Tip for C&R (state-specific)

A Compromise and Release is a FINAL settlement — you typically give up the right to future medical treatment and benefits for the claim

Tip for C&R (state-specific)

Consult a workers' comp attorney before signing — settlements cannot usually be reopened

Tip for C&R (state-specific)

The judge can reject the settlement if it is not in the injured worker's best interest

Workers' Compensationvery hard

Compromise and Release / Stipulated Settlement

C&R (state-specific) · State Workers' Compensation Agencies

Settlement agreement closing the workers' compensation claim, typically for a lump sum. Must be approved by a workers' comp judge or board in most states.

Form Details

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Filled by: both
Frequency: one time
State-specific: Yes — form may vary by state

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Where to Submit This Form

📬

File with your state's Workers' Compensation Board or Appeals Board

This is a legal settlement document — typically filed by your attorney or the carrier's attorney.

🏢

File at the Workers' Compensation Board during a hearing

Many settlements are approved at scheduled hearings.

Required Attachments

📎 Completed Compromise and Release agreement signed by all parties
📎 Medical reports supporting the settlement terms
📎 Wage documentation
📎 Attorney approval and fee disclosure (if represented)

Processing Time

A workers' compensation judge must approve the settlement. Typically scheduled within 2-6 weeks of filing.

What Happens Next

A Workers' Compensation Judge will review the settlement to ensure it is fair and adequate. If approved, you receive a lump sum payment and your right to future benefits may be waived.

Tips for This Form

✓ A Compromise and Release is a FINAL settlement — you typically give up the right to future medical treatment and benefits for the claim
✓ Consult a workers' comp attorney before signing — settlements cannot usually be reopened
✓ The judge can reject the settlement if it is not in the injured worker's best interest
✓ Consider whether you need future medical treatment before agreeing to a lump sum

More Workers' Compensation Forms

First Report of Injury (Generic FROI)

FROI · State Workers' Compensation Agencies

Report of workplace injury or occupational disease filed with the state agency and insurer. Required within 3-10 days of injury depending on state. Establishes the claim in the system.

California Workers' Comp Claim Form

DWC-1 · California Division of Workers' Compensation

Employee claim form for workers' compensation benefits in California. Employer must provide within one working day of learning of a workplace injury or illness.

New York Employee Claim

C-3 · New York Workers' Compensation Board

Employee's claim for compensation filed with the NY Workers' Compensation Board. Must be filed within 2 years of the accident or within 2 years of when the claimant knew or should have known the condition was work-related.

Texas Employee's Claim for Compensation

DWC-041 · Texas Department of Insurance, Division of Workers' Compensation

Employee's claim for compensation for a work-related injury or illness in Texas. Must be filed within one year of injury or within one year of when the employee knew or should have known the condition was work-related.

Florida First Report of Injury or Illness

DFS-F2 · Florida Division of Workers' Compensation

Florida's first report of injury or illness form. Employer must file within 7 days of knowledge of an injury or within 24 hours if the injury results in death.

North Carolina Notice of Accident to Employer

Form 18 · North Carolina Industrial Commission

Notice of Accident to Employer and Claim of Employee. Must be filed when injured on the job in North Carolina. Written notice to employer required within 30 days; claim filed within 2 years.

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Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the State Workers' Compensation Agencies or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.