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Erin Westvang 10/12/2023
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Erin Westvang 10/12/2023
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Last modified
10/13/2023 10:32:23 AM
Creation date
10/13/2023 10:30:46 AM
Metadata
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Template:
Contracts
Contractor's Name
Erin Westvang
Approval Date
10/12/2023
Council Approval Date
9/13/2023
Department
Human Resources
Department Project Manager
Marcy Hammer
Subject / Project Title
Claim Resolution Settlement Agreement Between Erin Westvang and the City of Everett
Tracking Number
0003982
Total Compensation
$170,000.00
Contract Type
Agreement
Contract Subtype
Settlement Agreements
Retention Period
6 Years Then Destroy
Imported from EPIC
No
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The Claimant is not currently receiving Social Security Disability benefits, but she has <br />been advised by legal counsel that there is a risk any future benefits may be offset by <br />the Social Security Administration. Nevertheless, the Claimant believes this agreement <br />is in her best interests <br />ii. Medicare Benefits, <br />The Claimant further understands that because this agreement does not compromise <br />any rights to medical treatment under the Claims, there should be no impact on <br />Medicare benefits. <br />Other Benefits <br />The Claimant has confirmed that any other benefits that the Claimant may receive <br />will not be impacted by this agreement <br />b) Self -insured Employer Understands <br />i Allowance Order: The Self -insured Employer acknowledges, agrees, and <br />understands this agreement does not set aside or reverse the allowance orders on <br />the Claims. <br />ii. Assessment Impact: The Self -insured Employer acknowledges, agrees, and <br />understands the total lump sum payment of $170,000.00 will be considered a <br />claim cost and will be reported to the Department of Labor and Industries <br />(Department) in the Employer's quarterly assessment, <br />iii, No Other Funds Impacted: The Employer represents this agreement does not subject <br />any Department funds covered under RCW Title 5I to any responsibility or burden <br />without prior approval from the director or designee. <br />15. Medicare Coverage <br />The parties acknowledge and warrant that it is not the purpose of this agreement to shift the <br />responsibility for payment of medical expenses for the treatment of industrial injury or <br />occupational disease -related conditions to Medicare, Medicaid, or any other government <br />program. <br />If the accepted medical conditions outlined in this agreement should worsen and require <br />treatment, the Claimant understands and accepts responsibility to seek treatment for those <br />conditions by following the process outlined in Section 10—Reopening. To the best of the parties' <br />abilities, they have tried to be clear that this agreement covers only the medical conditions <br />accepted and covered under the Claims, as outlined in this agreement. Other medical conditions <br />are not covered except as provided in Section 10-Reopening. <br />The Claimant's right to future treatment for the industrial injury or occupational disease related <br />conditions is not being compromised by this agreement; therefore, the Claimant and the Employer <br />do not expect that there will be any impact to the Claimant's Medicare benefits. Nevertheless, the <br />Page j 11 <br />
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