HomeMy WebLinkAbout10-30-06
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The Estate of Eugene A. Muller, II; *
and *
Victoria J. Ambrose, Administratrix, *
Petitioners *
IN THE COURT OF COMMON PLEAS,
CUMBERLAND COUNTY
ORPHAN'S COURT DI0~ON
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Arjay A. Chambers,
Respondent
*
No.: 21-06-00353
*
PETITION FOR APPROVAL AND SETTLEMENT OF
WRONGFUL DEATH AND SURVIVAL ACTIONS
NOW COMES Petitioner, Victoria J. Ambrose, as Administratrix of the Estate of
EUGENE A. MULLER, II, deceased, and hereby respectfully sets forth the following:
1. Victoria J. Ambrose is the natural daughter of the decedent. Said
individual was appointed Administratrix of the Estate of the decedent by Letters of
Administration dated May 30, 2006. (A copy of the Short Certificate representing the
Letters of Administration is attached hereto as Exhibit "An).
2. The decedent was a resident of Cumberland County, Pennsylvania.
3. Arjay A. Chambers, Respondent, is the owner of the automobile involved
in a collision which resulted in the death of Eugene A. Muller, II, a pedestrian.
4. The insurance companies involved herein, Progressive and GEICO
Insurance Company are duly registered corporations which conduct business, including
the issuance of automobile liability policies, within the Commonwealth of Pennsylvania.
5. The Administratrix's address for purposes of this petition is 130 West
Church Street, Dillsburg, PA 17019.
6. The Respondent is represented by his insurance company, Progressive.
Progressive's address for purposes of this petition is 5053 Ritter Road, Mechanicsburg,
PA 17055.
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7. On or about April 10, 2006, at approximately 11: 30 PM, Respondent was
driving his 1994 Chevrolet Pick up bearing Pennsylvania registration plate number YBZ
8328, in Camp Hill, Pennsylvania. While making a left-turn, Respondent's vehicle
struck Petitioner as he was crossing the street in the pedestrian crosswalk. (A copy of
the police report is attached hereto as Exhibit "B").
8. Steven W. Rickard, an expert accident reconstructionist reviewed the
Police Accident Report, all physical evidence collected by the Camp Hill Police
Department, inspected the accident scene and reviewed all relevant medical and other
reports collected in this matter. Mr. Rickard's investigation concluded that Respondent
struck Petitioner while he was in the crosswalk. (A copy of Mr. Rickard's report is
attached hereto as Exhibit "C").
9. As a result of the above-referenced collision, Petitioner was fatally injured
due to closed-head injuries. (A copy of the Certificate of Death is attached hereto as
Exhibit "0").
10. Petitioner was 59 years old at the time of the accident and his date of
birth was April 5, 1947.
11. The decedent was survived by his only child, Victoria J. Ambrose.
12. At the time of the accident, the decedent did not have a lawful Last Will
and Testament.
13. At the time of the accident, the decedent did not have minor children.
14. The following is a list of the names and addresses of all possible
beneficiaries to this action: Victoria J. Ambrose 2435 Winona Dr., Columbus, OH 43235.
15. At the above-referenced date and time, the vehicle driven by Respondent
was owned by Respondent, Arjay A. Chambers. Said vehicle was insured under an
insurance policy through Progressive, policy number 60498597-6. (See attached Auto
Insurance Coverage Summary, attached hereto as Exhibit "E").
16. The policy provided for bodily injury liability limits of $50,000.00 per
occurrence. (See Exhibit "E").
17. Victoria J. Ambrose, as Administratrix of the Estate of Eugene A. Muller,
II, has accepted a settlement offer of full policy limits, $50,000.00, made by Progressive
for the release of its insured, Arjay A. Chambers, from any and all claims arising from
the above-referenced incident, including but not limited to, wrongful death and survival
actions brought by the Estate of Eugene A. Muller, II and/or any entitled Pennsylvania
statutory beneficiaries under 42 Pa. C.S.A. Section 8301 and 42 Pa. C.S.A. Section
8302. (See Offer Letter, attached hereto as Exhibit "F").
18. Attached as Exhibit "G" is a release of all claims executed by Victoria J.
Ambrose, Administratrix of the Estate, which releases no other entities of potential
liability but-for Arjary A. Chambers and Progressive.
19. Progressive has been represented by Tyeddie Williams, a claims adjustor
for said entity.
20. At the time of the above-referenced accident, the decedent, Eugene A.
Muller, II, was a named insured under an automobile insurance policy underwritten by
GEICO Insurance Company. The policy number for said automobile is 2003461098.
(See attached Exhibit "H").
21. Under the terms of the insurance policy underwritten by GEICO, the
decedent was covered for claims wherein the responsible third-party was underinsured.
The policy limits for underinsured motorist accidents (UIM) is $15,000.00.
22. Victoria J. Ambrose, as Administratrix of the Estate, has accepted a
settlement offer of $15,000.00 made by GEICO Insurance Company for the release of
any and all claims the Estate had regarding underinsured and uninsured motorist
coverage, and all claims arising from the above-referenced incident, including but not
limited to, wrongful death and survival actions brought by the Estate and/or any entitled
Pennsylvania statutory beneficiaries under 42 Pa. C.S.A. Section 8301 and 42 Pa.
C.S.A. Section 8302. (See GEICO Offer Letter, attached hereto as Exhibit "I").
23. Attached as Exhibit "J" is a release of claims executed by Victoria J.
Ambrose, as Administratrix of the Estate, which releases GEICO Insurance Company from
any and all underinsured/uninsured motorist claims.
24. GEICO Insurance Company has been represented by its claims
representative, Michael Moeller.
25. Petitioners' counsel respectfully requests that this Honorable Court enter the
proposed Order approving the settlement and distributing counsel fees, expenses and
placing the proceeds of the Estate in escrow for future distribution.
26. The enclosed billing statement (attached as Exhibit "K") shows that
undersigned counsel has incurred the following expenses for which reimbursement is
sought
Expert Fees: Steven W. Rickard
Medical Records
Overnight Mail
$ 1,275.00
$ 166.83
$ 5.60
TOTAL
$ 1,447.43
27. Counsel requests attorney's fees in the amount of $19,500.00 representing
thirty (30%) percent of the gross proceeds of the settlement. (See Exhibit "l").
28. The estate administration is being handled by undersigned counsel's law
partner, David J. lenox, Esquire.
29. Petitioner's insurance company, GEICO, has paid $5,000.00 dollars as per
the terms of the policy covering him in this claim. The medical benefits have been
exhausted. (See Exhibit "M").
30. Petitioner's health insurance costs were not paid by Medicare because
Petitioner's coverage was not effective as of the date of his treatment. (See Exhibit "N").
31. Outstanding medical bills exist from the treatment provided to Petitioner prior
to his death. Specifically, transportation was provided by West Shore EMS and Hershey
Medical Center's Life Lion, emergency medical services by physicians at Hershey Medical
Center and hospital services by Hershey Medical Center. Total outstanding medical bills
to said providers are approximately $91,000.00. (Attached as Exhibit "0").
32. Undersigned counsel has entered into an agreement with the Penn State
Hershey Medical Center whereby the Estate will pay Hershey Medical Center and Hershey
Physicians $45,000.00 in full satisfaction of all medical bills owed by the estate. (See
Exhibit liP).
WHEREFORE, Petitioner requests that she be permitted to enter into a settlement
as described above and the Court enter an Order of Distribution as follows:
(a) Pennsylvania Wrongful Death Statute, Sixty (60%) percent of net
42 Pa. C.S.A. Section 8301. estate: ($26,431.54)
(b) Pennsylvania Survival Act; 42 Pa. C.S.A. Forty (40%) percent of net
Section 8302. estate: ($17,621.03)
(c) Wiley, Lenox, Colgan & Marzzacco, P.C. $19,500.00
Counsel Fees (30%).
(d) Wiley, Lenox, Colgan & Marzzacco, P.C. $ 1,447.43
Reimbursement of Costs.
$ 65,000.00
33. The Department of Revenue has been contacted regarding the allocation of
the proceeds to the estate. The Department has approved the above-referenced
allocation, for estate tax purposes. (See Exhibit "Q").
34. Victoria J. Ambrose, Administratrix of the Estate, believes it is in the best
interest of the Estate to accept the aforementioned settlement offer.
35. Petitioner has been advised that our investigation has determined that all
applicable liability and underinsured insurance policies have been discovered and limits
tendered. Therefore, litigation is unnecessary.
36. After reasonable investigation into the same, it appears that the Estate does
not have any creditors from this claim, other than outstanding medical bills (see Paragraph
31). All other debts of the estate will be paid via the separate administration thereof.
37. Representatives from Progressive, GEICO Insurance Company and the
Pennsylvania Department of Revenue have all indicated that they have no objections to
this Honorable Court approving the instant Petition without a formal hearing. (See Exhibits
"R", "F" and Q").
38. All aforementioned parties have been served with copies of the instant
Petition and have indicated that they will not attend a hearing, if scheduled. (See Exhibits
"R, "F" and "Q").
39. Approving the instant Petition without a hearing would prevent the
decedent's family from painful testimony and provide closure in this tragic case.
WHEREFORE, the Petitioner respectfully requests the following:
1. That the Petitioner be authorized and empowered to settle the above-
captioned matter on behalf of the Estate of Eugene A. Muller, II, as set forth in the
proposed Order of Court and Release.
2. That the Court approve the payment of the sum identified in this Petition and
Release as fully set forth in the attached document.
Respectfully submitted,
WILEY, LENOX, COLGAN & MARZZACCO, P.C.
by: Christo er J. Marzz
10 No.: 78262
130 West Church Street
Suite 100
Oillsburg, PA 17019
(717) 432-9666
EXHIBIT
"A"
STATE OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SHORT CERTIFICATE
I,
GLENDA FARNER STRASBAUGH
Register for the Probate of Wills and Granting
Letters of Administration in and for
CUMBERLAND County, do hereby certify that on
the 30th day of May, Two Thousand and Six,
Letters of ADMINISTRA T/ON
estate of EUGENE A MULLER II
in common form were granted by the Register of
said County, on the
, late of LOWER ALLEN TOWNSHIP
(First, Middle, LasrJ
in said county, deceased, to VICTORIA J AMBROSE
(First. Midd(e, LasrJ
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 30th day of May
Two Thousand and Six.
File No. 2006- 00353
FA File No. 21-06-0353
Da te of Dea th 4/15/2006
s. S. # 125-38-1106
NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL
EXHIBIT
"B"
APR-11-2004 05:29P FROM:
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METRO THE HARRISBURG AREA POLICE INFORMATION RESOURCE SYSTEM (CRSIPINC)
PAGE: 1 CRASH REPORT 04/20106 MLHl CAM3
CRASH NUMBER: F0006258
INCIDENT NUMBER: 20060400093 CAM
CASE CLOSED: Y
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AGENCY: 21401 CAMP HILL BOROUGH
DISP-TM: 2331 ARRV-TM: 2334 PATROL-ZN: 02 PRECINCT: 2199 WALNUT ST.
