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2022-10-04 IV. Exhibit 5 Added Item GExhibit 5 CITY OF OKEECHOBEE 55 SE THIRD AVENUE OKEECHOBEE, FL 34974 Phone: (863)763-3372 www.cifyofokeechobee.com MEMORANDUM Okeechobee City Council Mayor Dowling R. Watford, Jr. Noel Chandler Monica Clark Bob Jarriel To: City Council Members From: Gary Ritter, City Manager Gloria M. Velazquez, Assistant City Attorney Subject: Consider settlement proposal in the case of: STATE OF FLORIDA, DIVISION OF ADMINISTRATIVE HEARINGS OFFICE OF THE JUDGE OF COMPENSATION CLAIMS (-OJCC'� SAUM, WILLIAM V. CITY OF OKEECHOBEE, CLAIM No.: 2096-436 OJCC No.: 21-027716RLD DATE OF INJURY: 05/15/1995 Date: October 4, 2022 Bobby Keefe A workers' compensation settlement has been reached between the City of Okeechobee and the Claimant. The Claimant is a retired police officer with the City of Okeechobee. The Claimant retired on June 30, 2020. The matter was mediated and the result is this Settlement Agreement. See Attached. The Employer will pay to the Claimant, a lump sum in the amount of $24,000.00. This amount covers all of the City's obligation to the Claimant under the Settlement Agreement. Payment of the aforementioned lump sum is in full satisfaction of the obligation or liability of the Employer to pay any benefits of whatever kind or classification under OJCC Case No. 21-027716RLD. Pursuant to the Settlement Agreement, Claimant shall not seek reemployment. Claim No. 2096-436 Date of Accident: 05/15/1995 Claimant: William Saum Employer: City of Okeechobee 50 SE 3rd Avenue Okeechobee, FL 34974 Staff recommends acceptance of this settlement offer. SETTLEMENT AGREEMENT AND RELEASE Employee/Claimant: William Saum Employer: City of Okeechobee 50 SE 3rd Avenue Okeechobee, FI 34974 OJCC Case No. 21-027716RLD Claim No. 2096-436 Date of Accident: 05/15/1995 THIS AGREEMENT, subject to the terms and conditions as set forth below, is intended to be a complete, entire and final release and waiver of any and all rights, to any and all benefits, past, present and future, that the Employee/Claimant, William Saum, is, or may be, entitled to under Chapter 440, Florida Statutes, (as more fully set forth below), and any other actions, claims, demands, or causes of actions, whatsoever, that the Employee/Claimant may have against the Employer, City of Okeechobee, hereinafter, Employer. I. TERMS OF WORKERS' COMPENSATION SETTLEMENT AGREEMENT AND RELEASE PURSUANT TO 440.20(11)(c)(d) & (e) (2013): A. TOTAL SETTLEMENT AMOUNT: The Employer will pay to the Employee/Claimant, in a lump sum, the amount of $24,000.00, payment of which will be issued within thirty (30) days from the date of Certificate of Service on the Order approving the Motion for Approval of Attorney's Fee and Allocation of Child Support Arrearage for Settlement under Section 440.20(11)(c)(d) & (e). It is understood and agreed by the parties that the terms of this agreement are binding and fully enforceable. B. ALL BENEFITS RESOLVED: Payment of the aforementioned lump sum is in full satisfaction of the obligation or liability of the Employer to pay any benefits of whatever kind or classification OJCC #: 21-027716RLD Page 1 of 13 available under the Florida Workers' Compensation Law, including, but not limited to, temporary total and temporary partial disability benefits, impairment benefits, permanent total disability benefits, permanent total supplemental benefits, supplemental benefits, wage loss benefits, rehabilitative temporary total disability benefits, vocational benefits, required to be provided by the Employer, death benefits, attorney's fees, past, present and future medical benefits, attendant care, prescriptions, orthotics, prosthetics, transportation, or any other benefits contemplated under Florida Statute 440 relating to the alleged accident or occupational disease arising on account of or in connection with an alleged accident, occurrence, incident, exposure, or event which allegedly took place on or about 05/15/1995 when the Employee/Claimant was within the confines of Okeechobee County, Florida. The Employee/Claimant acknowledges by their signature below, that upon payment of the consideration referenced in paragraph I.A. herein, they waives all entitlement to any and all further Workers' Compensation benefits and that the Employer will be fully and forever discharged and released from the obligation or liability to pay any and all benefits of whatever kind or classification payable under the Florida Workers' Compensation Law. The Employee/Claimant stipulates and the parties agree that this Settlement Agreement and Release shall constitute an election of remedies by the Employee/Claimant with respect to the Employer herein. As a result of accepting the above referenced sum, the Employee/Claimant relinquishes all rights for recovery for negligence, intentional torts, employer liability under workers' compensation law, bodily injury and any other potential claims arising under the workers' compensation law and employers' liability policy (including, but not limited, Part II/Coverage B) in effect for the 05/15/1995 date of accident. The undersigned Employee/Claimant