ~ :.: ~o~ ~ I-IU z~~o ~ tr..~ I-IUUZ t:l A<Ol:l . , ~ , . '. , . . ..... . . . ~. , . ~p 3 17 '1", 4. As the vehicle attempted to cross U.S. Route 11, it entered into the path of a Ford Ranger pick-up which was being driven by Russell White, Jr. 5. As a result of the collision between the two vehicles, the said REBECCA A, ORRIS sustained the following injuries: (a) Severe closed head injury including right cerebellar, right thalamic and right occipital hemorrhages; (b) Right rib fractures; (c) Right hip abrasion; and (d) Aspiration pneumonia, 6, After extensive treatment, REBECCA A. ORRIS remains an inpatient at Healthsouth Rehab of Mechanicsburg. 7, Although this injured minor continues to improve after several weeks in a coma, she continues to be non-ambulatory and substantially disabled from severe brain injury. 8. After some initial errors in processing the medical claims by the automobile insurance carrier which were resolved through the efforts of counsel for Plaintiffs, all of the nearly $200,000 in medical bills to date are being paid, initially, by the first W^nn: F, SIl^\lI! ^nom~y II lAw .5.1 Wut I'omrrrl Slr~d ('lrlidr,I~lUlIyl"'lUlia 17111) -2- income taxes and reasonable expenses of annual preparation of income tax returns. Respectfully submitted, wa~~~ supreme Court No. 15712 53 West Pomfret Street carlisle, Pennsylvania 17013 Telephone: 717-243-0220 Attorney for Plaintiffs W^YNI! F, SH^()I! Anomry at taw B WeAl rnmfrd Slrrct C..lil/c. J'ron.ylvanil 171113 -5- I..' _... ;''' . ........ .. '.' .... .. -.. J. '.. I. ':: ~SJ . t."NKERS AND S1Jl.l'l'ERS INSURA."lC..... COMPANY , . .ni1J,:a.c.~.J." I ..IK...,.. i ;~~f~:.6~~~~;:~lowt,~~~~~~~I' -~'9;J'~/~ i SUPERCEDES ANY PRIOR WI T!l Tlla:; ti.I\ME NUMBER i I REhSON FOR AMENDMENT - ADD VEHICLE I EFFECTIVE FROM I 08/04/94 TO 02/04/95 , -'IV PA LOW PRICE AUTO POLICY LP!\ 040296300 006513900 PHONE II (117) 697-1958 Cl~BERLAND VALLEY INSURANCE P,O, BOX 451 NEW KINGSTOWN, PA JAMES S BURRY 36 REGENCY WOODS CARLISLE, PA 17013 I VEHICLES COVERED . UNrT 5T TER YR MAKE-DESCRIPTION SERIA~ NUMBER . 001 PA 027 93 CHEV CAVALIER IG1JC14401'7322954 002 PA 027 BO CHEV 5-10 BLAZER 1GNBTIORIJ0170196 003 PA 027 B8 PLYMOUTH COLT JB3BA26K9JU084212 INSURANCE IS PROVIDED WHERE A PREMIUM IS SHOWN FOR SYM CLJI.SS 24 MS3501 05 FS4001 14 FS4000 THE COVERAGE 17072 ST AM CHG DATE 09/19/94 09/19/94 09/19/94 COVERAGE LIMITS OF LIABILITY PREMIUMS UNIT 1 2 115.00 105,00 3 71.00 62.00 BODILY INJURY $50,000 EA PERSON $100,000 EA ACCIDENT E'ROPERTY DAMAGE $25,000 EACH ACCIDENT 100,00 UNINSURED MOTORIST .*REJECTEU.v UNDER1~SURED MOTORIST .*REJECTED*. 'COMPREHENSIVE $500 DEDUCTIBLE COLLISION $500 DEDUCTIBLE MEDICAL EXE'ENSES - $5,000 35.00 202.00 29.00 ~ 91. 00 21. 00 98.00 25.00 24,00 TOTAL BY UNIT 481.00 340.00 157.00 TOTAL TERM PREMIUM $979.00 : LIMITED TORT APPLIES \ ..'.\ 1)'\ '"..,\,.,' . r S \, \ , , , .' , (1:1 CONTINUED ON NEXT PAGE \. '. EXIUBIT "A" . ." '\. '. '.' " MU:N ICll)'Y AUTO BODY REPAIR ORDER M, A. BRIGHTBILL BODY WORKS, INC. 2701 E, Cumherland Street LEBANON, PENNSYLVANIA 17042 (717) 272.7691 Toll Free In Pennaylv.nl. 1 800.932-4625 1108 ClN 10S-.'n HOME P"ONE ... hIs- ...., ....... PAIN' CODE OOOY PMOO. DAft YIN, AIlJUSTtA INS, co. ___ ..J o.~ - o Repelr AI Pe, estlmete o Supplementary Repelrs I I ';;'O~nl I , 7;'1 P\:AtNllfios ""."";;c~ EXHIBIT." ~ l.~ .~.) sJ.. ....--'.....' " 2.S" ?&-Jll'"O I OTY PAlfH &. r.1ATERIALS AMOUNT I .:29n :"'" Ins. Co. Pays $ -~;~'~L ~'.2';R Customer Pays $ -:: ~ ~l ~:I:;-:: I hereby authonlB the above repair work to be done along with the necessary malenals. You and your employses may operate vehicle for purpose 01 IBlllng. inspectiOn. or delivery al my nsk. An express mechanics lion is acknowledged on above vehicle to secure the amounl of repairs therelo, It is undorslOOd thai you will not be held responsible rOf loss or damage to vehic!e or anleles left In vehicle in case of fire. theft or any other cause beyond your conlrol. illS also understood that full payment for repairs IS due upon release or delivery 01 vehicle. inctuding supplemental charges. - ;'.I..7~::;"lL3 / -:~~L. \. 1 I/V ~OL"- DEDUCTIBLE PAID BY o Cash 0 ChOCk OMC OAMEX '. '''' 31 ~4 '00 Othor ',' Signature Dele CCNo. I jeT.J.L '318"1J,.4i1 Than:~ '('JI,,; f'tIXl.