INV-DT: 04-10-2006 INVESTIGATOR: KIDMAN, JOHN K BADG: 0177
APP-DT: 04-20-2006 REVIEWER: HOPE, MICHAEL L BADG: 0173
COUNTY: 21 CUMBERLAND MUNICIPALITY: 401 CAMP HILL BOROUGH
CRS-DT: 04-10-2006 TM: 2330 #UNIT:
REPORTABLE: Y NOTIF HIWY MAINT: N
SCH BUS RELATED: N
FOLLOW UP: N CITY PROP DAM: Z
2 #PEOP: 2 #INJ:
PENNDOT PROP: N
SCH ZON RELATED: N
#KILL:
1
CRASH DESC: 8 REL TO RDWY: 1
INTERS TYP: 00 SPEC LOC: 0
ILLUM: 3 WEATHER: 1
SPEC JURIS: 0
RDWY SURF COND: 0
RDWY SURF TYPE: 2
PRINC RD - CNTY:
STR NM:
INSEC RD - CNTY:
STR NM:
LANDMARK1 - RT#:
STR NM:
LANDMARK2 - RT#:
STR NM:
21 RT#:
S 19TH
RT#:
SEG:
ST
SEG:
#LNS: 02 SPD LIM: 25 ORIENT: S
HOUSE#: 1STBLK RT S
#LNS: SPD LIM: ORIENT:
RT SIGN:
SEG MARKER: ORIENT:
DIST FR CRASH - FT: MI: .0
SEG MARKER: ORIENT:
MILEPOST: 0000
MILEPOST: 0000
TRAP CONTROL DEVICE TYPE: 2
WORK ZONE - TYP: 0 LOC:
LN CLOS: RD CL/DETOUR:
LANE CLOSED DUE TO CRS: 2
FUNCTIONING: 3
SPEED LIM:
SHLD/MED WK:
DIRECT: 5
WORKERS PRES:
MOVING WK: FLAGGER: OTHER:
TRAP DETOUR: Y EST TM CLOSE: 2
FIRST HARMFUL EV: 02 UN#: 01
ENV/RDWY FACTORS: 00
MOST HARMFUL EV: 02 UN#: 01
PRIME FACTOR: P 01 UN#: 02
EMERGENCY TRANSPORT - EMS AGENCY: CAMP HILL EMS
MED FACILITY: HERSHEY MEDICAL CENTER
UNIT I, A GREEN CHEVY PICK UP TRUCK, WAS TRAVELING WEST IN THE 1800 BLOCK OF
~ET ST. UNIT 1 MADE A LEFT TURN ONTO SOUTH 19TH ST FROM MARKET ST. UNIT 1
NEGOTIATED THE TURN AND STRUCK PEDESTRIAN MULLER. MULLER WAS KNOCKED
UNCONSCIOUS. MULLER WAS FLOWN TO HERSHEY MEDICAL CENTER WITH SEVERE HEAD
TRAUMA. MULLER WAS LISTED IN CRITICAL CONDITION IN THE I.C.U.
OPERATOR 1 WAS INTERVIEWED. HE STATED THAT HE MADE HIS LEFT TURN ONTO SOUTH
19TH ST FROM MARKET ST WITH THE STEADY GREEN TRAFFIC SIGNAL. OPERATOR 1
STATED HE STRUCK MULLER WHO WAS WALKING IN THE ROADWAY ON SOUTH 19TH ST.
OPERATOR 1 STATED THAT HE NEVER SAW MULLER IN THE ROADWAY UNTIL THE COLLISION.
IT DOES NOT APPEAR THAT THE PEDESTRIAN WAS IN THE CROSSWALK WHEN HE WAS
STRUCK. HE WAS NOT ABLE TO BE INTERVIEWED DUE TO HIS INJURIES. HE WAS
WEARING DARK BLUE PANTS, DARK BLUE JACKET AND CARRYING A CAMOFLAGE BACKPACK.
MEASUREMENTS WERE TAKEN AT THE ACCIDENT SCENE.
UNIT 1 DID NOT APPEAR TO HAVE ANY DAMAGE. OPERATOR 1 WAS NOT INJURED.
ON APRIL 15, 2006 AT APPROXIMATELY 2230 HOURS THIS OFFICER RECEIVED A
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METRO THE HARRISBURG AREA POLICE INFORMATION RESOURCE SYSTEM (CRSIPINC)
PAGE: 2 CRASH REPORT 04/20/06 MLHl CAM3
CRASH NUMBER: F0006258
INCIDENT NUMBER: 20060400093 CAM
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DISPATCH TO CALL CARMEN RUSSELL AT THE DAUPHIN COUNTY CORONER'S OFFICE,
234-5972. MS. RUSSELL INFORMED THIS OFFICER THAT PEDESTRIAN EUGENE
MULLER HAD PASSED AWAY THIS EVENING AT HERSHEY MEDICAL CENTER AND
WAS PRONOUNCED DEAD AT 2055 HOURS. MS. RUSSELL NEEDED SOME INFORMATION
FROM THE CAMP HILL POLICE DEPARTMENT. SHE REQUESTED MR. MULLER'S SOCIAL
SECURITY NUMBER, THE ADDRESS OF HIS DAUGHTER, VICTORIA AMBROSE, THE
NAME OF THE INVESTIGATING OFFICER, TYPE OF VEHICLE AND MAKE AND WHETHER
ANY ALCOHOL WAS INVOLVED ON THE PART OF EITHER PARTY. SHE ALSO STATED THAT
SHE NEEDED TO KNOW IF ANY CHARGES WOULD BE FILED AS A RESULT OF THIS ACCIDENT.
REPORTING OFFICER WAS ABLE TO ANSWER THE MAJORITY OF HER QUESTIONS AND I
DID CONTACT SGT. MICHAEL HOPE TO INQUIRE ABOUT CHARGES AND TO NOTIFY HIM
THAT THIS ACCIDENT IS NOW A FATALITY. I CALLED MS. RUSSEL BACK WITH THE
INFORMATION SHE REQUESTED AND SHE ADVISED THAT SHE WOULD BE FOLLOWING THROUGH
WITH THE FAMILY.
SERGEANT HOPE - APRIL 17, 2006
ON MONDAY, APRIL 17, 2006 I RECEIVED A TELEPHONE CALL FROM JILL P SMITH,
MD WHO ADVISED ME THAT THE DECEASED (MULLER) WAS AT HER HOME LOCATED AT 129
NORTH 30TH STREET, CAMP HILL ALL EVENING ON THE DATE OF INCIDENT. SHE ADVISED
THAT SHE HAS A HEPATITIS SUPPORT GROUP MEETING AND THEY MET ON APRIL 10TH.
THE MEETING RAN FROM 7 PM UNTIL 9 PM AND THEN SHE SERVED A DINNER TO THE
ATTENDEES. SHE ADVISED ME THAT SHE BELIEVED THAT MR. MULLER LEFT HER HOME
AROUND 11 PM AND HE DID WALK. SHE REMEMBERS THAT HE WALKED BECAUSE HE WAS
OFFERED RIDE (S) HOME. SHE KNOWS THAT MULLER HAD NOT CONSUMED ANY ALCOHOL
WHILE AT HER HOME AND DOES NOT BELIEVED THAT HE WAS ON ANY MEDICATION EITHER.
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DRIVER ACTION 1: 00
DRIVER ACTION 2:
DRIVER ACTION 3:
DRIVER ACTION 4:
PEDEST ACTION
o DVR ENDORSEMENT COMPL: 0 DVR LICENSE COMPL: 3
7 UNDER RIDE INDICATOR: 0 EMERGENCY USE: 0
o RESULTS: 0 PRINCIPLE IMPACT PT: 11
UNIT NUMBER: 01 TYPE: 01 COMMERCIAL VEH: N
OWNR NAME: CHAMBERS ARJAY
OWNR ADDR: 2101 PAGE STREET CAMP HILL
VIN: 1GCFK24KGRZ267292 YR: 1994 MAKE: 20
LIC PLATE: YBZ8328 PA TRAV SPD; 999
INS CO, PO, PH: PROGRESSIVE G0498597-5
TOW TO,BY,PH:
# TRL UNITS: 0
TYP UNIT: TAG NO,YR,ST:
TYP UNIT: TAG NO,YR,ST:
TYP: 01 SPEC USAGE: 00
DAMAGE: 0 DIR TRAV: S MOVEMENT;
TEST TYP: 0 RESULT:
DVR PRESENCE: 1 PEDESTRIAN
CHARGED:
POLE#:
POLE#:
POLE#:
POLE#:
VEHICLE COL: 04
INIT IMP PT: 12
ALCOH,DRG SUSP: 1
OWNER/DVR CD: 01
VIOLATION CD:
HARM EVENT 1: 02 L/R:
HARM EVENT 2: L/R:
HARM EVENT 3: L/R:
HARM EVENT 4: L/R:
VEH FAILURES: 00 00
(45F1) DVR RESTRICTIONS COMPL:
AVOIDANCE MANEUVER:
DRUG TEST TYPE:
MHE:
MHE:
MHE:
MHE:
Y UTIL
UTIL
UTIL
UTIL
A 7178020082
PA 17011
8009252886
ROLE: 1 POSITION: 01
12 GRAD: 1 ALIGNM: 1
PHYSICAL COND: 0
SIGNAL: PED LOC:
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PAGE: 3 CRASH REPORT 04/20/06 MLH1 CAM3
CRASH NUMBER: F0006258
INCIDENT NUMBER: 20060400093 CAM
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UNIT NUMBER: 02
OWNR NAME:
OWNR ADDR:
VIN:
LIC PLATE:
INS CO, PO, PH:
TOW TO,BY,PH:
# TRL UNITS:
TYPE: 31
COMMERCIAL VEH:
YR:
TRAV SPD:
MAKE:
VEHICLE COL:
INIT IMP PT:
ALCOH,DRG SUSP: 1
OWNER/DVR CD:
VIOLATION CD:
HARM EVENT 1: 11 L/R:
HARM EVENT 2: L/R:
HARM EVENT 3: L/R:
HARM EVENT 4: L/R:
VEH FAILURES:
(45F1) DVR RESTRICTIONS COMPL:
AVOIDANCE MANEUVER:
DRUG TEST TYPE:
TYP UNIT:
TYP UNIT:
TYP:
DAMAGE: DIR
TEST TYP: 9
DVR PRESENCE:
MHE: Y UTIL
MHE: UTIL
MHE: UTIL
MHE: UTIL
DRIVER ACTION 1:
DRIVER ACTION 2:
DRIVER ACTION 3:
DRIVER ACTION 4:
PEDEST ACTION 01
o DVR ENDORSEMENT COMPL: 0 DVR LICENSE COMPL: 1
7 UNDER RIDE INDICATOR: 0 EMERGENCY USE: 0
9 RESULTS: 9 PRINCIPLE IMPACT PT: 03
TAG NO,YR,ST:
TAG NO,YR,ST:
SPEC USAGE:
TRAV: MOVEMENT:
RESULT:
PEDESTRIAN
CHARGED:
POLE#:
POLE#:
POLE#:
POLE#:
ROLE: POSITION:
GRAD: ALIGNM:
PHYSICAL CONn: 9
SIGNAL: 2 PED LOC: 05
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PAGE: 4 CRASH REPORT 04/20/06 MLHl CAM3
CRASH NUMBER: F0006258
INCIDENT NUMBER: 20060400093 CAM
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* * * * * * * * * * * * PEOPLE INFORMATION * * * * * * * * * * * * *
PERSON TYPE: l=DRIVER 2=PASSENGER 7=PEDESTRIAN 8=OTHER 9=UNKNOWN
INJ SEVERITY: O=NONE 1=KILLED 2=MAJOR INJ 3=MODERATE 4=MINOR 9=UNK
UNIT NO: 01 PERSON NO: 01 TYP: 1
NAME (L,F,M,S): CHAMBERS
ADDRESS: 2101 PAGE STREET
CAMP HILL
DRIVER LICENSE: PA 24619612
SEAT POSN: 01 SAFE-EQ1,2: 03 00 EJECT: 0
INJ SEVERITY: 0 DOB: 19780814
ARJAY
SEX: M
A
PHONE: 7178020082
PA 17011
EJ-PATH: 0
EXTRIC: 0
TRANSP: N
UNIT NO: 02 PERSON NO: 01 TYP: 7
NAME (L,F,M,S): MULLER
ADDRESS: 2109-101 CEDAR
CAMP HILL
SEAT POSN: 00 SAFE-EQ1,2: 00 00
RUN DR
PA 17011
EJECT: 0 EJ-PATH: 0
INJ SEVERITY: 1 DOB: 19470405 SEX: M
EUGENE A
PHONE: 7177634651
EXTRIC: 0
TRANSP: Y
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- Camp Hill Borough
Police Crash Report Form
Crash # FOO06258 Incident # 2006040093 Agency Code 401 Agency Name Camp Hill Police Dept
Date 4/10/06 ArrivalTime 2334 Investigating Officer KIDMAN Badge # 177
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EXHIBIT
"e"
AUG-13-2006 07:50 PM RICKARD & ASSOCIATES
717 540 3458
P.02
Steven W. Rickard and Associates, Inc.
