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CHRISTINA M. RUDY, a minor by and:
through her Parent and Natural
Guardian Anita Rudy,
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY. PENNSYLVANIA
Plaintiff
v.
TIMOTHY LEACH.
Defendant
NO, 1~- f, M
(!/-.-t~L J.Muy1,'-.
CIVIL ACTION.. LAW
ORDER
AND NOW, this !5tl day of ~ 1996. it is hereby Ordered that a
Hearing on the foregoing Petition for Leave to Compromise Minor's Action shall be
held on the ~ day ofJ ..dloou.llI..';.? 1996 at'lli o'clock CL..m. in Court Room
No. ~ at the Cumberland County Courthouse. One Courthouse Square, Carlisle.
Pennsylvania.
BY ~~E COURI /
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4. On or about September 11, 1994, Christina M. Rudy was visiting the
home of Respondent, Timothy Leach, when a Golden Retriever type dog owned by
Respondent attacked and bit Christina M. Rudy causing lacerations about her face.
5. As a result of tho dog attack and bite wounds inflicted by the dog,
Christina M. Rudy was taken to the Holy Spirit Hospital where she was treated for her
lacerations.
6. Subsequently, Christina M, Rudy underwent a course of medical
treatment with Stephen Herceg, M.D., a plastic surgeon, which extended through
September 1, 1995. On September 1, 1995 Dr, Herceg determined that Christina M.
Rudy had obtained a good result from the revision surgery and that if any further
treatment needs to be done it will take place in the future when Christina is age 11
or 12. Dr. Herceg's records indicate that Christina's scars are beginning to fade, but
that there will continue to be some permanent visible scarring. Attached hereto, and
incorporated herein as Exhibit "A" is a copy of Dr. Herceg's office notes and records
of treatment including the initial Emergency Room records from the Holy Spirit
Hospital.
7. Respondent has offered the Petitioner a structured settlement, with a
present value of $130,000.00, as full and final settlement of the claim against the
Respondent asserting negligence on the part of the Respondent thereby causing the
injuries suffered by Christina M, Rudy, The structured settlement provides for an
initial lump sum payment of One Hundred Twenty Thousand ($120,000.00) payable
upon the approval of this Compromise and for future payments as follows:
2
$4,948.00 on August 11, 2008;
$4,948.00 on August 11, 2009;
$4,948.00 on August 11, 2010;
$4,948.00 on August 11, 2011.
8. Petitioner proposes to accept the settlement proposal from Respondent
thereby releasing Respondent from any all claims, suits, and other actions arising from
the injuries In the present case.
9. W. Scott Henning, Esq., of HANDLER AND WIENER, has been the
attorney for the minor in this action and he requests the reasonable counsel fees of
$32,500.00 for services rendered pursuant to a Power of Attorney and Contingent Fee
Agreement signed by Petitioner, plus costs and expenses of $398.04. The Fee
Agreement provides for a contingency fee of 33%, however, the aforesaid figure of
$32,500.00 is calculated based upon a contingency fee of 25%. (A copy of said
Agreement and billing summary are attached hereto, made a part hereof and marked,
"Exhibit B".)
1 O. Petitioner believes that this Compromise is in the best interests of minor,
Christina M. Rudy.
WHEREFORE, Petitioner requests this Honorable Court to:
a. Approve the Compromise above-stated;
b. Authorize the payment of fees in the amount of
$32,500.00 and costs in the amount of $398.04 from the
funds due the minor; and
c. Authorize payment of unpaid medical bills as follows:
Holy Spirit Hospital. $3,352.50
3
, Sc enning
1.0. #32298
31 9 Market Str. e
P.O. Box 1~7
Harrisburg, A 17108
(717) 238i 0 0
;
Attorneys Jor Petitioner Anita Rudy, on
behalf o!)1er minor child, Christina M.
Rudy
-p..'"
