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27-CV-23-19168
Filed in District Court
State of Minnesota
12/20/2023 10:50 AM
STATE OF MINNESOTA DISTRICT COURT
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COUNTY OF HENNEPIN FOIIRTH JUDICIAL DISTRICT
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PERSONAL INJURY
Case Type: Minor Settlement
Court File No.2
In Re: Petition for Approval of PETITION FOR APPROVAL AND
Minor Settlement of Meily Ayala-Chavez, DISTRIBUTION OF MINOR
a Minor, by Her Mother and SETTLEMENT
Guardian, Keyri Guadal Chaves Ce1jvantes. 8
Petitioner, Keyri Guadal Chaves Cervantes, mother and guardian of Meily Ayala-Chavez,
through her attorney, Jeffrey A. Jones, requests this Court to approve the minor settlement
petition and the distribution of the settlement proceeds in the above-captioned case. Petitioner,
in support of her Petition, states the following:
1. Meily Ayala-Chavez ("Meily';'.-)'is aiminor who was born on January 28, 2011. She is
presently 12 years of age and resides with her mother and guardian, Keyri Guadal Chaves
Cervantes ("Ms. Cervantes"), at 2388 Gall Avenue, Maplewood, MN 55109.
2. On March 19, 2023, Meily was a back seat passenger of a 2021 Nissan Rogue being driven
by her mother, Ms Cervantes. The vehicle was stopped at a red light on White Bear Avenue
at the intersection with
Arlington Avenue 1n the City of St. Paul, Minnesota.
3. When the light turned green, Ms. Cervantes remained stopped as the vehicle 1n fiont of her
was waiting to make a left turn. While she was waiting, a second vehicle driven by an
uninsured driver, Margalit Gerson, was not paying attention and slammed into the back of
Ms. Cervantes' vehicle. '
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4. As a result of the collision, Meily sustained injuries to her neck and back and initially
sought treatment fiom Dr. J ames Anderson, D.C. at City Lakes Chiropractic on March 24,
2023.
5. Based on Dr. Anderson's initial examination, he diagnosed Meily with cervical, thoracic
and lumbar ligament sprain as well as cervical, thoracic and lumbar segmental dysfunction
secondary to the motor vehicle accident.
27-CV-23-19168
Filed in District Court
State of Minnesota
12/20/2023 10:50 AM
6 In order to treat these injuries, Meily began chiropractic care. Treatments were initially
rendered three (3) times per week, gradually reducing 1n frequency as Meily' s condition
improved.
7 Meily's treatments for her injuries have been very beneficial in that she was able to
discontinue all care as of September 27, 2023. The enclosed medical records ("Exhibit l")
outline Meily's care and treatment.
In addition to treating with Dr. Anderson, Meily's treatment and injuries were reviewed by
Dr. Richard Reidt for an independent medical record review at the request of Progressive
Insurance. Based on his review cf the medical records, Dr. Reidt determined Meily's
injuries fiom the March 19, 2023 accident resolved and no further care was needed.
9 Following the aforesaid occurrence'and injury to Meily, Petitioner Keyri Guadal Chaves
Cervantes, mother and guardian of Meily, employed the Law Office of Jeffrey A. Jones,
P.A., as attorneys to represent Meily for recovery of damages as a result of her injuries. It
was agreed in writing that said attorneys would receive one-third (1/3) of the amount
recovered, plus costs, by way of suit or settlement. Said attorneys conducted extensive
investigation into the facts surrounding the occurrence of this accident and subsequently
entered into settlement
negotiations.
10. Petitioner brought an uninsured motorist claim against Progressive Insurance for uninsured
motorist benefits. Afier extensive negotiations, Progressive Insurance agreed to pay
$6,000.00 for a full and final settlement of all uninsured motorist benefit claims Meily may
have against Progressive Insurance relating to this accident.
11. Petitioner has discussed at length the Issues of liability, tort thresholds, and damages relative
to settlement. This settlement Was based on Petitioner's understanding that had the case
proceeded to trial, there was a chance the case might not have been successful and/or the
damages awarded would not have exceeded the amount offered. Petitioner believes, and she
has been so advised, that this sum should be accepted because it is in the best interest of the
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minor, Meily Ayala-Chavez.
12. It is proposed fiom the settlement amount of $6,000.00 that the Law Office of Jeffiey A.
Jones, P.A. would receive $2,000.00, which constitutes l/3 (33.3%) of the amount
recovered in the liability case, together with costs of $302.00 (for funds advanced for
Meily' s medical records and court filing fee for this petition) paid by the law firm on this
case, for a total of $2,302.00 to the Law Office of Jeffrey A. Jones, P. A. ,for its fees and
costs.
