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FIRST AMENDED
MC-350EX
ATTORNEY (Name, State
Bar number, and address): FORCOURT USE ONLY
MARK S. NELSON SBN: 131218
[LAW OFFICES OF MARK S. NELSON
215 McHenry Avenue Electronically Filed
MODESTO, California 95354 11/18/2020 3:47 PM
TELEPHONE NO.:(209)529-0995 FAXNO. (Optione):(209)529-6207
E-MAIL ADDRESS (Optional); Superior Court of California
ATTORNEY FOR (Neme):Balraj Sanghera, a minor, by and through his GAL, Jaspreet Kaur. County of Stanislaus
SUPERIOR COURT OF CALIFORNIA, COUNTY OF STANISLAUS Clerk of the Court
streer aooress: 801 10th Street By: Guadalupe Reynoso, Deputy
MAILING ADORESS: 801 10th Street
CITY AND zip cove: Modesto, 95354
BRANCH NAME: City Towers Courthouse (Civil)
CASE NAME: COMPROMISE OF A DISPUTED CLAIM FOR BALRAJ SANGHERA CASE NUMBER:
PR-20-000708
EXPEDITED PETITION TO APPROVE: [1 No hearing date is requested,
[Xx] COMPROMISE OF DISPUTED CLAIM
[] COMPROMISE OF PENDING ACTION (1 tearine ote:
[1] DISPOSITION OF PROCEEDS OF JUDGMENT
Minor [_] Person With a Disability DEPT. TIME:
NOTICE TO PETITIONERS
You must use this form if you wish to request expedited court approval of certain (1) compromises of disputed claims of
a minor,
(2) compromises of pending actions or proceedings in which a minor or a person with a disability (including a conservatee)
is a party,
or (3) dispositions of the proceeds of judgments for a minor or person with a disability. (See Code Civ. Proc., § 372; Prob.
Code,
§ 3500 et seq.) You may use this form if (1) you are represented by an attorney; (2) the statements in items
3a, 3b, 3c, 3d, 3e, 3f,
and either 3g(1) or 3g(2) below are true; and (3) the court does not otherwise order,
If you qualify and choose to use this form, the court may consider and act on your petition without a hearing. If your compromise
or
judgment does not qualify for expedited treatment or you choose not to use this form, you must use
the Petition to Approve
Compromise of Disputed Claim or Pending Action or Disposition of Proceeds of ‘Judgment for Minor
or Person With a Disability
(form MC-350), and the court will schedule a hearing. See Cal. Rules of Court, rules 7.950, 7.950.5, and 7.951.
4 Petitioner (name): Jaspreet Kaur
2. Claimant (name):Balraj Sanghera
a. Address: 1812 Sierra Glen Ave, Turlock, Ca 95380
b. Date of birth: 10/10/2008 c. Age:12 d. Sex:M e. [XX] Minor f. (] Person with a disability
3, Expedited petition
a. The claimant's claim or action is not for damages for the death of a person caused by the wrongful act or neglect
of another.
b. No portion of the net proceeds of the judgment or settlement in favor of the claimant is to be placed in a trust.
©. There are no unresolved disputes concerning liens to be satisfied from the proceeds of the judgment or settlement.
d. Petitioner's attorney did not become involved with this matter, directly or indirectly, at the request
of a party against whom the
claim is asserted or a party's insurance carrier.
Petitioner's attorney is not representing, employed by, or associated with a defendant in this matter or an insurance
carrier,
All defendants that have appeared in a pending action on the claim are participating in the proposed compromise
or the court
has finally determined that all settling parties entered into the settlement in good faith.
