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Rules L2039, L2064, and L2206. Approval of compromises involving minors, incapacitated persons, wrongful death and survival actions.
1. Minor or incapacitated person's compromises:
Situs of the filing of the petition.
(a) Petitions for approval of settlements in cases where minors or incapacitated persons have an interest shall be filed with the Prothonotary if the underlying suit has been filed with the Prothonotary. If no suit has been filed , such petitions shall be filed with the Clerk of the Orphans' Court.
(b) Contents of petition. The petition shall be substantially in the form set forth hereunder, and shall:
(1) set forth the date of birth and social security number of the minor plaintiff or incapacitated person, the names and addresses of the minor's parents, the name of the plaintiff's guardian and the appointing court, the address of the plaintiff, and a factual recitation of the salient facts which form the bases of the cause of action;
(2) state the terms of the settlement, including the specific provisions of any annuity, if applicable, including the credit rating of the entity which assumes responsibility for future payments, the present cost of the annuity, periodic and lump sum payments, and otherwise comply with Pa. R.C.P. 2039 and 2064;
(3) state whether a lien or claim has been raised on behalf of any medical supplier, including the Department of Public Welfare;
(4) contain or be accompanied by the following:
(a) a written report of a physician setting forth the present condition of the minor or incapacitated person;
(b) a statement under oath by the guardian and, if appropriate, the parent(s), certifying (i) the present physical or mental condition of the minor or incapacitated person, and (ii) approval of the proposed settlement and distribution thereof;
(c) a statement of the professional opinion of counsel as to the reasonableness of the proposed settlement and the basis for such opinion; and
(d) if there is to be an allocation between parents and children or incapacitated persons, or among children or other parties, the amounts allocated to each party and the specific reasons for such allocation must be set forth. In the event more than one plaintiff is involved, whether minor, adult or incapacitated, Petitioner must set forth the amount each plaintiff is to receive and shall provide justification for the requested allocation;
(e) in the event that a minor is sixteen (16) years of age or older, his or her written approval of the proposed settlement and distribution thereof.
(f) a proposed Order.
(g) Opinion of Guardian. When the minor or incapacitated person is represented by a guardian ad litem, the guardian ad litem shall submit a statement concerning his/her opinion as to the reasonableness of the proposed settlement and requested allocation of the gross settlement proceeds.
(h) Proof of Deposit and Compliance with Court Order. Within sixty (60) days of the entry of a final order, counsel shall file an affidavit with the Prothonotary certifying compliance with the court order, and shall submit proof of deposit in the form of a photocopy of the restricted certificate of deposit or bankbook. The affidavit shall be substantially in the form set forth hereunder.
2. Petitions for Approval of Settlements in Wrongful Death/Survival Actions.
(a) When Required.
(1) Survival Action. Court approval of settlements in survival actions is always required.
(2) Wrongful Death. If the complaint only raised a wrongful death claim, court approval of settlements shall be required only where a minor or incapacitated person has an interest.
(3) Combined Wrongful Death and Survival Actions. If the complaint raised wrongful death and survival claims, court approval is required as to allocation between the categories notwithstanding the absence of minors or incapacitated persons, even if plaintiff requests that the entire proceeds be allocated entirely to the wrongful death claim.
(b) Situs of the Filing of the Petition. Petitions for Approval of Settlements in Wrongful Death or Survival Actions shall be filed with the Prothonotary if the underlying suit has been filed with the Prothonotary. If no suit has been filed, such petitions shall be filed with the Clerk of the Orphans' Court.
(c) Contents of Petition. The Petition shall be substantially in the form set forth hereunder, and shall:
(1) set forth the date of death of plaintiff-decedent, the name of the personal representative of the estate and the county of appointment. A copy of the Decree of the Register must be attached;
(2) state the terms of the settlement, including the specific allocation as between wrongful death and survival, name the wrongful death beneficiaries and the amount each is to receive, name the intestate heirs of Plaintiff-decedent as of the date the cause of action arose, state reasons why the settlement and allocation are reasonable, and otherwise comply with Pa. R.C.P. 2206. In the event a portion of the settlement is payable through the purchase of an annuity, set forth the credit rating of the entity which assumes responsibility for future payments, the present cost of the annuity, as well as the periodic and lump sum payments.