1644 Whitley Drive
Harrisburg, PA 17111
Phone (717) 540-3457
FAX (717) 540-3458
E-mail: SWRickard@AOL.com
An A.socl,tlon of Nationally Recognized Experts & Instructors. Traffic At:cldent Investigation
August 14, 2006
Chris Marzzacc(), Esquire
Wiley, Lenox, Colgan & Marzzacco
130 West Church Street, Suite 100
DiIIsburg, PA 17J19
Re: Eugene Muller
Dear Attorney M arzzacco:
The following information has been obtained and/or provided; reviewed and
considered, in preparation of this report:
Camp Hill (PA) Police Accident Report
Scene Diagram
I will also Gonsider and incorporate the results of my inspection of the accident
site and discussil)n with Sergeant Hope, Camp Hill Police Department.
I offer the following observations and opinion on the data currently available. I
reserve the right to alter or amend this report if additional information becomes
available.
Overview
The overview is based upon the police investigator's observations and report.
This accident occurred on April 1 0, 2006 at approximately 11 :31 PM. The accident site
was on South 1911' Street, approximately 75 feet south of Market Street, Camp Hill
Borough, Cumberland County, Pennsylvania.
At the accident site, South 19th Street, oriented north - south, has a single travel
lane in each direction. A marked crosswalk is present at the Market Street intersection.
The intersection ils controlled by traffic lights. The posted speed limit is 25 MPH.
It was dark when this accident occurred. The accident site was illuminated by
ambient light or altificiallighting from overhead street lights. The roadway was dry, the
AUG-13-2006 07:50 PM RICKARD & ASSOCIATES
717 540 3458
P.03
weather clear and no adverse driving conditions were reported.
The polic:e accident investigator reported that Vehicle #1 was traveling
westbound on Market Street. As the operator of Vehicle #1 turned left (south) onto
South 191h StreE!t, he collided with a pedestrian that was crossing South 19th Street.
The operator of Vehicle #1 was Arjay Chambers. His vehicle Was described as a
1994 ChevrOlet.
The pede.strian was identified as Eugene Muller. Mr. Muller died as a result of
the injuries he rElceived.
The POliCl3 investigator indicated on an at-scene diagram that the passenger side
front tire of the pick-up came to rest (approximatelv) 28 feet south of the reference
point. The victim was found (approximately) 36 feet south of the reference point; (8 feet)
forward of the pclssenger side front tire of the pick-up.
No pre or post impact skid marks were reported.
The point of impact (on the roadway) Was not determined.
The operator of the pick-up truck told the police investigator that he never saw
the pedestrian prior to impact and that he had a steady green signal when he turned left
onto South 19th Street.
The police investigator indicated that it did not appear to him that the pedestrian
was in the crosswalk when struck; he also noted that the pick-up truck did not appear to
have any damagl~.
Pedestrian Accident Investlaation', 2
The fOllowing information pertains directly to the accident that is the subject of
this report.
If the vehic:le is not sloWing when it strikes the pedestrian, the force between
body and vehicle diminishes to zero when the body reaches the vehicle's speed. The
two do not separclte, but keep moving forward together. With pressure released
between them (bE!CaUSe the bOdy is no longer being accelerated), the body falls to the
ground in front of the vehicle. Road friction slows the body, but the vehicle keeps
traveling forward ,and runs over the body.
I Vehic/.~.edestrJtm Collision Investigation Manual, UniverSity of N. Florida,
Institute of Police Technology & Management, Jacksonville, FL Tony Becker ISBN 1-
884566-27 -s
2 Traffic Ac:cldent Reconstruction, Volume 2, Northwestern University Traffic
Institute, ISBN O-EI12642-07-6
2
PM RICKARD ~ ASSOCIATES
AUG-13-2006 07:51 ~
717 540 3458
P.04
If the force against the pedestrian is below the pedestrian's center of mass, as
when a car hits an adult pedestrian, the impact is said to be incomplete because as the
event contlnue:3, the pedestrian goes onto the hood, before going over the vehicle or
falling off. The pedestrian's slide can then be used to estimate the speed of the vehicle;
but only part of the speed. The pedestrian fall is difficult, if not impossible, to evaluate
because one does not know from what height the pedestrian fell.
If the impact is such that the pedestrian is struck by the front portion of the car,
the secondary contact with the hood, windshield, etc. is expected to be in alignment.
(Refer: Sir Isaaf:: Newton's First Law of Motion)
The bumper of the involved vehicle should always be inspected and any contacts
documented. Bumper impacts can range from no phYSical damage to gross
dIsplacement. In low-speed collisions and high-speed collisions where impact is made
with the legs of;:I pedestrian, there may be no physical damage observed. That's why
an inspection of the bumper absorber and adjOining supports can show signs of
displacement when the front of the bumper does not indicate a contact.
Pedestrian Motion as a Result of a Vehicle Collision
IIln a car.pedestrian collision it is possible for the body to reach the same speed
as the car and stay on the hood. If the driver then brakes with some intensity, for
example with a cfeceleration of O. 7 g, the body will slide off the hood. Presumably, the
only thing that h()/ds the body on the hood is the friction between the body and the
hood. A typical coefficient of friction would be around 0.3. Thus, if the car decelerated at
O. 7 9, then cleany the body would slide off. 10
r.:,;
~.. "0. '"
FULL.
IMPACT
CAR fl/IIO 800.,. Ar SAM!" VE'LOClrv
.........
"
Sl..fOINO
e.h/blt 19. ThIs exhibit shows a pedestrian at one point on the
hOOd I)f the Car. Clearly, this/a a full Impact because the pedelltrlatJ
and tn. Oar attain the SlJme apeed. If the caf 18 braking with e
higher drag factor than the coefficient of frictIon avaHable between
the bC'dy and Car hood, the body will alld() off the hood as Shown.
3 Tramc Accident Reconstruction, Volume II, Northwestern University Traffic
Institute, Lynne Fricke. 1990
3
AUG-13-2006 07:51 PM RICKARD & ASSOCIATES
717 540 3458
P.05
Perc8Dtion - Reaction Tlm.t
"Brake reaction time is the interval between the instant that the driver recognizes
the existence (If an object or hazard On the roadway ahead and the instant the driver
actually applje~~ the brakes. The interval includes the time required to make the decision
that 8 stop is necessary.'>f
I' ... the investigator or reconstructionist may use 1.5 or 1.6 seconds (perception-
reaction time) for daytime and 2.5 seconds for nighWme ... " S
SDeed - Time - Distanc,!
Based on an impact speed of 10 - 15 MPH, the following times and distances
relate to Arjay Chambers' ability to perceive/react and brake to a stop:
JO MPH
Perception/Reaction Distance
Slide Distance
Total Stopping Distance
Time in Slide
Total Time
15 MPH
Perception/Reaction Distance
Slide Distance
Total Stopping Distance
Time in Slide
Total Time
Conclusions/Opinions
23.46 feet
4.44 feet
27.90 feet
.60 seconds
2.20 seconds
35 feet
1 0 feet
45 feet
.91 seconds
2.51 seconds
The following conclusions and opinions, in addition to those that may be stated
throughout this report, relate to my investigation of the circumstances surrounding the
occurrence of this accident; they are held to be within the bounds of reasonable
scientific/engineering principles and/or accepted practices in traffic accident
reconstruction certainty, that reflect my education, training, background and experience.
4 A Policjl on Geometric Design of Highways and Streets, American
Association of State Highway and Transportation Officials, 1990.
S Tralnin" and Reference Manual for Traffic Accident InvestigatIon,
University of N. Florida, Institute of Police Technology & Management, Jacksonville, FL
RW. Rivers, 2nd Edition, 1995,
4
AUG-13-2006 07:52 PM RICKARD & ASSOCIATES
717 540 3458
P.06
If Arjay Chambers had been attentive to the task of safely operating his vehicle
by scanning ths roadway ahead, it would have been evident to him that Eugene Muller
was crossing the roadway ahead and was in his intended path.
The police investigator was unable to determine the point of impact, but it could
have been done if the proper evidence was located and documented.
