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LISA KOCH and ROBERT KOCH,
Parents and Natural Guardians
of TAYLOR KOCH, a Minor, and
LISA KOCH, Individually,
Petitioners
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
v.
AMICABLE ACTION - IN TRESPASS
NO, 9~' ~,8'93 &u-Jl ~~
ERIE INSURANCE COMPANY,
Respondent
UNDER INSURED MOTORIST CLAIM
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QBQm
'fit
AND NOW, this ~ day of
\ ) S. - cLi-l-J"-J1-;-1. 9 9 5, upon
-
consideration of the Petition to Approve Compromise Settlement
(Minor) :
1. It is hereby Ordered and Decreed that the
settlement, as described herein, is in the best interest of the
minor, Taylor Koch.
2. Lisa Koch and Robert Koch, parents and natural
guardians of Taylor Koch, are authorized to execute a release,
releasing Erie Insurance Co" its agents, employees, servants and
assigns from liability in return for the sum of $155,000.00.
3. The distribution of proceeds and fees, as set forth
herein, is approved and that the settlement proceeds shall be
distributed as follows:
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Attorney'. fee. 33 1/3\..... ..... .......
Por the purchase, by Erie Ins.
Co., of a structured Annuity with
4 payments of approximately $25,000.00
each, with payment on May 2000, May
2001, May 2002 and May 2003, and
a fifth payment of $23,809.00 on May
13, 2004................................
51,666.66
90,000.00
Reimburse Lisa and Robert Koch
for their direct and personal
expenses, including meals, travel
and lost wages.... . . . . . . . . . . . . . . . . . . . . . .
3,863.07
Payable to Lisa and Robert Koch
on behalf of, and for the benefit
of their minor son, Taylor Koch.........
9,470.27
BY THE COURT:
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2. Petitioners are parents and natural guardians of
Taylor Koch, a MinQr, born May 13, 1983 who resides at the same
address as Petitioners.
3. Respondent, Erie Insurance Company,
underinsured motorist carrier for Petitioners.
is the
4. Petitioner's' minor son was injured in an autol
pedestrian accident that occurred on December 14, 1994 in the
Boroug~ of Carlisle, Cumberland County, Pennsylvania.
S. At the aforesaid time and place, Petitioners' minor
son was crollsing Hanover Street in the crosswalk in front of
Lamberton Grade School at approximately 7:40 A.M. at which time
Robert Goril was traveling in the fast lane of Hanover Street and
struck Petitioners' minor son causing serious personal injuries, as
set forth herein.
6. As a direct result of the aforesaid accident,
Petitioners' minor son underwent surgery to repair fractures of
both legs, with placement of metal rods; underwent physical
therapy; was unable to participate in sporting activities; suffered
a refracture in May of 1995 merely from twisting his leg; had
- 2 -
surgery again in July 1995 to remove the metal rods from his leg;
and, additional physical therapy.
7. As a direct result of the aforesaid accident,
Petitioners' minor son has four (4) large permanent. scars on his
legs from both surgeries.
8. Attached hereto as Exhibit. "A" is a report dated
November 16, 1995 from David C. Baker, M.D., Taylor's treating
orthopedic surgeon. The report states that Taylor has a 20\ loss
of motion of the left leg, which will probably be permanent, and'
further explains that he is at risk for limb length inequality.
9. The Respondent, Erie Insurance Co., has denied
liability and responsibility, but has nevertheless agreed to pay on
the under insured claim, a settlement on behalf of Petitioners'
minor in the amount of $155,000.00 in exchange for a Joint
Tortfeasor Release, which is attached hereto as Exhibit "B".
10. The Plaintiffs believe that the proposed settlement
and compromise with Erie Insurance Co., and the distribution of
fees is reasonable, fair and equitable and in the best interest of
their minor son.
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LISA KOCH and ROBERT KOCH,
Parents and Natural Guardians of
TAYLOR KOCH, a Minor and
LISA KOCH, Individually,
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
Petitioners,
AMICABLE ACTION - IN TRESPASS
NO. 1995 - 06893
v,
ERIE INSURANCE COMPANY,
Respondent
UNDERINSURED MOTORIST CLAIM
TO THE PROTHONOTARY:
Please mark the docket in the above-captioned action settled, discontinuod and
ended,
RHOADS & SINON
B> ~'t ~ \~~
~~ DO~~ESQ~E
Supreme Court I. D, No, ;1.""'1-.:3,
One South Market Square
Harrisburg, PA 17101
Telephone: (717) 233.5731
Attorneys for Petitioners
DATED: l(~~1~
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Attorney's fees 33 1/3\............ .....,
Por the purchase, by Erie Ins.
