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HomeMy WebLinkAbout14-6071FILED -OFFICE OF THE PROTHONOTARY 20111 OCT I pm 12: T5 CUMBERLAND COUNTY PENNSYLVANIA IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA -CAV LCOURT DIVISION IN RE: Lance E. Lambert NO. I bbrli (2,1virrerot PETITION TO COMPROMISE A WRONGFUL DEATH CLAIM Filed on Behalf of the Petitioner, State Farm Mutual Automobile Insurance Company Counsel of Record for This Party: Kevin D. Rauch, Esquire Pa. I.D. #83058 SUMMERS, McDONNELL, HUDOCK & GUTHRIE, P.C. Firm #911 945 East Park Dr, Suite 201 Harrisburg, PA 17111 (717) 901-5916 #20520 4115.'75 PO ticn-1 0,4 304a IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA IN RE: LANCE LAMBERT, A Minor ORPHANS' COURT DIVISION NO. PETITION TO COMPROMISE A WRONGFUL DEATH CLAIM And NOW, comes the. Petitioner, State Farm Mutual Automobile Insurance Company, by and through its counsel, Summers, McDonnell, Hudock & Guthrie, P.C., and Kevin D. Rauch, Esquire, and sets forth the following Petition to Compromise a Wrongful Death Claim: 1. Decedent, Lance E. Lambert, was born on September 30, 2011, and at the time of the accident resided at 1008 S. Market St, Mechanicsburg, PA 17055. 2. This matter arises out of a motor vehicle accident that occurred on January 23, 2014, at the Decedent's residence. (Attached hereto as Exhibit "A" is a copy of the EMS report). 3. As a result of the accident, the Decedent sustained major injuries and was transported to Hershey Medical center, where he was pronounced deceased at 5:32 p.m. (Attached hereto as Exhibit "B" is a copy of the Death Certificate). 4. The motor vehicle involved in the accident was driven by the minor's father, Andrew Lambert, which was insured by State Farm Mutual Automobile Insurance Company providing $50,000 per person in bodily injury liability coverage. (A true and correct copy of the policies confirmation of coverage is attached hereto as Exhibit "C"). 5. Decedent cannot collect Underinsured Motorist benefits from the above policy as it is the only source of insurance in this matter. 6. After renunciation by the Decedent's father, Andrew Lambert, the Decedent's Mother, Brandi Lambert, was appointed sole -Administrator of the decedent's Estate by the Register of Wills of Cumberland County at File No. 2014- 00691, on July 28, 2014 via Letters of Administration. Brandi Lambert is an adult individual currently residing at 1008 S. Market St., Mechanicsburg PA, 17055. (Attached hereto as Exhibit "D" is a original Short Certificate). 7. Decedent died intestate. 8. Decedent is survived by the following adult individuals: Andrew Lambert (decedent's father), Brandi Lambert (decedent's mother). 9. Decedent was a two (2) year old child at the time of the accident and did not provide financial support to any other individuals. 10. Decedent's estate requests that one hundred (100) percent of the settlement be allocated under the Pennsylvania Wrongful Death Act, 42 Pa.C.S.A. § 8301. 11. Undersigned counsel represents that the proposed settlement set forth above is a fair settlement under the circumstances set for in this Petition, as there is no other means of recovery for the Estate. Respondent is in agreement with the proposed settlement. 