(Tfdf ,~ _ eo. .....1'" I,a.,...IlllfllflI a~ command assisting with dressing activity. Primary Care Giver (family) will be instructed re management of environmental structure ie. limiting visitors, allowing rest/down time us needed, maintaining routine and structure to promote security and consistency, Becky has no safety awareness or judgement which requires I: I supervision at all times, BOWEL PROGRAM Plan Client is incontinent of formed stool without assistance of medication, Client will be placed on a bowel progmm to promote regular and complete evacuation, The program will consist of care provider placing client on bedside commode or toilet in the bathroom at the same time every morning or evening, specific to clients routine. Ifbowel movement does not occur a glycerin suppository will be utilized until a routine is established, BLADDER PROGRAM Plan Client demonstrates bladder incontinence accompanied by an increase in restlessness. Client will be placed on a every two hour voiding schedule utilizing bathroom or bedside commode as appropriate, Praise for continence Dr other form of positive reinforcement. Voiding times will be recorded as to time and frequency, Fluids may be restricted Dr eliminated after 7 pm to assist with noctuma1 voiding. NUTRITION Plan Client hus recently been placed on a pureed diet by mouth utilizing G-tube for thin liquids and calories needed but not ingested orally, Plan to remove G-tube when client maintains caloric requirements orally. Primary Care Giver (family) will be instructed re signs and symptoms of aspiration, to structure meals in a quiet environment eliminating all unnecessary environmental detractors, proper positioning for meals and to remain upright for at least 30 minutes after eating, Diet will be progressed per physician order, RESPIRATORY Plan Primary Care Giver (family) will be instructed re respiratory function and basic lung sounds to become familiar with abnormal lung sounds. Tracheostomy tube was removed I week ago, trach site is closed and healing, Primary Care Giver (family) will be instructed regarding activities to increase respiratory function and encouraged to perfonn one or more of these activities in a daily routine while client is recovering and activity level is decreased. COGNITIVE Plan Based on Rancho level III -IV cognitive stimulation will be provided by care provider by repetition of activities ie, orientation to day, time, place, season, name, familiar pictures and objects, simple commands ie. open your eyes, touch the ball, point to body parts, progressing complexity as appropriate. A recording system will be used to measure consistent responses, These activities are aimed at improving cognitive skills translating those improvements to functional activities, Communication strategies will be used starting with basic method of yes/no (Becky currently nods head for yes/no response) At time of this review Becky follows simple commands with 50% accuracy. ACTIVITY Plan Client requires max assist of I for bed mobility at the time of this review and is beginning to assist with bed rolling 25% of the time. Transfers from bed to wheel chair require max assist of 1. Increase in tone significantly interferes with all physical activity. Care provider will perfonn range of motion and tone nonnalizing techniques before physical activity of stand pivot transfers and wheelchair activities, Exercises to encourage functional wheelchair mobility will be provided by care provider ie, outside activities as weather allows, community re entry, trips to park Dr favorite places of interest to client. Care provider will assist Primary Care Giver (family) to establish an emergency plan to be pmcticed on a routine basis, Physician and hospital phone numbers will be visible near all telephones, Primary Care Giver will be instructed re signs and symptoms of increased intracranial pressure. ADL (Activities of Daily Living) On the National Scale for Functional Independence: I - Complete Dependence 2 - Maximum Assistance 3 - Modemte Assistance 4 - Minimum Assistance 5 - Supervision 6 - Modified Independence 7 - Complete Independence Becky's score at time of this review Grooming I Bathing I Bowell Stairs N/A Tub Transfers N/A Toileting I Comprehension 2 Social Interaction 2 Memory I SOCIALIF AMIL Y Client was living at home with parents one brother and one sister, Client attends Cumberland Val1ey High School completing her tenth grade with a 90% grade point