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Home My WebLink About01-2412 FX '. " ~~,,-"'" : ^-'~.- - ,.---",-,- ,; 'J .~:;~:--" John A. Statler, Esquire Attorney 1 D. No. 43812 GOLDBERG, KATZMAN & SHIPMAN, P.C. 320 Market Street P.O. Box 1268 Harrisburg,PA 17108-1268 Telephone: (717) 234-4161 Attorney for Defendant Erie Insurance Group KEITH W. ROSSMAN and SUSAN L. ROSSMAN, Individually and as Co-Administrators of the ESTATE OF CHRISTOPHER W. ROSSMAN, Plaintiffs IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW v. NO. 01-2412 CIVIL TERM ERIE INSURANCE GROUP, Defendant PETITION FOR COURT APPROVAL AND ALLOCATION OF WRONGFUL DEATH AND SURVIVAL ACTION SETTLEMENTS AND NOW, comes the Defendant, Erie Insurance Group, by its attorneys, Goldberg, Katzman and Shipman, P.C., who file this Petition for Court Approval of Wrongful Death and Survival Action Settlements based on the following: 1. Plaintiffs Keith and Susan Rossman are adult individuals, husband and wife, who reside at 305 Cherokee Drive, Mechanicsburg, P A 17050. 2. Defendant Erie Insurance Group is an insurance company authorized to conduct business in the Commonwealth of Pennsylvania with a principal place of business at 4901 Louise Drive, Mechanicsburg, Pennsylvania 17055. - ,~" ,. ", ,c,. .~'~',_I'",},-,'''.''-'''> ,..v,;, ',::,~.,"_.,- - ~' ,- ,;"" ,,; - '.'. ',- ,-',,~' ''''','<f, 3. At all times relevant hereto, Plaintiffs were insured by the Erie Insurance Group for automobile insurance under Pioneer Family Auto Policy number Q09 1703197H. (A true and correct copy of the Declaration Page for the Erie policy is attached hereto as Exhibit "A"). 4. The Pioneer Family Auto policy provided $500,000.00 in stacked underinsured motorist coverage to the Plaintiffs. 5. Plaintiffs Keith and Susan Rossman were the parents of Christopher W. Rossman, who was killed in an automobile accident in the State of Texas on June 10, 2000. 6. At the time of his death, Christopher W. Rossman was 21 years old, unmarried, with no children or other dependents. 7. Plaintiffs have settled the liability claim against the party at fault for this accident, and now seek court approval to settle their claim for underinsured motorist benefits against Erie Insurance Group. 8. Erie Insurance Group has agreed to pay its full underinsured motorist policy limits of $500,000.00 to settle the Plaintiffs' claim. 2 ^ ."~-~-. '.- " "-i,~' _""__' '-~,~,,-i'_-. ~"" "'-"'h'/~"."';:'-~'c>",, '_"-;.',-(.'.k>J,,: " ~ "~r~ 9. The proposed settlement will be allocated as $380,000.00 to settle the wrongful death action and $120,000.00 to settle the survival action arising out of the death of Christopher W. Rossman. 10. The Commonwealth of Pennsylvania, Department of Revenue, has been apprised of the proposed allocation between wrongful death and survival claims and has approved the proposed allocation. (A copy of the March 14, 2001 approval letter form the Department of Revenue is attached hereto as Exhibit "B"). WHEREFORE, Defendant Erie Insurance Group respectfully requests this Honorable Court to approve the proposed settlement and allocation of wrongful death and survival action claims in accordance with the terms outlined in this Petition. Respectfully submitted, GOLDBERG, KATZMAN & SHIPMAN, P.C. By ~. s;:;U _ JO~A\ta~ ~ Attorney 1 D. No. 43812 320 Market Street P. O. Box 1268 Harrisburg, PA 17108-1268 Telephone: (717) 234-4161 Attorneys for Defendant Erie Insurance Group DATE: '-t /2&/0/ 61546.1 3 ~:' -." VERIFICATION