Here you’ll find the various documents related to my cases.

My FL Workers Comp Case

__________ Forced Settlement Agreement ______________________________________

STATE OF FLORIDA

DIVISION OF ADMm1STRATIVE HEARmGS

OFFICE OF THE JUDGES OF COMPENSATION CLAMS

DISTRICT “Jacksonville”

FFVA Mutual Insurance Company

Post Office Box 945927

Maitland, Florida 32794

JOINT STIPULATION FOR LUMP SUM SETTLEMENT

UNDER 440.20(11)(c), (d) & (e), FLA. STAT.

The above named parties hereby enter into the following agreement for the specific purpose of discharging the Employer/Carrier/Servicing Agent (hereinafter “E/C/SA”) from any further liability for all benefits under the Florida Workers’ Compensation Law, including, but not limited to monetary compensation, medical benefits, and death benefits, in exchange for a lump sum payment to the Claimant. In accordance therewith, the parties hereby stipulate and agree as follows.

1. JURISDICTION AND VENUE – The Judge of Compensation Claims (“JCC”) appointed under 5440.45, Fla. Stat., has jurisdiction of the subject matter and the parties hereto. The alleged industrial accident occurred in Duval County, Florida, and venue is properly in the Jacksonville OJCC district.
2. DESCRIPTION OF ACCIDENT(S) – On January 15, 2021, the Claimant allegedly sustained a compensable accident, as contemplated under 440.02(1), Fla. Stat., arising out of the course of employment with the Employer, when the Claimant allegedly stated that he experienced lower back pain while pulling an axel. On January 19, 2021, the Claimant was evaluated at CareSpot and initially diagnosed with a strain of lumbar region. On January 25, 2021 , the Claimant returned to CareSpot and was subsequently referred for an MRI of the lumbar spine and bilateral hip, which revealed multilevel degenerative disc disease at levels Ll -2, L2-3, L3-4, L4-5 and L5-Sl, with no acute injury appreciated. The parties stipulate and agree that this settlement agreement includes not only the above mentioned injuries/occupational disease(s), but any and all injuries and occupational diseases ever incurred by the Claimant while working for the Employer whether or not known, revealed, reported, diagnosed, developed or manifested.

3. AVERAGE WEEKLY WAGE – At the time of the accident, the Claimant’s average weekly wage was $751.33, with a con•esponding weekly compensation rate of $500.89.

4. AGE, EDUCATIONAL BACKGROUND AND WORK HISTORY – The

Claimant is 49 years of age. He is able to read and write. His work history includes employment as a carpenter. At the time of the injury, the Claimant was working as a carpenter.

5. MAXIMUM MEDICAL IMPROVEMENT. IMPAIRMENT RATING AND WORK RESTRICTIONS – The parties stipulate and agree that the Claimant has reached maximum medical improvement and waive any claims to the contrary. The parties stipulate and agree that the Claimant has no permanent work restrictions attributable to the industrial accident. The Claimant agrees to waive his right to receive an estimate as to future medical costs from his physicians.

6. SETTLEMENT AMOUNT AND DISCHARGE FROM LIABILITY FOR PAST AND FUTURE BENEFITS – The E/C/SA will pay the Claimant $30,000.00 in full satisfaction of its obligations and/or liability to pay monetary compensation benefits as set forth under Sections 440.13, 440.15 and 440.16, Fla. Stat., impairment benefits, death and dependency benefits, penalties, interest, costs, attorney’s fees, and rehabilitation benefits under 5440.491, Fla. Stat. , as well as past, present and future medical benefits, on account of the work-related accident(s) referenced herein. The settlement amount shall be allocated as follows:

The parties agee that the E/C/SA will have 30 days from the date copies of the Order approving the attomey’s fees and allocation of child support are fumished to the parties to make

payment, without incurring interest or penalties, and agree to waive any statutory provisions to the contrary. As contemplated by this agreement, monetary compensation benefits include, but are not necessarily limited to, compensation for pennanent total disability, temporary total disability, temporary partial disability, wage loss benefits, impairment benefits, impairment income benefits, supplemental income benefits, temporary total disability benefits during rehabilitation, and death and dependency benefits.

The payment of the lump sum set forth herein will definitely aid in the rehabilitation of the Claimant or will otherwise be in his best interest.

Upon receipt of the lump sum, the E/C/SA shall be forever released and discharged from all obligations and/or liabilities to pay monetary compensation benefits, medical benefits, training, education benefits, and death benefits. The Claimant shall be solely responsible for all medical liens except for those from authorized and medically necessary care and treatment which were received prior to this agreement being signed by the parties. The Claimant shall retain the right to apply to the Florida Department of Education for retraining under 5440.491, Fla. Stat.

7. ATTORNEY’S FEES PAYABLE BY CLAIMANT. WAIVER. AND AGREEMENT TO INDEMNIFY – The Claimant has been represented by Michael K. Horowitz, Esquire, in connection with this matter, who is entitled to a fee for legal services rendered. $7,500.00 is a reasonable fee for such services and is within the guidelines for the determination of a reasonable fee as set forth in “40.34(1), Fla. Stat., and/or the Miles v. City of Edgewater Police Dept. case. In addition, the Claimant shall reimburse his attorney for litigation costs. Notwithstanding the provisions of “40.34(3), Fla. Stat., the Claimant and not the E/C/SA is responsible for payment of the attomey’s fees because this settlement was made under “40.20(11), Fla. Stat. The Claimant has been informed of his right to a hearing on the amount of the attomey’s fee and hereby waives his right to a hearing on the fee amount. The fee and costs shall be paid from the settlement proceeds by the Claimant.

The Claimant and Claimant’s counsel hereby agree and stipulate that they will satisfy, in full, the lien asserted by Kirk Perrow, Esquire and/or the Morgan and Morgan law firm and agree to hold harmless and indemnify the E/C/SA if said attorney lien(s) exist and in which Claimant and Claimant’s counsel shall be solely responsible for satisfaction of any and all such lien(s).

