UNITED STATES DEPARTMENT OF LABOR EMPLOYMENT STANDARDS ADMINISTRATION OFFICE OF WORKERS COMPENSATION PROGRAMS SIXTH COMPENSATION DISTRICT IN THE

MATTER OF A CLAIM FOR COMPENSATION UNDER THE LONGSHORE AND HARBOR WORKERS COMPENSATION ACT Employee STANLEY LAWSON Employer UNIVERSAL MARITIME SERVICE CORP. Carrier Signal Mutual Indemnity Association, Ltd. SETTLEMENT AGREEMENT AND COMPENSATION ORDER SECTION 8(i) CASE NO.: 06-193959 SSN: ***-**-9715

The parties hereto, Stanley Lawson, employee, Universal Maritime Service Corp., employer, and Signal Mutual Indemnity Association, Ltd., carrier, have reached an agreement for the settlement of this claim for compensation pursuant to Sec. 8(i) of the Longshore and Harbor Workers Compensation Act, and as a basis for the settlement agree and stipulate as follows: 1. On June 10, 2004, the employee was in the employ of the employer, working as a longshoreman, when he fell into a hole (hatch) onboard a vessel. He injured his lowback, left leg, right knee, and shoulder, all while performing his job duties of a longshoreman. There is also the contention that the employees coronary ailment of during or near June, 2006 was somehow or other related to the work-related injuries and/or the treatment he received as a result of the earlier 06/10/2004 injuries. However, 1

there is no medical substantiation of that alleged connection. 2. The liability of the employer for the payment of Longshore and Harbor Workers Compensation benefits was insured by Signal Mutual Indemnity Association, Ltd. 3. Written notice was given within thirty (30) days of the injury. 4. The employer furnished medical services in accordance with Sec. 7 of the Act. 5. Following the accident, the employee was initially seen and treated by Dr. Alan Roberts at Sunshine Medical Center. His care was then transferred to Dr. Kenneth Jarolem in August 2004. Conservative care followed and in or around October, 2004 the employee decided to select Dr. Deepak Kapila as his treating physician. Continued conservative care was provided and on 02/07/05 Dr. Kenneth Hodor examined the employee at the request of the employer/carrier. Dr. Hodor noted a history of left rotator cuff tendonitis and persistent bilateral lumbar radiculitis. He agreed with Dr. Jarolem and thought epidural steroid injections would be of benefit. The employee continued to see Dr. Kaplila and conservative care (home exercise, medications, and PT) continued. A repeat lumbar MRI was made on 09/30/05 and it was interpreted as showing, Moderate spinal stenosis at L4-5 and L5-S1 as result of disc bulging superimposed on developmentally small spinal canal. No frank extruded lumbar disc herniation is identified. Dr. Kapila only suggested continued conservative care. Dr. Hodor then reexamined the employee on 01/23/06. He recommended aquatic therapy and felt the

employee could return to sedentary work activities. Dr. Kapila then stated that his patient had reached MMI as of 02/09/06. When next examined on 04/20/06, Dr. Kapila thought the employee was back at a TTD status, but only PT was recommended. In June, 2006, Dr. Kapila related that the employee had a recent episode of coronary artery disease with a myocardial infarction and the employee began taking Coumadin. That medication use precluded any epidural steroid injections. In Dr. Kapilas 09/21/06 report he states that the employee remains at MMI since 02/09/06 and he discharged him from his care. By 01/25/07 Dr. Kapila was recommending EMG/NCS be performed. On 05/04/07 he once again discharged the employee from his care and stated again that the employee had reached MMI. By 09/18/07, Dr. Kapila recommended a neurosurgical consultation, although he continued to examine the employee on several subsequent occasions. The employer/carrier arranged for Dr. Luis Pagan, a neurosurgeon, to examine the employee and he diagnosed degenerative disease of the lumbosacral spine and released the employee to light-duty work activities. No surgery was recommended. Dr. Wilfred McKenzie was also consulted by the employee, but that care was never authorized by the employer/carrier. In April 2009, the employer/carrier asked Dr. Seth Wachsman , a pain management specialist, to examine the employee. Since the employee was no longer taking Coumadin epidural steroid injections were recommended. The first was done on 05/01/09, the second on 05/20/09, but additional injections were not recommended since no significant relief was generated. On 06/16/09 Dr. Wachsman found the employee to be at MMI from a pain management standpoint. 6. The employees average weekly wage at the time of the injury was $1,586.05, which yields a corresponding compensation rate of $1,030.78 the maximum per Sec. 3