AND CONCURRENCE WE, KEITH W. ROSSMAN and SUSAN L. ROSSMAN, hereby verify that we have reviewed the proposed Petition for Court Approval and Allocation of Wrongful Death and Survival Action Settlements and concur in the proposed settlement and allocation. <f - / ~- .2...r-u / DATE x::I~/ KEITH W. ROSSMAN Ani:> ~ \a ? cY'l\ DATI J ~~L 'N.i'1l<.."",,~ SUSAN L. ROSSMAN '\ . , , T ,KM CONTINUATION NOTICE AA7646 FETROW INS ASSOCIATES KEITH W ROSSMAN & SUSAN LROSSMAN 305 CHEROKEE DR MECHANICSBURG PA 17055-2506 AGENT - FETROW INS ASSOCIATES ***** AGENT PHONE - (717) 766-3200 L , ~" ,- . '" ,~~' - , J" L h.~1 ~;'~ ERIE INSURANC& EXCHANGE PIONEER FAMILY AUTO POLICY 09/17/99 TO 09/17/00 Q09 1703197 H 5299 E. TRINDLE RD. MECHANICSBURG PA 17055 3552 ************************************************************ * CONGRATULATIONS! A PIONEER EXPERIENCE RATING CREDIT HAS * * BEEN APPLIED TO YOUR POLICY PREMIUM. * ************************************************************ ITEM AUTO 1 2 4. AUTOS COVERED YR MAKE 93 FORD EXPLORER 00 BUIC LESABRELTD VIN ST 1FMDU34X7PUA68888 PA 1G4HR54K7YU121903 PA TER 4F 4F SYM 6 A RATING CLASS AlAS-MULTI A1BS-MULTI DDP ITEM 5. INSURANCE IS PROVIDED WHERE A PREMIUM, OR INCL, IS SHOWN FOR THE COVERAGE. COVERAGES, LIMITS AND ANNUAL PREMIUMS ARE AS FOLLOWS- #1 #2 *****GOOD DRIVER RATES APPLY***** --- THE FULL TORT OPTION APPLIES TO ALL PRIVATE PASSENGER VEHICLES. LIABILITY PROTECTION- BODILY INJURY $250M/PERSON $500M/ACC PROPERTY DAMAGE $100M/ACC FIRST PARTY BENEFITS- MEDICAL EXPENSE $100M INCOME LOSS $ 1M/MONTH , $15M MAXIMUM ACCIDENTAL DEATH $5M FUNERAL BENEFIT $2.5M UNINSURED MOTORISTS COVERAGE- BOD INJ $250M/PERSON $500M/ACC-STACKED UNDER INSURED MOTORISTS COVERAGE- BOD INJ $250M/PERSON $500M/ACC-STACKED PHYSICAL DAMAGE COVERAGES- COMPREHENSIVE - $50 DED COLLISION - $500 DED OPTIONAL COVERAGES- ROAD SERVICE TRANSP EXPENSES - COLL $20/DAY, $900/LOSS 64 66 47 50 49 37 11 8 1 1 2 1 22 22 81 81 33 61 79 137 4 4 12 12 405 480 885 TOTAL ANNUAL PREMIUM FOR EACH AUTO TOTAL ANNUAL POLICY PREMIUM $ ITEM 6. APPLICABLE POLICY, ENDORSEMENTS, EXCEPTIONS TO DECLARATIONS ITEMS ALL AUTOS - FAP 04/97, AFPN01 10/98*, AFPA03 10/98*, ABPE01 12/90. AUTO 1 - AFPU01 04/99*. AUTO 2 -AFPU01 04/99*. . COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPARTMENT 280601 HARRISBURG, PA 17128-0601 Telephone 3/14/2001 717-783-0972 Michael J Kane, Esquire Kane and Mackin 3300 Trindle Road Camp Hill, PA 17011-4432 Re: Estate of Christopher W Rossman File Number 2100-0595 Dear Mr. Kane: The Department of Revenue has received a letter discussing the Petition for Approval of Settlement Claim to be filed on behalf of the above- referenced Estate in regard to a wrongful death and survival action. It has been forwarded to this Bureau for the Commonwealth's approval of the allocation of the proceeds paid to .settle the actions. Pursuant to the letter~ the motor vehicle accident. Oecedent W. Rossman and Susan L. Rossman. 21 year old decedent died as a result of a is survived by the decedent's parents, Keth Please be advised that, based upon these facts and for inheritance tax purposes only, this Department has no objection to the proposed allocation of the gross proceeds of this action, $ 380,000.00 to the wrongful death claim and $ 120,000.00 to the survival claim. Proceeds of a su~vival action are an asset included in the decedent's estate and are subj ect to the imposi t i.or.. :.....f PeT"J..n-s~11,,:,":,,,::lQi'9. inheritan~-:e tax. 42 .I?a.C.S.A. ~8302; 12 P.S. tls:9106,. 