13. Afier attomey's fees/costs, the remaining $3,698.00 shall be placed into a savings deposit
account at the U.S. Bank, Golden Valley, Minnesota on behalf of Meily Ayala-Chavez, a
minor. Petitioner believes that Said offer of settlement and division is reasonable and is in
the best interest of the minor and that such offer of settlement should be accepted.
27-CV-23-19168
Filed in District Court
State of Minnesota
12/20/2023 10:50 AM
WI-EREAS, Petitioner prays for an Order of the Court as follows:
1. That settlement of the liability claim and cause of action in the sum of $6,000.00 be
approved and that Petitioner be authorized to sign the necessary releases and other
settlement disbursement documents.
2. That Progressive Insurance be directed to transmit its draft payable to the Law Ofiice of
Jeffrey A. Jones, P. A. in the amount of $6,000. 00.
3. That payment to the Law Ofice of J effiey A. Jones, P.A., for attorneys' fees and costs in
the sum of $2,302.00 be authorized. That the law firm be authorized to draw fiom its
must account a check for $3,698.00 made payable to U.S. Bank, Golden Valley,
Minnesota, a federally insured institutiori, to be deposited in a savings account in the
name of Meily Ayala-Chavez, a minor.
4. That the Law Office of Jeffiey A. Jones, P.A., shall provide a copy of this Order to U.S.
Bank, in Golden Valley, Minnesota and the bank be directed to issue a savings account in
the name of Meily Ayala-Chavez, a minor. Further, that the Law Office of Jeffrey A.
Jones, P.A. shall elecuonically transmit the savings account documents to the Clerk of
District Court of Hennepin County, for safekeeping after receipt of said deposit by U. S.
Bank. Moreover, that U. S. Bank be directed to make no disbursements from said deposit
except upon Order of this court until Meily Ayala-Chavez attains the age of eighteen
(18) years on January 28, 2029, at which time said funds shall be made available Meily
Ayala-Chavez without further proceedings and upon Order of s Court.
Dated:
Wily/bl}? a;
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Keyri Guadal Chaves Cervantes, Petitioner
Pursuant to Minn. Stat. § 358.116, I declare under penalty of perjury that everything I
have stated in this document is true and correct.
Date:
oft/291)»?
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27-CV-23-19168 Filed in District Court State of Minnesota 12/20/2023 10:50 AM STATE OF MINNESOTA DISTRICT COURT ' COUNTY OF HENNEPIN FOIIRTH JUDICIAL DISTRICT ' 1; "I PERSONAL INJURY Case Type: Minor Settlement Court File No.2 In Re: Petition for Approval of PETITION FOR APPROVAL AND Minor Settlement of Meily Ayala-Chavez, DISTRIBUTION OF MINOR a Minor, by Her Mother and SETTLEMENT Guardian, Keyri Guadal Chaves Ce1jvantes. 8 Petitioner, Keyri Guadal Chaves Cervantes, mother and guardian of Meily Ayala-Chavez, through her attorney, Jeffrey A. Jones, requests this Court to approve the minor settlement petition and the distribution of the settlement proceeds in the above-captioned case. Petitioner, in support of her Petition, states the following: 1. Meily Ayala-Chavez ("Meily';'.-)'is aiminor who was born on January 28, 2011. She is presently 12 years of age and resides with her mother and guardian, Keyri Guadal Chaves Cervantes ("Ms. Cervantes"), at 2388 Gall Avenue, Maplewood, MN 55109. 2. On March 19, 2023, Meily was a back seat passenger of a 2021 Nissan Rogue being driven by her mother, Ms Cervantes. The vehicle was stopped at a red light on White Bear Avenue at the intersection with Arlington Avenue 1n the City of St. Paul, Minnesota. 3. When the light turned green, Ms. Cervantes remained stopped as the vehicle 1n fiont of her was waiting to make a left turn. While she was waiting, a second vehicle driven by an uninsured driver, Margalit Gerson, was not paying attention and slammed into the back of Ms. Cervantes' vehicle. ' L ,, 4. As a result of the collision, Meily sustained injuries to her neck and back and initially sought treatment fiom Dr. J ames Anderson, D.C. at City Lakes Chiropractic on March 24, 2023. 5. Based on Dr. Anderson's initial examination, he diagnosed Meily with cervical, thoracic and lumbar ligament sprain as well as cervical, thoracic and lumbar segmental dysfunction secondary to the motor vehicle accident. 27-CV-23-19168 Filed in District Court State of Minnesota 12/20/2023 10:50 AM 6 In order to treat these injuries, Meily began chiropractic care. Treatments were initially rendered three (3) times per week, gradually reducing 1n frequency as Meily' s condition improved. 