c. Permanent impairment (also known as vocational impairment, medical impairment or permanent partial
disability) benefits, payable up to a statutorily defined maximum and
d. A lump sum payment of awarded permanent impairment benefits up to a statutorily defined maximum and
e. Vocational rehabilitation benefits, including job training, income maintenance or any other benefits payable
as vocational rehabilitation and
f. Benefits for disfigurement, scarring, discoloration, and/or a limp up to a statutorily defined maximum, and
g. All penalties, interest, costs, and attorneys’ fees up to the date this settlement is approved by the Division.
The parties do not waive the right to seek post-approval penalties should either side fail to comply with the
terms of the approved settlement agreement.
h. Medical, surgical, hospital, and all other health care benefits, including chiropractic care and mileage
reimbursement incurred after the date of the approval of this settlement agreement by the Division of Workers’
Compensation or by an administrative law judge from the Office of Administrative Courts.
4. The parties stipulate and agree that this claim will never be reopened except on the grounds of fraud or
mutual mistake of material fact.
5. Respondents specifically retain waive their subrogation rights.
6. Claimant realizes that there may be unknown injuries, conditions, diseases or disabilities as a consequence of
these alleged injuries or occupational diseases, including the possibility of a worsening of the conditions. In
return for the money paid or other consideration provided in this settlement, Claimant rejects, waives and
FOREVER gives up the right to make any kind of claim for workers’ compensation benefits against Respondents
for any such unknown injuries, conditions, diseases, or disabilities resulting from the injuries or occupational
diseases, whether or not admitted, that are the subject of this settlement. The Claimant and Respondents agree
that this settlement, when approved by the Division of Workers’ Compensation or by an administrative law judge
from the Office of Administrative Courts, ends FOREVER the Claimant’s right to receive any further workers’
compensation money and benefits even if the Claimant later feels that Claimant made a mistake in settling this
matter or later regrets having settled.
7. Claimant understands that this is a final settlement and that approval of this settlement by the Division of
Workers’ Compensation or by an administrative law judge from the Office of Administrative Courts dismisses
this matter with prejudice and FOREVER closes all issues relating to this matter. Claimant is agreeing to this
settlement of Claimant’s own free will, without force, pressure or coercion from anyone. Claimant is not relying
upon any promises, guarantees, or predictions made by anyone as to Claimant’s physical or mental condition; the
nature, extent, and duration of the injuries or occupational diseases or as to any other aspect of this matter.
8. Neither Claimant nor Respondents intend to waive or give up any available rights, claims, privileges or defenses
by signing this Settlement Agreement unless and until it is approved by the Division of Workers’ Compensation
or by an administrative law judge from the Office of Administrative Courts. The parties acknowledge and agree
that approval by the Division of Workers’ Compensation or by an administrative law judge from the Office of
Administrative Courts applies only to those matters set forth in this agreement that are subject to the Workers’
Compensation Act and that the approval by the Division or by an administrative law judge from the Office of
Administrative Courts has no effect on any separate or contingent agreement(s) that the parties may have reached.
