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HomeMy WebLinkAbout99-06984 NOV 2 2 199 Kessler, Cohen, & Roth A Professional Corporation By: WILLIAM D. MARVIN, ESQUIRE Identification No. 34265 1705 Two Penn Center Plaza Philadelphia, PA 19102 (215) 567-3500 KRISTINE GULICK, a minor, by her mother and natural guardian, KELLEY FUSSSENEGGER, and KELLEY FUSSENEGER, Individually V. TRAVELERS INSURANCE COMPANY ATTORNEY FOR PLAINTIFFS COURT OF COMMON PLEAS OF CUMBERLAND COUNTY No. (CI ORDER ,,, ?,.?/ 4A AND NOVI, thisdq day of I yr& ? , 1999, upon consideration of the Petition for Approval and Leave to Settle or compromise a Minor's action, it is hereby ORDERED and DECREED that: 1. The settlement of the Uninsured Motorist claim by petitioners against respondent Travelers Insurance company, successor to Aetna, as set forth in the within Petition, having a gross present day value of $100,000.00 is APPROVED. 2. Petitioner Kelley Fussenegger and her counsel are granted leave to enter into the proposed settlement on behalf of the Minor, Kristine Gulick, and may execute the Release in the form attached to the Petition. ?;rr 99 CUB.:.... , ?,...: I 3. Respondent Travelers Insurance Company is directed to make disbursements as follows: (a) An Annuity having a present day value of $73,300.00 is to be purchased to provide the following benefits to, and/or on behalf of Kristine Gulick: 1) On August 31, 2004 (age 18), a payment of $10,000.00; 2) On August 31, 2007 (age 21), a payment of $20,000.00; 3) On August 31, 2010 (age 24), a payment of $30,000.00; 4) On August 31, 2013 (age 27), a payment of $45,000.00; 5) On August 31, 2017 (age 30), a payment of $62,650.00. (b) The sum of $1,700.00 to Kessler, Cohen, & Roth, P.C. as reimbursement of litigation expenses. (c) The sum of $25,000.00 to Kessler, Cohen, & Roth, P.C. representing a 25% contingency fee. 4. An Affidavit of Compliance with this order shall be filed with the Court within thirty (30) days. DATE: BY TH OURT: J. , Kessler, Cohen, & Roth A Professional Corporation By: PIILLIAM D. MARVIN, ESQUIRE Identification No. 34265 1705 Two Penn Center Plaza Philadelphia, PA 19102 (215) 567-3500 ATTORNEY FOR PLAINTIFFS KRISTINE GULICK, a minor, by her COURT OF COMMON PLEAS OF CUMBERLAND COUNTY mother and natural guardian, KELLEY FUSSENEGGER, and KELLEY TLa•? FUSSENEGGER, Individually No 179 69;"' L+_,,.,,z v. TRAVELERS INSURANCE COMPANY PETITION FOR LEAVE TO SETTLE OR COMPROMISE. A MINOR'S ACTION TO THE HONORABLE, THE JUDGES OF SAID COURT: Petitioner, KELLEY FUSSENEGGER, as parent and natural guardian of KRISTINE GULICK, a minor, and in her own right, by her attorneys, Kessler, Cohen, & Roth, P.C., respectfully requests that this Court approve the settlement of the within matter and the distribution of proceeds and in support thereof avers as follows: 1. Petitioner KELLEY FUSSENEGGER, a competent adult, is the minor's mother and natural guardian, and represents the interests of the minor in this action. 2. The minor, KRISTINE GULICK, was born on August 31, 1986, and is 13 years old. Now and at all relevant times, the minor has resided with her mother, the IE r? Petitioner, and her stepfather, Eric Fussenegger, at 606 York Circle, Mechanicsburg, Pennsylvania. 3. As described more fully below, this is a claim for Uninsured Motorist benefits, arising from personal injuries sustained by the minor, Kristine Gulick, in a motor vehicle accident on October 27, 1996. 4. on the accident date, the minor, Kristine Gulick, was a passenger in a motor vehicle being operated by her father, Larry Gulick (Mrs. Fussenegger's former husband), during weekend visitation. 5. The accident occurred when the motor vehicle operated by Mr. Gulick was proceeding northbound on Park Drive in Southampton Township, Cumberland County, Pennsylvania, just north of its intersection with Red Tank Road. The car failed to negotiate a curve and went off the paved surface and rolled over, inflicting serious personal injuries and economic losses on the minor. 6. Larry Gulick was not injured in the crash, but died suddenly in September 1998 from unrelated causes. Thus, petitioner Kelley Fussenegger, as the surviving parent, has sole legal and physical custody of Kristine. 7. After Mr. Gulick's death, this Court appointed his mother (Kristine's paternal grandmother) to administer his insolvent estate under the small estates provisions of the probate law. [Exhibit A]. Petitioners are satisfied that Mr. Gulick's estate is insolvent and have no interest in administering same or pursuing further claims against the estate's assets on behalf of the minor. 8. Kristine Gulick sustained multiple lacerations, avulsions, and destruction of the skin and subcutaneous tissues of both arms and her face and head, requiring emergency surgery, skin grafting, suturing, and repeated painful procedures. She has scarring on both arms and her face, as well as donor sites, with continuing severe disfigurement, which may be permanent. 9. The vehicle involved in this one-car accident had been purchased by Mr. Gulick for resale through his used car business, but had not yet been delivered to the prospective buyer. 10. Mr. Gulick had a business insurance policy through Pennsylvania General which provided $1,000,000 in liability coverage. 11. However, after receiving notice of the claim on behalf of the minor, Pennsylvania General reserved its, rights and disclaimed coverage, asserting that the dealer tag mounted on the accident vehicle was not listed on the policy endorsement for dealer tags, and the vehicle did not otherwise qualify as an insured auto under the policy. [Disclaimer letter, Exhibit B]. 12. Mr. Gulick did not own any other vehicles for his personal use and had no applicable source of motor vehicle financial responsibility insurance other than the Pennsylvania General policy. 13. Pennsylvania General filed a declaratory judgment action in this Court against the Petitioners, as well as Mr. Gulick and Cynthia Jumper. Ms. Jumper was a named insured on Mr. Gulick's Pennsylvania General policy and was the prospective purchaser of the vehicle. Pennsylvania General Insurance v. Larry G. Gulick, Jr., Cynthia K. Jumper, Kristine's Auto Sales And Kristine Gulick, a Minor, C. P. Cumberland County, No. 97-2889. That action remains pending. 