Page 4

8. WAIVER OF RIGHT TO BRING CASE BEFORE JCC AND TO BRING PETITION FOR MODIFICATION – The Claimant understands that he does hereby relinquish the right to have any unresolved conflicts or disputes involving the right to monetary compensation benefits, impairment benefits, death benefits, attorneys’ fees, past due medical benefits, future medical benefits and rehabilitation benefits heard and decided by a JCC, who will only retain the authority to hear and decide issues involving disputes regarding this agreement. This ayeement shall not be subject to modification under {440.28, Fla. Stat.

9. PRESENT WORTH AND POSSIBLE OFFSET FOR SOCIAL SECURITY DISABILITY BENEFITS CONSIDERED – In reaching this agreement, the parties have considered the present value of all future payment of indemnity benefits, impairment benefits, medical benefits and death benefits potentially payable to the Claimant under the Florida Workers’ Compensation Law on account of the injuries referenced herein. Consideration was also given to the possible loss of supplemental benefits due under 440.15(1)(f), Fla. Stat., and to the right of the Social Security Administration to offset disability benefits payable under state law. The Claimant was born on ————, and his life expectancy is 27.5 years or 1,430 weeks. When the overall lump sum payment is prorated on a weekly basis over the Claimant’s life expectancy, the lump sum is equal to payment of future benefits at a rate of $20.97 per week. This periodic repayment schedule results in a substantial loss to the Claimant on a consistent basis. Taking that into consideration, the parties hereby agree that those weekly payments are the same as if the lump sum for indemnity benefits would have been paid to the Claimant at a rate of $7.66 per week over his expected lifetime. The E/C/SA’s right to offset indemnity and medical benefits due under the Florida Workers’ Compensation Law against benefits payable on account of total disability under Title 42, United States Code, including benefits payable under the Medicare program, and any benefits paid by state disability funds, is also included in these calculations and has been considered by the parties in reaching this agreement.

The same is true for the lump sum payment of future medical benefits which, when reduced to present value, is equal to $10,963.70. The lump sum consideration given for the settlement of future medical benefits under Chapter 440, Florida Statutes, is the same as is if the lump sum would have been paid to the Claimant at a rate of $7.66 per week over his expected lifetime.

10. ALL KNOWN ACCIDENTS. INJURIES. AND/OR OCCUPATIONAL ‘DISEASES REVEALED AND ALL PENDING CLAIMS WITHDRAWN – In accordance with 440.20(11)(e), Fla. Stat. , the Claimant represents and affirms that all accidents, injuries and occupational diseases known to have occurred or sustained while employed by the Employer have been revealed and are settled in accordance with the terms herein. All pending claims are hereby voluntarily withdrawn.

11. E/C/SA SUBROGATED TO PROCEEDS OF THIRD PARTY CLAIM – The parties stipulate and agree that the Claimant may have been injured in the course of his employment by the negligence or wrongful act of a third party tortfeasor. Therefore, pursuant to the provisions of {440.39, Fla. Stat. , the E/C/SA is subrogated to the proceeds of any settlement or judgment that the Claimant may obtain from the third-party tortfeasor and/or insurance carrier in such amount as permitted by law. It is expressly stipulated and agreed that the provisions of this settlement in no way affect the E/C/SA’s subrogation rights under 5440.39, Fla. Stat.

12. CLAIMANT SOLELY RESPONSIBLE FOR MEDICAL LIENS – The Claimant and Claimant’s counsel stipulate and agree that there exist(s) no Medicare, Medicaid or medical provider liens, or medical bills submitted to Medicare or Medicaid in connection with the alleged industrial injuries referenced herein. The Claimant hereby further stipulates and agrees that if any such liens and or bills of any type submitted by any provider exist, Claimant will hold harmless and indemnify the E/C/SA and its counsel as to said liens and/or medical

13. WAIVER OF PENALTIES AND INTEREST – The Claimant does hereby waive all rights he may have to the recovery and/or receipt of any and all penalties and/or interest on account of the alleged accident(s) or occupational disease(s) referenced herein.

14. EMPLOYER GIVEN NOTICE OF LUMP SUM SETTLEMENT – The parties represent that the Employer has been placed on notice of this agreement and has been given adequate time to express any objections to this ageement.

15. STIPULATION SUBJECT To APPROVAL OF JCC – The parties understand that this stipulation does not become a binding agreement until such time as the JCC has entered an Order approving the attomey’s fees and the allocation of child support arrearage portions of this agreement and the Claimant, Claimant’s counsel, and counsel for the E/C/SA have signed this agreement. The Claimant understands that such agreements have been routinely disapproved by JCCs in the past and that he should not undertake any financially binding actions until formal approval is obtained. In the event that the attomey’s fee and child support provisions of this settlement are not approved in their entirety by the JCC, this stipulation shall be completely void and of no effect whatsoever. If the attomey’s fee and child support provisions of this stipulation are disapproved, the E/C/SA reserves the right to assert any and all defenses.

16. CURRENT EMPLOYMENT STATUS AND ANTICIPATED USE OF SETTLEMENT PROCEEDS – The Claimant is currently employed at a wage level greater than / less than / equal to (circle where appropriate) the pre-injury average weekly wage. The Claimant plans to use the proceeds of this settlement agreement as follows:

If unemployed, please explain reasons for unemployment:

17. COVERAGE B – The parties stipulate and agree that the industrial accident described herein, and the injuries sustained as a result thereof, were not the result of any willful and/or wanton misconduct, unprovoked physical aggression or gross negligence on the part of any officer, director, employee, supervisor or other agent or representative of the Employer or Carrier, and that the Claimant has no entitlement to any cause of action under any exception to workers’ compensation immunity as defined under 5440.11, Fla. Stat.