...:--';.,.....;T.~. . "
Stephen Herceg, M.D. . $751.00
d. Direct payment of the net funds In the amount of
$82,998.46 from the initial lump sum payment into an
interest bearing, federally insured savings account with
Petitioner, Anita Rudy, named as guardian for the benefit of
Christina M. Rudy, minor. The account is to be marked
"Not to be withdrawn until minor Plaintiff reaches her
majority or without the Court Order of a Court of competent
jurisdiction" .
Respectfully Submitted,
HANDLER AND WIENER
4
...
2101 North Front Street, Bldg, ~4
Harrisburg, PA 17110
t)ATIENT PROGRESS NOTES 0 '
Name C~~ ~~
Blrthdate ~ 1" ~~?O
Accounl No. /30.3 t. /
Stephen J. Herceg, M.D,
David C. Leber. M.D.
DATE
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ADM. DATE: 09/11/1994
CC
Dog bite injury of the face.
HPI This is a 4-year-old female admitted to the
Holy Spirit Hospital Observation Unit for
treatment of dog bite lacerations of the face.
The patient states that approximately half an hour before admission
to the Emergency Care Unit, she was bitten by a Golden Retriever
dog while the children were attempting to remove the dog's food
away from her. The patient sustained severe lacerations of the
face approximately 17 cm. worth of laceration on the right and left
sides of the cheek, periorbital region and nasolabial fold area.
PMH Otherwise noncontributory except for the fact
that her father died approximately 3-1/2
years ago from complications of AIDS. The mother states that she
has been tested for AIDS as recently as a month and a half ago and
has been negative. The child has never been tested for AIDS
because her physician stated that since the mother is not involved,
it was not necessary to test the child. However, a test for AIDS
will be taken today at the time of surgery for evaluation in the
treatment of this patient. The patient has no history of food or
drug allergies.
PHYSICAL EXAMINATION
GENERAL
Well-developed, well-nourished, young female
in distress because of vertical lacerations of
the face. On the right side of the face
beginning at the lateral canthus region and
extending inferiorly in a curvilinear fashion
for approximately 7-1/2 cm., there is an open
laceration. Below this on the right side
there is another 3 cm. laceration, On the
left nasolabial fold there is a 3-1/2 ern.
laceration, and along the mandibular curve
there is another laceration through the skin.
All these are through the skin showing fat.
One may possibly be intraoral.
Normal. Trachea is in the midline.
NECK
5/J.
Page 1
HOLY SPIRIT HOSPITAL
Camp Hill, PA
17011
NAME: RUDY, CHRISTINA MARIE
MR#: 322151
ROOM #: ECU
DR.: HERCEG,
HISTORY AND PHYSICAL
EXAMINATION
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CHEST
HEART
Clear to auscultation.
ABDOMEN
EXTREMITIES
Regular sinus rhythm and rate. No murmurs.
Normal.
Normal.
PELVIC/RECTAL
IMPRESSION
Not indicated.
Severe dog bite lacerations of the'face.
~S'i;N~~'~'
SH/is
D: 09/11/1994
T: 09/12/1994
Page 2
HOLY SPIRIT HOSPITAL
Camp Hill, PA
17011
NAME: RUDY, CHRISTINA MARIE
MR#: 322151
ROOM #: ECU
DR.: HERCEG,
HISTORY AND PHYSICAL
EXAMINATION
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ADMISSION DATE:
9/11/94
PREOPERATIVE DIAGNOSIS:
Severe dog bite lacerations of the
face.
POSTOPERATIVE DIAGNOSIS:
The same.
OPERATION:
Debridement and complex repair of
facial lacerations secondary to dog
bite.
SURGEON:
Dr. Herceg.
ASSISTANT:
DATE:
9/11/94
Findings: This patient was attacked by a Golden Retriever dog
approximately three hours prior to surgery and sustained the
following lacerations. On the right cheek, beginning just lateral
to the outer canthus and extending inferomedially in a curvilinear
line, a 7 cm. laceration which is approximately 2-1/2 cm. wide.
