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Workers Compensation Settlement Agreement
"Need a Workers Compensation Settlement Agreement for a manufacturing employee who suffered a back injury, with a settlement sum of $25,000 to be paid in tHRee installments, including ongoing physiotherapy coverage for 6 months from March 2025."
1. Parties: Identification of the employer and employee involved in the settlement
2. Background: Details of employment relationship, incident/injury, and claim history
3. Definitions: Key terms used in the agreement including 'Injury', 'Claim', 'Settlement Sum'
4. Settlement Terms: Detailed breakdown of compensation amount and payment terms
5. Release and Discharge: Employee's release of all claims related to the injury
6. Compliance with WICA: Confirmation that settlement complies with Work Injury Compensation Act requirements
7. Execution: Signature blocks and witnessing requirements
1. Medical Benefits: Additional provisions for ongoing medical treatment and future medical expenses
2. Confidentiality: Non-disclosure obligations regarding the terms and existence of the settlement
3. Return to Work: Terms and conditions for employee's return to work including any modifications to duties
4. Tax Implications: Clarification of tax treatment for settlement payments and responsibilities
1. Schedule 1 - Medical Reports: Copies of relevant medical reports and assessments documenting the injury and treatment
2. Schedule 2 - Calculation of Settlement Sum: Detailed breakdown of compensation calculation including all components
3. Schedule 3 - Payment Schedule: Timeline and details of settlement payment installments if applicable
4. Schedule 4 - MOM Approval: Copy of Ministry of Manpower approval documentation where required
5. Schedule 5 - Insurance Documentation: Relevant insurance policies and coverage details related to the claim
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