FILED September 24, 2020 TN COURT OF WORKERS’ COMPENSATION CLAIMS Time 4:16 p.M, EASTERN TENNESSEE COURT OF WORKERS’ COMPENSATION CLAIMS BUREAU OF WORKERS’ COMPENSATION MICHAEL WATKINS, DOCKET NO. 2020-03-0243 Employee, STATE FILE NO. 13065-2020 Vv. RFA NO. 2020250128 © G.UB.MK CONSTRUCTORS, INC. DATE OF INJURIES: 07/20/18' Employer, AGREED COMPENSATION ORDER OF DISMISSAL WITHOUT PREJUDICE Upon Motion and Agreement of the parties and counsel, after telephonic and email consultations with Specialist Madeline Shelly prior to the scheduled mediation on Thursday, September 24, 2020, and the parties agreement to an Order of Dismissal Without Prejudice of the Employee’s alleged occupational exposure illnesses and/or injuries arising from the Employee's work, from time to time, for the Employer at wenioUs TVA sites during the time period of September 28, 2011 to most recently March 29, 20192, as a commercial truck driver, the parties submit this Agreed Order for approval and entry by the Court of Workers’ Compensation Claims. While the parties dispute the compensability of the occupational exposures and illnesses alleged in this matter, the parties stipulate that the Employee has a third party ' The date of injury and compensability of this claim is disputed. For the purposes of the Petition for Benefit Determination in this matter, the date of injury used is the last date the Employee worked for the Employer. 2 Personnel records obtained in preparation for mediation indicate the Employee worked for G.UB.MK on several occasions after 07/20/18 as a commercial truck driver. 1 tort suit pending arising from these same claims, and that the Employee is currently working fulltime, without restrictions, as a truck driver with a valid Class A license and DOT medical certificate, for another employer, but wishes to preserve his right to re-file his workers compensation claim for occupational injuries and/or illnesses in the future. WHEREFORE, based upon the agreement and stipulations of the parties at mediation, the parties stipulate it is in the best interest of the Employee to dismiss Employee's claims of an occupational injury with the Employer at this time, without prejudice to the refiling of same, should he become partially or totally incapacitated from working and provide medical proof that this incapacity is due to an occupational illness that is more than 50% related to the Employee's work for the Employer, considering all causes, pursuant to T.C.A § 50-6-102(14) and T.C.A. § 50-6-303(a). The Court taxes the filing fee of $150.00 to G.UB.MK under Tennessee Compilation Rules and Regulations Rule 00800-02-21-.07 (2017), to be paid within five business days of the entry of this Order. In addition, G.\UB.MK shall prepare and submit an SD-2 form within ten business days of the date of this Order. IT IS SO ORDERED. ENTERED September 24, 2020. Lambe 2. jehnson , JUDGE Court of Workers’ Compensation Claims APPROVED FOR ENTRY: BRIDGEFRONT LAW GROUP; LLC Y JOHN Fe PREE, BPR#017339 616 W. Hill Avenue, 2™ Floor Knoxville, Tennessee 37902 865-223-5184 Attorney for Employee BERNSTEIN STAIR & McADAMS LLP t 3. KAREN & CRUTCHFIELD, BPR #016651 W. TYLER CHASTAIN, BPR #016029 116 Agnes Road Knoxville, Tennessee 37919 865-546-8030 Attorneys for Employer CERTIFICATE OF SERVICE I certify that a copy of this Order was sent as indicated on September 24, 2020. Name Mail Fax Via Service sent to: Email John D. Dupree, Xx johnbdupree14@gmail.com Employee’s Attorney Karen G. Crutchfield, Xx kcrutchfield@bsmlaw.com Employer’s Attorney Gees f LAcime wll! Po Penny Shrug) ugh) Court Clerk We.courtclerk@tn.gov