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Home My WebLink About95-03054 . . . o Schmidt and Ronca PC AU.""" ...4 toun...." II UW a.. ..... "'... _.r_tl..... "'01 . "" III..... . ~ 'JUN 8 '995Jt.- .. :i~;..:.~_'4_l~!'i;;I-'-i':7':;..-~,;j;~...'>-.1?~ r-""'l~- . " oM . .. . .... . , v. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 95-30,t/CIVIL, ~ UNDERINSURED MOTORIST ARBITRATION DAVID C. ATKINS, Petitioner STATE AUTO INSURANCE COMPANY, Respondent AND NOW THIS lUl.LI ./,., J ' \"J) day of -uv'-'; 1995, based on the foregoing Petition to compel Arbitration, a Rule is directed to the Respondent, STATE AUTO INSURANCE COMPANY, to show cause, if any, why it should not designate an arbitrator and why the above captioned matter should not proceed into arbitration. ""'.u\ RULE RETURNABLE ~ DAYS FROM SERVICE. By the Court I JJC\ ulJ=- 2l t..... . - i~ lR "..... - ~.r. ..... -, - :'C . .. "- .. C ~L' , g '. ., . , N , ....... '" - ~ .., DAVID C. ATKINS, Petitioner IN TilE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA v. NO. CIVIL, 1995 STATE AUTO INSURANCE COMPANY. UNDER INSURED MOTORIST ARBITRATION Respondent PBTITION TO COMPBL ARBITRATION AND NOW COMES, the Petitioner, David C. Atkins, by and through his attorneys, Schmidt and Ronca. P.c., and sets forth as follows: 1. The Petitioner, DAVID C. ATKINS, is an adult individual residing at 4183 Cove court, Apt. 106, Mechanicsburg, PA 17055. 2. The Respondent, STATE AUTO INSURANCE COMPANY, is an insurance company duly licensed to do business in the commonwealth of Pennsylvania with its principal place of busine.. located at 4900 Ritter Road, P.O. Box 2006/ Mechanicsburg, PA 17055. 3. On or about August 24, 1992, Petitioner was the owner of a 1990 Ford Truck that was involved in a motor vehicle accident with a vehicle operated by Julie A. Deard at the intersection of Eisenhower Drive and Eichelberger Streett lIanover Borough, York county/ Pennsylvania. See police report attached as Exhibit "A." 1 4. At the time of the aforesaid motor vehicle acoident, the Petitioner resided at 8 Stephen Road, Camp Hill, Cumberland county, Pennsylvania 17011, and was an insured under a policy of automobile insurance issued by the Respondent, policy number DAP 6543316. See attached Exhibit "D." 5. As a result of the aforesaid accident, the Petitioner suffered severe and permanent injuries inoluding, but not limited to. the followingl (a) acute lumbosacral strain, with damage to assooiated musoles, nerves and ligaments1 (b) oontusion of the left knee with damage to assooiated muscles, nerves and ligaments, (0) oontusion of the chest wall, with damage to associated muscles and nerves, (d) pain radiating from the low back to left buttooks, leg and foot, (e) disc bulge and/or herniation at the L5-S1 level, (f) strain and sprain of the paracervical, upper trapezius, and shoulder muscles, with damage to associated muscles, nerves and ligaments1 (g) pain and swelling of the left forearm, and (h) Fibromyalgia syndrome. 2 6. As a result of the aforesaid aooident, the insuranoe oarrier for Julie A. Beard, state Farm Insuranoe company, offered to pay its policy limits of Fifteen Thousand ($15,000) Dollars. 7. On or about June 28, 1993, the Respondent consented to settlement and agreed to waive its subrogation rights against the tortfeasor. Sse attached Exhibit "C." 8. The Petitioner subsequently aooepted the sum of Fifteen Thousand ($15,000) Dollars and executed a general release from state Farm, but specifically preserved the right to pursue eny claims or under insured benefits from his first party carrier. See attached Exhibit "D." 9. It is belieyed and averred at the time of the aooident that Julie A. Beard was an under insured motorist. 