Based on the final rest position of the Chambers' vehicle, as well as the time
required to per':eive/react and brake to a stop, it is my professional opinion that the
pedestrian was in the crosswalk when he was struck.
Respectfully Submitted,
~
Steven W. Rickard
5
EXHIBIT
"0"
)5 REV 1105
!;tis is t(\ certify that the information here given is conectly copied from an original celtificate of death duly filed with me as
ocal Registrar. The original celtificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
~fil~
Fee for this certificate, $6.00
Local Registrar
APR 1 8 2006
P 12410704
Date
1.00
.
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIACATE OF DEATH (CORONER) STATE ALE NUMBER
5,
3. SodoI Secunly _
- 38
4. OoI.ot~l_cloy.yooIj
April 15, 2006
Narre or Decect.nl {FnI. rriddle. kiSt}
~ugene A. Muller, II
""1Us1b1_~
59 Yr>.
Counry ot 0,,1h
7. OII.otSiI1h Month,da. eat
8.
lace andSlataorlor'
lauphin
Oecedenl's Usual Occ: lion 01 wort( doN duM n"OSC of we' do noI sial. rlllQd
['ruck ~::!rver DARTK'l)1"r~g
lJocedon1's MalnOAdd,fSS (SlrOf'.cIy-". s/aI.. z1> rode)
2109-101 Cedar Run Drive
:amp Hill, PA 17011
Hershey Medical Center
12. WasOtc_....nlh.US 13. DecodtnlsEllucation
Nmod Fof,,,7 EIemtnIt~ry 1ll-12)
o Y.. ~No
Decedllnrs
h:tu.aIResidenr:e 17.. SIal,
o R..kSInc, 0." .
10. __n_..-._....
W~te
'on
CoItOt (H.. S+)
... MaritISlalls:lIarritd.N......rritd. 15. SluvlmVSpouso (HwiIt, g;"._na...)
W\OoWtd.ll_(~
UlVOrCea .
PA
~.~' 17~ ~ Y".Oe<tdtnlUved~ Lower A en
T...-.I>\>7
T.".
'7b. Coun~
Cumberland
17d 0 No. _ Uvtd wilhho
Adut, Lmls 01
ClyAloro
F,thet's Nan (f"nt. middle. mQ
~ugene A. Muller
~lcmanrs Nt.. (Typ.'prinl)
Tictoria J. Ambrose
19. Mothe(s Nan (FISt,~. mtlclen sumlmt)
Mary R. Scully
2Gb. Int:>nronl's 1At'-g _... (Sbttl.cly_ 11I~.,.,-1
2435 Winona Drive, Columbus, OH 43235
IIoms Zla-c only.... ctiIIIynv
o.ll"is.IIClt-1YIllIIbM 81 "'- 01 dealh k)
1'""",,,01_.
12".26ftlStbe~bypat$On 24.
pR:W'lOurr.esde8th. ..,
21~ PltotolOispodlon (N.... oI.....ory. "",,"lOry.. _ """")
oIling Green Memorial Park
21d.location(CJIy"'''''I1I,....._1
Camp Hill, PA 17011
22c. Hen and Add.ess of Fatty
Stone&Murr~y FH 408 Third St.,NewCumberlaJJ?~R
Z2b. Ucanse N urrtJer
FO 012342 L
231>. LI:tnsoN..-
23c. OtIlSliJ>td(Moo1h.doy.,fff)
25. Dale Pronounotd Dead (Mcnth, day. year)
April 15, 2006
26. WaaCalo_k1._~
~ v" O.No
CAUSE OF DO'" ISto_and "'_1
'D. Plrt t E1itl d'II ~ - disuses. i;uies, Of COft"I)ic:;IIlons -INI dIredtt caused the dealh. 00 NOT Inlet I8IrilII evenls such as cardiac masl.
IatOry .nUl. Of Vtnhnvltlrilatlon wthouI showing Ihe tIhIogy. 00 NOT IittlrtYia1L Ent... ~ one tausI on line.
:DIAl![ CAUSE (F'llOldB........ Closed Head Injury
lion rOOUlilgtl ~1Il1 ~." 0", kI (.. aSf CO!1SOCl""'" o~:
1tnlitIy1a_..'any. b.
QQ ~.,. caUH blld on Lht I.
'... IlNDffll YIIlG CAUSE.
&HDf;,~IhiI;at8:th
Is I1ISUlilQllClotl1J lAST.
:~Stnlelvat
:onseIlodealtl
Patllt. EnI. other simlwn1 Qp,rdm"~m diad\,
bulnol'.uIn;.....undtl1yilv_ilO*I..Plnl. .
o v.. ~ No
32d. Trnlolkljury
321. HT,_Iion...., (SI>oa'M
o Driv-'lptnI.. 0 F'usetIQIf
II Ptd_. 0 CO>tr - $o:lody.
33b. Sl,naIUIf
28. D~ Tobtcoo USe~. kI 0ttIh7
o V. t;I.1'IU>tbIy
o No d. \JIWlown
29. HF_"
'0 No! PW>'flI ~paI.,.,
'Opj~""".,dotJ!l .
.d.Ho!pr-.bIJlIfOG'lfIIIwlIlil42cltys
otd_
o I/oIpr_nl.buIpr_43dayskllyur
_.-
o U_.pr_~_"'pu1Y'"
32t. FIor:oollnjorY._Fo""Slr...FocIory,OlIa
oar>t1~.(SI>oa'M
32g. localion (S1rotl cllyADwo......)
1800 block of Market St, Camp
iII,PA
D~~(orasl~UMCIoI):
~
Due co (Of IS . eonsequenee 01):
- an Au1cpo,
_7
d.
n. W". Aulopsy Rndngs
__k1~
of eo.... 0I00tIh7
OV"ONo
31._010_
o _.J 0 Ibricld.
~ kcldtnl 0 Pt~lnvtsIlOtlion
o Su;cide 0 Coull No! Be OoI.nrinod
320. o.".r ~ (Monlh. doy. ,..,)
April 10, 2006
32ll.D<<ocri>thcwinlJryO=ntd:
Car versus pedestrian
11 :30 P
c...- _..., ono}
CoI1lIyn; pIrysIdon (PIoyR:ttn c",",",o "... 01_;"" '"""'" phy<icltn.... _ dulh and "'"""'"" .... 23)
TD Ole belt o' "'f tnowIedge, dIdt oe:cuMd dUl to the taLM(a) and mal'lnlf as ated
Pwvnou~1ng and ClltUf)'fng phpIdIn (Phy5idln borh pronounei'lg (tN1tI_net C8l'11fP1g lei causI of dNlh)
To U. bes1 01 my knowtedge. deeIh ~ at the d", data,.nd plKe.lJ'Id eM to the caUM(s)'nd maN*'...tNd
lihdlcaluaml~.....
OIth ball of uanlin:dlon Indlar m.tJgatlon. n rtPf opinion, death octurNd at the UmI, Uta, and place. and due!D thI UUM(a).nd ....,.. u ItNd --.:...M
Reoislrar's Slg\fJurund Disl1i:l Nun<>tr 36. DaI. _ (IoIonIh. cloy. )'fO')
,-< I II ~I /1/ I ~ /,f- .1.""~
(See instructions and examoles on reverse)
u.
--D
33c. Uc
~r\'i1~~~""-)
n
34. &rn~'1lt;ld~=cr-l:oqlitItd eo.... 01O.1h _27) Typen'rH
1271 South 28th Street
Harrisburg, PA 17111
EXHIBIT
"E"
mm
rage 1 or L.
WOlfE J P INS INC
13Wt..lAlN!;T
SHIREMAN!;TOWN, PA 17011
,;ri"O'
---
ARIA Y A CHAMBERS
2101 PAGE 5T
CAMP HILL PA 17011
Policy number: 6U9ll.597.6
Underwritlon by:
hogro<<iv> Northern In<uranee Co.
Ii!bIUil)' 11,2006
Porocy Period: Mar 20,2006 - Mar la, 2007
Page . of 1
111-737-498'
WOLFE J P INS INC
Contact ywr agent Dr personai:zed seMe"-
driveinsurance.com
Online Service
Make payments, check billing activity, update
porocy inbrmatian or ched sta1us of a claim.
800..925-2886
To repoll a daim.
Auto Insurance
Coverage Summary
This is your Renewal
Declarations Page
The coverages, lirrits and policy period showr app~f on~ if you pay for this policy 10 renew.
Your coverage begins on Maret 20, 2006 at 1201 a.n. I his policy expires on MardllO, 200/ at 11:01 a.m.
Your insuranCl! poky and any policy endorsements m11ain a full explanation of YOlr coverage. The policy mntrcct is
form 9608 PA (05/01). The mnlrad is modified b-f forms 0101 (08/02),7951 PA {C 1103) ard 4985 PA (09/05).
Underwriting Company
Progressive Northern Il15Urance (0,
P.O. Box 6807
Cleveland, OH 441 01
800-925-2886
Drivers lII1d household residents ~ddtianal ~tonnillio,
........................ ." ............................... ........ .........................
ARJAY A CHAMBERS Fil5l Named IRsured
FoIlTl~ PAO'j(4)
a
C"""IOCI
IE-C~~~
http://sharedapps2/0nlineArchiveDocumentViewer/PrintPreview.aspx?Index=604985976... 07/14/2006
1:'fl m
yage L or L
fb6C'( number. 60498S9H
A~ Y A CHAM BERS
Page2af2
Outline of coverage
1994 Chevmlet 12590 4J:4pk
VI~J lGUICl4Kfi1lilbflYl
ij;;i;iii!YTo.oo;;;S.
Bod Iy njury liabi ity
Property DallBge _Iabil ty
FilS! PartVsenefiiS . ..
MediGiI txpenSlS $~.OOO ead! per;on
Income loss .. ...... ............... ....... "$i:l)iJ(i~Chmo';thi$l~.j()ii~xil11ul11
"-F~~'~~fB~'~" ....n ........ {i~5.oo.~~.~~~n
AaXkntaliieaiit ..... .hooo..........
UiiiriSureifMoii,riSt: NonSiaCJC2.d.... "si S:OOOeaChjJei5iiriii 3ii.jiiii~a.:f.i(Cidi;rii. .....
Underlnsurec--Motorisi~' Nonstadecf"' ... -.. 'S'lS:000'eadi "r.eMn"i$30:300 '2aCt "accident'-
compreheils.iVe..... . ........ "Attual Cash"Value--- -.... ..............h__...
toUision Mu.J1 lash ValUl'
Iimil<
D",udib~
Premium
......$7'43
$50,OOOead! pel5On/$100.000 ead" acddent
$25.000 each accident
..US7
._u........._u............_..........__._.........
T otaI12 month policy prHIium
Dismunt r :laid in fuB
Total 12 month policy premium if paid in fun
b
1
3
............ .....................
