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HomeMy WebLinkAbout02-4003SAMANTHA BARBUSH, by and through his natural parent and legal guardian, MICHELLE BARBUSH, Petitioners TODD BARBUSH, Respondent :IN THE COURT OF COMMON PLEAS :CUMBERLAND COUNTY, PENNSYLVANIA :NO. ." : CIVIL ACTION - LAW .. PETITION FOR LEAVE TO COMPROMISE MINOR'S ACTION Pursuant to Pennsylvania Rule of Civil Procedure No. 2039, Michelle Barbush, the natural parent and guardian of minor, Samantha Barbush, by and through their attorney, David H Rosenberg, Esquire, HANDLER, HENNING & ROSENBERG, LLP, petition this Honorable Court to enter an Order permitting settlement and compromise of this action and, in support, aver: 1. Samantha Barbush was born on July 20, 1990, and is, therefore, 12 years old and a minor, and was, at the time of this collision, residing at 502 Barry Court, Mechanicsburg, Cumberland County, Pennsylvania, 17050. 2. Petitioner, Michelle Barbush, an adult individual, is said minor's natural parent and legal guardian, and resides with her daughter at 502 Barry Court, Cumberland County, Mechanicsburg, Pennsylvania, 17050. 3. Respondent, Todd Barbush, is an adult individual and Samantha's father residing at 502 Barry Court, Cumberland County, Mechanicsburg, Pennsylvania, 17050. 4. On or about December 5, 2001, minor, Samantha Barbush was a passenger in a vehicle owned and operated by Respondent. The vehicle was traveling South on Brian Road in East Hampden Township, Cumberland County, Pennsylvania, when it collided with a vehicle traveling West on Trindle Road. 5. As a direct and proximate result of the collision, minor, Samantha Barbush, suffered minor injuries, including but not limited to a right shoulder contusion/sprain. She was taken from the scene via private vehicle to the Emergency Room of Holy Spirit Hospital and released. Attached hereto and marked Exhibit "A" is the Emergency Room record. 6. The minor followed up with her family doctor and has been released from medical treatment for the injuries sustained in the motor vehicle collision and returned to full activities on January 21, 2002. Attached hereto and marked Exhibit "B" is the doctor's record. 7. To date, Petitioner's first-party insurance carrier, State Farm Insurance Company, has paid for all of the minor's medical bills. 8. Respondent's vehicle was insured under a policy of motor vehicle insurance issued by State Farm Insurance Company. Said policy was in effect at the time of the collision. 9. State Farm Insurance Company has offered to settle minor's claim for Two Thousand Dollars ($2,000.00). 10. Petitioner believes said settlement is in the best interest of the minor and proposes to accept said settlement offer of $2,000.00 from State Farm Insurance Company, thereby releasing Respondent from any and all claims, suits, and/or actions in the future. (See, attached as Exhibit "C", the proposed settlement release.) 11. David H Rosenberg, Esquire, of HANDL.ER, HENNING & ROSENBERG, L. LP, has been the attorney for the minor in this action and he requests reasonable counsel fees of $500.00 for services rendered plus costs and expenses in the amount of $172.26 pursuant to a Contingent Fee Agreement signed by Petitioner. The 25% represents a reduction from the 33-1/3% fee agreement signed by the Petitioner for Samantha Barbush. Thus, the total amount requested for attorney's fees and costs is $672.26. (See, attached as Exhibit "D", a true copy of the billing summary is attached). 12. Petitioner further requests this Honorable Court to order a payment of the balance of $1,327.74 to be placed in an account investing only in securities guaranteed by the United States government or a Federal governmental agency managed by responsible financial institutions, bearing the name of the minor, Samantha Barbush, that is marked "Not to be withdrawn until minor reaches the age of 18 or without the Order of a Court of Competent jurisdiction." 