14. Petitioners have been represented by Joseph L. Romano, of Joseph L. Romano, P.C. (formerly of Rosenstein & Romano, P.C.), and the firm of Kessler, Cohen & Roth, P.C. since shortly after the accident. In the declaratory judgment case, Petitioners' counsel has thoroughly investigated and litigated the matter, including the filing of an Answer, New Matter, and Counterclaim. Petitioners filed a Motion for Summary Judgment in that action, seeking a declaration of coverage. This Motion was denied by the ( Court, on the Court's finding that genuine issues of material fact existed regarding the ownership and use of the motor vehicle at the time of the accident. 15. Petitioners filed a civil action against Kristine's father, Mr. Gulick, in order to preserve her rights to insurance coverage, if available, and to toll the limitations period. That case was transferred to this Court from the Common Pleas Court of Philadelphia County. That action remains pending. Pennsylvania General defended Mr. Gulick in that matter under a reservation of rights. Present counsel also represented the Petitioners in that action. 16. At the time of the accident, Kristine Gulick was insured for first-party benefits under the Fusseneggers' own policy of automobile insurance with Aetna, now Travelers. Aetna paid its limit of $10,000 in first-party benefits towards Kristine's medical expenses, and the remainder of her expenses have been covered under the family's group health plan. Under the Motor Vehicle Financial Responsibility Law, these expenses and insurance payments are not recoverable through this action and thus there is no subrogation lien. [A copy of the Declarations Sheet is attached as Exhibit C]. 17. Pennsylvania General's disclaimer to Mr. Gulick triggered Uninsured Motorist coverage under the Aetna/Travelers policy. Petitioners believe that even if Pennsylvania General would cover Mr. Gulick's liability up to the $1,000,000 limit of that policy, Travelers would still be obligated to pay $100,000 as Underinsured Motorist benefits because of the magnitude of Kristine's injuries. 18. Travelers has reviewed the facts and the status of this matter, and offered to pay its total limit of $100,000 to settle the minor's claim for Uninsured Motorist and/or Underinsured Motorist benefits. This amount represents stacked coverage of $50,000 for each of two vehicles owned by the Fusseneggers at the time of the accident. 19. Travelers has also confirmed that it has no interest in prosecuting the pending claims against Larry Gulick and Pennsylvania General, and thus has waived potential subrogation rights. 20. After consultation with counsel, Petitioners wish to accept a proposed structured settlement which will provide a series of guaranteed, tax-free lump sum payments to Kristine, at 3-year intervals, starting when she reaches her majority at age 18. The proposed schedule of payments is as follows: a) On August 31, 2004 b) On August 31, 2007 c) On August 31, 2010 d) On August 31, 2013 e) On August 31, 2017 21. The total of these pa Kristine Gulick is $167,650. 22. The lump sum payments (age 18), $10,000.00; (age 21), $20,000.00; (age 24), $30,000.00; (age 27), $45,000.00; (age 30), $62,650.00. yments to be made to described in the preceding paragraph shall be paid through one or more annuity contracts issued by Travelers Insurance Company, which has over 4 Billion Dollars in assets, an A+ rating from A.M. Best & Co. and "Excellent" ratings from other services. 23. The purchase price of this annuity, $73,300, has been locked in with Travelers, through Ringler Associates, an independent structured settlement consultant. Petitioners' counsel has independently calculated the rate of return and found that it represents approximately 6.44%, a favorable rate for a tax-free, secure investment. 24. Petitioners entered into a contingent fee agreement with counsel which provided for a fee of one/third of any recovery, plus reimbursement of costs. [Exhibit D1. 25. In order to provide greater benefits to the minor, in view of the tragic intervening death of her father and the possibility that no other assets or insurance coverage will be available, counsel for the petitioners have agreed to reduce their fee to 25% of the total recovery, plus reimbursement of costs. 26. Counsel for the plaintiffs request reimbursement of $1,700.00 in litigation costs incurred in representing the petitioners in all the matters described above. This amount is less than their actual outlay, summarized as follows: Deposition transcripts: $ 963.80 Medical records and other copying expenses: 333.48 Filing fees: 377.25 Travel expenses (reduced): 25.47 TOTAL: 51.700.00 27. An attorney's fee in the amount of $ 25,000.00, representing 1/4 of the present cash value of the settlement, to Kessler, Cohen, & Roth, P.C. in this matter, is requested and is provided for in the proposed distribution. To gather evidence of liability and damages, and litigate the declaratory judgment action, which was necessary to trigger the right to UM/UIM benefits, counsel engaged in extensive investigation and discovery. Counsel met and conferred with numerous witnesses, to develop the theories of liability and coverage These services took place with respect to the pending declaratory judgment action filed by Pennsylvania General, the civil action against Mr. Gulick, and the presentation and negotiation of this UM/UIM claim. 28. The Petitioners and Travelers have memorialized their consent to this agreement in the form of a Release, conditioned on this Court's approval. [Exhibit E]. 29. After discussing the proposed settlement with counsel, Petitioners believe and therefore aver that such settlement is in the best interests of the minor, Kristine Gulick. Attached hereto as Exhibit F is the Verified Statement of Petitioner, Kelley Fussenegger. 