Chris Guluarte 1/3/2022 - Laserfiche WebLink

13. Future Claims If the Claimant returns to work, and suffers a further industrial injury or occupational disease, the Claimant may file a new claim and receive appropriate benefits if the claim is allowed. 14. Parties' Understandings The parties acknowledge that each understands and agrees to the terms of this agreement,and has entered into this agreement knowingly and willingly. No party has been harassed or coerced to participate in this agreement. The parties have represented the facts and the law to each other to the best of their knowledge. The parties represent this agreement is not the result of a material misrepresentation of law or fact and the agreement is reasonable under the circumstances. Finally, the parties acknowledge and agree this agreement will bind each to all aspects of the above referenced claims except for medical benefits. Claimant Understands i) Industrial Insurance Benefits: The Claimant acknowledges, agrees and understands by entering into this agreement the Claimant will receive no other benefits related to the above referenced claims except as outlined in this agreement. The Claimant acknowledges that the Claimant could have continued to pursue additional benefits under the above referenced claims (benefits such as financial disability payments or additional vocational services), but instead opted to enter into this agreement. The Claimant understands his rights under RCW 51.04.063. ii) Claimant has retained counsel and has discussed this matter privately with his counsel. iii) Other Benefits Potentially Impacted: The Claimant acknowledges, agrees and understands that by entering into this agreement there is a chance that other government benefits that the Claimant is receiving, or may be entitled to receive in the future, may be impacted.• 1) Medicare Benefits The Claimant understands since this agreement does not compromise any rights to medical treatment under the Claim, there should be no impact on Medicare benefits. 2) Other Benefits The Claimant is not receiving Social Security Retirement benefits or any other benefits. 15. Medicare Coverage The parties acknowledge and agree it is not the purpose of this agreement to shift the responsibility for payment of medical expenses for the treatment of the April 25, 2017 industrial injury or occupational disease related conditions to Medicare. Medicaid or any other government program. Claimant understands that should Centers for Medicare and Medicaid Services (Medicare) find that a Medicare Set-Aside Allocation should have been established and that Medicare's interests Chris Guluarte Page 11 of 14