(1) [3X] The judgment for the claimant described in item 5c (exclusive of interest and costs) or the total of the settlement
described in items 12 and 13 payable to the claimant and all other Persons named in item 13
is in the amount of
$50,000 or less; or
2 CO The settlement described in item 12 represents payment of the single-person policy limits of all liability insurance
Policies covering the defendants named in that item. The investigation described in Attachment 3
shows that all of
those defendants are judgment proof outside of their insurance coverage. (Describe
investigation and results in
Attachment 3.) Page 1 of
Form Adopted for EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED
‘Alternative Mandatory Use ©o Probate
chi Procedure
ciusigal ‘Council of California CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS Code, § §372
3500 etet. seq
[New January 1, 201 Cal. Rules
of Cour, rules 3.1384,
OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY 7.101, 7.950, 7.950.5, 7.951
www courtinfo.ca.gov
(Miscellaneous) Westiaw oe & Form Bullder=
MC-350EX
CASE NAME: COMPROMISE OF A DISPUTED CLAIM FOR BALRAJ SANGHERA CASE NUMBER:
a
PR-20-000708
4. Relationship Petitioner's relationship to the claimant (check all applicable boxes):
Parent 9. [-] Other relationship (specify):
Guardian ad litem
Guardian
Conservator
Disabled adult claimant is a petitioner. (See instructions for items 4e and 4f.below.)
Disabled adult claimant's express consent to the relief requested inthis petition is provided on Attachment
4f.
(If you checked item 4e or 4f, state facts on Attachment 4e or 4f showing that the claimant has capacity under
Probate Code
section 812 to petition or consent to a petition. Only an adult claimant who hag sufficient capacity and who does
not have a
conservator of the estate may petition or consent to a petition. See Probate Code section 3613.)
5. Nature of claim The claim of the minor or adult person with adisability:
a. CX] Is notthe subject of a pending action or proceeding. (Complete items 6-23.)
b. [_] Is the Subject of a pending action or proceeding that will be compromised without a trial on the merits of the claim.
Name of court:
Case no.: Trial date: (Complete items 6-23.)
c. [1 is the subject of a pending action or proceeding that has been or will be reduced to a judgment for the claimant against
the defendants named below in the total amount (exclusive of interest and costs) of (specify):
Defendants (names):
$[ eS]
[] Additional defendants listed on Attachment 5. [=] The judgment was filed on (date):
(Attach a copy of the (proposed) judgment as Attachment 5c and complete items 14-23.)
6. LX] Incident or accident
The incident or accident occurred as follows:
a, Date 08/18/18 Time: 1134
b. Place: Baldwin Rd and Hatch Rd in Stanislaus County, California.
c. Persons involved (names):
Defendant: Carmelo Jimenez, Green Valley Labor, Inc, and Does 1-50, inelusive,
Claimant: Thomas Mathews and Balraj Sanghera.
[1 Continued on Attachment 6,
7 Od Nature of incident or accident
The facts, events, and circumstances of the incident or accident are (describe):
Claimant, Balraj Sanghera, was a passenger in claimant, Thomas, Mathews’, vehicle. Defendant, Carmelo
Jimenez, collided
with claimant's vehicle resulting in injuries and damages to claimants.
[[) Continued on Attachment 7.
(New lanary #201] EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED Page 20f8
CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS OF
JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY
(Miscellaneous)
MC-350EX
CASE NAME: COMPROMISE OF A DISPUTED CLAIM FOR BALRAJ SANGHERA __| cASE NUMBER:
fee PR-20-000708
8. CX) Injuries
The following injuries were sustained by the claimant as a result of the incident or accident (describe):
Pain at his hand, neck, back, knees, legs, right shoulder and right ear.
[] Continued on Attachment 8,
Treatment
The claimant received the following care and treatment for the injuries described in item 8(describe):
Memorial ER, Dr. Bindar, MD, and Dr. Malek, DC
[1] Continued on Attachment 9.
10. CX) Extent of injuries and recovery (An original or a photocopy of all doctors' reports containing a diagnosis of and prognosis
for the claimant's injuries, and a report of the claimant's present condition, must be attached to this petition as Attachment
10.