The skin and subcutaneous tissue and the fat was exposed. On the
right cheek, extending in a vertical direction, not continuing but
medial to this is a vertical oblique laceration measuring 2-1/2 cm.
with buccal fat protruding from it.
On the left nasolabial fold region, there is another 2-1/2 cm.
curvilinear lesion going around the angle of the mouth measuring
apprOXimately 2-1/2 cm. On the mandibular side, on the left
lateral region, there is a 4 cm. oblique laceration with fat
exposed. Incidentally, I had forgotten another I cm. laceration
under the left eye.
OPERATIVE PROCEDURE: General endotracheal anesthesia was
administered and was affective. The face was prepared with
pHisoHex solution and draped in the usual sterile fashion. The
lacerations were then scrubbed thoroughly with pHisoHex. They were
infiltrated with Xylocaine, 1/2% with Epinephrine 1:200,OOO. Then
debridement of the edges of the laceration which essentially were
rather clean and cut. They appeared to have occurred from the
dog's canine teeth causing a ripping action, tearing the tissues
apart with very little shredding.
5fJ
Page 1
HOLY SPIRIT HOSPITAL
Camp Hill, PA
17011
NAME: RUDY, CHRISTINA MARIE
MRII: 322lS1
ROOM II: ECU
RECORD OF OPERATION
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On the multiple layer closure of all the wounds carried out with
interrupted, inverted sutures of 114-0 and 115-0 vi cry I sutures.
When this was completed, beginning in the right outer canthus
region and extending inferiorly, a 115-0 Monofilament nylon running
suture was used to close this wound. The same procedure was used
on the right cheek wound. Also interrupted sutures in the infra-
ocular wound on the right side.
The same procedure was repeated with multiple layer closure of 114-0
Vicryl in the subcuticular layer and running 115-0 Monofilament
nylon sutures in the skin of the left mandibular and left cheek
area,
Tincture of Benzoin and steri-strips were applied to all the wounds
and these were covered with regular gauze dressings.
The patient tolerate the procedure well. She left the Operating
Room in good condition.
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STEPHEN HERCE~, M.D.
SH/sz
D: 09/12/1994
T: 09/19/1994
HOLY SPIRIT HOSPITAL
Camp Hill, PA
17011
NAME: RUDY, CHRISTINA MARIE
MRII: 322151
ROOM II: ECU
Page 2
RECORD OF OPERATION
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ACCIDENT INFORMATION
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DATE/TIMEI 09/11/94 .21105
DESCRIPTIONI DOG BITE FA~E
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OUARANTOR INFORMATION
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INFORMATION
POL.ICY," ' OROUP 41
PC VfV. MA'CONTRACT NUMBER
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1EDICA1,E SIGNATUHE ON FIL.EI
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ROBERT L. HARDING. M.D., F.A.C:S.
Date q- /6 - 94
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STEPHEN J. HERCEG, M.D., F.A.C.S, DAVID C. LEBER, M.D.. F.A.C,S.
Acct, No. / .3tJ.8t, I
(Leave Blank)
MEDICAL INFORMATION
PATIENT INFORMATION (Please PrlnlJ
Name 1f("'/v ct,N~)m<:i 171.
