HomeMy WebLinkAbout04-29-15 Stephen M. Greecher, Jr. � _n � �
Attorney's I.D. No. PA36803 `: o =o n "
2 �emoyne Drive, Suite 200 - =, — _ o
Lemoyne, PA 17043 ' ^ " -'i A
Telephone� (717) 234-4121 _ ` ��� co �.-' �
Facsimile�. (7�7) 232-6802 � � <>
Email: sareecher(c�Wckerlaw.com ATTORNEYS FOR PETITIONER - , �-' ;
,. � �,�
JOANNE CAVE as Administratrix . IN THE ORPHANS COURT OF � '`' o
of the Estate of THOMAS J. CAVE : CUMBERLAND COUNTY, PA � `
Deceased, . �
Petitioner. . No. 2015-00177
PETITION OF JOANNE CAVE. ADMINISTRATRIX OF THE ESTATE
OF THOMAS J. CAVE DECEASED REQUESTING APPROVAL OF SETTLEMENT
1. Thomas J. Cave, Deceased, died on January 8, 2014, and Joanne Cave was appointed
Administratrix oi his Estate by the Register of Wills of Cumberland County on February 17,
2015.
2. Joanne Cave is the wife of Thomas J. Cave.
3. Upon his death on January 8, 2014, Thomas J. Cave and Joanne Cave resided at 500
Geneva Drive, Apt. F2, Mechanicsburg, Pa 17055.
4. On January 5, 2014, a Sunday, sleet and freezing rain were falling.
5. Mr. and Mrs. Cave had plans to visit with their daughter and her family.
6. Mr. Cave went outside to check the weather conditions and he fell as a result of the
accumulation of ice on the sidewalk outside the Caves' apartment.
7. Mrs. Cave has asserted a daim against Conifer Realty, the owner of the apartment
complex at which the Caves' resided.
8. Mrs. Cave has daimed that Mr. Cave fell as a result of the negligent practices of Conifer
Realty.
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9. When Mr. Cave fell, he struck the back of his head and lost consciousness.
10. West Shore EMS arrived and transported Mr. Cave to the Hershey Medical Center. Mr.
Cave underwent extensive care at the Hershey Medical Center including surgery. Mr. Cave
died on January 8, 2014 at the Hershey Medical Center as a result of the injuries that he
sustained when he fell on January 5, 2014.
11. Mr. Cave was 79 years old at the time of his death and was retired. Mr. Cave had
limited income lhat consisted of a monthly social security check.
12. Mr. Cave had health insurance through a Medicare Advantage Plan offered through
Aetna.
�3. The Metlicare Advantage Plan has incurred $34,116.55 in medical expenses for the care
of Mr. Cave as set forth on the statement attached hereto as Exhibit "A".
14. Joanne Cave retained Tucker Arensberg, P.C. to represent her and the Estate of
Thomas Cave on a contingent fee basis providing for a fee of one-third of any amount
recovered for the injuries Mr. Cave suffered on January 5, 2014 and his resulting death. The
Contingent Fee Agreement also requires reimbursement to Tucker Arensberg, P.C. of its out of
pocket expenses incurred. The Contingent Fee Agreement is attached hereto as Exhibit "B".
15. Tucker Arensberg, P.C. has incurred out of pocket expenses in the amount of$467.66
as set forth on Exhiblt "C'.
16. The insurance company for Conifer Realty, PMA, has offered $60,000 to settle all claims
against Conifer Realty arising out of the injuries to Mr. Cave and his resulting death.
U. Given issues of liability and damages in this matter, Joanne Cave has determined that it
is in the best interest of the Estate to accept the $6Q000 settlement offer and avoid the risks
and costs of litigation.
2
18. The Medicare Advantage Plan has asserted a subrogation claim and has agreed to
reduce its subrogation daim to account for attorneys' fees and expenses and will accept
$20,000.00 as payment in full of its subrogation claims. See Exhibit "D".
19. Mr. Cave died intestate and his intestate's heirs are: his wife, Joanne Cave and his
adult daughters, Paula Creliak and Susan Daisley.
20. Tucker Arensberg, P.C. has agreed to accept $17,500 plus reimbursement of its costs of
$467.66 as payment in full for services rendered in this matter.
