Workers' Compensation Commission
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1BEFORE THE ARKANSAS WORKERS’ COMPENSATION COMMISSION
CLAIM NO. _______________
_________________________________________, EMPLOYEE
CLAIMANT
_________________________________________, EMPLOYER
RESPONDENT
_________________________________________, CARRIER
RESPONDENT
REPORT OF MEDIATION CONFERENCE
The (check one)
telephone
in-person conference on _______________________,
was attended by:
Claimant (
Yes
No)
Claimant’s attorney (
Yes
No)
Respondent Employer (
Yes
No)
Respondent’s attorney (
Yes
No)
Respondent Carrier (
Yes
No)
Other(s): ______________________________________________________________,
and the following issues were fully resolved by the parties in the presence of the undersigned
mediator:
None, or (list resolved issues)
A copy of this Report is placed in the case file and mailed to each party, who is to make
any written objection as to its accuracy within ten (10) days to the Clerk of the Commission, at
P. O. Box 950, Little Rock, AR 72203-0950.
_____________________________________________
Mediator
Date:
R
cc: Claimant / Respondent(s)
Form AR-R (Rev.1-1-2001)
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