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HomeMy WebLinkAbout99-03568 ar 41. 4 .r ?e r 2 r?1 ? 1 iL R ? yn r itlf?. ? h 4Jv C ?N • ?A - ? "sin. ? ....,;ivy •{? i All i a JSM L ?j ypp YW: ..3 MARY E. CHESSEY, & : IN THE COURT OF COMMON PLEAS SHANE M. CHESSEY, : CUMBERLAND COUNTY, PENNSYLVANIA PERSONAL REPRESENTATIVES OF : THE ESTATE OF COLBY CHESSEY, DECEASED, PETITIONERS V. : NO.9ci. 3y(, S C°.L tie GEORGE PIERCE, JR., RESPONDENT : CIVIL ACTION - LAW ORDER AND NOW, this /yam day of 1999 upon consideration of the Petition for Settlement, it is ORDERED that settlement of the above captioned case is approved as set forth in said Petition. By the Court: J. Ju_ ?? LJ i.r MARY E. CHESSEY, & SHANE M. CHESSEY, PERSONAL REPRESENTATIVES OF THE ESTATE OF COLBY CHESSEY, DECEASED, PETITIONERS V. GEORGE PIERCE, JR., RESPONDENT AND NOW, this. day of 1999, upon consideration of the foregoing Petition, it is ordered that Settlement in compromise of this action for the sum of $100,000.00 is approved. Furthermore, counsel fees and expenses are also set forth below. The distribution is directed as follows: a) To David H Rosenberg, Esquire, of HANDLER, HENNING & ROSENBERG, for counsel fees in the amount of $30,000.000 b) To David H Rosenberg, Esquire, of HANDLER, HENNING & ROSENBERG, for reasonable costs and expenses in the amount of $354.16. c) To the Federal Employees Health Benefits Program for repayment of a medical lien in the amount of $5482.10. d) To the Federal Employees Health Benefits Program and/or Hershey Medical Center for the repayment of a medical lien in the amount of $1,153.20. e) To Mary E. Chessey and Shane M. Chessey, as Personal Representatives of the Estate of Colby Chessey, Petitioners, in the amount of $63,010.54. BY THE COURT: IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 5? 9- 33-'6.P &?; T.w CIVIL ACTION - LAW ORDER J. Jci\chessey.pet MARY E. CHESSEY, & SHANE M. CHESSEY, PERSONAL REPRESENTATIVES OF THE ESTATE OF COLBY CHESSEY, DECEASED, PETITIONERS IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA V. GEORGE PIERCE, JR., RESPONDENT NO. 99. 35-(..f ee,,4 Tu,_,,. CIVIL ACTION - LAW PETITION FOR SETTLEMENT OF SURVIVAL ACTION AND SETTLEMENT OF WRONGFUL DEATH ACTION AND NOW, comes Petitioners, Mary E. Chessey and Shane M. Chessey, Personal Representatives of the Estate of Colby Chessey, by and through their attorneys, HANDLER, HENNING & ROSENBERG, by David H Rosenberg, Esquire, and petition this Honorable Courtto enter an Order permitting settlement of the above action and in support thereof, state the following: 1. Decedent, Colby Chessey, was born on April 3, 1997, and was, therefore, 19 months old and a minor, and was, at the time of death, residing at 9763 Lady Slipper Court, Apartment B, Laurel, Howard County, Maryland, 20723. 2. On or about November 27, 1998, Decedent, Colby Chessey, sustained fatal injuries in a two car motor vehicle collision. -t- 3. Petitioners, Mary E. Chessey and Shane M. Chessey, were appointed Personal Representatives of the Estate of Colby Chessey on December 17, 1998. Attached hereto and marked as Exhibit "A" is a short certificate from the Register of Wills of Howard County, Maryland. 4. Decedent's estate will be distributed according to the laws of Howard County, Maryland, the home of decedent at the time of death. Therefore, Decedent's estate shall not be subject to estate taxes pursuant to Pennsylvania law. 5. At all times material to this action, the Respondent and driver of the motor vehicle involved in the collision, George R. Pierce, Jr., was insured by a policy covering the owner of the vehicle, George R. Pierce, Sr., through Nationwide Insurance Company. Said policy provided liability coverage in the amount of $100,000.00 per person/$300,000.00 per accident. Attached hereto and marked as Exhibit "B" is a copy of said policy. 