21. After taking into account of attorney's fees, costs, and reimbursement of the Medicare
Advantage Plan subrogation claim, the net amount of the settlement is as follows:
Total Settlement $60,000.00
Attorney'sfees $�7,500.00
Costs $ 467.66
Medicare Advantage Plan $20,000.00
Total ($37,967.66)
Net settlement proceeds. $22,032.34
22. In accordance with the rules of intestate succession and in accordance with the
Wrongful Death Act, the entire net settlement proceeds are to be distributed to Joanne Cave.
23. Conifer Realty has requested that the Release attached hereto as Exhibit "E" be
executed releasing Conifer Realty of all claims.
24. The Department of Revenue has reviewed and approved the allocation and payment of
the net settlement proceeds as set forth in the letter from the Department of Revenue dated
february 4, 2015, Exhibit "F" hereto.
WHEREFORE, it is respectfully requested that the court enter an order:
3
1. Approving settlement with Conifer Realty of the claims for the injuries to Thomas
J. Cave and his resulting death for a payment of$60,000.00;
2. Approving the execution of the Release attached to the Petition herein by Joanne
Cave,
3. Approving payment of fees to Tucker Arensberg, P.C. of$17,500.00;
4. Approving reimbursement of costs to Tucker Arensberg, P.C. of$467.66;
5. Approving payment of$20,000.00 to Medicare Advantage Plan as payment in full
of its subrogation claim; and,
6. Approving the payment to Joanne Cave of the net settlement proceeds of
$22,032.34 with said payment being made pursuant to the Wrongful
Death Act.
Respectf ry s mi ed, � � �
TUCKE E
By:
teph eec r, r.
Attorney's I.D. No. PA-36803 ..
2 Lemoyne Drive, Suite 200
Lemoyne, PA 17043
Telephone: (717) 234-4121
Facsimile: (717) 232-6802
Email: sqreecherCc�tuckerlaw.com
� / / Attorney for Petitioner
DATE: � �' �S
H BGDB'.149650-1 0294]8-163111
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BYFACSIMILE: (717) 232-6802 ��� ��.` � �
November13, 2014 '
Steohen Greecher. Jr.. Esq.
Tucker Arensberg, PC
2 Lemoyne Drive
Suite 200
Lemoyne, PA 17043
Re: Patient THOMAS J CAVE
Date of Injury: January O5, 2014
Member. THOMASJCAVE
FRG's File No.: 472571-1 5661 4
�ear Mr. Stephen Greecher, Jr., Esq.: . �
Coventry Health Care, Inc. ("Coventry"), a Medicare plan, has retained the services of First
Recovery Group to represent Coventry in connection with their rights of subrogation andlor
recovery regarding medical claims paid on behalf oF THOMAS J CAVE.
At this time the Plan asserts a claim in the amount of 534,116.55. We will update you as
related paid claims are received. Please note that this amount is NOT fnal. PLEASE
CONTACT THE UNDERSIGNED FOR A FINAL CLAIM TOTAL PRIOR TO ENTERING INTO
ANY SE7TLEMENT AGREEMENT. Please feel free to email me at
ewa rsow�f rstrecove ryg roup.co m. �
Please let me know if you intend to dispute the validity of the claim being asserted in this case
so that approprizte action can be diswssed with (he Plan.
As noted in my email to Sue-Ellen of your offce of today's date, before I can accept the HIPAA
authorization previously forwarded, I will need some sort of documentation authorizing Joanne
n,.,,�. i„ .,,,� � , �,�-i,.,ir„f n�, i..i. i,��..i,,,�„r.�.�.,�� . ��:i, .,., i�u�,...,r.,��e,,.,�iy c„�„ ., i,�,�r.ri.�
court or a wlll naming the wife as executor of the estate. Once this documentation is received, I
vdill forward to your attention a Medical Payment Report detailing the type, date and providerof
related medical charges .