18. CONDITIONAL AGREEMENT – The Claimant and the E/C/SA stipulate and agree that in the event this stipulation and agreement are determined to be unconstitutional or invalid in the District Courts of Appeal or the Florida Supreme Court, or are otherwise not given full force and effect or are voided for any reason, in part or in whole, the E/C/SA shall be entitled to full reimbursement of the lump sum paid to the Claimant provided for herein, within 30 days of request by the E/C/SA. If any portion of the settlement proceeds are not immediately returned to the E/C/SA, the E/C/SA shall be entitled to offset 100% of compensation benefits and medical benefits until the full settlement amount is fully repaid. Under no circumstances shall the settlement funds be considered a gratuitous payment by the E/C/SA.

19. AUTHORIZED MEDICAL PROVIDER BILLS – The E/C/SA agrees to pay, once received on proper form, and pursuant to the applicable fee schedule in effect for the date(s) of service, all bills from authorized medical providers for medical care causally related to the accident incurred prior to entry of the order approving settlement of the claim. Claimant further agrees that if he receives medical bills from any authorized medical provider unpaid after the date of entry of the order approving this settlement, that he shall provide a copy of that bill to defense counsel and the carrier/third party administrator, via certified mail, and he shall not file a petition for benefits for 30 days after mailing said bill, to allow the E/C/SA appropriate time to investigate and pay said bill pursuant to the fee schedule.

20. ACCEPTANCE BY PARTIES – This Stipulation was signed by the Claimant and his counsel on the day of 2021, and by counsel for the E/C/SA on theday of, 2021.

Christopher Cannon Claimant

Michael Horowitz, Esquire Attorney for Claimant

James B. Birmingham, Esquire Attorney for the E/C/SA

STATE OF FLORIDA

COUNTY OF

The foregoing instrument was acknowledged before me by means of physical presence or online notarization, this day of2021 by

Christopher Cannon, who is personally known to me or who has produced _______________as identification, and who upon being duly sworn certifies that the information furnished by him and incorporated in the foregoing instrument is true and correct, and that he has read this instrument or had it read to him, and believes the lump sum settlement to be in his best interest.

(SEAL)

Notary Public

STATE OF FLORIDA

DIVISION OF ADMNISTRATIVE HEARIINGS

OFFICE OF THE JUDGES OF CONfPENSATION CLAMS DISTRICT “Jacksonville”

FFVA Mutual Insurance Company

Post Office Box 945927

Maitland, Florida 32794

AFFIDAVIT OF CLAIMANT REGARDING SETTLEMENT

BEFORE ME, the undersigned authority, personally appeared Christopher Cannon, who, being first duly sworn, deposes and says:

1. My name is Christopher Cannon, and I am the Claimant in OJCC case number 21002614WRH, now pending before the Office of the Judges of Compensation Claims, in which B & B Trailers and Accessories, Inc. is the Employer, and FFVA Mutual Insurance Company is the Carrier/Servicing Agent, concerning an industrial accident that occurred on January 15, 2021.
2. I am at least 18 years of age, of sound mind, and suffer from no mental disability or impairment.
3. The compensation, medical and rehabilitation aspects of my claim have been settled for a lump sum payment to me in the amount of $30,000.00, including attomey’s fees and costs.
4. I understand that the settlement agreement covers not only the above captioned case, but any and all industrial accidents or work related injuries I have sustained with this employer.
5. I have read or have had the Joint Stipulation for Lump Sum Settlement read to me, and fully understand the same and am in agreement therewith.
6. I have had the opportunity to discuss the Joint Stipulation with counsel of my choosing.

7. I understand that the Joint Stipulation is the equivalent of a complete release with regard to any additional monetary compensation, medical benefits, or rehabilitation benefits and/or expenses to which I might be entitled.

8. I understand that this Joint Stipulation does not become a binding agreement until such time as it has been sip-led by all parties and the Judge of Compensation Claims has entered an Order approving the attorney’s fees associated with this agreement, as well as, the allocation of child support arrearage portions pursuant to this settlement.

9. I understand that this matter cannot and will not be reopened for any past, present or future monetary compensation, medical or rehabilitation benefits and/or expcnses under the Florida Workers’ Compensation Law.

10. I understand that I have the right to an estimate of future medical costs, and I waive that right and elect to settle without that information.

11. I understand that I shall be solely responsible for payment of any and all liens asserted by Medicare. Furthermore, I understand that I shall be solely responsible for all medical liens.

12. I understand that receipt by me of the lump sum settlement completely discharges and terminates any liability and/or responsibility that my employer and its workers’ compensation carrier may have for past, present and future payments to me or monetary compensation, medical benefits, and rehabilitation benefits and/or expenses including, but not limited to, medical benefits, temporary total disability, temporary partial disability, rehabilitation temporary total disability, permanent impairment, wage loss, impairment income, supplemental income, permanent total disability, and training and/or education.

13. I understand that, by agreeing to settle thc compensation, medical and rehabilitation aspects of my claims, I am waiving and giving up any right that I would have to pursue my claims.

14. I understand that I am under no compulsion to settle my claim and acknowledge that 1 am settling this case voluntarily and of my own free will.

15. I understand that under the Florida Workers’ Compensation Law, I have the right to pursue my claim, to go to hearings and have the Judge of Compensation Claims determine what further benefits I am entitled to, if any. I also understand that this settlement is not my only remedy or way of handling my claim.

16. I understand that once the Judge of Compensation Claims enters an Order approving the attorney fee and child support allocation portions pursuant to this settlement, the Joint Stipulation will be final and will not be subject to modification, change or review.

17. I believe the settlement to be in my best interest.

Page 2

OJCC No. 21-002614WRH

Affidavit Regarding Settlement

18. It is my desire and request that the Judge of Compensation Claims enter an Order approving the attorney’s fee and the child support allocation pursuant to this agreement, and I request that the settlement be approved without the need for a formal hearing, which I specifically hereby waive.