10. While the Petitioner does not have a complste copy of the policy form, the Petitioner believes and avers that the automobile insurance policy issued by respondent contains an endorsement for under insured motorist ooverage whioh, in turn, contains an arbitration clause whioh provides for the resolution of disputes oonoerning entitlement to an amount of damages. 3 11. At the present time, there exists a dispute as to whether or not the Petitioner is leqally entitled to colleot damaqeB, and aB to the amount of thoBe damaqeB reBultinq from the motor vehiole aocident of AUqUBt 24, 1992. WHEREFORE, the Petitioner prays that the oourt issue a Rule directed to Respondent to show cause if any, why the Respond.nt should not desiqnate an arbitrator and why the matter should not prooeed to arbitration. BUbmitted, P.C. ( BYl Charles E. Schmidt, Jr. Attorney for Petitioner 1.0. No. 19198 209 state Street HarriBburq, PA 17101 (717) 232-6300 4 IXHI.IT A (!) COIlltfONWEALTHOFPENNSYLVANIA POLICE ACCIDENT REPORT REPORTABlE 0 NON. REPORTABlE 0 POliCE INFORMATION ACCIOENT ,..... 2082411 lOCOUNTyYORK I. 21.IotJNICIPAlITV PElHlOl ".".... ., LOCATION 01 I. lIDY I, 'BlIIOI .. PAlROl 1 lONE NlMlER Raw PRINCIPAL ROADWAY INFORMATION TIoE ACCIDENT INfORMATION '0. V~ E . PI: 1 21 US 1 t<<lHWAV CONTROl INTERSECTING ROAD: IlCULIIIGIl Sf 21 TVP . CCE6I t<<lHWAV CONTROl IF NOT A T INTERSECTION: NT It. DIlVEIICli HAVE IDlE REIoKlVED F_ TllE lICEHE? lHT t UNIT 2 lONO lONO 12. NlUIER CF ltIITS II. ACCIlENT V 17. VEIICli DAAMGE O.NOHE UNIT I I . lIGHT 2. MDllERAIE 3 : SEVERE 2 t. IMTtAW.S I.. PAllPIlRTY v UNIT' 1 30. CROSS STREET DR SEGMENT !MRKER 3. DIlECTIGN W 32. STANCE FIDlSITE N 5 E FIDlSrn: 33. IllST WAS o FT 0 MI. vO El MEASURED 0 @TRAFFIC CONTROl DEVICE ESTIMATtD PRtlClPAl @] INTERSECTNl @] PAfI(ED? 3I.P (lit .(If.STATE V" .0. UNIT' 2 37. PlATE 1"I'IIIILLIII14' III I 'II'B il ~IIOYII '111043. ~O NO UNKO 2 n AfSPONOtlCl EMS AllENCY IAIOVII AIIULAICI INCIDENT II: 92082411 7UtEDICAl. FAClITY mom HOSum IACCIDENTDATE: OB/24/~2 ~IOl'LI INfORMATION BCDEF G NAME ADDRESS H I J K L M 1 F 1 3 0 ULIA A IIAID (I 11011 DII ID III IIIGID IA 11110' 4 9 4 8 0 1 ~ ~ ~~ ~ I~ ~:~~, \ :::::I,:I,:~~:I::.I:. Ar~,~1 ^~~~~. a~~~, :~.::"" ~ ~ ; I~ . n 2 H 4 2 0 AIL DIVILllll :11 AIIOIISIOII 51 IISI IIILII IA lIlli, 4 5 1 A 0 1 2 Ii 2 U 1111 UllUIIll .11 ...."..... II !All DI"1I rft '''''' v V v " v ~R.LUMlNATION I!J &ATHER D @AOADSURFACEW lie DIAGRAM . ... PENNSYLVANIA SCHOOl DISTRICT (If APPlICABLE) . . II. DESCRIPTION Qf DAMAGED PROPERTY llII'tN:R AIlIHSS .... ... ...,...... ........ PHONE "........'IV..I I 'ACTORI; ~:e~~~~l 01' lYONtIl, H . . ;, AND PROVlG. A.... IIun.. I,C ANb. 08/2./92 10,.3,02 .. -..- -- ro;';HIl";;O; SIGN AT mICHiiLSBRGIlR ST AND THIN HAD I A LIFT TURN ONTO IISINHONIlR DR ,unn wn_ .n .. 'n' v. .. unMV' DR. THUS BOTH UNITS COLLIDED. FIILD ~T THE INTIlRSIlCTION, -- '.M.. OM" UNITlI THIS EISIlNHONER DR. AS UNIT,l HADE UNIT'I ENDIlD UP IN THE ... ,..u _a _nnavn va n~ on. nil IlICHIl'''M''"-R ST. I STOPPED AT THIl STOP SIGN. I DID NOT Sill ANY THING COHING OUT ElISIlNHONIlR DR.I PULLIlD OUT TO HAKEl A uua. avnn v,uv w. ,un v. nn ...; ... '1'1111 nP1l1 ns' IIl1lT.2 RIlLATElD THE FOLLONING I I WAS TRAVElLING lAST ON EISENHOWIlR DR. AND AS I CAHEl TO THE INTERSECTION OF ...- ... '"un vn m.v .._..uuw ._' nr 1111 T 1"11'1' 'I'n 'I'1lf! T.IlI''I' 'I'n I(IlIlP FROH HITTING HER PUT I STRUCK HIR ANYWAY. ... ~n.... .n.. .w_au-:A~n 'I'~n:llnavH' un";:;r ,""'.- .- ...v OR HINOR INJURY, DIU 2, COlt, INSURANCE COMP,,"Y NFORMATION INFORMATION~ ._._n ...__ .,,_ uro:T ,.~..~~~~~ .~~nn U~T- iW;;~433'i6 AIlOR SS PHONE N. WINTIII" I"""" _ ADORESS PHONE ll\.~j:k. 19 VIOLATIONS I'-OICAIED ijO SEcrlON NUMllERS (ONLY IF CltARGEDI TC HIe UNIT' ~In..... U" "II~ u.. UNlIZ 00 00 HI I "\:!'" I' il'i':ii1~ C/ USE UNIT I 0 A.HlilliZI 1!0~:E I!!J\ESULtS 0 NO lEST I:... 