average. Both parents work outside of the home. Mother is a school bus driver and leaves the home at 7am and again at 2pm. The physical arrangement of the house is a split level with 2 steps for entry and 12 steps to the second floor, two bathrooms are located on the first floor. Due to significant physical and cognitive impairments it is detennined that the client wil1 be unable to safely and appropriately direct his care independently. this wil1 require the presence of licensed care givers to provide environmental structure and behavior management techniques as related to each level of progression on the Rancho Scale and to ensure safety in all aspects of this Home Care Plan, The licensed care provider wil1 assist Primary Care Giver (family)to successful1y manage the home environment and direction of all care relating to client to include but not limited to medical, social, spiritual, environmental and safety issues, These activities must be managed and directed by licensed personnel until the Primary Care Giver (family) can direct all of these activities and manage nonlicensed personnel safely. The final determining factor in step down to nonlicensed personnel is the Primary Care Giver (family) ability to safely and appropriately direct his care, The other factor which detennines step down is the Nursing Board's Guidelines of what nonlicensed personnel can do in the home, Private individuals can be employed to provide these services, in which case the Primary Care Giver's (family) ability to direct these procedures becomes even more important. Fol1ow through with the rehabilitation process initiated in the Rehabilitation Hospital with emphasis on client adaptation to home environment and Primary Care Giver (family) to eventually manage this care is of prime concern to the Rehabilitation Home Care Team, with each Phase emphasizing education, instruction and practice for the Primary Care Giver(family) resulting in competent wel1 infonned prepared Care Giver (family) managing the client's needs, Al10wing Primary Care Giver (family) to express emotional response to change in the family unit is important to maintaining stability as roles and daily routines have been altered. The care provider will initiate education to client's peer group re brain injury and the recovery process, The Primary Care Giver (family) will be given assistance and direction to develop a daily . PROJECfION OF COST AND STEP-DOWN (All step-down require a physician's order) Complete nursing assessment at no cost to the carrier, Weekly client conferences in the home for one month, progressing to biweekly, then monthly as appropriate. Report documenting changes in the client's condition and attainment of rehab goals will be sent to carrier monthly. Rehabilitation RN to accompany client to all physician appointments. Phase I 4WKS GOALS Phase n 4WKS GOALS STAFFING PATIERN I\- 20 hours care per day x 7 days x ~ weeks Rehabilitation LPN 7a-3p 525,501hr x 8 = 5204 x 7 = $1,428 wk Rehabilitation LPN 9p-7a 525.501hr x 12 = 5306 x 7 = $2,142 wk TOTAL $510 PER DAY S3,570 PER WEEK TOTAL COST PHASE I SI4,280.00 Establish structure, Implement medical skill needs, Assess family knowledge and their ability for client management. Prioritize teaching plan for family, utilizing family/client goals; Perfonn skill needs. Continuation of therapy treatment plan begun in facility with nursing implementation, Establish all safety systems, Begin community re-entry (2nd week) as appropriate. Weekly case conference with all caregivers, client/family and Rehabilitation nurse, Obtain physician's order for step down as appropriate. '\ 20 hours care per day x 5 days x f weeks Rehabilitation LPN 7a-3p 525,501hr x 8 = $204 x 5 = $1,020 wk Rehabilitation LPN 9p-7a 525,501hr x 12 = $306 x 5 = $1,530 wk TOTAL S510 PER DAY 52,550 PER WEEK TOTAL COST PHASE n S10,200,OO Continue environmental structure. Establish new goals as appropriate, Continue client/family teaching plan. Orientation and client specific teaching of home health aide at no cost to carrier, Weekly case conference, Obtain physician's order for step down phase as appropriate, CENTRAL MEDICAL EQUIPMENT CO, \' " March 28, 1995 " To: Wayne F. Shade 53 W. Pomfret st. Carlisle PA 17033 Re: Rebecca orris EQUIPMENT NEEDED _a_____a___ac=== 18" :lC 18" La Bac Tilt-n-SpaoG Wheelohair Removable Footrests Desk Armrests Seat Belt Rear Anti-tippers otto Bock Headrest $3625.00 18" x 18" J2 Gel Cusion $ 400.00 $ 235.90 $ 50.00 $ 98.29 $2400.00 Lumo:lC Deluxe Bath Benoh w/Drop Arm Extra Seat Belt 3-n-l Commode Electric Hospital Bed Mattress Side Rails ======~__._..