Erin Westvang 10/12/2023 - Laserfiche WebLink

No other employer is subject to any responsibility or burden under the Claims or any other claim. 2. Criteria to Settle the Impacted Claims The parties agree that the following information is true and correct. Page Claimant Criteria to Settle Date Claimant of Birth and Age of' 01/ 59 years 14/1964 old Gender Female Life Claimant Expectancy of 86.1 Security an (26.5 (26.5 additional years years years Administration. pursuant x x 26.5 12 months 52 weeks years. to the Claimant = tables 318 1,378 months) weeks) provided is expected by the Social to live = Marital Status Married Dependents None Other Benefits The Everett Claimant benefits. Claimant in does the receives amount not receive a of pension $1,020.00 any Social from per Security the City or of The other month. CLAIM 1 Claim Number SH-28579 Date of Industrial Injury O1/30/2014 Description of Accident The neck wheelchairs Claimant and left sustained shoulder an driving occupational bus disease and assisting to her Nature Condition and and Extent Disability of The disability 3% claims settlement. of Claimant the and of left a Category upper subsumed was rated extremity 3 for within for cervical already a the permanent impairments paid value under of partial prior this and Date Claim Received 01/31/2014 Date of Claim Allowance 04/02/2014 Allowance Final Order the already On or Claimant's about paid. 06/10/2014, receipt of approximately the order with 60 days benefits after as Date Became