Okaloosa County BOCC — 2013 meeting #1140 (date undetermined) — Paxson settlement — reading text

STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS OFFICE OF THE JUDGE OF COMPENSATION CLAIMS Laraine Paxson, Employee/Claimant, vs. OICC#: 12-004395NSW Date of Accident: 12/9/11 per Okaloosa County Board of Commussioners JCC’s Order of 10/25/11 Employer, and Johns Eastern Company, Carrier/Servicing Agent. SETTLEMENT AGREEMENT PURSUANT TO §440.20(11)(c).(d), & (ce), FLORIDA STATUTES, (2001) The above-named parties hereby set forth the following agreement made for the specific purpose of discharging the employer/carrier/servicing agent from any further lability as to any and all dates of accident or injury, including, but not limited to the date(s) of accident listed above, for all past and future benefits under the Florida Workers' Compensation Law, in exchange for the payment of a lump-sum of money fo the claimant. The parties, therefore, stipulate as follows: 1. JURISDICTION - The Florida Department of Labor and Employment Security and the Judge of Compensation Claims (hereinafter referred to as “judge") appointed under FS. $440.45 have jurisdiction of the subject and the parties hereto. 2. DESCRIPTION OF (ALLEGED) ACCIDENT(s) - On 12/9/11, the employee (hereinafter designated as the claimant), contends she was injured by accident as contemplated under F.S. §440.02(1) arising out of and in the course of employment with the employer in Okaloosa County, Florida, when she developed cervical and lumbar pain after taking down temporary wall, causing injury to back, neck and (found not compensable by the JCC). 3. AVERAGE WEEKLY WAGE AND COMPENSATION RATE - At the time of the injury, the claimant's average weekly wage was $494.17 thus making the compensation rate $329.45 per week. A portion of Item #3 has been redacted along with all of items #4, #5 and #6 as they contain confidential medical information. 1 7. AGE, EDUCATIONAL BACKGROUND AND WORK HISTORY - The claimant is 49 years of age (DOB: 9/17/63) and has a GED. She is able to read, write and do simple math. Her work history includes employment as a custodian. At the time of the alleged injury, the claimant was working as a senior custodian. 8. SETTLEMENT AMOUNT AND DISCHARGE FROM LIABILITY FOR FUTURE COMPENSATION - Subject to the approval of the judge pursuant to Florida Statutes §440.20(11\(c),(d) & (e), employer/carrier/servicing agent will pay to the claimant $19,900.00 in accordance with the statutory formula, in full satisfaction of the obligation or liability to pay all past and future benefits of whatever kind or classification available under the Florida Workers’ Compensation Law including, but not limited to, future medical benefits, monetary compensation as contemplated under Section 440.15, Florida Statutes, impairment benefits, death benefits, attorney's fees, past medical benefits and rehabilitation and training and education benefits including temporary total disability compensation under Section 440.49(1989)&(1990) and 440.49 1(6)(b)( 1993), Florida Statutes, on account ef the alleged accident or occupational disease referenced herein which shall be allocated as follows: a. Past and future compensation Benefits $ & b. Past medical expenses 5 2 o. Future medical expenses $ 9,212,09 d. Rehabilitation temporary total disability compensation and rehabilitation and training and education expenses $ 5,000.00 &. Attorney’s fees and costs 5 5,687.91 TOTAL: $19,900.00 The parties agree that the injured claimant has attained maximum medical improvement. In addition, the payment of the lump-sum set forth herein will definitely aid in the rehabilitation of the injured claimant or will otherwise be in her best interest. Upon receipt of the lump-sum, the employer/carrier/servicing agent will be forever released and discharged from the obligation or liability to pay any and all benefits of whatever kind or classification payable under the Florida Workers' Compensation Law. The claimant does hereby waive any right she may have to any and all penalties and/or interest on account of the accident or occupational disease referenced herein and specifically 2 agrees that the employer/carrier/servicing agent will have thirty (30) days from the date of the entry of the Order approving the Motion for Approval of Attorney's Fee and Allocation of Child Support Arrearage to make payment. As further consideration for the aforementioned payment, the claimant agrees and does hereby release, discharge, and surrender any and all claims, whether or not asserted against the employer/ cartier/servicing agent, or any of its officers, agents, servants, employees, directors, successors, assigns, and any other person or entity so connected to the employer/carrier/servicing agent, of any nature whatsoever, without any limitations thereof under Chapter 440. 9. ATTORNEY'S FEES PAYABLE BY CLAIMANT AND WAIVER - The claimant has been represented by Antonio Bruni, Esquire, in connection with this matter who is entitled to a fee for legal services rendered. $2,750.00 is a reasonable fee for such services, and is within the guidelines for the determination of a reasonable fee as set forth in F.S. §440.34(1). In addition thereto, the claimant shall also reimburse the attorney $2,937.91 for non-taxable costs. Notwithstanding the provisions of F.S. §440.34(3)(a-d), the claimant and not the employer/carrier/servicing agent is responsible for the payment of his/her own attorney's fees because this settlement was made under F.S. §440.20(11)(c), (), & (e) F. 8. (2001). The claimant has been informed of the right to a hearing on the amount of the fee charged by the attorney and hereby waives her right to such a hearing. The fee and non-taxable costs shall be paid from the settlement proceeds, thereby making the net settlement amount $14,212.09. The claimant guarantees to hold the employer/carrier/servicing agent harmless from any claim or lien for attorney's fees and costs by any attorney with respect to any date of accident listed in this settlement agreement. The parties further stipulate and agree that the claimant is responsible for said claims or liens of prior attorneys. 