ADDENDUM TO COPELAND SETTLEMENT AGREEMENT.DOCX

ADDENDUM
TO SETTLEMENT AGREEMENT AND
RELEASE OF ALL CLAIMS
COPELAND V. CITY OF PHOENIX AND MARICOPA COUNTY
CV2017-001506
This Addendum to the Settlement Agreement and Release of All Claims executed
on or about January 30, 2019 (hereinafter “Addendum”) sets forth the agreement reached between
the parties regarding the tender of settlement funds to Plaintiff April Copeland (“Copeland”) as it
relates to her current Medicare status.
Medicare’s Right of Reimbursement for Past Medical Expenses. Copeland,
acknowledging and understanding her obligation to satisfy Medicare’s right of reimbursement, and
the consequences for failing to do so, acknowledges that as of November 1, 2018, she became
eligible for Medicare benefits. Copeland understands and acknowledges that Medicare cannot
accept the terms of a settlement as to an allocation of funds that does not adequately address
Medicare's interests; and that if Medicare's interests are not reasonably considered, Medicare will
refuse to pay for services related to the injury (and otherwise reimbursable by Medicare) until such
expenses have exhausted the amount of the entire settlement. Medicare may also assert a recovery
claim, if appropriate.
Copeland avows that none of the medical expenses incurred herein that are
compensated through the tender of settlement funds that are the subject of the Agreement executed
on or about January 30, 2019 (the “Agreement”) were submitted to Medicare for payment or paid
by Medicare. To the extent, however, that Copeland learns after the execution of the Agreement,
this Addendum, or the acceptance of settlement funds, that Medicare has made any conditional
payments for medical expenses incurred herein that are compensated through the Agreement, she
will take any and all necessary steps to satisfy any right of reimbursement asserted by Medicare.
Copeland further agrees to defend, indemnify and hold harmless the Released Parties from and
against any and all disputed or undisputed claims based on, or arising out of, any such subrogation
right, lien or encumbrance.
Medicare’s Interest in Future Medical Expenses. Copeland further understands
and acknowledges that it is not the purpose of the Agreement to shift responsibility of future

medical care in this matter to the Medicare program. Copeland, acknowledging and understanding
Medicare’s interest as to future medical expenses, specifically warrants and represents that the
portion of settlement funds tendered pursuant to the Agreement that are intended to compensate
her for medical expenses for future treatment alleged to be necessitated by the Accident giving rise
to the Lawsuit will be placed into Annuity and used for that purpose. Copeland avows not to
submit, or cause to be submitted, any claims to Medicare for future medical expenses necessitated
by the Accident giving rise to the Lawsuit.
THE UNDERSIGNED HAVE READ THIS ADDENDUM TO THE SETTLEMENT
AGREEMENT AND RELEASE OF ALL CLAIMS AND UNDERSTAND ITS TERMS
AND EXECUTE IT VOLUNTARILY WITH FULL KNOWLEDGE OF THOSE TERMS
AND THEIR SIGNIFICANCE.
______________________________
APRIL COPELAND Date
STATE OF ARIZONA )
) ss.
County of Maricopa )
On this ____ day of February 2019, before me, the undersigned Notary Public, in and for
the County of Maricopa, State of Arizona, personally appeared April Copeland known to me to be
or satisfactorily proven to me to be the person whose name is subscribed to the foregoing
instrument and acknowledged that they signed the same for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and seal.
______________________________
Notary Public
My Commission expires:

__________________________ ______________________________
JOSEPH COPELAND Date
STATE OF ARIZONA )
) ss.
County of Maricopa )
On this ____ day of February 2019, before me, the undersigned Notary Public, in and for
the County of Maricopa, State of Arizona, personally appeared Joseph Copeland known to me to
be or satisfactorily proven to me to be the person whose name is subscribed to the foregoing
instrument and acknowledged that they signed the same for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and seal.
______________________________
Notary Public
My Commission expires:
__________________________ ______________________________
JONATHAN COPELAND Date
STATE OF ARIZONA )
) ss.
County of Maricopa )
On this ____ day of February 2019, before me, the undersigned Notary Public, in and for
the County of Maricopa, State of Arizona, personally appeared Jonathan Copeland known to me
to be or satisfactorily proven to me to be the person whose name is subscribed to the foregoing
instrument and acknowledged that they signed the same for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and seal.
______________________________
Notary Public
My Commission expires:

__________________________ ______________________________
MARY COPELAND Date
STATE OF ARIZONA )
) ss.
County of Maricopa )
On this ____ day of January 2019, before me, the undersigned Notary Public, in and for
the County of Maricopa, State of Arizona, personally appeared Mary Copeland known to me to be
or satisfactorily proven to me to be the person whose name is subscribed to the foregoing
instrument and acknowledged that they signed the same for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and seal.
______________________________
Notary Public
My Commission expires:
__________________________ ______________________________
CHLOE COPELAND Date
STATE OF ARIZONA )
) ss.
County of Maricopa )
On this ____ day of January 2019, before me, the undersigned Notary Public, in and for
the County of Maricopa, State of Arizona, personally appeared Chloe Copeland known to me to
be or satisfactorily proven to me to be the person whose name is subscribed to the foregoing
instrument and acknowledged that they signed the same for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and seal.
______________________________
Notary Public

My Commission expires:
APPROVED AS TO FORM:
______________________________________
Thomas Shorall, Esq.
Attorney for Plaintiffs
FOR AND ON BEHALF OF
MARICOPA COUNTY
BY:
_____________________________________
Bill Gates, Chairman
Board of Supervisors
Date: _____________________
ATTEST:
_____________________________________
Clerk of the Board
Date: _____________________
APPROVED AS TO FORM:
_____________________________________
Joseph S. Kiefer
Deputy County Attorney

Date: _____________________