6. The tortfeasor had no other insurance coverage. Attached hereto and marked as Exhibit "C" is an Affidavit of No Other Insurance Coverage. 7. At approximately 9:58 a.m. on November 27, 1998, Petitioners' vehicle was traveling south on Williams Grove Road, in Monroe Township, Cumberland County, Pennsylvania. 8. At approximately the same time and place, the Respondent's vehicle was on Williams Grove Road, directly behind the Petitioners' vehicle, as it approached the Fisher Road intersection. -2- 9. While Petitioners were waiting at the intersection of Fisher Road to make a left turn, Respondent failed to observe the Petitioners'vehicle stopped in front of him, causing the front end of his vehicle to violently impact the rear of Petitioners' vehicle. 10. As a result Respondent's negligence, Petitioners' minor decedent suffered multiple trauma resulting in death. 11. Petitioners' decedent, Colby Chessey, is survived by his parents, Mary E. Chessy and Shane M. Chessey, and his brother, Michael Chessey, who reside at 9763 Lady Slipper Court, Apartment B, Laurel, Howard County, Maryland, 20723. 12. Petitioners have entered into an oral agreement with Respondent to settle the liability claim of the survival and wrongful death actions, subject to this Court's approval for the policy limits of $100,000.00. 13. Petitioners will continue to seek contribution or indemnity from other persons or entities who are or may bejointly, severally or otherwise liable for said injuries or death. 14. Petitioners' first party medical benefits coverage in the amount of $10,000, through their State Farm automobile insurance policy, has been exhausted. The Federal Employees Health Benefits Program has asserted a medical lien in the amount of $5482.10 against the Estate of Colby Chessey from medical bills paid to Hershey Medical Center. Attached hereto and marked as Exhibit "D" is a copy of said lien. Petitioners propose to pay this lien out of the settlement. -3- 15. There is also an outstanding medical bill with the Hershey Medical C enter in the amount of $1,153.20 which is pending with The Federal Employees Health Benefits Program. Petitioner proposes to pay either the bill or satisfy the potential lien out of the settlement. 16. Counsel has been retained by Petitioners to represent Petitioners and the Estate of Colby Chessey in claims from the incident of November 27, 1998. Attached hereto and marked as Exhibit "E" is the Contingent Fee Agreement. 17. David H Rosenberg, Esquire, attorney in this matter, believes said settlement is fair and equitable under the circumstances of this case. 18. David H Rosenberg, Esquire, of HANDLER, HENNING & ROSENBERG, has been the attorney for the Petitioners in this matter and he requests reasonable counsel fees of $30,000 for services rendered plus costs and expenses incurred of $354.16 pursuant to the Contingent Fee Agreement signed by Petitioners. David H Rosenberg, Esquire, is entitled to fees in the amount of 331/3 % but has reduced his fee in this case to 30%, which calculates as follows: 30% of $100,000.00 = $30,000.00. Thus, the total amount requested for atomey s fees and costs is $30,354.16. 