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HomePhone (~) (,91-/~-/
Work Phone (_)
Social Security No. /7 <:/ - 7:;" - '1..3 {, /
Occupallon
Employer
Address
Male 0 Female or
Marital Status: Single Ir(l"
Age <,L Birth Dale
For your benefit. please answer these quesllons so thai
we can determine the pollen!'s physical condlllon be'
fore surgery,
1. DO YOU HAVE:
Heart disease
, High blood pressure
Diabetes
Epilepsy
Thyroid disease
Asthma
Student [J Retired [J
Yes No
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2.' HAVE YOU EVER HAD:
Rheumallc fever
Yes No
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Yes No
0 51
0 Ii3
0 DJ
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0 Cil'
Yes No
0 6il
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0 Ilil
0 UI
Yes No
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Yes No
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0 1:d
Yes No
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3. DO YOU HAVE:
Shortness of breath
I 1~,~!', Dizzy spells
, Swelling of ankles
. . '!':.' ., Chest pain
. .i:;l . I .' Prolonged bleeding
. , Jaundice
'."4:;i~ DO YOU TAKE:
, l. . ,~.'~..;" -" Blood thinner medlcallon
~; Heart medlcallon
IF PATIENT IS UNDER 18, SHOW: . J ,J ";,,,,; High blood pressure medlcallon
MothE,U'S Name//A/I't"11 /?v/JtI. BD OlLfib?!'fo.~:~\:':.;' Dlurellcs (water pills)
E":lPIOyer 1/4/;;:/11,0 /1,;J-/,~ .. 83n::';. ,!I.~,::,:. ASp"lrln Frequenlly
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Father's Name BD' ~il;:ltl;'L~,::' "\,,,; ....:. ccas ana y
Employer :",5.\" DO YOU TAKE, or have
MEDICARE NO. ::,j/:,:; you ever taken steroids
. .. ':':, "r'. . (Cortisone.. etc.)
Do you have Blue Shield 65 Special? Yes '- No " I
If yes: Subscriber's Name 6:;" ARE YOU ALLERGIC TO:
:' , ' . Penicillin
Group" ID"':':,''- Novocaine
BLUE C:Ultln. -------1 Other drugs (please list)
Subs(
GraUl
OTHEI
Pollc\
Pollc\
Pollc\
Insure
Addu
Married ~her 0
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Mo. Dav Vear' ,'.
Referring Doctor
Reason for today's visit
Spouse's Name
Spouse's Employer
BD
Christina Rudy
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7.
DO YOU SMOKE?
Claim 11119652
Shiner Ins. Co.
1001 S. Market St.
Mechanicsburg PA 17055
766-1200
8.
List operallons you have had:
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9.
List medlcallons you presenlly take:
Is this:
HMO'
ID"J
Does \
Erie Ins. Co.
PO Box 2013
Mechanicsubrg
795-8200
10. Please list any unusual medical problems:
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Re: Christina Rudy 13038.1
9/22 - Mother's boyfriend called and asked for information concerning the
condition of patient.
How many stitches did she have?
How much did it cost?
How many operations will she need?
Could he have a report of what is to be expected in future for pt.
He said he contacted lawyers who said they would not take his case
since this was a single incidence by the dog. If there are other
attacks by the dog, there would be a case.
I suggested that the information needed be requested by an attorney.
I also mentioned that upon receipt of the operative notes, we would
be forwarding a copy to the insurance company along with the medical
claim. Perhaps he could work with the insurance company.
He said there was only $1,000 to be paid and he already received a
bill for over $500 for anesthesia services.
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POWER OF ATIORNEY
AND
CONTINGENT FEE AGREEMENT
KNOW ALL MEN BY THESE PRESENTS, Ihatl, ANITA RUDY, parent and natural
guardIan ofCIIRISTINA RUDY, a minor, do hereby retain HANDLER AND WIENER, of
Harrisburg, Pennsylvania, as my attorneys to negotiate for an adjuslment or to institute for me
in my name, any legal proceedings or actions that in their judgemenl are necessary, in
connection with my claim for damages againsl The owner of a Golden Retriever Dog, for
injuries or damages sustained by my daughter, Christina Rudy. as a result of an incident that
occuned on or about Seplember II, 1994,
I agree not to settle or adjusI the above claim or any proceedings based thereon without
the written consent of my said attorneys.
NOW, THEREFORE, in consideration of the services so to be rendered by my said
attorneys, I hereby covenanl, promise and agree to pay to my said attorneys for Iheir
professional services rendered, THIRTY-THREE AND ONE-THIRD (33 1/3) PERCENT of
whatever sum is recovered as a result of settlement wilhout suit; or FORTY (40%) PERCENT
in the event suit is filed; or TWENTY PERCENT (20%) of settlement or verdict if, for any
reason, I negotiate directly or engage other counsel 10 represent me. Any necessary expenses
and costs advanced or incuned by Handler and Wiener wilI be reimbursed regardless of whether
or not there is any recovery.