1'1'110IlAOlE TEST 0 I1[fUSE I c' USE o OlLo.lf, 0 ~K UNII Z 114.INVESTK1ATIOH COMPlETE,L YES 0 NO CJ 112. JI'ti'E I--"IESI ~J\'SUl" o NO TEST o I1[FUSE 0._ _010 0 ~K 0134243 PAGe CEtjTER FOR HIGH"Y SAFETY .",. . , _..1 L.' " , . I.... r (!) COMMONWEAL TH OF PENNSYL VANIA PAR CONTINUA TlON SHEET c'iCb REfER TO OVERlAY HErS . REPORTABlE 0 NOH,REPORTABlE 0 PEIHlOI UIE ONlY ~082411 I DATE '08/24/92 f~YO 1 1~~Al 1 . USE OVERlAY' 2 StEET roo coon 8CDEFQNAME ADDRESS H I J K L M . . , ~ LEFT THtl FOLLOWING SKID HARKS. LEFT TIRE 38FT, RIGHT .... .'. 8!T:.,__.;._ '"._ ___.___,'._ ..u.. una OU'" wo. D'" 0---" IIJURY : WAS LACRATION TO THIl HIlAD. , : I.llu", :TO CARL u.."IlLll,[~~ "AS /I """..".. l'U 'l'n!i u!i."l' !iT!i. n!i "/10 , '.n_ , DAVID e ATKINS WAS TRIlATtlD FOR INJURY TO HIS BACK AND WAS RILIIA811D .: : -- _"M ,,__, --- -----..-- -.-- ... , : . . : . . , .. -' .- - . . - _10 V IlO SECTION NUMBERS 10Nl Y If' CltARGED 1 10 NTC , .';,:!~ UNIT t '0 0 UNIT 2 0 0 lD'.:~ .!Y E ~~ ~SIJLTS DNDIEST F ~'ROUAiiiI'[TYPE ~ESULlS D NO TEST ,,''>j USE IESr ~.INVESTIOATION UN'T' D RErUSE' USE IFST D REFUSE COMPlETE , 0,__% 0 ~K UNIT 2 0,__0/0 D ~K YES 0 NO 0 - . -- . AA..5C 1111121 PAGE '~I\'ES1"'),\" '"1 'a!"If:'f ~ ~~""":"'.~_.." .....'. _ _....-'1.............. ...",.... .....~. tit . , . I ' , i ! i - I. .. I " ---..-- ....,. n.... J ~ W""'. <9 ~'f &1& .- ,I.. W6'Y ~ "':.-.. --) Ci}" cDlD' ~:-- '-'.-' 1'" 1 0 o~;. I · " ,~" , I_~ I!;;;' ." . .... t. '" I. I "', .J 1 I , , ..~. ., " ".,. , , . ., .. ". , . . , ~.~ " ',.j,', .\ " . , '.. '..1 i " .a ,- .. , ..'.0.. . ~1~$)~tt,.~ '~ (Y. II ~IW"~ l( F (\C\o\..t: _ . '~~. > 20 '~a .g_M ft:: O1J~. <;1'1') . , " . '.. . -..... ;...~ ...", ~ . .,. ..'W. ," .~.. . '-l""O"" _. . " " .'"0 -,. ...------ .. .~.=tlr"lrl:"\llf~ AMENDED DECLARATIONS - BUSINESS \UTO POLICY ",fIJ Insurance Companies . THESE DECLARATIONS PAGES AMEND THE POLICY EFFECTIVE 05/04/92. ITEM ONE- REASON FOR AMENDMENT DELETE VEHICLE AFCO -.It, ....... 'l!il.'C'Of'" ChlUc.I .,..,........ ...... .... IU. .. BAP 6543316 05/04/92 05/04/93 STATE AUTOMOBILE MUTUAL 681 00 .,......~........I.. .u.t DAVID CATKINS AND MICHAEL F BARNES PO BOK 115 CAMP HILL, PA R T DUNN INSURANCE 200 W MAIN STREET MECHANICSBURG, PA I NC MAY 6 1002 17011 17055 TELEPHONE 717/766-0770 POLICY PERIOD-12101 AM STANDARD TIME AT THE NAMED INSUREDS ADDRESS STATED ABOVE. FORM OF NAMED INSUREDS BUSINESS - PARTNERSHIP OCCUPATION - ELECTRICAL CONTRACTING NOTICE TO ?f:NNSYLVi\N I A INSUREDS: SEE REN'fAL ChR COVERAGE INFORHAT ION ON THE LAST PAGE OF YOUR POLICY DECLARATIONS. ITEM TWO- SCHEDULE OF COVERAGES AND COVERED AUTOS THIS POLICY PROVIDES ONLY THOSE COVERAGES WHERE A CHARGE IS SHOWN IN THE PREMIUM COLUMN BELOW AND AS INDICATED IN THE SCHEDULE OF ANY OTHER ITEM. EACH OF THESE COVERAGES WILL APPLY ONLY TO THOSE AUTOS SHOWN AS COVERED AUTOS. AUTOS ARE SHOWN AS COVERED AUTOS FOR A PARTICULAR COVERAGE BY THE ENTRY OF ONE OR MORE OF THE SYMBOLS FROM THE COVERED AUTO SECTION or THE BUSINESS AUTO FORM NEKT TO THE COVERAGE. COVERAGES LIABILITY INSURANCE 1ST PARTY BENEFITS MEDICAL EXPENSE WORK LOSS FUNERAL EKPENSE ACCIDENTAL DEATH UNINSURED MOTORISTS BODILY INJURY PHYSICAL DAMAGE COVERED AUTOS 07 08 09 07 LIMIT- THE HOST WE WILL PAY FOR ANY ONE ACCIDENT OR LOSS $500,000 EACH ACCIDENT SEE ENDORSEMENT UP TO $10,000 UP TO $15,000 TOTAL $1,000 PER MONTH UP TO $1,500 $25,000 PREMIUM 811.00 88.00 INCt. INCt. IHCt. IHCt. 07 $35,000 eACH ACCIDENT ACTUAL CASH VALUE OR COST or REPAIR, WHICHEVER IS LESS, MINUS DEDUCTIBLE SHOWN SEE SCHEDULE OF COVERED AUTOS SEE SCHEDULE OF COVERED AUTOS 14.00 COMPREHENSIVE COLLISION 07 07 282.00 682.00 Cd ~. '-' "",JIUIU",",UVVllltJUI"""o,J I THESE DECLARATIONS PAGES AMEND THE POLICY EFFECTIVE 05/04/92. ITEM ONE- REASON FOR AMENDMENT DELETE VEHICLE ""'..,...... .Ol...,...... U,'U"'._.OOI....'