6(1) of the Act. 7. As a result of the injury, the employee was temporary totally disabled (TTD) until he reached MMI on or about 09/23/2005. The employees benefits were then changed to permanent partial disability (PPD) benefits, but were kept at the TTD level. The claimant was then thought to have returned to a TTD status as of 08/11/06, but then returned to a PPD status as of 11/02/07. Temporary total disability payments made to the employee total $139,467.38 and non-scheduled PPD payments total $213,944.24 - as of 11/24/2011. PPD benefits of $812.83 will continue until this settlement application is approved and filed by the Department of Labor. 8. The employee attained maximum medical improvement on several different occasions and has been released to return to either light-duty or sedentary duty by various physicians, including his treating physician, Dr. Kapila. Labor Market Surveys have been conducted and a retained earning capacity of $366.80 has been established based on a number of available sedentary job prospects. 9. At this time the parties wish to compromise and settle any further liability for weekly compensation on a lump-sum basis. The employee has done reasonably well following his medical care and has been released to return to work in a light-duty to sedentary work capacity by the involved physicians. He was given these work releases by the involved doctors although he may still have some occasional residual pain.

10. Solely for the purpose of this application, the parties have compromised their differences and agree to settle the compensation claim and the claim for attorney fees and costs for the payment of Two Hundred Twenty Thousand and no /100 ($220,000.00) Dollars, to be paid as shown below: Employee to receive in compensation benefits Attorney to receive in fees and costs $200,000.00 $ 20,000.00

11. Approval and payment of this agreed settlement shall discharge the liability of the employer and its carrier for the payment of further compensation benefits as a result of the June 10, 2004 injury. 12. Prior payments of medical costs are outlined below: 2005 2006 2007 2008 2009 2010 2011 $11,939.04 $ 5,224.47 $ 1,447.84 $ 2,713.35 $ 6,748.97 $ 461.90 $ -013. As best can be determined, if future medical care is needed, its cost is not expected to exceed $14,996.26, which is the Medicare Set-Aside (MSA) estimated by PlanPoint. Additionally, the employee does have group health insurance through his union that will cover his future medical costs and he also has Veterans Administrative health benefits. 14. 5

It is further submitted that the compensation portion of the settlement is adequate. The employees date of birth is 01/11/1955, making him 56 years of age. The $200,000.00 being paid in compensation benefits equates to roughly 194 weeks of temporary total disability payments, which is more than adequate to cover either any unexpected period of temporary total disability or to compensate the employee for any claimed permanent partial disability benefit (scheduled or non-scheduled). 15. Employee is represented by legal counsel. His attorneys name is Marc Jay Tannen. 16. The employee attests the proposed settlement has not been procured by duress or any non-stipulated promises. 17. It is agreed and stipulated by all parties that the employee, employer, or carrier shall each have the right to withdraw their consent to this settlement at any time prior to its approval by the District Director by notifying the Office of Workers Compensation Programs of their withdrawal of consent. In the event that consent is withdrawn by any party, or in the event the District Director does not approve the settlement proposal, the stipulations made herein shall not be binding on any of the parties in any subsequent proceeding under the Act. It is also agreed and stipulated by all parties that the employers and carriers consent to this settlement is to be considered withdrawn, null, and void at the time of the employees demise, if the employee dies before the settlement is approved by the District

