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Home My WebLink About09-06-13 T i S � ► ;2 IN RE: ESTATE OF JENNIFER K. HELMAN, : IN THE COURT OF COMMON PLEAS DECEASED : CUMBERLAND COUNTY, : PENNSYLVANIA ' : ORPHANS' COURT DIVISION : t - � - 113� . NO. � � = PETITION TO APPROVE SETTLEMENT,APPORTIONMENT,AND DISTRIBUTION ; OF WRONGFUL DEATH AND SURVIVOR ACTION To: The Honorable Judges of the Court: This Petition of Christiana R. Noel, Administratrix of the Estate of Jennifer K. Helman, Deceased, by and through her attorneys, Caldwell & Kearns, P.C., by Elizabeth H. Feather, Esquire, petitions this Honorable Court to enter an Order approving the settlement of the wrongful death and survivor action, approving the apportionment of such settlement, and permitting the distribution of the settlement funds. 1. Petitioner, Christiana R. Noel, mother of Decedent, is an adult individual, currently residing at 9 Louis Lane, Enola, Pennsylvania 17025. She was appointed Administratrix of the Estate of Jennifer K. Helman, Deceased, on October 23, 2012. A copy of the Certificate of Grant of Letters of Administration is attached hereto, made a part hereof, and marked Exhibit"A". 2. Decedent, Jennifer K. Helman, was born on August 10, 1991, and resided in 3 Enola, Cumberland County, Pennsylvania, at the time of her death. 3. On September 23, 2012, the Decedent suffered multiple�au(''�matic ir-�-�rie�h��rty � "."� r'r ti♦ 4r 'i y..,.� 1�] , �.:_. :. y caused her death as a result of a motor vehicle accident in Enola, Penn�lv�;�i� Th�'Dec�d�nt �.."' �� ; �;--� `� was a passenger in the motor vehicle. �- �'" �� c� ..� � v..,�, t,�, .-� �;� ,-- � ;,� �s <�.z P�, -=� .. ,� c�::T . :. .,� .W ��J � �..�Yn +:.'�� . 1..,.. � � '"� �� .r'} ��9 .� 4� �� , � � . 4. Decedent died intestate on September 23, 2012. A copy of her death certificate is attached hereto as Exhibit"B". 5. Decedent, Jennifer K. Helman, was not married and had no children. 6. Decedent, Jennifer K. Helman, is survived by her parents, Christiana R. Noel and Kenneth P. Helman, Sr. 7. Petitioner proposes apportionment of the settlement fifty(50%)percent to the wrongful death claim and fifty (SO%)percent to the survivor claim. 8. Erie Insurance, the carrier on the driver's insurance policy, offered its policy limits of$100,000.00 without any lawsuit being brought against the driver of the vehicle. Petitioner, with the assistance of counsel, settled the case with Erie Insurance against the driver for these policy limits of$100,000.00. A copy of the release settling the claim is attached hereto as Exhibit"C". 9. Donegal Insurance Group, the carrier on the Decedent's insurance policy, offered its policy limits of$15,000.00 without any lawsuit being brought. Petitioner, with the assistance � of counsel, settled the case with Donegal Insurance Group for these policy limits of$15,000.00. A release was not required by Donegal Insurance Group in order to pay these policy limits. 10. Caldwell & Kearns, P.C., is the personal injury counsel associated with this matter. Counsel will be paid fees and costs under a Contingent Fee Agreement with the Petitioner in the amount of$38,333.00. 