Release Of Liability

RELEASE OF LIABILITY PURSUANT TO NEB. REV. STAT.§ 48-139. This is a Nebraska Workers’ Compensation Court form used to finalize settlements between an injured worker (plaintiff) and an employer or insurer (defendant) under Neb. Rev. Stat. § 48-139. This document allows the employee to waive future claims for weekly disability benefits, vocational rehabilitation, medical care, and other workers’ compensation rights in exchange for an agreed settlement payment. To be valid, the employee must generally be represented by counsel and not be Medicare-eligible or expecting Medicare eligibility within 30 months. The form requires full disclosure that no unpaid or Medicaid-covered medical expenses remain and must be signed by the employee, attorney, and employer (optional). It also includes notary acknowledgment pages. www.FormsWorkflow.com