A Drafting Guide for 8(i) Settlements

1. _____ Self-Sufficient: Make sure that the settlement application, when read on its own without any background information, stands on its own and supports that the settlement is adequate and should be approved.

2. _____ Stipulations signed by all parties: Don't forget to have all parties sign, especially claimant.

3. _____ Brief summary of the facts:
A. description of the accident
B. description of the nature and extent of the injury
C. degree of impairment./ disability

4. _____ Compensation: Make sure average weekly wage and compensation rate are listed as well as summary of compensation paid. (You can attach a copy of the LS-208 form when appropriate)

5. _____ Full Description of the Terms of the Settlement
A. list separate amounts for the settlement of compensation and medical benefits
B. list amount of attorney fees agreed upon (itemized in accordance with 702.132)
*make sure power of atty. and fee application are enclosed*

6. _____ Reasons for settlement/Issues in Dispute

7. _____ Claimant's Information:
A. date of birth or (if death claim) date of death, and list of dependents

8. _____ Claimant's employment status:
A. Is claimant working? (where? what rate of pay/salary?)
B. Not working? (attach vocational rehabilitation reports, describe claimant's educational level, work history, or other factors that would affect employability)

9. _____ Current Medical reports: attach reports that
A. Describe injuries and impairment
B. Describe other unrelated conditions
C. Lists the Maximum Medical Improvement Date
D. Describes anticipated future treatment and disability

10. _____ Statement of Adequacy: please explain in detail how the amount of settlement is an adequate amount given the facts of the case. Be specific.

11. _____ Include the statement "Claimant attests that this settlement was not procured under duress". To protect all the parties involved, every settlement is required to have a statement verifying that the proposed agreement was not forced upon the claimant.

12. _____ Collateral Sources: list any sources claimant has available or is expected to have available to pay medical bills if settlement is approved. *Remember that Medicare is NOT a collateral source*

12. _____ Listing of past 3 years of medical payments: (if meds settled)
Don't use unqualified "past medicals" language to include bills which should be paid.


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