19. I am / am not gainfully employed at the present time.

FURTHER, AFFIANT SAYETH NAUGHT.

Christopher Cannon

Claimant

STATE OF FLORIDA

COUNTY OF

The foregoing instrument was acknowledged before me by means of physical presence or online notarization, this   day of2021 by Christopher Cannon, who is personally known to me or who has produced _____ as identification.

(SEAL)

Notary Public

OJCC No. 21-002614WRH

Affidavit Regarding Settlement

STATE OF FLORIDA

DIVISION OF ADMNISTRATIVE HEARINGS

OFFICE OF THE JUDGES OF COIWPENSATION cLAn«s DISTRICT “Jacksonville”

FFVA Mutual Insurance Company

Post Office Box 945927

Maitland, Florida 32794

SUPPLEMENTAL STIPULATION BETWEEN PARTIES

COME NOW, the Claimant and Employer/CarHer/Servicing Agent, by and through their undersigned counsel, and hereby stipulate and agree as follows:

1. That the parties’ settlement agreement resolves all accidents, occupational diseases, and injuries sustained by the Claimant while in the employ of the instant Employer;
2. That no accidental injuries or occupational diseases other than any specifically mentioned in the Stipulation for Lump Sum Settlement have been sustained; and,
3. That the Claimant is not a Medicare beneficiary and has no expectation ofbecoming a Medicare beneficiary within 30 months from the date hereof.

            DATED this                              day of2021.

Christopher Cannon

Claimant

STATE OF FLORIDA

DNIs10N OF ADMINISTRATIVE HEARINGS

OFFICE OF THE JUDGES OF COMPENSATION CLARYIS DISTRICT “Jacksonville”

FFVA Mutual Insurance Company

Post Office Box 945927

Maitland, Florida 32794

JOINT STIPULATION RE CONSIDERATION OF INTEREST OF MEDICARE

It is not the purpose of this settlement agreement to shift responsibility of medical care in this matter to the Medicare program. Instead, this settlement is intended to resolve a dispute between the Claimant and the Employer/Carrier/Servicing Agent (hereinafter “E/C/SA”). In consideration thereof, the parties agree and stipulate as follows:

I. SETTLEMENT – The parties have agreed to settle this case in its entirety, including the Claimant’s right to future medical benefits related to the industrial accident(s), for the lump sum amount of $30,000.00.

II. CONDITIONAL PAYMENTS – No conditional payments have been made by Medicare. The Claimant is not presently a Medicare beneficiary and is not reasonably expected to become a Medicare beneficiary within 30 months of the date hereof.

III. FUTURE MEDICALS – This claim does not meet Medicare’s current review thresholds as described in the July 1 1, 2005 and April 24, 2006 CMS Policy Memoranda. As such, the claim does not require review and/or approval by the Centers for Medicare & Medicaid Services (“CMS”).

Nevertheless, the parties have voluntarily allocated $10,963.70 (the “claim settlement allocation”) to future medical treatment. The claim settlement allocation funds will be paid directly to the Claimant and are intended to be used for medical purposes related to this claim. This allocation represents a compromise settlement of future medical expenses.

IV. FUNDING – The claim settlement allocation amount will be funded by way of a lump sum payment at the time of settlement.

V. ADMINISTRATION – The Claimant acknowledges, understands and agrees that CMS has established requirements for MSA administration and that the Claimant must comply with these requirements in order to protect Claimant’s ability to obtain and/or maintain Medicare coverage. The Claimant will self-administer the claim settlement allocation funds, which must be properly exhausted on medical care related to this claim.

The Claimant acknowledges, understands and agrees that it is the Claimant’s sole and continuing responsibility to contact the assigned CMS Regional Office to obtain current CMS requirements for administration of the allocation.

The Claimant acknowledges, understands and agrees that Claimant is solely responsible for maintaining an accounting of all Medicare-covered expenses related to this claim and to provide this accounting to CMS upon their request, until such time as CMS has determined the allocation has been properly exhausted.

The Claimant acknowledges, understands and agrees that the allocation was calculated based on Florida’s worker’s compensation reimbursement schedule and as such, CMS requires that the best effort be made to obtain services from providers who accept said reimbursement schedule. The Claimant realizes, understands, and agrees that any monies paid in excess of the rates set forth in the Florida Workers’ Compensation Health Care Provider Reimbursement Manual for Medicare-covered treatment related to this accident will not count towards exhaustion of the allocation described herein.

VI. HOLD HARMLESS AGREEMENT – The Claimant agrees to indemnify, defend and hold the E/C/SA harrnless from any action by Medicare seeking payment of past, current, or future medical expenses for the Claimant.

Claimant shall further hold the E/C/SA harmless from any and all adverse consequences in the event this settlement results in the loss of rights to Social Security and/or Medicare benefits, to the extent Claimant would have been entitled to those benefits in the absence of this settlement agreement.

VII. WAIVER – The Claimant agrees to waive any and all future actions against the E/C/SA, including but not limited to any private cause of action for damages pursuant to 42 U.S.C.

VIll. CONCLUSION – This settlement is based upon a good faith agreement of the parties to resolve a questionable claim.

The parties have attempted to resolve this matter in compliance with both state and federal law and believe that the settlement tenns adequately consider Medicare’s interest and do not reflect any attempt to shift responsibility of treatment to Medicare.

Page 2

OJCC No. 21-002614WRH

Stipulation re Interest of Medicare

The parties acknowledge and understand that any present or future action or decision by CMS or Medicare on this claim settlement allocation, or on the Claimant’ s eligibility or entitlement to Medicare or Medicare payments, will not render this release void or ineffective, nor in any way affect the finality of this workers compensation settlement, except as specifically set forth herein.

IX. ACCEPTANCE – This Stipulation was sigied by the Claimant and Claimant’s counsel on the day of 2021, and by counsel for the E/C/SA on the ______ day of , 2021.