Director. No action by the employer or carrier shall be required to affect this withdrawal. It shall be automatic as of the moment of the employees death. It is stipulated that any action by the District Director to approve this settlement subsequent to the employees death shall be null and void. 18. The employee further attests that his current home address is 120 NW 15th Court, Pompano Beach, FL 33060 and his telephone number is ____________________. The employee must provide his current address and telephone number for the location at which he accepts certified or express mail. In accordance with the BRB decision in D. G. v. Cascade General, Inc. and Liberty Northwest Insurance Co. (#08-0238), the employee agrees to waive the Section 14(f) assessment, although the employer/carrier will do its best to deliver the settlement funds in a timely manner. 19. In addition to the above, Federal regulations provide that Medicare shall not make

payments with respect to any item or service to the extent that payment has been made, or

can reasonably be expected to be made, promptly under a workers compensation law or

plan of the United States or a State under an automobile or liability insurance policy or

plan, including an authorized group self insurer or self insured plan. If CMS determines

that the workers compensation settlement language represents an attempt to shift

responsibility from the workers compensation Authorized Group Self Insurer to

Medicare, CMS may disregard the settlement provisions and apportion the lump sum

between indemnity and medical allocations.

If the parties are settling a claim where there is a reasonable expectation that

Medicare covered medical attention will be needed, and the settlement is over $250,000

the parties must make reasonable allowance for the future projected costs. If such

allowance is not made in the form of an allocation or set aside arrangements for future

medicals, Medicare may claim the entire settlement amount as an allowance for medical

payments. Further, Medicare will not pay benefits to the Employee for medical services

that may be linked to the occupational injury until settlement amount is exhausted.

If the Employee is a current Medicare beneficiary at the time of settlement,

Medicare requests settlement and allocation be submitted for approval prior to its signing

regardless of the amount of medical payments involved. If the Employee is not a

Medicare beneficiary, but can reasonably be expected to be eligible within 30 months of

the settlement and the settlement is above $250,000, Medicare expects that its interests

will be taken into account in the settlement and strongly encourages all parties involved

to consult Medicare prior to final settlement.

If the Employee is not a Medicare beneficiary, is not expected to become a

Medicare beneficiary within 30 months following the settlement and the total settlement

is less than $250,000, Medicares position is that they waive any interest in the

settlement.

In this matter, Employee is receiving Social Security Disability benefits and is

receiving or is eligible for Medicare benefits. Thus, there is a requirement for the

Employee to seek CMS approval of any funds in a Medicare Set-Aside (MSA). The

MSA has been sent to CMS for its review and approval. The employer/carrier reserves

the option to either pay whatever is demanded by CMS to protect Medicares interests or

to leave Medical benefits open and available to the Employee. Once CMS decision and

demand is known, the employer/carrier and the Employee will attempt to settle the Future

Medical benefits in a separate 8(i) application. The employees attorney agrees to not

seek any attorney fee with regard to this probable future Medical settlement. If any

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Conditional Payments have been made by Medicare, the employee agrees to reimburse

Medicare for their payments. The claimant and his attorney also agree to indemnify and

hold-harmless the employer/carrier from any such Conditional Payments. 20. The undersigned parties have read the above stipulations and approve of same. The parties request that the District Director approve this proposed settlement agreement under Sec. 8(i) of the Act.

_________________________ Employee _________________________ Attorney _________________________ On behalf of Carrier/Employer

Date: __________________

Date: __________________

Date: __________________

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The undersigned District Director, pursuant to the provisions of Sec. 8(i) of the Longshore and Harbor Workers Compensation Act, having considered the foregoing stipulations and agreed settlement, together with the entire contents of the administrative file, makes the following: FINDINGS OF FACT 1. 2. The agreed settlement proposal is adequate and was not procured by duress. Settlement in the amounts set forth in the stipulations is hereby approved, and the parties are directed to fulfill their respective obligations listed within the agreement. The liability of the employer/carrier for all payments of compensation, future medical benefits, and attorney fees under the Longshore and Harbor Workers Compensation Act as a result of the employees June 10, 2004 accident and injuries will be discharged upon payment of the agreed sums. COMPENSATION ORDER IT IS HEREBY ORDERED that the employer/carrier shall forthwith pay all amounts due in accord with the provisions of this agreed settlement. GIVEN UNDER MY HAND at _______________, ________, this _______

3.

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day of ______________, 20__.

______________________________________ District Director Sixth Compensation District

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