7 Meily's treatments for her injuries have been very beneficial in that she was able to discontinue all care as of September 27, 2023. The enclosed medical records ("Exhibit l") outline Meily's care and treatment. In addition to treating with Dr. Anderson, Meily's treatment and injuries were reviewed by Dr. Richard Reidt for an independent medical record review at the request of Progressive Insurance. Based on his review cf the medical records, Dr. Reidt determined Meily's injuries fiom the March 19, 2023 accident resolved and no further care was needed. 9 Following the aforesaid occurrence'and injury to Meily, Petitioner Keyri Guadal Chaves Cervantes, mother and guardian of Meily, employed the Law Office of Jeffrey A. Jones, P.A., as attorneys to represent Meily for recovery of damages as a result of her injuries. It was agreed in writing that said attorneys would receive one-third (1/3) of the amount recovered, plus costs, by way of suit or settlement. Said attorneys conducted extensive investigation into the facts surrounding the occurrence of this accident and subsequently entered into settlement negotiations. 10. Petitioner brought an uninsured motorist claim against Progressive Insurance for uninsured motorist benefits. Afier extensive negotiations, Progressive Insurance agreed to pay $6,000.00 for a full and final settlement of all uninsured motorist benefit claims Meily may have against Progressive Insurance relating to this accident. 11. Petitioner has discussed at length the Issues of liability, tort thresholds, and damages relative to settlement. This settlement Was based on Petitioner's understanding that had the case proceeded to trial, there was a chance the case might not have been successful and/or the damages awarded would not have exceeded the amount offered. Petitioner believes, and she has been so advised, that this sum should be accepted because it is in the best interest of the ' ' minor, Meily Ayala-Chavez. 12. It is proposed fiom the settlement amount of $6,000.00 that the Law Office of Jeffiey A. Jones, P.A. would receive $2,000.00, which constitutes l/3 (33.3%) of the amount recovered in the liability case, together with costs of $302.00 (for funds advanced for Meily' s medical records and court filing fee for this petition) paid by the law firm on this case, for a total of $2,302.00 to the Law Office of Jeffrey A. Jones, P. A. ,for its fees and costs. 13. Afier attomey's fees/costs, the remaining $3,698.00 shall be placed into a savings deposit account at the U.S. Bank, Golden Valley, Minnesota on behalf of Meily Ayala-Chavez, a minor. Petitioner believes that Said offer of settlement and division is reasonable and is in the best interest of the minor and that such offer of settlement should be accepted. 27-CV-23-19168 Filed in District Court State of Minnesota 12/20/2023 10:50 AM WI-EREAS, Petitioner prays for an Order of the Court as follows: 1. That settlement of the liability claim and cause of action in the sum of $6,000.00 be approved and that Petitioner be authorized to sign the necessary releases and other settlement disbursement documents. 2. That Progressive Insurance be directed to transmit its draft payable to the Law Ofiice of Jeffrey A. Jones, P. A. in the amount of $6,000. 00. 3. That payment to the Law Ofice of J effiey A. Jones, P.A., for attorneys' fees and costs in the sum of $2,302.00 be authorized. That the law firm be authorized to draw fiom its must account a check for $3,698.00 made payable to U.S. Bank, Golden Valley, Minnesota, a federally insured institutiori, to be deposited in a savings account in the name of Meily Ayala-Chavez, a minor. 4. That the Law Office of Jeffiey A. Jones, P.A., shall provide a copy of this Order to U.S. Bank, in Golden Valley, Minnesota and the bank be directed to issue a savings account in the name of Meily Ayala-Chavez, a minor. Further, that the Law Office of Jeffrey A. Jones, P.A. shall elecuonically transmit the savings account documents to the Clerk of District Court of Hennepin County, for safekeeping after receipt of said deposit by U. S. Bank. Moreover, that U. S. Bank be directed to make no disbursements from said deposit except upon Order of this court until Meily Ayala-Chavez attains the age of eighteen (18) years on January 28, 2029, at which time said funds shall be made available Meily Ayala-Chavez without further proceedings and upon Order of s Court. Dated: Wily/bl}? a; gm)? Mal/z Keyri Guadal Chaves Cervantes, Petitioner Pursuant to Minn. Stat. § 358.116, I declare under penalty of perjury that everything I have stated in this document is true and correct. Date: oft/291)»? ' {Qt/1') film/Z l County: W) lull! [pm/(1V;