30. Counsel is of the professional opinion that the proposed settlement is reasonable and will help meet the future needs of the minor, Kristine Gulick. Counsel is experienced with the handling of these types of matters and in counsel's experience, this settlement represents a fair and reasonable settlement. This settlement constitutes recovery of the full amount of available insurance proceeds from Travelers' UM/UIM coverage without any discount, will resolve any uncertainty or risk as to these proceeds, and provides a substantial fund to provide for Kristine Gulick's needs in the future. 31. Counsel has not received any collateral payments as counsel fee for representation, or reimbursement of expenses, from any other source arising from this incident. 32. This Court has jurisdiction to approve the proposed settlement and distribution pursuant to Pa.R.Civ.P. 2039(b) (3), where all payments from the structures settlement will be made after the minor reaches adulthood. 33. Petitioner Kelley Fussenegger requests that she be permitted to execute the Release Agreement and enter the settlement recited above, and the court direct distribution as follows: (a) An Annuity having a present day value of $73,300.00 is to be purchased to provide the following benefits to, and/or on behalf of Kristine Gulick: 1) On August 31, $10,000.00; 2) On August 31, $20,000.00; 3) On August 31, $30,000.00; 4) On August 31, $45,000.00; 5) On August 31, $62,650.00. 2004 (age 18), a payment of 2007 (age 21), a payment of 2010 (age 24), a payment of 2013 (age 27), a payment of 2017 (age 30), a payment of (b) The sum of $1,700.00 to Kessler, Cohen, & Roth, P.C. as reimbursement of litigation expenses. (c) The sum of $25,000.00 to Kessler, Cohen, & Roth, P.C. representing a 25% contingency fee. oners respectfully request that the lement and enter an order in the form KESSLER, COHEN, & ROTH, A Professional Corporation r' BY: WILLIAM D. MARVIN ATTORNEY FOR PETITIONERS r,, • ??? Y'i ? .. i ?:, 4"`u I' i ?? ?I I' { I?. f?y ? ?, ? ?. ? (. it i'? R .1" i ;:.; .ti =< I' 't _ ?. l;, .. 717-243-6466 SRIDIS GUIDO SNUFF ..a/ - If a t, 261 P02 MAY 14 '99 08:?o r LCU Ir ? ?:; c. r. DECREE p AND NOW, this 5513 day of gelc- 1999 , upon consideration of the annexed petition of Toni Marie Gulick, mother of the deceased, and pursuant to 20 Pa. C.S. 53102, it is hereby ordered and decreed that the assets of Larry Gulick, Jr., decedent, be paid to Toni Marie Gulick, mother of the deceased, to distribute the estate in accordance with 20 Pa. C.S. 53392. BY THE COURT, J. I A TPUZ COPY FFKW RECOAD In l henpinto vA my hand g.nr? „e:•+, r :i1...;id CCCxf?'-t(?ti carllulo, PA EL ?` - Cumberland County J 1® PETITION FOR DISTRIBUTION PURSUANT TO 20 Pa. C.S. 93102 AND LOCAL RULE TO THE HONORABLE JUDGES OF THE ORPHANS COURT DIVISION OF CUMBERLAND COUNTY: The Petition of Toni Gulick respectfully states: 1. Larry Gulick, Jr. died on the 2nd day of September, 1998, domiciled at 1645 Trindle Road, Carlisle, Pennsylvania. 2. Petitioner is Toni Gulick, who resides at 6301 Chesterfield Lane, Mechanicsburg, Pennsylvania, the mother of the Decedent, who was not a member of Decedent's household at the date of Decedent's death. 3. Larry Gulick, Jr. died intestate and no Letters of Administration have been granted. 4. Decedent was not married at the time of his death. 5. The Decedent was survived by a daughter, Kristine, age 12, who is the sole heir of his estate. However, the estate is insolvent and there will be no distribution to the minor daughter. 6. The Decedent's property consisted of the following: a. Ten (lOg) percent of the shares of C & L Auto Sales and Service, Inc. $ 500.00 b. Personal effects 1.000 00 Total $1,500.00 7. Payments made prior to the filing of this petition are, as follows: a. Myers Funeral Home, Mechanicsburg, PA $5,600.00 b. Fenstermacher and Associates, P.C. , legal retainer 1,000.00 c. Rolling Green Cemetery Company 2,255.00 Total $8,255.00 8. All bills as aforesaid have been paid by the Decedent' s parents, Toni Marie Gulick and Larry Gulick, Sr. .9. All of the following claims are unpaid at this time and are a dmitted by Petitioner: a. PP&L, electric bill $260.04 b. Masland Associates, medical bill 42.00 c. Carlisle Community Ambulance 308.00 d. Moffit, Pease & Lim Associates, medical bill 30.00 e. Belvedere Medical Corporation , medical consult 100.00 2 f. Penn Credit Corporation on behalf of RWC Emergency Physicians 96.00 g. Chambersburg Hospital, medical bill 233.00 h. Carlisle Advanced Life Support 396.76 i. Carlisle Hospital 219.00 j. Carlisle Hospital 60.00 k. Fenstermacher and Associates, P.C., legal fees, costs and expenses of administration 500.00 Total $2,244.80 10. No Inheritance Tax Return has been filed, but will be filed within nine months from the date of death. Respectfully submitted, By: ?j??, VN-\ Ci'; , "Q k Toni Marie Gulic fcj DATED: ?? ?(yl9$ 3 VERIFICATION I, Toni Marie Gulick, hereby certify and verify that the facts set forth in the foregoing Petition for Distribution are true and correct to the best of my knowledge, information and belief. I understand that any false statements herein are subject to the penalties of 18 Pa. C. S. §4904 relating to unsworn falsification to authorities. Toni Marie Gulick DATE : ??/?j IqB BEFORE THE REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA IN RE: ESTATE OF LARRY GULICK, JR. CERTIFICATE a. I, David A. Jones, II, Esquire, attorney for Petitioner, hereby certify that the Notice of Intention to Petition for Distribution Pursuant to 20 Pa. C.S. served upon all creditors of the above referenced b. c received. A copy of the Notice of Intent is attach, No objection to the filing of-the Petiti4 DATED: It /13'98 A I. D vid A. Ones, Attorney for Pet NOTICE OF INTENTION TO PETITION FOR DISTRIBUTION PURSUANT TO 20 Pa. C.S. §3102 BEFORE THE REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA IN RE: ESTATE OF LARRY GULICK, JR. Notice is hereby given of Petitioner's intention to, after the expiration of ten days, submit a Petition for Distribution of the Estate of Larry Gulick, Jr., late of 1645 Trindle Road, Carlisle, Pennsylvania 17013. Decedent died intestate on September 2, 1998, in Carlisle, Pennsylvania. Petitioner