Christopher Cannon

Claimant

Michael Horowitz, Esquire Attorney for the claimant

James B. Birmingham, Esquire

Attomey for the E/C/SA

STATE OF FLORIDA

COUNTY OF

The foregoing instrument was acknowledged before me by means of physical presence

or online notarization, this ____ day of ___, 2021 by Christopher Cannon, who is personally known to me or who has produced ____ as identification.

(SEAL)

Notary Public

Page 3

OJCC No. 21-002614WRH

Stipulation re Interest of Medicare

STATE OF FLORIDA

DIVISION OF ADMNISTRATIVE HEARRNGS

OFFICE OF THE JUDGES OF COMPENSATION CLAIMS DISTRICT “Jacksonville”

FFVA Mutual Insurance Company

Post Office Box 945927

Maitland, Florida 32794

GENERAL RELEASE OF ALL CLAIMS

The parties have reached an agreement and settlement of the above captioned workers’ compensation claim in its entirety, as well as any and all other claims and causes of action that Christopher Cannon (hereinafter “Claimant”), has or may have as of the date of this General Release of Claims (“Release”) against the Employer and its Carrier (collectively “E/C”) as well as their affiliates, subsidiaries, and/or parent companies either individually, jointly, or severally.

ELECTION OF REMEDY AND RELEASE OF EMPLOYER LIABILITY – The parties stipulate that the Claimant has elected workers’ compensation and not tort liability as his exclusive remedy.

The parties further stipulate that as additional consideration for the payment of the settlement agreement and release by the E/C, the Claimant releases, waives and settles any Employer liability (Coverage B) and any other type of liability or cause of action, including but not limited to, a claim for unemployment benefits of any type and/or retaliatory discharge, coercion, or similar claim as set forth in {440.205, Fla. Stat. (1994), and/or 440.10 and 440.11, Fla. Stat. (2004).

The foregoing includes, without limitation, all claims for unpaid or disputed wages and/or employer provided benefits of any type; wrongful termination; unemployment benefits; retaliation; constructive termination; emotional distress; sexual harassment; sexual discrimination; sexual orientation discrimination; national origin or race discrimination; hostile work environment; defamation; breach of contract; negligent hiring, supervision or retention negligence; all claims for compensation; claims arising out of agreements, representations or policies related to the Claimant’s employment; claims arising under federal, state or local laws or ordinances prohibiting discrimination or retaliation on the basis of race, color, national origin, sex, sexual preference, age

disability or any other status; any type of claim against any insurance policy of any type for the Employer; claims for violation of public policy; and all claims for attorneys’ fees, costs, or expenses incurred in connection with raising any such claims.

This Release includes any and all claims, demands, rights, causes of action, obligations and liabilities of any kind whatsoever, known or unknown, at law or in equity, which the Claimant may have or claims to have which are or which may be based upon any facts, acts, conduct, omissions, documents, representations, proposals, contracts, claims, events or other things occurring any time on or before the date of execution of this Release, and relating to or arising from any aspect of the employment of the Claimant.

The Claimant understands that this Release includes any and all claims, including pending claims, which he could bring before the US Equal Employment Opportunity Commission (EEOC), and/or state or local agencies which enforce employment discrimination laws on the same or similar bases. The Claimant specifically agrees that any and all such pending claims are hereby waived.

VOLUNTARY RESIGNATION – The Claimant represents that, as a result of the limitations and restrictions from the industrial accident and injuries, he is not requesting, nor shall he request, reasonable accommodation for re-employment. The Claimant voluntarily resigns from the employment of the Employer and agrees not to seek to be re-hired by the Employer, its affiliates, subsidiaries and/or parent company thereof, or to accept such employment if offered.

The Claimant’s agreement not to seek re-employment is made as a specific inducement for the E/C to resolve the workers’ compensation claim by agreement and release of claims as opposed to obtaining or locating re-employment for the Claimant within his limitations and restrictions. The Claimant stipulates that he has considered returning to work within reasonable accommodations without imposing an undue hardship on the Employer.

WRONGFUL DISCHARGE, AGE DISCRIMINATION IN EMPLOYMENT ACT, AMERICANS WITH DISABILITIES ACT, AND TITLE Vll OF THE CIVIL RIGHTS ACT OF 1964 RELEASE – As further consideration for the E/C’s agreement to settle the above captioned workers’ compensation claim, the Claimant releases, settles and waives any and all claims, whether or not asserted, against the Employer for any of its officers, agents, servants, employees, directors, successors, assigns and any other person or entity, without any limitation, including any and all past, present or future claims as to the Americans with Disabilities Act, wrongful discharge, and claims or suits under Title VIl of the Civil Rights Act of 1964.

The Claimant acknowledges that this settlement and release constitutes an election of remedies and constitutes a complete release of all actions against the released party arising out of any workers’ compensation accident in any way related to any accident or incident previously specified in this release including, but not limited to, all express, implied or other warranty claims and any claims directly or indirectly related to spoliation, loss or destruction of evidence, intentional or otherwise; and any claims against the released parties for negligent hiring or retention.

COVENANTS – In consideration as set forth above, the undersigned Claimant, for himself, his heirs, executors, administrators, successors, and assigns, does hereby remise, release, waive and forever discharge the E/C, its affiliates, subsidiaries, parent company, agents, officers, employees, directors, members, insurers, predecessors, successors and assigns from any and all claims, demands, rights, debts, agreements and contracts, sums of money, and actions or causes of action, of whatever nature or type, whether legal or equitable, which he has or may have as of the date of this Release, including but not limited to claims, actions or causes of action asserted or which could have been asserted by the Claimant in this or any other workers’ compensation claim, including but not limited to, claims for further allowance and/or additional medical coverage or compensation.