accepts and assumes all risk, chance, or hazard that said injuries, damages, manifestations or losses are now or may become greater, more numerous or more extensive than is now know, anticipated or expected; and the undersigned Employee/Claimant agrees that this release applies to all injuries, damages, manifestations or losses of every kind and character which have arisen, or which may hereafter arise, even though now unknown, unanticipated or unexpected. The undersigned Employee/Claimant hereby acknowledges full responsibility for all future medical benefits. OJCC #: 21-027716RLD Page 2 of 13 C. ATTORNEYS FEES: 1. FEES/COSTS PAID BY THE EMPLOYEE/CLAIMANT: The Employee/Claimant will pay to the attorney the sum of $6,000.00, out of the above settlement. Additionally, the Employee/Claimant shall pay the sum of $ , as costs. The fee and non-taxable costs shall be paid from the settlement proceeds thereby making the net settlement amount of $ 2. PRIOR REPRESENTATION: The Employee/Claimant will be responsible for any and all attorney's fee liens filed or held by any prior attorney, for representation of the Employee/Claimant. The Employee/Claimant agrees to indemnify and hold the Employer harmless as to any attorney fee liens. D. CHILD SUPPORT ARREARAGE: The Employee/Claimant agrees that, if there is any outstanding child support, it shall be deducted from the Employee/Claimant's net settlement proceeds pursuant to the Motion for Attorney Fee Approval and Child Support Allocation. Any payments to child support shall be made by the Claimant's Counsel from the Employee/Claimant's net settlement proceeds. The Employer shall in no way be responsible for any child support owed by the Employee/Claimant. The Employee/Claimant also stipulates and agrees that the Employer shall be indemnified and held harmless against any action brought by any third party for payment of child support arrearage. E. THIRD PARTY LIENS The Employer does not waive any lien rights pursuant to Florida Statute 440.39 and the lump sum benefits paid herein shall be included in the amount thereof. The Employee/Claimant agrees to give written notification to the Employer or their attorney as to the filing of any suit against third parties arising out of the accident or injuries giving rise to this claim and to advise as to any recovery received from third parties OJCC #: 21-027716RLD Page 3 of 13 arising out of the accident or injuries which are the subject matter of this claim. The Employee/Claimant further agrees that no proceeds from any third -party claim shall be disbursed prior to satisfaction of the Employer's lien. II. STIPULATED FACTS: A. MEDICAL CARE: The Employee/Claimant understands and acknowledges that this claim was controverted by the Employer and is being settled on a controverted basis. The Employee/Claimant understands that the Employer is not responsible for any medical bills and that the Employee/Claimant shall be responsible for all medical bills as described in more detail below. III. SPECIFIC WAIVERS AND REPRESENTATIONS: A. WAIVER OF RIGHT TO HAVE CASE HEARD BY JUDGE OF COMPENSATION CLAIMS AND RIGHT TO BRING PETITION FOR MODIFICATION: The Employee/Claimant understands that he does hereby relinquish the right to have any unresolved conflicts or disputes involving the right to monetary compensation benefits, impairment benefits, death benefits, attorney's fees, past due medical benefits, future medical benefits, and rehabilitation benefits heard and decided by the Judge of Compensation Claims. The Employee/Claimant also understands that this Settlement Agreement and Release shall not be reviewed by the Judge of Compensation Claims in accordance with Florida Statute section 440.20(11)(c). In addition, the Employee/Claimant also understands that the Order approving the Motion for Approval of Attorney's Fee and Allocation of Child Support Arrearage for Settlement under Section 440.20(11)(c)(d) & (e) is not an award under the Florida Workers' Compensation Act and is not subject to modification or review. B. WAIVER OF PENALTIES AND INTEREST: OJCC #: 21-027716RLD Page 4 of 13 The Employee/Claimant does hereby waive any right he may have to any and all penalties and/or interest on account of the alleged accident or occupational disease referenced herein. C. RIGHT TO FUTURE MEDICAL CARE CLOSED: As provided under Florida Statutes section 440.20(11)(c), the lump sum payable herein will fully discharge and satisfy the Employer's liability, to provide future remedial and palliative medical care under Florida Statute section 440.13 and 440.134, including, but not limited to, follow up examinations, pain medication, diagnostic testing, attendant care, and surgery. The Employer shall not be liable for any past or future medical benefits resulting from the alleged accident or occupational disease referenced herein. Any past or further/future medical expenses will be the sole responsibility of the Employee/Claimant. The Employee/Claimant agrees to notify his treating physicians' that they is alone fully financially responsible for any and all medical care and treatment. The Employee/Claimant has considered or had the opportunity to