A new report is not necessary so long as a previous report accurately desdribes the claimant's current condition.)
a. [X] The claimant has recovered completely from the effects of the injuries described in item 8, and there are no
permanent injuries.
b. [1 The claimant has not recovered completely from the effects of the injuries described in item 8, and the following
injuries from which the claimant has not recovered are temporary (describe the remaining injuries):
[1 Continued on Attachment 10b.
c. [-] The claimant has not recovered completely from the effects of the injuries described in item 8, and the following
injuries from which the claimant has not recovered are permanent (describe the permanent injuries):
[1 Continued on Attachment 10c.
1.00 Petitioner has made a careful and diligent inquiry and investigation to ascertain the facts relating to
the incident or
accident in which the claimant was injured; the responsibility for the incident or accident;
and the nature, extent,
and seriousness of the claimant's injuries. Petitioner fully understands that if the compromise
proposed in this
petition is approved by the court and is consummated, the claimant will be forever barred from seeking
any further
recovery of compensation from the settling defendants named below even though the claimant's injuries
may in the
future appear to be more serious than they are now thought to be.
12. 7X) Amount and terms of settlement
By way of settlement, the defendants named below have offered to pay the following sums to the claimant:
a. The total amount offered by all defendants named below is (specify):
b. The defendants and amounts offered by each are as follows (specify):
sl8,500.00]
lefendants (names) Amounts
Green Valley Labor 8,500.00
[1 Additional defendants and amounts offered are listed on Attachment 12.
c, The terms of settlement are described on Attachment 12. (if the settlement is to be paid in
installments, both the total
amount and the present value of the settiement must be included.)
(Now January 210) EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED Page
3 0f8
CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS OF
JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY
(Miscellaneous)
MC-350EX
CASE NAME: COMPROMISE OF A DISPUTED CLAIM FOR BALRAJ SANGHERA _| CASE NUMBER
fas PR-20-000708
13, EX] settlement payments to others
a. [2] No defendant named in item 12b has offered to pay money to any person or persons other than the claimant to
settle claims arising out of the same incident or accident that resulted in the claimant's injury.
6 Ed By way of settlement, one or more defendants named in item 12b have also offered to pay money to a person or
persons other than claimant to settle claims arising out of the same incident or accident that resulted in the
claimant's injury.
$ 10,000.00
(1) The total amount offered by all defendants to others (specify):
(2) (1 Petitioner would receive money under the proposed settlement.
(3) The settlement payments are to be apportioned and distributed as follows:
Other plaintiffs or claimants (names) Amounts
Green Valley Labor $ 10,000.00
$
$
$
[1 Additional plaintiffs or claimants and amounts are listed on Attachment 13,
(4) (21 The settlement Payments are apportioned between the claimant and each other plaintiff or claimant
named above on a pro rata basis, based upon the special damages claimed by each. The special
damages claimed by each other plaintiff or claimant are specified on Attachment 13.
(5) [1] Reasons for the apportionment of the settlement payments between the claimant and each other
plaintiff or claimant named above are specified on Attachment 13.
14. The claimant's medical expenses, including medical expenses paid by petitioner, Medicare,
Medi-Cal, and private
insurers, that are to be reimbursed from proceeds of settlement or judgment
a. Totals
(1) Total expenses: $ 4,473.93
(2) Total amount paid (including payments by private insurance, Medi-Cal, of Medicare): $(
(3) Total of negotiated reductions, ifany:
[sites]
$
(4) Total amount of medical expenses to be paid or reimbursed from proceeds:
$
(5) Total amount of medical liens, if any: $3,126.93
(Identify each medical expense payer and the amount each paid, and explain a ny differences between items 14a(1), (4) and (5)
in Attachment 14a.)
6. (1) EX None of the claimant's medical expenses have been paid by Medicare.
2) CO Medicare paid some or all of claimant's medical expenses. In full satisfaction of its lien rights,
Medicare will be reimbursed in the amount of $
(Attach a copy of the final Medicare demand letter or letter agreement as Attachment 14b(2).)
e (1) CI None of the claimant's medical expenses have been paid by Medi-Cal,
@ Od Medi-Cal paid all or some or all of the claimant's medical expenses.
