Third-Party Claims Examiner
Resume:
DISTRICT OF COLUMBIA DEPARTMENT OF EMPLOYMENT SERVICES
OFFICE OF WORKERS’ COMPENSATION
**** ********* ******, *.*. Washington, DC 20019
CURTIS WRIGHT *
Claimant * Claims Examiner: Ms. Robyn Abrams
v. * OWC No.: 824737
CORE *
Employer *
and *
LIBERTY MUTUAL INSURANCE CO. *
Insurer/Third-Party Admin. *
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * JOINT PETITION FOR APPROVAL OF LUMP SUM SETTLEMENT PURSUANT TO SECTION 32-1508(8)
NOW COME Curtis Wright (“Claimant”), CORE (“Employer”) and Liberty Mutual
(“Insurer/Third-Party Administrator”), by and through their undersigned representatives, and do hereby request that the Office of Workers’ Compensation approve the following settlement agreement and state as follows:
1. On February 24, 2023, the Claimant, Mr. Curtis Wright, suffered injuries to his neck, back, and left leg, while working for the Employer, CORE, when a tent fell on top of him.
2. At the time of the injury, the Employer’s workers’ compensation insurance was provided by Liberty Mutual Insurance Company.
3. Jurisdiction for this accidental injury is in the District of Columbia. OWC No.: 836299
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4. Claimant’s average weekly wage is $1,080.00 and the compensation rate is
$720.00.
5. No benefits have been paid on this claim and the instant settlement was reached prior to entry of an order finding the case compensable. The case is contested on issues including claimant’s entitlement to any benefits, the nature and extent of Claimant’s alleged disability and average weekly wage. The parties have reached this agreement to resolve all potential controversies. 6. Considering the aforementioned circumstances of this case, the Employer and Insurer have agreed to pay, and the Claimant has agreed to accept, the sum of TWELVE THOUSAND FIVE HUNDRED DOLLARS AND ZERO CENTS
($12,500.00) in exchange for a full and final settlement of this case. This settlement is a release of any and all liability related to the workplace accident, with the sole exception that Employer and Insurer shall remain responsible for any authorized, reasonable, necessary and causally related medical care and treatment incurred prior to the date on which this agreement is approved. 7. The settlement amount is not subject to any credit or setoff for any other sums previously paid, if any, from any source.
8. This settlement is being made with prejudice to the Claimant’s right to receive reasonable and necessary, causally related medical treatment at the expense of the Employer and Insurer, should there be any. Employer argues, relying on the reports of the treating and examining doctors, that the Claimant has reached maximum medical improvement and requires no further treatment related to this work injury. Claimant has been given the option to designate a portion of his recovery for future medical treatment related to this injury. Relying on Employer/Insurer’s representation that they will deny any requested treatment as OWC No.: 836299
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not related to this work injury, Claimant has elected not to designate any portion of his recovery for future medical treatment.
9. The Claimant understands that this Agreement terminates the Claimant’s right to obtain further medical treatment under this claim. The Claimant understands that because of the settlement, it is possible that Medicare and/or Medicaid may decide that it will not pay for future medical expenses for the accidental injury which is the subject of this claim.
10.The Claimant acknowledges that by settling this case, the Claimant has voluntarily agreed to close this matter and bar any and all further efforts of recovering benefits or compensation pursuant to this claim other than those set forth in this Agreement. 11.The lump sum payment required by this settlement is in addition to any money previously paid pursuant to this claim.
12.The Employer waives and forfeits any and all credits, known and unknown, that they might claim against the Claimant and/or the proceeds of this settlement pursuant to this claim. This includes, but is not limited to, any credits for payment of temporary total disability benefits in excess of the amount required by law. The Employer and Insurer agree that they shall not seek reimbursement from the Claimant for any payments they made to or on behalf of the Claimant prior to the date of approval of this agreement.