9107. Costs and.tees must be deducted in the same percentages as the proceeds dre allocated. In re Estate of Merryman, 069 A.2d 1059 (Pa. Cmwlth. 1995)_ I trust that this letter is a sufficient representation of the Department's position on this matter. As the Department has no objections to the Petition, an attorney from the Department of Revenue will not be attending any hearing regarding it. Please contact me if_you or the Court has any questions or requires anything additional from this Bureau. Finally, the approval of this allocation is limited to this estate and does not reflect the position that the Department may take in any other proposed distribution of proceeds of a wrongful death / survival action. Pau Dibert Inheritance Tax Division Bureau of Individual Taxes cc: Cumberland County Clerk of Courts ~'iii!aL~~'~!~-'1$j;,I""!',-il"h,;;,~~ii"l!iS"\Hil;,W~Iilll';!l.'~(.,~"'iO~"f~;<l,""ili."";li;o:,ki0;~1.4:~-,"..1,iM%Jiji,~~,'~~M.' ~:Ii.~t H ,=., 'i-\N '<t.,...... ,-" " '_,~.'~_~'e, ~,'" . ""~_"" ~.'"~!. .'7'<.. . "'?"-",~' '~" ." ,-,-" .';<' ",-, ,.. 1)~l~lu""^.- ~"Blllil- o c ;2' -0 oj rnlT, z::.!~ ~'::~'-: r::::C:J S?;c:; L-C-' 5c z :;;! ,,^< ,-, -, o :1t ~ ~ 11Ilil~ "I I II i II II 1 , o -'l.l .-n ,,= i,l ,.""'1 ",--..' -"0 ...". --,~ I-j -, ~ ._~--, i,,:~ (") ~8rl1 <;0 ::.<. r;-? N ...J 1 .__, 'U-'.'_ '"--"~"'^~~"-""=.~'""--,,,", .,~-".--, ,'. ".:",,'," _~_~'i'-'~-_;,,,,,~ +"'--~~~...C";:_'::"-_"_ - ,,';--;; - ~'-~ John A. Statler, Esquire Attorney 1 D. No. 43812 GOLDBERG, KATZMAN & SlDPMAN, P.C. 320 Market Street P.O. Box 1268 Harrisburg, P A 17108-1268 Telephone: (717) 234-4161 Attorney for Defendant Erie Insurance Group KEITH W. ROSSMAN and SUSANL. ROSSMAN, Individually and as Co-Administrators of the ESTATE OF CHRISTOPHER W. ROSSMAN, Plaintiffs IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYL VANIA CIVIL ACTION - LAW v. NO. 01-2412 CIVIL TERM ERIE INSURANCE GROUP, Defendant ORDER AND NOW, this 3~ dayof p. ~ , 2001, it is hereby ordered that the Petition for Court Approval and Allocation of Wrongful Death and Survival Action Settlements in this case is APPROVED. It is further Ordered that $380,000.00 of the settlement proceeds shall be allocated to the settlement of the wrongful death action and $120,000.00 of the settlement proceeds shall be allocated to the settlement of the survival action. J. ~l~:-'--li JtL--~-~"-i~i'''' f~ '.,. iEJ_~~iliiIhlb-"'-.ix ~~ ":~~~'d~~bIL:11 ViN\flllASMJ3d 'LN,n/'V"; l"1n"ln.'\ ^ 1''-,;...1 ':-'1'1'1'''(1,,,-1 o I :8 FU '~!.- /. v~~ f 0 ) i:fiJJCJ\:;"', ',j. ' '. . 'Jbfj~~u. ,,, ""Po_,. y" ~, -~--, ~~-- , - ~." ,---~ 'I I .: , ! i , . ~, ... KEITHW. ROSSMAN and SUSAN L. ROSSMAN, Individually and as Co-Administrators of the ESTATE OF CHRISTOPHER W. ROSSMAN, Plaintiffs v. ERIE INSURANCE GROUP, Defendant r__'!,,,,, . ~ IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA : CIVlLACTION -LAW NO. 01-2412 CIVIL TERM PRAECIPE TO THE PROTHONOTARY OF CUMBERLAND COUNTY: Please mark the above-captioned action settled and discontinued on the docket. DATE: 5 -tel - 2.n I 62787.1 Respectfully submitted, ~viL- By: KEITH W. ROSSMAN and ~~ \---- ~:s6~l'l--- SUSAN L. ROSSMAN, Individually and as Co-Administrators of the ESTATE OF CHRISTOPHER W. ROSSMAN Plaintiffs ",,^,. .' _ ~ d __ c""'.,'" . ,. _w,-_'~~; , CERTIFICATE OF SERVICE I HEREBY CERTIFY that I served a true and correct copy of the foregoing document upon all parties or counsel of record by depositing a copy of same in the United States Mail at Harrisburg, Pennsylvania, with first-class postage prepaid on the I f1" day of M~ \ 2001, addressed to the following: Mr. and Mrs. Keith Rossman 305 Cherokee Drive Mechanicsburg, PA 17055 Respectfully submitted, GOLDBERG, KATZMAN & SHIPMAN, P.c. BY~ John A. tatler, Esquire Attorney I. D. No, 43812 320 Market Street P. 0, Box 1268 Harrisburg, PA 17108-1268 Telephone: (717) 234-4161 Attorneys for Erie Insurance Group ~~ilillkt>.