(a) Notice of this claim or action has been given to the State Director of Health Care Services under
Welfare and
Institutions Code section 14124.73. A copy of the notice and proof of its delivery [[) isattached,
was filed in this matter on (date):
(b) In full satisfaction of its lien rights, Medi-Cal has agreed to accept reimbursement
in the amount of:
(Attach a copy of the final Medi-Cal demand letter or letter agreement as Attachment 14¢(2).)
sL__ 303.93 ]
a LJ The claimant's health plan is requesting reimbursement for medical expenses paid under
the plan. In full satisfaction ofthe plan's lien rights, it wil be reimbursed in the amount of: $[_______—————~+d
(Attach statements from the plan showing expense payments and requesting reimbursement It.)
e. [] Petitioner has paid claimant's medical expenses to be reimbursed in the amount of
(See instructions for item 16.) SSS
(New January 1, 2010) EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED Page
4 0f8
CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS OF
JUDGMENT FOR MINOR OR PERSON WITHA DISABILITY
(Miscellaneous)
MC-350EX
CASE NAME: COMPROMISE OF A DISPUTED CLAIM FOR BALRAJ SANGHERA __| cASE NUMBER:
Hie PR-20-000708
14, The claimant's medical expenses, including medical expenses paid by petitioner, Medicare, Medi-Cal, and private
insurers, that are to be reimbursed from proceeds of settlement or judgment
f. EX] There are one or more liens from medical service providers for payment of claimant's medical expenses.
In full satisfaction of their lien claims, the lienholders have agreed to accept the sumof:
$
9g. (Select (1) or (2) below.)
(1) [) Latest statements from all medical service providers are attached as Attachment 14g.
(2) [1 All medical expenses have been paid by private insurance, Medicare, or Medi-Cal.
15, The claimant's attorney's fees and all other expenses (except medical expenses), including fees or expenses
paid by
petitioner and claimant's attorney, to be paid or reimbursed from proceeds of settlement
or judgment
a Total amount of attorney's fees for which court approval is requested:
(if fees are requested, attach as Attachment 15a a declaration from the attorney explaining the basis
sL___ 3,125.00]
for the request, including
a discussion of applicable factors listed in rule 7.955(b) of the Cal, Rules of Court. Include a copy of any written
attorney fee
agreement in Attachment 15a.)
The following additional items of expense (other than medical expenses) have been incurred
or paid, are reasonable, resulted
from the incident or accident, and should be paid or reimbursed out of claimant's share
of the proceeds of the settlement or
judgment:
Items Payees (names) Amounts
Records & Filing Fee Law Office 692.50
SS
[[) Continued on Attachment 15b. Total: s[___ 692.50]
c. [_]Costs of suit attributable to more than one Settling plaintiff are not apportioned between them
on a pro rata basis based
on their gross settlement amounts. The apportionment of these costs is described and explained
in Attachment 15c.
16. Reimbursement of expenses paid by petitioner
a. CX] Petitioner has paid none of the claimant's expenses listed in items 14 and 15 for which reimburseme
nt is requested.
b. [_] Petitioner has paid the following total amounts of the claimant's ex; penses for which reimbursement is requested,
(1) C2) Medical expenses listed in item 14: $
(2) (3 Attorney's fees included in the total fee amount shown in item 15a: $
(3) (1) Other expenses included in the total shown in item 15b: $
(Attach proofs of the expenses incurred and payments made, e. g., bills or
invoices, canceled checks, credit card statements, explanations of benefits
Total:
: |
from insurers, etc.)
