HomeMy WebLinkAbout09-0350ANAPOL, SCHWARTZ, WEISS, COHAN,
FELDMAN AND SMALLEY, P.C.
BY: JAMES R. RONCA, ESQUIRE
JOEL D. FELDMAN, ESQUIRE
I.D. NOS., 25631, 35472
1710 Spruce Street
Philadelphia, PA 19103
Phone: (215) 735-3716 Attorney for Petitioner
IN THE ORPHANS COURT OF CUMBERLAND COUNTY, PA
IN RE: Charles M. Casey and Diana R. Casey, Co-Administrators
of the Estate of Harold James Casey, Deceased
NO.
L
PETITION TO SETTLE WRONGFUL DEATH & SURVIVAL ACTION
TO THE HONORABLE, THE JUDGES OF THE SAID COURT:
The Petition of Charles M. Casey and Diana R. Casey, Co-Administrators of the Estate of Harold
James Casey, Deceased, by their attorneys, ANAPOL, SCHWARTZ, WEISS, COHAN, FELDMAN AND
SMALLEY, P.C., respectfully represents that:
1. Petitioners are Charles M. Casey and Diana R. Casey, were appointed Administrator on
October 14, 2005 by the Register of Probate for the State of Maine, Docket No. 06-798 dated February 13,
2007. A copy of the Letters of Authority of Personal Representative is attached hereto as Exhibit "A".
2. Charles M. Casey and Diana R. Casey are the parents of the decedent, Harold James Casey,
and they reside at 35 Courtland Circle, Bangor, Maine 04401.
3. Charles M. Casey and Diana R. Casey are the grandparents of Charles M. Case
decedent's son. Y, a minor, the
4. At the time of his death, decedent was 42 years old with a residence at 35 Cortland Circle,
Bangor, Maine.
5. At the time of his death, decedent had one minor child, a son, Charles Martin Case
resided with his mother, Leila Arimas Casey, at 6000 Marchester Wa y, who
y, Pinson, AL 35126.
6. At the time of his death, decedent was divorced from his wife, Leila Arimas Casey, said
minor's mother. y'
7. The decedent, Harold James Casey, died on December 7, 2006 as a result of injuries he
suffered in an automobile accident that occurred in Middlesex Township, Cumberland County, Pennsylvania
on December 7, 2006. No formal lawsuit was instituted in connection with this accident.
8. Decedent did not have an executed Will at the time of his death.
9. There were three individuals injured in the motor vehicle accident of December 7 2006, and
accordingly, there were a total of four claims presented, including the claims of the Estate of Harold
Casey. M.
10. The total policy limits of Peerless Insurance (now Ohio Casualty) insurer for the responsible
party in this accident was Three Hundred Thousand ($300,000.00) single limit.
11. Given the limited insurance proceeds, the parties elected to try to resolve the case through
mediation, and on March 20, 2008 a mediation was held before the Honorable Albert G. Blakey, Retired.
12. Numerous telephone conferences and discussions were held involving the division of the
settlement proceeds and the competing interests of all parties as well as insurers and resolution of workers
compensation claims/liens.
13. Ultimately, all parties agreed to an equitable division of the total insurance
petitioners agreeing to accept the sum of $225,00.00 in settlement of the estate's proceeds with
recommendation of Judge Albert G. Blakey, Retired. , The proposed settlement consists of an up front
payment in the amount of One Hundred and Ten Thousand ($110,000.00) Dollars and the arch
annuity in the sum of One Hundred and Fifteen Thousand ($115,000.00 Dollars p ase of an
to make payments to the
decedent's son, Charles Martin Casey, as set forth. Attached hereto as Exhibit "B" is a
Settlement Agreement and Release and annuity information. copy of the executed
14. There are no inheritance taxes that are due under the laws of the State of Maine w
state of residence of the decedent at the time of his death. Attached hereto which was the
as Exhibit "C" is a copy of a
letter from Maine counsel, Jane Skelton, Esquire, attorney for the Estate dated December
5, 2008.
15. There is no proof of conscious pain and suffering suffered by decedent prior to his
death.
16. Additionally, under Pennsylvania law, it would be appropriate to allocate all of the r
to Wrongful Death as opposed to Survival. Because decedent was a resident proceeds
of the State of Maine, , no
inheritance taxes are due the Commonwealth of Pennsylvania. Attached hereto as Exhibit ' D" is a letter
from the Department of Revenue, Division of Inheritance Tax, Commonwealth of Pennsylvania advising that
no inheritance tax is due the Commonwealth.
17. At the time of decedent's death, he was within the course and scope of his employment
with
CRST International. As such, the workers compensation carrier, AIG made payments in the amount of
$112.00 per week to the decedent's minor son, Charles Martin Casey, said payments
reaches the age of 18 on July 25, 2009, or in the event he attends an accredited school after high school
graduation, the age of 23 on July 25, 2014. In addition, AIG expended $3,000.00 toward burial expenses.
Attached hereto as Exhibit "E" is the Agreement for Compensation for Death.
18. As of October 22, 2008, the workers compensation carrier, AIG, has expended
$14,244.54 as a result of the accident involved herein. AIG Insurance has agreed to accept $9,357.42 as full
payment for that lien.
19. In addition, the appropriate Third Party Settlement Agreement will be prepared and filed with
the Bureau of Workers Compensation.
20. Charles M. Casey and Diana R. Casey, Parents of Harold James Casey, personally incurred the
below-listed funeral expenses for which reimbursement is requested:
(a) Clay Funeral Home 4,306.09
(b) Page & Son Memorial Shop
memorial & foundation 1,929.75
(c) Plane fare advanced for
decedent's son and his mother
to attend funeral
560.00
(d) Advance to Leila Arimas Casey
In lieu of decedent's regular child
support payments until social
security benefits arrived for
decedent's son 1,000.00
(e) Johnson's Florists 105.00
(f) NicastroIs - mowing and
raking of cemetery plot
30.00
(g) NicastroIs - seeding,
grooming, fertilizing etc.
cemetery plot
211.00
(h) motel room for Leila Arimas
Casey and and decedent's son,
Charles Martin Casey to
Attend decedent's funeral
_70.00
Total out of pocket expenses personally paid
by Charles M. Casey and Diana R. Casey
for which reimbursement is requested
$8,211.84
(Copies of said expenditures are attached hereto and marked collectively as Exhibit "F".
21. Petitioners, Charles M. Casey and Diana R. Casey, Co-Administrators of the Estate of
Harold
James Casey, request the allowance of $1,330.00 to be made payable to Jane Skelton, Esquire
, as her fee as
attorney in her capacity as the attorney for the Estate of Harold James Casey, Deceased which includes
communicating and negotiating with creditors and preparation of estate documents for filing with Probate
Court in Bangor, Maine. (Attached hereto as Exhibit "G" is a copy of the itemized bill of Jane
Skelton,
Esquire.)
22• Counsel has incurred the following expenses for which reimbursement is sought:
Clerk of Orphans' Court for filing of Settlement
Petition
David L. Hopkins, A.S.A. economic expert $ 15.00
Resolute Systems, Inc. - mediation fee 1,200.00
Travel Expenses for mediation 950.00
Photocopying charges 100.99
Total Costs: ---49.60
$2,315.59
23• Petitioner executed a Contingent Fee Agreement with counsel in the amount of ThirtPer Cent of the gross settlement of Two Hundred Twenty-Five Thousand (30%)
($225,000.00). After deduction of
expenses, of litigation, said counsel fee would be $66,805.32. Petitioners' counsel seeks a fee of Twenty-
Five (25%) Per Cent of the settlement proceeds after deduction of expenses of litigation, to wit, $55,671.10,
which fee petitioners consider to be fair and reasonable and requests this Honorable Court to approve same.