The undersigned Claimant further does hereby remise, release, waive and forever discharge the released parties from any and all other claims, actions or causes of action arising out of or in any way connected with his employment with the Employer, including, but not limited to, retaliation/coercion or any other claim arising under “40.205, Fla. Stat.; those for discrimination based on disability and/or age; violations of the Americans with Disabilities Act of 1990; the Age Discrimination in Employment Act; the Older Workers’ Benefit Protection Act; Title VII of the Civil Rights Act of 1964 and 1991; the Equal Pay Act; the Welfare and Pension Plans Disclosure Act; the Employee Retirement and Income Security Act (ERISA) of 1974 which includes, but is not limited to long and short term disability benefits and retirement plan benefits; the Fair Labor Standards Act; the Family & Medical Leave Act; violations of any municipal, state or federal common law; violation of public policy; breach of contract; constructive discharge; pain and suffering; intentional infliction of emotional distress; mental distress and/or anguish; humiliation and/or embarrassment; wrongful discharge; defamation; assault and battery; invasion of privacy; any claims arising under any other tort theories; claims for lost wages; loss of fringe benefits; compensatory damages; exemplary and punitive damages; and, interest, court and litigation costs, and attorneys’ fees. This list is illustrative, and not intended as exhaustive list of claims released.

The Claimant understands and agrees to fully and finally settle the within mentioned workers’ compensation claim against the E/C and agrees to release and discharge the E/C from all claims for injury, disability, compensation, medical, hospital or nursing expenses whether incurred prior to or after the effective date ofthis Release, and/or any other benefits otherwise available to the Claimant.

The Claimant understands and agrees that this is a full and complete release of any and all claims which he may have against the E/C, upon or by reason of any matter, cause, fact, circumstance, or thing whatsoever which has occurred prior to the date of this Release.

The Claimant agrees to pay, and to indemnify and hold the E/C han•nless as to, all hospital, doctor, pharmaceutical, and other medical costs which have not been submitted to the E/C as of the date this Release is executed, except those submitted by authorized treating physicians for authorized medical necessity and causally related treatment incurred prior to the date of denial and/or settlement of the underlying workers’ compensation claim.

The Claimant agrees and acknowledges that his consideration for this Release is the Employer’s payment of ONE HUNDRED DOLLARS ($100.00). The Claimant further acknowledges that the E/C’s agreement to settle his workers’ compensation claim constitutes additional consideration for this Release.

The Claimant agrees to keep the terms and conditions of this Release, as well as the substance of the negotiations leading to this Release, strictly confidential, except as necessary to enforce this Release, and/or as necessary to comply with state and federal tax disclosure law.

The Claimant agrees that this settlement is made without any admission of or adjudication of liability, fault, or truth of any allegations made by the Claimant against the E/C. The Claimant declares that no representation concerning the nature or extent of the legal liability or financial liability of any of the parties herein released has been made by any attorney, agency or other representative employed by or acting on behalf of the E/C, and that no promise, inducement or agreement not herein expressed has been made to him. The Claimant ayees to take no action which is intended, or would reasonably be expected, to harm the E/C, or its reputation, or which would reasonably be expected to lead to unwanted or unfavorable publicity to the E/C.

The Claimant warrants, represents, and agrees that he is not relying upon the advice of the E/C or its counsel as to the legal or income tax consequences of this settlement or the payment of the above sum to him. Further, the Claimant hereby releases and discharges the E/C and its agents, employees and attorneys from any and all claims, rights, damages, costs or expenses of any nature whatsoever that may accrue to or be incurred by the Claimant by reason of the legal or income tax consequences of this settlement.

The Claimant hereby expressly waives any right of revocation of this release under the Age Discrimination in Employment Act, 29 U.S.C. 621-634, as amended, and any other right of revocation under state, federal, or local law.

RELEASE OF CARRIER AND EMPLOYER LIABILITY – The Claimant hereby waives and releases any claim against the Carrier and its agents and/or law firms and/or lawyers for any intentional tort arising within or without the claims process, including any possible claim as allowed by Florida Statute and/or case law, including but not limited to Aguilar v. Inservices, Inc., 905 So.2d 84 (Fla. 2005).

The intent of this release is to resolve the claims between the Claimant and E/C, the parties to this workers’ compensation dispute. Nothing in this document is intended to in any way release any third party tortfeasor(s) from liability.

INTEGRATION AND ACCEPTANCE – This Release, in conjunction with the Stipulation for Lump Sum Settlement, voluntary resignation, Affidavit of the Claimant, supplemental Stipulation, and Stipulation re Interest of Medicare, represents, constitutes, and incorporates the entire, exclusive, and complete understanding of the parties mentioned herein and reduces to writing all oral negotiations and agreements. It is the intent of the parties that this Release shall absolve the E/C from liability for any and all claims for damages and/or benefits which the Claimant could assert based on events occurring prior to the date of this Release.

The terms, provisions, and conditions of this Release may not be altered, modified, changed or omitted unless such alterations are made in writing and signed by the Claimant and an authorized representative of the Employer and Carrier, before a notary public.

Christopher Cannon Claimant

STATE OF FLORIDA

COUNTY OF

The foregoing instrument was acknowledged before me by means of physical presence

or online notarization, this day of, 2021 by Christopher Cannon, who is personally known to me or who has produced _____ as identification.

(SEAL)

Notary Public

NOTICE OF VOLUNTARY SEPARATION

Christopher Cannon

B & B Trailers and Accessories, Inc.

2875 US Highway 1 S

Saint Augustine, FL 32086

To Whom it May Concern:

I, Christopher Cannon, hereby separate my employment with B & B Trailers and Accessories, Inc., and swear and affirm that I shall not seek re-employment with B & B Trailers and Accessories, Inc. or with any of its clients, affiliates, subsidiaries, or parent companies, and that I shall not accept such employment if offered.

I further affirm that I am under no compulsion to tender my resignation, but that I do so voluntarily and of my own free will.

Christopher Cannon

STATE OF FLORIDA

COUNTY OF

The foregoing instrument was acknowledged before me by means of physical presence or online notarization, this day of2021 Christopher Cannon, who is personally known to me or who has produced _____ as

identification.