consider any and all reports submitted by medical providers and rehabilitation providers. In addition, the Employee/Claimant has consulted with or had the opportunity to consult with medical providers and rehabilitation providers. The Employee/Claimant stipulates and agrees that he has determined that the amount of money being proposed to settle medical care and treatment is reasonable and adequate to meet the Employee/Claimant's future medical needs, in connection with the alleged accident, occurrence, incident, exposure or event, which allegedly took place on or about 05/15/1995. D. ALL KNOWN ACCIDENTS, INJURIES AND OCCUPATIONAL DISEASES REVEALED AND ALL PENDING CLAIMS AND/OR PETITIONS FOR BENEFITS WITHDRAWN AND/OR ACTIONS WAIVED: The Employee/Claimant represents and affirms that all accidents, injuries, and occupational diseases known to have occurred or sustained while employed by City of Okeechobee, have been revealed to the Employer. All pending Claims/Petitions for Benefits are hereby voluntarily withdrawn and dismissed, with prejudice. It is stipulated and agreed that no accidental injuries or occupational diseases other than that specifically mentioned herein have been sustained, while the Employee/Claimant was employed with the City of Okeechobee. This settlement represents a settlement of any and all claims or actions that may arise from the accident referenced herein and any claims or actions that OJCC #: 21-027716RLD Page 5 of 13 may have arisen out of the Employee/Claimant's employment with the City of Okeechobee, whether reported or unreported. As part of this settlement, the Employee/Claimant further specifically agrees to release and discharge the Employer, City of Okeechobee, its officers, agents, servants, employees, directors, successors, assigns, and any other person or entity so connected to the Employer, of any and all claims relating to retaliatory discharge under section 440.205, Florida statutes. In addition, as further consideration for such payment, the Employee/Claimant agrees and does hereby release, discharge, and surrender any and all claims, whether or not asserted, against the Employer, City of Okeechobee, , or any of their officers, agents, servants, employees, directors, successors, assigns, and any other person or entity so connected to the Employer, of any nature whatsoever, without limitations thereof. E. PAYMENT OF PAST MEDICAL BILLS: As this claim is controverted and is being settled on a controverted basis, the Employer does not agree to pay any bills from any health care providers/facilities and the Employee/Claimant stipulates and agrees that they is solely responsible for resolving and satisfying any liens or attachments filed by any such health care provider/facility. The Employee/Claimant also stipulates and agrees that they is not aware of any liens or attachments, filed by any health care provider/facility. Moreover, the Employee/Claimant stipulates and agrees that the Employer shall be indemnified and held harmless, against any action brought by any third party for payment of past medical bills. The Employee/Claimant stipulates and agrees that they is not aware of any liens or attachments, filed by any health care provider/facility or Medicare, including Medicare Advantage Organizations, its assignees, and/ or its subcontractors, or Medicaid. Moreover, the Employee/Claimant stipulates and agrees that the Employer shall be indemnified and held harmless against any action brought by any third party for payment of past medical bills. The Employee/Claimant shall be responsible for any Medicare, including Medicare Advantage Organizations, its assignees, and/ or its subcontractors, or Medicaid liens. OJCC #: 21-027716RLD Page 6 of 13 F. FULL AND COMPLETE KNOWLEDGE: The Employee/Claimant acknowledges that they has full and complete knowledge of all pertinent and material facts in the instant claim and it is their desire to settle this claim, fully and finally, consistent with and under the provisions of Section 440.20 of the Florida Statutes. The Employee/Claimant has entered into this agreement after full discussion and consideration of the matter and with full knowledge of the reports and opinions of the Employee/Claimant's treating physicians and rehabilitation counselors, as well as the Employee/Claimant's own estimate of their physical condition. The Employee/Claimant further represents that their rights under the Florida Workers' Compensation Law have been explained to their satisfaction and that they made independent inquiry concerning the reasonableness of the settlement and medical and disability status or has waived the opportunity to do so. The Employee/Claimant understands that if this case were not settled, the Employee/Claimant would have a period of time in which to make a further claim against the Employer herein because of alleged injuries suffered in this alleged accident. The Employee/Claimant feels it is advantageous and in their best interest to terminate this litigation and accept the settlement agreed to hereunder in full and final adjudication and settlement of this claim to compensation and medical benefits. The Employee/Claimant