Efforts of counsel included preparation of the case, preparation for multi-party mediation extensive
negotiations with other parties' attorneys, discussions concerning purchasing of an annuity to protect interests
of the minor beneficiary, research into estate laws of Maine, consulting with an economist and obtaining an
economic loss report. A copy of the contingent fee agreement is attached hereto as Exhibit "H"
24• Petitioners have served a copy of this Petition on the following parties who ma
have a possible interest: may
Charles Martin Casey, a minor, by his mother
Leila Arimas Casey
6000 Marchester Way
Pinson, AL 35126
Peter Staats, Senior Analyst
Ohio Casualty
275 Grandview Avenue, Suite 300
Camp Hill, PA 17011
Lisa Rusveld
Ringler Associates
110 Gilsum Mine Road
Alstead, NH 03602
WHEREFORE, Petitioners request that they be permitted to enter into the settlement recit
above, and that the Court enter the Order of Distribution set forth below. recited
I. SETTLEMENT:
(1) Defendant shall pay to the petitioners and their attorneys the sum of One Hundred Ten Thousand
($110,000.00) Dollars "up front cash" to be distributed as set forth below;
DISTRIBUTION:
TO: Anapol, Schwartz, Weiss, Cohan,
Feldman & Smalley, P.C. as
reimbursement for costs advanced
$ 2,315.59
TO: Anapol, Schwartz, Weiss, Cohan,
Feldman & Smalley, P.C. as counsel
fee of approximately 25%, after
deduction of expenses
TO: AIG Insurance Company - payment of
workers compensation lien as of 10/22/08
$14,244.54 reduced to
TO: Charles M. Casey and Diana R.Casey, parents of
Harold Martin Casey, Deceased, as reimbursement
for out of pocket funeral expenses and child support payment
that they personally paid following decedent's death
as follows:
(a) Clay Funeral Home 4,306.09
(b) Page & Son Memorial Shop
memorial & foundation 1,929.75
(c) Plane fare advanced for
decedent's son and his mother,
Leila Arimas Casey to attend
funeral 560.00
(d) Advance to Leila Arimas
Casey in lieu of decedent's
regular child support payments
until social security benefits
arrived for decedent's son 1,000.00
(e) Johnson's Florists 105.00
(fl Nicastro's - mowing and
raking of cemetery plot
30.00
$ 55.671.10
9,357.42
(9) Nicastro's - seeding,
grooming, fertilizing etc.
cemetery plot
211.00
(h) motel room for Leila Arimas
Casey and decedent's son,
Charles Martin Casey to
Attend decedent's funeral 70.00
Total out of pocket expenses personally paid
b
YCharles M. Casey and Diana R. Casey to be reimbursed
$ 8,211.84
TO: Jane Skelton, Esquire, attorneys fee in her
capacity as attorney for the Estate of Harold
James Casey, Decd
$ 1,330.00
TO: Charles Martin Casey, a minor,
the sum to be deposited in the name of the minor only in
federally insured savings accounts, certificates of deposit or
credit union accounts or accounts investing only in securities
guaranteed by the United States government or a Federal
governmental agency managed by responsible financial
institutions. The account shall be marked "not to be withdrawn
until the minor reaches the age of eighteen (18) years, to wit,
on July 25, 2009, except for the payment of local, state and
federal income taxes on earnings of the certificate or account
or upon further Order of the Court."
TOTAL Up FRONT CASH 33
$110,000.00
(2) Defendant shall arrange for the purchase of an annuity from Liberty Life Assurance Co
with the sum of One Hundred and Fifteen Thousand ($115,000.00 Dollars Company which will make payments to the
decedent's son, Charles Martin Casey, as follows:
(a) $8,000.00 payable annually, guaranteed for
five years beginning 7/25/09 at age 18
with the last guaranteed payment on
7/25/2013 at age 22
(b) $15,000.00 to be paid as a lump sum on 7/25/2016 at age 25.
(c) $15,000.00 paid as a lump sum on 7/25/2019 at age 28
(d) $119,384.62 paid as a lump sum on 7/25/2021 at age 30
The death of Charles Martin Casey shall not discharge any obligation to make the payments set
forth above. In the event of the death of Charles Martin Casey, any remaining guaranteed
payments shall instead be paid, as they become due, to the Estate of Charles Martin Casey, with
the last guaranteed payment to be made on July 25, 2021; however, upon attaining the a e of
g
twenty-one (2 1) Charles Martin Casey shall have the right to submit a request to change the
Beneficiary Designation.
As provided hereunder, Petitioner's counsel is hereby authorized to execute all document
to purchase an annuity. anon necessary
Counsel shall file with motion Court within thirty (30) days from the date of this order
Proof of the
establishment of the annuity contract and the deposit of the sum of $33 ,
,114.05 as required herein by
Affidavit of counsel certifying compliance with this order. Counsel shall attach to the Affidavit a copy of
the Annuity Contract setting forth the payment schedule.
Respectfully submitted,
ANAPOL, SCHWARTZ, WEISS, COHAN,
FEL?? AND SMALLEY, INC.
Y:
RONCA
D. ELDMAN, ESQUIRE
eys for Petitioner
VERIFICATION
I, JOEL D. FELDMAN ESQUIRE, am the Attorney for the Petitioner in this action
and hereby
verify that the statements contained in the foregoing Petition for Approval of Allocation
of Settlement
Proceeds Between Wrongful Death and Survival Acts are true and correct to the best of
information and belief. I understand that the statements in said my knowledge,
Petition are made subject to the penalties of
18 Pa.C.S.A. Section 4904, relating to unworn falsification to authoritiPc
Dated:
VERIFICATION
We, Charles M. Casey and Diana R. Casey, are the Petitioners in this action and hereby verify statements contained in the foregoing Petition for Approval of Settlement of Wrongful Death Action are true
and correct to the best of our knowledge, information and belief. We understand that the statements in said
Petition are made subject to the penalties of 18 Pa.C.S.A. Section 4904, relating to unsworn
falsification to
authorities.
Vv?.
CHARLES M. CASE
DIANA R. CASEY
Dated:
ANAPOL, SCHWARTZ, WEISS, COHAN,
FELDMAN AND SMALLEY, P.C.
BY: JOEL D. FELDMAN, ESQUIRE
JAMES R. RONCA, ESQUIRE
I.D. NOS. 35472, 25631
1710 Spruce Street
Philadelphia, PA 19103
Phone: (215) 735-3716
Attorney for Petitioner
IN THE ORPHANS COURT OF CUMBERLAND COUNTY, PA
IN RE: Charles M. Casey and Diana R. Casey, C 'o-Administrators
of the Estate of Harold James Casey, Deceased
NO.
AFFIDAVIT
STATE OF MAINE
COUNTY OF PENOBSCOT
SS.
CHARLES M. CASEY AND DIANA R. CASEY, being duly sworn according to law,
deposes and says that they are the Administrators of the Estate of Harold James Casey, Deceased,
that they have reviewed the proposed settlement of the instant action and the distribution of the
settlem rit funds, and they request this Honorable Court to approve the within Petition and Order
because they consider same to be fair and reasonable under the circumstances described herein.
UYl ,
Charles M. Casey
Sworn to and subscribed
b-' f ire me this (6fh day
o i [k ??f 2008
cry Pub ?c
?C J
Diana R. Casey
KELLY J. FER
?c „ • state of MWn
Expires November 9, 2015
ANAPOL, SCHWARTZ, WEISS, COHAN,
FELDMAN AND SMALLEY, P.C.
BY: JOEL D. FELDMAN, ESQUIRE
JAMES R. RONCA, ESQUIRE
I.D. NOS. 35472, 25631
1710 Spruce Street
Philadelphia, PA 19103
Phone: (215) 735-3716 Attorney for Petitioner
IN THE ORPHANS COURT OF CUMBERLAND COUNTY, PA
`l
f?l ...ia..livJ iV?. .1a _. •''l r.
of the Estate of Harold James Casey, Deceased
NO.
AFFIDAVIT
STATE OF ALABAMA )
SS.
COUNTY OF )
CHARLES MARTIN CASEY, being duly sworn according to law, deposes and says that
he is a minor over the age of fourteen having been born on July 25, 1991, that he is the beneficiary
of the Estate of Harold James Casey, Deceased and he requests this Honorable Court to approve
the within t'etition and Order because he consider same to be Lair and reasonable under the
circumstances described herein.
Sworn to and subscribed
before me this 30*'-day
-Of 2008
tary3k-ublic/
Charles Martin Casey
ANAPOL, SCHWARTZ, WEISS, COHAN,
FELDMAN AND SMALLEY, P.C.
BY: JAMES R. RONCA, ESQUIRE
JOEL D. FELDMAN, ESQUIRE
I.D. NOS., 25631, 35472
1710 Spruce Street
Philadelphia, PA 19103
Phone: (215) 735-3716 Attorney for Petitioner
IN THE ORPHANS COURT OF CUMBERLAND COUNTY, PA
IN RE: Charles M. Casey and Diana R. Casey, Co-Administrators
of the Estate of Harold James Casey, Deceased
NO.
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF PHILADELPHIA 1
JOEL D. FELDMAN, ESQUIRE, being duly sworn according to law, deposes and says that
he is the Attorney for Charles M. Casey and Diana R. Casey, Co-Administrators of the Estate of
Harold James Casey, Deceased, that he has reviewed the proposed settlement of the instant action
and the distribution of the settlement funds, and they request this Honorable Court to approve the
within Petition and Order because he considers same to be fair and reasonable under the
circumstances described herein.
