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WILLIAM D. CLEGG, Administrator of the : IN THE ORPHANS' COURT OF
Estate of LORI A. CLEGG : CUMBERLAND COUNTY,
: PENNSYLVANIA
: NO. 21-12-0440
PETITION FOR APPROVAL OF PARTIAL SETTLEMENT
AND ALLOCATION OF PROCEEDS OF
WRONGFUL DEATH AND SURVIVAL ACTIONS
AND NOW, this�day of September, 2013, comes Petitioner, William D. Clegg,
Administrator of the Estate of Lari A. Clegg, through his attorney, Herman A. Gailey, III,
Esquire, and petitions the Court as follows:
l. Petitioner, William D. Clegg, is an adult individual residing at 345 Foxleigh
Drive, Hanover, York County, Pennsylvania 17331.
2. Letters of Administration were issued to Petitioner on April 13, 2012, by the
Register of Wills, Cumberland County, Pennsylvania, said letters being docketed to number 21-
12-0440. A copy of the Short Certificate is attached hereto as Exhibit A and made a part hereof
by reference.
3. Lori A. Clegg died on March 23, 2012.
�
4. At the time of her death, Lori A. Clegg was 32 years of age, having been born on
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August 15, 1979.
5. Ms. Clegg did not leave a Will.
6. On March 23, 2012, in the early morning, Lori A. Clegg was operating her
vehicle westbound on Route 283 in Mount Joy Township, Lancaster, Pennsylvania.
7. At the above time and place, a truck and livestock trailer owned by Ronald
Ressler and being operated by Matthew Miller, was traveling eastbound on Route 283 in Mount
Joy Township, Lancaster, Pennsylvania.
8. A large wheel and tire assembly from Ressler's trailer became disengaged from
the trailer, traveled across the roadway, and entered the westbound lane of Route 283 directly
into the path of the vehicle being operated by Lori A. Clegg and a forceful collision occurred.
9. As a result of the collision, Lori A. Clegg was pronounced dead at the scene.
10. Further information regarding the facts and circumstances surrounding the motor
vehicle accident are contained in the Commonwealth of Pennsylvania Police Crash Report, a
copy of which is attached as Exhibit B and made a part hereof by reference.
11. As a result of the circumstances of the motor vehicle accident, Petitioner has
made an underinsured claim against Lori A. Clegg's automobile insurance company, GEICO
Insurance Company. That policy provided $300,000 underinsured limits. The full limits of
underinsured coverage have been offered to settle that component of this claim. A copy of
GEICO's tender letter is attached as Exhibit C.
12. The liability claim regarding this accident remains outstanding and has been
appropriately preserved by way of the filing of a lawsuit docketed as follows:
William D. Clegg, Administrator of the Estate of Lori A. Clegg v. Ronald and Josephine
Ressler, R&J Enterprises and Matthew Miller, Case No.: 12-09987 in the Court of
Common Pleas of Lancaster County
13. Petitioner respectfully requests that this Court grant permission to resolve the
underinsured claim with GEICO Insurance Company.
14. Statutory wrongful death beneficiaries are as follows:
(a) William D. Clegg, father, and
(b) Sharon Clegg, mother.
15. William Clegg, Administrator of the Estate of Lori A. Clegg, is Petitioner in this
matter and believes that the above partial settlement is fair and reasonable.
16. Sharon Clegg, mother of Lori A. Clegg and wrongful death and survival
beneficiary, has executed a Joinder form evidencing her concurrence in the proposed partial
settlement and this Petition. The Joinder form executed by Sharon Clegg is attached hereto as
Exhibit D.
17. Petitioner has entered into a contingency fee agreement with the law firm of
Martz & Gailey in this matter with respect to the settlement of this claim.
18. There are no present creditors of the Estate of Lori A. Clegg.
19. The Commonwealth of Pennsylvania, Department of Revenue, Bureau of
Individual Taxes has reviewed this matter. The Department of Revenue has no objection to the
allocation of settlement proceeds between wrongful death and survival claims with respect to the
settlement proposed for present distribution. This is evidenced by a letter from the Department
of Revenue, Trust Valuation Specialist dated August 19, 2013, attached as Exhibit E.