(3) show compliance with Pa. R.C.P. 2205 and set forth the name, relationship and address of plaintiff-decedent's intestate heirs who must be served with a copy of the petition (as required by 20 Pa. C.S.A. § 2101, et. seq.)
(4) identify any other parties who may have a possible interest in plaintiff-decedent's estate, and list unpaid claims raised, or which are outstanding, in the decedent's estate;
(5) state whether a lien or claim has been raised on behalf of any medical supplier, including the Department of Public Welfare; and
(6) attach a proposed order.
(d) Proof of Deposit and Compliance with Court Order. Within sixty (60) days of the entry of a final order, counsel shall file an affidavit with the Prothonotary substantially in the form set forth hereunder, certifying compliance with the court order and shall submit proof of deposit in the form of a photocopy of the restricted certificate of deposit or bankbook. The affidavit shall be substantially in the form set forth hereunder.
3. Petitions for Allowance
(a) Petitions for Allowance in those cases where a guardian has been appointed by the Orphans' Court Division of Warren/Forest County shall be filed directly with such division. A copy of the order approving the settlement shall be attached to the petition.
(b) Petitions for Allowance in those cases where a guardian has been appointed by the Orphans' Court Division of a county other than Warren/Forest County, or by a different state, shall be filed directly with such appointing court. A copy of the order approving the settlement shall be attached to the petition.
(c) Petitions for Allowance in those cases where a guardian has not been appointed shall be filed with the Orphans' Court Division of the appropriate county or other state. A copy of the order approving the settlement shall be attached to the petition.
IN THE COURT OF COMMON PLEAS
OF THE 37TH JUDICIAL DISTRICT OF PENNSYLVANIA
WARREN/FOREST COUNTY
CIVIL
_________________________________
Plaintiff
vs. No.
_________________________________
Defendant
PETITION FOR LEAVE TO SETTLE OR COMPROMISE
MINOR'S ACTION
To the Honorable, _________________the Judge of the said court:
The petition of _________________________, a minor, by his guardian (see
Pa. R.C.P. § 2028), by his attorney,____________, Esq. respectfully
requests:
1. Petitioner is (see Pa. R.C.P. 2026):__________________.
2. The minor was born on __________________and his/her social security
number is________________________.
3. The minor resides with_______________________at the following
address:________________________________________
4. A guardian (was)(was not) appointed for the minor as
follows:________________________________________________
________________________________________________
A copy of the order is attached.
5. The minor's mother is _________________________who resides at the
following address:_____________________________.
6. The minor's father is__________________________who resides at the
following address:_____________________________.
7. The defendant is _____________________________who resides or whose
principal place of business at all relevant times
was___________________________________________________.
8. On____________________________, the minor sustained the following
injuries at the following location (set forth in
detail):___________________________________________________
___________________________________________________________
___________________________________________________________
(If additional space is needed, please continue on separate page.)
A complaint was filed against defendant(s) as follows:__
_______________________________________________________
Attached hereto is a report by Dr.__________________
dated__________which sets forth the present condition of the minor.
11. Attached hereto is a statement, under oath, of the minor's parents
and/or guardian and/or guardian ad litem certifying the physical and/or
mental condition of the minor, as well as the parents' and/or guardian's
and/or guardian ad litem's approval of the proposed settlement and
distribution.
12. Attached hereto is the written approval of the proposed settlement
and distribution by the minor, who is sixteen (16) years of age or older.
13. The following settlement has been proposed:
__________________________________________
__________________________________________
(If additional space is needed, please continue on separate page.)
