Fill and Sign the Order Approving Compromise Settlement Mississippi Form

BEFORE THE MISSISSIPPI WORKERS' COMPENSATION COMMISSION       , CLAIMANT vs. MWCC NO.             , EMPLOYER and       , CARRIER ORDER APPROVING COMPROMISE SETTLEMENT This cause came on for hearing this day on Petition of the Claimant, Employer and Carrier seeking approval of a compromise settlement pursuant to Section 7l - 3 - 29 of the Mississippi Code of l972, Annotated. The Commission, having heard and considered said Petition and having been fully advised in the premises, finds as follows: l. That on or about       ,       , hereinafter referred to as Claimant, was employed by       , earning an average weekly wage of approximately $       . That on said date and while was working in the scope and course of employment for said employer, the Claimant alleges that sustained accidental injury when hand slipped into the hole in a garnet wheel and tore fingers. Claimant alleges that was unable to work as a result of said injury until       , upon which date       was released by his/her physician to return to work. 2. That the Claimant received medical treatment and examinations from doctors, hospitals and other persons and entities including       . That the Claimant's primary treating physician was       , and released Claimant to return to work on       , with a       % disability to       . 3. That the Claimant represents that although       did suffer injury to       on the date aforesaid and although       was for a time unable to work, has now recovered and is able to return to his/her former employment as a       or to other similar employment and does not intend to seek or accept any further medical treatment on account of his/her injuries aforesaid. 4. That the Employer and Carrier deny and dispute that the Claimant ever sustained any accidental injuries of any kind and further deny that the Claimant has been seriously disabled at any time or unable to work on account of any physical condition, whether caused by accident or otherwise, and the Employer and Carrier deny that Claimant has suffered any medical or physical impairment or loss of wage earning capacity, temporary or permanent, as a result of any accidental injury sustained while       was in the course and scope of his/her employment with       . Nevertheless, the Employer and Carrier have previously paid to the Claimant the sum of $       as compensation for       temporary total disability from the date of injury to       , and have paid all medical and related expenses incurred by the Claimant. 5. That the Commission finds that in any event the extent of both temporary and permanent disability and/or loss of wage earning capacity sustained by Claimant as a result of alleged accidental injuries is incapable of exact determination. 6. That though denying any further liability to Claimant in the premises, the Employer and Carrier have offered to pay       in addition to such compensation, medical benefits and other benefits as have been previously paid, the sum of       , provided that said sum will be accepted by the Claimant as an accord and satisfaction of any and all claims and causes of action which       may now have or hereinafter have against either the Employer or the Carrier for damages sustained by Claimant to       as a result of the injury on       . 7. That the Claimant has fully discussed the proposed settlement with attorney and represents to the Commission that       fully understands the settlement proposal and its consequences and the Commission finds that it would be in the Claimant's best interest for the settlement to be consummated on the terms and conditions proposed. 8. That the Claimant has employed       , an attorney at law from       , Mississippi, to represent       in this cause and has agreed to pay an attorney's fee of $       to       and the Commission finds that this is a reasonable attorney's fee and that the Claimant should be authorized upon consummation of the proposed settlement to pay from the proceeds of said settlement an attorney's fee of       to       . IT IS, THEREFORE, ORDERED AND ADJUDGED AS FOLLOWS: l. That the said proposed settlement is hereby approved and that Claimant is authorized to consummate the same on the terms and conditions proposed and to execute any and all releases and receipts necessary in order to evidence consummation of same and 2. That Claimant is authorized and directed to pay from said settlement the sum of       to as attorney's fees for representing Claimant herein and 3. That except to the extent of compensation, medical benefits and other benefits previously paid to or for the Claimant on account of said accidental injury as set forth in the Petition filed herein and except for the settlement to be made as set forth herein, all compensation, medical benefits and other benefits are hereby finally denied the Claimant in this cause and Claimant's motion to controvert is hereby fully dismissed with prejudice. SO ORDERED AND ADJUDGED this the       day of       , A. D. MISSISSIPPI WORKMEN'S COMPENSATION COMMISSION BY: ______________________________________________ COMMISSIONER ______________________________________________ COMMISSIONER ______________________________________________ COMMISSIONER APPROVED BY: _______________________________________