10. WAIVER OF RIGHT TO HAVE CASE HEARD BY JUDGE OF COMPENSATION CLAIMS AND RIGHT TO BRING PETITION FOR MODIFICATION - The claimant understands that he/she does hereby relinquish the right to have any unresolved conflicts or disputes involving the right to monetary compensation benefits, impairment benefits, death benefits, attorney's fees, past due medical benefits, future medical benefits and rehabilitation and training and education benefits heard and decided by a judge. il. PRESENT WORTH AND POSSIBLE OFFSET FOR SOCIAL SECURITY DISABILITY BENEFITS CONSIDERED - In reaching this agreement, the parties have considered the present value of all future payment of indemnity benefits, impairment benefits, medical benefits and death benefits potentially payable to the claimant under the Florida Workers’ Compensation Law on account of the injuries referenced herein. The injured claimant was bom 9/17/63 and her life expectancy is approximately 32 years, or 1664 weeks. When the present value of the lump sum payment for future indemnity benefits of $5,000.00 herein is prorated on a weekly basis over the claimant's life expectancy, the lump sum is equal to payment of future indemnity benefits at a rate of $3.00 per week. This periodic repayment schedule results in a substantial loss to the claimant on a consistent basis. Taking that into consideration, the parties hereby agree that those weekly payments of indemnity benefits are the same as if the lump sum would have been paid to the claimant at a rate of $3.00 per week over her expected lifetime. The same is true for the lump sum payment of future medical benefits, which, when reduced to present value, is equal to $5,687.91. The Jump sum consideration given for the settlement of future medical benefits is the same as if the Jump sum would have been paid to the claimant at a rate of $3.42 per week over her expected lifetime. The employer's/carrier's/servicing agent's right to offset workers' compensation indemnity and medical benefits due under Florida Workers' Compensation Law againsi benefits payable on account of total disability under Chapter 42, UNITED STATES CODE, including benefits 3 payable under Medicare, is also included in these calculations and has been considered by the parties in reaching this agreement. 12. MEDICARE CLAIMS AND/OR REIMBURSEMENT RIGHT PURSUANT TO MEDICARE SECONDARY PAYER PROGRAM AND/OR LIEN OF THE DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES UNDER F.S.§409.910 (MEDICAID THIRD PARTY LIABILITY ACT) - The claimant confirms that no claim or nght of reimbursement by Medicare or Medicare Secondary Payer Program exists, or lien of the Department of Health and Rehabilitative Services under F.S.§409.910 for treatment of the injuries arising from the work related accident referred to herein. Claimant hereby acknowledges that all responsibility for Medicare claims or Medicare Secondary Payer Program and/or all claims or liens of the Department of Health and Rehabilitative Services under F.S. §409.910, for any and al] past treatment for which Medicare or Medicare Secondary Payer Program and/or the Department of Health and Rehabilitative Services under F.S. §409.910 has a claim, if any, is that of claimant, subject to the rules and regulations of Medicare and/or the Department of Health and Rehabilitative Services under F.S. §409.910, Claimant indemnifies and holds harmless the employer/carrier/servicing agent against any liability in favor of Medicare or Medicare Secondary Payer Program and/or the Department of Health and Rehabilitative Services under F.S. §409.910, as to payment of past, current or future medical expenses for the Claimant. : This claim does not meet Medicare’s current review thresholds as described in the 7/11/05 and 4/24/06 Medicare Policy Memorandum. As such, the claim does not require review and/or approval from CMS. Nevertheless, the parties have voluntarily allocated $5,687.91 towards future medical treatment. These funds will be paid directly to claimant and are intended to be used for medical purposes related to this claim. Claimant shall further hold employer harmless from any and all adverse consequences in the event this settlement results in the loss of right to Social Security and/or Medicare benefits to the extent claimant would have been entitled to those benefits in the absence of this settlement agreement. The claimant further agrees to waive any and all future actions against the employer, including but not limited to, any private cause of action for damages pursuant to 42 U.S.C. § 1395y(b)(3)(A) et seq. Because the claimant is not a Medicare recipient, no conditional payments have been made by Medicare. It is not the purpose of this Settlement Agreement to shift responsibility of medical care in this matter to the Medicare program. Instead, this settlement is intended to resolve a dispute between the claimant and employer. 13. WAIVER OF PENALTIES, INTEREST, AND FORMAL NOTICE - The claimant does hereby waive any right she may have to any and all penalties or interest on account of the alleged accident or occupational disease referenced herein. 14, ALL KNOWN ACCIDENTS, INJURIES, AND OCCUPATIONAL DISEASES REVEALED AND ALL PENDING CLAIMS WITHDRAWN - The claimant once apain represents and affirms that all accidents, injuries and occupational diseases known to have occurred or sustained while employed by the employer have been revealed. All pending claims and notices of denial pertaining thereto are hereby voluntarily withdrawn. 15. AGREEMENT SUBJECT TO APPROVAL OF. JUDGE OF COMPENSATION CLAIMS - The parties clearly understand that attorney fees and costs, as well as child support obligations of claimant must be approved by the Judge of Compensation Claims, before settlement becomes formally binding. The claimant understands that these items have been routinely