Evan Newhouse* Karo Maladzharyan**

Amy Creager*
Jamie M. Jacoby*
Katie Sayyah
Elizabeth Engelberg
Rebecca Breitburg
Arezoo Jafroodi*
Glen Winter *Certified Specialist -
Workers Compensation Law
Jozef Finneran The State Bar of California, Board of Legal Specialization
Hannah Katz
**Lien Hearing Representative
Rebecca Kim

WWW.NEWHOUSEANDCREAGER.COM LOS ANGELES ORANGE COUNTY

Rosa Farrell September 13, 2023

2773 Bolker Drive
Port Hueneme, CA 93060

RE: ROSA FARRELL VS. CALIFORNIA SELF DIRECTED SERVICES LLC

WCAB Case Number : ADJ14227256
Claim Number : 1991701548
Our File Number : 5766

Dear Ms. Farrell:

Enclosed is the original of the proposed Compromise and Release Agreement in the above-entitled
matter.

Please execute the original compromise and release where indicated before a Notary Public or two
disinterested witnesses and return it to this office for filing with the Workers’ Compensation
Appeals Board.

Upon our receipt and filing with the Board, an executed copy will be forwarded to you for your
file.

I thank you for your kind attention with regard to this matter.

Very Truly Yours,

NEWHOUSE AND CREAGER

BY: JOZEF FINNERAN

038:133
e-mail: jfinneran@newhousecreager.com
Enclosure
cc: Angela Johnson, LWP Claims Solutions - Sacramento

Direct all correspondence to our central scanning location in Los Angeles

23801 Calabasas Road, Suite 1015, Calabasas, CA 91302 | Telephone 818-222-5600 | Fax 818-855-8082
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THIS SETTLEMENT RESOLVES ALL FUTURE MEDICAL CARE
Powered by TCPDF (www.tcpdf.org)
 RE: Rosa Farrell VS. California Self Directed Services LLC
WCAB Case Number : ADJ14227256
Claim Number : 1991701548
Our File Number : 5766

ADDENDUM “A” ( REASONS FOR COMPROMISE & RELEASE)

10. A bona fide dispute exists regarding one or more of the following: Nature, extent and duration of
temporary and permanent disability, apportionment, self-procured medical treatment, mileage
reimbursement, future medical treatment, medical-legal costs and entitlement to Supplemental Job
Displacement Benefits. The applicant desires to avoid the risks of litigation and defendants wish
to buy their peace. This settlement provides adequate money as consideration for and settles any
and all claims for the follows:

a) If payment of consideration herein is commenced within thirty (30) days from the date that
the defendants receive the Order Approving this Compromise and Release, it shall be
deemed to be a timely payment and any penalty and/or interest to be claimed based thereon
is hereby waived.
b) For any interest, penalty, increased benefits or accrued benefits on any and all types of
benefits that have, may have, or could have been alleged against defendants up to the date
the Court executes the Order Approving hereon;
c) For all back temporary partial and/or temporary disability, due applicant up to and
including the date the Court executes Order Approving Compromise and Release pursuant
to this agreement. There is no claim for retroactive benefits.
d) Applicant has been advised and fully understands that the amount stated in Paragraph (7)
of this settlement, settles any potential compensation, accrued benefits and/or medical
benefits which might arise out of any injury sustained during applicant’s participation in a
Return to Work Program as a compensable consequence of incident(s) and/or injuries
which are the subject of the Workers’ Compensation claim(s) settled by this Compromise
and Release.
e) For any and all of applicant’s accrued and outstanding out of pocket expenses, including
but not limited to, any and all mileage claims, parking claims, self-procured medical
treatment and prescriptions, to the date of defendant’s receipt of copy of the Order
Approving this Compromise and Release Agreement;
f) Settles all accrued interest under Labor Code Section 5800, if payment is commenced
within thirty (30) days of defendant’s receipt of the Order Approving;
g) Applicant hereby certifies that she is not on SSDI, nor a Medicare beneficiary at this time.
Further, applicant certifies that she has not applied for Medicare or SSDI benefits and that
she is not within 30 months of being eligible for said benefits.
h) Settles all claims of injury or illness to the parts of body listed in Paragraph (1) of this
settlement with California Self Directed Services LLC as administered by LWP Claims
Solutions - Sacramento.

Dated:___________________________
Applicant
Rosa Farrell
 STATE OF CALIFORNIA
WORKERS' COMPENSATION APPEALS BOARD

Case No.
6SWE*EVVIPP
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Applicant
vs.
'EPMJSVRME7IPJ(MVIGXIH7IVZMGIW00'0;4 DECLARATION OF DEFENDANT
'PEMQW7SPYXMSRW7EGVEQIRXS RE: RESOLUTION OF LIENS

Defendants.

I, .S^IJ*MRRIVER2I[LSYWIERH'VIEKIV , am the attorney or representative for defendant

'EPMJSVRME7IPJ(MVIGXIH7IVZMGIW00'0;4'PEMQW7SPYXMSRW7EGVEQIRXS in the above-entitled matter.

I have made the following good faith efforts to resolve each of the liens in this case. List ALL lien claims

below. Use supplemental pages as necessary.

Lien Claimant Nature and Date of Lien Resolution Efforts Result

2334)20-)2732
6)'36(

4)6)((2334)20-)2

I declare under penalty of perjury that the foregoing is true and correct and that this affidavit was executed at

'EPEFEWEW , California on 

.S^IJ*MRRIVER2I[LSYWIERH'VIEKIV

WCAB-003