Free Report of Litigation Expenses, Employer/Insurer Attorney (IC-1023) - Idaho

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State: Idaho
Category: Workers Compensation
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Page Size: Letter (8 1/2" x 11")

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INDUSTRIAL COMMISSION P. O. BOX 83720 BOISE, ID 83720-0041 I.C. CASE NO. ________________ I.C. CASE NAME _____________________________________________ _______________________________________________________ REPORT OF LITIGATION EXPENSES (EMPLOYER/SURETY/ISIF/SELF INSURERS) 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. 2. 3. 4. 5. 6. 7. Attorneys fees paid in case: Expenses charged by attorneys: $_____________ _____________

Charges for reports or testimony of witnesses: _____________ Cost of any depositions taken: Cost of investigations made before or during hearing: Costs of research or legal briefs (if separate from attorneys fees): Filing fees paid on account of the litigation: TOTAL $_____________ _____________ _____________ _____________ _____________

Dated this _______ day of __________________, 19 ____. FIRM NAME_____________________________________________ BY____________________________________________________ Check Applicable Box: ___Self Insured ___ Uninsured Employer ___ Surety ___State Insurance Fund ___Industrial Special Indemnity Fund

IC Form 1023