Confidential Mediation Statement

CONFIDENTIAL MEDIATION STATEMENT. This form is used in the Rhode Island Workers' Compensation Court for confidential mediation purposes. It is submitted solely to the mediation coordinator and not shared with opposing counsel. The form requires information about the case, including the case name, case number, and details about the counsel filing the statement. It also asks for specifics regarding compensation rate, latest demand and offer, remaining weeks to the gate (if applicable), and whether a Medicare Set-Aside (MSA) is needed and completed. The form solicits explanations for why past efforts to resolve the dispute have failed, details about any Family Court liens, important factors affecting the client’s chances for success at trial, potential or acceptable outcomes for the mediation, and any other relevant information to assist the mediator. An additional statement, no longer than five pages, outlining the client's position, including medical opinions and summaries of lay witness testimony, is also required. www.FormsWorkflow.com