14. Counsel is of the professional opinion that the proposed settlement
is reasonable due to the following:
____________________________________________________________
____________________________________________________________
(If additional space is needed, please continue on separate page.)
15. Counsel has incurred the following expenses for which reimbursement
is sought. (Please set forth in detail):
____________________________________________________________
____________________________________________________________
____________________________________________________________
(If additional space is needed, please continue on separate page.)
16. The following costs have been incurred by or on behalf of the minor
and must be paid from the proceeds of the settlement:
____________________________________________________________
____________________________________________________________
____________________________________________________________
(If additional space is needed, please continue on separate page.)
17. The Department of Public Welfare, or any other entity, does (not)
have a claim or lien against the plaintiff(s) as follows:
____________________________________________________________
____________________________________________________________
(If additional space is need, please continue on separate page.)
18. Counsel requests a fee in the sum of $______________which is______%
of the net settlement payable to the minor. A copy of the retainer fee is
attached.
19. Counsel (has)(has not) and (will)(will not) receive collateral
payments as counsel fees for representation involving the same matter from
third parties (i.e. subrogation).
20. The net settlement payable to the minor (after deduction of costs
and attorney's fees) is $________________.
WHEREFORE, Petitioner requests that he/she be permitted to enter into the
settlement recited above and that the Court enter an Order of Distribution
as follows:
To______________________________________
$_______________
Reimbursement for Costs
To______________________________________
$_______________
To ______________________________________
$_______________
Counsel fee
d. To: Adult Plaintiff(s) (if applicable)
________________________________________
$_______________
e. To ____________________________, a minor, in
restricted accounts not to be withdrawn before
majority or upon leave of Court
$_______________
OR
f. To _____________________________, the guardian
of the estate of_________________, a minor,
appointed or to be appointed by the Orphans' Court
of____________County, after posting appropriate
security.
$_______________
______________________________
Name of attorney
Attorney for petitioner
VERIFICATION
I, ________________________, am the petitioner in this action and hereby
verify that the statements made in the foregoing petition to settle or
compromise minor's action are true and correct to the best of my
knowledge, information and belief.
I understand that the statement in said petition are made subject to the
penalties of 18 Pa. C.S. § 4904 relating to unsworn falsification to
authorities.
________________________________________________
Date Petitioner
IN THE COURT OF COMMON PLEAS
OF THE 37TH JUDICIAL DISTRICT OF PENNSYLVANIA
FOREST/WARREN COUNTY
CIVIL
No. of
ORDER APPROVING SETTLEMENT AND
ORDER FOR DISTRIBUTION
AND NOW, this _______day of ________________, ____, upon consideration
of the Petition for Leave to Compromise a Minor's Action,
filed____________________ it is hereby ORDERED and DECREED that Petitioner
is authorized to enter into a settlement with
Defendant(s)_____________________________in the gross sum
of__________________($__________) dollars. Defendant(s) shall forward all
settlement drafts or checks to Petitioner's counsel for proper
distribution.
IT IS FURTHER ORDERED and DECREED that the settlement proceeds be
allocated as follows:
1. To: Minor Plaintiff(s)
Name Date of birth Social Security
___________________________________________$________________
___________________________________________$________________
2.Adult Plaintiff(s)
___________________________________________$________________
___________________________________________$________________
IT IS FURTHER ORDERED and DECREED that the settlement proceeds be
distributed as follows:
Name Date of birth Social Security#
___________________________________________$________________
To:___________________________________, Esq.
$________________
Reimbursement costs
To:_______________________________________
$________________
Costs to:______________________________, Esq.
$________________
Counsel fees
d. The balance, the sum of $_______________payable
to______________________,a minor, shall b distributed as follows:
OPTION 1
To: ______________________________, Guardian $_______________ of the
Estate of___________________, a minor; provided, however, that no payment
shall be made to the guardian until the guardian has posted additional
security as required by the Orphans' Court Division of
_______________County pursuant to 20 Pa. C.S. § 5121, et seq. An
appropriate petition shall be filed with the Orphans' Court within thirty
(30) days.