1 l. For inheritance tax purposes only, Petitioner requested and received approval � from the Pennsylvania Department of Revenue of allocation of the gross proceeds of the $115,000.00 settlement to be apportioned $57,500.00 to the wrongful death claim and 2 F � a � / 1 � $57,500.00 to the survivor claim. The letter from the Pennsylvania Department of Revenue approving this allocation is attached hereto as Exhibit"D". 12. Petitioner proposes the apportionment of the entire amount of the settlement funds $57,500.00 to the wrongful death claim and $57,500.00 to the survivor claim, with the net ; < proceeds distributed equally between the two (2) intestate beneficiaries, Christiana R. Noel and Kenneth P. Helman, Sr. WHEREFORE, Petitioner requests this Honorable Court to: (a) Approve the settlement in the amount of$115,000.00; (b) Approve the apportionment of$57,500.00 to the wrongful death claim and $57,500.00 to the survivor claim; and ' (c) Direct distribution of the $57,500.00 wrongful death claim to the intestate , beneficiaries and $57,500.00 to the Estate of Jennifer K. Helman for the survivor claim with the net proceeds to be distributed equally between the ' intestate beneficiaries. ; Respectfully submitted, CALDWELL & KEARNS, P.C. � ; Date: � 13 By: V. r Eliz eth H. 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THEREFORE, I, GLENDA FARNER STRASBAUGH , Register of Wills in and for CUMBERLAND County, in the Commonweal th of Pennsylvania, have F this day granted Letters of Administration to: ' CHRISTIANA R NOEL who has duly qualified as ADMINISTRATOR (RIX) of the estate of the above named deceden t and has agreed to admini s ter the es ta te � according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 23rd day of October 20�2. >. ^ � � ` egister il �,. � � _,.� � � °�. _ '�. � ____ Depu y i t. . • ' tt lt � �x�c��-� � r ; **NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) �S.tSU�Jt�V i�)/11) . � �,��,�, �� -�� p��`°��' ��' �� ' �� 'l��a 1� �� a�� sy��i��: ��i� �:�� f�� .��T��a: ' :e fUr#his eertificat�, ��.�}� i�,�u,jf';°`r>:", ,,� ��215 is t� �ertify ihat the in�c��nation here �1Vell 1` ,�S� ��`�� 44,,�� --,�r��";��,�-�,� carrectl}r c;opied fron�an origil�al�ertificate vf Deatl� ti4�/�- ��=� d�l�� filed v�itl� �ne as Lo�a� Registrar. '�'he origina ;.�, ; ��-.� .�. ;��__ ,�� 'w ��rti�icat� �vill b� for�varded to the State '+Iita `�� 'r R- :�'°~ �.eca�c�s �ffice for�ennanent filin�. � �� . ~�}p ��-�� t ��..� ��i _��_�- ,`1+1 1 �F N,' t,x. .w 3:.:, ��L4 �r` a"".. , . ,..... ,� w. a. �..,' . '...� -� ��1 O`�'r�1� � � • �" �, �`� � '->��l�� .,,� ; :��:r� .�� ,,� Cerlification Number +�� ----,,,,,,•,�,""•'` g Lacal Re�istrar �ate Issued � VMt In COMMONWEAITH OF PENNSYtVANU•OFPARtN1EM OF NEAL7H•VITAL AECOqDS """` CERTIFICATE OF DFATH t Ink -Statc Hk Number. L DecedaG's Lepl Mam!lFUSt Ntlddk.lut.5uH6c) L Sex 3.SoUat Senulty Num6er � a.Date of Oatfi lM11o/UaY/rrllSGd�Mo1 1ri� � • • �t F o -7a-� Sepiember 23.2012 � Sa.A{edast Birthday(Yrs) 56.Und�r 1 Year Sc Under 1 Da G Date M BIM�MO/Day/Year�(SpeM tAOnth� 7a.Nrthplacs� md Sbte w fwN{n Countex) � al �� H� �� us�-. ro 1q9� �b.a��,,, '� . . . ..� - . .8a,Aaldenoe�State or.FOrel�n CovrdM Bb.Rerkenu(Streef and Number-hdude Apt No.) 8c Dld Deudent Uve in a-Townsh�P7 . . . .. �_ . . . . .._.. . .. - -.�. - _. q !_ou�5 ya,��: �.Ye�,��_�.