... ...... .... .... .. BAP 6543316 05/04/92 05/04/93 STATE AUTOMOBILE MUTUAL 681 00 ............. ,.. ,-.. '...., DAVID CATKINS AND MICHAEL F BARNES PO BOX 11S CAMP HILL, PA R T DUNN INSURANCE INC 200 W MAIN STREET MECHANICSBURG, PA 17011 17055 TELEPHONE 717/766-0770 rORMS/ENDORSEMENTS AND EDITION DATES MADE PART or THE POLICY- BAPl (01/87) ,CAOOOl (01/87) ,CA9944 (01/87) ,CA0029 (12/88) ,IL0246 IL0910 (01/81) ,CM180 (07/90) ,CA2238 (01/87) ,AU1U (10/85) ,AU1U CA2106 (07/90) ,CA2191 (07/90) ,CA2237 (07/90) ,CA2238 (07/90) . (06/89) , (08/87) , ESTIMATED TOTAL PREMIUM $1877.00 - ISSUE DATE 04/30/92 --------------------------------- AUTHORIZED REPRESENTATIVE -'hi In;u7lnCeC6mpa~s'' ~ AMENDED DECLARAT10N5 - BUSINESS AUTO POLICY THESE DECLARATIONS PAGES AMEND THE POLICY EFFECTIVE OS/04/92. ITEM ONP;- REASON FOR AMENDMENT DELETE VEHICLE ...., ...... .......,...... .... .. OS/04/93 STATE AUTOMOBILE MUTUAL .rot.' BAP 6543316 OS/04/92 II............. ,.. '...1.. DAVID CATKINS AND MICHAEL F BARNES PO BOK 11S CAMP HILL, PA 17011 ITEM THREE- AUTO ST TER 011 PA 007 012 PA 007 U,IUGI '.....""."'.... R T DUNN INSURANCE INC 200 W MAIN STREET MECHANICSBURG, PA TELEPHONE 717/766-0770 SCHEDULE O~OV R~D AUTOS YOU O"lN I 1+ f(Af?~ Ct)fC/ F IsO 'XLT flU IFriJF/SNtN{J/M/ . STATED y~ DESCRIPTION ~ SERIAL NUMBER AGE COST CLASS AMOUNT 90 FaRD F 259 plu lFTN(:~&H&Ll..\1&3'lS 3 Z01t01l-tl-H-&9- 90 FORD F-2S0 p/u 1FTHF25H1LLA26749 3 20000 01189 COVERAGES- PREMIUMS AND DEDUCTIBLES SPEC CAUSE COMP LOSS $141 $141 AUTO LIAB 011 $3H.00 012 $3H.00 MED PAY UNINS HTRST $7.00 $7.00 PIP $44 $44 ~akt,.v ,D} /-Q;Y19 /,;{..:f_r -d.. "A_l 11~.1:_'_'_" ./ftt.\....(.~ /t.. IL-"/j-:t c ,P(L / q 1.117 ',. - TOW , DEDUCTIBLE COLL LABOR OTHER COMP COLL $341 100 250 $341 100 250 MltIC' "lIt 681 00 1705S VEH WEIGHT 10000 10000 TOTAL PREMIUM $907.00 $907.00 .....CONTINUED ON NEXT PAGE......* SAP 6543316 AGENTS COPY .I!J 1!!~!~m~I~ THESE DECLARATIONS 37VAA 0010 AMENDED DECLARATIONS - BUSINESS AUTO POLICY PAGES AMEND THE POLICY EFFECTIVE 05/04/92. ITEM ONE- REASON FOR AMENDMENT DELETE VEHICLE ....'~. ....'-'",," .... '. CO'IUCoI "",,'CUIII '... ..... - BAP 6543316 05/04/92 OS/04/93 STATE AUTOMOBILE MUTUAL 681 00 ......IIItlAt........... -c." DAVID CATKINS AND MICHAEL F BARNES PO BOX 115 CAMP HILL, PA 17011 R T DUNN INSURANCE INC 200 W MAIN STREET MECHANICSBURG, PA 17055 TELEPHONE 717/766-0770 EXCEPT FOR TOWING, ALL PHYSICAL DAMAGE LOSS IS PAYABLE TO YOU AND THE LOSS PAYEE NAMED BELOW AS INTERESTS HAY APPEAR AT THE TIME or LOSS- AUTO LOSS PAYEE 011 FRANCIS FOR FORD PO BOX 1737 HARRISBURG PA AUTO LOSS PAYEE 012 rRANCIS FOR rORD PO BOX 1137 17111 HARRISBURG PA HUNT VALLEY,ND 17111 & ti; Ji' - ~ ~ F K gAP 6543316 AGENTS COpy . .STATE.AUTO ~ Insurance Companies . THESE DECLARATIONS 37 V A A 0010 AMENDED DECLARATIONS - BUSINESS AUTO POLICY PAGES AMEND THE POLICY EFFECTIVE 05/04/92. ITEM ONE- REASON FOR AMENDMENT DELETE VEHICLE ....t ...... ,....,....... CO...U.. ""'.-11'"'''' ........ - .... .. BAP 65'3316 05/04/92 05/04/93 STATE AUTOMOBILE MUTUAL 681 00 ................. ....... 'C.I.t DAVID CATKINS AND MICHAEL F BARNES PO BOK 115 CAMP HILL, PA R T DUNN INSURANCE INC 200 W MAIN STREET MECHANICSBURG, PA 17(111 170S5 TELEPHONE 717/766-0770 ITEM rOUR- SCHEDULE OF HIRED OR BORROWED COVERED AUTO COVERAGE AND PREMIUMS LIABILITY INSURANCE- RATING BASIS, COST OF HIRE STATE PA ESTIMATED COST OF HIRE IF ANY RATE PER $100 COST OF HIRE 1.363 PREMIUM $35 TOTAL PREMIUM $35 COST or HIRE MEANS THE TOTAL AMOUNT YOU INCUR FOR THE HIRE or AUTOS YOU DO NOT OWN (NOT INCLUDING AUTOS YOU BORRON OR RENT FROM YOUR EMPLOYEES OR THEIR rAMILY MEMBERS). COST OF HIRE DOES NOT INCLUDE CHARGES FOR SERVICES PERFORMED BY MOTOR CARRIERS or PROPERTY OR PASSENGERS. ITEM FIVE- SCHEDULE FOR EMPLOYERS NON-OWNERSHIP LIABILITY COVERED AUTOS BORROWED FROM YOUR EMPLOYEES OR MEMBERS OF THEIR RATING BASIS-NUMBER or EMPLOYEES ESTIMATED NUMBER OF EMPLOYESS 10 HOUSEHOLDS I LIABILITyl PREMIUM $28, - .....CONTINUED ON NEKT PAGE.......PAGE 5 SAP 6543316 AGENTS COpy J!J I!!