is Toni Marie Gulick, mother of Decedent, with an address of 6301 Chesterfield Lane, Mechanicsburg, Pennsylvania. Counsel for the Estate is the Offices of Fenstermacher and Associates, P.C., 5115 East.Trindle Road, Mechanicsburg, PA 17055. Additional information can be obtained from above counsel. E B I i. I i? 1 1 . e#l i . s i General Accident Insurance Co. P.O. Box 8351 100 Corporate Center Drive Camp Hill, PA 17001-8851 717-763-7331 May 5, 1997 Certified and Regular Mail Kristine's Auto Sales Larry G. Gulick. Jr. & Cynthia K. Jumper 1645 Trindle Road Carlisle. PA 17013 RE: Claim: 636 51421 AD Insured: Kristine's Auto Sales Larry G. Gulick, Jr. & Cynthia K. Jumper Date of Loss: October 27, 1996 Policv No: G0227651-00 Dear Mr. Gulick & Ms. Jumper: We acknowledge the report of the above captioned incident. This is notice that General Accident is reserving its rights to decline coverage and/or indemnity and/or defense of this matter. We direct your attention to the terms of the policy of insurance you carry with us, page 3 of 15 which states: "1• WHO IS AN INSURED a. The following are "insureds" for covered "autos": (1) You for any covered "auto". b. The followins are "insureds" for "garage operations" other than covered "autos": (1) You. (2) Your partner, employees, directors or shareholders but only while acting within the scope of their duties." To the extent the claim does not involve an "insured", the policy does not provide coverage and/or an obligation to indemnify or defend you. We also direct your attention to the terms of the policy of insurance you carry with us, page I of IS which states: e= "SECTION 1 - COVERED AUTOS ITEM TWO of the Declarations shows the "autos" that are covered "autos" for each of your coverages. The following numerical symbols describe the "autos" that may be covered "autos". The symbols entered next to a coverage on the Declarations designate the only "autos" that are covered "autos". A. DESCRIPTION OF COVERED AUTO DESIGNATION SYMBOLS SYMBOL DESCRIPTION 27 = SPECIFICALLY DESCRIBED "AUTOS". Only those "autos" described in ITEM SEVEN of the Non-Dealers' and Trailer Dealers' Supplementary Schedule or ITEM NINE of the Dealers' Supplementary Schedule for which a premium charge is shown (and for Liability Coverage any "trailers" you don't own while attached to a power unit described in ITEM SEVEN or ITEM NINE). 28 = HIRED "AUTOS" ONLY. Only those "autos" you lease, hire, rent or borrow. This does not include any "auto" you lease, hire rent or borrow from any of your employees or partners or members of their households. 29 = NON-OWNED "AUTOS" USED IN YOUR GARAGE BUSINESS. Any "auto" you do not own, lease, hire, rent or borrow used in connection with your garage business described in the Declarations. This includes "autos" owned by your employees or partners or members of their households while used in your garage business." The policy of insurance which you carry with us covers symbols 27. 28 & 29 as indicated in Item Two of your Declaration, a copy of which is attached. "Symbol 27 = Specifically Described "Autos"" applies to endorsement CA 20 27 12 93, a copy of which is attached and covers the description of plates F46-5801 F and F46-58OF only. Since the plates on the 1994 Chevrolet Camaro at the time of the accident were not one of the described plates. coverage may not be applied based on Symbol 27. The 1994 Chevrolet Camaro may not be considered a Hired "Auto" as described above for Symbol 28 coverage to apply. Nor does our investgation support the 1994 Chevrolet Camaro as being used in the garage business and therefore. Symbol 29 may not apply. To the extent the claim does not involve a "covered auto", the policy does not provide coverage and/or an obligation to indemnify or defend you. We now direct your attention to "Section II-Liability Coverage" on page 2 of 1.5 which states: "A. COVERAGE l- We will pay all sums an "insured" legally must pay as damages because of "bodily injury" or "property damage" to which this insurance applies caused by an "accident" and resulting from "garage operations" other than the ownership, maintenance or use of covered "autos"....." and "Section VI - Definitions" on page 14 of 15 which states: E. "Garage operations" means the ownership, maintenance or use of locations for garage business and that portion of the roads or other accesses that adjoin these locations. "Garage operations" includes the ownership, maintenance or use of the "autos" indicated in SECTION I of this Coverage Form as covered "autos". "Garage operations" also include all operations necessary or incidental to a garage business. Our investigation currently does not support that this accident resulted from "garage operations" other than ownership, maintenance or use of covered "autos To the extent the claim does not involve an "insured" and/or a "non resultin -covered auto" used in or g from "garage operations", the policy will not provide coverage and/or an obligation to indemnify or defend you. I now direct you back to "Section II - Liability Coverage" on page 2 of 15 which also states: ""GARAGE OPERATIONS" - COVERED "AUTOS" We will pay all sums an "insured" legally must pay as damages because of "bodily injury" or "property damage" to which this insurance applies, caused by an "accident" and resulting from "garage operations" involving the ownership, maintenance or use of covered "autos"......." To the extent the claim does not involve an "insured", a "covered auto" or result tom "garage operations", the policy does not provide coverage and/or an obligation you. to indemnify or defend If you have any questions or any additional information for us to consider, please call Attorney Douglas Nlarcello at (717) 255-7238 May we suggest that you consider referring this matter to your counsel for review at your own expense. Sincerely, Dee Benner Claims Representative cc: Christian Baker Co. 427622 i . Number Automobile Policy Policy233SY0017850239PCS Annual Effect" Cato Renewal Declarations 10/01/96 Policy Perron THE STANDARD FIRE INSURANCE COMPANY HARTFORD CT 06156 NUTTER AGENCY INC PO BOX 2424 