__c======__._._____ma==a====3=~._____.K====== Total $6809.19 *As of 3-28-95, the family has put a $2000.00 depoDit on the wheelohair. Tho chair will be fitted on 3-29-95 and the family is expected to pay the balanoe of $2025.00 for the ohoir. PLAlNTlFP8 EXHIBIT 3 3 ~. -'/5" ~ 3517 WALNUT STREET. HARRI$BURC, PENNSYLVANIA 17109 717-657.2100 . 1-800.845.4204 . Fn.717.657-2176 " JAMBS B. ORRIS, and CHARLOTTB R. ORRIS, as parents and natural guardian of REBBCCA A. ORRIS, a minor, plaintiffs I IN THB COURT OP COMMON PLEAS OP I CUMBERLAND COUNTY, PENNSYLVANIA I I I I NO. 95-1430 CIVIL TERM I I I I t CIVIL ACTION - LAW v. AMY It. CLINE, Defendant IN RB I MINOR'S SBTTLEMENT ORDBR OP COURT AND NOW, this 29th day of March, 1995, upon consideration of the within petition, and upon motion of Wayne P. Shade, Bsquire, attorney for Petitioners/plaintiffs, the compromise settlement referred to in the within petition is hereby approved, and distribution is ordered and decreed as follows I 1. Attorney's fees in the amount of $12,500.00 to counsel for the Petitioners/Plaintiffs. 2. Distribution of the net balance of the $50,000.00 settlement figure for the benefit of the said Rebecca A. Orris to be deposited in one or more savings accounts in the name of the minor in banks, building and loan associations or savings and loan associations, deposits in which are insured by a federal governmental agency, provided that the amount deposited in anyone such savings institution shall not exceed the amount to which accounts are thus insured. No withdrawal shall be made from any such account until the minor attains her majority exoept as authorized by prior Order of Court. Proof of the deposit shall be promptly filed of reoord. 3. It is noted that an insuranoe fund of the employer or union of the father, the Teamsters Union, is olaiming subrogation rights with respeot to some or all of the " i I prooeeds herein, and, exoept as authorized by the Court, the fund shall not be subjected to depletion without oonsu1tation with the Teamsters Union. 4. The parents and natural guardians of the said Rebeooa A. Orris are, notwithstanding any other provision herein, authorized to ~ithdraw interest for payment of annual inoome taxes and reasonable expenses of annual preparation of inoome tax returns from the said deposit(s). By the Court, J Wesley 01 Wayne P. Shade, Esquire - C"S'Q~..c... 3/31/9Sf" Counsel for Petitioners/Plaintiffs ~. , Is1r q ,. _ J'i 3 () CU,;J T .L-VV- 001 BRANCH OESIGNATlQN 113002 NON.NEGOTIABLE I NON TRANSFERABLE I -.ll..L TIME CERTIFICATE OF DEPOSIT OEPOSITOR(S) ,.Wayne F.. Shade,. Esquire ._escrow_agent fnr .Rebecca A. Orris 'n,-~~_q~71 ""'".0110_1101 53 W..Pomfret Street Cbrlisle, PA 17013 717-243-0220 -~. FARrvtERS~ TRUST~ ONE WEST HIGH smEET, P,O. BOX 220 CARLISLE, PENNSYLVANIA '7013 717.243-3212 s137,500,oo ADDRESS ...." 313 MEMBER FDIC -FINANCIAL....,? EI"'\I"'\..l...l' Q't"\...+ HAS DEPOSITED IN THIS BANK "'1>1l~'r !:,~~p i') .:7V..u.uwS ~I.~ PAYABLE TO SAID OEPOSI70R(SI. SUBJECT TO 7HE CONOl710NS PRIN7EO ON THE REVERSE SIDE OF CERTIFICATE, Issue TERM OF MATURITY PERClHTAGE RAll INTEREST PAYASlE 0 MAIL CHECK DATE RTIFICATE DATE 'fR AHHtJU MONTHLY D SEMI.ANNUALLY r: COMPOUNDING o ANNUAllY 'Ii 5-11-95 7 da s 5-18-95 3.50\ DouAllTERLV K1.7....7URlTV 0 CREDIT ACCT. NO, O UNDEA PENALTIES Of PEA.lURYI CEATlFYTH"T THE A.OV!NUIoIBeR IS ..."CORRECT 'AXPAYER IDENTIFICATION NUMBER. 0 I&HGLUIATUMYcamncATI(lTDUONUCKI O UNDER PENAL mSD"VUUAY ICtATIN THAT I AN NOT SUUCTTO IACKUP WlTHt1Ol.DlNG. W'HfA IECAUSI!! I HA\It.- r:'1 HOlBEEN NOTIFIED THATIAM SUBJECTTOBACKUPWtTHHOl..DlNQASARESUI,TOF AFAllUAE TOREPORT ALLINTEAEt(f ') gu AUTOMATlCAU.YMNCWAILI ratfTUUON....CKJ OR Ofl/lOEHO$. OR THE INTtRNAL REVENUE SEfMCE HAS NOTIfiED UE THAT I AU NO LONGER SUBJECT TO BACK~ 0 ADJUlT.....7rm& 1 UCKJ WlTl1l<OlOING. ~1~t?f~~~~.S separate W-9 being signed ~:tJ~fr~~~O Z '? '--./ ~>~......,..,........-z;"f'- ,.- '~', "j' !;".' W"J' =>> ,. .. . . ~ _. c._ r- u N "-J , e-- - >- " ... '" c; = -' . ..-l .". ~ 41 III -11-I tIll1-1 H',..j gai:\ O.,..j ." , ..-l f>!p.. ~ ~~ ~~ tIlf>! jStIl ...:If>! ~~ P<lS 01>:: ~~tIl OU,::l ~><~ H~U fj~~ ~ - ~ .