Fillable Dwc-Ca Form 10214 - Compromise And Release

Dwc-Ca Form 10214 - Compromise And Release - 2008 Page 7

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9. The parties wish to settle these matters to avoid the costs, hazards and delays of further litigation, and agree that a

serious dispute exists as to the following issues (initial only those that apply). ONLY ISSUES INITIALED BY THE APPLICANT

OR HIS/HER REPRESENTATIVE AND DEFENDANTS OR THEIR REPRESENTATIVES ARE INCLUDED WITHIN THIS

SETTLEMENT.

Applicant Defendant

earnings

temporary disability

jurisdiction

apportionment

employment

injury AOE/COE

serious and willful misconduct

discrimination (Labor Code §132a)

statute of limitations

future medical treatment

other

permanent disability

self-procured medical treatment, except as provided in Paragraph 7

vocational rehabilitation benefits/supplemental job displacement benefits

COMMENTS:

Any accrued claims for Labor Code section 5814 penalties are included in this settlement unless expressly excluded.

10. It is agreed by all parties hereto that the filing of this document is the filing of an application, and that the workers'

compensation administrative law judge may in its discretion set the matter for hearing as a regular application, reserving to the

parties the right to put in issue any of the facts admitted herein and that if hearing is held with this document used as an

application, the defendants shall have available to them all defenses that were available as of the date of filing of this

document, and that the workers' compensation administrative law judge may thereafter either approve this Compromise and

Release or disapprove it and issue Findings and Award after hearing has been held and the matter regularly submitted for

decision.

DWC-CA form 10214 (c) (Rev. 11/2008) (Page 7 of 9)

Dwc-Ca Form 10214 - Compromise And Release - 2008 Page 7

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