7
12
$,00 84
...................,
$)00 4~Y
.-.. ......... '-0'-'"""",-..-.- ......._. .
$1,421
.]60
$1.2li1
Tort Option
This policy provides limited tort insurance.
COWSlON COVERAGE FOR RENTAL VEHICLES
IF THIS POUCY PROVIDES COLUSION COVERAGE,IT WILL APPLY TO VEHICLES YOU RENT. BUT NOT TO
VEHIClES RENTED FOR 6 MONTHS OR MORE.
Penalty for Insurance FRlud
Any pelSon Vlho knowingly iIIId with intent to injure or defraud any insurer files an application or daim containing
lase. incomplete or misleading infonnation shall. upon conviction. be subject to imprisonment lor up to seven years
and payment 01 a fine of up to $15.000.
Infonnation Regarding Your Premium
A surcharge ci $512.00 due to violations or acodents is included in the total policy premium.
Notice of Available Premium Discounts
You may be eligible for discwnls mandated by Ad 6 of 1990:
on firn party benefits coverage if your car is equipped with a passive restraint system
on comprehensive co~erage if your car is equipped with a passive anti-theft device
if all named insureds are 55 or older and have successfully completed a motor vehide driver improvement course
approved by PennDOT.
If you have any cuestions about your eligibility. please contact your agent
Company officers
. JfJ()!f?r
President
~G l..J.W
Secretary
-~PI\l1.,D4l
!E=C(Q)!PW
http://sharedapps2/0nlineArchiveDocumentViewer/PrintPreview.aspx?Index=604985976... 07/14/2006
EXHIBIT
"F"
PROGREJJIVE
5053 Ritter Road
Mechanicsburg, P A 17055
(717) 791-51170
FAX: (717) 697-67JJ
i-800-PROGRESSIVE
(1-800-776-4737)
24 hours a day, 7 days a week
Se habla espana!.
Claim Number:
Your Client:
Date of Loss:
Date of Letter:
068167072 _
Estate of Eugene Muller
4/10/06
9/26/06
The Wiley Group
Attn: Christopher Marzzacco, Esq.
130 W Church St., Suite 100
Dillsburg, PA 17019
Dear Attorney Marzzacco:
As discussed, we are tendering our insured's policy limits of $50,000 in settlement of your client's
bodily injury claim.
Please be advised that this settlement offer is contingent upon our receiving the enclosed
completed release, confirmation all medical liens/bills are satisfied, and a copy of the court
approval. Upon receipt of same, we will forward the settlement payment directly to you.
At this time, we have no need to attend any court hearings for this case.
Thank you for your cooperation throughout the handling of this file.
Progressive Northern Insurance Company,
Tyecfdie Wi{{iams
Tyeddie Williams
Claims Representative
717-791-5151
enclosures
EXHIBIT
"G"
FULL RELEASE OF ALL CLAIMS WITH INDEMNITY
Page 1 of 2
KNOW ALL BY THESE PRESENTS, that I, Estate of Eugene Muller for and in
consideration of the sum of Fifty Thousand and 00/100 ($50,000), the receipt whereof is hereby
acknowledged, does hereby for myself, my heirs, executors, administrators, successors and
assigns and any and all persons, firms, employers, corporations, associations, or partnerships
release, acquit and forever discharge Arjay A. Chambers, its agents, employees, subsidiaries, and
affiliates (hereinafter "Releasees") from any and all claims, actions, causes of actions, demands,
costs, property damage, loss of wages, expenses, hospital medical and nursing expenses, accrued
or unaccrued claims for loss of consortium, loss of support or affection, loss of society and
companionship on account of or in any way growing out of, any and all known and unknown
personal injuries and damages resulting from an automobile accident which occurred on or about
4/11/06, at or near Camp Hill, P A. It is understood and agreed that this settlement is in full
compromise of a doubtful and disputed claim as to both questions of liability and as to the nature
and extent of the injuries and damages, and that neither this release, nor the payment pursuant
thereto shall be construed as an admission of liability, such being denied.
It is further understood and agreed that the undersigned relies wholly upon the
undersigned's judgment, belief, and knowledge of the nature, extent, effect, and duration of said
injuries and liability therefore and is made without reliance upon any statement or representation
of the party or parties hereby released or their representatives.
In consideration of the payment of the sum, the undersigned further agrees to indemnifY
Arjay A. Chambers, it's agents, employees, subsidiaries, and affiliates and save them harmless
from any and all further liability, loss, damage, claims of subrogation and expense, arising because
of any injuries and damages, sustained by the undersigned, and, if necessary in order to save them
so harmless, to satisfY on their behalf any judgment against them arising in any way out of the
undersigned injuries or damages.
I have read this release and understand it.
~
Signed:
C--~ h-;1;~n"'
Witness . da e
tJ~J.Oh&i: 10;n/01,
Victoria 1. Am rose Ctate
Administrator of Estate of Eugene Muller
Witness
date
date
. Government Employees Insurance Company
. GEICO General Insurance Company
. GEICO Indemnity Company
. GEICO Casualty Company
One GEICO Blvd. . Fredericksburg, V A 224 I 2-0001
GEICO
CERTIFICATION OF LIMITS
To Whom It May Concern:
This will certify that GEICO General Insurance Company has issued an automobil€ policy, 2003461098,
to:
EUGENE A. MULLER
2109 CEDAR RUN DRIVE
APT 10 1
CAMP HILL PA 17011
that was in effect on the accident date of 04/11/06 providing the following coverage on a 2002 JEEP,
Vehicle Identification Number (VIN) IJ4GL48K92W27 4021 :
Bodily Injury Liability
Property Damage Liability
First Party Benefits
Medical Expenses
Income Loss
Funeral Expenses
Accidental Death
Extraordinary Medical Benefits
Uninsured Motorist Bodily Injury
Stackable - # 1 vehicles
Underinsured Motorist Bodily Injury
Stackable - # 1 vehicles
Comprehensive Coverage
Collision Coverage
Tort Option
ERS
Rental Reimbursement
HI PA (l0/03)
$15,000
$30,000
$5000
per person!
per accident
per accident
$5,000 per person
N/A per person
N/A
N/A per person
N/A per person
N/A per person
$15,000 per person!
$30,000 per accident
$15,000 per person!
$30,000 per accident
N/A deductible
N/A deductible
Limited
N/A
per day maximum
per accident maximum
QQDL
David Wilson
Claims Manager
EXHIBIT
"I"
GEICO
. Government Employees Insurance Company
. GEl CO General Insurance Company
. GEl CO Indemnity Company
. GEICO Casualty Company
One GEICO Blvd. . Fredericksburg, V A 22412-0001
July 03, 2006
CHRISTOPHER MARZZACCO
130 WEST CHURCH ST STE 100
DILLSBURG PA 17019
CLAIM NUMBER:
INSURED:
DATE OF LOSS:
YOUR CLIENT(S):
0169307190101028
Eugene Muller
04/1 0106
Eugene Muller
Dear Mr. Marzzacco:
This will confirm receipt of your letter dated June 28, 2006. I hereby extend GEICO's consent to
the estate of your client to settle the injury claim with Progressive Insurance Company and waive
our right of subrogation.
Upon written confirmation that the Progressive Liability Limit applicable to this loss is $50,000,
I will tender the UIM limit of $15,000.
Should you have any questions please call me at the number below.
Sincerely,
fIJJ~
Michael Moeller
Claims Examiner
1-800-841-1003 ext 4374
EXHIBIT
"J"
GEICO
. Government Employees Insurance Company
. GEICO General Insurance Company
. GEICO Indemnity Company
. GEICO Casualty Company
One GEICO Blvd. . Fredericksburg, V A 22412-0001
RELEASE AGREEMENT
Claim Number: 0169307190101028
I/We, The Estate of Eugene Muller, Releasor(s), of2109 Cedar Run Dr. Apt. 101 Camp Hill PA
17011, being over the age of majority, for and in consideration of a draft for the sum of fifteen
thousand ($15,000), lawful money of the United States of America, to The Estate of Eugene
Muller in hand paid, the receipt of which is hereby acknowledged, do for ourselves, our heirs,
executors, administrators, successors and assigns, herby remise, release and forever discharge
GEICO General Insurance Company, Releasee, its successors and assigns, from any and all
claims for Underinsured motorist benefits arising under the terms and conditions of Policy No.
2003461098. Arising as a result of any and all loss and injury which may now exist, but which at
this time may be unknown and unanticipated or which may develop at some time in the future, or
any and all unforeseen developments arising from said injuries from an accident that occurred on
or about the 10th day of April, 2006, at or near Camp Hill P A.
As a further consideration for the making of said settlement and payment, it is expressly warranted and
agreed:
That this is a final settlement and disposition of the disputes for any and all legal claims for
Underinsured motorist benefits resulting for said accident, the liability for which is denied by
GEICO General Insurance Company, Releasee, and it is covenanted and agreed between
Releasor(s) and Releasee herein that this release and settlement is not to be construed as consent
or admission of liability on the par of Releasee, and that this release and settlement agreement
shall not be used by Releasor(s) or anyone of them as a defense or estoppel in any action which
is now pending or may be brought hereinafter by Releasee against the Releasor(s) or its agents
and servants on any claim for Underinsured motorist benefits arising from said accident.
The undersigned will indemnify and save harmless Releasee from any and all claims and
demands for Underinsured motorist benefits of any kind or character which may be asserted by
reason of said injuries, illness or disease, or the effects or consequences thereof.
That no promise, agreement, statement or representation not herein expressed has been made to
or relied upon by The Estate of Eugene Muller, and this Release contains the entire agreement
between the parties.
IN WITNESS WEREOF, we have hereunto set our hands and seals this i7 t' day of () {obi! v ,
2006.
tJ~ 1~
PA UMlUIM (11/03)
EXHIBIT
"K"
THE WILEY GROUP
130 WEST CHURCH STREET
DILLS BURG P A 17019
Invoice
Date
Invoice #
] 0/3/2006 764
Bill To
Estate of Eugene Muller
PERSONAL INJURY
Terms
Net 10
Date Description Attorney Time Rate Amount
8/15/2006 Medical Records Marzzacco 1 166.83 ]66.83
8/1 7/2006 Preparation of Report Marzzacco 1 450.00 450.00
9/7/2006 Inspection of Accident Site and Completion of Report Marzzacco 1 825.00 825.00
9/15/2006 Postage for large package mailed to Progressive Marzzacco ] 5.60 5.60
T ota I $1,447.43
EXHIBIT
"L"
APR-29-2004 11:45A FROM:
~O/~LILO~O ~C;L~ (~(q~LVqLb
TO: 17174320426
I MI:. W.1LC,T \:lI'I:uur-
P.2
rMOr::. O.LIO.L
Jan M. Wiley
David J. Lenox
limothy 1. Colgan
Chrim-opher J. Mal'lMCCo
David E, Hershey
Bradley A. Winnick
Thomas M. Clark
Afi D. Weitzman
THE 'WILEY GROUP
Attorneys at Law
Wiley, Lenox, Colgan & Marz2:acco, p,c.
