IC Form MSC7 (rev. 10/2017) NORTH CAROLINA INDUSTRIAL COMMISSION N.C. Industrial Commission Mediation Section 1236 Mail Service Center Raleigh, NC 27699-1236 , Plaintiff v. REPORT OF EVALUATOR , Defendant , Carrier Evaluatortelephone fax Address The undersigned evaluator reports the following results of a neutral evaluation conference in this case: Conference was held. was not held. If not held, the reasons were: .Number of sessions held: Date conference was completed: Names of parties, attorneys, insurance representatives or others who were absent: The parties reached: agreement on all issues. an impasse. agreement on the following issues: If this case was not settled in mediation, and there is a pending request for hearing, the parties estimate that the length of the hearing in this case will be . Issues settled to be disposed of by: clincher other agmt. voluntary dismissal removal from hearing docket The person who will submit the agreement/clincher /dismissal to the Commission is , who will submit it by (date). Evaluator222s Fee ADMINISTRATIVE FEE: $ EVALUATION FEE: $ TotaltimespentinNeutralEvaluationConference:.hours OTHER FEE (Postponement fee, etc...., if any) $ TOTAL FEE: $ All fees to the evaluator have been paid except as follows: Party owing fee Amount owed Address of party I have mailed this report to the Commission within seven days of the conclusion of the neutral evaluation conference. This the day of , . Evaluator This report is to be returned to the Commission in all cases, whatever the neutral evaluation results. American LegalNet, Inc. www.FormsWorkFlow.com