Co., of a structured Annuity with
4 payments of approximately $25,000.00
each, with payment on May 2000, May
2001, May 2002 and May 2003, and
a fifth payment of $23,809.00 on May
13, :1004................................
51,666.66
90,000.00
Reimburse Lisa and Robert Koch
for their direct and personal
expenses, including meals, travel
and lost wages. . . . . . . . . . . . . . . . . . . . . . . . . .
3,863.07
payable to Lisa and Robert Koch
on behalf of, and for the benefit
of their minor son, Taylor Koch.. .... ...
9,470.27
BY THE COURT:
J.
-2 -
.
D.vld B. Dowling, Eequlrt
AItom.y I,D, No, 25452
RHOADS & SINON
On. South M.rltet Squ.rt, 12th Floor
P.O, Bo)(1148
H.m,burg, P.nn.ylY.nl' 17108-1146
Attorney for p.tlllone...
LISA KOCH and ROBERT KOCH,
Par~nt8 and Natural Guardians
of TAYLOR KOCH, a Minor, and
LISA KOCH, Individually,
petitioners
IN THE COURT OF COMMON PLEAS
t CUMBERLAND COUNTY, PENNSYLVANIA
v.
AMICABLE ACTION - IN TRESPASS
NO.
ERIE INSURANCE COMPANY,
Respondent
UNDER INSURED MOTORIST CLAIM
.. .. .. .. ., ., .,
fEIIIlQti.:
NOW COME Petitioners, Lisa Koch and Robert Koch, Parents
and Natural Guardians of Taylor Koch, a Minor, and Lisa Koch,
Individually, by their attorneys, Rhoads & Sinon, who represents as
follows:
1. Petitioners, Lisa Koch and Robert Koch, Parents and
Natural Guardians of Taylor Koch, a Minor, are adult individuals
residing at 153 South pitt Street, Carlisle, Cumberland County,
Pennsylvania 17013.
2. Petitioners are parents and natural guardians of
Taylor Koch, a Minor, born May 13, 1983 who resides at the same
address as Petitioners.
3. Respondent, Erie Insurance company,
underinsured motorist carrier for Petitioners.
is
the
4. petitioners' minor son was injured in an auto/
pedestrian accident that occurred on December 14, 1994 in the
Borough of Carlisle, Cumberland County, Pennsylvania.
5. At the aforesaid time and place, Petitioners' minor
son was crossing Hanover Street in the crosswalk in front of
Lamberton Grade School at approximately 7:40 A.M. at which time
Robert, Goril was traveling in the fast lane of Hanover Street and
struck PeLitioners' minor Bon causing serious personal injuries, as
set forth herein.
6. As a direct result of the aforesaid accident,
petitioners' minor son underwent surgery to repair fractures of
both legs, with placement of metal rods; underwent physical
therapy; was unable to participate in sporting activities; suffered
a refracture in May of 1995 merely from twisting h.is leg; had
- 2 -
.
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010950048655
RELEASE AND AGREEMENT
Under policy DP6 0705248 Issued by ERIE INSURANCE EXCHANGE/ERIE INSURANCE COMPANY,
IIwe, claiming coverage lor mysell/OIJlselves or on behall of ---TAy1 M IlMh-------___~
......... "" .....-... --........ ---..... --............................... --................................ --.................................................. ,-....... =-1"'..............--.:..=.=t.:L-
in consideralion 01 --One Hundred Fiftv Five Tho\lund --------------------------,........
-:----------------( IM1>t&e&-i~....e~....._a..-R.\..lu.~-u-_________________ ($1 55, 000. )00
dollars. which IIwe have received, RELEASE AND DISCHARGE ERIE INSURANCE EXCHANGE/ERIE
INSURANCE COMPANY from any and all claims, causes of action or other rlghls which IIwe have, have
had or could have under the, Under insured Motorist _
coverage as set forth in said policy, which claims, causes 01 actIon or olher rights arose or could have
arisen as a result of a loss or accldenl which happened on the ,.J.1u:.h._ day of Dec9"llar 19-94-
al or near Carli.Ie
in the county of r.llmh"rl.nrt
in Ihe State of Pennsylvania
In consideration of such payment, IIwe agree as follows: 1) to assign Erie Insurance Exchange/Erie In-
surance Company to my/our rights of recovery against any person(s) or party(les) legally liable to me/us.
