FILED Jul 29, 2021 10:42 AM(CT) TENNESSEE COURT OF WORKERS' COMPENSATION CLAIMS TENNESSEE BUREAU OF WORKERS’ COMPENSATION IN THE COURT OF WORKERS’ COMPENSATION CLAIMS AT COOKEVILLE KENNETH RAY, JR., ) Docket No 2020-04-0228 Employee, ) v. ) ROLLINS, INC., ) State File No. 90714-2018 Employer, ) And ) NEW HAMPSHIRE INS. CO., ) Judge Robert Durham Carrier, ) And ) ABIGAIL HUDGENS, Director, and ) The Subsequent Injury and ) Vocational ) Recovery Fund. AMENDED COMPENSATION HEARING ORDER GRANTING BENEFITS This matter came before the Court on July 28, 2021 on Mr. Ray’s Motion to Alter or Amend the Final Judgment entered in this matter to include a paragraph regarding the amortization of the award and its offset against Social Security disability benefits as set out in Tennessee Code Annotated section 50-6-207. Rollins and the Subsequent Injury Fund did not have any objection to the amendment. Thus, the Order is amended to include the following paragraph in its decree: 2. Mr. Ray was thirty-nine years old at the time he reached maximum medical improvement. According to mortality tables from the United States Centers for Disease Control and Prevention, Mr. Ray’s life expectancy is 42.5 years, or 510 months. The judgment amount minus attorney’s fees of $54,260.10 and expenses of $2,756.13 constitutes a total lump-sum of $440,368.02, or an amortized monthly benefit of $863.46 beginning November 1, 2019, representing the maximum monthly set-off for Social Security or other disability benefits under Tennessee Code Annotated section 50-6-207. No representations or warranties were made to Mr. Ray concerning the Social Security Administration’s right to 1 offset benefits received by Mr. Ray under this settlement agreement and the Workers’ Compensation Law against Mr. Ray’s Social Security disability benefits. ENTERED on July 29, 2021. _____________________________________ ROBERT DURHAM, JUDGE Court of Workers’ Compensation Claims CERTIFICATE OF SERVICE I certify that a copy of the Order was sent as indicated on July 29, 2021. Name Certified Via Via Service sent to: Mail Fax Email Jill Draughon X JDraughon@hughesandcoleman.com Charles Pierce X cepierce@mijs.com Patrick Ruth X Patrick.Ruth@tn.gov _____________________________________ PENNY SHRUM, Court Clerk WC.CourtClerk@tn.gov 2