13. Petitioner, Michelle Barbush, believes that this Compromise is in the best interest of her minor daughter, Samantha Barbush. WHEREFORE, Petitioner requests this Honorable Court to: a. Approve the Compromise above-stated; b. Authorize the payment of fees from the above stated funds due the minor; and c. Direct payment of the net funds due, in accordance with the Compromise above-stated. DATE: Respectfully submitted, HANDLER, HENNING & ROSENBERG, LLP BY: H Rosenberg, Esquire · 20569 inglestown Road ~ Harrisburg, PA 17110 (717) 238-2000 Attorney for Petitioners CHIEF COMP[ AINT: Motor vehicle accident with cheat pein ADM. DATE: 12/05/2001 I HISTORY: ~ The patient was r~s~,=~ned passenger ~n the front passenger's seat when the car was T-boned from the driver's s;de The car was dnvable The pebent was seat belted and pulled against the seat belt Them were aw bags present but they d~d not deploy The patient presents w~th taft painful shoulder from the seat belt MEDICATIONS: Allegra and Albuterol pm AL ~LERGIES: AMOXICILLIN - PATIENT GETS RASH. PAST MEDICAL HISTORY: Asthma REVIEW OF SYSTEMS: Conatltutione! Den~es fever, chilis or any other I[Iness or any ot~er InJUry Eyes' Derses visual changes Neck: Dan~e$ neck pe~n Neurological Dances ~ny t~ngling or numlmess ~n the u~per extremities Mueculo~al~al Admits to tondemase ruth range of mobon of the right '~houlder Allar~t,'.,/Immunologl~ As noted Other ~abent deniea h~ng ~' head or any other ~rt of hat body on the $~de$ of the vehicle I PHYSICAL E~AM CONSTITUTIONAL: Th~s ~s a well-developed, 11-year-old, white female who appears ~n no acute d~stn~se VIT~M. SIGNS:i AS per nursing flow sheet NECK: Supple, symmetrical, non-tender, no lymphadenopathy Trachea m~dhne Thyroid non-palpable I EXTREMITIES: Exam;nat;on of the upper extremities - the shoulders are symmetrical to antenor visualization There ~s no obv~oua edema or ecchymos;s over the shoulder There is tendemess to palpation1 above the clawde on the nght There is no tenderness to palpation HOLY SPIRIT HOSPITAL ~Camp Hdl, PA ~ 17011 EMERGENCY ROOM REPORT ] Page I of 2 MR#NAME 246133Barbush' Samantha N ROOIV~ ER3 JAN 0 ? 20 ORIGINAL C71~) 763-2316 ( ) gd~-Hum~ ()~n ()~W~m perox~la Do ) Keep w~Jnd ( ) Wear ce~c~ ( ) Rest ADDr~ONA/ ( ) LJgi'~ Duty ph~ ~ra~; w~ B~oma~m/~nn ( )ToOtt~c~e ( ) U~i nad Ca~d~ ()Other (.A,O'ea~i~E~..~l~ulxolen) or Tyfonal aB needed for pain, fear a~:xxxdmg to package mdmc'fl~'m for age, wetght ~ foiling m~lan~ ac~r~ng ~ ~. ~e ~OWl~ ~l~ ~y CaUH d~m~a NOT DRIVE OR OPE~ ~CHINERY WHI~ TA~N~ , ( J T~e folk3w~g medma3ae may DO NOT DRIVE C HOLY SPIRIT ~I.OSPITAL EMERGENCY CENTER ;RAY COPY r-T(3LUC your '[']~$ NAME: Barbush, Samantha I~1 MRS; 248133 ove~' the ciavtc~ dar ama There is no crep~tus or step-off felt Patent has full tango of m°bo~ of the [nght shoulder however, w~h tenderness She has good ~,-ength in the upper extremlbes w~t~ good capdlary refill dtstal to the injury Radial pulses am good and equa . HOSPITAL COURSE: While in the U~g~-Care Center, ice was applied to the nght shoulder A slipg was given for support X-ray was done which was mad as negative for fracture by the ~'adiologist CLI~NICAL IMP~J~SSION: I~ght shoulder spram/contus~n DISPOSITION: As per dmcharge ~structton sheet w~t~ parameters for follow-up and retu,m J~N/am DOC # 197~97 D* 12/06/2001 T' 12/07/2001 [9 20 A 144119 HOLY EMERGE: ,{ }PIRIT HOSPITAL .~amP Hdl, PA 17011 Pege~ of 2 Smgr~d JANE WENGER, CRNP 12/14/2001 12:45 NAME Barbush, Samantha N MR# 246133 JANE WENGER, CRNP {CY ROOM REPORT ORIGINAL UAN 0 7 - / Address DISPOSITION: ICail Back Chart # Medication Allerg3 IHandled b?: RELEASE Barcode Only For the Sole Consideration of Exactly Two Thousand and No 1100 **********************************************--********************* Dollars the receipt and sufficiency whereof is hereby acknowledged, the undersigned hereby releases and forever discharges Todd BArbush h is heirs, executors, administrators, agents and assigns, and all other persons, firms or corporations liable or, who might be claimed to be liable, none of whom admit any liability to the undersigned but all expressly deny any liability, from any and all claims, demands, damages, actions, causes of action or suits of any kind or nature whatsoever, and particularly on account of all injuries, known and unknown, both to person and property, which have resulted or may in the future develop from an accident which occurred on or about the 5th day of December , (year) 2001 at or near Trindle and Brian Rds., Hampden Twp, Cumberland