12. The Pennsylvania Department of Revenue has been put on notice of the impending settlement of this estate. Petitioner is still awaiting confirmation to distribute the entirety of the settlement pursuant to the Wrongful Death Statute. Petitioner expects • to receive confirmation from Department of Revue within 30-40 days of the date of this filing. (See letter to Department of Revenue do Shannon Baker attached hereto as exhibit "E") WHEREFORE, the Petitioner requests that this Honorable Court enter an Order approving the Petition to Compromise Lance Lambert's Wrongful Death claim in the amount of $50,000, to be allocated entirely under the Wrongful Death Act. Respectfully submitted, SUMMERS, McDONNELL, HUDOCK & GUTHRIE, .C. K v n Rau h, squire C unsel for Petitioner N THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA IN RE: Lance Lambert, A Minor ORPHANS' COURT DIVISION NO. ORDER AND NOW, to wit, this day of , 2014, it is hereby ORDERED, ADJUDGED and DECREED that the Petition to Compromise Lance Lambert's Wrongful Death Claim is approved. It is further granted that the amount of $50,000 be allocated solely under the Wrongful Death Act, 42 Pa.C.S.A. § 8301. BY THE COURT: J. Distribution List: Brandi Lambert, 1008 South Market Street, Mechanicsburg, PA 17055 Kevin D. Rauch, Esquire, SUMMERS, McDONNELL, HUDOCK & GUTHRIE, P.C. 945 East Park Drive, Suite 201, Harrisburg, PA 17111 VERIFIED STATEMENT I, Kevin D. Rauch, Esquire, being the attorney for the Petitioner, State Farm Mutual Automobile Insurance Company, in the within action, am duly authorized to make this Verified Statement on the Petitioner's behalf. I hereby verify that the statements set forth in the foregoing Petition to Compromise Wrongful Death Claim are true and correct to the best of my information and belief based upon knowledge obtained from the Respondent. I understand that false statements made herein are subject to the penalties of 18 Pa. C.S. Section 4904, relating to unsworn falsifications to authorities. Kevi D. Rauch, Esquire Co nsel for Petitioner Dated: /0 "--10 y DEFENDANT'S EXHIBIT From West Shore EMS 1.717531.3723 Fri Jan 24 12:41:37 2014 EST Page 1 of 2 I 43-.11 Pennsylvania EMS Report Service NameStation West Sham EMS 62 6 criel '''7 to F Station . M1CU nit Name, 60 / 2102260 / MICU PCR No. 1401456 01/23/2014 Incident Loadinu Patients Addiess, 1008 S. Hiatt St, Mech.oirsbvtg. PA 17055 County, Municipality 6c Incident Zip CUMBERLAND. Upper AR rn Township. 17055 PSAP lucid. No. C11144 Hi:me/Residence eic LIFE LION - Hershey Med, Ctr ''. Patient Name :i.., . ,-:.- ,':' :CWitif E Cl: Manning, Ill. Thomas BMT -P 222650 . A: -Cl: - ... S AA, 1008 S. Market St II, Deanna EMT 165963 . '. City .5. Mac • b State Zip PA 17055 C4: :,. ' Sees Male Age 1 Years DOB PhoncNo. 795-5487 P ry Caregiver: Cl Driver: C2 09/30/2012 (717) - ........... ., . ..„ ......... - . • . Pattaifl Number $ocjttjSec.No. ft Weight :,.: •'• :;..,..k .. , . — " , • Out On.Scene Deat. In Private Phyalcian. v r's Licence Transporting Assist Units A.Scirt OS , . Response Time: 1 911: Response Outcome Care transferred inertimcdical, other .. , s7,19 1,Ir . 