<J.' 11"I ... ~1 r .. ~~i~ - r( [; i.l:!' x: ()::~ -:::::. '" ~ ~~.}~j \ti ... 0 a, :::.~~ 1 lJ': ." (I> u, I _:J~ >- rCm UJ l(l'. F "'" '"'C1- ::t: :.~ 11_ r- ::1 0 0" <.:> ij F' c..;:s O~ ~~ p..tIl z~ ::E Of>! i>: ~p.. ~ 8~'j~ c..z :> O::J I H o U !jU Z ... 00 ::J,::l H <'l o~ E-<-:t U t.,)..-l <, f>! Ln :I:f>! ...:I 0'1 E-<IQ H ::E:> . Z::>HO ~ ~ = -." ~-g H41 ...:111-I , t.,) 41 > ,::l . ~ '" ~ ~ ~ i rIJ !C~~ i i I ~ ~ !! i u , . , . . MAY 0 9 199tJ...... , ~ . 9. Respondent has paid hundreds of thousands of dollars of those medical expenses in a total amount of several times the net proceeds of the third party compromise settlement. 10. In addition to the third party recovery, there were $3,300,000 in stacked first party under insured motorist coverages applicable to the injuries to Rebecca A. orris. 11. Those coverages were in the form of $300rOOO per person stacked on each of eight vehicles owned by Petitioners and $300,000 stacked upon each of three vehicles owned by the brother of Rebecca A. Orris, James E. orris, Jr., who was a member of her household on the date of her injuries. Copies of the policy declarations for Petitioners and James E. orris, Jr., are attached hereto as EXhibits "AO and "BO and incorporated herein by reference as though fully set forth. 12. The liability of the driver of the vehicle in which Rebecca A. orris was a passenger and the absence of comparative negligence on the part of Rebecca A. orris as a passenger is so obvious that Erie Insurance company has been advancing thousands of dollars per month for one-to-one therapy for Rebecca A. orris from January of 1996 to the present, 13. WAYNI! F, SHADI! A_....... 51 Wed Pomf'rd Street Culitlt, Pmuylvanla 17013 Erie Insurance company has been advancing those funds against the first party under insured motorist coverages even -5- though it did not even have an established procedure for such advancements when our request was initially made therefor. 14. On June 12, 1996, James E. Orris, the father of Rebecca A. orris, was seriously injured when he was struck by an automobile while he was operating his motorcycle. 15. Mr. orris was off work for nine months as a result of his injuries. 16. Because his injuries were sustained while he was operating a motorcycle, he did not have first party wage loss coverages. 17, Since the release of Rebecca A. Orris from inpatient rehabilitation in the spring of 1995, Petitioners have cared for their daughter in their home at great emotional and financial sacrifice in lieu of having her placed in an institution. 18. Because their home and vehicle are not equipped for wheelchair access, it has been very difficult for them to care for their daughter who has very limited ambulation and weighs approximately 170 pounds. 19. WAYN!! F. SHAD!! A_....... 13WCII........._ Culislt, I'mDI7lvoaio 17013 On March 17, 1995, an Order was issued by your Honorable Court in the person of the Honorable J. Wesley Oler, Jr., J., approving the compromise settlement proceeds, a copy of which is -6- WAYNB F, SHADE A_ II Law l)W............._ Culltle, ......,"'... 1701) attached hereto as Exhibit .c. and incorporated herein by reference as though fully set forth. 20. Petitioners request that the balance of the third party compromise settlement proceeds in the amount of $40,075.86, including accrued interest thereon, be distributed to them to enable them to acquire a van in which they can transport their daughter and to make modifications to their home to accommodate her disabilities. 21. petitioners believe and therefore aver that the subrogation claims of Respondent are amply secured by the first party under insured motorist coverages in this case. 22. Rebecca A. Orris joins herein to indicate her approval of this Petition. WHEREFORE, Petitioners respectfully pray that your Honorable Court issue a Rule upon Respondent to show cause why its subrogation interests are not sufficiently protected by Petitioners' first party under insured motorist coverages to enable the Court to permit Petitioners to utilize the net proceeds of the third party compromise settlement in the above- -7- The statements in the foregoing Petition are based upon information which has been assembled by our attorney in this litigation. The language of the statements is not our own. We have read the statements; and to the extent that they are based upon information which we have given to our counsel, they are true and correct to the best of our knowledge. information and belief. We understand that false statements herein are made subject to the penalties of 18 Pa.C.S. 54904 relating to unsworn falsification to authorities. Date: May 5, 1997 {!