Maine > Workers Compensation
Lump Sum Settlement WCB-10 - Maine
| Lump Sum Settlement Form. This is a Maine form and can be used in Workers Compensation . |
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STATE OF MAINE WORKERS' COMPENSATION BOARD 27 STATE HOUSE STATION, AUGUSTA, MAINE 04333-0027 ,1685(5 ),/( 180%(5 (03/2<(5 1$0( (03/2<(5 0$,/,1* $''5(66 $1' 3+21( 180%(5 ,1685(5 1$0( ,1685(5 0$,/,1* $''5(66 62&,$/ 6(&85,7< 180%(5 ODVW GLJLWV (03/2<(( /$67 1$0( $''5(66180%(5 $1' 675((7 &,7< '$7( 2) ,1-85< 67$7( =,3 '(6&5,37,21 2) ,1-85< +20( 3+21( :&% ),/( 180%(5 ),567 1$0( 0, LUMP SUM SETTLEMENT ;;;;; 7<3( 2) 6(77/(0(17 6758&785(' 6(77/(0(17 $77$&+ '2&80(17$7,21 /803 680 6(77/(0(17 727$/ 9$/8( 2) 6(77/(0(17 BBBBBBBBBBBBBBBBB $02817 3$,' BBBBBBBBBBBBBBBBBBBBBBBBBBBBB 3(50$1(17 ,03$,50(17 5$7,1* BBBBBBBBBBBBBBBBBBB 6285&( 2) 5$7,1* BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB '$7( 2) 5$7,1* BBBBBBBBBBBBBBBBBBBBBBBBBBBBBB BBBBBBBBBBBBBBBBBBBBBBBB (;3(&7(' )8785( 0(',&$/ &2676 5(/$7(' 72 7+( ,1-85< &200(176 (03/2<(5,1685(5 5(35(6(17$7,9( 7<3( 25 35,17 (03/2<(( 5(35(6(17$7,9( 7<3( 25 35,17 (03/2<(('(3(1'(17 RELEASE , $0 7+( 3(5621 (17,7/(' 72 :25.(56¶ &203(16$7,21 %(1(),76 21 $&&2817 2) 7+,6 ,1-85< 25 '($7+ , +$9( 5($' 7+,6 )250 $1' $// $77$&+0(176 , &216(17 72 7+( 6(77/(0(17 :+(1 7+( 6(77/(0(17 ,6 $33529(' %< 7+( +($5,1* 2)),&(5 , 5(/($6( 7+( (03/2<(5 $1' ,1685(5 1$0(' $%29( )520 $// )857+(5 /,$%,/,7< )25 7+,6 ,1-85< (;&(37 $6 27+(5:,6( $33529(' %< 7+( %2$5' _________________________________ (03/2<(('(3(1'(17 6,*1$785( ____________ '$7( ____________________________________ (03/2<(( 5(35(6(17$,9( 6,*1$785( _____________ '$7( (03/2<(5,1685(5 7+( (03/2<(5 &216(176 72 7+( 6(77/(0(17 7+( ,1685(5 &216(176 72 7+( 6(77/(0(17 <(6 <(6 12 12 BBBBBBBBBBBBBBBBBBBBBB 6,*1$785( BBBBBBBBBBBBBBBB '$7( BBBBBBBBBBBBBBBBBBBBBB 6,*1$785( BBBBBBBBBBBBBBBB '$7( 7+( 5(48(67(' 6(77/(0(17 ,6,6 127 $33529(' 7+( (03/2<(5,1685(5 ,6 25'(5(' 72 3$< 7+( (03/2<(('(3(1'(17 7+( 6(77/(0(17 $02817 2) BBBBBBBBBBBBBBBBBBBBBBBBBBBBBB $1' $// 28767$1',1* &203(16$7,21 2%/,*$7,216 ,1&855(' 35,25 72 7+( 6(77/(0(17 3$<0(17 0867 %( 0$'( :,7+,1 '$<6 38568$17 72 $ 056$ 7+( (03/2<(5,1685(5 ,6 25'(5(' 72 3$< 7+( (03/2<(('(3(1'(17¶6 $77251(< $ )(( 2) BBBBBBBBBBBBBBBBBBBB $// 3(1',1* 3(7,7,216 %$6(' 21 7+,6 &/$,0 $5( +(5(%< ',60,66(' BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB +($5,1* 2)),&(5 6,*1$785( BBBBBBBBBBBBBBBBBBBBBBB '$7( DECISION 7KH 6WDWH RI 0DLQH SURYLGHV HTXDO RSSRUWXQLW\ LQ HPSOR\PHQW DQG SURJUDPV $X[LOLDU\ DLGV DQG VHUYLFHV DUH DYDLODEOH WR LQGLYLGXDOV ZLWK GLVDELOLWLHV XSRQ UHTXHVW )RU DVVLVWDQFH ZLWK WKLV IRUP FRQWDFW WKH $'$ &RRUGLQDWRU DW WKH 0DLQH :RUNHUV¶ &RPSHQVDWLRQ %RDUG 7HOHSKRQH RU 77< 0DLQH 5HOD\ :&% HII American LegalNet, Inc. www.FormsWorkFlow.com
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