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Home My WebLink About09-17-08Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717)774-1445 ESTATE OF JEAN M. KASUN 1N THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHAN'S COURT DIVISION ~~ W~ NO. 2006-01164 r-=, ~ ~ ~~ ti 4 0 cn -tea v ~. ,.. _; .c- O Pursuant to 20 Pa.C.S.A. §3323, Rebecca A. Clark, Executrix of the Estate of Jean M. Kasun ("Petitioner"), petitions this court for authority to compromise claims on behalf of the Estate of Jean M. Kasun. Petitioner respectfully represents that: 1. Petitioner, Rebecca A. Clark, Executrix, is an adult individual residing at 413 Westchester Glen Carbon, IL 62034. 2. Petitioner was appointed Executrix of the Estate of Jean M. Kasun by Last Will and Testament dated September 14, 1998. 3. The Certificate of Grant of Letters was issued on December 29, 2006 to Petitioner by the Cumberland County Register of Wills. Petitioner qualified and thereafter acted as and is still acting as Executrix of the Estate. 1 ON BEHALF OF ESTATE 4. Jean M. Kasun, decedent, was struck by a vehicle on December 15, 2006 and later passed away on December 20, 2006 in Hershey Medical Center, Hershey, Pennsylvania. 5. The driver of the vehicle which struck Jean M. Kasun was Ms. Melissa L. Eckman. 6. At the time of the incident, Ms. Eckman was insured by Progressive Insurance Company, Policy No. 060578704, with applicable policy limits of $25,000.00. 7. Jennifer Oprosky, Claims Representative of Progressive Insurance, has offered the sum of Twenty-Five Thousand Dollars ($25,000.00), representing policy limits, to the Estate of Jean M. Kasun in exchange for release of all claims against Ms. Eckman, her agents, employees, subsidiaries and affiliates. A true and correct copy of the proposed Full Release of all Claims with Indemnity is attached hereto as Exhibit "A". 8. Petitioner desires to settle the matter pursuant to the terms of the Release attached as Exhibit "A" in exchange for payment of the sum of Twenty-Five Thousand Dollars ($25,000.00). 9. Additionally, at the time of the incident, Jean M. Kasun, decedent, had her own 2 policy of insurance with Erie Insurance Company, Policy No. 010170898169, which carried underinsurance coverage in the maximum amount of $100,000.00. 10. Douglas G. Kocher, Claims Representative of Erie Insurance Company, has offered the sum of One Hundred Thousand Dollars ($100,000.00) to the Estate in exchange for release of all claims of the Estate against Erie Insurance Company. A true and correct copy of the proposed Release and Agreement is attached hereto as Exhibit "B". 11. Petitioner desires to settle the matter pursuant to the terms of the Release attached as Exhibit "B" in exchange for the sum of One Hundred Thousand Dollars ($100,000.00). 12. Jean M. Kasun was not survived by any beneficiary authorized to bring a wrongful death action pursuant to 42 Pa. C.S.A. §8301(b). 13. The beneficiaries of the Estate pursuant to the terms of her Last Will and Testament are Petitioner, David M. Kasun, Cheryl Peoples, Rose K. Hopkins and Pamela K. Grundon. 14. No legal action has been filed arising out of these matters, either by Jean M. 3 Kasun, during her lifetime or by Petitioner. 15. Petitioner further requests Court approval of the amounts paid or payable to counsel with respect to this matter. Counsel fees paid or payable are estimated to be less than Six Thousand Five Hundred Dollars ($6,500.00). 16. As set forth on the attached Certificate of Service, copies of this Petition are being served on all beneficiaries, Erie Insurance Company and Progressive Insurance Company. 17. Petitioner believes that these settlements are in the best interest of the Estate. Additionally, all beneficiaries of the Estate of Jean M. Kasun have been advised of these proposed settlements and concur with same. 18. Petitioner requests this Honorable Court approve this Petition and authorize the proposed settlement pursuant to the terms of the Releases attached hereto as Exhibits "A" and "B", specifically being: 1) Twenty-Five Thousand Dollars ($25,000.00) from Progressive Insurance Company; and 2) One Hundred Thousand Dollars ($100,000.00) from Erie Insurance Company. 19. No judge has been assigned to this matter presently. 