Sworn to and subscribed
befor me this/ V-day
of 200,9
Notary Public
COMMONWEALTH OF PENNSYLVANIA
NOTARIAL SEAL
LINDA S. DOMBROWSKI, Notary Public
City of Philadelphia, Phila. County
M Commission € Tres February 26, 2011
ANAPOL, SCHWARTZ, WEISS, COHAN,
FELDMAN AND SMALLEY, P.C.
BY: JOEL D. FELDMAN, ESQUIRE
JAMES R. RONCA, ESQUIRE
I.D. NOS. 35472, 25631
1710 Spruce Street
Philadelphia, PA 19103
Phone: (215) 735-3716 Attorney for Petitioner
IN THE ORPHANS COURT OF CUMBERLAND COUNTY, PA
IN RE: Charles M. Casey and Diana R. Casey, Co-Administrators
of the Estate of Harold James Casey, Deceased
NO.
CERTIFICATION
I, the undersigned, Joel D. Feldman, Esquire, attorney for petitioners herein hereby
certifies that the within Petition is uncontested by all parties.
ANAPOL, 5CHWARTZ, WEISS, COHAN,
FELPMAN AND SMALLEY, P.C.
ANAPOL, SCHWARTZ, WEISS, COHAN,
FELDMAN AND SMALLEY, P.C.
BY: JOEL D. FELDMAN, ESQUIRE
JAMES R. RONCA, ESQUIRE
I.D. NOS. 35472, 25631
1710 Spruce Street
Philadelphia, PA 19103
Phone: (215) 735-3716 Attorney for Petitioner
IN THE ORPHANS COURT OF CUMBERLAND COUNTY, PA
IN RE: Charles M. Casey and Diana R. Casey, Co-Administrators
of the Estate of Harold James Casey, Deceased
NO.
I, JOEL D. FELDMAN, ESQUIRE, certify that a copy of the foregoing Petition was mailed by regular U.
S. mail, postage prepaid on the date set forth below to the following:
Charles Martin Casey, a minor, by his mother
Leila Arimas Casey
6000 Marchester Way
Pinson, AL 35126
Peter Staats, Senior Analyst
Ohio Casualty
275 Grandview Avenue, Suite 300
Camp Hill, PA 17011
Lisa Rusveld
Ringler Associates
110 Gilsum Mine Road
Alstead, NH 03602
ANAP ,L WARTZ, WEISS, COHAN,
F AND SALkLLAy, P Q"1
Date Mailed: / -C) ) - 6
cz/z5/z0^7 MON IQ: 09 FAX 2079476400 Skelton Law Offices LLC
I '
STATE OF MAINE
Docket 06-798
PENOBSCOT, ss. REGISTRY OF PROBATE
I, SUSAN M. ALMY, Register of the Probate Court for said County of
PENOBSCOT, hereby certify, that on the thirteenth day of February, 2007,
Charles K Casey and.Diana R. Casey were duly appointed
Personal Representatives of the estate of HAROLD JAMES CASEY, late of Bangor,
without bond, according to law.
I also certify, that it appears by the records and files of said Court that said
appointment is still in full force and effect.
In Witness Whereof I have hereunto set my hand
and affixed the Official Seal of said Court, this
twenty-first. day February, 2007.
1 Register
Deputy Register
0004/004
Ex ki 6,14,b
10/14/2008 09:30 6038358026 RINGLER ASSOC PAGE 02/10
SETTLEMENT AGREEMENT AND RELEASE
THIS SETTLEMENT AGREEMENT AND RELEA,S,?y(the "Settlement
Agree ent") is made and entered into this ' (? day of
'204M, by and between [among]:
"CLAIMANTS" CHARLES M. CASEY and DIANA R CASEY,
Individually and as co-Administrators of the ESTATE of
HAROLD JAMES CASEY, deceased
"DEFENDANTS" DENNIS EUGENE SHULER and BETHANY SMITH
"INSURER" PEERLESS INSURANCE COMPANY
RECITALS
A. On or about December 7, 2006, Harold James Casey was fatally injured in
an accident occurring in Middlesex Township, Pennsylvania. Claimants allege that
the accident and resulting physical injuries arose out of certain alleged negligent acts
or omissions of the Defendants, and have made a claim seeking monetary damages on
account of those injuries.
B. Insurer is the liability insurer of the Defendants, and as such, would be
obligated to pay any claim made or judgment obtained against Defendants which is
covered by its policy with Defendants.
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.
AGREEMENT
The parties agree as follows:
1
10/14/2008 09:30 6038358026 RINGLER ASSOC PAGE 03/10
1.0 RELEASE AND DISCHARGE
1.1 In consideration of the payments set forth in Section 2, Claimants hereby
completely release and forever discharge Defendants and Insurer from 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 Claimants now have, 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 Claimants, or any future wrongful death claim of
Claimants' representatives or heirs, which have resulted or may result from the
alleged acts or omissions of the Defendants.
1.2 This release and discharge shall also apply to Defendants' and 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.
1.3 This release, on the part of the Claimants, shall be a fully binding and
complete settlement among the Claimants, the Defendants and the Insurer, and their
heirs, assigns and successors.
1.4 The Claimants acknowledge and agree that the release and discharge set
forth above is a general release. Claimants expressly waive and assume the risk of
any and all claims for damages which exist as of this date, but of which the Claimants
do not know or suspect to exist, whether through ignorance, oversight, error,
negligence, or otherwise, and which, if known, would materially affect Claimants'
decision to enter into this Settlement Agreement. The Claimants further agree that
Claimants have accepted payment of the sums specified herein as a complete
compromise of matters involving disputed issues of law and fact. Claimants assume
the risk that the facts or law may be other than Claimants believe. 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 Defendants, by whom liability is expressly denied.
10/14/2008 09:30 6038358026 RINGLER ASSOC PAGE 04/10
1.5 It is understood and agreed that the Claimants warrant that no Insurer,
attorney, employer, judgment creditor or other person has any type of lien or
prospective lien upon the cause of action described in Recital A above or upon the
proceeds of this settlement with the exception of the lien for worker's compensation
benefits paid by AIG Insurance Company and described in paragraph 1.7 herein; the
Claimants further agree to defend, indemnify and hold harmless the parties released
herein from any such claims or actions or from any other claims or actions brought
against them by virtue of any inaccuracies or omissions in any representations made
herein by the undersigned.
1.6 The undersigned fiuther represents that there are no past or future
liens or rights of reimbursement by any hospital, ambulance service, or other
medical provider, Medicare, Medicaid, insurance company, or attorney enforceable
against the proceeds of this settlement or against the parties released, or the
persons, firms or corporations making the payment herein. If such a lien or right is
asserted, against the proceeds herein or against the parties released or against any
person, firm, or corporation making payment herein, then, in consideration of the
payment made to the undersigned, the undersigned covenants to pay and satisfy
such asserted lien or right, or to satisfy the same on a compromise basis, and to
obtain in any event, a release and discharge of such lien or right, and, in any event,
to indemnify and hold harmless the parties released and the persons, firms or
corporations making the payment herein, from any costs, expenses, attorney fees,
claims, actions, judgments, or settlements resulting from the assertion or
enforcement of such lien by any entity having such lien or right.
1.7 It is understood and agreed further that at the time of the incident described
in Recital A above, Harold James Casey was within the course and scope of his
employment and that AIG Insurance Company, as Workers' Compensation carrier,
therefore, is interested in any claim arising out of said incident. This workers'
compensation lien, as well as any and all liens or claims arising out of the incident
will be the responsibility of and will be paid and discharged out of the settlement
proceeds by Claimants or their attorneys, representatives, assigns, successors in
interest and executors.
10/14/2008 09:30 6038358026 RINGLER ASSOC PAGE 05/10
2.0 PAYMENTS
In consideration of the release set forth above, the Insurer, on behalf of the
Defendants, agrees to pay to the individual(s) named below ("Payee(s)") the sums
outlined in this Section 2 below:
2.1 Payments due at the time of Settlement as follows:
One Hundred Ten Thousand Dollars and No Cents ($110,000.00) to be paid to
Charles M. Casey and Diana R. Casey, individually and as co-Administrators of the
Estate of Harold James Casey and to their attorney, Adam Green, Esq. (Anapol,
Schwartz, Weiss, Cohan, Feldman & Smalley, P.C., 1710 Spruce Street, Philadelphia,
PA 19103) upon execution of this agreement by the parties below and upon approval
by a court having proper jurisdiction.
2.2 In addition to any cash payments set forth in section 2.1 above, the Insurer,
on behalf of Defendants, will fund an annuity through Liberty Life Assurance
Company of Boston which will make future payments in accordance with the
schedule as follows (the "Periodic Payments"). The amount of premium used to fund
the structured settlement annuity and the related fees, if any, is $115,000.00.