understands that the Employer also waives substantial rights in settling this claim. The Employee/Claimant also understands that if they initiates legal proceedings pertaining to this Settlement Agreement and Release, after the Judge of Compensation Claims approves that Motion for Approval of Attorney's Fees and Allocation of Child Support Arrearage for settlement under Section 440.20(11)(c)(d) & (e), the Employee/Claimant shall be liable to the Employer for all its' expenses, including reasonable attorney's fees incurred during the proceeding. As a further consideration and inducement for this compromise settlement, the undersigned Employee/Claimant agrees to indemnify, protect, and hold harmless all the parties named in this Settlement Agreement and Release and all other persons, firms, and corporations whomsoever, from all judgments, costs, attorney's fees and expenses whatsoever arising on account of any action, claim or demand including but not limited to the following: all claims for subrogation, workers' compensation liens, bills and any and all claims under any Federal, State or local income disability act; any claim under the Americans with Disabilities Act; any other public programs providing medical expenses, OJCC #: 21-027716RLD Page 7 of 13 disability payments or other similar benefits; any and all claims under Medicaid, Medicare, including Medicare Advantage Organizations, its assignees, and/ or its subcontractors; any and all claims for reimbursement or subrogation under any group medical policy, individual medical policy or any health maintenance organization; any and all claims for reimbursement or subrogation under any health, sickness, or income disability insurance, automobile accident insurance, and any other similar insurance that provides health benefits or income disability coverage; any and all claims for reimbursement or subrogation under any contract or agreement with any group, organization, partnership or corporation which provides for the payment or reimbursement of medical expenses or wages during the period of disability; and any and all actions, claims, demands whatsoever of any type or nature which may hereafter be brought or asserted against the parties named in this Settlement Agreement and Release, on account of any injury, loss or damage resulting from the accident, occurrence, incident or event aforesaid. The undersigned Employee/Claimant warrants that no promise or inducement not herein expressed has been made; that in executing this Release the undersigned Employee/Claimant is not relying upon any statement or representation made by any person, firm or corporation hereby released or any agent, physician or doctor or other person representing them or any of them concerning the nature, extent or duration of the injuries, losses or damages here involved or the legal liability therefore, or concerning any other thing or matter; that the payment of the above -mentioned sum is in compromise and in full satisfaction of the aforesaid actions, claims and demands whatsoever; that the undersigned Employee/Claimant is over the age of twenty-one (21) years and legally competent to execute this Settlement Agreement and Release and that the undersigned Employee/Claimant is fully informed of the contents of this Settlement Agreement and Release and signs it with full knowledge of its meaning. G. VOLUNTARY SEPARATION AGREEMENT As a result of an irreparable Employer/Employee relationship, it is stipulated that the Employee/Claimant voluntarily separated from his employment and will not seek re-employment with City of Okeechobee. The agreement to voluntarily separate and not seek re-employment is not being entered into due to any disabilities the Employee/Claimant may allege and is not the sole consideration for settlement of the claim referenced herein. The Employee/Claimant's voluntary separation from further employment with City of Okeechobee became effective on June 30, 2020. OJCC #: 21-027716RLD Page 8 of 13 H. VOLUNTARY SETTLEMENT: The Employee/Claimant understands that he, like the Employer, does not have to settle and is doing so freely, voluntarily and with no duress or coercion from anyone. The Employee/Claimant also affirms that he is mentally competent and understands all of the terms of this agreement and the consequences therefrom and further has had advice of counsel, with whom the Employee/Claimant is satisfied. The Employee/Claimant further understands that they has the right to take any claims/petition for any Workers' Compensation benefits to a hearing to have said claim/petition heard by a Judge of Compensation Claims and that by settling, gives up that right permanently. The Employee/Claimant represents that they has read this Settlement Agreement and Release and hereby acknowledges that they understands and accepts all of the terms and conditions herein and that he has done so with the advice of counsel. I. MEDICARE CONSIDERATIONS: Pursuant to Federal Regulations, and in accordance with internal guidelines issued by the Centers for Medicare and Medicaid Services ("CMS"), Medicare's interests must be considered in a workers' compensation settlement where a