Fill and Sign the Dwc Ca Form 10214 C Dir

STATE OF CALIFORNIA WORKERS' COMPENSATION APPEALS BOARD Case No. Applicant vs. ORDER APPROVING COMPROMISE AND RELEASE Defendants Based upon the reasons given in the settlement, medical reports on file, the settlement appears fair and reasonable and is deemed adequate. A serious and legitimate issue of injury AOE/COE exists, which, if resolved against the employee would totally bar employee recovery of workers' compensation benefits. (Thomas vs. Sports Chalet, Inc. (1977), 42 CCC 625), as set forth in the Compromise and Release. The applicant has been advised and the Workers' Compensation Judge has considered the release of death benefits in determining the adequacy of this settlement. The applicant has been advised and the Workers' Compensation Judge has considered the Rodgers release in determining the adequacy of this settlement. (Rodgers vs W.C.A.B., et al (1985) 50 CCC 299) This Compromise and Release does not settle future Labor Code section 139.5 benefits. The parties to the above-entitled action having filed a Compromise and Release herein, on , and requesting that it be approved; and this Board having settling this case for $ considered the entire record, including said Compromise and Release, now finds that it should be approved. IT IS ORDERED that said Compromise and Release be approved. Award is made in favor of- THE ABOVE-NAMED APPLICANT AGAINST THE ABOVE-NAMED DEFENDANTS, PAYABLE AS FOLLOWS: as In the above sum, less permanent disability advances, if applicable, less $ attorneys' fees,. payable to applicant's attorney or attorneys as described in the Compromise and Release. BALANCE TO APPLICANT EXECUTED ON: (date) NOTICE TO WORKERS' COMPENSATION ADMINISTRATIVE LAW JUDGE Pursuant to Rule 10500 you are designated to serve this/these documents on all parties shown on the Official Address Record