Memorandum No. 1999-18

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MEMORANDUM NO. 1999-18

VOLUNTARY AGREEMENT FORMS

TO:	Commissioners, District Administrators, Self-Insureds, Insurance Carriers, Attorneys, Unions, Medical Practitioners, and Advisory Board Members
FROM:	John A. Mastropietro, Chairman
DATE:	November 17, 1999
RE:	VOLUNTARY AGREEMENT FORMS

The Workers' Compensation Commission will accept the following voluntary agreement forms:

GREEN for all injuries up to and including September 30, 1991
ORANGE for all injuries between October 1, 1991 and June 30, 1993*
GOLDENROD for all injuries between July 1, 1993 and June 30, 1995*
BLUE for all injuries occurring on or after July 1, 1995

* Please note that Memorandum No. 1999-13, dated July 22, 1999, incorrectly omitted the orange form.

[NOTE: This form is available from our website or any district office.]