Payee: Charles Martin Casey as Beneficial of the Estate of Harold James Casey
Eight Thousand Dollars and No Cents ($8,000.00), payable annually on the
25th day of July for a period certain of four (4) years, beginning July 25, 2009 and
ending July 25, 2013; and,
Fifteen Thousand Dollars and No Cents ($15,000.00) guaranteed to be paid on
July 25, 2016; and,
Fifteen Thousand Dollars and No Cents ($15,000.00) guaranteed to be paid on
July 25,2019; and,
One Hundred Nineteen Thousand Three Hundred Eighty-Four Dollars and
Sixty-Two Cents ($119,384.62) guaranteed to be paid on July 25, 2021; and, no
further payments beyond said date.
10/14/2008 09:30 6038358026 RINGLER ASSOC PAGE 06/10
2.3 Claimants hereby warrant and represent that Charles Martin Casey
was born on July 25, 1991. Notwithstanding anything to the contrary herein, if the
actual date of birth is not as stated above, and if Insurer or Assignee relies or has
relied to its detriment on the accuracy of the above-stated date of birth, then Insurer
may adjust the amount and/or timing or remaining Periodic Payments so that no
additional cost than that necessary to purchase the Annuity Contract is incurred by
the Insurer or Assignee.
All sums set forth herein constitute damages on account of physical injuries
and sickness, within the meaning of Section 104(a)(2) of the Internal Revenue Code
of 1986, as amended.
3.0 CLAIMANT'S RIGHTS TO PAYMENTS
Each Claimant acknowledges and agrees that neither the Periodic Payments
nor any rights thereto or interest therein (collectively, "Payment Rights") can be:
3.1 Accelerated, deferred, increased or decreased by the Claimants or any
other Payee; or,
3.2 Sold, assigned, pledged, hypothecated or otherwise transferred or
encumbered, either directly or indirectly, by such Claimants or any other Payee unless
such sale, assignment, pledge, hypothecation or other transfer or encumbrance (any
such transaction being hereinafter referred to as a "Transfer') has been approved in
advance in a "qualified order" as defined in Section 5891(b)(2) of the Internal
Revenue Code of 1986, as amended (a "Qualified Order"), and otherwise complies
with applicable state law, including without limitation any and all applicable state
structured settlement protection statutes.
No Claimant or other Payee shall have the power to affect any Transfer of
Payment Rights except as provided in Section 3.2 above, and any other purported
Transfer of Payment Rights shall be wholly void.
If Payment Rights under this Settlement Agreement become the subject of a
Transfer approved in accordance with Section 3.2 above: (A) the rights of any direct
or indirect transferee of such Transfer shall be subject to all terms of this Settlement
Agreement and any defense or claim in recoupment arising hereunder; and (B) the
transferee shall be liable to the Insurer, Peerless Insurance Company, to any Assignee
10/14/2008 05:30 6038358026 RINGLER ASSOC PAGE 07/10
(as hereinafter defined) and to the Annuity Issuer (as hereinafter defined) for any and
all liabilities and costs, including attorneys' fees, arising from compliance by any of
such parties with the Qualified Order approving such Transfer or arising from any
claim to any of the transferred Payment Rights by any party
other than the transferee. Following any such Transfer, any liability of the transferee
under this paragraph, under the Qualified Order approving such Transfer or under
applicable state law may, at the Insurer, Peerless Insurance Company's option, be
credited and set off against any of the transferred Periodic Payments.
4.0 CLAIMANTS' BENEFICIARY
Any payments to be made after death of Charles Martin Casey, pursuant to
the terms of this Settlement Agreement, shall be made to the Estate of Charles
Martin Casey. Upon reaching the age of majority, Charles Casey shall have the
right to submit a request to change the Beneficiary designation. No such
designation, nor any revocation thereof, shall be effective unless it is in writing,
signed by Charles Martin Casey, 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.
5.0 CONSENT TO QUALIFIED ASSIGNMENT
5.1 Claimants acknowledge and agree that the Defendants and/or 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 Defendants' and/or the Insurer's
liability to make the Periodic Payments set forth in Section 2.2 to Liberty Assignment
Corporation ("the Assignee"). The Assignee's obligation for payment of the Periodic
Payments shall be no greater than that of the Defendants and/or the Insurer (whether
by judgement or agreement) immediately preceding the assignment of the Periodic
Payments obligation.
5.2 Any such assignment, if made, shall be accepted by the Claimants without
right of rejection and shall completely release and discharge the Defendants and the
Insurer from the Periodic Payments obligation assigned to the Assignee. The
Claimants recognize that, in the event of such an assignment, the Assignee shall be
the sole obligor with respect to the Periodic Payments obligation, and that all
10/14/2008 09:30 6038358026 RINGER ASSOC PAGE 08/10
other releases with respect to the Periodic Payments obligation that pertain to the
liability of the Defendants and the Insurer shall thereupon become final, irrevocable
and absolute.
5.3 Liberty Mutual provides a Certificate of Guarantee on all cases, which
guarantees the performance of Liberty Life Assurance Company of Boston, the
annuity issuer.
6.0 RIGHT TO PURCHASE AN ANNUITY
The Insurer, through its Assignee, reserves the right to fund the liability to
make the Periodic Payments through the purchase of an annuity policy from Liberty
Life Assurance Company of Boston. The Assignee shall be the sole owner of the
annuity policy and shall have all rights of ownership. The Assignee may have Liberty
Life Assurance Company of Boston mail payments directly to the Payee(s). The
Claimants shall be responsible for maintaining a current mailing address for Payee(s)
with Liberty Life Assurance Company of Boston.
7.0 DISCHARGE OF OBLIGATION
The obligation of the 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 Section 2.2 of this Settlement
Agreement.
8.0 REPRESENTATION OF COMPREHENSION OF DOCUMENT
In entering into this Settlement Agreement, the Claimants represent that
Claimants have relied upon the advice of their attorneys, who are the attorneys of
their own choice, concerning the legal and income tax consequences of this
Settlement Agreement; that the terms of this Settlement Agreement have been
completely read by and explained to Claimants by their attorneys; and that the terms
of this Settlement Agreement are fully understood and voluntarily accepted by
Claimants.
10/14/2008 09:30 6038358026 RINGLER ASSOC PAGE 09/10
9.0 WARRANTY OF CAPACITY TO EXECUTE AGREEMENT
Claimants represent and warrant 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 Claimants have the
sole right and exclusive authority to execute this Settlement Agreement and receive
the sums specified in it; and that Claimants have 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.
10.0 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 Settlement Agreement or any of the amounts, numbers or terms and conditions
of any sums payable to Payee(s) hereunder. It is understood and agreed that the terms
of this settlement, including the payment schedule, must be presented to the Court of
Common Pleas for Cumberland County, Pennsylvania for approval for the settlement
and allocation of proceeds between the wrongful death claim and the survival claim.
11.0 GOVERNING LAW
This Settlement Agreement shall be construed and interpreted in accordance
with the laws of the Commonwealth of Pennsylvania.
12.0 ADDITIONAL DOCUMENTS
All parties agree to cooperate fully and execute any and all supplementary
documents and to take all additional actions that may be necessary or appropriate to
give full force and effect to the basic terms and intent of this Settlement Agreement.
10/14/2008 09:30 6038358026 RINGLER ASSOC
OCT 14 2008 7:17 At1 FP. PEE RLESS-LIA1.IL1TY' 303 2290 TO 91603835GO26
13.0 ENTIRE AGREEMENT AND SUCCESSORS IN INTEREST
This Settlement Agreement contains the entire agreement between the
Claimants, the Defendants 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 represMatives, heirs, successors and assigns of each.
14.0 EF'F'ECTIVENESS
This Settlement Agreement shall become effective immediately following
execution by each of the parties below and upon approval by a court having proper
jurisdiction.