13.The purpose of this settlement agreement is to provide the Claimant with funds that will compensate him for future workers’ compensation benefits, including medical benefits, and that will foreclose the Employer and Insurer’s responsibility for such benefits. It is not the purpose of this settlement agreement to shift to Medicare the responsibility for payment of medical expenses for the treatment of work-related conditions. The parties hereby acknowledge and have considered the potential OWC No.: 836299
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impact of the Medicare Secondary Payer statute, 42 USC§1395yy(b), on lump sum settlements that purport to the release employers/carriers from liability for future medical expenses. The parties further acknowledge that if Medicare’s interest in the lump sum payment is not adequately considered per 42 CFR §411.46, Medicare may refuse to make medical payments once the Claimant becomes entitled to Medicare benefits. The Claimant hereby acknowledges that he is not entitled to Medicare benefits on account of either age or disability: nor have any Medicare benefits been paid in connection with the claim referenced herein. The Claimant agrees and acknowledges that Medicare has not paid for any treatment related to the accident. Claimant further agrees and acknowledges that he is not now receiving Social Security Disability or Medicare benefits. The Claimant also acknowledges and understands that should he receive any further treatment related to this injury, he cannot seek to transfer the costs of such treatment onto Medicare. Pursuant to the July 23, 2001 “All Associate Regional Insurers” memo by the Center for Medicare and Medicaid Services (“CMS”) and CMS guidance memos subsequent thereto, this case does not meet the threshold criteria for CMS review. 14.The parties recognize that the Social Security Act provides for pro-ration of workers’ compensation benefits received from a settlement in determining whether there should be an offset of workers’ compensation benefits against Social Security Benefits. The Claimant requests and the Employer and Insurer concur, that the compromise settlement of the Claimant’s future right to periodic cash benefits are premised on present value and should be apportioned taking into consideration the attorney’s fees, expenses, and evaluation fees. For the period beginning with the first day after the periodic monthly compensation ends the present value of the OWC No.: 836299
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settlement agreement which Claimant will receive shall be pro-rated in accordance with POMS DI 52150 et seq, in the manner most advantageous to the total family and/or the wage earner.
Specifically, this petition designates that the rate at which the lump sum award will be pro-rated is to be based on the life expectancy of the Claimant. Life expectancy is determined in accordance with the table (Social Security Administration, Table for 2019, https://www.ssa.gov/oact/STATS/table4c6.html). Claimant, being 60 years and 5 months of age, has a life expectancy of approximately 22.9 additional years, or 274.8 additional months. Therefore, the balance of the lump sum should be pro-rated by the Social Security Administration by dividing the remainder of the indemnity lump sum after the attorney’s fee and legal costs, providing a net recovery of $8,719.89 representing the settlement and the compromise of all future claims for disability benefits, including permanent total disability benefits. These benefits could potentially have been paid over the remainder of the Claimant’s life expectancy. Therefore, even though paid to the Claimant in a lump sum, the benefit shall be treated as though pro-rated and considered to be a monthly payment of no more than $31.73 per month, commencing on the date on which this agreement of Final Compromise and Settlement is approved by the Department of Employment Services, Office of Workers’ Compensation.
15.The Claimant understands that this represents a full and final settlement of any and all compensation benefits, services, attention, and claims to which Claimant or Claimant’s heirs may be entitled to, both now and in the future, against the Employer and Insurer relating to the subject workplace accident and any OWC No.: 836299
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compensable consequences (with the exception that the Employer and Insurer agree to assume the responsibility for all authorized, verifiable medical expenses to the extent they are reasonable, customary and necessary, which are causally related to the Claimant’s workplace accident and incurred prior to the date of entry of an Order approving this settlement.) The Claimant understands and agrees that this lump sum settlement is a payment of compensation. 16.The parties believe that this settlement is in the best interest of the Claimant and should be approved.
17.The Claimant has been continuously represented by Lauren Pisano, an attorney at Berman Sobin Gross LLP, in connection with this claim. Counsel has continually reviewed this file from a legal standpoint, has provided numerous consultations to the Claimant, and has compiled documentation necessary to maintain the action. The Claimant understands that the law firm of Berman Sobin Gross LLP is seeking a fee in the amount of $2,500.00, reimbursement of case cost expenses for obtaining medical records on behalf of the Claimant in the amount of $83.11, and payment of case cost expenses to Premier Orthopedics for Dr. Frederic Salter’s IME, in the amount of $1,197.00. If approved, this amount will be deducted from the total settlement amount. The Claimant understands that he will receive $8,719.89 in a lump sum (new money) from this settlement agreement. 18.All sums set forth herein are compensation for personal physical injuries or physical sickness, within the meaning of § 104(a)(1) of the Internal Revenue Code of 1986. 19.The Claimant has been fully advised of his rights under the Act and is fully aware that the approval of the agreed settlement will discharge and release the Employer and Insurer from further liability in this matter. Claimant wishes to proceed. OWC No.: 836299
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WHEREFORE, it is respectfully requested that the Office of Workers’ Compensation approve this settlement agreement as submitted.
[Signatures on Following Page]
Respectfully submitted,
Mr. Curtis Wright
19 42nd Street, N.E. – Unit 104
Washington, D.C. 20019
Lauren E. Pisano, Esquire
Attorney for Claimant
Berman, Sobin & Gross
481 N Frederick Ave, Suite 300
Gaithersburg, MD 20877
Christopher Costabile, Esquire
Attorney for Employer/Insurer
P.O. Box 7217
London, KY 40742
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