Let's talk about Form 105 – Agreement to Extend 180 Day Payment without Prejudice Period. Payment Without Prejudice Requirements.Insurers must begin payment within 14 days of receiving the first report of injury or employee claim form. An example of a without prejudice save as to costs settlement offer letter from a claimant (with drafting notes), also known as a claimant's Calderbank offer. I am forwarding the original of Daniel Tsai's letter to Joel Rosen, who I would ask to obtain the signatures of all Plaintiffs' counsel. Conflicts with respect to cases pending in the Massachusetts Superior Court and this court, the following scheduling policy shall apply: (1). Whether or not an accommodation is reasonable is a fact and casespecific inquiry. If you are an injured employee you must complete Form 110 and file a claim with the Department of Industrial Accidents (DIA). In this sense, a dismissal without prejudice is only a temporary dismissal. Upon the terms and conditions set forth in this Settlement Agreement and will be dismissed with prejudice. 1. Recitals.