CLADL NTS . INSURER
Peerless Insarance Company
y
Charles M. Casey, Individaik and
as co-Adnifi hator of the Estate of
Harold James Casey, deceased
Cl Title:
Date: 117
*.61 Jl e2
Date: -L6 ) Yl ld$
By:
Dram R Casey, 111dMduall and
as co-Administrator of the Estate of
Harold James Casey, deceased
Date:
PAGE 10/10
P. 11:01
9
** TOTAL PAGE.01 **
Ringler Associates
, New Hampshire
(866)609-1237
Settlement Proposal for: Casey, Charles FINAL
Owner State : Delaware (0.00% tax) Quote Date : 07/30/2008
Rate Series : LL0118 Purchase Date : 08/15/2008
Rates Effective : 07/23/2008
[For: Charles Casey Male, Date of Birth: 07/25/1991 Age: 17, Rated Age: 17v
Benefit Description Guaranteed
Benefit Expected
Benefit
Cost
- Including Attorney's Fees
Cash Up Front to Claimant - $110,000.00 $110,000 $110,000 $110,000.00
- Tax.Free Annual Payments Ages 18 - 22 •
Period Certain Annuity - $8,000.00 payable annually, guaranteed for
5 year(s), beginning on 07/25/2009 at age 18, with the last guaranteed
payment on 07/25/2013 at age 22. $40,000 $40,000 $37,064.00
• At Age 25 •
Guaranteed Lump Sum - $15,000.00 paid as a lump sum on
07/25/2016 guaranteed. $15,000 $15,000 $10,249.00
• At Age 28 -
Guaranteed Lump Sum - $15,000.00 paid as a lump sum on
07/25/2019 guaranteed. $15,000 $15,000 $8,399.00
•AtAge30-
Guaranteed Lump Sum - $119,384.62 paid as a lump sum on
07/25/2021 guaranteed. $119,385 $119,385 $58,988.00
Subtotal For Charles Casey .................................................................... $299,385 $299,385 $224,700.00
SUMMARY INFORMATION
G uaranteed Expected
Benefit Benefit Cost
Total Cash Up Front .............................................................................. $110,000 $110,000 $110,000.00
ANNUITY COST ................................................................................. $114
700.00
Assignment Fee .......................................................................
TOTAL ANNUITY COST W/ FEES ................................................
$189,385
$189,385 ,
$300.00
$115,000.00
TOTAL ANNUITY W/ CASH & FEES ............................................ $299,385 $299,385 $225,000.00
* This is an illustration only and is subject to approval by Liberty Life Assurance Company of Boston.
Quote W Casey, Charles FINAL Ju130, 2008
Prepared by Structured Settlement Specialist- Page 1 of 1
Ringler Associates
Version 1.20
?xh'b?+ ?
12/05/2008 FRi 9:26 FAX 2079476400 Skelton Law Offices LLC
®001/002
Skelton Law Offices
The Elder Law Firm
277 State Street • Suite 2A • Bangor, Maine 04401 • TEL: 207-yw-oo00 . PAX: 7A7.947.W
?++?e!?ledaw mm
December 5, 2008
VIA FACSIMILE e- REGULAR MAIL: (215) 875-7734
Adam M. Green, Esq.
Anapol, Schwartz, Weiss, Cohan, Feldman & Smalley,-P.C.
1900 Delancey Place
Philadelphia, PA 19103
Re: Estate of Harold J. Casey
Dear Adam
Charles M. Casey and Diana R. Casey are the parents of Harold J. Casey who died on
December 7, 2006. Mr. and Mrs. Casey engaged this firm to assist them in matters relating
to the administration of the Estate of Harold J. Casey. In particular, we assisted them in
getting appointed as Personal Representatives of the probate estate and in responding to
claims filed against the estate by creditors.
This confirms that the value of this estate is so modest that there is no exposure to either
federal estate tax or Maine estate tax. There is no inheritance tax in the State of Maine.
When Harold J. Casey died, he had credit card debt. The following companies filed
timely claims against the probate estate in the Penobscot County Probate Court, and those
companies have agreed to accept the following amounts in the event that the probate estate
collects any assets:
Estate Information Services (Providian Credit Card) $1,136.42
DCM Services (HSBC Credit Card) $4,923.91
Balogh Becker (Discover Card) $2,467.50
In Maine, a recovery from a personal injury claim would be payable to the Personal
Representative of the decedent's probate estate. But a recovery from a wrongful death claim
is not payable to the decedent's probate estate. The wrongful death statue provides that
the recovery under a wrongful death statute, "is for the exclusive benefit of the :.. [minor]
children if no surviving spouse..." 18-A M.R.S.A. §2-804.
Jane Skelton, Attorney
Kelly Fe%ola, pffim MIga • Jennifer Reynolds, Legal A-steat • Jeannie Valley, Legal AwWant
12/05/2008 FRI 9:26 PAX 2079676600 Skelton Law Offices LLC ®002/002
Adam M. Green, Esq.
December 5, 2008
Page 2
I rely on you as to whether the settlement monies to be paid are pursuant to a personal
injury claim or to a wrongful death claim. If the latter, then none of the proceeds of the
settlement will be available to satisfy the claims of creditors.
Very truly youfs,
Jane Skelton
iskelto 0maineelderlaw.com
JES/kjf
Skelton Law Offices • 717 State Street 9 Suite 2A. • Bangor, Maine 04!01 •3'fi[.:W-947-6500 • FAX: 207-47-640D
ex kvb;+ -D
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO Box 280601
HARRISBURG, PA 17128-0601
December 29, 2008
Joel D. Feldman, Esq.
1710 Spruce Street
Philadelphia, PA 19103
Re: Estate of Harold Casey
File Number Unknown
Dear Mr. Feldman:
The Department of Revenue received 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 was forwarded to this Bureau for the Commonwealth's approval of the allocation of the
proceeds paid to settle the actions.
Pursuant to the Petition, the 42, year old decedent died as a result of injuries sustained a
motor vehicle accident . Decedent was a resident of Maine at the time of his death; letters of
administration were granted by County of Penobscot.
Please be advised that Pennsylvania inheritance tax is not.imposed upon intangible
personal property of a nonresident decedent; including proceeds of a court action. 72 P.S.
§§9101, 9106, 9107. As decedent was not a resident of Pennsylvania at the time of death, the
Estate would not be liable to the Commonwealth for taxes due on any amount of the proceeds
of the within action. The Department therefore has no objection to the allocation of any
settlement proposed in this matter.
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, no attorney from the Department
of Revenue will be attending any hearing regarding it. Please contact me if you or the Court has
any questions or requires anything additional from this Bureau. Thank you.
Sincerely,
Shannon E. Baker
Trust Valuation Specialist
Inheritance Tax Division
Bureau of Individual Taxes
Originat Now 717-783-5824 • Fax: 717-783-3467 • EMAIL: shabaker@state.pa.us
b h I W;+ 1C
Domestic Claims, Inc.
.. ,:. Box 1836
Alpharetta, GA 30023
(800) 258-7152
(all other) Fax (866)-958-1211
(new losses) Fax (866) 420-1404
January 8, 2008
LEILA CASEY
2304 PENTLAND DRIVE
BIRMINGHAM, AL 35235
RE: Insured: CRST INTERNATIONAL, INC
Carrier: INSURANCE CO OF THE STATE OF PA
Claim Number: 709-417380
Policy No: 001178309
Date of Loss: 12/07/2006
Claimant: HAROLD CASEY
Dear Ms. Casey:
I am the claims adjuster who is assigned to the above-captioned workers' compensation case. I would like to first of
all explain to you the attached Agreement for Compensation for Death which we need you to sign and return as soon
as possible. Please keep one copy for your own personal files. This document will be forwarded on (after all
signatures are obtained) to the Bureau of Workers' Compensation in Harrisburg, PA so that they are aware that
benefits are due to your son, Charles. He is due $112.00 per week until he reaches the age of 18 (7/25/09) or in the
event that he attends an accredited schooling after high school graduation, the age of 23 (7/25/14).
Once/if Charles has determined if he will be conti nuing his education, I will need you to forward to me proof of his
acceptance in that facility and a copy of his school schedule on that facility's letterhead.
As you are Charles' legal guardian, the checks will be made payable to you on his behalf. I would ask that you
provide me with your social security number as well as Charles' so payments can begin. If you would kindly
indicate that information on a separate piece of paper and return it with the signed Agreement, I would appreciate it.
Thank you so much for your time and cooperation in this matter. Should there be any questions, please do not
hesitate to contact me at 866-747-0547. My extension is 27192.
Sincerely,
Terri Sturgeon
SR.Technical Specialist
411-WC Pittsburgh, PA
(412) 393-7192
cc: Adam Green, Esq. I/
Paget of 2
Services Provided by Members of
American International Group, Inc
'COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF LABOR AND INDUSTRY
BUREAU OF WORKERS' COMPENSATION
1171 S. CAMERON STREET, ROOM 103
HARRISBURG, PA 17104-2501
(TOLL FREE) 800-482-2383
AGREEMENT FOR
COMPENSATION
FOR DEATH
Deceased's
Social Security Number: 004-72-3741
Date of Injury: 12/7/2006
M rvvY
PA BWC Claim Number: (WKNOW
Deceased Employee Employer
First Name Last Name
HAROLD CASEY
Date ofBMh 8/1/1964 Dateofl)eeth 12/7/2006
W oo Yyrr MM oo Yvrr
Dependent
First Name I" Name
CHARLES CASEY
steel 1
2304 PENTLAND DRIVE
SUM 2
cWr- SMIe zip code
BIRMINGHAM AL 35235
Carty Telephone
Injury
ct" it ooa,paberw Diem ?