~!~m~~:r~ THESE DECLARATIONS 37 V A A 0010 AMENDED DECLARATIONS - BUSINESS AUTO POLICY PAGES AMEND THE POLICY EFFECTIVE 05/04/92. ITEM ONE- REASON FOR AMENDMENT DELETE VEHICLE ,.". ....... ...oC'"'''' ".."01'.........11I'... ...., .... I i 681 001 'M. .. BAP 6543316 05/0_/92 05/04/93 STATE AUTOMOBILE MUTUAL ",............~.....II ..,,,, DAVID CATKINS AND MICHAEL F BARNES PO BOK 115 CAMP HILL, PA R T DUNN INSURANCE INC 200 W MAIN STREET MECHANICSBURG, PA 17011 17055 TELEPHONE 717/766-0770 NAMED INSURED AS SHOWN IN ITEM ONE (OR AS SHOWN ABOVE) IS EXTENDED TO THE FOLLOWING PERSONS AND/OR ENTITIES: DBA SPECTRON ELECTRICAL SER RENTAL CAR COLLISION COVERAGE NOTICE (PA ACT 63 OF 1990) YOUR POLICY WILL PROVIDE COLLISION COVERAGE FOR "AUTOS" YOU RENT ONLY Ir THE DECLARATIONS OR SUPPLEMENTARY SCHEDULES INDICATE THAT COLLISION COVERAGE FOR HIRED "AUTOS" AS COVERED "AUTOS" IS INCLUDED. HIRED "AUTOS" DOES NOT INCLUDE ANY "AUTO" YOU LEASE, HI~, RENT OR BORROW FROM ANY OF YOUR EMPLOYEES OR PARTNERS OR MEMBERS OF THEIR HOUSEHOLDS. PURSUANT TO PENNSYLVANIA LAW, WE ARE REQUIRED TO NOTIFY YOU THAT: ANY PERSON WHO KNOWINGLY AND WITH INTENT TO INJURE OR DEFRAUD ANY INSURER FILES AN APPLICATION OR CLAIM CONTAINING ANY FALSE, INCOMPLETE OR MISLEADING INFORMATION SHALL, UPON CONVICTION, I BE SUBJECT TO IMPRISONMENT FOR UP TO SEVEN YEARS AND PAYHENT OF A FINE or UP TO $15,000. I I THESE DECLARATIONS PAGES REPLACE ALL PRIOR I DECLARATIONS - PLEASE ATTACH TO YOUR ?OLICY .VU...'I' ,. . . IfIfSTATE AUTO~ Jc{] INSURANCE COMPANIES ~~ .t8ro.dSI'H1 C OUt Ohoo U~lI ",tem Offlc. · 4800 R/tter Roed · P.O. 80. ZOOfI · Mechen/cabu",. PI. 17055 . Phone: (717) 8'7.HZ' June 28, 1993 Sch.idt & Ronca, P.C. 209 State Street Harrisburg, PA 17101 Attentionl Chsr1es Schmidt, Jr. Our Insured Clai. No. Clai.ant I Dats of LOllI David C. Atkins 10 6 543 316 Judy Beard 8/24/92 Daar Hr. Schmidtl In rSlards to our phona conversation of June 23, 1993, State Auto con.ents to the third party sett1em.nt end waive. ita subrogation interest. Pleasa eand us copies of H.. Beard's d.c1aration sheet, draft copy and Releaa. fro. State Farm estab1i.hing their liability and payment. S ncaraly, Sharry Hut!!!d 1(.t'1 Clai.. Rapra.antativ. SH/ajr - ITAr. NJm j11INANCIAL CCAPOAATION IfAfl AUtO ftAOp(RT'f ANO CASUAtlv INSUAANtI CO~N'" STATI 4UlOMOBIlI UlIfUAllNBUAANCe COMPANy Sf"" AUra LlFII INBURANCIl CQUPllNY SfArl AUTO HATtON4&. IkSUAANCI COMPANY " . Schmid~\nd Ronca PC 109 StAte Slreet HArr'lburl, PennlylvAnlA 17 101 717 I 131,6300 Attorne)'s And Counselors At LAW June 15, 1993 Me. Sherry Miller Stat. Auto Ea.tern cftice 4900 Ritt.r Road, P.O. Box 2006 Mechanic.burg, PA 17055 RE: David Atkin. Underinsured Motorist Claim Dear M.. Mi1l.r: I am ..ndinq this letter a. a follow-up to my previous letter to you on May 26, 1993. Enc1o.ed you will find an affidavit from the D.f.nd.nt in the und.rlying action conc.rning the nonexi.t.nc. of any other policy of in.uranc. which would apply to this c.... I would appreciate h.aring from you a. to wh.n {our review will b. compl.t.d. If con..nt i. not forthcoming, we ntend to fil. a Schaidt v. Clothier type action which will th.n allow you to pur.u. the pereonal a..et. of the tortfea.or if you f.el ~hat i. nec...ary. Thank you. P.C. /6-'0 ]]5 &5'1 / CIRllfllO ..~I\. 'RICI::l'~~t~:=::~ "1'~.. A,.'"'' I . 5"'1O~ J 0 "" . t\t't'1'1 ft I led 01\1'1'1'1 Ft' p\ ,"O'fll1nq In ~tt" 0.11 Otll'lI.ld _and 10.1'\0'" lU'" RiK11pl '=~~~''''f'''1 .