17. Net balance of proceeds for the claimant
The balance of the proceeds of the proposed settlement or judgment remaining for the claimant after
payment or
reimbursement of all requested fees and expenses is (specify):
$[9555.87]
(Naw nary 201 EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED Page
§ of 8
CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS OF
JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY
(Miscellaneous)
MC-350EX
CASE NAME: COMPROMISE OF A DISPUTED CLAIM FOR BALRAJ SANGHERA CASE NUMBER:
fea:
PR-20-000708
18. Summary
a. Gross amount of proceeds of settlement or judgment for claimant:
8,500.00
b, Medical expenses to be paid from proceeds of settlement
or judgment:
$ 3,126.93
Attorney's fees to be paid from proceeds of settlement or
judgment: $ 2,125.00
Expenses (other than medical) to be paid from proceeds
of settlement or judgment: $ 692.50,
Total of fees and expenses to be paid from proceeds of settlement or judgment
(add (b), (c), and (d)): $( 5,944.43)
Balance of proceeds of settlement or judgment available for claimant after payment
of all
fees and expenses (subtract (e) from (a)): s [255557]
19, Information about attorney representing or assisting petitioner
a. The attorney [_] CX is representing or employed by any other party involved in this matter.
is not
(If you answered ‘is," identify the other party and explain the relationship in Attachment 19a.
If the other party is a defendant,
you must use form MC-350 for your petition and are not eligible for expedited considerati
on by the court. See item 3e on page 1
and Cal. Rules of Court, rule 7.950.5(a)(6).)
The attorney [] has neither received nor expects to receive [X] has received or expects to receive _ attorney's fees
or other compensation in addition to that requested in this petition for services provided
in connection with the claim giving rise
to this petition (if you answered "has received or expects to receive," identify the person
who paid or will pay the fees or other
compensation, the amounts paid or to be paid, and the dates of ‘payment or expected
payment):
From Whom Paid or Expected (name): Date Paid or Expected Amount Paid or Expecte:
Tom Mathews 09/20/19 2,635.00
[5 Continued on Attachment 19b. Total: aa
20. Disposition of balance of proceeds of settlement or judgment
Petitioner requests that the balance of the proceeds of the settlement or judgment
be disbursed as follows:
a. [] There is a guardianship of the estate of the minor or a conservatorshi ip of the estate of the
adult person with a
disability filed in (name of court):
Case no.:
“Cos of the proceeds in money or other property will be paid or delivered to
the guardian of the estate of the minor or the conservator of the estate of the conservate
e. The money
or other property is specified in Attachment 20a(1).
@C Petitioner is the guardian or conservator of the estate of the minor or the adult person
with a disability,
Petitioner requests authority to deposit or invest $
of the money or other
Property to be paid or delivered under 20a(1) with one or mare financial institutions
in this state or with a trust
company, subject to withdrawal only as authorized by the court. The money or other property
and the name,
branch, and address of each financial institution or trust company are specified in Attachment
20a(2).
MC-3508 EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED
New January 201 1 Page 6 of 8
CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS OF
JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY
(Miscellaneous)
tare
MC-350EX
CASE NAME: COMPROMISE OF A DISPUTED CLAIM FOR BALRAJ SANGHERA __| CASE NUMBER:
be PR-20-000708
20. Disposition of balance of proceeds of settlement or judgment
Petitioner requests that the balance of the proceeds of the settlement or judgment be disbursed
as follows:
a. There is a guardianship of the estate of the minor or a conservatorship of the estate of the
adult person with a disability
(3) [1 Petitioner proposes that all or a portion of the proceeds not become part of the guardianship or
conservatorship estate. Petitioner requests authority to deposit or transfer these proceeds as follows
(check all that apply):
(a) $ will be deposited in insured accounts in one or more financial
institutions in this state from which no withdrawals can be made without a court order.
The name, branch, and address of each depository are specified in Attachment 20a(3).