First Recovery Group, LLC
AtM: Erik Warsow
26899 Northwestern Hwy �
Suite 250 .- . �
Southfield, MI 48033
If you have any questions, please contact me at (248) 443-4800 eM. 213. �
Very truly yours,
26899 Northv.estern Hwy-Suite 250-Southfield, MI 48033
Toll Free (96fif 449-0800-Phone(248)443-4800-Fax(248)443-4804
1]/t9/2014 A'.�� oH FROM: FI[s!0.eccveryGGo'�p +0: l�11232680� opGH'. OW JF 0:]
�- � . �'`'"�""`
Erik Warsow
Rewvery Attomey
coNFioENlinurv NoncE:
This f�transmission and any accompanying document Is for the sole use of the Intendetl reclplent(s)antl may contein
inforira[ion pmtecied by federal HI PAA�:aws,the attomey-dient privilege, the adomey vwrk product doct:ine or otner applicable
privlleges or conflCentlelly lews ar ragulah'ons_If you ara no�an in�ended recipient,you may no[revtew, use,oopy,disolose or
dls[dbute thls message or any of the InformaHon contalned In this messa8e to anyone. If you are notMe intendeA redpleot,
please wntact the sende�at 248-043-0800 antl destroy ell mpies of this messa8e and any attachments.
25899 Northwester�Hwy-Suite 250-Southfield,MI 58033
. Toll Free(866)449-4800-Phone(248)443�4800�Fax(24B)443-4804
E � HIBIT B
LAW OFFICE
� TUCKERARENSBERG, P.C.
ATTORNEY'S AGREEMENT
THIS AGREEMENT, entered into this7C�kday of ���+.�- , 201� by and behn�een
TUCKER ARENSBERG P.C., (hereinafter"Attorney"), and ��'on���F Ca .s C �n% ��(/,���C�
(hereinafter"ClienY'). WITNESSETH: That Attorney, for the consideration hereinafter stipulated, has
undertaken and does hereby undertake and agree with Cllent to act as legal counsel in negotiating a
settlement„and if thg same/i�'not effected, in bringing, conducfing and proseculing an action against
�' ,�n! fC�i` J C.C�Q /'}'tj to recover damages f r personal injuries sustained by Yhe
Clien in an accidenVincident which occurred on or about / � L � .
ATTORNEY FEE �
In consideration for services so rendered by Attomey, it is hereby agreed by and between the
parties hereto that Attorney shall be compensated as follows �
(a) -hirty-Three and One-Third (33-1/3%) percent of the gross recovery if the case is
settled before jury selection in a jury trial case, before commencement of tnal in a non-jury trial case, or
before the commencement of the hearing in a matter frst heard by arbitrators; or �
(b) Forty (40%) percent of the gross recovery if the case is settled any time after it
proceeds to jury selection at trial or if a gross recovery is obtained in any other manner at or after the
seledion of the jury In a jury tnal case, after commencement of the trial in a non-jury tnal case or after
the commencement of the hearing in a matter first heard 6y arbitrafors.
The Attorney's ree as set forth above covers only the Attomey's services through and including
the trial of the Cllenfs case and�any post trial proceeding before the trial court. If the case is appealed to
a court beyond the trial wurt, then the Client must enter a new agreement with the Attorney or make
additional arrangements for the Attomey's fee for services for representing ihe Client in the appeal.
"Gross recovery" shall mean the full amount of settlement proceeds or the fuil amount of verdict,
incWding any pre-judgment interest, without reduction for expenses or costs advanced or incurred.
Attomey shall have a lien on any sum or sums recovered, whether by setHement orjudgment,
for services rendered, costs advanced and expenses incurred under.this Agreement.
If for any reason the services of the Attomey are terminated, either by the Attomey or by the
Client, Attorney shall have a right to be compensated for the reasonable value of the services provided
to Client The reasonable value of the Attorney's services shall be the greater of the amoun,s
determined as follows:
(a) by applying the hourly rates crdinarily charged by the Attorney during th=time of
Attorney's representation to the time expended by Atbrney in this matter, or �
(b) Thirty-Three and One-Third (33-1l3°/) percent of the highest offer to settie
ClienPs case received prior to termination.
The right oFAttomey to receive any such compensation will be contingent upon Client obtaining.
a recovery in this case by settlement, verdict or otherwise. Additionally, the Client will then also become
responsible for the payments of all the expenses and costs incurred by TUCKER ARENSBERG, P.C.
on the Clienfs case. Said expenses and costs will become immediately due and owing to TUCKER
ARENSBERG, P.C..