20. Proposed distribution of the total underinsured settlement is as follows:
A. Wrongful Death Action - $ 150,000 (50 %)
$ 98,339.43 William and Sharon Clegg
$ 1,660.57 Martz & Gailey (costs)
$ 50,000.00 Martz & Gailey (fee)
B. Survival Action - $ 150,000 (50%)
$ 98,339.42 William Clegg, Administrator
$ 1,660.58 Martz & Gailey (costs)
$ 50,000.00 Martz & Gailey (fee)
WHEREFORE, Petitioner prays your Honorable Court to enter an Order authorizing
settlement and allocation in accordance with the terms set forth above and that leave of Court be
granted to sign a Release to resolve the underinsured portion of this claim.
Respectfully submitted,
�� �� Q
Herman A. Gailey, III, Esquire
MARTZ & GAILEY LLP
96 South George Street
Suite 430
York, PA 17401
(717) 852-8379
ID No.: 31097
WILLIAM D. CLEGG, Administrator of the : IN THE ORPHANS' COURT OF
Estate of LORI A. CLEGG : CUMBERLAND COLTNTY,
: PENNSYLVANIA
: NO. 21-12-0440
_ ,� _ ,,,.� VERIFICATION
,
I, William D. Clegg, do hereby verify that the facts set forth in the foregoing Petition for
Approval of Partial Settlement and Allocation of Wrongful Death and Survival Action are true to
the best of my knowledge, information and belief.
I understand that false statements made herein are made subject to the penalties of the 18
Pa. C.S.A. 4904 relating to unsworn falsification to authorities.
ILLIAM D. CLEGG
Date: � Z G /3
WILLIAM D. CLEGG, Administrator of the : IN THE ORPHANS' COURT OF
Estate of LORI A. CLEGG : CUMBERLAND COUNTY,
: PENNSYLVANIA
: NO. 21-12-0440
ORDER
AND NOW, this day of , 2013, upon presentation and consideration of
the Petition, it is hereby Ordered and Decreed as follows:
1. Petitioner may execute the Release in favor of GEICO Insurance Company and
disburse proceeds as set forth below:
A. Wrongful Death Action - $ 150,000 (50 %)
$ 98,339.43 William and Sharon Clegg
$ 1,660.57 Martz & Gailey (costs)
$ 50,000.00 Martz & Gailey (fee)
B. Survival Action - $ 150,000 (50%)
$ 98,339.42 William Clegg, Administrator
$ 1,660.58 Martz & Gailey (costs)
$ 50,000.00 Martz & Gailey (fee)
By the Court,
J.
WILLIAM D. CLEGG, Administrator of the : IN THE ORPHANS' COURT OF
Estate of LORI A. CLEGG : CUMBERLAND COLTNTY,
: PENNSYLVANIA
: NO. 21-12-0440
CERTIFICATE OF SERVICE
I hereby certify that I have this,c� r vl day of September, 2013, served a true and correct
copy of the foregoing Petition for Approval of Partial Settlement and Allocation of Proceeds of
Wrongful Death and Survival Actions on the following individuals as set forth below by first
class mail:
Ms. Danielle Pelletier
Claims Adjuster
GEICO
P.O. Box 9505
Fredericksburg, Virginia 22403-9504
Underinsured Adjuster
AND
Joseph F. Murphy, Esquire
Forry Ullman
540 Court Street
Reading, Pennsylvania 19603
Tortfeasor Counsel
Respectfully submitted:
=-�U ��� —
Herman A. Gailey, III, Esquire
MARTZ & GAILEY, LLP
96 South George Street, Suite 430
York, Pennsylvania 17401
(717) 852-8379
ID Number: 31097
WILLIAM D. CLEGG, Administrator of the : IN THE ORPHANS' COURT OF
Estate of LORI A. CLEGG : CUMBERLAND COUNTY,
: PENNSYLVANIA
: NO. 21-12-0440
SCHEDULING ORDER
AND NOW, this day of , 2013, a hearing on the
merits of the within Petition is hereby set for the day of 2013, at
o'clock A.M./P.M. in Courtroom Number
J.
