Settlement Approval Request Under Section 8(i)
This form is essential for requesting approval of a settlement under Section 8(i) of the Longshore and Harbor Worker's Compensation Act. Users must attach a fully executed settlement agreement with supporting documents. Helpful details are included to streamline the submission process.
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How do I fill this out?
To fill out this form, start by gathering all necessary information about the incident and the parties involved. Be sure to provide detailed summaries and medical information as required. Finally, ensure all signatures are obtained before submission.
How to fill out the Settlement Approval Request Under Section 8(i)?
1
Gather required information and documentation.
2
Complete each section thoroughly and accurately.
3
Attach the necessary medical reports and settlement agreements.
4
Obtain all required signatures.
5
Submit the completed form as per instructions.
Who needs the Settlement Approval Request Under Section 8(i)?
1
Injured workers seeking compensation settlements.
2
Employers agreeing to settlements under the Longshore Act.
3
Insurance carriers managing claims and settlements.
4
Legal representatives assisting clients with settlement requests.
5
Medical professionals providing reports related to worker's compensation.
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Editing this PDF on PrintFriendly is simple and intuitive. Users can easily highlight sections, add notes, or modify text directly within the document. Our editing tools allow you to create a personalized and accurate settlement request.
1
Open the PDF in PrintFriendly.
2
Use the editing tools available to highlight or modify sections.
3
Add notes or comments as necessary.
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5
Download the edited PDF once completed.
What are the instructions for submitting this form?
Submit this form and any required documents to the OWCP/DLHWC Central Mail by certified mail with return receipt requested, or use a commercial delivery service that provides tracking. The mailing address is U.S. Department of Labor, Office of Workers' Compensation Programs, Division of Longshore and Harbor Workers' Compensation, 400 West Bay Street, Suite 63A, Box 28, Jacksonville, FL 32202. Ensure to send everything in one submission for faster processing.
What are the important dates for this form in 2024 and 2025?
Important dates for submission in 2024 and 2025 will include the OMB expiration date on 03/31/2026. Ensure to submit your form well before this date to avoid delays. Keep an eye on any changes in regulations that may affect the submission process.
What is the purpose of this form?
The purpose of the Settlement Approval Request form is to formally request approval of a settlement from the Office of Workers' Compensation Programs. This document ensures that all necessary information is presented for the assessment of the settlement's adequacy. Completing this form accurately is crucial for a smooth transaction and compliance with legal requirements.
Tell me about this form and its components and fields line-by-line.
- 1. Date of Accident/Illness: The date when the injury or illness occurred.
- 2. Carrier's No.: The identification number assigned by the insurance carrier.
- 3. OWCP No.: The claim number provided by the Office of Workers' Compensation Programs.
- 4. Name of Injured Worker: The full name of the individual who suffered the injury.
- 5. Claimant's Telephone Number: A required contact number if the claimant is not represented.
- 6. Average Weekly Wage: The claimant's average earnings per week before the injury.
- 7. Compensation Rate: The rate at which compensation is calculated.
- 8. Settlement Amount for Compensation: Total settlement amount proposed for compensation.
- 9. Settlement Amount for Medical Treatment: Amount designated for medical treatments.
- 10. Liens: Indicate if there are any existing liens against the settlement.
- 11. Attorney Fees: Confirmation and amount of any agreed-upon attorney fees.
- 12. Total Amount Due: The total sum that will be payable to the claimant if approved.
- 13. Medicare Secondary Payer Act: Confirmation if Medicare considerations have been addressed.
What happens if I fail to submit this form?
Failing to submit the form may result in delays or denials of your settlement request. It is important to ensure that all required sections are completed and that the form is submitted correctly to avoid complications.
- Delayed Processing: Incomplete information can cause longer waiting times for settlement approval.
- Denial of Settlement: Missing signatures or documents may result in the rejection of your request.
- Legal Complications: Failure to comply with the submission guidelines may lead to legal issues.
How do I know when to use this form?
- 1. Settlement Procedures: This form is essential to initiate the approval process for settlements.
- 2. Legal Compliance: It ensures compliance with federal regulations regarding workers' compensation settlements.
- 3. Requesting Approval: Used explicitly for seeking official approval for settlement arrangements.
Frequently Asked Questions
What is the purpose of the Settlement Approval Request?
The purpose of this form is to obtain approval for settlements under Section 8(i) of the Longshore Act.
Who needs to fill out this form?
Injured workers, employers, and their insurance carriers must fill out this form to facilitate settlement approvals.
How do I submit the completed form?
The completed form can be submitted by certified mail or uploaded via the Secure Electronic Access Portal.
Can I edit the form once downloaded?
Yes, you can edit the form using PrintFriendly's PDF editor before submitting it.
Is it necessary to attach medical reports?
Yes, medical reports describing injuries and treatment history must be attached to support the settlement request.
What happens if the form is incomplete?
An incomplete form may delay processing or result in a denial of the settlement request.
Can I save the edited PDF?
You can download the edited PDF; however, saving directly on the site is not supported.
How long does it take to process this form?
Processing times may vary, but it generally takes several weeks to review settlement requests.
Are there any fees associated with this form?
There are no fees for submitting the Settlement Approval Request form.
Is the submission of this form mandatory?
Yes, submitting this form is mandatory to obtain official approval for settlements.
