The total settlement amount includes the following:

1) future medical or prescription expenses;

2) indemnity benefits;

3) attorney fees;

4) any settlement advances;

5) lien payments (including repayment of Medicare conditional payments);

6) amounts forgiven by the carrier or employer;

7) prior settlement amounts for the same claim; and

8) liability settlement amounts on the same workers’ compensation injury (unless apportioned by a court on the merits).

 

*Note:  If an annuity will be used in the settlement, the expected payout must be included instead of the cost to purchase the annuity