4 WHEREFORE, Petitioner requests this Honorable Court issue the proposed Order in the form of a Rule requiring answers attached hereto, and thereafter approve this Petition, authorizing the proposed settlements pursuant to the terms of the Releases attached hereto as Exhibits "A" and "B", specifically being: 1) Twenty-Five Thousand Dollars ($25,000.00) from Progressive Insurance Company, and 2) One Hundred Thousand Dollars ($100,000.00) from Erie Insurance Company. DATE: / / ~`/~ ", 2008 5 Barbara Sumple-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070-1931 (717) 774-1445 Supreme Court I.D. 32317 FULL RELEASE OF ALL CLAYMS 'WY7'H YNDEMNITY Page 1 of 2 KNOW ALL BY THESE PRESENTS, that We, The Estate of Jean Kasen for and in consideration of the sum of Twenty-five thousand dollars and zero cents ($25,000.00), the receipt whereof is hereby acknowledged, do hereby for ourselves, our heirs, executors, admuaistrators, successors and assigns and any and all persons, firms, employers, corporations, associations, or partnerships release, acquit and forever discharge McUssa Eckmaa, her agents, employees, subsidiaries, and affiliates (hereinafter "lZeleasees") from any and all claims, actions, causes of actions, demands, costs, property damage, loss of wages, expenses, hospital medical and nursing expenses, accrued or unaccrued claims for loss of consortium, loss of support or affection, loss of society and companionship on account of or in any way growing out of, any and all ltnown and unkno~uvn personal injuries and damages resulting from an automobile accident which occurred on or about December 15, 2006, at or near Market Street, at Karns Grocery Store, in Lemoyne, Camberl9nd County, Pennsylvania.. It is understood and agreed that this settlement is iz~ full compromise of a doubtful and disputed claim as to both questions of liability and as to the nature and extent of the injuries and damages, and that neither this release, nor the payment pursuant thereto shall be construed as an admission of liability, such being denied. It is further understood and agreed that the undersigned relies wholly upon the undersigned's judgu~ent, belief, and knowledge of the nature, extent, effect, and duration of said injuries and liability therefore and is made without reliance upon any statement or representation of the parry or parties hereby released or their representatives. 7n consideration of the payment of the sum, the undersigned further agrees to indemnify Melissa Eckman, her agents, employees, subsidiaries, and affiliates and save them harmless from any and all further liability, loss, damage, claims of subrogation and expense, arising because of any injuries and damages, sustained by the undersigned, and, if necessary in order to save them so harmless; to satisfy on their behalf any judgment against them arising in any way out of the undersigned injuries or damages, both the indemnification and satisfaction obligations being capped in the aggregate at the amount paid ($25,000.00) pursuant to this release_ I have read this release and understand it_ Signed: Witness date Estate of Jean Kasen Representative date FULL RELEASE OF ALL CLAY1viS WITH INDEMIVIT'SC Page 2 of 2 State of County of On this day of , 2 ,before me personally appeared to me known to be the person(s) who executed the foregoing instrument, and aclmowledged this as a free act and dead. IN TESTIMONY WHEREOF, I have hereto subscribed my name and affrxed my seal this. day of , 2 _ My commission expires Notary Public Claim No.: 060578704 CLAIM #: 010170898169 RELEASE AND AGREEMENT Under policy # Q06-0803903 issued by ERIE INSURANCE EXCHANGE/ERIE INSURANCE COMPANY, UWe, claiming coverage for myself/ourselves or on behalf of The Estate of Jean M. Kasun in consideration of One Hundred Thousand ($100,000.00) dollars, which UWe have received, RELEASE AND DISCHARGE ERIE INSURANCE EXCHANGE/ERIE INSURANCE COMPANY from any and all claims, causes of action or other rights which UWe have, have had or could have under the Underinsured Motorists coverage as set forth in said policy, which claims, causes of action or other rights arose or could have arisen as a result of a loss or accident which happened on the 15th day of December, 2006 at or near The Parking Lot of Karns Food/West Shore Plaza, Lemoyne, in the county of Cumberland, in the State of Pennsylvania. In consideration of such payment, I/We agree as follows: 1) to assign Erie Insurance Exchange/Erie Insurance Company to my/our rights of recovery against any person(s) or party(ies) legally liable to me/us, to the amount of and for the purpose of the payment noted above; 2) that UWe have not and will not make any separate settlement with nor give any separate release to any person(s) or party(ies) who caused or are alleged to have caused the above mentioned loss or accident; 3) that suit may be instituted by Erie Insurance Exchange/Erie Insurance Company in my/our name; 