to fhe amount of and lor the purpose 01 the payment noted above; 2) that IIwe have not and will not
make any separate settlement with nor give any separate release to any person(s) or party(ies) who
caused or are alleged to have caused the above mentioned loss or accident; 3) Ihat suit may be Inslltuted
by Erie Insurance Exchange/Erie Insurance Company in my/our name; 4) to execute all papers required
to commence sucll suit; and 5) to cooperate in prosecuting any or all actions which Erie Insurance
Exchangt't/Erie Insurance Company may bring to recover Irom any person(s) or party(les) for the claims
or causes of action which IIwe have growing oul 01 said loss or accidfilnl.
II is expressly understood and agreed thai, out of any amount recovered, costs of collection, including
but not limited 10 counsel fees, shall be lirst paid 10 ERIE INSURANCE EXCHANGE/ERIE INSURANCE
COMPANY, Excepl in states which apply comparative negligence in determining legal liability, any recov-
ery In excess of collection costs shall be paid to me/us, up to the full extent of my/our loss, In stales
which apply comparative negligence, any recovery of my/our loss, in excess of collection costs, shall
be reduced by a factor equal to the percentage of my/our negligence which contributed to cause Ihe
above mentioned accident, before II IS paid 10 me/us
Intending to be legally bound thereby, WITNESS my/our hand(s) and seal(s) this
01
19
Witnesses'
(Seal)
X Robert J. Koch
,____________..__________ (Seal)
X Lisa W. Koch
C7A W87 I~)
day
Struature
. co.t of Struature , 90,000.00
On 5/13/2000 , 25,000.00
5/l3/2001 , 25,000.00
5/13/2002 I 25,000.00
5/13/2003 I 25,000.00
5/13/2004 , 23,809.00
Total Value of Structure '123,809.00
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...... IIAIUUSBURG I4lQQ~
Page 1
BRIE FAMI~Y LIPE INSURANCB COMPANY
100 Brie Inlurance Place
Brie, PA 16530
Benefit Cost Summary for TAYLOR KOCH
Guaranceed 05/13/2000
Guaranteed 05/13/2001
Guaranteed 05/13/2002
Guaranceed 05/13/2003
Guaranteed 05/13/2004
sub-Total for TAYLOR KOCH.. ........
Quote Id
Settlement Date
Quote Date
State
Sex
Date of Birth
010.95.0048665~02
12/15/1995
12/01/1995
PA
Male
05/13/1983
Lump SUI\II Payment Date
-~---------------- --------------
Guaranteed Payouc
Rate Seriell
First Payment Date,
Guaranteed tor
Scate Premium Tax
Age
Rated Age
SSBT10 (+)
05/13/2000
30 Days
2.00\ Tax
12
12
Age Amount
----...-------
17 $25.000
18 $25,000
19 $25,000
20 $25,000
21 $23.809
Premium
----...-...--------
$20,149
$19,099
$18.103
$17,159
$15,490
Bxpected payout :
$90,000
$123,809
$123,809
TOTAL COST
-..------...------
..... ................
$90,000
* This quote is valid for 30 days from the quote date and is subject to
review for accuracy by the Company. This quote assumes the premium
required to provide the benefits indicated will be received by the Company
on or before the settlement date. If the premium is received after the
settlement date, the premium required may change.
HOV-
TUE
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Attorney'. fe.. 33 l/n.................
'or the purcha.e, by Erie In..
Co., of a .tructured Annuity with
4 payment. of approximately $25,000.00
each, with payment on May 2000, May
2001, May 2002 and May 2003, and
a fifth payment of $23,80~.00 on May
13, 2004.........,... I . . . . . . . . . . . . . . . . . .
51,666.66
90,000.00
Reimburse Lisa and Robert Koch
for their direct and personal
e~penses, including meals, travel
and lost wages.......... . . . . . . . , . , . . . . . .
3,863.07
Payable to Lisa and Robert Koch
on behalf of, and for the benefit
of their minor son, Taylor Koch.. .... ...
9,470.27
BY THE COURT:
J.
" .' '
... :2 ...
2. Petitioners are parents and natural guardians of
Taylor Koch, a Minor, born May 13, 1983 who resides at the same
address as Petitioners.
3. Respondent, Erie Insurance Company,
underinsured motorist carrier for Petitioners.
is the
4. petitioners' minor son was injured in an auto/
pedestrian accident that occurred on December 14, 1994 in the
Borough of Carlisle, Cumberland County, Pennsylvania.
