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Report Of Mediation Conference - Oklahoma

Report Of Mediation Conference Form. This is a Oklahoma form and can be used in Workers Comp .
 Fillable pdf Last Modified 3/14/2014
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Commission Rule 810:2-3-9(6) - Mediation OKLAHOMA WORKERS' COMPENSATION COURT MEDIATION SYSTEM REPORT OF MEDIATION CONFERENCE MUST be completed. Please type or print legibly. Claim for Compensation (i.e. CC-Form-3 or CC-Form-3B) on File With the Workers' Compensation Commission? G Yes (Commission File No. ____________________) G No Claimant/Injured Worker (Full Name): _____________________________________________________ Respondent/Employer (Name): ____________________________________________________________ Insurer (Name):__________________________________________________________________________ Check One: G Mediation By Mutual Agreement of the Parties (i.e. No Commission Order of Referral to Mediation) G Court Ordered Referral to Mediation 1. 2. 3. 4. Mediation conference date:______________________________________________________ Mediation conference location (city and county):_________________________________ Mediation conference length ______ hours ______minutes. The case was (circle one letter): a. settled in full; b. not settled; c. settled in part (circle appropriate number): (1) parties reached agreement on one or more issues or claims; (2) case settled as to some parties, but not all parties. Mediation conference was held with (circle one letter): a. all participants present in person; b. by advance permission of the referring administrative law judge, one or more participants present other than in person; all others present in person; c. by advance agreement of the mediator and parties mediating by mutual agreement, one or more participants present other than in person; all others present in person. Total number of participants (excluding mediator):____________________________ 5. 6. ____________________________________ Mediator __________________________________ Date (Send original to Workers' Compensation Commission Counselor Division, 1915 N. Stiles Ave. Oklahoma City, OK 73105) Created 2-1-14 American LegalNet, Inc. www.FormsWorkFlow.com
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