\1 "rid "..wI' 01",1 F." TOt M. po,laqt ,.VO , 9 \ ", Add. . I. P.ldl II. IOnl~ "'. ___ qUit I.., Po"""lI' ill 0,11 &;/1{;/95 c r .. VBRIrICATION 1. My name is JUlie A. Beard ot 45 Brown Dam Road, New oxtord, Pennsylvania 17350. 2. As ot AugUJt 24, 1992, I was insured under a policy ot insurance issued to my daughter, Judy A. Beard, by state rarm Insurance company, Policy No. B026-479-38C 3. As of August 24, 1992, I was covered by no other insurance po1ici.. that would apply to the automobile accident that occurred on that date. 4. I understand that intentional false statements herein are made subject to the penalties ot 18 Pa. C.S.A. 14904 relating to unsworn ta1sitication. made to authorities. .r /fl -I} LIE A. BEARD - .VU'.I'I' n . . FULL AND FINAL RELEASE FOR AND IN CONSIDERATION ot the sum ot Fitteen Thousand Dollars ($15,000) paid to the undersiqned, David C. Atkins, and other qood and valuable consideration the receipt and sutticiency ot which is hereby acknowledqed, the undersiqned aqrees to fully release, discharqe and hold harmless and indemnity Julie A. Beard and State Farm Mutual Automobile Insurance Company, and all other persons, associations and corporations whether or not named herein, their heirs, executors, administrators, successors, assiqns and insurers, and their respective aqents, attorneys, servants and employees trom any or all causes ot action, claims and demands ot whatsoever kind on account ot all known, and unknown injuries, 10ssss and damaqes a11eq.d1y sustained by the und.rsiqn.d on Auqust 24, 1992, and, sp.citica1ly trom any claims or joind.rs, tor sole liability, contribution, indemnity or oth.r-wis. as a result ot, arisinq trom, or in any way connected with injuries sustained by the undersiqn.d, on account of which a Leqa1 Action was instituted by the undersiqned in the Court ot Common Pleas tor York County, Pennsylvania, at Dock.t No. 93-SU- 00672-01, and the de tense and handlinq thereot trom the inception ot the claim until the date ot this Full and rina1 R.l..... Th. undersiqn.d understands and aqrees that the acceptance of said sum is not an admission of liability by any party named h.rein. - paqe 1 ot 3 ~ (.~ It i. expressly understood and agreed that this Re1eaeo and settlement is intended to cover and does cover not only all now known injuries, losses and damages, but any turther injuries" losses and damages which arise trom or are related to the oocurrences set torth in the Legal Aotion noted above and the handling and de tense thereot. This Release shall not apply to any pending under insured motorist claim, by Hr. Atkins, against his underineured motorist oarrier, state Auto. It is turther understood and agreed that this is the complete Release agreement, and that there are no written or oral understandings or agreements, direotly or indirectly connected with this Release and settlement that are not incorporated herein. This agreement shall be binding upon and inure to the succes.ors, assigns, heirs, executors, administrators and legal repre.entatives of the respective parties hereto. The undersigned hereby declare. that he is of legal agel that the terms ot this settlement have been oompletely readl that he has disoussed the terms ot this settlement with legal counsel ot ohoicel and that eaid term. are tully understood and voluntarily aocepted tor this purpose ot making a tu1l and tina1 compromise, adjustment and settlement ot any and all claims on account of the injuries and damages above-mentioned, and tor the express purpo.e of precluding forever any turther or additional suits, administrative proceedings or any other claims tor reliet ... arising out of the aforesaid olaim. Page 2 ot 3 (- (II IN WITNESS