- ~ ""~~- '" ."-~._,"".~.'-~ .'. '. ~ illtl'it(-Ll..Uwk~Yitti -'f(.~'~" ,". ~"" "''''. - - " ,. '." , ',"j-'~ '1 " (') ~: uD: ITlr" :;~:::f', Le,. U).' ~2-, ~~! --LJ >~ ::2 -., ~ - - . ~ ~ ,~- ,.- (~. ""' J.:.J~ -;J ,....;... ~ :.n rr, - . II II II II II ': '- ..:. KEITH W. ROSSMAN and SUSAN L. ROSSMAN, Individually and as Co-Administrators of the ESTATE OF CHRISTOPHER W. ROSSMAN, 305 Cherokee Drive Mechanicsburg, PA 17055 Plaintiffs v. ERIE INSURANCE GROUP, 4901 Louise Drive P. O. Box 2013 Mechanicsburg, P A 17055-0719 Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 0/- ~L//~ C;Ul( '---r-~ - PRAECIPE TO THE PROTHONOTARY OF CUMBERLAND COUNTY: Please issue a Writ of Summons in the above-captioned matter against the Defendant Erie Insurance Group advising them that the Plaintiffs have commenced an action and that they will be required to defend. DATE: I./-/). ~fTV{ 61832.1 Respectfully submitted, By: ~/l KEITH w. ROSSMAN and C:~.u.~ \..--- Re>~-S~",,^_. SUSAN L. ROSSMAN, Individually and as Co-Administrators of the ESTATE OF CHRISTOPHER W. ROSSMAN 305 Cherokee Drive Mechanicsburg, P A 17055 Plaintiffs ~~-. ,,-~,,-",,",--c'-imHdf'" 1'\"1"'---'"' ~~;,.;;-- ii -,~, ~-- "",I>- ....... ....... R f' --. ~~ ~ 0 ~ <Q. \l ~ ~ ~~ ~ ? 9 a ~ ~ ~ J't f :. , ~-~ (") 0 () Q .~ -r, ". -~ iR4 -0 -~ :::0 ~hp N ~St? ~~ .c- uc' ~o --.{ ..d -r.. ~--+J ~(") :;;:: :;:;~~- ""-0 >8 W OM ~ .. );l 0 N ~ 1.2 f e .J.". <~" I-j,'"",<.~:" " - ~~ ~ _~.~ = ,j l. Commonwealth of Pennsylvania County of Cumberland Keith W. Rossman and Susan L. Rossman, Individually and as Co-Administrators of the Estate of Christopher W. Rossman, 305 Cherokee Drive Mechanicsburg, PA 17055 VS. Erie Insurance Group 4901 Louise Drive P.O.Box 2013 Mechanisburg, PA 17055-0719 Court of Common Pleas No. _____.9X::f5X~_~j.~t:L:r~J;l1l__________ 19____ In ______~_:lyU_Agj.QrL::_~~_________________ Erie Insurance Group To _____________________________________________ Yot! are hereby notified that Keith W. Rossman and Susan L. Rossman, Individually and i?&_~9:M@Jl:j,Qt1:.1!t9!J;,_ Qt_.:tQ~_ ~~tg.t~_Qt__G.l.!;r;::j,~tQJ2b_~1:.J39E_~E1___________ __ _____ __ _ _ _ _____ the Plaintiff has commenced an action in __uu_____u__CiriLAc.tiorL::_la\ll__u______u_____u against you which you are required to defend or a default judgment may be entered against you. (SEAL) Curtis R. Long ------------------------------------------------- Prothonotary Date ____ApriJ...2.4.1_2QQL_______ 1Lu ~_2"__~ Deputy L.._!{C ~QS~~&i~MI!j;M;bli0o",h,"'''h0.l'~".;;i>",';kli:""!t~~_~.ll,,,,*~,j"-;!Htt.ili;i;J\L''J;g",...::<;*;;-:d1i"'Y;"'!R#t.iI!!lMW~Ri!i::iWn._M"i~{",""ff-=.''''''~~<-'^~" , H-.l~'"d((JW~"-4 /f:O~~ ~g:g'~ , . f-;' . rt N 0 , , tJ-.l 0'i0f-'::>" ("lOOt-'. Ul t-'- , ' I 'i' Pi 0. ::l iif' f-' fD t-"O PJ IT , Nt-'-B':;:~O" UlO::l::>" , ",",WUl 0" fD ((J 0 ~.~ t;<!;' fjlt":S , "'O":><fD~.::lIT t-'- , ... I ~ 'i PJ <: ("l C Ul '0 ., , W~ I--:' rt t-'. Ul Nt-'.~ ffi .:;,J::O , CO f-' N~ it' ~ H r , H O"OUl , f-;' O"'l... 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