Name
AIG DOMESTIC CL41M INC
street 1
P O BOX 22035
street 2
Cilyrrown state zip code
PITTSBURGH PA 15222
Telepto- Bureau Code
C 0157
ounty
ALLEGHENY
Clam Number FEIN
709-417380 132925174
We, the following persons, dependents of the aforementioned deceased employee, and the undersigned employer,
agree upon the following matters which determine dependents' rights to compensate and its amount and duration:
NAME RESIDENCE DATE OF RELATIONSHIP
CHARLES CASEY 2304 PENTLAND DR BIRMINGHAM AL 7/25/1991 SON
Compensation was paid for the deceased employee's disability resulting from said injury beginning
12/7/2006 and ending 7/25/2009
MM DD YYYY MM DD YM
Wage information must be completed in accordance
with Section 309 of the Pennsylvania Workers'
Compensation Act, and attached to this Agreement.
In case of a change in the status of any dependent,
this agreement shall be modified by Supplemental
Agreement or order of a Workers` Compensation
Judge in accordance with the Pennsylvania. Workers'
Compensation Act.
Name
CRST INTERNATINAL INC
street 1
3930 16TH AVENUE SW
Street 2
Corrown state zip Code
CEDAR RAPIDS IA 52404
County
Telephone FEIN
Insurer or Third Party Administrator (if self-insured)
(OVER)
UBC-338 REV 12-97
LIBC-338
The compensation payable under the agreed facts, based on the average weekly wage of $ 350.00 , is as
follows:
WEEKLY RATE FROM
(Mma ym TO # WEEKSM DAYS REASON FOR CHANGE
( uoWf" AMOUNT
$ 112.00 12/7/2006 7/25/2009 137 2/7 TURNS 18 YEARS OF AGE y 15,376.00
s
s
s
s
s
s =
s
s
s
s
s
Amount expended for medical $ 0. oo Amount expended for burial $ 3, 000 . oo
Further matters agreed upon:
DATE OF THIS AGREEMENT: 1/7/2007
AM oo WW
Dependent
FW Neme L" Name
CHARLES CAS&Y
Employer
R* Name
Authorized Agent for Insurer or TPA (if self-insured)
F * Name L" Name
TERRZ STURGEON
Sipnehas
NOTICE: Agreernont Should be dearly completed (pniftrably typed) and original mailed to the Bureau at the address in
the upper left comer on the front A copy must be sent to the dependent.
Any individual filing misleading or incomplete information knowingly and with intent to defraud is in violation of Section
1102 of the Pennsylvania Workers' Compensation Act and may also be subject to criminal and civil penalties through
Pennsylvania Act 165 of 1994.
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CLAY FUNERAL HOME
. 7 Lee Road
Lincoln, ME 04457
(207) 794-2941
April 18, 2007
Mr. Charles Casey
POBox 111
Lincoln, W 04457
Re: Harold J. Casey Funeral Expenses
Services 3623.00
Rent of Casket 650.00
Alternative container 75
00
Urn .
605
00
Urn Vault .
293.00
Extra mileage to Boston 528:75
Transportation in Pennsylvania 625.00
Med. Examiner permit 40.00
Cemetery expense 325.00
Certified copies 72.00
Newspaper notices 421.34
Mass cants 40
00
Air transportation .
306.00
Crematory fee 300.00
Total: 7906.09
Payments:
Insurance company $ 3000.00
Veterans Administration _ 600.00 3600.
Balance due $ 4306.09
CONTRACT
Sold to
Address
/D
Cemetery (location, etc.)
Tel
Danicl Coffin, D13A
PAGE & SON MEMORIAL SHOP
13 Lcc Road
Lincoln, ME 04457-1406
794-3341 - 942-2210
DATE
20
E-mail .
Interest Marred on all accounts
after 30 days
Description of work.
MARKER ?CEI?ZSRY?LE?TTBRZG
CLEANING REPAIR
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Please call immediate attention to errors of spelling or dates. J
vl contracts taken subject to. delays unavoidable or beyond our control,
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Minimum Amount Due $628.86
Payment Due Date February 02
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Total Credit Li ,
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Total Available Credit
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° Available Credit for Cash $10,000
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P.O. Bat 30Z8S
Chariotty NC 28272-0884 SLC, UT 84130-0285
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Vheu you provide a check as payment' you authorize us either
use information from your check to make a ore-time
ectronic fund transfer firm youraccount or to process the
ryment as a check won. When we use information
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TJX Rewards 17/01-12130
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Skelton Law Offices
The Elder Law Firm
277 State Street*Suite 2A*Bangor, Maine 04401*TEL: 207-947-6500*FAX 207-947-6400•www.maineelderlaw.com
October 23, 2008
Mr. Charles M. Casey
Mrs. Diana R. Casey
P.O. Box 111
Lincoln, ME 04457
Re: Estate of Harold J. Casey
File No. 06-2669
I.R.S. Employer Identification No. 01-0546355
FOR PROFESSIONAL SERVICES:
4/06/2007 JAM Telephone call from Diana Casey regardin 0
g
Payment of credit card and to disregard notice .20
of court.
4/21/2007 JES Telephone call from creditor regarding Case 0
y
estate; memorandum to file. .20
4/30/2007 JMV Prepare letter to Verizon Wireless informing of 0.30
no money to.pay claim; copy to Clients.
5/21/2007 JMV Research Maine Probate Code-18A 3
801
-
-
Creditors' Claims; prepare memo to Atto 0.50
5/26/2007 JES rney.
Brief legal research; draft letter to creditors who
0
60
have filed Claims Against Estate; instructions to .
Jeannie Valley.
6/04/2007 JMV. Receipt of Claims Against Estate from Client; 0
80
respond to Claims from Providian and .
Discover; file response to Claims with the
Penobscot County Probate Court; copies to
7/17/2007 JMV . .Telephone call to Diana Casey regardin
g
phone call from stranger seeking Harold's 0.20
location.
9/05/2007 JMV Telephone call to Providian Visa in response to 0
20
their voice mail message asking for an
update .
.
on the lawsuit/settlement.
October 23, 2008
Page 2
9/25/2007 JMV Receipt of letter from DCM Services, LLC;
prepare letter to DCM Services, LLC informing 0.30
that no funds are available to pay claim against
estate; copies to Client.
10/16/2007 JMV Telephone call from Diana Casey regarding 0.40
need to fax birth certificate; prepare fax and fax
to Attorney Adam M. Green.
2/14/2008 JMV Telephone call from and Telephone call to 0.30
Diana Casey regarding status of wrongful death
claim; estate account.
3/27/2008 JMV Telephone call from Diana Casey with update 0.20
on case with Attorney Green.
4/08/2008 JES Telephone call from Amanda of Providian;
0.20
respond to request for satisfaction of half of
claim; note to file.
7/08/2008 JMV Receipt of letter from DCM Services regarding 0.30
Verizon claim; prepare letter to DCM Services.
8/19/2008 JES Telephone call from Adam Green regarding 0.30
contemplated settlement of wrongful death
claim; discuss annuity for Charles; discuss
costs and expenses of estate, including credit
card debt; instructions to Legal Assistant
Jeannie Valley.
8/19/2008 JMV Review file and prepare a list of
claims/outstanding bills that would be payable 0.60
from the estate for Jane Skelton's review.
9/11/2008 JMV Telephone call from Diana Casey regarding 0.20
legal paperwork to be signed for Attorney
Adam Green.
9/16/2008 JES Consider debts of the estate, especially claims 1.10
from credit card companies; telephone
conference with Diana Casey, review
Engagement Agreement with Anapol Schwartz;
e-mail correspondence to attorney Adam
Green; instructions to Legal Assistant Jeannie
Valley.
October 23, 2008
Page 3
9/16/2008 JMV
10/23/2008 JMV
Review of instructions from Jane Skelton;
telephone calls to DCM Services, Estate
Information Services, and Balogh Becker
regarding current balances owed; telephone
call from Martha Baldwin of DCM Services
regarding Discover balance; memo to file and
Jane Skelton.
Fee for assistance with payment of claims,
costs and expenses of the estate; preparation
of documents required to finalize and close the
Estate of Harold J. Casey.