WHEREOF, and intending to be legally bound hereunto set my hand and seal this ~ day of 1993. --- ~.. )L.. I ;J.,;/!? ~ David c. Atkins (SEAL) ~ I - Page 3 of J VBRIrICATIOH BASBD UPON PI.80HAL IHOWL.DOI AND IHrORHATIOH OBTAIHBD THRouaH COUHS.L I, DAVID C. ATKIHS, verify that I am the Petitioner in the foregoing action and that the attaohed Petition to compel Arbitration is based upon information which has been gathered by my counsel in the preparation of this lawsuit. The language of the Petition to the extent that it is based upon information which I have given to my counsel is true and correct to the beat of my knowledge, information and belief. To the extent that the contents of the Petition is that of counsel, I relied upon coun.el making this Verification. .1 understand that intentional false statements herein are , subjeot to the penalties of 18 Pa.C.B.A. 54904 relating to unsworn falsifications to authorities. Date. S-21.1S- t ) , /-:!~//--;;/ ~L-~f( 'l DAVID C. ATIIIlS /---..,. 0)\, ,~"' (' Iv ~ --. - ~ ~ -.... "-' A "," ~ C,~ '1 ~ ..tv \' L .. ~ ~ ,n.! ., l....\" u.- ./,;::"",,' en /' ~ . I..,\.l , ,. . , " N ~\ : -" ..."}-'I IJI -t:---- .r.(:;, '-", l~ . , "I ::i ~I r") . . -,'<< 1....'" i .... C':l '-:Q -( tf1 " .... ... I '" 'i' [- J ~ { .' l/; .. o . ~ !' ;"\ !' [ .0 . ' ! ! I" " !I ; I , , '. , , ':1' i I " , o. ., , , .. 0 , . , , i 0, " , Ij o. 1 . , 0 0 l r. .' r -I j . f! /', ~ i ~ i 'i '. , I (:1 ':,\:1 !it i-. 'I, .: o. . ! 'i . , , . 'i;. I" t. ;.... I .., " ,,1 ~t:/..-" 7 ,..;:!.,:;.,-" /.~"'! ;# ."p'o ,. ,.,'vP~' '[ ,'- ',. .;ff';' /)II~,w-~jz J'T l!.- l),,, _ (I.;' (--}/ L.'-' (I. ] h l Li t- 1.Jf:t:;, v. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 95-3054 civil Term DAVID C. ATKINS, Plaintiff STATE AUTO INSURANCE COMPANY, Defendant UNDERINSURED MOTORIST ARBITRATION ! I I CERTIFICATE OF SERVICE AND NOW this ~~~ day of November, 1995, I, Charles E. Schmidt, Jr., Esquire, hereby certify that I have this day served a Notice of Deposition of Douglas K. Sanderson, M.D., by depositing a copy of the same in the united states Mail, p08ta9a Prepaid, at Harrisburg, Pennsylvania, addressed tOI Douglas B. Marcello, Esquire THOMAS, THOMAS & HAFER 305 North Front street, 6th Fl. P.O. Box 999 HarriSburg, PA 17108 Douglas K. Sanderson, M.D. 205 Grandview Avenue camp Hill, PA 17011 S //--..) , / / ~ON~' P. . ~ _{tk.t~ BYI Charles E. Schmidt, Jr. Attorney at Law 209 State Street Harrisburg, PA 17101 Attorney I.D. 119198 (717) 232-6300 Attorney for the Plaintiff ")t' c' l.a: . ',,'1'; .... J "1', . =- .",- "'" ...., <:::) ., ." "'1 ~. !. ~-', , , 1,_) 'I ." ':; - ,.., _<II J, . . ~ kf .""tJ "'" ~ ..., DAVID C. ATKINS, I IN TilE COURT OF COMMON PLEAS Plaintiff I CUMBERLAND COUNTY, PENNSYLVANIA I v. : NO. 95-3054 civil Term I STATE AUTO INSURANCE : COMPANY, : UNDERINSURED MOTORIST Defendant ARBITRATION CERTIFICATE OF SERVIOE d 'g ~ day of November, 1995, I, Charle. E. AllD NOW this Schmidt, Jr., Esquire, hereby certify that I have this day served a Notice of Deposition of Mark P. Lutness, M.D., by depositing a copy of the same in the United states Mail, postage Prepaid, at Harrisburg, Pennsylvania, addressed tOI Douglas B. Marcello, Esquire THOMAS, THOMAS & HAFER 305 North Front street, 6th Fl. P.o. BOle 999 Harrisburg, PA 1710B By: Mark P. Lutness, M.D. PHYSICIANS OF REHABILITATION MEDICINE, P.C. 450 Powers Avenue Harrisburg, PA 17109 ,,- / Charles E. Schmidt, Jr. Attorney at Law 209 state Street Harrisburg, PA 17101 Attorney I.D. #19198 (717) 232-6300 Attorney for the Plaintiff ,~. !.; :0- r:' .,,- '" ... t, ",'lr' L " ...., " "., " c::::. , ',p. , .. , , .' , ~ .<> , ~. ~ \... .~ ~, " ,.- " '" . . '" :-<;. 0'" ::x: ~ " - .' ~ '. . Schm~t and Ronca PC AU.r...w. ..... Cou"utarl .. UW Jot ..... ...... H__,P_",,_ nlol f1" 111..100 NOV 29 1995~ o , ..."