1I • • Nature of incident ALS ER Iline: 2 OS Time: 6 ER13 Time: ' 1 Dispatch: 16:05 Enroute: 16:06 Arrive Scene: 16:08 Ughtaand Sirens Destination Timm 43 Contact: 16:08 Patient Condition on Scene ' o • ag . Patient Condition at Facility Total Time: 53 Tine Out of 0 Depart Scene: 16:14 Transfer: 16,15 Quarters: Available: 16.58 In Quarters: Chief Complaint; Trauma Currant Meth: U Allcrghz (medal; Unknown PMliai Unknown • „ ",. , •••• •;.N. .;,% • • • $4, :?. * Dispatched emergency by CCCC for pedestrian struck. En route advised pt 2 y/o M, unknown if conscious, run over by car backing out of garage. Placed air medical on stand-by. Frigid weather with scattered flurries. On arrival found child lying on driveway at edge of garage. unresponsive. Requested air medical to the scene. PD reports SUV was backing out of garage and did not see child, ran him over. SUV several feet away from pt. outside of garage. Grandfather huddle over pt., "can't tell if he's breathing". Printed On: 01/24/2014 12:39 EMSIat Reporting(c) 1998-2014. Med Media, Inc All Rights Reserved Provider Page: 1 of 2 ri 7 2,711 From West Shore EMS 1.717,531.3723 Fri Jan 24 12:41:37 2014 EST Page 2 of 2 Pennsylvania EMS Report Service Nacre West Shore EMS Unil No 60 / 2102260 / MICU PCR No. 1401456 Dole 01/23/2014 Patient Name Lance B Lambert Data of Birth 09/34x2012 Socml Security Number PSAP C11144 Pt 16 month old male, lying supine with head turned completely to his left, blood noted around mouth and ears. Tire tracks noted transverse across R side of head beginning at level of temple with width of tread extending toward neck. Pulseless and apneic. Initiated chest compressions. Gently rotated head to inline position to open airway and begin ventilations. C-spine maintained while ventilating w/ BVM 100% 02. Confirmed pulses wI compressions. Placed on pedi-board and rapid moved to unit. OPA placed, ventilating well. Pupils fixed and dilated. Frothy blood from mouth, noted blood and CSF oozing from ears with each ventilation (CSF suspected due to halo around blood stains on sheet). Noted deformity and step off at approx C3 level. Monitor PEA @ 40. Remains pulseless and apneic, M81 (Jim Grundon) arrives at LZ to assist, est. I0 access. Life lion at LZ. Care transferred to crew, assisted w/ admin of epi doses per Braslow tape, intubated by flight crew. MC contacted by flight medic (Clay Wood), orders to fly to University. Packaged for flight and transferred to helicopter. CPR maintained with minimal interruption throughout, assisted by Chief 23 (J. Salter). : ACBB LOAN DEPT Fax 7177371628 Feb 12 2014 09.41am P002/005 LOCAL. REGISTRAR'S C "WATT I r D 4arrrAfl NC: i< <s ;et g! <u QMO'ICtet -. wapy v;: ohoiosta or lot o•twigr;?p,h r.ee for this ct rut'icate $6 (A) P 202908 7 Certification `;uini.cr Type/Print In P.rnon.nt 1c14043012 _cl;'iil ')'w" "t• if•"til'mauorhere wrri:'eli ) .. .C• Gi E . ell~l_'r.i 9, i A origami i (.errthct:ty Dear. RCcgiltr r Tait, (,rurinee ‘• 1 (>.e',.1 i(? she State VIt2 (7t4sI t. if "L"1en: ri)lni} comemmemiwsArrem GP PENNMVAHI., • D8 AR1T T Or N0.A4'M - %ATM. RECOOPs Of 0'1 Dec issued r- .a./y 1 G 'W ..a C -f t t 1"1 Store Rte Nembe•• ^^"� �E{+, i7 wet' M 4. Oats o:y 2Z ! 2.014. lY'r)($Ir.)1 Met) January 2�, 2094 i u ndar 1 Day Hoene Min user a, batt ere+ne. (me Gov r ..r (9p.il MGnti) sepC.ambQM 7a. Olrttrplam <C,ty an. Stltm On!Anion Country) 3(ttrr2nbt1T-f.. Pttnn�vjvitnia 30. 2017. 7O. afnhpYo (County) AAV •ttia Y.. ommionee pima. or rbretg t (ountry) FaT,SA'I,azioanta> "b. it. .nen Istr.at .n • plumber. In..ppyo NO.) 1009 8. Market St. sa. Did D<t.d.nt Uva h. a TOrrantp? 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Name, - - . ^159 and Kip rbc.00 Paraan Cowrawca..4 W+A. ..