�P�•,,��h� �. ed.x�tcow,n,► _ �.wriatl,�tno caa�� _,1"�p OHo,e�M i�.d wreia o��r _ . dty/boro.��: . . 9.everu.us�m�ed r•orcest 7Q Muhal StaUe rt Tlme of Deatb p�ar�ee p waowed ii.w�sv�'s N.me Inwne.r��ame a�:e nixe marwat � � p rH g�ao ❑unkrow�, �owaeed p,Never Mar.rA ❑u�6ww�, - � � 72.father's Name(fYSi Mlddle,last,SuMlt) f3.Mether'a Name Prkr to Hrst MaMage(fkst,Middle,tast) d Chrtisfi' ` l�a.M(orma�'s Mune i Ndatlon�Mp to Decedent !4e hbmuMY MaMg Addras(SVeet and Number.Oty.State.Lp Code] ' ; ' v� a 'S nici. 1?w1 ; s.. ,,.�°o�nn l. . _.�^"1.. ...... _ . „ �..... . � . _ . _�� IfUeiM�OmwfedinaNnspltalc W�lnVatlent� •••••.•«•�•••�•.MNDwthOmmedSemeufiereOtl�er7lunaHefpiW:• .»•�HmpkeFsdNv ��DecedmtsHome�� . ... .. � �E�ee�crnoamlouroanms.: ❑oe�dw�a.wal ; H�tqHamel�on�-rae,VRCxtlhy onKr(se�dM ' ` _ . . �: � . _-..� ISb:hdIMY Name(If not les[IMioti ih'emeet and numberl !SC aW aTovm.State.xd LO Cnde. `.. . - ...�- ]Sd.C�nry of Oeath . :: . � � . ; Hershey Mediql Canter Derry Twp;PA i 7033 ' Oauphin ;,;iw.�nei+md at ohvos�ewn- �eurim ❑c,emado� iab.mee at o�s�odebn 76c P6ce oi Dfsnosilta+IPpme of ameeery.aemataY.or o�her W«i , ; ❑aemov.�trom sf,te p uomnop - �,��ti� _ 4 a�a�i Ro11i Grezn YVievw.r�via�.. �u-►�.- ; - �. . . . � .:� 76d.lqtatlon of dsposiibn(Uty or Tpwn,Sute,a�LP) ...-�.� I7i. 't5te .FUqenl Se or n M M Inte�me�t 17E.11ce�oe Number � 3 CAm H�11 PA S��c�.l ; � - ' _ � PTX�t.'!'7�tSL - 3 .. . -.. � - .� } Dc Name ond Cmnplete Addrcss ot iunenl PadIM . . . . --- - . . ; ` .. . :: .. � ..-.� ` .. _. . . . . ..: . -.- �..-. � . � .. ..� � � J . .. -. . $ IE. deiCs£duotbn• the bos tha�bea destAbes the 19.Oecedent o(Hk In•fhedc ehe M.D�oedmYs Wce•O„tk ONE OA ONE rsus to Md�te whrt . s � '- highest dyne a Nval of Wiod tompletM at the Nme d death. box that best desni6es whether the deeede�n Ne d�oedent mnsideted himseM arhxself to 6e. , ❑ath�raae er ru s sa.��Nwro��r/tamw.ened�sne-wo• �wnn. p¢or..e ❑ao mdoma.vm-�zu� Ms il decetleni k oot SP+�sAM�sWn�rJlatlro. ❑&act or Akkan i►merian ❑vkm.mae ❑N�h fchoot ysduate e�GED mmpkted Ho,not Sp:mcl�H4yanic/litlno~ ❑Amerkan Ldlan a Alaska N�tive ❑OthetAsian �Same mY�p cedu,buc ro degree ❑res.Ma�nn.Mnuon nmerican,aacano p af Wn iad�an ❑Nanve wrraean ❑Assoti�u degre�la&M.AS) ❑Yes.PueRO Rian ❑�bwse ❑Guamanian a Qumorto � - . . . . . � � � - � ❑e.d�dorsd�t�.a•sA,�e,esl ❑v�,o,ba� ❑Aeprvw ❑sa�om ❑�+.sars deaK les ena.Ms.��.Med.Msw.�neat ❑Yes.ather Spaofsh/ltisrynidLaNno ❑Hwnes� ❑OtherPadikls�nder - �ooaaate ie.[.P►�o.Edol w Profassbro{de�ree (svKNV) � O other(svedhl e MD DY L181D - 21.De[tdenCs Singie Itaoe XH-Oesfg�utbn-Chetk ONIY ONE to Indinie what the deoedent wmidered Fimsdt or herseB M be.22p.DecedenYs Uwal Oacupadon-Indkate type d work ,�Whiee ❑laWMSe ❑Sammn � donedutNgmoitotwottl�giYe.00NOTU5ERE7UtE0. _ �Bbck or Afrian Amerkan ❑Korean ❑Other Padfic hbnder � L . ❑Amerion Indfan ar A{atb NaWe ❑Vlebumese ❑Oonti Know/NOC Surc Q 1�Q� p asian u,d�a� ❑od��wn p n�tusee xzn.Kmd or eusr�mnnausw � ❑tldnese ❑NaUve ihwaBin ❑Other(Spetlfy� �� . ❑Pobk+o ❑GuamaNan m Chamorro -��..- .:..... : REMS 23a-13d MUST RE CAM WtTEO Z3a.Daie Pmnewred Wad(MOIWYI.Yr)� 736.9gnmue_ot Perren Pronow�d'q oeatA.tOnH vrM�appltcabkl 23c.llunse Number�. �,. ..�..`. .� .,. �.:�. -..�.�..- srva�soMwtwvisoNOUNCESOn September 23,2012 . _: ��so�►n� _ ,_, � .. �.