Last updated: 5/2/2006
Approval Of Compromise Of Third Person Cause Of Action {LS-33}
Start Your Free Trial $ 13.99What you get:
- Instant access to fillable Microsoft Word or PDF forms.
- Minimize the risk of using outdated forms and eliminate rejected fillings.
- Largest forms database in the USA with more than 80,000 federal, state and agency forms.
- Download, edit, auto-fill multiple forms at once in MS Word using our Forms Workflow Ribbon
- Trusted by 1,000s of Attorneys and Legal Professionals
Description
Approval of Compromise of Third U.S. Department of Labor Person Cause of Action Employment Standards Administration Office of Workers Compensation Programs Claimant OWCP Case No. V. Employer Insurance Carrier The above named employer and its insurance carrier, having liability for disability/death benefits under the Act in the above captioned case, and being advised that the claimant or representative above named has compromised the cause of action against third person(s), which arose out of the injury/death on in the case, in the gross amount of $ , and the net amount of $ dated herewith approves said compromise on the date shown below, pursuant to the provisions of Sec. 33(g) of the Longshore and Harbor Workers Compensation Act, 33 U.S.C. 933(g). Employer By Title Date Insurance Carrier By Title Date Claimant By Title Date Filed on in the Office of the District Director for the CompensationDistrict Date District Director This form, or a signed statement in lieu thereof containing language of the same intent, must be filed in the office of the District Director having jurisdiction of the subject injury or death within 30 days after compromise is made in order to insure that the employer shall be liable for compensati on as provided in section 33. Form LS-33 Rev. Jan . 2003 American LegalNet, Inc. www.USCourtForms.com
Related forms
-
Evidence Required In Support Of A Claim For Occupational Disease
Official Federal Forms/US Dept Of Labor/ -
Leave Buy (LBB) Worksheet - Certification And Election
Official Federal Forms/US Dept Of Labor/ -
Official Superiors Report Of Employees Death
Official Federal Forms/US Dept Of Labor/ -
Time Analysis Form
Official Federal Forms/US Dept Of Labor/ -
Notice Of Termination Suspension Reduction Or Increase In Benefit Payments
Official Federal Forms/US Dept Of Labor/ -
Approval Of Compromise Of Third Person Cause Of Action
Official Federal Forms/US Dept Of Labor/ -
Black Lung Benefits Act Evidence Summary Form (OALJ)
Official Federal Forms/US Dept Of Labor/ -
Notice Of Alleged Safety Or Health Hazards
Official Federal Forms/US Dept Of Labor/ -
Applicant Background Questionnaire
Official Federal Forms/US Dept Of Labor/ -
Authorization For Release Of Medical Information (Black Lung Benefits)
Official Federal Forms/US Dept Of Labor/ -
Health Insurance Claim Form
Official Federal Forms/US Dept Of Labor/ -
Pretrial Statement (OALJ San Francisco District)
Official Federal Forms/US Dept Of Labor/ -
Request For Appointment Of Settlement Judge (OALJ)
Official Federal Forms/US Dept Of Labor/ -
Certification Of Health Care Provider For Employees Serious Health Condition
Official Federal Forms/US Dept Of Labor/ -
Certification Of Health Care Provider For Family Members Serious Health Condition
Official Federal Forms/US Dept Of Labor/ -
Employer Response To Employee Request For Family Or Medical Leave
Official Federal Forms/US Dept Of Labor/ -
Designation Notice (Family And Medical Leave Act)
Official Federal Forms/US Dept Of Labor/ -
Certification Of Qualifying Exigency For Military Family Leave
Official Federal Forms/US Dept Of Labor/ -
Certification For Serious Injury Or Illness Of Covered Servicemember
Official Federal Forms/US Dept Of Labor/ -
Subpoena To Produce Documents Information Or Objects (OALJ) (Hard Copy Requests)
Official Federal Forms/US Dept Of Labor/ -
Subpoena To Appear And Testify At A Deposition (OALJ) (Hard Copy Requests)
Official Federal Forms/US Dept Of Labor/ -
Subpoena To Appear And Testify At A Hearing (OALJ) (Hard Copy Requests)
Official Federal Forms/US Dept Of Labor/ -
Subpoena To Appear And Testify At A Deposition (OALJ) (For Email Processing)
Official Federal Forms/US Dept Of Labor/ -
Subpoena To Appear And Testify At A Hearing (OALJ) (For Email Processing)
Official Federal Forms/US Dept Of Labor/ -
Subpoena To Produce Documents Information Or Objects (OALJ) (For Email Processing)
Official Federal Forms/US Dept Of Labor/ -
Order Appointing Mediator (OALJ)
Official Federal Forms/US Dept Of Labor/ -
Agreement To Mediate (OALJ)
Official Federal Forms/US Dept Of Labor/ -
Request For Appointment Of Mediator (OALJ)
Official Federal Forms/US Dept Of Labor/ -
Non-Attorney Notice Of Appearance (OALJ)
Official Federal Forms/US Dept Of Labor/ -
Attorney Notice Of Appearance (OALJ)
Official Federal Forms/US Dept Of Labor/ -
Self-Represented Party Notice Of Appearance (OALJ)
Official Federal Forms/US Dept Of Labor/ -
Request For EFS Access–Consolidated Cases (OALJ)
Official Federal Forms/US Dept Of Labor/ -
H-1B Nonimmigrant Information Form
Official Federal Forms/US Dept Of Labor/ -
Notice Of Representatives Change In Business Or Contact Information (OALJ)
Official Federal Forms/US Dept Of Labor/ -
Motion By Party To Withdraw Representation (OALJ)
Official Federal Forms/US Dept Of Labor/ -
Motion (By Attorney Or Other Representative) To Withdraw From Representation (OALJ)
Official Federal Forms/US Dept Of Labor/ -
Agriculture Clearance Order Form ETA-790
Official Federal Forms/US Dept Of Labor/ -
Operator Response To Notice Of Claim
Official Federal Forms/US Dept Of Labor/ -
Report Of Earnings
Official Federal Forms/US Dept Of Labor/ -
Application For Permanent Employment Certification
Official Federal Forms/US Dept Of Labor/ -
ETA-9089 Appendix A (Foreign Worker Information)
Official Federal Forms/US Dept Of Labor/
Form Preview
Contact Us
Success: Your message was sent.
Thank you!