EXPENSES OF LITIGATION:
Any necessary and reasonable costs advanced by Attorney in the preparation and presentation
of Cllenfs daim, and all expenses attendant thereto, shall be the responsibility of the Client to pay upon
the CIIenYs obtainin� a recovery in the case. Attorney retains the right to request that the Client
advance said expenses and costs. Attorney may apply any funds held In escrow on behalf of Client to
the costs and expenses of litigation.
SETTLEMENT PROVISIONS:
A!I offers to settle, adjust or compromise the above daim shall be reviewed between Client and
Aftomey before any such offer is either accepted or rejected. Client further agrees to consider seriously
� any recommendation for settlement made by Attomey and not to unreasonably withhold consent to such
settlement recommendation.
DISCHARGE OR WITHDRAWAL �
In the event that Attomey subsequently determines that the daim or suit lacks merit, or Client
unreasonably withholds consent to any bona fide settlement recommendation made by Attomey, or
Client refuses or faiis lo cooperate with Attomey, or Client conceals or misrepresents facts regarding the
above claim, or Client commits a breach of thls Agreement, Attomey shall have the right to terminate his
services upon giving reasonable notice to ClienL �
MISCELLANEOUS:
Client understands, acknowledges and agrees that Attomey does not guarantee thz outcome or
evzntual result of the above daim.
IN WITNESS WHEREOF, the parties hereto, intending to be legally bound, have hereunto set
iheir hands and seals b this Agreement, in execution thereof, the day and year first above written.
j�
WITNESSES: TUCKE/RARE SB G�.
' "�; ,//� � / � �- (SEAL) .
�Ste -en M. G�eecher
� /CG.�, �c� /1' �''Gl �" �sea�>
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� � 2252015 2:ll AM FROM: Fi[eL 4ecovery 6xoup TO: P1i2326E02 PAGG: 001 CF 001
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REC�,3�rERY
�;�sc,��it
BY FACSIMILE: (717) 232-6802
February 24, 2015
Stephen Greecher, Jr., Esq.
Tucker Arensberg, PC
2 Lemoyne Drive
Suite 200
Lemoyne, PA 17043
Re: Patient: THOMAS J CAVE
Date of Injury: January O5, 2014
Member THOMAS J CAVE
FRG's File No.: 472571-1 5661 4
Dear Mr. Stephen Greecher, Jr., Esq.:
Coventry Health Care, Inc. ("Coventry'�), a Medicare plan, has retained the services of First
Recovery Group to represent Coventry in connection with their rights of subrogation andlor
recovery regarding medical claims paid on behalf of THOMAS J CAVE.
This will confirm that the Plan has agreed to resolve this matter for the sum of$20,000.00.
Payment in the sum of$20,000.00 should be made payable to First Recovery Group LLC and
forwarded to the undersigned's attention at the address below.
First Recovery Group, LLC
Attn: Erik Warsow
26899 Northwestern Hwy
Suite 250
Southfield, MI48033
If you have any questions, please contact me at (248) 443-4800 ext. 213.
Very truly yours,
;^ . ;'1 �,7�..__.-
�
Erik Warsow
Recovery Attomey
coNFioENnAurv Nonce
This f�transmission and any accompanying document is for the sole use of the intended recipient(s)and may contain
infarmation protected by federal HIPAA laws, Ihe attomey-client privilege,Ihe attomey work product doc[rine or other applicable
privileges or confidentiality laws or regulations. If you are not an intended recipient, you may not review, use, copy,disclose or
distribute this message or any of the information contained in this message to anyone. If you are not the intendetl recipient,
please contac[the sender at 248-443-4800 antl tlestroy all copies of this message and any attachments.
