A Drafting Guide for 8(i) Settlements

___ Self sufficient

___ Signed by all parties

___ Contains a brief summary of the facts including:
• date of injury
• name and address of claimant, all employers, insurance carriers and third party administrators
• description of the incident
• description of the nature of the injury
• degree of Impairment
• degree of disability
• availability of the type of work claimant can perform

___ Claimant's:
• date of birth
• date of death and list of dependents with their dates of birth
• work status and ability to work
• educational level, work history, other factors that could effect future employability

___ Benefits:
• summary of compensation paid
• average weekly wage
• compensation rate
• a full description of the terms of the settlement
• settlement amount for compensation
• settlement amount for survivor's benefits
• amount for attorneys fees Itemized in accordance with Section 702.132 (if claimant was
represented by more than one attorney, each attorney should itemize fees)

___ Contains the reason for the settlement and any issues still in dispute

___ Current medical report containing:
• description of injuries relating to impairment
• description of any other unrelated conditions
• date of maximum medical improvement
• anticipated future disability and needed -medical treatment

___ Statement of why settlement is adequate

___ Statement that the settlement was not procured under duress

___ If medical benefits are covered in settlement:
• an Itemized list of amounts paid for medical treatment during the three previous years
• settlement amount for medical treatment
• an estimate of claimant's need for future medical treatment and the cost of the treatment which should indicate the inflation factor and/or the discount rate
• Information on any collateral sources available to pay for future medical expenses
• a statement that the parties have considered Medicare requirements

___ If mental disability or incompetence alleged:
• is there medical opinion/report as to claimant's capacity to understand the consequences of entering into a settlement
• is there an indication that the claimant can administer a lump sum settlement
• If the answer to the above is no, is there a court appointed guardian or personal representative, separate and distinct from the claimant's legal counsel


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