On November 03, 2016 a
Complaint,Petition
was filed
involving a dispute between
Daponte, Irene,
Daponte, Jose M.,
and
Fed Leasing Corp.,
Susi, Larry,
for Torts
in the District Court of Bristol County.
Preview
io BRISTOL, SS SUPERIOR COURT abt \\.
FILED
28
DEC 20 @OiMONWEALTH OF MASSACHUSETTS
TRIAL COURT OF THE COMMONWEALTH
MARC J SANTOS, SEPERIOR COURT DEPARTMENT
CLERK/MAGISTRAT
Bristol, ss. C.A. NO.: 1673CV01040
JOSE M. DAPONTE and )
IRENE DAPONTE, )
Plaintiffs, ) MA DIA Board #: 13508-14
Vs. )
)
\ FED. LEASING CORP. and )
K LARRY SUSI, )
. Defendants, )
ee
PETITION FOR APPROVAL OF
THIRD PARTY SETTLEMENT UNDER G.L. c. 152, §15
S
st Jose M. Daponte Plaintiff/Employee
. Irene Daponte Co-Plaintiff
Fed. Corp. Inc. Employer
Acadia Insurance Workers’ compensation insurer
Fed. Leasing Corp. and Larry Susi Defendants/Third Parties
Acadia Insurance Third Party Insurer
The above-named parties request approval of a third party settlement under G.L. c. 152, §15.
Following are the terms and conditions of the settlement:
1) The plaintiffs/employee and the workers’ compensation insurer are entitled to a hearing
before the board, or the reviewing board, acts on the petition. Do the parties: (please check
one):
& Request such a hearing?
XK
e xX Waive their right to a hearing?
0
XQ 2) Provide the date(s) of injury, and describe in detail the accident, event, incident or series of
1
ds
XN
NN
NU
~
incidents which forms the basis for the workers’ compensation claim and the third party
claim.
Document Filed Date
January 02, 2018
Case Filing Date
November 03, 2016
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io BRISTOL, SS SUPERIOR COURT abt \\. FILED 28 DEC 20 @OiMONWEALTH OF MASSACHUSETTS TRIAL COURT OF THE COMMONWEALTH MARC J SANTOS, SEPERIOR COURT DEPARTMENT CLERK/MAGISTRAT Bristol, ss. C.A. NO.: 1673CV01040 JOSE M. DAPONTE and ) IRENE DAPONTE, ) Plaintiffs, ) MA DIA Board #: 13508-14 Vs. ) ) \ FED. LEASING CORP. and ) K LARRY SUSI, ) . Defendants, ) ee PETITION FOR APPROVAL OF THIRD PARTY SETTLEMENT UNDER G.L. c. 152, §15 S st Jose M. Daponte Plaintiff/Employee . Irene Daponte Co-Plaintiff Fed. Corp. Inc. Employer Acadia Insurance Workers’ compensation insurer Fed. Leasing Corp. and Larry Susi Defendants/Third Parties Acadia Insurance Third Party Insurer The above-named parties request approval of a third party settlement under G.L. c. 152, §15. Following are the terms and conditions of the settlement: 1) The plaintiffs/employee and the workers’ compensation insurer are entitled to a hearing before the board, or the reviewing board, acts on the petition. Do the parties: (please check one): & Request such a hearing? XK e xX Waive their right to a hearing? 0 XQ 2) Provide the date(s) of injury, and describe in detail the accident, event, incident or series of 1 ds XN NN NU ~ incidents which forms the basis for the workers’ compensation claim and the third party claim.