Full And Final Mediation Request

FULL AND FINAL MEDIATION REQUEST FORM. This form is used to request mediation services for resolving disputes related to a workers' compensation claim in Virginia. Mediation is an alternative dispute resolution (ADR) process where a neutral mediator helps the parties communicate and potentially settle their dispute without going to court. The form allows the injured worker, their attorney, claim administrator, employer, or medical provider to initiate the mediation process. It requires details such as the injured worker’s name, date of injury, and jurisdiction claim number. Additionally, the person requesting mediation must provide their contact information, specify if any of the parties involved are represented by an attorney, and if the case has been mediated before. The form also includes questions about the claimant's Medicare status, conditional payments, and whether a Medicare Set-Aside (MSA) is needed. Once completed, the form must be submitted to the Virginia Workers' Compensation Commission, either electronically via their WebFile system, by mail, or in person. By signing the form, the person requesting mediation agrees to participate in the process and commit to settling in good faith. The mediation process includes different types of sessions, such as orientation sessions, issue facilitation, issue mediation, and full and final mediation, each with varying goals and time requirements. Full and final mediation is used to resolve entire cases and requires the involvement of attorneys. If mediation is unsuccessful, the parties retain the right to a hearing before the Commission. www.FormsWorkflow.com