-. -: T3d.wtesynedi�lmY/'hl Te.txneofoe,cn . ,. � �,. .- �..� -� -� � -. �� - . -. . e 06:48 FM u.wu W�edlo�EnmU�er a eoroeer emmctea7. �res D �+o -. _ CAUSE dF dEATIi ':_.:. ;, ; naoro�n,x..: " ; � � . .. 26.Part L Enter tl+e d+aln o(evenu-dlseases.En�uries,a mmplkatlons-tbat dtectly caured the deith UO N07 enter terminal events sucA u nrmacanest. hReml: tespintory ufefC w ventrlt�larA6t11bHon wlthout show{n`the tlfabgy.00 N0T ABBR£VIATf.Enler onN one ouse on i IMt.Md eddiNOnal l(nes it�ecessary i ��ath IMMEdAlEGUSE ..-� :Multiple Traumatic Injuries `• �pml d�uase a mnAean Oue m�w u a mnsequenre on: . . resultlns M death) b. 6 - .. .... .SequemV�MlkcmndWons,.-... . Duem(wasam,uequeroeofJ: .. . .. � ,.� . � �� ..�.� �� '� - If�nY.kadin6 W the nuse.- � � . ..� . . `: i . . �. . � ,� .. �. . - -�Ikted on 9ne a.Entv tf�e - .�c - .. . � . . . . � .. � . ' - � - � . - UNOERtYING UUSE - Due m la u�mnse4ue�ce a�: .� � � .. � �: i � ..- . -� .� �. �y ��.(dl:easeorMhirvthst -.:�. .-:_ . .. � , .. ... .. - � � --t- Initlated d�c evenct tesuk3ry d . .:� . � . .. . .. � �.. . . indnth)lAST. . Due io(a n�mme4uence ot�: . . . . p, . . . . _ . : � . - . . .. --�..�. . ��-. � . . . _... .. � . � . � �.-� . . ::S '16.Vart p.Enter aher sianiRaM cadiNons mntributin¢to deathbut not.resuRir�g in the undeclyky ause Biven In Oan 1 �� 21.Wu an wiopry perfom�edi . . -. .. . ,. . _. . .. .. : .�y . .... ...� '� � �� ._' � - ..� .-. . :�.�Yes- ❑Nn �.: . :.._. ,.._ . . �': ..� - . . .-. . � . _ f `za.w�.ewwPSytMm�s�nuaek.. : , � . � .. - � _ .� _.- � � � � �.'y> . _ _ - .. � .� �.-to mmpletrihe�ause ot deafAt � . � � - - _ . .... ---� ..._.. -_� � � :. � � .. �- � ... . . ..�.. -�--... .. ..-_.. - "�Yes �.❑�NO . . . -... __ . b � . � 79.Kiemale: 30.qd ToWao Uu Confdbute to DeatAt 31.Manner M Drath � g ❑NMpre�naMwhhln Wstyea� ❑Yes ❑P�obably �Natural ❑Homidde ❑Prepun[at ttme af death �No (]Unknown �Accidmt ❑Pandi'q Invest�WNon � `a ❑NotD�q^�^4�PK6NMMdtld��2tlaysoldeatt . �Suldde �WvWfwt6ad�oermined . � � (]Nut prqnalrt,bul Dn6��4;Qrys to 1 year betme deatt 32 Date of i�ury(MO/Osy/Yr)�SpeN MonthJ � (�u"a°"'^M a°g"'"�"""tl'h`he P'n ye" September 23,2012 ��n11°°��M'""A x 04:50 P �n� p � 3e.Platt of In�ury I�.home;miatructlon site:brm;xhool) 35.lxsUon o!7nj�ay(SVeet ard Num6er.Cky,State.Dp Cnde) � . Highway 2000 Blk Valley Rd,Enola,PA 17025 36.In�uryrtWork 3�.Ntraroponstla�tr�ury.SpedN= 3&Desal6efiowlnJuryOccvrted: . . ❑r�s ❑Orlver/Opentor p v�am�,�, Unrestrained and ejected passenger of roilover crash m Ho �r,�� ❑owK�so�ah� �X�(I��.� ��3 �r 3sa.eerener(efieck ody one): � � ❑4rtltyfn�PM'sl[vn-To U+e Dest of mY knowrkdQe,daM acarted due m The nusr�sl��d manner snted ❑pronoundng b Certllying pl�ysltlan-To the best ot my knouAMye,tlearh ocnured uthe tlme,dace,and plxe,ad due to tAe ause�s)and nnma sbted j$tdefiiol EsamMn/ ro f�nt�e zamtnarion and/a lmastlesHan.in mv opi+bn,dead�occuree at the orne,eate.uK!vtace.and due w the auu4si and manner sutee �. " . ._. sy�amie ot«nx(er. � nek o�cM7n�r:Chief DePuh� tLx�sse Numbe.: � � - � �.`39h.Name,Address and LP fnde of Person Campktln[6me of De 26)- . . � �. . . . �� 9c Qaee SP�ad tMO/Oatl/'� � . Lisa A.Porieiper,1271 South 28th Sfreet,Hartisburg.PA 171'I1 September 24,2012 � _ �. ...M.�Re{isUar'T IXstrkt NumLcr ]. -_- .