AUTHORtty'TO REPRES-BNT
ON A 'CONTINGENT FEE BASIS
I, Victoria Ambrose, as personal representative of the Estate QfEugene A
Multer, II, do hereby retain and employ the LAW OFFICES OF WILEY, LENOX,
COLGAN &'MARZZACCO, P.C. as my attorneys to represent me in my claim
against Arjay A. cnambers or -against any ather person, firm. or coq>oration liahle for
the damages resulting from an autOlnobile accident which occurred on or aboutApriJ
I I, 2006 in Cumberland County, Pennsylvania,
I agree to pay the Law Offices of wtLEY, LENOX, COLGAN &..
MARZZACCO, P.C., from the proceeds of any recovery by settlement or verdict, as
follows: Thirty percent (30%) of any amounts .recovered from any available source in
this case.
I understand and agree that all COSts in this matter will be advanced by my
attorneys, but will remain my responsibility, jf recovery is made. Furthermore, all
advanced costs will be deducted and repaid to my attorney from my pottion of the
recovery. I hereby agree to pay for the costs of investigation, prepara.tion ami court
costs only if there is a r~overy made on the estate's behalf.
Should either pany terminate this contract before payment of an outstanding
settlement offer or verdict. my attorney is entitled to payment for his time .at his
hourly rate of $250.00, or 30% of any. existing settlement offer negotiated by him,
plus advanced COsts, as of that date.
Therefore, haVing read this document a.nd discu..qsf.ng arty concerns With my
attorneys, r hereby sign this document and agree to be bound by itS t.erm.s.
Dated this J:t-...;-. day of f11~J .2006.
~
1J~~
CLIENT
cr.. ,~~ ~J....r f'1-1rn..q....co
130 w. Church Stree4 Suite rOO it DlIIsburg, PA 17019 · Phone: (717) 432~9666 ,. (BOO} 682-4250" Fax: (717) 432-04:l6
Offices in Harrisburg. Yorl< · Carbondele
www.wlleygrouplaw.com
EXHIBIT
"M"
09/14/2006 08:56
5402867265
GEICO CLAIMS
PAGE 02/02
· Government Employees Insurance Company
G E I C 0 · GEIea General Insurance Company
. GEJeO Indemnity Company
. GEICO Casualty Company
One GETCO Blvd. . Fn:dericksburg,VA 224]2&0001
September 14, 2006
WILEY GROUP
ATTN: CHRIS MARZZACCO
130 WEST CHURCH STREET
DILLSBURG P A 17019
CLAIM NUMBER:
INSURED:
DATE OF LOSS:
YOUR CLIENT\:
016930719-010]-028
EUGENE MULLER
04/10/06
EUGENE MULLER ESTATE
Dear Mr. Marzzacco
Please be advised that the First Party Benefits on Mr. Eugene Muller's GEICO policy have been
exhausted.
EXHIBIT
"N"
Please Read the Enclosed Material
Before Making Your Choice
you DO want Medical Insurance, cut out your Health
lsurance Card, Your coverage and your Medica/Insurance
remium begin on the date shown, Throwaway the rest of
lis form.
you do NOT want Medical Insurance, carefully follow the
lstructions on the back of this form.
*********AUTO..... 3-DIGIT 170
1111111111111111.11111111111111.1111111111.1.1111.1.11...11111
0504 00- -0000091 24 059
EUGENE A MULLER JR
2109 CEDAR RUN DR
APT 101
CAMP HILL PA 17011-7482
,rm CMS-40 (0512005)
2'd
92b02[bLlL 1:01
MEDICARE
MEDICARE CLAIM NUMBER SEX
125-38-1106-A MALE
IS ENTITLED TO EFFECTIVE DATE
HOSPITAL (PART A) 08-01-2006
MEDICAL (PART B) 08-01-2006
SIGN
HERE -
DO NOT SEND CLAIMS FOR PAYMENT OF
MEDICARE BENEFITS TO THIS (oJ.) ADDRESS
SOCIAL SECURITY ADMIN
NORTHEASTERN PROG SERV CNTR
PO BOX 315900
JAMAICA NY 1 1431-5900
125381106A 0504 1 VV
:WO~~ d91:S0 b002-82-lnr
EXHIBIT
"0"
RUG-16-2004 07:46P FROM:
TO: 17174320426
P.3
WESTSHOREEMS-ALS
205 GRANDVIEW AVE
SUITE 211
CAMP HILL, PA 17011
Phone #: (800) 367-0512 Federal Tax 10: 23-2463002
PATIENT NAME:: EUGENE MULLER
PATIENT NUMBER:
CAll NUMBER:
DATE OF CAll:
TIME OF CALL:
CALLER:
FROM:
TO:
INSURANCE: GEl CO
2003461098
3062249A
EUGENE MULLER
2435 WINONA DR
COLUMBUS, OH 43235~5540
REASON(S)
FOR
TRANSPORT
INVOICE
~~
WEST SHORE
EMERCiENCY MEDICAL S~_RVICES
49696 EXH
3062249A EX3
04/1 012006
19TH ST & MARKET ST
LIFE LION
UNCONSCIOUSNESS
TRAUMA FACE
DESCRIPTION OF CHARGE QUANTITY UNIT PRICE AMOUNT
NEEDLES (ALL) A0394 1.0 1.10 1.10
OP SITE A0394 1.0 4.94 4.94
RINGERS LACTATE 1000CC A0394 1.0 4.22 4.22
STYLET A0422 1.0 5.70 5.70
VERSED 5mg/ml VIAL A0394 1.0 2.76 2.76
Total Charges 708.26
DESCRIPTION OF PAYMENT
RECEIPT
PAYMENT DATE
PLEASE PAY THIS AMOUNT - INVOICE DUE UPON RECEIPT -.
RETURNED CHECK FEE - $31.00
AMOUNT
--
Total Credits 0.00
$708.26
PATIENT NAME:
PATIE:NT NUMBER:
MULLER. EUGENE A
49696
CALL NUMBER
BILLING DATE:
3062249A
08/17/2006
DETACH ALONG PERFORMATION AND RETURN STUB WITH PAYMENT
AMOUNT DUE
AMOUNT $
ENCLOSED
This account is now PAST DUEll Payment must be received
WITHIN 10 DAYS. Collection process will begin.
WEST SHORE EMS - ALS 205 GRANDVIEW AVE
708.26
~ ~:: '.1
MASTI!R CARD
CAMP HILL, PA HrfH'TED
- .
JUL-21-2006 FRI 10:30 AM PATIENT FIN SERVICES
FAX NO, 7175310300
p, 02/19
'HE MILTON S HERSHEY MEDICAL CENTER
'.0. BOX 853 HERSHEY, PA 17033
OUTPJ\TIENT HOSPITAL STATEMENT
~EDERAL I D :
251854772
Pi;GE :
>ATIENT NAME:
)ATIENT ACCT#:
MULLER EUGENE A
7026158
VISIT DA'II:: 04/10/06
C::"ERK: CKF
)HYSICIAN NAME: DEFLITCH CHRISTOPHER J
DIAGNOSIS CODES:
9599
E8147
95901
linT
SERVICE CODE
DESCRIPTION
AMOUNT
1
13
-1
711107
711108
902040
AIR AMBULANCE TRANSPO
AIR AMBULANCE MILEAGE
AUTO/WORK COMP PAYMEN
10229.00
1287.00
5000.00-
TOTAL CHARGES:
PAYMENT RECEIVED:
BALANCE DUE:
11516.00
5000.00-
6516.00
THIS STATEMEN'l:' MAY NOT REFLECT ALL CHAR( ~S
JUL-21-2006 FRI 10:30 AM PATIENT FIN SERVICES
FAX NO, 7175310300
P. 03/1 9
~HE MILTON S HERSHEY MEDICAL CENTER
).0. BOX 853 HERSHEY, PA 17033
OUTPATIENT HOSPITAL STATEMENT
~EDERAL ID:
251854772
>ATIENT NAME:
>ATIENT ACCT#:
MULLER EUGENE: A
6605933
)HYSICIAN NAME: CHERRY ROBEH.T A
UNIT SERvICE CODE
DESCRIPTION
_ _ ~w -... _ _ _ _ _ _ _ _ _ _ _ _ _ _ ..... _ ... _ _ _ _ _ ... _ _ _ _ _ _ _ _ _ .
AMOUNT
---------- --------------
1 16501
1 44604
1 46122
1 46473
1 46620
1 46694
1 46717
1 46794
1 46843
1 104002
1 104009
1 104042
1 104060
1 104111
1 104131
1 104145
1 105052
1 105059
1 105657
1 10144
1 46121
1 46699
2 46931
2 46932
1 101003
1 101004
1 101005
2 101021
4 101120
4 101220
1 104042
1 104065
2 104110
ADULT LEVEL I TRAUMA
INTUBATE, BNDOTRACH, EM
HEMOCCULT, STOOL
ER,CRITICL CARE,30-75
ROUTINE VENIPUNCTIJRE
lillMIN VACCINE, SINGLE
NONINVAS PULSE OX, MU
IV PUMP, SINGLE LINE
BLADDER CATH, SIMPLE
ALCOHOL (ETOH), BLOOD
AMYLASE, BLOOD
CREATININE, BLOOD
GLUCOSE, BLOOD
BLOOD GAS PANEL W/02
?OTASSIUM (K), BLOOD
SODIUM (NA), BLOOD
?ARTIAL THROMBOPLAS T
?ROTHROMBIN TIME
CBC W/PIJTjDIFF AUTO
I CRITICAL CARE UNIT
URINALYSIS DIPSTIX PR
THERA/DIAG INJECTION
IV INF,HYDRAT,UP TO 1
IV INF,HYDRAT,UP TO 8
ABO BLOOD GROUP
ANTIBODY SCREEN
RH TYPE
COM PAT , IMMED SPIN
THAW F'ROZ PLASMA/U
?FP SINGLE DONOR EA U
CREATININE, BLOOD
UREA NITROGEN (BUN),
BLOOD GAS PANEL
----------------------------------.-~.~-------
- Continue -
PAGE:
VISIT DAT j:; 04/11/06
CLERK: CKF'
DIAGNOSIS CODES:
80125
86121
8082
3506.00
374.00
7.00
1117.00
16.00
21.00
90.00
3.00
132.00
49.00
42.00
13.00
12.00
145.00
13.00
13.00
36.00
22.00
46.00
2795.00
7.00
53.00
394.00
244.00
20.00
45.00
19.00
134.00
80.00
616.00
13.00
12.00
244.00
JUL-21-2006 FRI 10:30 AM PATIENT FIN SERVICES
FAX NO. 7175310300
P. 04/19
~HE MILTON S HERSHEY MEDICAL CENTER
J.O. BOX 853 HERSHEY, PA 17Q33
"EDERAL ID:
OUTPATIENT HOSPITAL STATEMENT
251854772
P.ll.GE:
,)
?ATIENT NAME:
?ATIENT ACCT#:
MULLER EUGENE A
6605933
VISIT DA'l~: 04/11/06
CLERK: CKF
?HYSICIAN NAME: CHERRY ROBER'r A
UNIT
4
1
4
4
2
5
14400
3
2
1
6
6
20
2
1
1
1
2
3
5
4
1
1
3
1
2
200
1
2
2
1
2
1
DIAGNOSI~ CODES:
80125
86121
8082
SER.VICE CODE
DESCRIPTION
AMOUNT
--.---------------------------------- ---
104398
104711
105052
105059
105656
106041
108590
111001
245206
245553
246201
246420
246422
246425
246538
246764
248716
250986
251127
251846
272199
272979
273298
273532
273935
274218
274324
305614
307101
307220
307280
310501
310516
ELECTROLYTES
DRUG SCREEN, URINE
PARTIAL THROMBOPLAS T
PROTHROMBIN TIME
CBC W/PLT AUTO
OSMOLALITY, SERUM
~7A RECOM NOVO 600UG
GLUCOSE BEDSIDE MaNIT
LIDOCAINE 10MG/ML
LIDOCAINE 1 ML
HYDRALAZINE 20 MG/ML
PHENYTOIN 100 MG/2 ML
PHENYTOIN 250 MG/5 ML
PHYTONADIONE 10 MG/ML
TRIMETHOBENZAMIDE HCL
DIPHTHERIA TETANUS O.