COMMONWEALTH OF PENNSYLVANIA SHORT CERTIFICATE
COUNTY OF CUMBERLAND
exr
I, GL ENDA FARNER S TRA SBA UGH
Register for the Probate of Wills and Granting
Letters of Administration in and for
CUMBERLAND County, do hereby certify that on
the 13th day of April, Two Thousand and Twelve,
Letters of ADMINISTRATION
in common form were granted by the Register of
said County, on the
estate of LOR/A CLEGG , late of NEW CUMBERLAND BOROUGH
(Fiist,Middle,Lastl
in said county, deceased, to WILLIAM D CLEGG
/First,Middle,Last)
and that same has not since been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the
seal of said office at CARLISLE, PENNSYLVANIA, this 13th day of April
Two Thousand and Twel ve.
Fi 1 e No. 2012- 00440
PA Fi 1 e No. 21- 12- 0440
Da te of Dea th 3/23/2012
S. S. # 220-15-2132
,
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7�Pedestnan OZ=Froot Seat M(ddle PoSiUon 0 2=W p Ae�t Used 3=PdNa lly Ejc�ed
e=Other 03=Front Seat Right S�de 03=lap And Shouider Belt Used 9=Unknown
9=Unknown 00.:Second ftow•Left S�de Ot 05�MO��t�o Sa�b„Imel U ed
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05=5eCOndROw-Middle Posicion o6=8icycte Helmet Used M ��in �p�h;
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M=Mdle Og�Thi(d RGw Or Gr�ter• 90=qesValnt�sed,7ype Unknown 3�Throuph WinBs�ield
�cllnknOwn Mlddle Po;il�On 99=Unknow� Q=Through BaGk D00�
� 09�Third Row Or Greater• . 5=lhrough Back Door Taitga�e Opening
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� � 1=Kill¢d Passenger 0�Cargo Aiea 02�5ide Air Bag DeCloyed(for This SeoO Top�p�
2=Major(njury �Z=1n�pe�A�ea 03=0�her Type A'�r Bag Oep�oyed 9�Unknown
3=Moderate (Back Of Piw:up,Et�•1 04=Multiple Air 8ags Deployed
� 05=MotorCycle Eye P�otection
����ry 13-7fa�ling Unit
4>{Nmot Injury 1d=RiG�ng On Vehide ERterior 06=Biryclist Wearing Elbow�YCneeRads F ' 1� •
8=Injury,Unk lO�Air Ba Not Oe lo d Swilch On � O=Not AppbWble
15=8us Fassengtr 9 P � ' 1=Noi ExlricatEd
Seve��ry 9B-Q1hef ��=A�r 8ag Nol Deployed.Swicch off
9=Unknown il 99�Unknown 12=Air 8ag Not Deployed, 2=Exuiteled By MechaniWl Means
Unk Swnlch Setting 3�freed By Non•Mechanical Means
lnjury 13=A(r Bag Ramoved(Prior To Crash) ga0ihe�
19=Unknown�(Air 8ag DeDloyed 9=Unknown
99=Unknown
�3 EMS Agenry: NORTHW�ST�MS Mzd�w�F�d�iti' ��A _
Date o�Birlh (MM-DD-YYY`� A B C D E P G H I
untt wo �erso�No petetoZ �_� �a�o p� 99 99 p a LJ
�� O1 01 O 09 �9 - 1995
Ivame I Address I P hone EMS T�ans por4
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Opctdtor • .
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O1 02 O �6 - 13 - 1966 2 M 0 03 99
Plame/Addre�/Phone EMS TranspoR
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02 O1 O 08 ° 15
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Un+t 2 was found disabled in the travel lan0 by a passerby, Unit 2 had suffered significanf fronta)impaCt starting
at tha hood.Driver was found deceased behind the wheel with engine running.
A Varge wheel with tire mounted an it was found behind Un�t 2 and sitting up against the guard rail off fhe
shouidet of the roadway.Paint chips on the wheel indicate ik had collided wiiFr Unit 2.
Wheei marks faund in the grass median indicake the wheel had come from the east bound side oP the roadway,
� No vehicles were lacated disabled missing a wheel,and na marks were presenk on the roadway indicating that
� 1he vehicle which iasf the wheel was draging an axle.This suggests a dual wheel trailer or pick up truck
� Owner of unit 1,identified as Ronaid J Ressier,came faruard atter being made aware of khe accidenk by a frlend
'� who had seen the sfory on the news.7he owner identifted tho driver 2s Matihew Miiler, 46 years of 2ge.Yhe
zt�� awner oper2tes a livestock hauiing business and does not have proper license and documentat�on for
� GOmmerical Motor Vehicles(OOT, PUC, )CC numbers}Driver,Miller is aiso nat praperiy iicensed to operate
Commerciai Motor Vehicies.Owner Ressler,eonfirmed Unit 1 was traveiling on the esst bound side af the
roadway at ihe 1(me of the coilision.