County, PA This release expressly reserves all rights of the parties released to pursue their legal remedies, if any, against the undersigned, their heirs, executors, agents and assigns. Undersigned hereby declares that the terms of this settlement have been completely read and are fully understood and voluntarily accepted for the purpose of making a full and final compromise adjustment and settlement of any and all claims, disputed or otherwise, on account of the injuries and damages above mentioned, and for the express purpose of precluding forever any further or additional claims arising out of the aforesaid accident. Undersigned hereby accepts draft or drafts as final payment of the consideration set fodh above. Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or a statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties. In Witness Whereof, have hereunto set In presence of: hand(s) and seal(s) this Signed X Witness Signed X Address 104077.2 Rev. 02-07-2002 day of , (year) ndl -r' nmng senberg ATTORNEYS AT LAV./ August 16, 2002 Billing through 08/31/2002 1300 Linglestown Road P.O. Box 60337 Harrisburg, PA 17106-0337 717-238-2000 717-233-3029 Fax Invoice# 2609 DHR Samantha Barbush 502 Barry Court Mechanicsburg, PA 17050 Our file# 206627 DISBURSEMENTS [CASE 12/20/2001 23.97 12/20/2001 VendorCOCOA FAMILY PRACTlCE;GeneralCaseExpense 02/05/2002 27.71 02/05/2002 VendorCOCOA FAMILY PRACTICE;GeneralCaseExpense ICASE 03/11/2002 30.12 I 03/11/2002 VendorELECTRONICHEALTH;GeneralCaseExpense ICASE 08/12/2002 50.50 [ 08/12/2002 VendorPROTH OF CUMBERLAND CO;GeneralCaseExpense 08/31/2002 5.40 I IcomY 08/31/2002 DocumentReproduction IFAX 08/31/2002 10.00 I 08/31/2002 Fax Charges Iisi 08/31/2002 19.80 I 08/31/2002 DocumentReproduction [POS 08/31/2002 3.12 I 08/31/2002 Postage Costs IPOST 08/31/2002 3.24 I 08/31/2002 Postage Costs TOTAL DISBURSEMENTS FOR THIS MATTER 23.97 27.71 30.12 50.50 5.40 lO.O0 19.80 3.12 3.24 $173.86 BILLING SUMMARY Total Disbursements Total of new charges for this invoice $173.86 $173.86 Total balance now due $173.86 206627 Barbush, Samantha (DHR) Invoice# 2609 Page 2 IN'I'EREgT OOMMENCEg AT ,~ RAT[ OF 1.5% PER MONTH ON ANY UNPAID BALANCE THIRTY {$0) DAYg FROM THE DATE OF INVOICE VERIFICATION The undersigned hereby verifies that the statements in the foregoing document are based upon information which has been furnished to counsel by me and information which has been gathered by counsel in the preparation of this lawsuit. The language of the document is of counsel and not my own. I have read the document and to the extent that it is based upon information which I have given to counsel, it is true and correct to the best of my knowledge, information and belief. To the extent that the contents of the document are that of counsel, I have relied upon my counsel in making this Verification. The undersigned also understands that the statements made therein are made subject to the penalties of 18 Pa. C.S. Section 4904, relating to unsworn falsification to authorities. Michelle Barbush VERIFICATION The undersigned hereby verifies that the statements in the foregoing document are based upon information which has been furnished to counsel by me and information which has been gathered by counsel in the preparation of this lawsuit. The language of the document is of counsel and not my own. I have read the document and to the extent that it is based upon information which I have given to counsel, it is true and correct to the best of my knowledge, information and belief. To the extent that the contents of the document are that of counsel, I have relied upon my counsel in making this Verification. The undersigned also understands that the statements made therein are made subject to the penalties of 18 Pa. C.S. Section 4904, relating to unsworn falsification to authorities. Michelle Barbush VERIFICATION The undersigned hereby verifies that the statements in the foregoing document are based upon information which has been furnished to counsel by me and information which has been gathered by counsel in the preparation of this lawsuit. The language of the document is of counsel and not my own. I have read the document and to the extent that it is based upon information which I have given to counsel, it is true and correct to the best of my knowledge, information and belief. To the extent that the contents of the document are that of counsel, I have relied upon my counsel in making this Verification. The undersigned also understands that the statements made therein are made subject to the penalties of 18 Pa. C.S. Section 4904, relating to unsworn falsification to authorities. Michelle Barbush SAMANTHA BARBUSH, by and through her natural parent and legal guardian, MICHELLE BARBUSH, Petitioners TODD BARBUSH, Respondent : : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA :NO. (~.