Opinion ID: 1999216
Heading Depth: 1
Heading Rank: 5

Heading: workers' compensation release

Text: WHEREAS, Grazina Kulawas, of the Town of East Greenwich, State of Rhode Island, claims that on or about April 5, 2005, she suffered a work-related injury, to wit, a right femur fracture, which arose out of and in the course of her employment, which claimed injury is alleged to have been compensable under the provisions of the Rhode Island Workers' Compensation Act. WHEREAS, the said employer, Rhode Island Hospital/Lifespan and their workers' compensation insurance carrier, The Beacon Mutual Insurance Company, denies the claimed work-related injury of the said petitioner, and WHEREAS, there is a bona fide dispute existing between the parties as to whether or not the said petitioner is entitled to-workers' compensation benefits for the claimed injury under the Workers' Compensation Act of the State of Rhode Island, and WHEREAS, the said petitioner requests and desires the payment from the said respondent of the sum of Forty-Eight Thousand ($48,000.00) Dollars to her in lieu of all payments of workers' compensation for total, partial or specific compensation and all other expenses including medical and hospital expenses under the Workers' Compensation Act of the State of Rhode Island, which amount under all the circumstances is admitted by all parties to be fair, adequate and reasonable. NOW THEREFORE, I, Grazina Kulawas, for and in consideration of the sum of Forty-Eight Thousand ($48,000.00) Dollars to me, paid by Rhode Island Hospital/Lifespan and their workers' compensation insurance carrier, The Beacon Mutual Insurance Company, the receipt of which is hereby acknowledged, do hereby remise, release and forever quitclaim unto the said Rhode Island Hospital/Lifespan and their workers' compensation insurance carrier, The Beacon Mutual Insurance Company, its successors and assigns, all due debts, claims, demands, actions or causes of actions, which I now have, ever had or in the future may have against said Rhode Island Hospital/Lifespan and their workers' compensation insurance carrier, The Beacon Mutual Insurance Company, for the claimed injury under the provisions of the Workers' Compensation Statute of the State of Rhode Island, and more specifically any and all claims for compensation whether total, partial or specific, medical, hospital and any and all other expenses and any and all other payments provided for under the said Workers' Compensation Act of the State of Rhode Island, by reason of the aforesaid claimed work related injury. Without in any way limiting the foregoing, I hereby state that I voluntarily seek and desire the payment of the aforesaid sum, that I know of the petition now pending in the Workers' Compensation Court in the State of Rhode Island wherein I am seeking compensation, medical expenses and other payments under the Workers' Compensation Act of the State of Rhode Island; that I hereby expressly authorize my attorney, Gregory L. Boyer Esquire, to assent to a decision, decree or stipulation to be filed in the Workers' Compensation Court whereby my petition for compensation for the claimed injury and all other relief under the Workers' Compensation Act of the State of Rhode Island shall be denied and dismissed as a nonwork-related injury; that I further understand that by my acceptance of the aforesaid sum of money and by the entry of the aforesaid decision, decree or stipulation, I have set up an effective bar against my recovering any additional sum or sums of money for the claimed injury, under the Workers' Compensation Act of the State of Rhode Island, and that I voluntarily seek and desire payment of the aforesaid sum having full knowledge of the above facts. This release is specific to the claim that the injury is work-related and does not bar possible nonwork-related claims. IN WITNESS WHEREOF, I have hereunto set my hand and seal in duplicate original in Providence on this 2nd day of March, A.D., 2006. /s/ Grazina Kulawas Grazina Kulawas Executed in the presence of: /s/ [Signature] STATE OF RHODE ISLAND PROVIDENCE, SC. On this 2nd day of March, 2006, before me personally appeared Grazina Kulawas, to me known and known by me to be the party described in the aforesaid instrument and who executed the above instrument and acknowledged to me that she executed the same. /s/ [Signature] Notary Public