Counsel reserves the right to withdraw if, after complete invesligalion. they determine
Ihat there is no meri t to the clai m,
I hereby authorize the said attorneys to pay bilIs for medical and hospital treatment by
payment directly to physicians or hospitals concerned.
I ACKNOWLEDGE that I have read, approved and understood the above Contingent Fee
Agreement and Power of Attorney and I acknowledge having received a copy of the same. The
terms set forth are agreeable.
IN ~S W~REOF, I have hereunto sel my hand and seal this
;1~~, 1994,
-~>
IC' r, \
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(SEAL)
EXHIBIT
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717-23K-2IKIO
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February 1. 1 996
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Christina Rudy
347 Maple Lane
Carlisle PA 17013
11/22/94
1 2/05/94
12/07/94
09/19/95
10/17/95
10/17/95
01/16/96
01/16/96
STATEMENT OF COSTS
Cutler Camera - photographs
Herceg & Leber Plastic Surgery - records
Hospital Corresp. Copiers - medical records
Cutler Camera - photographs
Book Binding Costs
Cutler Camera - photographs
Herceg & Leber Plastic Surgery - records
Cumberland Co. Prothonotary - file Petition
$ 36.00
25.00
52.47
24.00
2.00
6.00
15.00
45.50
Document Reproduction
Postage Costs
Cumberland Co. Prothonotary. discontinuance
159.20
27.87
5.00
TOTAL DISBURSEMENTS
$398,04
.. ..
VERIFICATION
I verify that the statements made in the foregoing Petition for Leave To
Compromise Minor's Action are true and correct to the best of my knowledge,
Information and belief. I understand that false statements made herein are subject to
the penalties of 18 Pa.C.S. ~4904 relating to unsworn falsification to authorities.
Date
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Anita Rudy Parent and ~atural Guardian of
Christina M. Rudy V
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CHRISTINA M, RUDY, a minor by
and through her Parent and
Natural Guardian Anita Rudy,
PLAINTIFF
V.
TIMOTHY LEACH,
DEFENDANT
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
96-0602 CIVIL TERM
ORDER OF COURT
AND NOW, this 20th day of February, 1996, following a hearing on the within
petition for leave to compromise a minor's settlement, IT IS ORDERED:
(1) Settlement of this minor's claim of Christina M. Rudy, born August 11,
1990, IS APPROVED.
(2) Defendant shall make immediate payment of $120,000 which shall be
distributed by plaintiff's attomey, W. Scott Henning, Esquire, as follows:
(a) $32,500 to W. Scott Henning, Esquire as counsel fees.
(b) $398.04 to W. Scott Henning, Esquire as expenses.
(c) $3,352.50 to Holy Spirit Hospital.
(d) $751 to Stephen Herceg, M.D.
(e) The sum of $82,998.46 shall, within 15 days of this date, be
placed by W. Scott Henning, Esquire, In a federally insured Investment
at the highest retum available IN THE NAME OF CHRISTINA M. RUDY,
bom August 11, 1990, at the Fulton Bank. The Investment shall contain
a provision that: NO WITHDRAWN CAN BE MADE UNTIL THE MINOR
ATTAINS HER MAJORITY EXCEPT AS AUTHORIZED BY A PRIOR
ORDER OF A COURT OF COMPETENT JURISDICTION,
>~... .
(3) Defendant shall make the following additional payments directly to
Christina M, Rudy:
(a) $4,948 on August 11, 2008;
(b) $4,948 on August 11, 2009;
(c) $4,948 on August 11, 2010;
(d) $4,948 on August 11, 2011.