26899 Northwestern Hny-Suite 250-Southfield, MI 48033
Toll Ree(866)449-4800-Phone(248)44&4800- Fax (248) 443-4804
E � HIBIT E
PMAMC Claim Number L001327709
GENERALRELEASE
L Consideretion and Release of Claims
For the Sole Consideration of Sixty Thousand Dollars and no cents ($60,000.00), the
receipt and sufficiency whereof is hereby acknowledged, the undersigned The Estate of
Thomas Cave ('Releasing Party"), Intending to be legally bound releases and forever
discharges Conifer Realty, Geneva Greens, PMA Management Corp. ("TPA"), Third-Party
Administrators ("Insured"), the Navigators insurance Co. ("Excess Insurer") and any other
person, partnership, firm, corporation or other entity charged or chargeable with responsibility or
liabillty and his/her/theidits heirs, executors, administrators, agents, insurers and assigns, and in
case of corporations, all of its parents, subsidiaries and affiliates, and its or their predecessor or
successor corporations, and its or their former and current directors, offcers, employees,
agents, insurers and attorneys (collectively referred to as the "Released Parties") none of whom
admlt any liability to the Releasing Party but all expressly deny any liability, from any and all
debts, claims, demands, damages, actions, causes of action or suits and liabilities of any kind or
nature whatsoever including any claim for contribution or indemnity and particularly on account
of all injuries, known and unknown, both to person and property, which have resulted from or
may in the future develop from an occurrence or incident which occurred on or about the 5`" day
of January, 2014 at or near 500 Geneva Dr., Mechanicsburg, Pa 17055 (the "Occurrence").
II. Representatlons and Warranty as to Medicare Involvement
The Releasing Party hereby understands and acknowledges that the Medicare,
Medicaid and SCHIP Extension Aci of 2007 (the "Extension AcY') requires the reporting to
designated representatives of Medicare any settlement in which all future claims are released
and the injured party is either a current Medicare beneficiary or has the potential to be eligible
for Medicare benefits within thirty months of the settlement. In further consideretion of the
settlement agreed to herein, the Releasing Party warrants and represents to the Released
Parties, Insurer and their attorney(s) the following:
A. Medicare Beneficiarv Status Thomas Cave was a Medicare beneficiary or
expecled to be eligible for Medicare benefits within the next 30 months.
B. Medicare Involvement. Medicare has either (1) made past conditional payments
for medical expense or prescriplion expense related to the Occurrence; or(2) may, in the future
make payments for medical expense or prescription expense related to the Occurrence.
C. Notification to CMS or MSPRC. I (or my attomeys or agents working for or on
my behalf) will notify the Centers for Medicare and Medicaid Services ("CMS") of this settlement
and provide a copy of this Settlement Agreement to CMS or its designated Medicare and
Medicaid Services Recovery Contractor ("MSPRC") no later than 60 days from the date of this
Settlement Agreement. I will abide by all regulations and requirements of Medicare, CMS
and/or the designated MSPRC in connection with this Settlement Agreement.
D. Past Conditional Pavments. With respect to past conditional payments:
1. No additional medical bills or expenses for medicai care, treatment or services have
been submitted to Medicare or the applicable Medicare Advantage Plan in addition to those
disclosed or identified in the conditional payment letter (or supplemental conditional payment
lettedschedule of payments) supplied by CMS or in the letter dated November 13, 2014
submitted on behali of the Medicare Advantage Plan both of which have been provided to the
released parties; Duty to Obtain Final Demand Letter. I or my attorneys or agents working for or
on my behalf(will secure a final demand letter for CMS or its designated MSRPC if a conditional
payment letter disdosed conditional payments made by Medicare or will secure a final demand
for payment from the Medicare Advantage Plan before any payments are made or are due
under the terms of the settlement agreement. I acknowledge that it is my sole responsibility to
communicate with CMS or its designated MSRPC in order to secure a final demand letter if
appllcable or to communicate with the Medicare Advantage Plan or its designated
represenlative so as to allow the disbursement of the settlement proceeds contemplated by this
settlement agreement;
2. I acknowledge my responsibility to devote a portion of the settlement proceeds otherwise
payable under the settlement agreement to reimburse Medicare for the amount determined by
CMS or its designated MSRPC for past conditional payments for medical care, treatment, -
services and prescription drugs related to care or treatment of the injury or damage sustained in
the occurrence that is the subject matter of this settlement agreement or to so reimburse the
' Medicare Advantage Plan; "
