Report Of Mediation Conference
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Report Of Mediation Conference Form. This is a Arkansas form and can be use in Workers Comp.
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Tags: Report Of Mediation Conference, AR-R, Arkansas Workers Comp,
BEFORE THE ARKANSAS WORKERS’ COMPENSATION COMMISSION
CLAIM NO. _______________
_________________________________________, EMPLOYEE
CLAIMANT
_________________________________________, EMPLOYER
RESPONDENT
_________________________________________, CARRIER
RESPONDENT
REPORT OF MEDIATION CONFERENCE
The (check one) telephone in-person conference on _______________________,
was attended by:
Claimant ( Yes No)
Respondent Employer ( Yes No)
Respondent Carrier ( Yes No)
Claimant’s attorney ( Yes No)
Respondent’s attorney ( Yes No)
Other(s): ______________________________________________________________,
and the following issues were fully resolved by the parties in the presence of the undersigned
mediator: None, or (list resolved issues)
A copy of this Report is placed in the case file and mailed to each party, who is to make
any written objection as to its accuracy within ten (10) days to the Clerk of the Commission, at
P. O. Box 950, Little Rock, AR 72203-0950.
_____________________________________________
Mediator
Date:
R
cc: Claimant / Respondent(s)
Form AR-R (Rev.1-1-2001)
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