OPTION 2
Counsel is hereby authorized to execute all documentation necessary to
purchase saving certificate(s), from federally insured banks or savings
institutions having an office in Forest/Warren County, in the sum of
$______________, each not to exceed the insured amount, with the funds
payable to the minor upon majority. The certificate shall be titled and
restricted as follows:
____________________________, a minor, not to be redeemed except for
renewal in its entirety, not to be withdrawn, assigned, negotiated, or,
otherwise alienated before the minor attains majority, except upon prior
order of Court.
Counsel shall open a savings account in the sum of $_______________in the
name of the minor. The savings account shall be titled and restricted as
follows:
____________________________, a minor, not to be withdrawn before the
minor attains majority, except for the payment of city, state, and federal
income taxes on the interest earned by the savings certificate and savings
account, or upon prior order of Court.
2. Adult Plaintiff
The portion of the settlement payable to ________________, an adult
plaintiff named in the complaint, shall be distributed as follows:
To:________________________________Esquire $______________
Reimbursement of Costs
To:________________________________ $______________
Costs
To:________________________________,Esquire $______________
Counsel Fees
To:________________________________ $______________
Plaintiff
Counsel shall file with the Prothonotary within sixty (60) days from the
date of this final order, proof of the establishment of the accounts as
required herein, by affidavit from counsel certifying compliance with this
order. Counsel shall attach to the affidavit a copy of the Certificate of
Deposit and/or bank account containing the required restrictions.
BY THE COURT
_______________
Judge
IN THE COURT OF COMMON PLEAS
OF THE 37TH JUDICIAL DISTRICT OF PENNSYLVANIA
FOREST/WARREN COUNTY
CIVIL
_______________________
vs. No. of
_______________________
AFFIDAVIT
I,______________________Esquire, hereby state and affirm that I have
complied with the order issued on ________by the
Honorable__________________as follows:
Copies of bank accounts are attached hereto.
I verify that the statements in the affidavit are made subject to the
penalties of 18 Pa. C.S. § 4904 relating to unsworn falsification to
authorities.
____________________________,Esq. _______________
Attorney for Petitioner Date
IN THE COURT OF COMMON PLEAS
OF THE 37TH JUDICIAL DISTRICT OF PENNSYLVANIA
FOREST/WARREN COUNTY
CIVIL
_______________________
vs. No. of
_______________________
PETITION TO SETTLE WRONGFUL DEATH
AND SURVIVAL ACTIONS
To the Honorable_____________, the Judge of the said court:
The petition of _________________,Administrator/Executor of the Estate
of______________________________, deceased, by his
attorney,____________________________,Esq., respectfully requests:
1. Petitioner is ____________________ who was appointed
Administrator/Executor of the Estate of_______________,deceased,
on____________,___, by the Register of Wills of _________County. A copy
of the Decree of the Register is attached.
2. The plaintiff decedent died on___________________as a result of: [set
forth relevant information describing the underlying negligence or cause of
action as required by Forest/Warren Rule L_______]
___________________________________________________________
___________________________________________________________
(If additional space is needed, please continue on separate sheet).
3. Notice of the institution of the action as required by Pa. R.C.P.
2205 and Forest/Warren Rule L_______ was given on _________________to the
following individuals:
Name Address
________________________________________________
________________________________________________
________________________________________________
4. Pursuant to Forest/Warren Rule L_______Petitioner has served a copy
of this petition on the intestate heirs of plaintiff decedent (as provided
in 20 Pa. C.S. § 2101 et seq.) who are as follows:
Name Relationship Address
___________________________________________________________
___________________________________________________________
___________________________________________________________
5. Pursuant to Forest/Warren Rule L________ Petitioner has served a copy
of this petition on the following parties who may have a possible interest:
Name Relationship Address
___________________________________________________________
___________________________________________________________
___________________________________________________________
6. Decedent (did)(did not) have a will. A copy is attached.
7. The following unpaid claims have been raised and/or are outstanding
in the decedent's estate:
Creditor Amount due
___________________________________________________________
___________________________________________________________
___________________________________________________________
8. A complaint was filed against defendant(s) as
follows:___________________________________________________
___________________________________________________________
9. The following settlement has been proposed:___________
_______________________________________________________
(If additional space is needed, please continue on a separate page).