For All Services:
Total New Charges
Previous Balance
1.00
3.00
$1,330.00
$1,330.00
$854.05
4/23/2007 Payment
Total Payments and Credits
Balance Due
staff
Juliette A. Malmstrom I-I_
ourg
Rate
Fees
Jane E Skelton 0.20 $100.00 $20.00
Jeannie M Valley 2.40 $200.00 $480.00
Kelly J Fergola 8'30 $100.00 $830.00
0.00 $100.00 $4,00
$-863.05
$-863.05
$1,321.00
This Firm's Invoices are due upon receipt and wig accrue Interest at a rate of 1.5% per month be&nhg 3o.
days from the date of the Finns Invoice. Unpaid kridoes are sub)ect
reasonable attorney's fees. to costs of collection, inducting
E,wlf µ
R
CONTINGENT FEE AGREEMENT
THIS AGREEMENT entered into the day of 1200-,
by
and between ANAPOL SCHWARTZ and the Estate of Harold Casev
hereinafter referred to as "Client."
WITNESSETH:
The law firm of ANAPOL SCHWARTZ, will act as Client's attorney in
negotiating for a settlement, and in bringing a claim against
All responsible parties , arising out of an accident which occurred
on 12/07/06 in Cumberland County, PejM61IMBAi a• In addition,
ANAPOL SCHWARTZ, will pursue all claims for underinsured or uninsured
motorist benefits to which the Client may be entitled under their insurance
policies.
In return, the Client will: -
1. Agree to cooperate fully with ANAPOL SCHWARTZ Cooperation
includes: promptly supplying accurate information, as requested by ANAPOL
SCHWARTZ, and being available for meetings with ANAPOL SCHWARTZ or for
legal proceedings. Client promises all information supplied will be truthful and
accurate.
2. (a) In any claim brought on Client's behalf, to pay to ANAPOL
SCHWARTZ, for its services an amount equal to 30% of all funds or property
accruing to Client as a result of ANAPOL SCHWARTZ's services in securing a
settlement of these claims without litigation, and an amount equal to 35% for
services in securing a settlement of these claims after a suit has be
after start of trial or as a result a verdict orJ'ud been filed;
gment. Trial begins at the Pre_
Trial Conference, or when testimony is taken for trial, u'hicheve
In any matter submitted to arbitration, suit is filed w r occurs first.
when the arbitrators are
appointed or when a petition to Appoint Arbitrators is filed, whicheve
occurs. In any matter submitted to arbitration, trial starts the first day the
arbitrators have convened to hear testimony.
(b) Client will not settle or negotiate the above claim or any
proceedings based thereon.
(c) If Client terminates this Agreement before recovery, Client
des
that AVAPOL SCHWARTz shall be entitled to a fee based upon work done and
benefit conferred.
3. Client agrees to reimburse ANAPOL SCHWARTZ, out of any
recovery, in addition to attorneys' fees, all costs and expenses incurred on
Client's behalf in order to make the claim All such costs andax
advanced penses will be
by ANAPOL SCHWARTZ as they are incurred. Such costs and
expenses include, but are not limited to, filing fees, cost of medical records,
copying costs, fax costs, long distance telephone costs, expert witne
sheriffs service costs. witness fees and
responsible for any costs-or interest charges.
Costs will be repaid to ANApOL SCHWARM out of any funds or property
collected either by settlement or judgment.
In the event there is no recovery, the Client will not be
4• Claims for first
Paxty medical benefits and income loss benefits are
separate items, ANAPOL SCHWA?, will help Client process these claims, A
separate agreement will have to b? entered into for fee
occurs s '
? a major dispute
requiring the filing of suit for these benefits. 5• Client's aware that JANE S LTI o ON, MQUIRE will receive a 33
ART
Z'S 13 ° f ANAPOL SCHW
fee for acting as referral/cooperating counsel.
Cle?'tt understands that the
payment of ref'errat/cooperating counsel fee does not
increase or affect the total contingent fee paid by the Client. The Client does not
of fees
r'
The Client
has read and does undmtlld this
Agreement.
Signed the day and year set forth above.
By: U?
Approved:
ANAPOL SCHWARTZ
By;
Agreement.
I have received a copy of this Contingent Fee
Initials
i
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IN THE ORPHANS COURT OF CUMBERLAND COUNTY, PA
IN RE: Charles M. Casey and Diana R. Casey, Co-Administrators
of the Estate of Harold James Casey, Deceased
NO. 09-0350
PRAECIPE TO AMEND PETITION TO SETTLE WRONGFUL DEATH and
SURVIVAL ACTION OF THE ESTATE OF HAROLD JAMES CASEY
1. On or about January 21, 2009 an original and one (1) copy of a Petition to Settle
Wrongful Death and Survival Action of the Estate of Harold James Casey was mailed to
the Prothonotary for Cumberland County.
2. The above-stated Petition was assigned to the Honorable J. Wesley Oler, Jr. for
disposition.
3. The Petition did not include an Affidavit from the mother of the minor beneficiary.
4. Accordingly, the notarized Affidavit of Leila Arimas Casey is attached hereto for filing
of record.
Respectfully submitted,
ANAPOL, SCHWARTZ, WEISS, COHAN,
FELDIl,.A"T '`.TD SMALLEY, P.C.
BY:
JOEI FELDMAN, ESQUIRE
Atto ev for Petitioner
ANAPOL, SCHWARTZ, WEISS, COHAN,
FELDMAN AND SMALLEY, P.C.
BY: JAMES R. RONCA, ESQUIRE
JOEL D. FELDMAN, ESQUIRE
I.D. NOS., 25631, 35472
1710 Spruce Street
Philadelphia, PA 19103
Phone: (215) 735-3716 Attorney for Petitioner
IN THE ORPHANS COURT OF CUMBERLAND COUNTY, PA
IN RE: Charles M. Casey and Diana R. Casey, Co-Administrators
of the Estate of Harold James Casey, Deceased
NO. 09-0350
AFFIDAVIT
STATE OF ALABAMA
SS.
COUNTY OF
LEILA ARIMAS CASEY, being duly sworn according to law, deposes and says that I am
an adult, the mother of Charles Martin Casey, a minor, that my minor son is the beneficiary of the
Estate of Harold James Casey, Deceased, that I have reviewed the Petition to Settle the Wrongful
Death and Survival Action and requests this Honorable Court to approve the Petition and Order,
because I consider it to be fair and reasonable under the circumstances described herein and
approve of the distribution of the settlement funds, including the purchase of an annuity and
payments to be made according to the schedule set forth in the Petition.
x,," 61;1
LEILA ARIMAS CASEY/ /
Sworn to and subscribed (-?'
before me this day
of )q b 2009
7J
NOTARY PUBLIC
MY COMMISSION EXPIRES 1/15/2011
IN THE ORPHANS COURT OF CUMBERLAND COUNTY, PA
IN RE: Charles M. Casey and Diana R. Casey, Co-Administrators
of the Estate of Harold James Casey, Deceased
NO. 09-0350
VERIFICATION TO PRAECIPE TO
AMEND PETITION TO SETTLE WRONGFUL DEATH and
SURVIVAL ACTION OF
THE ESTATE OF HAROLD JAMES CASEY
A copy of the Praecipe to Amend Petition was mailed by regular US mail postage pre-
paid on the date set forth below to the following:
Charles Martin Casey, A Minor
By his Mother, Leila Arimas Casey
6000 Marchester Way
Pinson, AL 35126
Peter Staats, Senior Analyst
Ohio Casualty
275 Grandview Avenue, Suite 300
Camp Hill, PA 17011
Lisa Rusveld
Ringler Associates
110 Gilsum Mine Road
Alstead, NH 03602
ANAPOL, SCHWARTZ, WEISS, COHAN,
FELDMAN AND SMALLEY, P.C.
BY:
Dated: 3-q -o q
FELDMAN, ESQUIRE
for Petitioner
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IN THE ORPHANS COURT OF CUMBERLAND COUNTY, PA
IN RE: Charles M. Casey and Diana R. Casey, Co-Administrators
of the Estate of Harold James Casey, Deceased
NO. 6 ? - 35-6 ctv i ! -t &4-M
ORDER
AND NOW, this t 6 day of VA V Ll, 2009, upon consideration of the Petition to
Compromise Wrongful Death and Survival Action, it is hereby ORDERED that the settlement of the claim of
Charles M. Casey and Diana R. Casey, Co-Administrators of the Estate of Harold James Casey, Deceased in the
gross amount of Two Hundred and Twenty Five Thousand ($225,000.00) is APPROVED and distribution shall
be entirely under the Wrongful Death Act and shall be made in accordance with this Decree.
