Compromise and Release Form Injured Workes's Attornery/Representation type, first and last name of represenative, the lasw firm number and name and it's address Defendant Attornery/Representation type, first and last name of represenative, the lasw firm number and name and it's address Insurance Carrier name and address Claims Administrator name and address Information regarding the disability payments. Applicant and Defendand sign off Contains the case number, injury type (S, C), injury start date, the body parts and address of where the injury occurred. Weekly rate, Start and Stop Date Not required Agreed upon payment Contains the Employer Role Type (I, S,L, U) the Employer name and address the Applicant and Defendent initials. Used in the initials section Contains all information on temp or perm disability payments Amount payable and payable to fields used to deduct from the settlement amount