10. Counsel is of the professional opinion that the proposed settlement
is reasonable due to the following (state the reasons why in the
professional opinion of counsel the settlement is
proper):________________________________________________
________________________________________________________
________________________________________________________
11. Petitioner is of the opinion that the proposed settlement is
reasonable.
12. Counsel has incurred the following expenses for which reimbursement
is sought (Please set forth in detail):
_________________________________________________________
_________________________________________________________
_________________________________________________________
(If additional space is needed, please continue on separate page).
13. Counsel requests counsel fees in the amount of $______________which
represents _______% of the net proceeds of the settlement.
14. Petitioner requests allocation of the net proceeds of the settlement
(after deduction of costs and attorneys fees) as follows:
a. Wrongful Death Claim $____________________
b. Survival $____________________
15. The reasons for the requested allocation are as
follows:_________________________________________________
_______________________________________________________
16. Pursuant to the Wrongful Death Statute (42 Pa. C.S. § 8301), the
beneficiaries of the Wrongful Death claim, and the proportion of their
interest, are as follows:
Name Amount due
________________________________ $__________________
________________________________ $__________________
________________________________ $__________________
________________________________ $__________________
17. The pecuniary loss suffered by the beneficiaries listed in Paragraph
15 is as follows:_________________________________
_______________________________________________________
(If additional space is needed, please continue on a separate page).
Wherefore, Petitioner requests that he/she be permitted into the
settlement recited above, and that the Court enter an Order of
Distribution as follows:
a. To:______________________ $_________________
Reimbursement for costs
b. To:______________________ $_________________
Costs
c. To:______________________ $_________________
Counsel fees
d. Wrongful Death Claim
i. To: Spouse; and/or $_________________
ii. To: Adult child(ren); and/or $_________________
77
iii. To: Minor child(ren) and/or incapacitated persons;
$_________________
and/or
(a) in restricted accounts; or $_________________
(b) to the guardian of the minor(s) estate;
and/or $_________________
iv. To: Parent(s) $_________________
e. Survival claim
To:________________________, Administrator/
Executor of the Estate of __________________,
Deceased $_________________
Respectfully submitted,
__________________________________ Attorney for Petitioner
VERIFICATION
I, _____________________________, am the Petitioner in this action and
hereby verify that the statements made in the foregoing Petition to Settle
or Compromise Minor's Action are true and correct to the best of my
knowledge, information and belief.
I understand that the statement in said Petition are made subject to the
penalties of 18 Pa. C.S. § 4904 relating to unsworn falsification to
authorities.
__________________________________
__________________ Petitioner Date
IN THE COURT OF COMMON PLEAS
OF THE 37TH JUDICIAL DISTRICT OF PENNSYLVANIA
FOREST/WARREN COUNTY
CIVIL
_______________________
vs. No. of
_______________________
NOTICE
To:_____________________________
(name of beneficiary)
Date:___________________________
You are hereby notified that,________________________,
Administrator/Executor of the Estate of ________________, deceased has
filed (or will file) on __________, a Petition to Approve a Settlement of
a Wrongful Death and Survival Action. A copy of that Petition is
enclosed.
If you object to the proposed settlement and/or proposed distribution,
you must submit your written objections on Response to the Petition on or
before ____________, ______, to the following address:
Prothonotary
Warren County Courthouse
204 Fourth Avenue
Warren, PA 16365
Prothonotary
Forest County Courthouse
Tionesta, PA 16353
I hereby certify that the within Notice has been mailed to the above
named individual(s) on the date set forth above.