� � _.. . 42 Fle Date P�/�Y/Yh ��.��..� �`j� � � _ e'� �4��l _, . . �a3.Nna�amenu H7q5-f�3 ��o��o. 4�93�39 �o�r�� / ( GENERAL RELEASE CLAIM 010171254173--INJ For the consideration of ONE HtJNDRED THOUSAND AND NO/100---------------------------- -------------------------------------dollars ($100,000.00) receipt of which is hereby acknowledged w/o release and discharge, and for myself/ourselves and for my/our heirs, representatives, executors, administrators. successors and assigns, do hereby remise, release and forever discharge KATHRYN MCBRIDE AND 30SHUA OZIO hereinafter referred to as the release(s), his/her/their/its heirs, executers, administrators, insurers, successors and assigns, and any and all other persons, firms, corporations. associations, of and from any and all causes of action, suits, rights, judgments, claims and demands of whatsoever kind, in law or in equity, known and unknown, which we now have or may hereafter have, especially the claimed legal liability of releasee(s) arising from or by reason of any and all bodily or personal injuries and/or property damage known and unkriown, foreseen and unforeseen which heretofore has/have been or which hereafter may be sustained by me/us arising out of the accident on or about SEPTEMBER 23, 2012 at or near EAST PENNSBORO TOWNSHIP in the county of CUMBERLAND in the State of PENNSYLVANIA which liability releasee(s) expressly deny(ies}. I/We agree that the consideration set forth above is specifically applicable to and paid to me/us with respect to any and all damage to any property, either real or personal, of mine/ours and with respect to any and all personal or bodily injury of mine/ours, whether presently known or unknown, foreseen or unforeseen or which may subsequently develop and the consequences thereof, all as arising out of the aforementioned accident. UWe further agree that the consideration set forth above is specifically applicabie to and paid to me/us with respect to any right of contribution that I/we may have against the releasee(s), his/her/their/its heirs, executors, administrators, insurers, successors and assigns relative to claims of others that may be brought against me/us by reason of said accident. I/We further agree that the consideration set forth above is specifically applicable to my/our agreement that I/we will not join nor attempt to join the releasee(s), his/her/their/its heirs, executors, administrators, insurers, successors and assigns in any capacity, in any action that may be brought against me/us arising out of said accident. I/We warrant for myself/ourselves and my/our heirs, representatives, executors, administrators, successors and assigns that I/we have received no money or other valuable consideration from any other person or persons by reason of any causes of action, suits, covenants, agreements,judgments, claims a�zd demands of whatsoever kind which I/we now have or may hereafter have, for inj uries to my/our person or property or for the other matters for which this release is given. I/W e further understand and agree that this Release 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. Uwe understand and agree fhat 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 expenses, liens, workers compensation liens, ERI S A liens, liens asserted by any federal, state or local governinental entity or agency or any medical expense claim. Should any person or entity make claim for payment of any liens or charges against The ERIE or their counsel, I/We agree to �.