Laserfiche WebLink
CLAIM#7: SB12275 <br /> Claim Number SB 12275 <br /> Date of Injury May 19, 2006 <br /> Description of Accident Occupational disease resulting in bilateral carpal tunnel <br /> syndrome and bilateral tennis elbow. <br /> Date Claim Received by On or about May 19,2006 <br /> Employer <br /> Date of Claim Allowance The claim was allowed by the self insured employer on <br /> • or about May 19, 2006 _ <br /> Date Allowance Order The allowance order became final 60 days after it was <br /> Became Final received, which was on or about July 19, 2006. <br /> Nature and Extent of As a result of the occupational disease, Claimant <br /> Condition and Disability sustained bilateral carpal tunnel syndrome and bilateral <br /> tennis elbow. <br /> Claimant underwent conservative treatment for the <br /> condition. The claimant did not have any permanent <br /> partial disability as a result of this occupational disease. <br /> Attending Physician Unknown <br /> Claim Status The claim was closed as medical only on January 30, <br /> 2007 without any permanent partial disability. <br /> Condition(s) <br /> Accepted Conditions bilateral carpal tunnel syndrome and bilateral tennis <br /> elbow <br /> . <br /> Denied Conditions None _.•_ ____ __ <br /> (Hereafter referred to as Denied Conditions) <br /> Unrelated Conditions None <br /> (Hereafter referred to as Unrelated Conditions) <br /> 3. Claims Not Impacted <br /> The parties agree the scope of this agreement is limited to the Claims outlined above and no other <br /> claims are impacted by this agreement. <br /> 4. No Further Disability Entitlement <br /> In consideration for the lump sum amount listed in Section 6-Lump Sum Payment, the Claimant <br /> relinquishes any further Washington Industrial Insurance Act disability benefits or payments to <br /> which the Claimant may be entitled under the Claim outlined above. Disability benefits include <br /> payment of time loss compensation (wage loss), loss of earning power (partial wage loss), <br /> permanent partial disability. and pension benefits. <br /> 5. Vocational Entitlement <br /> In consideration for the lump sum amount set forth in Section 6-Lump Sum Payment, the <br /> Claimant relinquishes any further Washington Industrial Insurance Act vocational benefits and <br /> services to which the Claimant may be entitled under the Claim outlined above. The Claimant <br /> Chris Guluarte Page 8 of 14 <br />