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n Allegany County construction worker left permanently disabled with a severe head injury when an overly fatigued truck driver rear-ended his vehicle at a Southern Tier Expressway bridge resurfacing site has accepted a $4.3 million insurance settlement during trial.  The trucker, who had illegally been at the wheel of his westbound tractor-trailer for 21 hours, rear-ended the construction worker's pickup truck, ejecting the victim from his vehicle and causing him to be thrown 140 feet down an embankment and knocked unconscious. The victim remained in a coma for 3.5 weeks. Letro said doctors have told the victim that he can never hold another job because of balance problems stemming from the head injury.  Letro forced the settlement of the negligence case by obtaining the trucker's toll and fuel receipts and bills of lading, which proved he had been on the road for 21 hours and was "acutely and cumulatively fatigued" court officials said.