Compromise And Release (Dependency Claim) {DWC-CA 10214(d)} | Pdf Fpdf Docx | California

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Compromise And Release (Dependency Claim) {DWC-CA 10214(d)} | Pdf Fpdf Docx | California

Last updated: 6/8/2018

Compromise And Release (Dependency Claim) {DWC-CA 10214(d)}

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DWC-CA form 10214 (d), COMPROMISE AND RELEASE (Dependency claim), Upon the approval of this compromise agreement as provided by law, and payment in accordance with the provision of the said order of approval, said applicants and each of them do hereby release and forever discharge said employer and said insurance company of and from all claims, demands, actions or causes of action, of every kind or nature whatsoever on account of, or by reason of injury and death sustained as aforesaid by the employee, and in particular of any, all and every claim or cause of action which the undersigned, heirs, executors, representatives, and administrators may have had, now have, or shall hereafter have against said employer, said insurance carrier, and each of them under Division 4 of the Labor Code of the State of California. (REV. 11/2008).

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