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Mediation Request

If a hearing is scheduled for today or tomorrow, please contact the Administrative Law Judge's judicial assistant to request cancellation of the hearing so that the mediation can be scheduled:
  Salem 503-378-3308
  Portland 971-673-0900
  Eugene 541-686-7989
  Medford 541-776-6217

WCB Case Number(s):
Claimant's Name:*
Claim Number(s):*
Hearing Date:
Name of Submitter:*
Submitter's Phone Number:* ( )
Claimant's Attorney:

Employer's/Insurer's Attorney:

Other Attorneys Involved:
*Required
 

Please list at least 3 mutually-agreeable dates for all parties to conduct this mediation:
Please indicate mediator(s) preference(s) (if any):
Mediation location:
Interpreter: No Yes                 Language:
*NOTE: Written confirmation is required, with copy to opposing party/attorney.

If you have questions about the mediation program, please follow this link, or contact the WCB Mediation Coordinator, Kerry Garrett, at 503-934-0104 (Salem) or toll free anywhere in Oregon at 1-877-311-8061, or by email at Mediation.WCB@state.or.us