5. At the aforesaid time and place, Petitioners' minor
son was crossing Hanover Street in the crosswalk in front of
Lamberton Grade School at approximately 7:40 A.M. at which time
Robert Goril was traveling in the fast lan6 of Hanover Street and
struck petitioners' minor son causing serious personal injuries, as
set forth herein.
6. As a direct result of the aforesaid accident,
Petitioners' minor son underwent surgery to repair fractures of
both legs, with placement of metal rods; underwent physical
therapy; was unable to participate in sporting activities; suffered
a refracture in May of 1995 merely from twisting his leg; had
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1./19/1995 14131
7172437192
IlAI<ER
F'I<\GE iI ~
DAVID c. BADR, M.D., ....A.C.!
all.VKI)JtaJ MUleAI. CKNTltlt
III Wa"a.t ....... R..d
c......... PA I70U
(717) 2...,.lI010
~~:;rt'rr; ;-:,f "pi' ~~ I, :'., '...J,"'I~ : ~. on ~..~)......,.. ., '. ....If.i,;".: ">>..~'~'. :-'~l'. ,\. ..iJ';~I'; ~f .:., ,'II..' ,I....)~ I ;I'oj 'I ..~,!
Nnwmllcr 16, 1995
Illi: l'aylor J.:OI:h
To W1Iom It May Concern:
lbis Icner i~ 10 o.:onfinn my lasl tindina! on Taylor ~1I\:h, ,o\~ YCHI ~now. T:J~'lnl' \\a~ in\'('" ~II
in a mOlOr vehicl~ ledden' in NfI\'cm"cr Ilf 1994, nlllh fr'tlur.:' \\~e IrO::Jlo:J wilh IIllo:raliw
1"lo",'o.:"lion which ~uh~cqucnlly l'c'luiN.' I111hofl3Cdio.: h;lrdwnrc rcmov~1 This \\'3' d"ne in July
01' 1995.
Thc fUelun:, h3\'0 hCOlled an\l allhis lime 1'a:--Ior i~ amhula.inll \\.-11 and 11.1I1icillaling in hi, \1'11;11
childhood ..cti\'ilic~, He d'le~ hll\'c a 20' lo~~ of mOli,'n of 1hc I.;ti lei \\hi\,h \\ ill pl'llh:thly he
",..""ano.:n. v.i\'cn tMI il is nO\\ 11 mo",h! after the ori&inaJ irtiul'Y, fie alslI i, 81 Iis~ fill' a Ii,"h
length ineqllllli~', nil: prc<cnee of I fr:JclUrc can aclU.1l1y uimulalc IIone arow.h and Ihi~ i,~ ar
~n ilTcllular unpl'cdiclahlc ralc. lIe will ha\'e 10 he monitored for Ihi-,
If you hIVe any other quulions, I'lel$e fecI free 10 conla" me,
Sincerely,
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Page 1
IRIB FAMILY LIP! INSURANCB COMPANY
100 Brie In.urance Placl
Brie, PA 16530
Benefit COlt SUlllMry for TJ.YLOil. KOCH
Rate Seril'
p!r.t Peyment Dati:
Guaranteed tor
State Prlmium Tax
Age
Rated Age
Amount
SSBT10 (+)
05/13/2000
30 Day.
:a.00\ Tax
12
12
OUote leS I 010-95-0048665-02
Settlement DaCe 12/15/1995
Quote DacI 12/01/1995
State PA
SIX Male
Date 0:1: Birch 05/13/1983
Lump Sua Payment Date AgI
-------------..... --------...---- .. -"."''''
Guarantied 05/13/2000 17
Guaranteed 05/13/2001 18
Guaranteed 05/13/2002 19
Guaranteed 05/13/2003 20
05/13/2004 21
premiUIII
...---------
---...........-----
$20,149
$19,099
$18,103
$17,159
~lS,490
$25.000
$25,000
$25,000
$25,000
$23,809
Sub-Total for TAYLOR KOCH. ... ......
$90,000
$123,809
Guaranteed Payout
$123,809
TOTAL COST
Bxpected payout :
.......................... ..
$90,000
. This quote 11 valld tor 30 day. trom the quote date anel ill lubject to
review for accuracy by the Company. 'l1L1. quote a..ume. thl pl'emium
required to provide the banefits indicated will be received by thl Company
on or betore thl 'Ittlement date. If the premium is receivecS after the
.ettlement date, the premium required may change.
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