-""..,...".....,.."><,"",..,.".7...,."'....-..'"... ^ -.,-~"..~'i_-;W.;;,. - ~l""~ri~t.tit:.' . r' M . . , " , .,~. .. .' - '~." ~. DAVID C. ATKINS, Petitioner I IN THE COURT OF COMMON PLEAS I CUMBERLAND COUNTY, PENNSYLVANIA I : NO. 95-3054 CIVIL TERM I I UNDERINSURED MOTORIST I ARBITRATION : v. STATE AUTO INSURANCE COMPANY, Respondsnt AND NOW, this IUlLI LrtL( b \.-.L day of 0 ( ~V../ /', , 1995, based upon the foregoing Petition, a Rule is hereby directed to the Respondent, state Auto Insurance company, to show cause, if any, why either tho Honorable John c. Dowling or the Honorable Al Blakey should not be designated aa a neutral arbitrator in accordance with the foregoing Petition. RULE RE'fURNABLE 7. L) DAYS FROM SERVICE HEREOF. BY THE COURT I U( L dFJ( "t j \: I\J; oj d'; f i I ::' o lie / " '.. .... \0" r. ..... ..1 P"" '~l...'...-,. '. ' ''''1 " ./, :...L)(lj-.'j" . J. DAVID C. ATKINS, Petitioner : IN THE COURT or COMMON PLEAS I CUMBERLAND COUNTY, PENNSYLVANIA I I NO. 95-3054 CIVIL TERM : I UNDERINSURED MOTORIST I ARBITRATION : v. STATE AUTO INSURANCE COMPANY, Respondent PITITIOM TO APPOIMT MIUTRAL ARBITRATOR AND NOW, Comes the Petitioner, by his attorneys, Schmidt and Ronca, P.C., and sets forth as fo110wsI 1. This action was commenced by Petition on June 6, 1995, to compel the designation of an arbitrator for purposes of under insured motorist arbitratjoll. 2. The Petition was served by the Sheriff of Cumberland County on the Respondent on or about June 15, 1995. 3. On or about July 28, 1995, the partie., by telephone conversation, designated their respective arbitrators, who are identified as follows: Robert r. Claraval, Esquire, Adler' Claraval, 125 Locust Street, Harrisburg, PA 17101, arbitrator for the Petitioner; and Timothy I. Mark, Esquire, Caldwell' Kearns, 3631 North Front Street, Harrisburg, PA 17110, arbitrator for the Respondent. 4. Since that time, the arbitrators and the parties have been unable to agree to a neutral arbitrator. 5. The Petitioner has suggested that the following individuals serve as neutral arbitrators I Former Judge John c. Dowling, Harrisburg, PAl Former Judge A1 Blakey, York, PA. See attached EKhibit "A." CBRTIrICATI or 8BRVICI AND NOW this ~~day of November, 1995, I, Charles E. Schmidt, Jr., Esquire, hereby certify that I have this day served a true and correct copy of the foregoing Petition, by depositing a copy of the same in the united States Mail, Postage Prepaid, at Harrisburg, Pennsylvania, addressed to: Douglas B. Marcello, Esquire THOMAS, THOMAS , HAFER 305 North Front street, 6th Fl. P.O. Box 999 Harrisburg, PA 17108 . / / -) BYI Char1e. E. Sohai Attorney at Law 209 State Street Harrisburg, PA 17101 Attorney I.D. 11919B (717) 232-6300 Attorney for the Petitioner I)AVID c. M'KINS, plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 95-3054 civil Term v. STATE AUTO INSURANCE COMPANY, UNDERINSURED MOTORIST ARBITRATION Defendant C..TIWICAT. or ...VIC. AND NOW thh J IoU, day of December, 1995, I, Charles E. Schmidt, Jr., Esquire, hereby certify that I have this day served a copy at Judge Sheely's signed Rule dated December 4, 1995, by dapo.iting a copy at the same in the united States Mail, Postage prepaid, at lIarrbburg, Pennsylvania, addressed tal Douglas B. Marcella, Esquire THOMAS, THOMAS' HAFER 305 North Front street, 6th Fl. P.O. Box 999 Harri.burg, FA 17108 BYI S~f MIDT~D RO~NA' \A?l... ( J , P.c. Charle. E. Schmidt, Jr. Attorney at Law 209 State Street Harri.burg, PA 17101 Attorney 1.0. 119198 (717) 232-6300 Attorney for the Plaintiff P 'D ~ :=~ UI C'J ~I "",rd rq !'~(n ':'-J ','<." '1"' ~~l.:. : W 'oj ij ,.... , .:J. .~ 1M, :'i? ;.:(''} .~ tj- ,...~\.-. .~ '* 'C" (.~, 15 -, .;J ::'j 0 ~ ..... VI ..'