Free Report of Litigation Expenses, Claimant's Attorney (IC-1022)   - Idaho

INDUSTRIAL COMMISSION P. O. BOX 83720 BOISE, ID 83720-0041 I.C. CASE NO. ________________ I.C. CASE NAME _____________________________________________ _____________________________________________________ REPORT OF LITIGATION EXPENSES (CLAIMANTS' ATTORNEY) In accordance with the requirements of Section 72-528, Idaho Code, this form shall be filled out and returned to the Industrial Commission within 30 days following the time of entry of a final award by the Industrial Commission in the above case, or, in the event of an appeal to a final court, within 30 days following a final ruling by the court. If there is an appeal,

the totals specified below shall include the expenses, costs, or fees incurred in the appeal. 1. Attorneys fees incurred in litigation and charged to claimant: $_____________________

2. Expenses incurred in litigation and charged to claimant: $_____________________

TOTAL

$_____________________

Dated this ________ day of _______________, 19____. FIRM NAME ____________________________________________ BY____________________________________________________
IC Form 1022 IDAPA 17.02.05.281