A compromise settlement agreement must contain the following information:
(1) that the agreement is executed on a form approved by the board;
(2) that the agreement is accompanied by physician’s signed report of the findings of a recent examination of the employee;
(3) that the employee has achieved maximum recovery, or that good reason exists for settlement prior to maximum recovery;
(4) that in the event of serious injury to claimant’s eye, healing has occurred and the board furnished with a medical report on whether the other eye is or may be affected;
(5) that in all instances of severe and disfiguring burns or lacerations, a descriptive medical report of the scars will be submitted by either the association or claimant. In all such cases involving injury to the face, arms, or hands, a color photograph taken after maximum healing must be submitted to the board by either the claimant or carrier;
(6) all compromise settlement agreements submitted to the board must be submitted in four parts–the original must be white, the second copy pink, the third copy yellow, and fourth copy white. The forms must either be on NCR paper or be submitted with carbon left intact. The board will provide a copy of the compromise settlement agreement to the claimant, claimant’s attorney if one has been employed, and the carrier’s Austin representative in lieu of a separate approval notice.
The provisions of this § 55.15 adopted to be effective November 20, 1977, 2 TexReg 4320; amended to be effective September 1, 1981, 6 TexReg 3274; amended to be effective June 1, 1993, 18 TexReg 3194.