Workers Comp Release Form Template for England and Wales

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Key Requirements PROMPT example:

Workers Comp Release Form

"I need a Workers Comp Release Form for a manufacturing employee who suffered a back injury in January 2025, with a settlement amount of £45,000 and provisions for ongoing physiotherapy treatment for 12 months."

Document background

The Workers Comp Release Form is a crucial document in English and Welsh employment law, used when settling workplace injury or illness claims. It serves as a formal agreement documenting the terms of compensation and releasing the employer from future liability related to the specific incident. This document is typically used after negotiations have concluded and both parties have agreed to settlement terms. It must comply with various UK regulations, including the Health and Safety at Work Act 1974 and the Employers' Liability Act 1969. The form typically includes details of the incident, medical evidence, compensation amount, and terms of release.

Suggested Sections

1. Parties: Identifies the employer and employee/worker involved in the settlement

2. Background: Brief description of the incident/injury and circumstances leading to the settlement

3. Definitions: Key terms used in the agreement including relevant legislation references

4. Settlement Amount: Specific compensation amount and payment terms

5. Release of Claims: Worker's agreement to release employer from future claims related to the incident

6. Confidentiality: Terms regarding disclosure of settlement details

7. Governing Law: Specification of English and Welsh law as governing law

Optional Sections

1. Future Medical Treatment: Terms regarding ongoing medical care and future treatment requirements

2. Return to Work Provisions: Terms for returning to work if the worker will continue employment

3. Medicare/Benefits Consideration: Special provisions regarding state benefits and their interaction with the settlement

4. Non-Disparagement: Mutual agreement not to speak negatively about each other

Suggested Schedules

1. Schedule 1 - Medical Reports: Copies of relevant medical assessments and reports documenting injuries

2. Schedule 2 - Benefit Statements: Details of any state benefits received related to the injury

3. Schedule 3 - Incident Reports: Official documentation of the workplace incident and investigation findings

4. Schedule 4 - Payment Schedule: Detailed breakdown of payment terms if settlement is to be paid in installments

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

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Let's create your Workers Comp Release Form

Authors

Alex Denne

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