In every injury case involving a minor, a petition must be filed with the court requesting the court’s approval of the settlement. Here is a sample you can use to draft your own petition. Feel free to call me at 215 563 7088 to discuss your injury case. For more blogs on children’s injuries.
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PETITION FOR LEAVE TO SETTLE OR COMPROMISE MINOR’S ACTION
The Honorable, the Judges of the said Court:
The Petition of Ken Smith, a minor, by his parent and guardian, Stacie Smith, and their attorney, Evan Aidman, Esquire respectfully represents:
1. Petitioner is Ken Smith, a minor, by his parent and guardian, Stacie Smith.
2. The minor was born on September 25, 1993 and his social security number is 173-74-6923.
3. The minor resides with his grandmother, Elaine Jones, 642 Anderson Street, Philadelphia, PA19119.
4. A guardian was not appointed for the minor.
5. The minor’s mother is Stacie Smith who resides at 109 Hart Avenue,
Norristown, pa 19401 and his father is Ken Smith, Sr. who resides at 173 Fairview Avenue, Willow Grove, PA19090.
6. The defendant is Oulia Wedmann who resides at 793 Montgomery Avenue, Elkins Park, PA 19027.
7. On October 2, 2008, the minor sustained injuries to his neck, back, right shoulder, chest and head as the result of an accident that occurred on that date at Easton Road and Pleasant Avenue, Glenside, PA.
8. Attached hereto is a report by Dr. Mahendra Sharr which sets forth the present condition of the minor.
9. Attached is a statement under oath of the minor’s parent, Stacie Smith, certifying the minor’s physical and/or mental condition, as well as her approval of the proposed settlement and distribution.
10. Attached is the written approval of the proposed settlement and distribution of the minor, who is sixteen years of age or older.
11. The following settlement has been proposed:
To: Evan K. Aidman, Esquire (Reimbursement for costs – $110.49)
To: Ken Smith, a minor, in restricted accounts not to be withdrawn before maturity or upon prior leave of the court – $4,759.68
To: Evan K. Aidman, Esquire (Counsel fee – $2,629.83)
To: Mahenda C. Shar, M.D. – $500.00
12. Counsel is of the professional opinion that the proposed settlement is reasonable since the minor has fully recovered from his soft tissue injuries after less than a year.
13. Counsel has incurred the following expenses for which reimbursement is sought: Medical Records $65.49 Filing Fees $45.00
14. No other costs have been incurred by or on behalf of the minor that must be paid from the proceeds of the settlement.
15. There are no claims or liens against the plaintiff by the Department of Public Welfare, any medical provider or any other entity.
17. Counsel requests a fee in the amount of $2,629.83, which is 33 1/3 percent of
the net settlement after deduction for costs. A copy of the retainer agreement is attached.
19. Counsel has not and will not receive collateral payments as counsel fees for representation involving the same matter from third parties.
20. Because PIP benefits were exhausted, the bill of Mahendra C. Shar, M.D. was not paid in full. Dr. Shar has agreed to accept $500.00 as payment in full of his balance of $1,615.00.
21. The net settlement payable to the minor after deduction of costs and
attorney’s fees is $4,759.68.
WHERFORE, Petitioner requests that he be permitted to enter into the settlement recited above and that the Court enter an Order of distribution as follows:
To: Evan K. Aidman, Esquire (Reimbursement for costs – $110.49)
To: Ken Smith, a minor, in restricted accounts not to be withdrawn before maturity or upon prior leave of the court – $4,759.68
To: Evan K. Aidman, Esquire (Counsel fee – $2,629.83)
To: Mahendra C. Shar, M.D. – $500.00
____________________________
EVAN K. AIDMAN, ESQUIRE, Attorney for Petitioner
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