MECHANICSBURG PA 17055 717-766.0281 From: 10/01/96 TO: 04/01/97 12:01 A.M. Standard Time Declaration Number Effect" Date 065 10/01/96 INSURED COPY This Declarations Page, along with form 16290-B and the following policy provision forms, completes this policy. This policy provides only those coverages for which a premium is shown below. Named Insured ERIC E & KELLY LYNN FUSSENEGGER and Address I MEHANCSBURG PA 17055 'ull Tenn Total Policy Premium remium Charge $588.00 Transaction rremfum Limits rerages CAVALE BLAZER and Limits A. Personal Liability 000 $50 588.00 578.00 Each Accident , Other Than Collision D . DEDUCTIBLE 550.011 ACTUAL CASH VALUE $31.00 $70.00 NU UEUUUI ISLE ACTUAL CASH VALUE Collision DEDUCIBLE $500.00 ACTUAL CASH VALUE S68.00 $114.00 Coverages only apply where a premium is shown. Other Coverages Underinsured Motorist Stackin Each Accident $50,000 532.00 $32.00 Uninsured Motorist Stacking $50,000 $19.00 $19.00 Each Accident First Party Benefits Coverage $20.00 $17.00 See Endorsement 18377-D Policy Credits Passive Restraint Credit Multi Car Discount FAccount Credit INCL INGL INCL INCL INCL INCL tion of D escescr ipip Name Binh Date 90 CHEV E 95 L;HF-V BLAZER r t' D CAVAL % Use % Use KELLY LYNN FUSSENEGGER 12/22169 10 59 KRISTINE LYNN QULICK 06/31/66 90 41 ERIC E FUSSENEGt?ER 10/12/69 DECLARATION PAGE 1 e or "INDICAT ES CHANGE IIII IIII IIIIII?II?IIIIII?IIIIIIII? I IIII I?III?IIIIII II?IIIII?I 19371 (06.92) II IIIIIIIIIIIIIII?I?IIII I u u Description of Yr Name Model Type VIN Symbol Class . Your Auto(s) 90 CHEV CAVALE 2DR-SED 1G1JF74T1L7125560 10 81122080 R 95 CHEV BLAZER 1GNDT13W1S2125764 17 81112080 R unless otherwise stated, all vehicles are garaged at the named Insured residence. Autos Garaged Elsewhere Forms and Endorsements Loss Payee Special Message(s) This section does not apply to your policy. The following Endorsement(s) are A PART of Your Policy: Form Number Endorsement Name 19175-B Underinsured Motorists Coverage Pennsylvania (Stacking) 16030-P Amendment of Personal Auto Policy Pennsylvania # 17085-E Surcharge Plan Disclosure Form Pennsylvania 18377-D First Parry Benefits Coverage Pennsylvania $10,000 Medical Expense Limit 85,000/ $1,000 Income Loss Limit (Maximum Umit/Monthly Max) 81,500 Funeral Expense Limit 19173-8 Uninsured Motorists Coverage Pennsylvania (Stacking) Other optional coverages are available; please contact your agent for more information. Name and Address Auto Due Date GMACC BR#062 95 CHEV 00/00/00 P.O.BOX 2525 HUDSON OH 44235-0000 Full Tort Coverage applies. See attached 'IMPORTANT NOTICE PN10181-PA' regarding: Pennsylvania Premium Discounts Available, RENTAL CAR INFORMATION, and Warning Notice for Motor Vehicle Insurance Fraud. Loss Payee Loss or damage under this policy shall be paid as interest may appear to you and the loss payee shown in Clause the Declarations. This insurance with respect to the interest of the loss payee shall not become invalid because of your fraudulent acts or omissions unless the loss results from your conversion, secretion or embezzlement of your covered auto. However, we reserve the right to cancel the policy as permitted by policy terms and the cancellation shall terminate this agreement as to the loss payee's interest. We will give the loss payee 10 days notice of cancellation. When we pay the loss payee for loss for which you are not covered we shall, to the extent of our payment, be subrogated to the loss payee's rights of recovery against you. 't LAST PAGE DECLARATION PAGE 2 ;< ;?s ir'? ??.. CONTINGENT FEE AGREEMENT Date I/We hereby constitute, appoint and retain the law firm of ROSENSTEIN & ROMANO, P.C., Joseph L. Romano, Esquire, as my/our attorneys to prosecute a claim for personal injuries against . Gam- C4eiee ->I- The claimant is ?ifi7 ?v?Srw?un , and the cause of action arose on D?Tvt 7, /5?? I/We hereby agree that the compensation of my/our attorneys for services rendered by them shall be determined as follows: 1) One-Third (1/3) of the fund resulting from said settlement or verdict, plus reimbursement of all legal expenses and costs incurred by counsel and advanced by counsel in my/our behalf. Costs shall be deducted from settlement after any attorney fee is taken. In the event of no recovery on my/our behalf, counsel is to have no claim against me/us as a fee for services rendered or for legal expenses and costs expended. In the event that there are any unpaid balances for treat- ment or services made necessary by the injuries sustained in the accident, I/we hereby authorize my/our attorneys to pay such balances out of the proceeds realized by me/us from settlement or trial of the case. V - .. I/We hereby acknowledge receipt of a duplicate copy of the Contingent Fee Agreement. ame/ &L ?;I GOF l 1 rC Address Ac 1i G 17G DATE: -/±-/f ?i?rl Name Address ROSENSTEI & ROMANp, p,C BY: Jos L. no G.; LAW OFFICES R06EN6TEIN & RONIANO. P.C. 14 31 CMCWaTRCCT ALLCNTOWN. PCN43ILVANIA 191OUa)V1.1 WEST 9MCRC 01IICC CCnTCR CAM. MILL. ACNN9YLVANIA 171711]-.4407 CXCCU TI V C C"ICCO AT O.,,N,, CLO LANCAaTCR..CNNIYLVANIA 17171301.2010 JOSEPH L. ROMANO OIRCCT 0uL:10101 270.7501 DIRCCI IAX:10101 a 79.7000 Mr. Eric Fussenegger 600' York Circle Mechanicsburg, PA 17055 Re: Kristine Gulick Our File No.: 13967J Dear Mr. Fussenegger: 610.279.3900 FAX: 610.279.6269 May 19, 1997 CCNTR000UARC IMILAOCLANIA. ACNNUVLVANIA y 19199...7440 3-a BOULCVARC OW TNC ALLIC] PIT T SOU90... PCNN$y4VANIA ..1.1.71.7700 ...OCN-X BUILDING WILMC!•B.RRC..CNN]VLVANIA 17-71649-.411 This will confirm our conversation of May 16, 1997 where you and your wife agreed to allow Stewart L. Cohen, Esquire of the firm Kessler & Cohen to work with me as co-counsel in this case. There will be no additional fee to you should this case be successful. Mr. Cohen and 2 will be working on this matter jointly as co-counsel. Very yours, & ROMANO, P.C. Jos JLR:tag Kelley Fu sene er j .2 (:1 1 cric Fussenegger QC-; ONE LAFAYETTE PLACE 2 WEST LAFAYETTE STREET NORRISTOWN. PA 19401.4725 Date L/ 5 2t-9-4 Date I ,,1t ?: `,i ,; ,? E ,r'1 ..t. i `.` I i ,? `:; t• (r' 1 Y ,' ,, .. ?. ? .. 1 ? i r ? ,! 