099.00.97 Ark. Code R. 006 - Report of Mediation Conference (WCC Form R)

BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION.

CLAIM NO.________________

_________________________________, EMPLOYEE CLAIMANT

_________________________________, EMPLOYER RESPONDENT

_________________________________, CARRIER RESPONDENT

REPORT OF MEDIATION CONFERENCE

At the ([]telephone [] in person) conference on ____________________ (date)

authorized representatives of the Claimant ( [] Yes [] No) and the Respondent ( [] Yes [] No) attended, and the following issues were fully resolved by the parties in the presence of the undersigned mediator: [] None, or

A copy of this Report is filed in the case file and mailed to each party, who is to make any written objection as to its accuracy within ten (10) days to the Clerk of the Commission.

_________________________________

Mediator

Notes

099.00.97 Ark. Code R. 006

10/27/1997