) COs will be invested in a single-premium deferred annuity subject to
withdrawal only on order of the court. The terms|and conditions of the annuity are specified in
Attachment 20a(3).
ols will be transferred to a custodian for the benefit of the minor under the
California Uniform Transfers to Minors Act. The name and address of the proposed
custodian
and the property to be transferred are specified in Attachment 20a(3).
b. [] There is no guardianship of the estate of the minor or conservatorship of the estate of the adult person with a disability.
Petitioner requests that the balance of the proceeds of the settlement ‘or judgment be disbursed
as follows (check all
that apply):
(1) [1 A guardian of the estate of the minor or a conservator of the estate of the adult person with a disability
will be appointed. $ of money and other property will be paid or delivered to the
person so appointed. The money or other property are specified in Attachment 20b(1).
@ Od $2,555.57 of money will be deposited in insured accounts in one or more financial
institutions in this state, subject to withdrawal only upon the authorization of the court. The
name, branch,
and address of each depository are specified in Attachment 20b(2).
@ CI $ of money will be invested in a single-premium deferred annuity, subject to
withdrawal only upon the authorization of the court. The terms and conditions of the annuity
are specified
in Attachment 20b(3).
4) C5 $ will be paid or delivered to a parent of the minor, upon the terms and under the
conditions specified in Probate Code sections 3401-3402, without bond. The name and address of the
parent and the money or other property to be delivered are specified in Attachment 20b(4).
(Value of minor's entire estate, including the money or property to be delivered, must not exceed $5,000.)
6 CI $ will be transferred to a custodian for the benefit of the minor under the California
Uniform Transfers to Minors Act. The name and address of the proposed custodian and the money or other
property to be transferred are specified in Attachment 20b(5).
© CI $ of money will be held on such conditions as the court in its discretion determines
is in the best interest of the minor or the adult person with a disability. The proposed
conditions are
specified on Attachment 20b(6). (Value must not exceed $20,000.)
” $ of property other than money will be held on such conditions as the court in its
discretion determines is in the best interest of the minor or the adult person with a disability.
The proposed
conditions and the property are specified in Attachment 20b{7).
@) CO $ will be deposited with the county treasurer of the County of (name):
The deposit is authorized under and subject to the conditions specified in Probate Code section
3611(h)
(9) CO $ will be paid or transferred to the adult person with a disability. The money or other
property is specified in Attachment 20b(9).
[5] Continued on Attachment 20.
(New. eruery 2010)
EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED Page
7 of 8
CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS OF
JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY
(Miscellaneous)
CASE NAME: COMPROMISE OF A DISPUTED CLAIM FOR BALRA] SANGHE MC-350EX
RA | case numaen:
21, Petitioner recommends the compromise settlement or the proposed
disposition of 1@ proceeds of the judgment for the claimant to
the court as being fair, reasonable, and in the best interest of the claimant
and re lests that the court approve this compromise
Settlement or proposed disposition and make such other and further
orders as ma: be just and reasonable.
22. [_] Additional orders
Petitioner requests the following additional orders (specify
and explain):
[© Continued on Attachment 22.
23, Number of pages attached:
why.
Date:07/06/2020
MARK S. NELSON
(TYPE OR PRINT NAME OF ATTORNEY) (SIGNATURE OF ATTORNEY)
| declare under penalty of Perjury under the laws of
the State of California that the foregbing is true and
correct.
Date: 07/06/2020
Jaspreet Kaur
(TYPE OR PRINT NAME OF PETITIONER)
»
(SIGNATURE OF PETITIONER)
okt oot au)
(New ananry 1201 EXPEDITED PETITION TO APPR OVE COMPROMISE OF DISPUTED Page
8 of 6
CLAIM OR PENDING ACTION O} R DISPOSITION OF PROC
EEDS
JUDGMENT FOR MINOR OR PERSON WITH \DISABILITY OF
(Miscellaneous)
ATTACHMENT 10
Legal Copy
MEMORIAL MEDICAL CTR
al
Sutter Health MODEST(
Seni hera, Balraj
MRN: 62387629, DOB: 10/10/2008,
1700 Coffee Road Adm: