Form 116B - Addendum to Lump Sum Agreement: Vocational Rehabilitation Status

This form must be filed at the lump sum conference. It is not sent in with the Form 116 (Request for Lump Sum Conference). It must be signed by the claimant, the claimant's counsel, and the counsel for the insurer.

When the claimant has been found suitable for vocational rehabilitation this form must also be signed by the Office of Education and Vocational Rehabilitation.

Print Addendum To Lump Sum - Vocational Rehabilitation.