Release of Liability Procedures — Leaving Future Medical Liability Open

NEB. REV. STAT. § 48-139(1)(a) lists the factors that determine whether a Lump Sum Settlement Application must be submitted to the Worker’s Compensation Court for review, or whether the parties may submit a Release of Liability (release).*   

The parties shall use only this form, which has been approved by the Nebraska Workers’ Compensation Court pursuant to NEB. REV. STAT. § 48-139. Other than an itemized list of medical expenses incurred as a result of the alleged accident(s) and injury(s), no additional documents may be filed with this form. Failure to abide will result in your filing being rejected. Please contact the court clerk via email or call 402-471-6468 if you have questions.

A release cannot be filed if:

1. The employee is not represented by counsel;

2. The employee, at the time the settlement is executed, is eligible for Medicare, is a Medicare beneficiary, or has a reasonable expectation of becoming eligible for Medicare within 30 months after the date the settlement is executed. This subdivision (ii) is not applicable if the employee's right to receive future medical, surgical, and hospital services as provided in section 48-120 is specifically excluded from the settlement and Medicare has not paid medical, surgical, or hospital expenses or if Medicare has paid medical, surgical, or hospital expenses for which it claims it is entitled to reimbursement and Medicare has been reimbursed for such expenses at the time the settlement is executed;

3. Medical, surgical, or hospital expenses incurred for treatment of the injury have been paid by Medicaid and Medicaid will not be reimbursed as part of the settlement;

4. Medical, surgical, or hospital expenses incurred for treatment of the injury will not be fully paid as part of the settlement; or

5. The settlement seeks to commute amounts of compensation due to dependents of the employee.

This form may only be used if: 

1. The employee is not a Medicare beneficiary, eligible for Medicare, or has no reasonable expectation of becoming eligible for Medicare within thirty months after the settlement execution date and the employee's right to receive future medical, surgical, and hospital services as provided in section 48-120 is specifically excluded from the settlement.
   
   OR
   
   

2. The employee is a Medicare beneficiary,eligible for Medicare, or has no reasonable expectation of becoming eligible for Medicare within thirty months after the settlement execution date and the employee's right to receive future medical, surgical, and hospital services as provided in section 48-120 is specifically excluded from the settlement and 

Medicare has not paid medical, surgical, or hospital expenses; or if Medicare has paid medical, surgical, or hospital expenses for which it claims it is entitled to reimbursement and medicare has been reimbursed for such expenses at the time the settlement is executed.

Filing Fee:

• A $15.00 filing fee must be included with the release form. 

Other Filing Instructions:

• The court’s form must be used to file a Release of Liability. If you have any questions regarding this form, please contact the court clerk via email or call 402-471-6468.

• The settlement amount may include a description of the settlement amount and any other payments or consideration to be paid / exchanged. For example, “Upon the payment of $$, and Defendant waiving its rights to subrogation. . .”

• If the case has not previously been assigned a docket number, an Addendum 3 must be submitted with the release.

• Section 48-139(4) of the Act requires an order of dismissal to be entered on all cases in which a release of liability is filed. Also, Rule 47(J) requires the parties to file a receipt or satisfaction, in all such cases.

• The receipt or satisfaction, does not need to accompany the release of liability and can be filed after the employer has made payment to the employee.

• The receipt, satisfaction, or joint stipulation for dismissal cannot be accepted via email. These filings must be efiled. The proposed order is the only document accepted via email attachment (to the email address listed below). Such attachment must be provided in either editable Microsoft Word format (*.doc or *.docx) or Rich-Text Format (*.rtf).