Settlement Advance Recap Sheet | Pdf Fpdf Docx | Montana

 Montana   Workers Compensation 
Settlement Advance Recap Sheet | Pdf Fpdf Docx | Montana

Last updated: 5/31/2024

Settlement Advance Recap Sheet

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Description

SETTLEMENT/ADVANCE RECAP SHEET. This form is used by the Montana Department of Labor & Industry's Employment Standards Division to summarize and document the details of a workers' compensation settlement or advance payment. It includes specific information about the claimant, their injury, and the settlement or advance amount. The form requires details such as income and expenses before and after the lump sum, impairment ratings, and settlement calculations. It is signed by both the claimant and the insurer (or their representatives) and reviewed by an Employment Standards Division examiner. www.FormsWorkflow.com

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