19. After the payment of medical liens, fees and expenses, the balance of $63,010.54 shall be paid to the Estate of Colby Chessey to be allocated pursuant to Maryland Law. -4- WHEREFORE, Petitioners request this Honorable Court to: (a) Approve the Settlement and Compromise stated above; (b) Approve payment of counsel fees and expenses stated above from the funds received; and (C) Direct distribution of the net funds recovered to the Estate of Colby Chessey as stated above. Respectfully Submitted, HANDLER, HENNING & ROSENBERG Date: ?? L?9,? Dav H Rosenberg, Esquire I.D No. 20569 31 Market Street P.O. Box 1177 Harrisburg, PA 17101 -1177 (717) 238 - 2000 Attorney for Petitioner -5- VERIFICATION We, Shane M. Chessey and Mary E. Chessey, verify that the statements contained in the foregoing document are true and correct to the best of our knowledge, information and belief. We understand that false statements contained therein are made subject to the penalties of 18 Pa. C. S. §4904 relating to unswom falsification to authorities. Dated: 6 /(145 Dated:_ 6 /I/ 15f Shane M. Chess y Mary E. C ssey Exhibit "A" v '^ a? n P r( p z z C1 N y 16' 2 State of -134aryfand LETTERS OF ADMINISTRATION OF A SMALL ESTATE Estate No. 12804 1 certify that administration of the Estate of COLBY A CHESSEY was granted on the 17th day of December, 1998 to MARY E CHESSEY AND SHANE M CHESSEY as personal representative(s) and the appointment is in effect this 17th day of December, 1998 Will probated ae 0 Intestate estate. . K. a ?- - E Register of Wills for Howard County VALID ONLY IF SEALED WITH THE SEAL OF THE COURT OR THE REGISTER RW 1107 PS-3563 IN THE ORPHANS' COURT FOR (OR) BEFORE THE REGISTER OF WILLS FOR IN THE ESTATE OF: COLBY A CHESSEY ,MARYLAND ESTATE NO: 12804 ORDER FOR SMALL ESTATE Upon the foregoing Petition, it is this 17TH day of DECEMBER 1998 , by the Register of Wills ordered that: 1. The estate of COLBY A CHESSEY shall be administered as a small estate. 2. MARY E CHESSEY AND SHANE M CHESSEY s a serve as persona represen a Ide(s). 3. The personal representative shall pay fees due the register, expenses of administration, allowable funeral expenses, and statutory family allowances, and, if necessary, sell property of the decedent in order to pay them. 4. The will dated (including codicils, if any, dated ) accompanying the petition is: admitted to probate; or retained on file only. 5. Publication is: 66 not required; or C] required and Notice of Appointment shall be published once in a newspaper of general circulation in the county. 6. When publication is required, the personal representative shall, subject to the statutory order of priorities and the resolution of disputed claims by the parties or by the court: (a) pay all proper claims, expenses, and allowance; nui Plcvlcusiy paid; (b) if necessary, sell property of the estate in order m oo so, (u) uibtribute Vie remaining properly of the estate in accordance with the will or, if none, with the intestacy laws of this State; and (d) file a certificate of compliance with the register pursuant to Rule 6-211 within 60 days after the expiration of the time for filing claims. Register of Wills This order does not constitute letters of administration and does not authorize the transfer of assets. I hereby certify that on this 17TH day of DECEMBER , 1998 , I delivered or mailed, postage SHANE M H SEY prepaid, a copy of the forgoing Order to MARY E CHESSEY 9763 LADY SLIPPER CT APT. 1 B LAUREL, MD 20723 9763 LADY SLIPPER CT APT. 1B LAUREL, MD 20723 { TJ ?t (r HAR B B egisler of Wills Howard County Personal Representative(s). RW 1108 Re,,%ee 7192 ?C.'ISF.c Exhibit "B" Ilyi 13i ?I `.I'?`.? ?I'd: i•1 tl.lj la 14411jh _.? -"'- VEH, LIEN, DISC POLICY: 299 7280-F24-20F CHESSEY, MARY E 6 SHANE 9763 LADY SLIPPER CT APT 1B NAUREL, MD 20723-6341 "VEHICLE SUMMARY" II_II l1' AMIIlA tiF 1f R? JANUARY 04, 1999 PAGFF '01 AGENT COPY AGENT: P656/9190 PHONE: (11) 301-317-9647 94 DODGE SPIRIT 4DR VIN: 3B3AA4631RT293306 IRG: 018 CLASS: 1F0050 OXD: 06/24/1986 COV: A 100/300/100, P10000, D, G250, H, R1, U 100/300/100, S AFD 20t $81.12, PASS REST 20% 8.40. Ef£ date: (01/04/99) Curr date: (01/04/99) Time- (02:50 PM) SFPP#:0362588521 vnxnve...ov xvxvvevxc___xxxxxxv_vovv.anna.vax ..... x_n----......se=vxxxxn...... v.. •+VRHICLE'+ ) Year: (1998) VIN:(1B4HS28Y3WFI63425) IRG: (029) odometer: (424 Veh Descr':(DODGE DURANGO 4WD ) Date purch:(01/04/99) Modified? (N) Prior dmg:(N) •*LIENHOLDB:R•" CHANGED Lienholder name and address **NO CLASS CHANGE" •*DISCOUNTS•• Passive r-estr disc: (30)% ANTHONY F AMOIA 301-498-7'737 INITIALS(SB ) (N) (AMERICREDIT FINANCIAL SERVICES) (N) (INSURANCE SERVICE CENTER ) (A) (PO BOX 742137 ) ( ) ( 1 CITY:(DALLAS ) ST: (TX) ZIP: (75374-2137) Post-W Fax Note 7671 ewr, ?1 a v ? * To :J ??D ? U from ?, ce.v.plaS i co Co. oro . Ph .I I - 3 U Slat- Farm Mulual AulombbJa Insurance Company One Stale Farm Onvu _ Frederick MD 21109 POLICY NUMBER _ 2997280 F2420F DEC 2419981. JUN 24 1999 C9C9 55EE ``tyyt FFEE [[55 FF224B -9190 A LAU EL LA11110 2072 -6741APr IB Your premlum la beside, IM rallowing...11 .1 .."An" confacr yourr 1994 DODGE SPIRIT VIN 3B3AA4631RT293306 Gus IF00501 Urlvars of vehicle In your household... Thera are no male or unm vni d Tamale driven under age 25 Ordinary use of vehicle,,. To and from work or school, ova, 100 Was weekly Driven over 7,500 mdes annually (National average a 10,000 m4ee annually ) Additional informstimi . This Policy expires on the data due it premium b not paid. AL) IU f4ENLWAL 1994 DODGE SPIRIT •.,? Ready Injury I OO.000 JOO,000 Proporlyy Damao 100,000 P3 No-Fa 1110 00? 160.00 u , D Com aihensivo 3336 66 ,.011 G 2508oducUDle Colliton 111.60 H Emargency Read Sann.. 2.00 RI Car RentallTrovel Expense 9.50 U Uninuuad Motor Vehicle Bodily Injury 100,000130D,Ooo Property Damage 100,000 26.20 S Death Indemnity 2,40 Amount Due 0433,06 Your premium has already been adrysted by the Wflomng. Premium Reductions At Ba n 11.40 Accide t Free 88.12 The following list of divan is shown for informatlcnal Purposes only and does not extend or expand coverage beyond that contained in this automobile panty Our records indicate the Persons listed below ma the only licensed driven reported to us MARY CHESSEY, SHANE CHESSEY If the above informolwn a Inacounle or incomplete, please contact your agent Immediately to make correction. Ehazod on your driving record, you have our aaoldent•frse discount for preferred customers, / R4+?f'?ir ? utdFiroc r?ar.. TONY AMOIA ° Sri nvenallda W inoport nflnbrmaWn. .: .,.., (301)49B-7737 or (301)4987738 Plaaas ASeP Orly part brYOUrrswrd. Prepared NOV 181998 - ADDED OR HAVE MOVED, PLEASE COi COIK}TACT YOUR AO[UIM -- . '- . PLEASE RENRNTHnp"Y's' HYOUR INSURED CHESSEY, MARY E 6 SHANE CHECK MADE PAYABLE TO STATE FARM 1 DATE DUE PLEASE PAY TN. AMOUNT J OLICY NUMBER 2997260-F24-20F 1894 DODGE DEC 241998 $433.06 Please contact your Slate Farm agent to make changes to your policy. T. 2109901152 State Farm Insurance Companies 2248 REP DT %1.18.98 PPOT 02.02.99 9199656 2;1r did ?w F MUTL VOL 30021853 459835800043306 720200299728011121) t r r ': Exhibit "C" AFFIDAVIT OF INSURANCE COVERAGE My name is George R. Pierce, Jr. , and 1 l:;• i,!.. ; Market Street, Dauphin, Pennsylvania 17018. On November 27, 1998, I was involved in a mot%r -;;Meta; collision in which Mary Elizabeth Chessey was the .Ir i. •-r. t!;.. other vehicle. I understand that a claim is being n1,,i by Mr. and Mrs. Shane Chessey indi•:idually and on beha. ;; ;_: Chessey and the Estate of Colby Chessey, for an amount that 'is J-- excess of the limits of the automobile insurance policy Nationwide Insurance Company. These limits are $100,0^0,^0 damages caused to any one person in a vehicular accident an:; $300,000.00 for the entire claim. I CERTIFY that I am not covered by any other ir.suranc_- policy, whether it be an excess policy or an umbrella colicp 0 --- otherwise which would provide additional coverage for damacl.s Mr, and Mrs. Shane Chessey, Michael Chessey and the Estate of Colby Chessey as a result of this accident. I FURTHER CERTIFY that, at the time of the acci an _ was not acting