SAMPLE SETTLEMENT STATEMENT
SAMPLE SETTLEMENT STATEMENT
JANE J. GOOD CLIENT
versus
NEVERPAY INSURANCE COMPANY
24TH JUDICIAL DISTRICT COURT, PARISH OF JEFFERSON
CASE NO. 144488, DIVISION "J"
Settlement Amount: $25,000.00 $25,000.00
Attorney's Fee: 10,000.00 (10,000.00)
40% of gross amount recovered
after filing suit
Payments to Third Parties:
East Jefferson General Hospital
- Emergency Room Fees 252.00 (252.00)
Expenses:
UPS overnight charges 9.50
Filing fees with 24th Judicial
District Court 175.00
Sheriff of East Baton Rouge Parish 40.00
(service on Neverpay)
$224.50 (224.50)
Advance by Attorney:
Net to Client: $14,523.50
SUMMARY
Net to client $14,523.50
Net to third parties $252.00
Net to attorney $10,224.50
TOTAL SETTLEMENT $25,000.00
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