(SEAL)

Notary Public

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

OFFICE OF THE JUDGE OF COMPENSATION CLAIMS

DISTRICT “JACKSONVILLE”

MOTION FOR APPROVAL OF ATTORNEY’S FEES ALLOCATION OF CHILD SUPPORT AND APPROVING ATTORNEY’S FEES

COMES NOW the Claimant herein, by and through the undersigned counsel, and hereby moves this Honorable Court for approval of attorney’s fees and allocation of child support arrearage pursuant to Section 440.2001)(c),(d) and (e), Florida Statutes (2001) and as grounds therefore, would show the Court as follows:

1. A settlement was reached in the amount of $30,000.00 regarding the above captioned industrial accident.
2. Pursuant to the attached contract of representation and waiver, the Claimant and the Claimant’s attorney entered into a contract of representation whereby the Claimant agreed to pay a contingency fee in the amount of 25% of any and all benefits secured by the Claimant’s attorney. The Claimant knowingly waived the Claimant’s right to pay a lesser amount based on the statutory fee formula found in F,S. 440.34(1).
3. Subsequently, a settlement of the above workers’ compensation claim(s) was reached by and between the Claimant’s attorney and the Employer/Carrier as indicated above in the amount of $30,000.00. The Claimant agrees to pay, and the Claimant’s attorney

agees to accept $7,500.00 as attorney’s fees, which is above the statutory percentages set forth in Section 440.34, Florida Statutes. The net settlement after fees of $7,500.00 and costs of $472.61, will be $21,927.39. The Claimant and Claimant’s counsel also agree to satisfy the lien asserted by Kirk Perrow, Esquire and/or the Morgan and Morgan law firm of $500.00 as to attomey fees and costs of $42.10.

4. The Claimant understands that the Claimant may request a hearing to determine a reasonable fee to be paid under the circumstances of this case. The Claimant waives the right to a hearing on this issue.

5. Documentation has been provided from the Florida Department of Revenue and from the Clerk of Circuit Court and County Court Central Depository and the total amount of outstanding child support is $0. Accordingly, the amount of $0 is being withheld from the Claimant’s net settlement amount and will be forwarded to the appropriate child support division. The Claimant’s attorney is responsible for paying the child support arrearage, none in this case, to the proper authorities.

6. Pursuant to 60Q-6.115(2) and 60Q-6.102(12), the undersigned has contacted opposing counsel and there is no objection to the filing and the granting of this motion.

7. The claimant, by signing this Motion, specifically acknowledges contracting with the undersigned to pay a 25% attorney’s fee, and respectfully requests this Court enter an order approving the $7,500.00 attorney’s fee and $472.61 in costs.

WHEREFORE, the Claimant and the undersigned counsel request an entry of an Order approving the attorney’s fee and costs to be paid within 14 days of the entry of the order approving the settlement proceeds and the zero child support arrearage allocation under this settlement. Dated this day of2021.

MICHAEL K. HOROWITZ, ESQUIRE

Attorney for the Claimant

CHRISTOPHER CANNON

Claimant

JAMES BIRMINGHAM, ESQUIRE

Attorney for the E/C

KIRK PERROW, ESQUIRE

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of the above was furnished via eJCC on

____ day of ______ 2021, to: Michael K. Horowitz, Esquire, mhorowitz.mhcomplaw.com, diane@mhcomplaw.com.

JAMES B. BIRMINGHAM, ESQUIRE Fulmer, LeRoy & Albee, PLLC 910 N. Femcreek Ave.

Orlando, FL 32803

Fla. Bar No. 0906621

(407) 264-7070

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

OFFICE OF THE JUDGES OF COMPENSATION CLAMS

DISTRICT “Jacksonville”

AFFIDAVIT REGARDING OBLIGATION(S) TO PAY CHILD SUPPORT

BEFORE ME, the undersigned authority, personally appeared Christopher Cannon, who being first duly sworn, deposes and says:

The undersigned hereby affinns that there exists no support order entered anywhere in the United States requiring the undersigned to pay support to or on behalfof any child, except as disclosed on the attached documentation. On the date of the industrial accident, the undersigned resided in Clay County, Florida. As of the date hereof, the undersigned resides in Clay County.

FURTHER, AFFIANT SAYETH NAUGHT.

Christopher Cannon

Claimant STATE OF FLORIDA

COUNTY OF

The foregoing instrument was acknowledged before me by means of _ physical presence or

online notarization, this ____ day of ____ 2021 by Christopher Cannon, who is personally known to me or who has produced ______ as identification.

__________ End of Settlement Agreement ______________________________________

My Virginia Case

__________ DOJ vs. VA __________________________________________________________

3/2/24, 11:55 AM
DOJ Settlement Agreement
Home »
Department of Behavioral Health and Developmental Services
An o cial website Here’s how you know
DOJ Settlement Agreement
DOJ Settlement Agreement
Find a Commonwealth Resource
In August 2008, DOJ initiated an investigation of Central Virginia Training Center (CVTC) pursuant to the Civil Rights of Institutionalized Persons Act (CRIPA). In
April 2010, DOJ notified the Commonwealth that it was expanding its investigation to focus on Virginia’s compliance with the Americans with Disabilities Act
(ADA) and the U.S. Supreme Court Olmstead ruling. The Olmstead decision requires that individuals be served in the most integrated settings appropriate to
meet their needs consistent with their choice. In February 2011, DOJ submitted a findings letter to Virginia, concluding that the Commonwealth fails to
provide services to individuals with intellectual and developmental disabilities in the most integrated setting appropriate to their needs.
In March 2011, upon advice and counsel from the Office of the Attorney General, Virginia entered into negotiations with DOJ in an effort to reach a settlement
without subjecting the Commonwealth to an extremely costly and lengthy court battle with the federal government. On January 26, 2012, Virginia and DOJ
reached a settlement agreement. The agreement resolves DOJ’s investigation of Virginia’s training centers and community programs and the
Commonwealth’s compliance with the ADA and Olmstead with respect to individuals with intellectual and developmental disabilities.
Final Order and Settlement Agreement (8/23/2012)
Complete Set of Agreed Upon Compliance Indicators (1/14/2020

__________ End of DOJ Vs. VA ___________________________________________________

Below is the case law I referred to that Chris White sent me via email on April 05th 2024. As you can see there is no correlation between this case and mine other than the charge of assault on law enforcement. I already showed through all the articles how many hundreds of cases there were!

