Agreement As To Compensation Paid

AGREEMENT AS TO COMPENSATION PAID. This form is used in the State of Delaware's Office of Workers' Compensation to document an agreement between an employee who has sustained an injury, an insurance carrier or self-insurer, the employer, and potentially a third party adjuster. The purpose of the form is to outline the terms of compensation for the injured employee and provide information about the injury, disability, and related details. The agreement specifies the compensation amount, payment frequency, and other relevant information, as well as the requirement for notifying any changes in employment status or disability. The form also emphasizes the obligation to provide a modified duty availability report to the healthcare provider/physician and includes sections for signatures of witnesses, the employee, and the adjuster/attorney. The completed form is submitted to the Delaware Office of Workers' Compensation for approval. www.FormsWorkflow.com