1 ,r (? s ::.. _ _. ?, f--- VTINSDRED ROTOR 8T RE ROBE 1 This Settlement Agreement and Release (the "Settlement Agreement") is made and entered into this _, day of . 19 , by and among: "Claimant" - Kelley Fussenegger as parent and natural guardian of Kristine Gulick, a Minor "Insured" - Eric Fussenegger "Insurer" - Travelers Property Casualty Corporation R$OITA-2 A. On or about October 27, 1996, Kristine Gulick was injured in an accident occurring at or near South Middleton Township, Cumberland County, Pennsylvania. Claimant alleges that physical and personal injuries arose out of this accident, and has made a claim seeking monetary damages on account of those injuries. B. Travelers Property Casualty Corporation as the insurer of Eric Fussenegger, would be obligated to pay any claim made or judgment obtained which is covered under the Uninsured Motorist sections of Policy No'. 233SY17850239PCS issued to the Insured. C. The parties desire to enter into this Settlement Agreement in order to provide for certain payments in full settlement and discharge of all claims which have, or might be made, by reason of the incident described in Recital A above, upon the terms and conditions set forth below. i t '-l AGRZFJONT The parties agree as follows: A. In consideration of the payments set forth in "Payments, Sections A and B," Claimant hereby completely releases and forever discharges the Insurer from any and all past, present, or future claims, demands, obligations, actions, causes of action, wrongful death claims, rights, damages, costs, losses of services, expenses and compensation of any nature whatsoever,., whether based on a tort, contract or other theory of recovery, which the Claimant now has, or which may hereafter accrue or otherwise be acquired, on account of, or may in any way grow out of the incident described in Recital A above, including, without limitation, any and all known or unknown claims for bodily and personal injuries to Claimant, or any future wrongful death claim of Claimant's representatives or heirs, which have resulted or may result from said accident. B. This release and discharge shall also apply to Insurer's past, present and future officers, directors, stockholders, attorneys, agents, servants, representatives, employees, subsidiaries, affiliates, partners, predecessors and successors in interest, and assigns and all other persons, firms or corporations with whom any of the former have been, are now, or may hereafter be affiliated. C. This release, on the part of the Claimant, shall be a fully binding and complete settlement between the Claimant and the insurer, and their heirs, assigns and successors. D. The Claimant acknowledges and agrees that the release and discharge set forth above is a general release of her Uninsured Motorist claim. Claimant expressly waives and assumes 2 the risk of any and all claims for damages which exist as of this date, but of which the Claimant does not know or suspect to exist, whether through ignorance, oversight, error, negligence, . or otherwise, and which, if known, would materially affect ClaimantIs decision to enter into this Settlement Agreement. Tha'°-~!< Claimant further agrees that she has accepted payment of the slims specified herein as a complete compromise of matters involving disputed issues of law and fact. Claimant assumes the risk that the facts or law may be other than Claimant believes. It is understood and agreed to by the parties that this settlement is a compromise of a doubtful and disputed claim, and the payments are not to be construed as an admission of liability on the part of the Insurer, by whom liability is expressly denied. PAYMENTS In consideration of the release set forth above, the Insurer agrees to pay to the individual(s) named the sums outlined in Sections A and B below: A. Payments due at the time of settlement as follows to Claimant and her attorney: The sum of $26,700.00 on or before fourteen (14) days from receipt of this fully and properly executed document and approval by the competent Court of local jurisdiction. B. Periodic payments made to Kristine Gulick ("Payee"), according to the schedule as follows (the "Periodic Payments1f): $10,000.00 paid on 08/31/2004; $20,000.00 paid on 08/31/2007; $30,000.00 paid on 08/31/2010; $45,000.00 paid on 08/31/2013; $62,650.00 paid on 08/31/2016. 3 i All sums set forth herein constitute damages on account of personal injuries and/or sickness, within the meaning of Section 104(a)(2) of the Internal Revenue Code of 1986, as amended. PAYERIB RIGHTS TO PAYKENTS Claimant acknowledges that the Periodic Payments cannot be accelerated, deferred, increased or decreased by the Claimant or any Payee; nor shall the Claimant or any Payee have the power to sell, mortgage, encumber, or anticipate the Periodic Payments, or any part thereof, by assignment or otherwise. PAYBEIG BENEFICIARY Any payments to be made after the death of any Payee pursuant to the terms of this Settlement Agreement shall be made to such person or entity as shall be designated in writing by Payee or Payee's guardian while Payee is a Minor to the insurer or the insurer's Assignee. If no person or entity is so designated, or if the person designated is not living at the time of the Payee's death, such payments shall be made to the estate of the Payee. No such designation, nor any revocation thereof, shall be effective unless it is in writing and delivered to the Insurer or the Insurer's Assignee. The designation must be in a form acceptable to the Insurer or the Insurer's Assignee before such payments are made. CONSENT TO A QUALIFIED ASSIGNMENT A. Claimant acknowledges and agrees that the Insurer may make a „qualified assignment" within the meaning of Section 130(c) of the Internal Revenue Code of 1986, as amended, of the insurer's liability to make the Periodic Payments set forth in "Payments, Section B" to Travelers Life and Annuity Company ("the Assignee"). The Assignee's obligation for payment of the 4 Periodic Payments shall be no greater than that of the insurer (whether by judgment or agreement) immediately preceding the assignment of the Periodic Payments