�(t�r�� -�- t�G ►� r , , � indemnify and hold harmless The ERIE and their counsel from any and all such liens, charges, fees, claims, attorney fees, costs, interests and any other sum. I/We 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. This Release does not apply to any Underinsured Motorist (UIM) claims and/or medical negligence claims. Intending to be legally bound thereby, WITNESS my/our hand(s) and seal(s) this �S� �'' day of , 20 /,3 NOTlCE: Any person who knowingiy and with intent to defraud any insurance company or other person files an appiication for insurance or statement of claim containing any materially false information or conceals for the purpose of misieading information conceming any fact material thereto commits a fraudulent insurance act, which is a crime and subjects the person to criminal and civil penaities. WITNES S: � � � ��,�, � Gi� (SEAL) (SEAL) 12364-001/202200 . , . . + . e � AUG 3 t 2�� enns lvania p y ; � DEPARTMENT OF REVE'NUE . � August 27, 2013 Elizabeth Feather,Esquire Caldwell&Kearns,PC 3631 North Front Street Harrisburg,PA 17110 Re: Estate of Jennifer K.Helman File Number 2112-1135 Court of Common Pleas Cumberland County Dear Ms. Feather, The Department of Revenue received the Petition for Approval of Settlement Claim to be filed on behalf of the above-referenced Esta.te 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 21 year old decedent died as a result of a motor vehicle accident. The sole heir to decedent's estate is her parents. Therefore,any proceeds paid to settle the survival action would pass to decedent's parents and would be subject to a zero percent inheritance tax rate. 72 P.S. Y §9116(a)(1.2). Accordingly,regardless of the allocation of the subject proceeds,there would be no inheritance tax consequences. Please be advised that based upon these facts and for inheritance tax purposes only,this Department has no objection to the proposed allocation of the gross proceeds of this action, $57,500.00 to the wrongful death claim and$57,500.00 to the survival claim. Proceeds of a survival action are an asset included in the decedent's estate and,although subject to the imposition of a zero percent inheritance tax ' rate in this instance,they must be reported on decedent's Pennsylvania inheritance tax return. 42 Pa.C.S.A. § 8302; 72 P.S. § 9106, 9107. Costs and fees must be deducted in the same percentages as the proceeds are allocated. In re Estate of Merr�, 669 A.2d 1059(Pa. Cmwlth. 1995). ' I trust that this letter is a sufficient representation of the Department's position on this matter. As the Department has no objections to the Petition, an attorney from the Department of Revenue will not be attending the hearing regarding it. Please contact me if you or the Court has any questions or requires anything additional from this Bureau. Sin ely, S annon E.Baker Trust Valuation Specialist : Inheritance Tax Division ; �.X}�}I�ai`) "� " Bureau of Individual Taxes � PO Box 280601 � Harrisburg, PA 17128 � 717.783.5824 � shabaker@pa.gov