William Cantrell is a 65-year-old workers’ compensation claimant who was employed by the Escambia County Board of County Commissioners as a heavy equipment operator. His date of birth is May 6, 1950, and he was employed for just over two years prior to his work-related accident. On November 6, 1992, Mr. Cantrell was involved in a serious motor vehicle accident in the course of County employment. A truck driver ran a red light and struck the claimant’s vehicle. As a result of the accident, the claimant sustained injuries to head, ears, neck, right shoulder, both wrists, and lower back.

Following the accident, Mr. Cantrell underwent several surgeries for his numerous injuries with follow-up care. Mr. Cantrell was ultimately diagnosed with permanent injuries to his head, neck, right shoulder, and lower back. He was assigned permanent impairment ratings of twenty percent for his head injury, ten percent for his neck injury, seven percent for his shoulder injury, and eight percent for his back injury.

After reaching overall Maximum Medical Improvement in 1994, the County commenced payment of Permanent Total Disability (PTD) benefits. Mr. Cantrell has continued to receive PTD benefits since that time. Utilizing a four percent discount factor, the present value of future PTD exposure amounts to more than $160,000.00.

Mr. Cantrell has elected not to pursue medical treatment in conjunction with his workers’ compensation claim since 2002.  Pursuant to federal law, when considering the settlement of any workers’ compensation claim involving a Medicare beneficiary (such as the claimant in this case), the County is required to account for the interests of the Centers for Medicare & Medicaid Services (CMS). In order to comply with this requirement, the County recently obtained CMS approval of a Medicare Set-Aside allocation in the amount of $9,977.00. Essentially, CMS determined that this amount from the proposed settlement is sufficient to adequately account for Mr. Cantrell’s anticipated future Medicare-covered treatment.

Midwest Employers Casualty Company (Midwest), the excess insurer for this claim, will ultimately be responsible for reimbursing a substantial portion of the proposed settlement funds. The self-insured retention for this claim amounts to $300,000.00. Medical and indemnity benefits paid to date amount to $198,494.35. Accordingly, if the Board of County Commissioners approves the proposed settlement agreement, the County will ultimately be responsible for a maximum of $101,505.65 of the settlement proceeds. With respect to the total settlement amount of $150,000.00, Midwest will reimburse a minimum of $48,494.35. Please note that, in accordance with the provisional settlement agreement, Mr. Cantrell will continue to receive PTD benefits through the date that the Judge executes the required settlement Order. Thus, by the time the settlement is finalized, the ultimate reimbursement from Midwest will likely exceed the current figure of $48,494.35.

In light of the potential exposure associated with this claim, Mr. Brian Hanley, the attorney retained by the County's workers' compensation carrier, respectfully recommends that the Board of County Commissioners approve the proposed settlement agreement. This office and the Risk Manager are in agreement.