~ Orr s ~tltk/2, Charlotte R. Orr s -R~t~ ~. O~ Rebecca A. Orr s WAYNE F. SHADE A_ at Law 51 Weal Pomf"'_ CarU.Ie. Pmauylvaaia 17011 ...,.: 3".~ -<.',...'I'-'.~.':\:....rJ ,. :.; i..~';';.y.... ,',: },V-' ..,~.."'! .....:..:,.~....I,'O:,,!'\'k,~..., oIJ.. :;; ).":~fl.. 01.-. \..:,......\ . i' ....".,,":' '\~,.. ~.~\- t'\'.'\~l:'~t'];;,'t"~~' O:"'i1'~~.'''-''t'':j\';~, '.l":...J......".:...,...:',..'\:~. ,~"!,~...... ,~ ',:: ; -J 11.~~' ;..<'; ;i; .~';. ~:: i:,'. ,- ,,'v' ':'..: h~ !.: ~. '~', ;i.'. )" -';;!I~~l ~.~}:~~.;:...~~~ ; ,..~;..':,J,.<I, \:~,.::11..: i~,:\~'':~...:II:.4~:i~t:::-.~~ ;\~;.~~I.l ~~~r~:~fTh~~. .,,(TK~i' \~)~~)o':\~I\~.\.i\.. \I;~~\t~~r~~~~I~~~i i;{~ .....~ I .\. '; " "-," '. ~":. '... " . .': .., " '~ '~:' ~." ,_~.: ,,,:.::' ;: .:S'~. ::'.-...>..:: ,'f:.';.';',)" ~,:y':,:~ '. ::.' " .L,;,'. ; ~..~.~':,~:~.,:.:~!_:~:.~.~;'J:':':G.;'~;:~. ~.~:: .~~~ ..~..,::::, - ~"..:.;,'~_..'...I:"':".::: 160f'....) UG-lO.tl ,~tV (,';] AUTO DECLARATIONS II ERIE i ~ INSURANCE ERIE INSURANCE EXCHANGE ! .11 GROUP PIONEER ~'AMILY AUTO POLICY I ~. l00E"cln.PI AMENDED DECLARATIONS 01 * * EFFECTIVE 07/24/94 ,.~ Eric,PA 16530 ATTACH THIS TO YOUR POLICY. ERIE. AGENT AA764 F T ITEM 1. NAMED INSURED AND ADDRESS 1".111...111......11..11.1.1..11.....1.1.1..1..1.111...,..111 JAMES E ORRIS & CHARLOTTE R ORRIS 7320 WERTZVILLE RD CARLISLE PA 17013-9024 AGENT - FETROW INS ASSOCIATES AGENT PHONE - (717) 766-3200 N FIRST DECI.ARATlIDlS PAGE ITEM 2. POLICY PERIOD POLICY NUMBER H ITEM 3. OTHER INTEREST 5299 E. TRINDLE RD. MECHANICSBURG PA 17055 ************************************************************** * YOU HAVE BEEN INSURED WITH THE ERIE FOR AT LEAST 15 YEARS. * * THIS POLICY WILL NOT BE SURCHARGED FOR FUTURE ACCIDENTS * ************************************************************** . ITEM 4. AUTOS COVERED AUTO YR MAKE VIN ST TER SYM ~ 88 FORD CLWGN E150 1FMEE11NXJHA33349 PA 27 8 I 82 CHEVE PU 2GCEK14C8C1140767 PA 27 8 89 FORD F350 PU 2FTJW36M6KCB39740 PA 27 N 91 YAMAH SNWHBL 88H001223 PA 27 14 ~ 92 YAMAHA SNOW MOBIL 89H001307 PA 27 13 ~ 94 YAMAHA VX600 8CC000680 PA 27 K1 ITEM 5. ~M~~i~ I~o~~A~~~ ~~v~SA~nE~~m1ALO~RiU~fJMsIKR~H2~Fb~~o~~!: #1 #2 #3 #4 #6 *****GOOD DRIVER RATES APPLY***** --- THE FULL TORT OPTION APPLIES TO ALL PRIVATE PASSENGER VEHICLES. --- LIABILITY PROTECTION- BODILY INJURY S300M6P~RSON $300M/ACC 98 139 98 25 25 PROPERTY DAMAG~ S10 M/ACC 42 60 42 7 7 FIRST PARTY BENEFITS- MEDICAL EXPENSE $100M 46 65 46 INCOME LOSS SlM/MONTH, $15M MAXIMUM 10 14 10 ACCIDENTAL D~ATH S5M 1 2 1 FUNERAL BENEFIT S2.5M 2 2 2 UNINSURED MOTORISTS COVERAGE- BOD INJ S300M7PERSON ~300~ACC-STACKED 15 15 15 UNDERINSUR~D MOTORISTS OVE GE- BOD INJ S300MlpERSON 300M ACC-STACKED 43 43 43 PHYSICAL DAMAGE COVE RAG S- COMPREHENSIVE - $50 DED 19 22 42 COLLISION -JlOO DED COLLISION - 500 OED 54 86 OPTIONAL COVE GES- ROAD SERVICE 4 TOTAL ANNUAL PREMIUM FOR EACH AUTO 334 362 385 112 121 199 PREMIUM REDUCTION DUE TO THIS CHANGE $ 257CR SEE REVISED INVOICE BELOW ITEM 4. AUTOS COVERED AUIO YR MAKE VIN ST TER SYM RATING CLASS 80 YAMAHA MIDNIGHTSP 4H3000145 PA 27 D6 AlAS 86 PONT FIREBIRD 1G2FS87S2GL203950 PA 27 N E2Y-MULTI ITEM 5. INSURANCE IS PROVIDED WHERE A PREMIUM, OR INCL, IS SHOWN FOR THE COVERAGE. COVERAGES, LIMITS AND ANNUAL PREMIUMS ARE AS FOLLOWS- p' (' Jj;-- '~C:(I RATING CLASS AlAS-MULTI A3-MULTI AlAS-MULTI DDP #7 25 7 15 43 22 15 43 31 15 43 44 65 DDP EXHIBIT "A" . ~~-_.------------:::'-'Td::.'.T~--;;..-.:.-::.j,-- ,~~'I ~'~..-:-, - ------ ------.-......... . --- THE FULL TORT OPTION APPLIES TO LIABILITY PROTECTION- BODILY INJURY S300H6P~RSON $300H/ACC PROPERTY DAMAGE 510 M/ACC FIRST PARTY BENEFITS- MED I CAL EXPENSE .,$lOOW . INCOME LOSS SIM/MONTH, $15M MAXIMUM ACCIDENTAL DEATh SSM FUNERAL BENEFIT S2.5M UNINSURED MOTORISTS COVERAGE- BOD INJ HiOOM7PERSON S300~ACC-STACKED UNDERINSUR D MOTORISTS COVE GE- BOD INJ 300NlpERSON S300M ACC-:8'l'ACKED. PHYSICAL D GE COVERAGES- COMPREHENSIVE - $50 DED COLLISION - $500 DED Q07 2402236 #8 #9 *****GOOD DRIVER RATES APPLY***** ALL PRIVATE PASSENGER VEHICLES. 