(4) Upon opening the restricted account In the name of the minor at Fulton
Bank, plaintiffs counsel, as required by Pa. Rule of Civil Procedure 2039(b)(2), shall
Il"f:lmedlately file In the office of the Prothonotary, and direct a copy to this judge,
proof of said Investment.
/
,
Edgar B, Bayley, J.
W, Scott Henning, Esquire
For Plaintiffs c.~ '~Llq( .;I./.).0/1f
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IN RE: CHRISTINA M. RUDY, a
minor by and through her Parent
and Natural Guardia;'! Anita Rudy
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
: NO. 96.602
: CIVIL ACTION. LAW
ORDER OF COURT
AND NOW, this
(\".1/1, J
S day of ~. 1996, upon consideration
of the foregoing Petition,
IT IS HEREBY ORDERED that Petitioner may withdraw at Fulton Bank, Acct. No.
122-0078068, the sum of $572.00, from minor, Christina M. Rudy's, settlement
account to pay an unpaid medical bill owed to West Shore Anesthesia as set forth in
attached Petition.
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BY TijE COURT > .1
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IN RE: CHRISTINA M. RUDY, a
minor by and through her Parent
and Natural Guerdlan Anita Rudy
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
: NO. 96.602
: CIVIL ACTION. LAW
PETITION FOR WITHDRAWAL OF FUNDS
FROM MINOR'S SETTLEMENT ACCOUNT
Pursuant to Pennsylvania Rule of Civil Procedure No. 2039, Anita Rudy, the
natural mother and guardian of minor, Christina M. Rudy, by and through their
attorney, W. Scott Henning, Esquire, HANDLER AND WIENER, petition this Honorable
Court to enter an Order authorizing an unpaid medical bill in the amount of $572.00
to be paid out of minor, Christina M. Rudy's, settlement account and, in support, aver:
1. Petitioner, Anita Rudy, is the natural mother and guardian of minor, Christina
M. Rudy, currently age six (6) years old, whose date of birth is August 11, 1990.
2. Petitioner resides with her minor child at 347 Maple Lane, Carlisle,
Cumberland County, Pennsylvania.
3. On or about September 11, 1994, Christina M. Rudy was visiting the home
of Respondent, Timothy Leach, when a Golden Retriever type dog owned by
Respondent attacked and bit Christina M. Rudy causing lacerations about her face.
4. Respondent offered the Petitioner a structured settlement, with a present
value of $130,000.00, as full and final settlement of the claim against the Respondent
asserting negligence on the part of the Respondent thereby causing the injuries
suffered by Christina M, Rudy. The structured settlement provided for an initial lump
.; .~ tit
sum paymant of One Hundred Twenty Thousand ($120,000.00) payable upon the
approval of this Compromise and for future payments as follows:
- $4,948.00 on August 11, 2008
- $4,948.00 on August 11, 2009
- $4,948.00 on August 11, 2010
$4,948.00 on August 11, 2011.
5. On February 2, 1996, Petitioner filed a Petition For Leave To Compromise
Minor's Action, and on February 5, 1996, the Court ordered a hearing to be held
regarding the petition.
6. On or about February 20, 1996, a hearing was held on this matter and the
Minor's Settlement was approved by Order of Court dated February 20, 1996,
7. Subsequently, an amount of $82,998.46 from Christina M. Rudy's initial
lump sum payment from her settlement was deposited into an interest bearing
Certificate of Deposit at Fulton Bank.
8. Recently, it was discovered that one of Christina M. Rudy's medical bills
related to this action was not included in the February 2, 1996, Petition For Leave To
Compromise Minor's Action. This bill owed to West Shore Anesthesia is now being
handled by Peerless Credit Services, Inc" 3400 Trindle Road, P.O. Box 636, Camp
Hill, PA 17011. (See attached Exhibit AI. The amount of the bill is $572.00.
2
..
WHEREFORE, Petitioner requests this Honorable Court to authorize the
withdrawal of $672,00 from minor, Christina M, Rudy's, settlement account to pay
an unpaid medical bill owed to West Shore Anesthesia.
