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Division of Workers' Compensation |
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| Settlement
Documents |
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Form |
Description |
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Settlement Agreement - Represented Claimant Form # WC104
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This is the standard settlement agreement for represented claimants
required by the Division. See
Rule 7-2,
Content and Approval of Settlement Agreements |
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Settlement Agreement - Pro Se
(Unrepresented)
Claimant
Form # WC103
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This is the standard settlement agreement for unrepresented claimants
required by the Division. See
Rule 7-2,
Content and Approval of Settlement Agreements |
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Settlement
Routing Sheet
Form
# WC105
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This is a checklist
used by attorneys. It accompanies settlement documents and is
required by the Division to ensure all required information is included. |
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Settlement
Order -
Represented
Claimant
Form
# WC73
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This is the standard
Settlement Order submitted to the Director or Administrative Law Judge
for settlement approval on represented claimants. |
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Settlement
Order - Pro Se
Unrepresented
Claimant
Form # WC102
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This is the standard
Settlement Order submitted to the Director or Administrative Law Judge
for settlement approval on unrepresented claimants. |