118 313 54 138 150 32 5 2 15 43 118 244 15 43 13 CONTINUED ON NEXT PAGE . ABBREVIATIONS USED IN ITEM 5 (All policies except Garage) ACC - ACCIDENT INJ - INJURY PRSN - PERSON BOD - BODILY M - THOUSAND TRANSP - TRANSPORTATION CAC - COMBINED ADDITIONAL COVERAGE MAX - MAXIMUM RCV - RECREATIONAL CAMPING VE!-;!C~= COLL - COLLISION MED EXP - MEDICAL EXPENSE WC - WORKERS COMPENSATION COMP - COMPREHENSIVE OCC - OCCURRENCE WK(S\ - WEEK(S\ COV - COVERAGE PERS - PERSONAL OED - DEDUCTIBLE PROP PROPERTY Unless otherwise stated on the front side of this Declarations, the fallowing apply: POlicy period begins and ends at 12:01 A.M., standard time at the stated address of the Named Insured, Until terminated. :r::. policy will continue in lorce for successive pOlicy periods, The auto we insure will be principally garaged in the area indicated by the address shown in Item 1. If the auto we Insure is a commercial vehicle, it is used in the business shown on this Declarations and is not used reOUla' (regularly means twice a month or more) to haul goods more than 50 miles, - Item 9, Except with respect to a Lienholder's interest, the named Insured is the sole owner 01 the auto we Insure. LOSS PAYABLE CLAUSE IN VIRGINIA, LOSS PAYABLE ENDORSEr.1ENT :W.'.: This clause applies to the Physical Damage coverages provided by this policy lor Ihe Lienholder named in Item 3 of tile policy Deciaralice, It protects the Lienholder's financial interest in the vehicle insured, Payment for any loss under these coverages will be made in accordance with the financial interest the Named Insured and the Lienholde' .:, its interest may appear for specific vehicle[s)) have in the loss. Payment may be made to the Named Insured and the Lienholder 10lntly cr~: either or both separately, II separate payments are made. the financial interests of both will be protected by us. When we pay the lienholder for a loss for which the Named Insured is not insured, we are entitled to the Lienholder's light of recovery ag3,c~~ the Named Insured. to the extent of our payment. Our recovery will not Impair the right of Ihe Lienholder to recover the full amount of its cia,.,.. The Lienholder Will. on demand. pay any premium due under this policy for coverages which protect the Lienholder's interests, ,f the Na".~: Insured fails to do so. WE PROMISE THE LIENHOLDER THAT: ,. The Lienholder's Iinancial interest will be protected regardless of the acts or neglect of the Named Insured. subsequent legal encumbrance or any change in ownership 01 the property. However, this clause does not apply in any case of fraudulent acts or omissions by the Name~ Insured or anyone reoresenting him, 2. lithe Named Insured fails to submil proof of loss within the time granted by the policy, the Lienholder may protect its interest by filing SWc" proal within 60 days atter that time. 3. II we cancel or reluse to renew this policy. not less Ihan 10 days advance notice of such termmation Will be given to the LI~n~c:cer. 4. (For nil stales exceot Virglma) IIlh.s policy is cancelled by the Named Insured, we wili send notice of cancellation to the Lienholder. I '"rglma only, ":h,s colicy IS cancelled by the Named Insured, the PhYSical Damage coverages prOVided by thiS oollcy Will be e'ter.ce~ ::. , 0 d.1VS lor th~ L~~~'4"lcm .:\fter the ~tfp.c~lve oato of c.1ncellallon. l,Va will send notice of cancellation to !,e Lient1cld~r 'Jefore C. -:ur,nc :", ': ~:1 .::a;.. [;erlcr~ - , ',. ..'.... ~ . ~ -:' ':' ': ::~ ~ ,~., .,. '. ~ ". ..., "I(~ r....' J n:~ .... (~ ;: '"',:: ~;1' ~ :"Ir.':: ..~: "t~ ,",,: ~, :~,:-:". c, ... . . 4, ~ ir: VI ~ t ..:f " ~:or; - l"i - c.;) . .~ :x: :..;z ...: 9~ f.' N [)~ c..: ~ -lr.J fJ .ijf.j ~ en l!Ji:L. & ,... f3 C" fz< o ~~ llo<CIl Z~ :E OlL! i>:: ~llo< ~ 8~j::l fz<Z ::- O::J. H o U E-<UZ ~!sg o E-<..;t U U r-I <. !illL!....:l~ E-<e;!H zS~O HUUZ '" Iii 0 IlII i!! .... ~ ~.U2 i : ~ J j ! I! j . , r-I as ~ Gl z o ~ llo< H E-< CIl 01 'lH CIllH ~U o.s as '.... lL!llo< ~ ~ .