~ -- /3/~)O,~ : : MINOR'S COMPROMISE : : CIVIL ACTION - LAW AND NOW, this 2002, upon consideration of the foregoing Petition, IT IS HEREBY ORDERED that the disbursement of funds, including counsel fees and expenses, is approved as set forth in said Petition and the funds shall be disbursed in accordance with the terms and conditions of the settlement agreement as follows: A. Direct payment of six hundred seventy two dollars and twenty six cents ($672.26) to David H. Rosenberg, Esquire, representing reasonable attorneys' fees of five hundred dollars ($500.00) and one hundred seventy two dollars and twenty six cents ($172.26) for reimbursement of costs; B. Direct the remaining one thousand three hundred twenty seven dollars and seventy four cents ($1,327.74) to be placed in an account investing in securities guaranteed by the United States government or a federal governmental agency managed by responsible financial institutions, bearing the name of the minor, Samantha Barbush, that is marked "Not to be withdrawn until the minor reaches the age of 18 or without the Order of a Court of competent jurisdiction."; and C. Proof of deposit is to be filed with the Court. SAMANTHA BARBUSH, by and through his natural parent and legal guardian, MICHELLE BARBUSH, Petitioners TODD BARBUSH, Respondent :IN THE COURT OF COMMON PLEAS :CUMBERLAND COUNTY, PENNSYLVANIA : : :NO. 02-4003 : : CIVIL ACTION - LAW : : PROOF OF DEPOSIT AND NOW, comes the Petitioner, MICHELLE BARBUSH, natural parent and guardian of, SAMANTHA BARBUSH, a minor, and by and through her attorneys, HANDLER, HENNING & ROSENBERG, LLP, and avers that a restricted account was opened for the said minor, in Federally-insured Certificate of Deposit, in accordance with the April 23, 2002, Order of Court, signed by The Honorable George E. Hoffer, Judge. Attached hereto, made a part hereof, and marked, "Exhibit A," is documentation evidencing the opening of the said restricted account for the said minor. DATE: HANDLER, HENNING & ROSENBERG, LLP BY: Harrisburg, PA 17110 Tel. No.: 717-238-2000 Supreme Court ID No.20569 Attorneys for Petitioner SAMANTHA BARBUSH, by and through her natural parent and legal guardian, MICHELLE BARBUSH, Petitioners TODD BARBUSH, Respondent IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA M,.OR'S COMPROM,SE CIVIL ACTION - LAW ORDER AND NOW, this ~3~ day of~, 2002, upon consideration of the foregoing Petition, IT IS HEREBY ORDERED that the disbursement of funds, including counsel fees and expenses, is approved as set forth in said Petition and the funds shall be disbursed in accordance with the terms and conditions of the settlement agreement as follows: A. Direct payment of six hundred seventy two dollars and twenty six cents ($672.26) to David H. Rosenberg, Esquire, representing reasonable attorneys' fees of five hundred dollars ($500.00) and one hundred'seventy two dollars and twenty six cents ($172.26) for reimbursement of costs; B. Direct the remaining one thousand three hundred twenty seven dollars and seventy four cents ($1,327.74) to be placed in an account investing in securities guaranteed by the United States government or a federal governmental agency managed by responsible financial institutions, bearing the name of the minor, Samantha Barbush, that is marked "Not to be withdrawn until the minor reaches the age of 18 or without the Order of a Court of competent jurisdiction."; and C. Proof of deposit is to be filed with the Court. TRUE COPY FROM RECORD In Testimony whereof, I here unto set my hand. and/~e seal.of saijl Court aAJEarlisla, Pa. ~ ........... f.. ..,, BY THE COURT: - ~/ ~0. j.