3. I acknowledge that it is my sole responsibility (or that of my designated attorney or
agent) to negotiate the nature and exlent to which reimbursement must be made to the
Medicare Trust Fund andlor CMS and/or the designated MSRPC and/or the Medicare
Advantage Plan for the conditional payments made in the past or in the future by Medicare or
the Medicare Advantage Plan arising from the injuries or damages suffered by me and it is
expressty agreed that neither the released parties nor the insured nor their attomeys have any
duty, obligation, responsibility to attempt to reduce or eliminate the amount that I will require to
reimburse Medicare Trust Fund and/or CMS and/or the Medicare Advantage Plan from the
settlement proceeds specified in the settlement agreement;
4. I acknowledge that in agreeing to the settlement that there have been no representations
or warranties made by or on behalf of any of the released parties or insurer or attomeys as to
the amount that Medicare and/or CMS and/or the Medicare Advantage Plan will require that I
must pay to reimburse for past conditional payments made by Medicare or the Medicare
Advantage Plan. Further, I agree lhat the failure of CMS or the Medicare Advantage Plan io
approve any proposed amounts suggested or offered by me to reimburse Medicare or the
Medicare Advantage Plan for any prior conditional payments made shall not operate to void this
settlement agreement and shall not be valld grounds or a basis to reopen negotiations�,
5. I hereby waive any right to entitlement to the payment of the settlement proceeds out of
any escrow maintained by me or my attorneys within any specific time frame andlor within the
time specified in any applicable statute, ordinance, local rule or customary prectice with respect
to the timing of the payment of the settlement proceeds. Further, I acknowledge that the
settlement proceeds will not be disbursed until such time as the amount of the reimbursement
for past or conditional payments made by Medicare or the Medicare Advantage Plan has been
finally determined by Medicare/CMS and/or the Medicare Advantage Plan;
E Responsibility for Future Medical Treatment I agree that any additional
expenses for medical care, treatment, services and/or prescription drugs related to care or
treatmenl of the injuries or damages arising out of the occurrence that is the subject of this
Settlement Agreement that are not presently known to Medicare and have either been incurred
and not yet submitted to Medicare or may be incurred in the future and are later submitted for
payment to Medicare shall be reimbursed to the Medicare Trust Fund andlor to CMS and/or to
the MSPRC by me and not by the Released Parties or Insurer, or their attorney(s).
F. Waiver of Private Cause of Action. In consideration of the payments set forth in
the Settlement Agreement, I hereby waive, release, and forever discharge the Release Parties,
Insurer, and their attomey(s) from any obligations for any daim, known or unknown, arising out
of the failure of the Released Parties, Insurer, and their attorney(s) to provide for a primary
payment or appropriate reimbursement pursuant to 42 LLS.C. 1395y(b)(3)(A).
G. Acknowledqement of Potential Impact of Settlement I understand this
settlement may impact, limit or preclude my right or ability to receive future Medicare benefits
arising out of the injuries alleged in connection with the Occurrence, and nevertheless wish to
proceed with the settlement.
III. Other Terms
A. Indemnification. Releasing Party acknowledges that all subrogation and lien
daims arising out of contract or under state or federal law, including but not limited to, any
subrogation or lien daims of Releasing Party's health care providers, insurance carriers, state
worker's compensation and any federal agency or programs such as Medicare, Medicaid, Social
Security, are the sole and separate obligation of Releasing Party which Releasing Party agrees
to pay or othervvlse resolve. Releasing Party further hereby covenants to defend, indemnify and
hold harmless the Released Parties, Insurer, and their attorney(s) from and against all such lien
and subrogation daims brought against the Released Parties, Insurer and their altorney(s).
B. Release Bindinq on Successors Heirs Eta This release shall be binding upon
the Releasing Party and his/hedtheir/its successors, assigns, heirs, executors, administrators
and legal representatives.
C. Voluntary Settlement. The Releasing Party hereby dedares that the terms of this
settlement have been completely read and are fully understood and voluntarily accepted for the
purpose of making a full and final compromised settlement of any and all present and future
daims, disputed or otherwise, on account of the injuries and damages above mentioned, and for
the express purpose of preduding forever any further or additional claims arising out of the
aforesaid occurrence or incidenL The Releasing Party further states that the foregoing release
has been read carefully and the contents are known and this release is signed as his/her own
free act and deed.
