Order Approving Pro Se Settlement Agreement
Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Order Approving Pro Se Settlement Agreement Form. This is a Colorado form and can be use in Workers Comp.
Loading PDF...
Tags: Order Approving Pro Se Settlement Agreement, Colorado Workers Comp,
STATE OF COLORADO
OFFICE OF ADMINISTRATIVE COURTS /OR
DIVISION OF WORKERS' COMPENSATION
W. C. No.:
ORDER APPROVING PRO SE SETTLEMENT AGREEMENT
In the claim of:
________________________________________________, Claimant,
vs.
________________________________________________, Employer,
and
________________________________________________, Insurer,
Respondents.
________________________________________________________________
This matter comes before the undersigned Administrative Law Judge
(ALJ)
for
consideration
of
a
Settlement
Agreement
dated
______________________. The parties seek approval of the agreement in
accordance with the Workers’ Compensation Act of Colorado.
Claimant has:
____ Observed the advisement video.
____ Reviewed and discussed the Settlement Agreement with the ALJ.
Accordingly, the Settlement Agreement is approved in accordance with
the Act. The proceedings were electronically recorded in CR _____ beginning at
________or on Tape No. ______________.
SO ORDERED: ___________
________________________________
ADMINISTRATIVE LAW JUDGE
Office of Administrative Courts /or
Division of Workers' Compensation
File: form order.approving settlement
American LegalNet, Inc.
www.USCourtForms.com
