Pre-Mediation Statement Form (Contested Original Claim)

Description

This form is for voluntary use in Full And Final Mediation as a way to convey information to the mediator prior to the mediation. It has been designed for use in a case where the original claim for benefits is contested. It may be uploaded as an ADR Confidential Document via Web File, or faxed to the ADR Department at 804-823-6904.