Used when initial compensability of a claim is denied. No recap sheet required.
Petition for Settlement - Injury/OD, Medical Benefits Reserved
Petition for Settlement - Injury/OD, Medical Closed on an Accepted Claim
Used when settlement of medical is in best interest of parties or settling wage loss entitlement (other than Perm Total) and settlement of medical is in best interest of parties.
Petition for Settlement - Injury/OD, Disputed Medical Closed
Used when settling wage loss entitlement & disputed perm total benefits and disputed medical benefits.
Petition for Settlement - PTD, Injury/OD Medical Benefits Reserved
Used when settling perm total benefits and medical benefits are reserved.
Petition for Settlement - PTD, Injury/OD Medical Closed on an Accepted Claim
Used when settling perm total benefits and settlement of medical is in best interest of parties.
