Chris Guluarte 1/3/2022 - Laserfiche WebLink

were not adequately protected,Medicare may require the Claimant to expend the entire lump sum amount on Medicare-covered expenses related to the Claimant's industrial injury or occupational disease before Medicare will provide additional coverage for those conditions. As noted in Section 10—Reopening, the Claimant's right to future treatment for the industrial injury or occupational disease is not being compromised by this agreement; therefore, the Claimant and the Employer do not expect that there will be any impact to the Claimant's Medicare benefits, nor any need for a Workers' Compensation Medicare Set-Aside (WCMSA). Nevertheless, the Claimant voluntarily accepts this risk and waives any and all claims of any nature and/or damages against the self-insured employer should Medicare take such action, including but not limited to a Private Cause of Action against the Self-Insured Employer under the Medicare Secondary Payer Act (MSP) pursuant to 42 USC § 1395y(b)(3)(A). The Claimant acknowledges that any decision regarding entitlement to Social Security Medicare or Medicare/Medicaid benefits including the amount and the duration of payments and offset reimbursement for prior payments is exclusively within the jurisdiction of the Social Security Administration, the United States government, and the United States federal courts and is determined by federal law and regulations. As such, the United States government is not bound by any of the terms of this agreement. If the accepted medical conditions outlined in this agreement should worsen and require treatment, the Claimant understands and accepts responsibility to seek treatment for those conditions by following the process outlined in Section 10—Reopening. To the best of the parties' abilities, they have tried to be clear this agreement covers only the medical conditions accepted and covered under the Claim, as outlined in this agreement. Other medical conditions are not covered except as provided in Section 10-Reopening. The Claimant's right to future treatment for conditions allowed in the Claim listed above is not being compromised by this agreement. 16. Assignability The Claimant will not and has not already agreed to sell,mortgage,encumber or otherwise assign any part of the payments. All payments will be made to the Claimant except in the event of the Claimant's death. In the event of the Claimant's death prior to the final payment, payment will be made in accordance with Section 17-Claimant's Beneficiaries. 17. Claimant's Beneficiaries In the event of the Claimant's death prior to payment, the payment will be made in accordance with Section 6-Lump Sum Payment to Diane Guluarte, spouse of claimant. 18. Attorney Fees Each party will pay all attorney's fees and costs arising from the actions of its own counsel in connection with the administration of the Claim and this agreement up to the date this agreement becomes final. This provision is not intended to affect any rights the Claimant may have under RCW 5 1.52.1 30 to obtain attorneys' lees in any future superior court appeal regarding the Claim. Chris Guluarte Pate 12 o1 1.1