claimant is already a Medicare beneficiary and the total settlement amount is greater than $25,000.00; or in such cases wherein there is a reasonable expectation that the claimant will be eligible to receive Medicare benefits within thirty (30) months of the settlement date and the anticipated total settlement amount is expected to be $250,000.00 or greater. In the present matter, there is no reasonable evidence that the Employee/Claimant is currently a Medicare beneficiary or will become a Medicare beneficiary, including a beneficiary of a Medicare Advantage Plan, prior to the effective date of this Settlement Agreement and Release. Specifically, the Employee/Claimant affirms and states that the Employee/Claimant is not current receiving any Medicare benefits, including benefits under a Medicare Advantage Plan, will not become a Medicare beneficiary prior to the effective date of this Settlement Agreement and Release, and the settlement is under $250,000.00. In addition, the Employer has received no notice from Medicare, including Medicare Advantage Organizations ("MAOs"), their assignees, and/ or their subcontractors, CMS or any other third party that the Employee/Claimant is a Medicare beneficiary, including a beneficiary of Medicare Advantage Plan, or will become a OJCC #: 21-027716RLD Page 9 of 13 Medicare beneficiary prior to the effective date of this Settlement Agreement and Release. The parties have not considered the receipt of any Medicare, including MAOs, their assignees, and/ or their subcontractors, or Medicaid assistance for the purpose of an alternative means of medical recovery pursuant to negotiations. The settlement reached herein has been based upon the full anticipated value of future workers' compensation indemnity and medical benefits exposure offset by future uncertainty as to the nature and extent of the Employee/Claimant's entitlement to these benefits, and available statutory defenses. In the event of Medicare, including MAOs, their assignees, and/ or their subcontractors, or CMS make a claim for past or future Medicare benefits, Medicare Advantage Plan benefits, Medicaid asserts a lien, or there are any child support liens, arrearages, orders, obligations or claims, on any part of this settlement, the Employee/Claimant agrees to fully and completely indemnify, defend and hold harmless the Employer against any resulting obligation, claim, penalty, fine, or lien. The Employee/Claimant expressly agrees to accept full liability for any prior attorney liens for representation or benefits acquired for the Employee/Claimant in relation to the industrial accident(s) and the Employee/Claimant's counsel agrees to hold settlement proceeds in trust until any prior attorney lien, if any, is resolved. The Employee/Claimant acknowledges that the Employee/Claimant has not relied on any representations, advice or counsel of the Employer, their attorneys, agents or adjusters regarding the Employee/Claimant's entitlement to Social Security, Medicare, Medicare Advantage Plan, or Medicaid benefits or the impact the terms of this Settlement Agreement and Release may have on such benefits. The Employee/Claimant further acknowledges that any decision regarding entitlement to Social Security, Medicare, Medicare Advantage Plan, or Medicaid benefits, including the amount and duration of payments and offset or reimbursement for prior or future 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. As such, the United States Government is not bound by all the terms of this agreement. The Employee/Claimant has been advised of their right to seek assistance from legal counsel of their choosing or directly from the Social Security Administration or other governmental agencies regarding the impact this agreement may have on the Employee/Claimant's OJCC #: 21-027716RLD Page 10 of 13 present or future entitlement to Social Security, Medicare, Medicare Advantage Plan, Medicaid, or other governmental benefits. Notwithstanding the foregoing, the Employee/Claimant desires to enter into the terms of this Agreement and release of claims. OJCC #: 21-027716RLD Page 11 of 13 This Settlement Agreement and Release was Employee/Claimant on this day of and by the attorney for the Employee/Claimant on this 20 , and by the attorney for the Employer on this ,20 signed by the 20 day of day of William Saum, Claimant Michael Clelland, Esquire Attorney for Employee/Claimant Mr. Michael Clelland Morgan & Morgan (Orlando) 20 N Orange AVE Orlando, FL 32802 407-420-1414 Kelly Schaet, Esquire Attorneys for Employer SCHEFER PETRIC & SIMPSON 1645 Palm Beach Lakes Blvd Suite 350 West Palm Beach, FL 33401 561-537-8040 OJCC #: 21-027716RLD Page 12of13 STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me by means of ❑ physical presence or ❑ online notarization, this day of , 20_ by William Saum, who is personally known to me or who has produced as identification SWORN TO AND SUBSCRIBED before me, by means of ❑ physical presence or ❑ online notarization, this day of , 20 William Saum NOTARY PUBLIC, State of Florida My Commission Expires: (Print, Type or Stamp Commissioned Name of Notary Public) OJCC No: 21-027716RLD Page 13 of 13