STATE OF FLORIDA  DIVISION OF ADMINISTRATIVE HEARINGS  OFFICE OF THE JUDGES OF COMPENSATION CLAIMS  ) , ) (Employees name) ) Claimant, ) ) vs. ) OJCC Case No.__________________ ) Judge Assigned:________________ , ) Date of Accident:____/____/____ (Employers name) ) Employer/Carrier. ) _____________________________) ADDENDUM TO STIPULATION IN SUPPORT OF PETITION FOR ORDER APPROVING A LUMP-SUM SETTLEMENT The parties, by and through their undersigned counsel, hereby waive the right to a washout/settlement hearing before the Judge of Compensation Claims and agree to rely upon the settlement documents, submitted herein as Attachment One, which includes an affidavit of the employee waiving the employees right to a hearing. Dated this day of , 20 . _____________________________ Attorney for Employer/Carrier American LegalNet, Inc. www.USCourtForms.com