Indemnity Only Stipulation

INDEMNITY ONLY STIPULATION. An indemnity only stipulation is a full and final settlement of the indemnity portion of your case. It does NOT affect your ability to obtain reasonable or necessary medical treatment that may be related to a compensable claim. Once it is approved by the Administrative Law Judge, the indemnity portion of your case is closed. You cannot recover any further indemnity benefits, including but not limited to temporary total, temporary partial, permanent partial, and permanent total disability benefits, from this employer for this injury. Acceptance of this settlement means that you are waiving your rights to a formal hearing, which is a trial, regarding any issues that your employer or the insurance company may be disputing with respect to indemnity benefits only. You may, however, pursue litigation, if necessary, for claims for medical treatment. By accepting this stipulation, you give up your rights to any future loss of income benefits to which you might be entitled. www.FormsWorkflow.com