Utah Regulations R612-1-9
From Wcc
§ R612-1-9 Compensation Agreements
| A. An applicant, insurance company, and/or employer may enter into a compensation agreement for the purpose of resolving a worker's compensation claim. Compensation agreements must be approved by the Commission. The compensation agreement must be that contained on Form 019 of the Commission forms and shall include the following information:
1. Signatures of the parties involved; 2. Form 122 - Employer's First Report of Injury; 3. Doctor's report of impairment rating; 4. Form 141 - Payment of Benefits Statement. B. Failure to provide any of the above documentation and forms may result in the return of the compensation agreement to the carrier or self-insured employer without approval. |