Respectfully Submitted,
HANDLER AND WIENER
Attorneys for P itioner Anita Rudy, on
behalf of her minor child, Christina M.
Rudy
3
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G1)
-... ,
PEERLESS CREDIT SERVICES,INC
3400 TI<INDLE RD.
CAMP HILL PA 17011
~
07/10/%
01468685-1-03
RUDY, ANITA
;347 MAPLE LN
RE YOUR ACCOUNT WITH OUR CLIENT:
WEST SHORE ANESTHESIA
ACCT#: RUDYCHOO
CARLISLE, PA
17013
FOR: CHRISTINA
PRINCIPAL
'1;572. 00
TOTAL DUE
$572,00
This is an attempt to collect a debt,
Any information obtained will be
used for that purpose.
- - - - - .. - .. - .. - .. - - .. .. .. - -SEE-REVERSE SIl)EFOR IMPORTANT iNFORMATlolli" - - - .. - .. - - .. .. - -, - .. - .. - .
DON'T JEOPARDIZE YOUR CREDIT HISTORY III
OUR CLIENT HAS AUTHORIZED US TO REPORT THIS DEBT AGAINST
YOUR CREDIT HISTORY AS AN UNPAID COLLECTION ACCOUNT.
IF YOU ALLOW THIS TO HAPPEN THE CONSEQUENCES YOU FACE ARE:
1) THE DEBT MAY REMAIN ON YOUR CREDIT REPORT FOR 7 YEARS.
2) THE DEBT COULD HINDER YOUR ABILITY TO OBTAIN FUTURE CREDIT AND
COULD ALSO LESSEN YOUR BUYING POWER.
3) THE INFORMATION IS REPORTED TO A NATIONWIDE DATA BANK AND CAN BE
ACCESSED BY ANY CREDIT GRANTOR. EXAMPLE: AUTO DEALERS, MORTGAGE CDS.
AND LANDLORDS.
>>PAYMENT IN FULL MUST BE RECEIVED DR YOU MUST CONTACT US TO STOP THIS
UNPAID ACCOUNT FROM APPEARING ON YOUR EQUIFAX CREDIT REPORT.
>>RETURNED CHECKS CHARGED $20.00 FEE<<
JOE RATHMAN, ACCOUNT MGR.
TEL. (717) 73'7-4283
01468685-1-03
:+::+:;+;;+;;+; RETURN TU: ;+:;+:*:1;;+:
P.O. BOX 636
CAMP HILL, PA 17001-0636
07/10/96
WEST ~;;HORE ANESTHESIA
ACCT#: RUDYCHOO
FORWARD &. ADDRE:;;::; CORRECTION
TOTAL DUE
'1:572,00
PEERLESS CRED I T SERV I CI:'::;. I ~IC
P.O. BOX 636
CAMP HILL. PA 17001-0636
RUDY, ANITA
347 MAPLE L1~
EXHIBIT
CAm.l'3LE, PA 17013
OOOS/.E1l R
PLEASE ENCLOSE TH S PORTION WITH YOUR PAYME
VERIFICATION
The undersigned hereby verifies that the statements in the foregoing
PETITION FOR WITHDRAWAL OF FUNDS FROM MINOR'S SETTLEMENT ACCOUNT
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 above-named PETITION FOR WITHDRAWAL OF FUNDS FROM
MINOR'S SETTLEMENT ACCOUNT is of counsel and not my own. I have read the
PETITION FOR WITHDRAWAL OF FUNDS FROM MINOR'S SETTLEMENT ACCOUNT
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 PETITION FOR WITHDRAWAL OF FUNDS FROM MINOR'S
SETTLEMENT ACCOUNT is that of counsel, I have relied upon my counsel in making
this verification. The undersigned also understands that the statements therein are
made subject to the penalties of 18 Pa.R.C,P. 2252(d) C.S. Section 4904, relating to
unsworn falsification to authorities,
Date: ~ ... ;Z 3 -'96
and
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