LABETALOL 100MG/ML
WHITE PETROLATUM CPD
2LINDAMYCIN 900MG
VERSED 5MG/5ML
ONDANSETRON 2MG/ML 2M
~AMOTIDINE 20MG PRE~M
20MBIVENT INHALER 14.
PROPOFOL 10MG/ML 100M
PANTOPRAZOLE 40 MG VI
2EFAZOLIN SODIUM BAG
HUMULIN R
HAND 3 OR MORE VIEWS
CHEST 4. VIEW
PELVIS 1-2 VIEWS
~OREARM AP&LAT VIEWS
2T HEAD UNENHANCED
2T THORAX ENHANCED
116.00
92.00
144.00
88.00
58.00
250.00
25344.00
81.00
6.00
3.40
244.50
27.15
42.95
14.20
17.30
58.30
4.70
8.60
39.55
3.05
54.50
10.35
241.10
198.75
12.75
11. 60
36.00
106.00
228.00
300.00
105.00
1438.00
1490.00
~~----------------_._-~~------~-------------------------------- ------------------
JUL-21-2006 FRI 10:31 AM PATIENT FIN SERVICES
FAX NO. 7175310300
p, 05/19
rHE MILTON S HERSHEY MEDICAL 2ENTER
?O. BOX 853 HERSHEY, PA 1'7033
OUTPATIENT HOSPITAL STATEMENT
:;'EDERAL ID:
251854772
?ATIENT NAME:
?ATIENT ACCT#:
MULLER EUGENE A
6605933
?HYSICIAN NAME: CHERRY ROBE:~T A
UNIT
SERVICE CODE
DESCRIPTION
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
6
1
1
1
3
1
2
1
1
1
1
1
2
3
1
-4
4
1
310519
310528
310560
310562
310564
310567
310704
347001
347037
503140
511202
511803
521211
600510
620168
621112
621387
622024
623017
625010
626080
626081
661154
667765
670330
10144
104106
104110
104145
104438
105052
105059
105657
CT ABDOMEN ENHANCED
CT SINUS MAXILLOFAC V
CT C-SPINE UNENHANCED
CT T-SPlNE UNENHANCED
CT L-SpINE UNENHANCED
CT PELVIS ENHANCED
OMNIPAQUE 300MG/ML 15
MRI BRAIN UNBNRANCED
MRI C SPINE UNENHANCE
OFF SITE FULL SERVICE
VENTILATOR DAY INITIA
VENTILATOR CIRCUIT
12 LEAD ELECTROCARDIO
PULSE OXIMETER SNSR A
COVER DISPO BAIR HUG
KIT BLOOD GAS SAFT ND
IV KCL 20 MEQ
IRRIGATION SOD CHL O.
ADAPTOR, VENTED SPIKE
SET BLOOD SOLUTION
IV DILUENT NML SALINE
IV DILUENT NML SALINE
ORAL ENDOTRACH TUBE A
SCD SLEEVES, KNEE LEN
IV INFUSION SET, UNIV
I CRITICAL CARE UNIT
MAGNESIUM
BLOOD GAS PANEL
SODIUM (NA) , BLOOD
RENAL FUNCTION PANEL
PARTIAL THROMBOPLAS T
PROTHROMBIN TIME
~BC W/PLT/DIFF AUTO
._------------~~--~---------------------------
PJ:,GE:
VISIT DA1 ~: 04/11/06
CI.ERK: CKF
DIAGNOSI~ CODES:
80125
86121
8082
AMOUNT
1029.00
917.00
797.00
743.00
750.00
1169.00
78.00
1571.00
1571; 00
280.00
486.00
22.00
111.00
11. 00
17.00
30.00
8.00
6.00
9.00
72.00
8.00
16.00
17.00
75.00
16.00
2795.00
46.00
244.00
39.00
42.00.
144.00
se.oo
46.00
--------- -----..... ...-------_____r-_.....__
JUL-21-2006 FRI 10:31 AM PATIENT FIN SERVICES
FAX NO. 7175310300
P. 06/19
mE MILTON S HERSHEY MEDICAL CENtER
?O. BOX 853 HERSHEY, PA 17J33
OUTPATIENT HOSPITAL STATEMENT
"EDERAL ID:
251854772
P,~,GE: .
?ATIENT NAME:
?ATIENT ACCT#:
MULLER EUGENE A
6605933
VISIT DA'J:~: 04/11/06
CLERK: CKF
?HYSICIAN NAME: CHERRY ROBEH.'r A
DIAGNOSH CODES;
80125
86121
8082
UNIT SERVICE CODE
DESCRlPTION
AMOUNT
-_.~---------------------------~----- '--
1 106041
5 111001
1 245482
7 246201
6 246420
10 246845
3 248356
1 248716
1 273298
1 273532
1 273935
4 274808
1 307101
1 310501
2 511354
2 621387
1 623017
2 626081
2 670330
1 670334
1 10144
1 104106
1 104110
4 104145
1 104438
4 105052
4 105059
1 105657
4 111001
1 245690
4 246201
4 246420
5 246705
OSMOLALITY, SERUM
GLUCOSE BEDSIDE MONIT
~EXTRO$E 5% IN WATER
~~YDRALAZINE 20 MG/ML
PHENYTOIN 100 MG/2 ML
POTASSIUM PHOSPHATE 3
METOPROLOL 5MG/5ML
LABETALOL 100MG/ML
COMBIVENT INHALER 14:.
PROPOFOL 10MG/ML 100M
PANTOPRAZOLE 40 MG VI
MAGNES~UM SULF 2G/100
CHEST :t. VIEW
CT HEAD UNENHANCED
MDI TREATMENT
tv KCL 20 MEQ
J~APTOR, VENTED SPIKE
IV DILUENT NML SALINE
IV INFUSION SET, UNIV
IV INFUSION SET, UNIV
I CRITicAL CARE UNIT
['<1AGNES 1UM
BLOOD GAS PANEL
SODIUM (NA), BLOOD
RENAL FUNCTION PANEL
PARTIAL THROMBOPLAS T
PROTHROMBIN TIME
CBC W/PLT!DIFF AUTO
GLUCOSE BEDSIDE MONIT
CLONIDINE HCL 0.1 MG
HYDRALAZINE 20 MG/ML
?HENYTOIN 100 MG/2 ML
MORPHINE SULFATE 4 MG
50.00
135.00
3.00
285.25
27.15
8.75
31.50
4.70
241.10
66.25
12.75
10.15
114.00
719.00
132.00
16~00
9.00
16.00
32.00
8.00
2795.00
46.00
122.00
52.00
42.00
144.00
88.00
46.00
108.00
3.00
163.00
18.10
15.00
I___________~--~-----------_.._-----------------------_________
JUL-21-2006 FRI 10:31 AM PATIENT FIN SERVICES
FAX NO. 7175310300
P. 07/19
'HE MILTON S HERSHEY MEDICAL CENTER
1.0. BOX 853 HERSHEY, PA 17033
OU'l'PATIENT HOSPITAL STATEMENT
~EDERAL ID:
251854772
lATIENT NAME:
)ATIENT ACCT#:
MULLER EUGENl~ A
6605933
lHYSICIAN NAME: CHERRY ROBEHT A
UNIT SERVICE CODE
DESCRIPTION
-_...._-------~--~-------------------_. ~-
AMOUNT
.--------- -------------~
2 246706
4 248356
1 273935
1 307101
1 511203
5 511354
1 600510
3 621105
1 621387
1 622024
2 626081
1 627069
1 661154
1 670520
1 10144
1 104106
1 104110
3 104145
1 104438
2 104507
1 105052
1 105059
1 105657
5 111001
1 246049
8 246201
8 246420
2 246705
7 248356
3 248716
1 249053
1 273935
1 307101
~10RPHINE SULFATE 2 MG
METOPROLOL SMG/5ML
PANTOPRAZOLE 40 MG VI
CHEST 1 VIEW
VENTIL1\.TOR DAY SUBSEQ
~1DI TREATMENT
PULSE OXIMETER SNSR A
YANKAUElR sueT TB W/O
:V KCL .20 MEQ
:RRIGATION SOD CHL O.
=:V DILtj"ENT NML SALINE
ST EXT MICRO 60N IML
ORAL ENJ)OTRACH TUBE A
~:'RACH CARE SYSTEM 14
J: CRITICAL CARE UNIT
MAGNESIUM
BLOOD GAS PANEL
SODIUM . (NA) , BLOOD
RENAL FTJNCTION PANEL
DlLANTIN
PARTIAlj THROMBOPLAS T
PROTHROMBIN.TIME
eBC W/PLT/DIFF AUTO
GLUCOSE BEDSIDE MONIT
CALCIUM CHLORIDE 10 M
HYDRALAZINE 20 MG/ML
PHENYTOIN 100 MG/2 ML
HORPHlNE SULFATE 4 MG
HETOPROLOL 5MG/5ML
I~BETA~OL 100MG/ML
CLONIDINE TTS O.3MG
PANTOPRAZOLE 40 MG VI
CHEST 1 VIEW
PAGE:
VISIT DA'I I;: 04/11/06
CLERK: CKF
DIAGNOSIS CODES:
80125
86121
8082
6.00
42.00
12.75
114.00
486.00
330.00
11. 00
15.00
8.00
6.00
16.00
7.00
17.00
20.00
2795.00
46.00
122.00
39.00
42.00
160.00
36.00
22.00
46.00
135.00
5.10
326.00
36.20
6.00
73.50
14.10
113.70
12.75
114.00
------------~---------------_._-----------------------..------- ---~-------------
':'
'-~~:.
f
JUL-21-2006 FRI 10:31 AM PATIENT FIN SERVICES
FAX NO. 7175310300
P. 08/19
~HE MILTON S HERSHEY MEDICAL CENTER.