obligation. B. Any such assignment, if made, shall be accepted by the Claimant without right of rejection and shall completely release and discharge the Insurer from the Periodic Payments obligation assigned to the Assignee. The Claimant recognizes that the Assignee shall be the sole obligor with respect to the Periodic Payments obligation, and that all other releases with respect to the Periodic Payments obligation that pertain to the liability of the Insurer shall thereupon become final, irrevocable and absolute. RIGHT TO PURCHASE AN ANNUITY The insurer, itself or through its Assignee, reserves the right to fund the liability to make the Periodic Payments through the purchase of an annuity policy from Travelers Insurance Company. The Insurer or the Assignee shall be the sole owner of the annuity policy and shall have all rights of ownership. The Insurer or the Assignee may have Travelers Insurance Company mail payments directly to the Payee(s). The Claimant shall be responsible for maintaining a current mailing address for Payee(s) with Travelers Insurance Company. DISCHARGE of OBLIGATION The obligation of the Insurer and/or Assignee to make each Periodic Payment shall be discharged upon the mailing of a valid check in the amount of such payment to the designated address of the Payee(s) named in "Payments, Section B" of this Settlement Agreement. 5 ff. ATTORNEY-1B rase Each party hereto shall bear all attorney's fees and costs arising from the actions of its own counsel in connection with this Settlement Agreement, the matters and documents referred to herein, and all related matters. REPRESENTATION OF COMPREHENSION OF DO MMNT In entering into this Settlement Agreement the Claimant represents that she has relied upon the advice of her attorney, who is the attorney of her own choice, concerning the legal and. income tax consequences of this Settlement Agreement; that the terms of this Settlement Agreement have been completely read and explained to Claimant by her attorney; and that the terms of this Settlement Agreement are fully understood and voluntarily accepted by Claimant. ARR N'$Y OF CAPACITY TO EXECUTE AOREM(BNT Claimant represents and warrants that no other person or entity has, or has had, any interest in the claims, demands, obligations, or causes of action referred to in this settlement Agreement, except as otherwise set forth herein; that Claimant has the sole right and exclusive authority to execute this Settlement Agreement and receive the sums specified in it; and that Claimant has not sold, assigned, transferred, conveyed or otherwise disposed of any of the claims, demands, obligations or causes of action referred to in this Settlement Agreement. CONFIDENTIALITY The parties agree that neither they nor their attorneys nor representatives shall reveal to anyone, other than as may be mutually agreed to in writing, any of the terms of this 6 settlement Agreement or any of the amounts, numbers or terms and conditions of any sums payable to Payee(s) hereunder. This settlement Agreement shall be construed and interpreted in accordance with the laws of the Commonwealth of Pennsylvania. All parties agree to cooperate fully and execute any and all supplementary documents and to take all additional actions which may be necessary or appropriate to give full force and effect to the basic terms and intent of this Settlement Agreement. ENTIRE_AOREEMENT AND SUCCESSORS IN INTEREST..... _ This Settlement Agreement contains the entire agreement between the Claimant and the Insurer with regard to the matters set forth in it and shall be binding upon-and inure to the benefit of the executors, administrators, personal representatives, heirs, successors and assigns of each. 7 This Settlement Agreement shall become effective immediately following execution by all of the parties and approval by the competent Court of local jurisdiction. Claimant: Kelly Fussenegger as parent and natural guardian of Kristine Gulick, a Minor By: Date: Claimant's Attorney: William Marvin Bv: Date: Insurer: Travelers Property Casualty Corporation By: Date: 8 iI F y?v i s. k% { _I it C I ? f I ) ti l VERIFICATION Kelley Fussennegger, of lawful age, being first duly sworn, does hereby state as follows: 1. I am the natural mother of Kristine Gulick who was born on August 31, 1986. 2. Since her birth Kristine has resided with me, and I have had custody of her since my divorce from her father, Larry Gulick, deceased. 3. Kristine she has continued to live with me at all times after the accident, except when she was hospitalized for several weeks after the accident, and then when she returned to the hospital for additional surgery on numerous occasions. 4. I have reviewed the contents of the Petition for Approval of the settlement with Travelers. All the facts stated there are true and correct to the best of my information and belief. 5. I have reviewed the proposed settlement with Kristine-and my husband. We all agree that it is in her best interests to receive a structured settlement based on the full amount of the policy limits, after paying my attorney fees. f' 6• We have reviewed various distribution schedules which have been offered and concluded that the schedule of increasing lump sum payments at 3 year intervals is in Kristine's best interests. We believe that this will provide the maximum amount of compensation possible, given the coverage limits, for her serious injuries, at times when she will be ahle to use and manage the funds. 7• My husband and I have agreed to waive any claims we may have for out of pocket expense we have expended on Kristine's behalf, to provide more funds for her benefit. 8• I will continue at all times to be involved in the care of my daughter. This Verification is made subject to the Penalties of 18 Pa.C.S.A. §4904, which relates to unsworn falsifications to authorities. Date U-/ L?Ot?