-4; 4'sh (Itom SC) Liao A. Potteiger 1279 South $8th S)reet, Haat; ut PA 17111 50.. Gate IMO/D.Wit ) Ja:tuaiy 24. X14 6 . AO. ItegDew: . . roe ' 1. Nag mar 'atm ret I 42. Rog (a,Mr elle Dot. (INo/Crr%Yr) Am.O-m0M9 _.,..i ...... --i,' StateFarm Confirmation of Coverage This policy is issued by: Z State Farm Mutual Automobile Insurance Company O State Farm County Mutual Insurance Company of Texas O State Farm Fire and Casualty Company 0 State Farm Lloyds El State Farm Indemnity Company O State Farm Guaranty Insurance Company LI State Farm Florida Insurance Company CI (Write in the name of the appropriate State Farm® affiliate) 38-3T82-387 Claim Number This confirms that policy number 016580738R, covering a(n) 2014 Mercedes ML350, 4JGDA5HBOEA29O934, was issued to Andrew Lambert and Brandi Lambert and was in effect on the accident date of January 23, 2014. The coverages and limits of liability for this policy on that date were: A 50/100/50 Claim Team Manager 11/25/2013 COMMONWEALTH OF PENNSYLVANIA SHORT CERTIFICATE COUNTY OF CUMBERLAND 1, LISA M. GRAYSON, ESQ. Register for the Probate of Wills and Granting Letters of Administration in and for CUMBERLAND County, do hereby certify that on the 28th day of July, Two Thousand and Fourteen Letters of ADMINISTRATION in common form were granted by the Register of said County, on the estate of LANCEEDWARD LAMBERT , /ate of UPRERALLENTOWNSIWP (First, Middle, Last) in said county, deceased, to BRANDI LAMBERT (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 28th day of July Two Thousand and Fourteen. File No. 2014- 00691 PA File No. 21- 14- 0691 Date of Death 1/25/2014 S.S. # 152-45-3041 NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL SUMMERS, MCDONNELL, HUDOCK & GUTHRIE, PC. ATTORNEYS AT LAW • STEPHEN J, SUMMERS THOMAS A. McooNNELL. Josepii A. HUDOCK, JR, GREGG A. GUTHRIE PETER 8. SKEEL PATRICK M. CONNELLY* JEFFREY C. CATANZARITE KEVIN D. RAUCH *ALSO ADMITTED IN WV **ALSO ADMITTED IN NJ ***ALSO ADMITTED IN OH Via Email: shabakerpa.gov Commonwealth of Pennsylvania Department of Revenue Attn: Shannon Baker Bureau of Individual Taxes PO Box 280601 Harrisburg, PA 17128-0601 HARRISBURG OFFICE: 945 EAST PARK DRIVE SUITE 201 HARRISBURG, PA 17111 PHONE: 717-901-5918 FAX: 717-920-9129 October 6, 2014 In Re: Lance Lambert Our File Number 20520 Dear Ms. Baker: JASON A. HINES ERIN M. BRAUN GUY E. BLASS* SETH T. BLACK** GARTH A, GARTIN KRISTA M. CORABI*** CARRIE J. TAYLOR** REBECCA M. MURRAY KYLE W. KROMBACH SAMUEL L. MACK RYAN M. FLAHERTY ANTHONY J. DELGRosso Enclosed please find a draft copy of our Petition for Approval of Settlement in the above -referenced matter. Once you have had a change to review the Petition, kindly provide me with a letter indicating whether there are any objections to the Petition on behalf of the Department of Revenue. I look forward to hearing from you. AJD:ard Enclosure Sincerely, Antho J. D&Grosso osso PITTSBURGH OFFICE! GULF TOWER. SUITE 2400, 707 -GRANT STREET. PITTSBURGH, PA 12219 PHONE 412-261-3232 FAX 412-261-3299 IN RE: LANCE LAMBERT, A Minor Count? at tuatbertanb IN THE COURT OF COMMON PLEAS OF THE NINTH JUDICIAL DISTRICT 2014-6071 CIVIL TERM IN RE: PETITION TO COMPROMISE LANCE LAMBERT'S WRONGFUL DEATH CLAIM ORDER OF COURT AND NOW, this 22"d day of October 2014, upon consideration of Petition to Compromise Lance Lambert's Wrongful Death Claim, it is hereby ORDERED that the Petition is GRANTED, and the settlement funds of $50,000 will be allocated solely under the Wrongful Death Act, 42 Pa.C.S.A. §8301. Thomas A'. Placey D�istribution: ✓B ndi Lamberrt ,/Kevin D. Rauch, Esq. 0-4C)1Es,, /6/a.apit C.P.J. -0 z .x- —i rn czr c-4 rri Cr)tv = c3 w rv. 72