HBG�B:1502904 0284]8-1631 N
* '*CAUTION READ BEFOR1i SICNLVG. TIIISISARELEASE. * ' �' �
M WITNESS WE3EREOF,
UWchevchereu�[ose[my/ou[hand(s)a�dseal(s)8ris _dayof _ . _ ,_ ___
SigoaWce of W imess#1 Signatuxe ofReleasing Pury Bl
PnotedNameofWi'sess8l YrinzdNameofReleasi�gParty#L
Address of Wit�ess kl Address ofReleasing Yarty'�1
�. . . . __.- _
Sio amreofWit�ess�2 Sionah¢eofReleas'ngPa�Ty#2
PnntedNzmeofWittess#2 � Pr���edNameofReleesingPa�Ty#2
Address of W itcess,72 Address of Rcicvsi�g Party#2
Subscri6cd and swom to bcfure�ne by lhis day of
20
1 -
Nota[y Public .
My Couunissioa Expi:es:
Subscribedandsworurobeforemeby this deyof ,20_
Vo�ary Public .
My Commfssion Expires: � .
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� A; pennsylvania
� DEPAPTMENT OFREVENUE
�
March 3Q 2015
Stephen G�eecher, Jc,Esquice
Law O%ce
2 Lcmoync Drive, Suite 200
Lemoyne, PA L7043
Re: Estate of Thomaz Cave
Pile Number 2115-0177
Court oi Common Yleas Cumberland County
Dear Mi. Greecher:
1'he Department of Aevenue has received tLe Pctition fot Approval of Settlemen[Claim to be
filed on behalf of[he above-refcrcnced Estate in regard to a wrongful death and survival actioa It has
been forwarded to this Bureau for the Commonwealth's approval oFthe allocation of the procecds paid to
scttic lhe actions.
Puisuan[to[he Petitioq the 79 year old decedent died as a result of inju�ies received in a fall.
Uecedent is survived by his wife and daughter.
Please be adviscd[hat,based upou these facts and for inheritance tax putposes only,this
DepaRment has no objection to the proposed allocation of tlie net pxoceeds of this ac[ioq $22,04734 to
[he wrongful death claim aiid$0 to[he survival claim. Proceeds of a survival action are an asset included
in the deeedent's estate and aw subject to[he imposition of Pcnnsylvania inheritance tax. 42 Pa.C.S.A.
§8302; 72 P.S. §9106, 9107. Costs and fces mus[be deducted in tUe same percentages as the proceeds are
allocated. In re Estale of Merrymari, 669 A2d 1059 (Pa.Cmwlth. 1995).
I.tmst that this IGter is a sufficient representalion of the Departrnont's posiNon on this matter. As
the Deparimen[has no objections[o the Petition,an atlomey Crom Il�e Departmen[of Revenue will not be
attending any hearing regarding iL Please contact inc if you or the Court has any questions or requires
anything additional from this Bureau.
Si erely,
` ���., '����.�
annon E. Baker
Tmst V aluation Specialist
Inheritance Tax Division
. . . . . _ ...... . .... . .. . .
eureau of Individual Taxes I P� eox 280601 I Harrisburg, PA ll128 I 7llJ63.5824 I shabaker@pa.gov
VERIFICATION
7, Joanne Cave, the Petitioner, in the within action, verify that thc stateme�ts made in the
Petition Requesti�g Approval of Settlement are true and correct. We understand that Lalsc
statements herein are made subjcct to the penaltics of 18 Pa.C.S. Section 4904, relating ro
unswo�n falsification to authorities.
i
Dated: A� n� Z3 , Z.�15 � ���d, �Q(/-� �
J anne Cavc
HBGDB.1 W289-1 0294]8-163111
CERTIFICATE OF SERVICE
AND NOW, this day of April, 2015 I, Stephen M. Greecher, Jr., Esquire, for the
law firm, Tucker Arensberg, RC., attorneys for Petitioner, hereby certify that I have this day
served the within document by depositing a true and correct copy of the same in the United
States Mail, first class, postage prepaid, at Lemoyne, Pennsylvania, addressed as follows:
Joanne M. Cave
1753 Village Path
Hermitage, Pa16148
Paula M. Creliak
8 Sunset Drive
Mechanicsburg, Pa 17055
Daniel Daisley
141 Lancaster Boulevard
Mechanicsburg, Pa 17055
First Recovery Group
Attn: Erik Warsow
26899 Northwestern Highway
Suite 250
Southfield, MI 48033 ��"—`
�
� � /�
,
,
en e r, Jr.
6