4) to execute all papers required to commence such suit; and 5) to cooperate in prosecuting any or all actions which Erie Insurance Exchange/Erie Insurance Company may bring to recover from any person(s) or party(ies) for the claims or causes of action which UWe have growing out of said lcss or accident. It is expressly understood and agreed that, out of any amount recovered, costs of collection, including by not limited to counsel fees, shall be first paid to ERIE INSURANCE EXCHANGE/ERIE INSURANCE COMPANY. Except in states which apply comparative negligence in determining legal liability, any recovery in excess of collection costs shall be paid to me/us, up to the full extent of my/our loss. In states which apply comparative negligence, any recovery of my/our loss, in excess of collection costs, shall be reduced by a factor equal to the percentage of my/our negligence which contributed to cause the above mentioned accident, before it is paid to me/us. I/We further understand and agree that this RELEASE AND AGREEMENT is inclusive of any and all present and future liens or claims for subrogation against the payments to be made in accordance with this RELEASE AND AGREEMENT. I/We understand and agree that I/we are responsible for the payment of any liens or charges against the payments to be made hereunder should any such liens, subrogation, claims or claims for expenses and charges be asserted. This includes, but is not limited to, medical expense liens, worker's compensation liens, ERISA liens, liens asserted by any federal, state or local governmental entity or agency or any medical expense claim. Should any person or entity make claim for payment of any liens or charges against ERIE INSURANCE EXCHANGE/ERIE INSURANCE COMPANY or their counsel, I/we agree to indemnify and hold harmless ERIE INSURANCE EXCHANGE/ERIE INSURANCE COMPANY and their counsel from any and all such liens, charges, fees, claims, attorney fees, costs, interests and any other sum. UWe understand that this settlement is the compromise of a disputed claim, and that the payment is not to be construed as an admission of liability on the part of the persons, firms and corporations hereby released by whom liability is expressly denied. (CAUTION: READ BEFORE SIGNING) intending to be legally bound thereby, WITNESS my/our hand(s) and seal(s) this Witnessed by: (Administrator of The Estate) STATE OF COUNTY OF On this day of to me known to be the person _ executed the same as My commission expires SS day of > ,before me personally appeared who executed the foregoing instrument, and acknowledged that free act and deed. Notary Public (SEAL) (SEAL) NOTICE: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects the person to criminal and civil penalties. Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717)774-1445 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF JEAN M. KASUN ORPHAN'S COURT DIVISION NO. 2006-01164 VERIFICATION I, Rebecca A. Clark, Executrix of the Estate of Jean M. Kasun, hereby certify that the facts set forth in the foregoing PETITION are true and correct to the best of my knowledge, information and belief. I understand that any false statements made herein are subject to penalties of 18 Pa. C.S.A. §4904 relating to unsworn falsification to authorities. Dated:~~Ir~-' ~' , 2008 Rebecca A. Clark, Executrix of the Estate of Jean M. Kasun Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717)774-1445 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF JEAN M. KASUN :ORPHAN'S COURT DIVISION NO. 2006-01164 CERTIFICATE OF SERVICE I, BARBARA SUMPLE-SULLIVAN, ESQUIRE, do hereby certify that on this date, I served a true and correct copy of the Petition for Authority to Compromise Claim on Behalf of Estate, in the above-captioned matter upon the following individual(s), by United States first- class mail, postage prepaid, addressed as follows: Mr. Douglas Kocher Claims Representative Erie Insurance Company 4901 Louise Drive P.O. Box 2013 Mechanicsburg, PA 17055-0710 Mr. David M. Kasun 925 Tarpon Avenue, #19 Fernandina Beach, FL 32034 Ms. Cheryl Peoples RR 1, Box 475 Altoona, PA 16601 Medicare Secondary Payer Recovery Contractor P.O. Box 33828 Detroit, MI 48232-5828 DATE: , 2008 Ms. Jennifer Oprosky Claims Representative Progressive Insurance Company 100 Scenery Dr. Ste. B State College, PA 16801-7941 Ms. Rose K. Hopkins 20 Cedar Cliff Drive Camp Hill, PA 17011 Ms. Pamela K. Grundon 414 Candlewyck Road Camp Hill, PA 17011 Barbara Sumple-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070-1931 (717) 774-1445 Supreme Court I.D. 32317 Attorney for Petitioner