I. SETTLEMENT:
(1) Defendant shall pay to the petitioners and their attorneys the sum of One Hundred Ten Thousand
($110,000.00) Dollars "up front cash" to be distributed as set forth below;
DISTRIBUTION:
TO: Anapol, Schwartz, Weiss, Cohan,
Feldman & Smalley, P.C. as
reimbursement for costs advanced $ 2,315.59
TO: Anapol, Schwartz, Weiss, Cohan,
Feldman & Smalley, P.C. as counsel
fee of approximately 25%, after
deduction of expenses $ 55,671.10
TO: AIG Insurance Company - payment of
workers compensation lien as of 10/22/08
$14,244.54 reduced to 9,357.42
I
TO: Charles M. Casey and Diana R.Casey, parents
of Harold Martin Casey as reimbursement
for out of pocket funeral expenses and child support payment
that they personally paid following decedent's death
as follows:
(a) Clay Funeral Home 4,306.09
(b) Page & Son Memorial Shop
memorial & foundation 1,929.75
(c) Plane fare advanced for
decedent's son and his mother,
Leila Arimas Casey to attend
funeral 560.00
(d) Advance to Leila Arimas
Casey in lieu of decedent's
regular child support payments
until social security benefits
arrived for decedent's son 1,000.00
(e) Johnson's Florists 105.00
(f) Nicastro's - mowing and
raking of cemetery plot 30.00
(g) Nicastro's - seeding,
grooming, fertilizing etc.
cemetery plot 211.00
(h) motel room for Leila Arimas
Casey and decedent's son,
Charles Martin Casey to
Attend decedent's funeral 70.00
Total out of pocket expenses personally paid
by Charles M. Casey and Diana R. Casey to be reimbursed $ 8,211.84
TO: Jane Skelton, Esquire, attorneys fee in her
capacity as attorney for the Estate of Harold
James Casey, Dec'd $ 1,330.00
TO: Charles Martin Casey, a minor,
the sum to be deposited in the name of the minor only in
federally insured savings accounts, certificates of deposit or
credit union accounts or accounts investing only in securities
guaranteed by the United States government or a Federal
governmental agency managed by responsible financial
institutions. The account shall be marked "not to be withdrawn
until the minor reaches the age of eighteen (18) years, to wit,
on July 25, 2009, except for the payment of local, state and
federal income taxes on earnings of the certificate or account
or upon further Order of the Court." 33,114.05
TOTAL UP FRONT CASH $110,000.00
(2) Defendant shall arrange for the purchase of an annuity from Liberty Life Assurance Company of Boston
with the sum of One Hundred and Fifteen Thousand ($115,000.00) Dollars which will make payments to the
decedent's son, Charles Martin Casey, as follows:
(a) $8,000.00 payable annually, guaranteed for
five years beginning 7/25/09 at age 18
with the last guaranteed payment on
7/25/2013 at age 22
(b) $15,000.00 to be paid as a lump sum on 7/25/2016 at age 25.
(c) $15,000.00 paid as a lump sum on 7/25/2019 at age 28
(d) $119,384.62 paid as a lump sum on 7/25/2021 at age 30
The death of Charles Martin Casey shall not discharge any obligation to make the payments set
forth above. In the event of the death of Charles Martin Casey, any remaining guaranteed
payments shall instead be paid, as they become due, to the Estate of Charles Martin Casey, with
the last guaranteed payment to be made on July 25, 2021; however, upon attaining the age of
twenty-one (21) Charles Martin Casey shall have the right to submit a request to change the
Beneficiary Designation.
As provided hereunder, Petitioner's counsel is hereby authorized to execute all documentation necessary
to purchase an annuity.
Counsel shall file with Motion Court within thirty (30) days from the date of this Order, proof of the
establishment of the annuity contract and the deposit of the sum of $33,114.05 as required herein by Affidavit of
counsel certifying compliance with this Order. Counsel shall attach to the Affidavit a copy of the Annuity
Contract setting forth the payment schedule.
BY THE COURT:
J.
file
c .
t
IN THE ORPHANS COURT OF CUMBERLAND COUNTY, PA
IN RE: Charles M. Casey and Diana R. Casey, Co-Administrators
of the Estate of Harold James Casey, Deceased
No. 09-0250. 3 SO
PRAECIPE TO SUPPLEMENT PETITION TO SETTLE WRONGFUL
DEATH AND SURVIVAL ACTION OF THE ESTATE OF HAROLD JAMES CASEY
1. On or about March 11, 2009, The Honorable J. Wesley Oler, Jr. signed an Order
approving settlement and distribution in this wrongful death and survival action.
2. Judge Oler's Order required that counsel file proof of the establishment of the
annuity contract and the deposit of the sum of $33,114.05 in a restricted account for the benefit
of the minor.
3. Accordingly, proof of the purchase and establishment of the annuity contract is
attached hereto, as well as proof of the sum of $33,114.05 at Wachovia Bank on April 7, 2009, in
an account marked "Not to be withdrawn until the minor reaches the age of 18 years, to wit, on
7/25/2009, except ... upon further order of the Court."
Respectfully submitted,
[WARTZ, WEISS, COHAN,
AND SMALLKY, P.C.
By:
JOEL D. F MAN, ESQUIRE
1710 Spry e S et
Philadelphia, 19103
(215) 735-3716
Attorneys for Petitioner
kMS3 A346252 TF8G9518
Customer:
prg: 075 Serv: DDA Acct:
Name:
CHARLES MARTIN CASEY, ME
COURT ORDERED RESTRICTED
Acct Maint - Comments CZ663001 04/07/09
Cust Tax Id: 12:38
1010220588951 State: PA Merger:
Address: Bank: 008 Status: OPEN
NOR 6000 MARCHESTER WAY
ACCOUNT PINSON AL 35126
Sel RESTRAINT CODE: N Comments:
Comm Typ: IN Br: 95616 Eff: 04072009 CHARLES MARTIN CASEY, NOT TO BE
Src: A346252 Exp: 10072009 WITHDRAWN UNTIL THE MINOR REACHES THE
Comm Typ: IN Br: 09561 Eff: 04072009 AGE OF 18 YEARS, TO WIT, ON 07/25/2009,
Src: A346252 Exp: 10072009 EXCEPT FOR THE PAYMENT OF LOCAL, STATE,
Comm Typ: IN Br: 95616 Eff: 04072009 AND FEDERAL INCOME TAXES ON EARNINGS OF
Src: A346252 Exp: 10072009 THE ACCOUNT OR UPON FURTHER ORDER OF THE
Comm Typ: IN Br: 95616 Eff: 04072009 COURT
Src: A346252 Exp: 10072009
Comm Typ: Br: Eff:
Src: Exp:
NO DATA CHANGED
Command: AMS4
PF1=Hlp 3=Exit 4=Next 5=Refresh 7=Bkwd 8=Fwd
WACHOVIR 8"r NA
RjfTD# Ot SWARE
Philadelphia
DEPOSIT TO ACCT# lxKXXX XX8?
AMW 04/07/09 95616 0074 # 0000061
Time; 0101 PM
Calendar Date: 04+17/09
Deposit Effective date, 04%07/09
Thank You For Your usiness
Wachovia
MQVa
February 9, 2009
Lisa Tusveld
110 Gilsum Mine Road
Alstead, NH 03602
RE: Charles Casey
Dear Ms. Tusveld:
Liberty Life Assurance Company of
Boston
PO Box 1525
Dover, NH 03821
(603) 749-2600
Policy .Number: NP3-038488
I am writing in response to your request for specific information on the above referenced
structured settlement annuity. The settlement payments are being provided by an
annuity policy purchased from Liberty Life on August 7, 2008.
Liberty Mutual Insurance Company includes a certificate of guarantee.
The A.M. Best ratings are as follows:
Liberty Mutual Insurance Company A Class XV
Liberty Life Assurance Company of Boston A Class X
Standard & Poor's:
Liberty Mutual Insurance Company A-
Liberty Life Assurance Company of Boston A-
The payment schedule of this annuity is uniquely matched with the Settlement
Agreement and the terms of the annuity contract may not be changed. We can pay
benefits only on the specified dates and in the specified amounts below.
Please note: Because there is no money available in this annuity until a payment is due,
there is no cash value to borrow against, use a collateral or "cash out".
$8,000.00 payable annually, guaranteed for 5 years beginning on July 25, 200%
with the last guaranteed payment on July 25, 2013
$15,000.00 guaranteed lump sum payable on July 250 2016.
$15,000.00 guaranteed lump sum payable on July 25s; 2019
$119,384.00 guaranteed lump sum payable on July 25"; 2021
Please let me know if you need any additional information.
Sincerely,
Kathleen L Raymond, CSSC
Structured Settlements Services
FOILED-OFri^E
TWE ROTHf, 'I
2009 AP 4,/AM 10: 2 5