Parties interested in settling the loss of earning capacity involving a claim with approved apportionment should complete the attached form and submit for consideration. The claimant and carrier/self-insured/TPA must contribute to the questions and submit the signed certifications before the claim will be reviewed. After submission of all required information, Special Fund will perform its evaluation of settlement, taking into consideration of all relevant factors, including Roth credits, prior scheduled credits and any overpayments. Based upon its evaluation, Special Fund will offer to contribute a certain amount towards settling the matter. Under no circumstances, however, will Special Fund contribute more than 50% of the final settlement amount ultimately negotiated by the parties.