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The Covered Member also shall give the Authority immediate written notice of any of the following: <br />I. a fatality; <br />2. any claim involving an infectious disease <br />3. an amputation of a major extremity; <br />4. any serious head injury (including skull fracture or loss of sight of either or both eyes); <br />5. any injury to the spinal cord; <br />6. any second or third degree burn of 25% or more of the body; <br />7. any accident which causes serious injury to two or more employees; <br />8. any claim believed to be fraudulent and $20,000 or more has been paid in allocated <br />expenses; <br />9. any claim likely to result in a permanent disability of 50% or more; or <br />10. any disability of more than one year or when it appears reasonably likely that there will <br />be a disability of more than one year. <br />Notice given to the Authority shall contain complete details. If a suit, claim, or other proceeding is <br />commenced because of an incident described above or of any injury that might involve a loss to the <br />Authority, the Covered Member shall give the Authority: <br />1, all notices and legal papers related to the claim, proceeding, or suit, or copies of these <br />notices and legal papers; <br />2. copies of narrative medical reports; <br />3. copies of reports on investigations made by the Covered Member on such claims, <br />proceedings, or suits; and <br />4. copies of DWC Form I (Employee Claim Form), Form 5020 (Employer's Report of <br />Injury), and any report completed by a supervisor investigating or reporting the claim. <br />The Covered Member also shall provide the Authority with supplemental reports on any incident stated in <br />Part Six, paragraph A of this Memorandum of Coverage. The report shall be on a form satisfactory to the <br />Authority and submitted 90 days from the date of the initial notice and every 90 days thereafter, unless <br />indicated otherwise by the Authority. The supplemental report shall include the paid -to -date amounts, the <br />reserve amounts, the employee's medical status, and the status of the settlement. Copies of narrative <br />medical reports and legal correspondence received since the last report was submitted should also be <br />included with subsequent supplemental reports. <br />B, Settlement <br />Any claim, suit, or proceeding with a total incurred amount in excess of the Covered Member's retained <br />limit shall not be settled without the written consent of the Authority's Claims Manager. The Authority's <br />Claims Manager also has the right to consult and participate with the Covered Member in the settlement, <br />defense, or appeal of any other claim, suit, or proceeding that might involve a loss to the Authority. <br />PART SEVEN — CONDITIONS <br />A. Acceptance <br />By acceptance of this Memorandum, the Covered Member agrees that the statements made on the <br />Declarations Page are the Covered Member's agreements and representations, that this Memorandum is <br />issued in reliance upon the truth of such representations, and that this Memorandum embodies all <br />agreements existing between the Covered Member and the Authority or any of the Authority's agents <br />relating to this coverage. <br />B. Cancellation <br />The Covered Member may not withdraw from this Memorandum during the program year. <br />Memorandum of Coverage Page 7 Effective July 1, 2019 <br />