Hi Wink, Yes that was me....I am retired from Police Chief position after a accident at work.

This is the portion of the C&R that is of interest, IF you receive social security it is written in this amanner...no biggie, just added piece of work to the attorney's to calculate I assume.
Hope this helps...(I am going through this with my son and W/C telling him, oh good you do not ahve SSDI, that makes it easier, LOL for them not him!)



Compromise and Release Agreement (this is Pennsylvania)
By Stipulation Purseant to Section 449 of the Worekers Comensation Act.

1. This agreement in the case of the above listed employee
2. State the date of injury or disease
3. State weekly was of employee
4. State the injury, the percise nature of the injury: (The Diax here)
5. The payable amount
6.State indeminty benefits (non)
7. State the amount of the payment of ideminity benefits to be made at or after the date of the stipulation or agreement or death, and the length of time such as payment of benefits is to continue.$_(amount of setlement)__
for lum sum.
8. (these were not used..it refers to death of employee

9. This compromise and release is for wage loss only. all reasonable and necessary related medical expenses incurred by the claimant, after the date of this agreement the payment of reasonable and necessary with request to the wok injuries in paragraph #4.

10. Sumerize all benefits -Please see paragraph 9 of this agreement

11. IS there acualt or potential lien for this agreement _ yes _ no
(my workers comp agreement stated yes against my car accidnet if I recovered monies)

12. Current child or spousal support orders in place against the client ___yes ____no

13. Claimant is presently receiving Medicaid and Social security disability benefits. Out of the sttlenment amount claimant is paying $XXXX in attorney's fees. Claimant will net the sum $ XX,XXX. Claimants remaining life expectancy, based upon her birthdate of XXXX X, XXXX (according to the National Center for Health Statistics, Vital statistics at the United States 1989, Life table vol. II, section 6 DHHS Publication (no. PHs) 92-1104. Public Health Service Washinton, US Government Printing office 2004) is 52.2 years or 624.4 months. Therefore, even though the above settlement is paid in a lump sum, Claimant's monthly Workers Compensation benefits for the purpose of determining the set-off by the social security Adminsitration shall be $20.75 per month for the 624.4 months, commensing June XX, XXXX. the last day of payment of temporary total disability benefits. See Sciarotta Vs Rowen 837 F 2d 135. 140-141 (3d Cir......unreadable.
(I was not yet receiving Soc sec benfits but, mine was written similary) My structure is $1.44 a month set-off)