North Carolina > Workers Comp
Order For Mediated Settlement Conference MSC3 - North Carolina
| Order For Mediated Settlement Conference Form. This is a North Carolina form and can be used in Workers Comp . |
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IC Form MSC3 (rev. 4/11) THIS FORM IS TO BE USED UNDER THE RULES FOR MEDIATED SETTLEMENT CONFERENCES OF THE NORTH CAROLINA INDUSTRIAL COMMISSION Attn: Dispute Resolution Coordinator I. C. File No. _____________________ NC Industrial Commission Emp. Code No. ___________________ Mediation Section Carrier Code No. __________________ 4342 Mail Service Center Carrier File No. ___________________ Raleigh, NC 276994342 _______________________________ Plaintiff v. ORDER FOR MEDIATED SETTLEMENT CONFERENCE _______________________________ Defendant _______________________________ Carrier Appearances ________________________________ Name of Plaintiff or Plaintiff's Attorney _________________________________________ Telephone number of Plaintiff or Plaintiff's Attorney ______________________________________________________________________________ Address of Plaintiff or Plaintiff's Attorney ________________________________ Name of Defendant or Defendant's Attorney __________________________________________ Telephone number of Defendant or Defendant's Attorney ______________________________________________________________________________ Address of Defendant or Defendant's Attorney IT IS ORDERED that the parties in the above captioned case and their attorneys participate in a mediated settlement conference pursuant to NC General Statutes 9780(c) and the Rules for Mediated Settlement Conferences of the North Carolina Industrial Commission (ICMSC Rules). The conference shall be completed by ________________, _______ (within 120 days of mediation order). The parties have 21 days from the date of this Order to select by agreement a mediator or to designate by agreement the Commission's list from which the parties desire that the Commission select a mediator. Within 21 days of the date of this Order, the American LegalNet, Inc. www.FormsWorkFlow.com Defendant or the Defendant's counsel shall file a stipulation as to the mediator or notice of the parties' failure to agree on a mediator on IC Form MSC 4. See ICMSC Rule 2. The parties and a mediator selected by agreement shall agree upon the mediator's rate of compensation. A mediator appointed by the Commission will be compensated at the rate of $150 per hour for time spent in the mediated settlement conference, to be billed in quarter hour segments, in addition to a $150 administrative fee, in accordance with ICMSC Rule 7. All parties, their attorneys and individuals with authority to settle the claim shall attend, as set forth in ICMSC Rule 4(a). The parties shall exchange all medical and rehabilitation records available to the parties related to the injury in question and any recorded statements, expert opinions, reports and other documents, tapes and photographs that are relevant or material to the issues in controversy at least 15 days prior to mediation. This case will be set for hearing on the next available calendar to be heard in due course unless sooner settled by mediation. HEREBY ENTERED AND ORDERED, this ___ day of ________, _______. NORTH CAROLINA INDUSTRIAL COMMISSION By: __________________________________ Commissioner/Deputy Commissioner/Dispute Resolution Coordinator American LegalNet, Inc. www.FormsWorkFlow.com
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