Upon speaking with QwnEr,Rossier and Driver, Miller we iearned that th�twa did not nofice that a whee)had
been last on the trailer until reaching their desGnation, at�he New Nolland sales barn in New NaHand
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�z PA.Owner Ressier was nvt made aware of ths accident unti!evening hours on�r(day Merch 23rd,2012,
after he had returned homo ta Ohia. Our department receiued not+fcation(rom Ftessie�s 8tto�ney on
Monday evening March 26fh, 20i 2 of his intention to come fon�rard and provide required informat+on.
N1ay 24, 2fl12. Upan�eview oP this CRASN report it was determined ihat Ute notation in Block 12 af the
report as it relates to Unit 1 was coded'+ncarr�ctiy,designating ths lrail'tng un+t of Unik 1 as a{6}Trailer,
when it in fact should have been caded as{7j Serni-7rail�r,t made the correction this
date.
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� ��'�O� GEICO General Insurance Company
- geico.com
P.O. Box 9505
Fredericl<sburg, VA 22403-9�04
7/15/2013
Martz & Gailey, Llp
Mr. Herman Gailey-iii
96 South George Street Suite 430
York, PA 17401
Company Name: Geico General Insurance Company
Claim Number: 037868006-0101-022
Loss Date: Thursday, March 22, 2012
Policyholder: Lori Ciegg
Your Client: The Estate of Lori Clegg
Dear Mr. Gailey-iii,
Please allow this to confirm our telephone conversation of July 15, 2013 in which I extended
an offer of the UIM limits of $300,000.
Please be advised that this matter will require court approval.
If you have any questions, I can be reached at the number below.
Sincerely, ,
Danielle Pelletier, Examiner Code J365 •
1-800-841-1003x4277
Claims Department
EC0749(12/2011)
WILLIAM D. CLEGG, Administrator of the : IN THE ORPHANS' COURT OF '
Estate of LORI A. CLEGG : CUMBERLAND COUNTY,
: PENNSYLVANIA
: NO. 21-12-0440
JOINDER
This is to confirm that I have reviewed the foregoing Petition for Approval of Partial
Settlement and Allocation of Proceeds of Wrongful Death and Survival Action in the above-
stated case. This proposed settlement and distribution of funds is acceptable to me in all ways
and by signature of this Joinder, I hereby join in the Petition referenced above.
/ �
Date S ARON CLEGG
SWORN and SUB�RIBED to
before me this�_day of
September, 2013
� �� .
N TARY PU LIC
COMMONWEAL711 OF PENNSYLVANIA
NoWrlal Seal •
P.Jo Mne Bennett,Notary Public
My Commission Exp res: cnyo�ror�,Yatccouney
mm ss on res lune 4,2014
, s� � pennsyLvania
.� DEPARTMENT OF REVENUE " ��n � j_' a ,�?
.�,._.,_m .��,�"� ,,• .} �'���
August 19, 2013
Herman A. Gailey, Esquire
Martz& Gailey
96 South George Street, Suite 430
York,PA 17401
Re: Estate of Lori Ann Clegg
File Number 2112-0440
Court of Common Pleas Cumberland County
Dear Mr. Gailey:
The Department of Revenue has 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 has
been 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 32 year old decedent died as a result of a motor vehicle accident.
Decedent is survived by her parents.
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 net proceeds of this action, $98,339.43 to
the wrongful death claim and$98,339.42 to the survival claim. Proceeds of a survival action are an asset
included in the decedent's estate and are subject to the imposition of Pennsylvania inheritance tax. 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 Merrvman, 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 any hearing regarding it. Please contact me if you or the Court has any questions or requires
anything additional from this Bureau. �
Sinc ely,
` .
annon E. Baker
Trust Valuation Specialist
Inheritance Tax Division
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Bureau of Individual Taxes � PO Box 280601 � Harrisburg, PA 17128 � 717.783.5824 � shabaker@pa.gov