on behalf of my employer in any manner. I UNDERSTAND that I am giving this Affidavit to induce Mr. and Mrs. Shane Chessey to accept the policy limits of m-r :Zbo•,e_ named insurance policy, in full settlement of the claim against me. I further understand that they are relying on this information in making their decision to accept such settlement. I VERIFY that the statements in this Affidavit are true and correct. I understand that false atements herein are mad= subject to the penalties of 18 Pa. C.S. 4903, rel ing to falsa swearing. (SEAL) G rge R. Pie e, Jr. Sworn and subscribed before me this ' day of _Murl? 1999. otary Public My commission expires Jobn P FeVOw. Notary Pubic Silver Spring Twp Cumberland County My Cor<imiss,on 5 pues AucJ. 27. 2001 t: o11ne5 Memt!ci :. ° .'::. it iapnn Of Exhibit "D" t Subscriber Patient Contract Group No. Group Name Services Provided ICU /Peds Pharmacy IV Therapy Med-Sur Supplies Laboratory/Lab Dx X-Ray DX X-Ray/Chest CT Scan/Head CT San/Body Blood/Admin Respiratory SVC Drugs/Detail Code TOTALS Capital BlueCress but % PA 17177 .ro..rr. rrns... ....ties Shane Chessey Colby Chessey 851050298 000003000 Federal Provider Charges 1725.00 69.60 73.00 557.00 508.00 225.00 138.00 1071.00 1504.00 381.00 1236.00 96.00 7583.60 'ACTUAL AMOUNT PAID $5325.36 EXPLANATION OF PLUG CROSS BENEMS THIS IS NOT A BILL This is a bm of alstament for the peUant noted If you haw any questlotle, please cohtner your dearest EWe Clow ofAOe. Locations are noted on the reverse atde. Claim Provider Type of service Service Date(s) Blue Cross Benefits 1725.00 69.60 73.00 557.00 508.00 225.00 138.00 1071.00 1504.00 381.00 1236.00 96.00 7583.60' 0719922 Hershey Medical Center Inpatient 11/27/1998 Non-Covered Remarks Charges Code THIS IS A COPY OF THE ORIGINAL EOB Exhibit "E" CONTINGENT FEE AGREEMENT 5hmL KNOW ALL MEN BY THESE PRESENTS, that I, feel and Mary Elizabeth Chessey, natural parent/guardian of Colby Chessey, do hereby retain HANDLER, WIENER, HENNING and ROSENBERG, of Harrisburg, Pennsylvania, as my attorneys in this matter to represent me and to process, negotiate and/or arbitrate a settlement or to institute for me in my name any legal proceedings or actions that, in their judgment are necessary, against George R. Pierce, Jr. and all individuals as a result of any and all injuries or damages sustained by Colby Chessey in an incident that occurred on 11-27-98. I agree not settle, negotiate or adjust the above claim or any proceedings based thereon without the written consent of my said attorneys. NOW, THEREFORE, in consideration of the services so to be rendered by Handler, Wiener, Henning & Rosenberg, I hereby covenant, promise and agree to pay them for their professional services rendered, THIRTY-THREE AND ONE-THIRD PERCENT (33 1/3%) of whatever sum is recovered as a result of settlement without suit; or FORTY PERCENT (40%) in the event of arbitration, mediation or if suit if filed. I will reimburse Handier, Wiener, Henning and Rosenberg for any necessary expense and costs advanced on my behalf in pursuing my claim. Counsel reserves the right to withdraw if, after complete investigation, they determine that there is no merit to the claim. I ACKNOWLEDGE that I have read, approved and understood the above Contingent Fee Agreement and Power of Attorney and I acknowledge having received a copy of the same. The terms set forth are accepted. IN WITNESS WHEREOF, I have hereunto set my hand and seal this e191 day of 1998. (SEAL) Shane Chessey --- Natural parent/guar 2an of Colby Chessey '1'1?,?., ?_? >> ile4l.?' SSF'\ (SEAL) abe li Mary kz Chessey Natural parent/guardian of Colby Chessey 1 •J ?J. J ? 1 t\ / \ n I" 1 1,>. T T vv ? I I O Q O _ P _y J Co'f`]I ml\ I\? O Q <? 26 Y L Q c W O CI N n rrww O vJ oe p, Oo a .`O ~ = L Q T