_______________________________
Attorney for Petitioner
IN THE COURT OF COMMON PLEAS
OF THE 37TH JUDICIAL DISTRICT OF PENNSYLVANIA
FOREST/WARREN COUNTY
CIVIL
_______________________
vs. No. of
_______________________
ORDER
AND NOW, this _______day of _____________, ______, upon consideration of
the Petition to Compromise Wrongful Death and Survival Action filed on
___________,______, it is hereby ordered and decreed that Petitioner is
authorized to enter into a settlement with
Defendant(s)______________________________, in the gross sum of
($___________) dollars. Defendant(s) shall forward all settlement drafts
or checks to Petitioner's counsel for proper distribution.
It is further ordered and decreed that the settlement proceeds are
allocated as follows:
1. Wrongful Death $___________________
2. Survival Claim $___________________
It is further ordered and decreed that the settlement proceeds be
distributed as follows:
1. To:___________________________, Esq. $______________
For costs
2. To:___________________________, Esq. $______________
For counsel fees
3. The Wrongful Death Claim in the sum of $______________
shall be paid as follows:
a. To: Spouse; and/or $______________
b. To: Adult Child(ren); and/or $______________
c. To: Minor Child(ren) as provided hereunder $______________
OPTION 1
To:_______________________________________, $___________
Guardian of the Estate of ____________________________, a minor; provided,
however, that no payment shall be made to the guardian until the guardian
has posted additional security as may be required by the Orphans' Court
Division of ______________County pursuant to 20 Pa. C.S. § 5121, et seq.
An appropriate petition shall be filed with the Orphans' Court within
thirty (30) days.
OPTION 2
Counsel is hereby authorized to execute all documentation necessary to
purchase saving certificate(s), from federally insured banks or savings
institutions having an office in Forest/Warren County, in the sum of
$_____________, each not to exceed the insured amount, with the funds
payable to the minor upon majority. The certificate shall be titled and
restricted as follows:
Not to be redeemed except for renewal in its entirety, not to be
withdrawn, assigned, negotiated, or otherwise alienated before the minor
attains majority, except upon prior order of Court. Counsel shall open a
savings account in the sum of $__________in the name of the minor. The
savings account shall be restricted as follows:
Not to be withdrawn before the minor attains majority, except for the
payment of city, state, and federal income taxes on the interest earned by
the savings certificate and savings account, or upon prior order of Court.
d. To: Parent(s) $______________
4. The Survival Claim in the sum of $_________shall be paid
to_________________,Administrator/Executor, of the Estate of
________________________, deceased; provided, however, that counsel shall
not distribute any funds to the said Administrator/Executor until the
additional security as may be required by the Register of Wills of
________________County pursuant to 20 Pa. C.S. § 3323(b)(3) is posted.
Within sixty (60) days from the date of this final Order, counsel shall
file with the office of Civil Administration an Affidavit from counsel
certifying compliance with this order. Counsel shall attach to the
Affidavit a copy of the Certificate of Deposit and/or bank account
containing the required restrictions.
BY THE COURT
_______________________________
Judge
cc: Register of Wills of _______________County
IN THE COURT OF COMMON PLEAS
OF THE 37TH JUDICIAL DISTRICT OF PENNSYLVANIA
FOREST/WARREN COUNTY
CIVIL
_______________________
vs. No. of
_______________________
AFFIDAVIT
I,_______________________Esq. hereby state and affirm that I have
complied with the Order issued on_________________by the
Honorable_____________________________as follows:
Copies of bank accounts are attached hereto.
I verify that the statements in this affidavit are made subject to the
penalties of 18 Pa. C.S. § 4904 relating to unsworn falsification to
authorities.
____________________________, Esq. _______________
Attorney for Petitioner Date