~ ~] , d~ > t:l , ~ ~ . . . . ~ . , . #SEP 22 t997 ~ . .. JAMES E, ORRIS and CHARLOTI'E R. ORRIS, as parents and natural guardians of REBECCA A, ORRIS, a Minor, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW Plaintiffs NO. 95-1430 CIVIL TERM v, AMY K. CLINE, Defendant ORDER OF COURT AND NOW, this ~day Of~, 1997, upon consideration of the within Stipulation, it is ordered and decreed that the third-party compromise settlement proceeds in the above-captioned matter be distributed to James E. Orris and Charlotte R, Orris to offset the extraordinary expenses of caring for their daughter, Rebecca A, Orris, The distribution ordered herein would be subject to all of the conditions set forth in the within Stipulation including, without limitation, the following: I. Expenditure of the funds is to be restricted to the needs of caring for Rebecca A. Orris including the purchase of a van for her transportation and adaptive modifications to the Orris family residence; 2, James E. Orris and Charlotte R, Orris will personally guarantee repayment of the full amount of the distribution of the third-party settlement proceeds and all accrued interest thereon from the first dollars received or recovered after the date of this Order 429701 , that are subject to the subrogation rights of the Central Pennsylvania Teamsters Health and Welfare Fund; 3. The subrogation reimbursement to the Central Pennsylvania Teamsters Health and Welfare Fund, to the extent of the third-party settlement proceeds and all accrued interest thereon, shall not be reduced by claims for counsel fees; and 4. Wayne F. Shade, Esquire, as counsel for the Orris family, will use his best efforts to ensure that the subrogation rights of the Central Pennsylvania Teamsters Health and Welfare Fund are respected and that the Central Pennsylvania Teamsters Health and Welfare Fund will receive all amounts to which it is entitled pursuant to its subrogation rights, By the Court, Wayne F, Shade, Esquire Attorney for Plaintiffs Frank C. Sabatino, Esquire Schnader Harrison Segal & Lewis LLP Attorneys for Central Pennsylvania Teamsters Health and Welfare Fund -2- 429701 FllEO-QFACE OF Ih':. pr:'')i\ :O':OWW 91SEP22 Pll:\:~l ~~d\oQ~~ CUMGtrlJ:.:'lu COUim \I\O\~~d -\onll. ~i(\" PE~li~SY\.W,,'!'/\ ~ "" , , 4. James, Charlotte and the Fund have, by Court Order, established an Escrow Account that is presently in an interest bearing account at Financial Trust Company with a balance as of June 19, 1997, in the amount of $40,291.57, This Escrow Account represents the net of a Court-approved settlement of the third-party claims in the above matter arising from the November IS, 1994, accident plus interest accrued thereon, The Fund's interest in the Escrow Account is designed to protect the Fund's subrogation rights, 5, James and Charlotte have indicated that they wish to have the proceeds of the Escrow Account spent to provide care for Rebecca, They have initiated litigation to compel this result, 6. The Fund wishes to safeguard its subrogation rights, 7. James, Charlotte and the Fund wish to resolve this matter in an amicable manner that provides for Rebecca's needs, protects the Fund's subrogation rights and avoids the expenses and uncertainty inherent in litigation, S, Wayne F, Shade, Esquire, is counsel to James, Charlotte and Rebecca in connection with the matters arising from Rebecca's injury on November IS, 1994. NOW, THEREFORE, in consideration for the promises exchanged herein, and intending to be legally bound, it is hereby agreed that: -2- 429701 I, The Escrow Account will be released to James and Charlotte to be spent for the exclusive purpose of providing for the needs of caring for Rebecca A, Orris including the purchase of a van for her transportation and adaptive modifications to the Orris family residence. 2, James and Charlotte personally guarantee repayment of the full amount of the distribution of the third-party settlement proceeds and all accrued interest thereon from the first dollars received or recovered after the date of this Order that are subject to the subrogation rigl-ts of the Central Pennsylvania Teamsters Health and Welfare Fund, 3, Shade represents that, to date, the Orrises have not recovered any sums, other than the aforesaid third-party recovery, in which the Fund has a subrogation interest. Shade also agrees that, as counsel to the Orrises, he will use his best efforts to ensure that the Fund's subrogation rights in these matters are respected and that the Fund receives all amounts to which it is entitled pursuant to its subrogation rights, -3- 429701 ">- .... . -- ;- [-- -. .::l .? i-'~: ,~,j ~-) UJ~ - I ., . , -- .. .:, Li: , ""'- ~7-~ c,':5i, co_ " , '.0 .' ti) C: , , U' ,.. r .., _..1 1-' i.] c; .. ~ ,,) ;:J.. ,-' c::J lI, r- =-; 0 C7' D