Adams v. Commonwealth

Court of Appeals of Virginia

September 26, 2000, Decided

Record No. 0654-99-1

Reporter

33 Va. App. 463 534 S.E.2d 347 2000 Va. App. LEXIS 672 ***

JEREMY BRITT ADAMS v. COMMONWEALTH OF VIRGINIA

Prior History: FROM THE CIRCUIT COURT OF GLOUCESTER COUNTY. William H. Shaw, Ill, Judge.

Disposition: Affirmed.

Case Summary

Procedural Posture

Appellant challenged judgment from the Circuit Court of Gloucester County (Virginia), convicting him of assault and battery on a law enforcement officer, in violation of Va. Code Ann. 18.2-57(C), by shining a laser light at the officer’s eye.

Overview

Appellant challenged his bench trial conviction of an assault and battery on a law enforcement officer in violation of Va. Code Ann. S 18.2-57(C). The conviction was based on the alleged shining of a laser light beam on the officer. On appeal, the appellant contended the evidence was insufficient to prove a touching and that he had the requisite intent to commit the offense. The court disagreed and affirmed the conviction. Appellant contended that shining the laser on the officer was insufficient to constitute a touching for the purposes of assault and battery. The evidence established that appellant hit the police officer in the eye with a laser light. Appellant, by aiming the laser at the officers, effected a contact that caused bodily harm to the police officer. Appellant argued there was no touching because the laser had no mass, and therefore, could not have physically touched the officer. The argument was misplaced. The trial court was entitled to reject appellant’s argument that he was just goofing off. Judgment was affirmed.

Outcome

Judgment was affirmed. Appellant committed an assault and battery upon law enforcement officer by shining a laser light at officer’s eye.

__________ End of Case Law ____________________________________________________

__________ Mr. White’s response to the VA Bar Complaint ______________________

Chris White Lawyer, LLC.
PO Box 246
Forest, VA 24551
Tel:(434) 660-9701
Fax: (434) 818-0866
Chriswhitelawyer@gmail.com
TO: Christopher Cannon
1289 Izaak Walton Rd.
Madison Heights, VA 24572
Tel:(434) 849-2824
AND: Virginia State Bar
1111 East Main Street, Suite 700
Richmond, Virginia 23219-0026
Email: intakereb@vsb.org
RE: Complaint from Christopher Cannon VSB Docket # 25-444-132607
RESPONSE TO JULY 22, 2024 VSB LETTER
Dear Mr. Cannon and VSB,
July 23, 2024
You have my phone number and I have attempted to call you several times with no success. Your
fee was applied to the work done on your case. You signed the written retainer agreement and we
met in my office and went over your case for approximately an hour. I reviewed all the information
you sent me including your news articles and emails.
I drafted, obtained endorsement and filed the
motion for substitution of counsel. After that, I filed on your case with the court. I sent them a
letter of representation, notice of representation, and request for discovery.
I began a line of communication with the commonwealth attorneys office including several emails,
phone calls and filled out forms in order to obtain a copy of the body cam footage for your charges.
I reviewed all the footage. After that you and I met in my office and went over the discovery
provided by the government for your charges. I provided you plenty of time to review the discovery
and you did so in my conference room with me watching the video and discussing the matter.
I then prepared for your preliminary hearing. You discussed with me the questions you wanted me
to ask the police officer that accused you of the assault charge. I prepared for the hearing by
researching case law and reviewing your discovery again. When I went to the hearing, I cross
examined the officer on your behalf. At the conclusion of the hearing the judge certified the case
to the grand jury.
After that I met with the government in their prosecutor’s office to discuss your case. They
informed me that we could likely divert away from the minimum mandatory sentence of 6 months
for your charges. The government requested I obtain a copy of your psychological records from
your psychologist.
I then began requesting your medical records from Family Insight, Counselor Romano and
Horizon Mental health facilities and providers. I obtained a signed medical records release from
you and made a separate one for each of the providers. I drafted and sent a letter to each provider
separately for your medical records. This included a call before drafting the letter and after it was
sent to confirm receipt. After a few weeks I obtained all the medical records. Once I received the
medical records I reviewed them and forwarded the applicable documentation to the government
for your case.
A few weeks later you decided you did not like my representation and indicated that because I
could not provide you a specific date with which your case would end or resolve that you did not
want me to be your lawyer anymore. You did not allow me the opportunity to set your case for the
jury trial you wanted.
Unfortunately, in Virginia, when a case is certified to the grand jury after a preliminary hearing
the attorney does not have a court date or trial date for the client. This is because the date needs to
be either pre-set or go to a calendar call hearing with the judge. There is a period time where the
attorney does not know when the next court date will be. I informed you of this several times.
Once you made it clear that you did not want my representation anymore, I drafted and filed a
motion to withdraw as counsel and went to the hearing wherein withdraw was endorsed by the
court.
AsIdid significant documented work on your case I cannot provide you with a refund. Opportunity
to obtain other work was lost as a factor of accepting and working on your case. All the fees were
earned by spending several hours on your case. Please refer to our written retainer agreement that
I have previously provided you a copy with.
Thank you for your courtesy and cooperation in this matter. Please do not hesitate to contact me
with any questions or concerns regarding this matter at (434) 660-9701.
Sincerely,
y,
Christopher G. White, Esq

__________ End of Response ____________________________________________________