).0. BOX 853 HERSHEY I PA 17(l33
OUTPATIENT HOSPITAL STATEMENT
~EDERAL ID:
251854772
PAGE:
I.
)ATIENT NAME:
)ATIENT ACCT#:
MULLER EUGENE A
6605933
VISIT DA'II:: 04/11/06
C~ERK: CKF
)HYSICIAN NAME: CHERRY ROBERT A
DIAGNOSIS CODES:
80125
86121
8082
UNIT
SERVICE CODE
DESCRIPTION
AMOUNT
--........-....--------
--_.._-----~------------------._------_. --
1
5
1
1
1
2
1
1
1
1
1
1
2
4
1
3
8
2
25
1
12
1
1
1
400
3
3
1
1
1
-1
511203
511354
621386
621387
626080
626081
670330
104106
104110
104131
104438
105657
111001
246420
246705
246706
248356
251185
272628
273298
273399
273631
273935
307101
511201
511354
621113
621387
670330
670722
985039
VENTILATOR DAY SUBSEQ
rIDI TREATMENT
IV KCL 20MEQ+DS NACL
IV KCL 20 MEQ
IV DILUENT NML SALINE
IV DILUENT NML SALINE
:~V INFTJSION SET I UNIV
t1AGNESIUM
BLOOD GAS PANEL
POTASSIUM (K), BLOOD
RENAL FUNCTION PANEL
eBC W/PI,T/DIFF AUTO
GLUCOSE BEDSIDE MONIT
PBENYTOIN 100 MG/2 ML
MORPHIX\fE SULFATE 4 MG
~10RPHI~E SULFATE 2 MG
METOPRQLOL SMG/5ML
HETAPROTERENOL 10MG/S
MORPHINE 1MG/ML BAG
COMBlVENT INHALER 14.
ISOSOURCE 250ML CAN
GLUTAMINE ORAL SUSP
PANTOPRAZOLE 40 MG VI
CHEST 1 VIEW
STERILE: WATER UP TO 5
l-mI TREATMENT
KIT BLOOD GAS ART LIN
IV KCL ;20 MEQ
IV INFUSION SET, UNIV
FEEDING BG ENTERAL 10
AUTO/WKC LATE eRG ADJ
486.00
330.00
9.00
8.00
B.OO
16.00
16.00
46.00
122.00
13.00
42.00
46.00
54.00
18.10
3.00
9.00
84.00
6.00
30.65
241.10
24.25
27.10
12.75
114.00
5.00
198.00
15.00
8.00
16.00
4.00
280.00-
------------------------------------------------------.-------.
- Continue -
-----------------
JUL-21-2006 FRI 10:32 AM PATIENT FIN SERVICES
FAX NQ 7175310300
P. 09/19
rHE MILTON S HERSHEY MEDICAL CENTER
?O. BOX 853 HERSHEY/ PA 1'7033
OUT:?~TIENT HOSPITAL STATEMENT
?EDERAL I D :
251854772
P.A.GE :
?ATIENT NAME:
?ATIENT ACCT#:
MULLER EUGENE A
6605933
VISIT DA~ ~: 04/11/06
CI,ERK: CKF
?HYSICIAN NAME: CHERRY ROBERT A
DJAGNOSH CODES:
80125
86121
8082
UNIT SERVICE CODE DESCRIPTION AMOUNT
---------- -------------- -------~-------------------_.~--~--- --- -------------
TOTAL CHARGES:
PAYMENT RECEIVED:
BAL1\NCE DUE:
67271.50
280.00-
66991.50
THIS ST.~TEMEN'f MAY NOT REFLECT ALL CHARC ~S
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EXHIBIT
"P"
OCT-19-2006 THU 10:52 AN
FAX NO.
p, 02
PENNSTf,;rE
.~~:I The Milton S. Hershey
"1JIl Medical Center
October 19, 2006
Attorney Christopher Marzzacco
130 VI Church St. Ste.1 00
Dillshurg, Pa 17019
Re: Patient: Eugene Muller
Account: 879561
Physician Balance: $16,078.00
fiospital Balance: $73,787.50
Dear Attorney Marzzacco,
l1ris letter confIrms that the Penn State Milton S. Hershey Medical Center & Physicians Group has
agre.;d to accept $45,000.00 from the deceased-patient's estate. Payment will be made by your office
by December 15, 2006.
IfYOll have any questions or concerns, please feel free to contact me at (717) 531-0304 or 1-800-254-
2619 ext. 0304 Monday, Tuesday, Thursday and Friday from 8:00 am to 4:00 pm., Wednesday
9:00 am to 5:30 pm.
~n1ank you for your prompt attention to this matter.
Sincc:rely,
Patient Financial Services
The Milton S. Hershey Medical Center
PO IJox 854
Hershey, PA 17033
. Jan M. Wiley
David j. Lenox
Timothy j. Colgan
Christopher j. Marzzacco
M
III
David E. Hershey
Bradley A. Winnick
Thomas M. Clark
THE "WILEY GROUP
Attorneys at Lavv
Wiley, Lenox, Colgan & Marzzacco, P.c.
September 29, 2006
VIA FAX: 717-531-0295
Tina Girvin, Billing Department
Penn State Hershey Medical Center
500 University Drive
Hershey, PA 17033
Re: Patient:
SSN:
Treatment Date(s):
Eugene A. Muller
125-38-1106
April 10-14, 2006
Dear Ms. Girvin:
This letter confirms that the Penn State Hershey Medical Center has agreed to
accept $45,000.00 as full and final payment of all medical bills incurred by Eugene
Muller.
Because we will need approval from the Court of Common Pleas, Cumberland
County, I request that you fax me a brief letter confirming this agreement so I can attach
a copy of the same to my petition.
Very truly yours,
WILEY, LENOX, COLGAN
& MARZZACCO, P.C.
.
Ci-:1--K~
by: Christopher J. Marzzacco
CJ M/jfs
cc: Victoria Ambrose
130 W. Church Street, Suite 100 · Dillsburg, PA 17019 · Phone: (717) 432-9666 . (800) 682-4250 . Fax: (717) 432-0426
Offices in Harrisburg · York · Carbondale
www.wileygrouplaw.com
EXHIBIT
"Q"
OFFICE OF CHIEF COUNSEL
DEt-'T. 281061
HARRISBURG, PA 17128-1061
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
October 18, 2006
Lara A. Kulick
Direct Dial: (717) 346-4644
Ikulick@state.pa.us
Fax: (717) 772-1459
Christopher J. Marzzacco, Esq.
The Wiley Group
130 W. Church Street
Suite 100
Dillsburg, PA 17019
Re: Estate of Eugene A. Muller, II, deceased
Court of Common Pleas of Cumberland County
No. 21-06-00353
Dear Mr. Marzzacco:
The Department of Revenue received the draft Petition for
Approval and Settlement of Wrongful Death and Survival Actions
to be filed on behalf of the above-referenced. It was forwarded
to this Office for the Commonwealth's approval of the allocation
of the proceeds paid to settle the actions.
Pursuant to the Petition, the fifty-nine year old decedent
died within days of sustaining injuries upon being struck by a
motor vehicle. Decedent is survived by his adult daughter.
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,
$26,431.54 to the wrongful death claim and $17,621.03 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.
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, I will not be attending any
Christopher J. Marzzacco, Esq.
October 18, 2006
Page 2
hearing regarding it. Please contact me if you or the Court has
any questions or requires anything additional from this Office.
Sincerely,
~
Lora A. Kulick
Senior Counsel
cc: Clerk of Court
LAK: she: dmm
#18687
EXHIBIT
"R"
.
GEICO
. Government Employees Insurance Company
. GEICO General Insurance Company
. GEICO Inderrmity Company
. GEICO Casualty Company
One GEICO Blvd. . Fredericksburg, V A 22412-0001
September 14,2006
CHRISTOPHER MARZZACCO
130 WEST CHURCH ST STE 100
DILLS BURG PA 17019
CLAIM NUMBER:
INSURED:
DATE OF LOSS:
YOUR CLIENT(S):
0169307190101028
Eugene Muller
04/10/06
Eugene Muller
Dear Mr. Marzzacco:
This will confirm receipt of your facsimile dated September 14, 2006.
Enclosed please find the requested release and be advised that GEICO will not be attending the
petition hearing. GEICO will not object to the petition on condition that the release remains
unaltered.
Should you have any questions please call me at the number below.
Sincerely,
Michael Moeller
Claims Examiner
1-800-841-1003 ext 4374
.
VERIFICATION
The undersigned, VICTORIA J. AMBROSE, verifies that the statements made in
this document are true and correct to the best of my knowledge, information, and belief.
I understand that false statements herein are made subject to the penalties of 18 Pa.
C.S. S4904, relating to unsworn falsification to authorities.
Respectfully submitted,
1J~ 1 0Jxc-
by: VICTORIA J. AMBROSE
The Estate of Eugene A. Mu"er, n, *
and *
Victoria J. Ambrose, Administratrix, *
Petitioners *
IN THE COURT OF COMMON PLEAS,
CUMBERLAND COUNTY
ORPHAN'S COURT DIVISION
*
v.
*
No.: 21_06-00353
*
Arjay A. Chambers,
Respondent
*
CERTIFICATE OF SERVICE
I, Christopher J. Marzzacco, Esquire, hereby certify that I am this ?oS"" day of
October, 2006, servicing a copy of the foregoing document upon the person(s) and in
the manner indicated below, which service satisfies the requirements of the
pennsylvania Rules of Civil Procedure, by first-class mail delivery, to:
Progressive Insurance Company
Attn: Tyeddie Williams
5053 Ritter Road
suite 101
Mechanicsburg, PA 17055-6925
GEICO Insurance Company
Attn.:Michael Moeller
One GEICO Boulevard
Fredericksburg, VA 22412-0001
Respectfully submitted,
WILEY, LENOX, COLGAN & MARZZACCO, P.C.
0~~
by: Christopher J. Marzzacco, Esquire
10 No.: 78262
130 West Church Street
suite 100
Oillsburg, PA 17019
(717) 432-9666