/ ?fJ ' KELLEY FJ6SSENIj GGER I ,,,.??cccccc' rr i-: ry a v U J RECEIPT FOR PAYMENT Cumberland County ProL-honotarrY''s Office Receipt Date 11/18/1999 Carlisle, Pa 170 1.3 Receipt Receipt Time 15:48:50 No. 88058 GULICK KRISTINE ETC WS) TRAVEL ERS INSURANCE CO Case Number 1999- 06984 Received of PD ATTY MARVIN RL_ Total Cheep...... + 45.50 Check No. 17390 Total Cash.... + 00 Change ......... . _ Receipt total. = 45.50 ------------- Distribution Of Payment- ------------ ---------------- Transaction Description Payment Amount PETITION 35.00 50 CUMBERLAND CO GENERAL FUND BUREAU OF RECEIPTS AND CONTROL TAX ON PETITION . 00 5 CUMBERLAND CO GENERAL FUND SETTLEMENT . 00 5 BUREAU OF RECE IPTS AND CONTROL JCP FEE . 45.50 r Kessler, Cohen, & Roth A Professional Corporation By: WILLIAM D. MARVIN, ESQUIRE Identification No. 34265 1705 Two Penn Center Plaza Philadelphia, PA 19102 (215) 567-3500 AUG 2 5 2000 ATTORNEY FOR PLAINTIFFS KRISTINE GULICK, a minor, by her COURT OF COMMON PLEAS OF mother and natural guardian, CUMBERLAND COUNTY KELLEY FUSSSENEGGER, and KELLEY FUSSENEGER, Individually V. No. 99-6984 civil TRAVELERS INSURANCE COMPANY AMENDED ORDER T AND NOW, this a day of ?-n 2000, upon consideration of the Petition for Approval and Leave to Settle or Compromise a Minor's action, it is hereby ORDERED and DECREED that: 1. The settlement of the Uninsured Motorist claim by petitioners against respondent Travelers Insurance Company, successor to Aetna, as set forth in the within Petition, having a gross present day value of $100,000.00 is APPROVED. 2. Petitioner Kelley Fussenegger and her counsel are granted leave to enter into the proposed settlement on behalf of the Minor, Kristine Gulick, and may execute the Release in the form attached to the Petition. 1 y 3. Respondent Travelers Insurance Company is directed to make disbursements as follows: (a) An Annuity having a present day value of $73,300.00 is to be purchased to provide the following benefits to, and/or on behalf of Kristine Gulick: 1) On August 31, 2004 $10,000.00; 2) On August 31, 2007 $20,000.00; 3) On August 31, 2010 $30,000.00; 4) On August 31, 2013 $45,000.00; 5) On August 31, 2016 $62,650.00. (age 18), a payment of (age 21), a payment of (age 24), a payment of (age 27), a payment of (age 30), a payment of (b) The sum of $1,700.00 to Kessler, Cohen, & Roth, P.C. as reimbursement of litigation expenses. (c) The sum of $25,000.00 to Kessler, Cohen, & Roth, P.C. representing a 25% contingency fee. 4. An Affidavit of Compliance with this Order shall be filed with the Court within thirty (30) days. DATE : 04/40 BY THE C T: a v O ?q, ^/ jl ? a`:IV LAW OrrICC5 KESSLER, COHEN & ROTH A PROrC5510NAL CORPORATION SUITE 1]05 TWO PENN CENTER PLAZA PHILADELPHIA, PENNSYLVANIA 18102 WILLIAM 0. MARVIN 1x15150)-3500 wJnlQk..s1arcohon. Co., FAX(215)567 8010 la WYGMZ Rasslarcohen. Co. August 21, 2000 Prothonotarv Cumberland County Courthouse One Courthouse Square Carlisle, PA 17103-3387 Re: Kristine Gulick, a minor, v. Travelers Minor's Settlement No. 99-6984 Civil - Cumberland County C.C.P. Dear Sir/Madam: AUG 25 20 With this letter I am submitting an Amended Order to correct a typographical error; I request that you transmit this for the Court's consideration. This letter explains the circumstances; kindly let me know if a formal Motion is necessary. By Order dated November 24, 1999, the Court approved this minor's settlement, which involved a structured settlement with a series of lump sum payouts. We have encountered delay in imniementing this settlement b-?cause of the helared assertion of a lien on the-part of a health insurer. This problem has been resolved, but the insurance carrier issuing the annuity noticed a typographical error in the order as it was submitted to the court. The final payout should be made on August 31, 2016, not 2017. Obviously, the corrected schedule is beneficial to the minor in producing the final payment one year sooner. I am enclosing a copy of the original Order, and an Amended order which contains the correct date. Also enclosed is a letter from Michael Mullen, the annuity consultant representing Travelers, explaining the situation. Prothonotary August 21, 2000 Page 2 If this amendment meets with the Court's approval, I have enclosed self-addressed, stamped envelopes to myself and Mr. Mullen. Thank you for your attention. Respectfully yours, ADM/pc WILLIAM D. MARVIN CC: Michael Mullen Roxanne Youndt, Travelers I Kessler, Cohen, & Roth A Professional Corporation By: WILLIAM D. MARVIN, ESQUIRE Identification No. 34265 1705 Two Penn Center Plaza Philadelphia, PA 19102 (215) 567-3500 KRISTINE GULICK, a minor, by her mother and natural guardian, KELLEY FUSSENEGGER, and KELLEY FUSSENEGGER, Individually V. TRAVELERS INSURANCE COMPANY ATTORNEY FOR PLAINTIFFS COURT OF COMMON PLEAS OF CUMBERLAND COUNTY No. 99-6984 Civil AFFIDAVIT OF COMPLIANCE WITH ORDER APPROVING COMPROMISE OF A MINOR'S ACTION TO THE HONORABLE, THE JUDGES OF SAID COURT: WILLIAM D. MARVIN, attorney for Petitioner, KELLEY FUSSENEGGER, as parent and natural guardian of KRISTINE GULICK, a minor, and in her own right, having been duly sworn, hereby deposes and says: 1. The parties have fully complied with this Court's order approving the settlement. 2. In particular, distribution has been made as follows: (a) an Annuity having a present day value of $73,300.00 was purchased and has been delivered to plaintiff, provide the following benefits to, and/or on behalf of Kristine Gulick: 1) On August 31, 2004 (age 18), a payment of $10,000.00; -. J.. 2) On August 31, 2007 $20,000.00; 3) On August 31, 2010 $30,000.00; 4) On August 31, 2013 $45,000.00; 5) On August 31, 2016 $62,650.00. (age 21), a payment of (age 24), a payment of (age 27), a payment of (age 30), a payment of (b) The sum of $1,700.00 was paid to Kessler, Cohen, & Roth, P.C. as reimbursement of litigation expenses. (c) The sum of $25,000.00 was paid to Kessler, Cohen, & Roth, P.C. representing a 25% contingency fee. 3. Copies of this Affidavit are being served on all parties. DATE : ©61 • 01 '-6yjr Sworn to and subscribed before me this=day aa,?vt??=.. NOTARIAL SEAL SANDRA KELL1' POZANSKI, Nowry Puolic city d Philaiolphia, Phila. County M GOmnll-sion Ez iros in 27, 2002 14 KESSLER, COHEN, & ROTH, A Professional Corporation BY: WILLIAM D. MARVIN ATTORNEY FOR PETITIONERS L _7 u. "CZ l!A 1.L1 U G U . 1