STATE OF CALIFORNIA GRAY DAVIS, Governor DEPARTMENT OF INDUSTRIAL RELATIONS DIVISION OF INDUSTRIAL ACCIDENTS - WORKERS' COMPENSATION APPEALS BOARD 100 PASEO DE SAN ANTONIO, 2ND FLOOR, ROOM 241 SAN JOSE, CALIFORNIA 95113 APPLICATION FOR ACCESS TO WCAB INDEX CARDS AND COMPUTER BY DWC STAFF NAME: DATE OF BIRTH: Research will be done by written request only. can be returned to you. I, (print name) SOCIAL SECURITY NO.: DATE OF INJURY: Please include a stamped, self-addressed envelope so this form , request permission for DWC to research I am an employee of WCAB INDEX CARDS of the San Jose district office of the WCAB. , and my office address is My DWC AUTHORIZATION NUMBER is: Reason(s) you want this information: I agree to comply with all policies and procedures established by the WCAB/DWC with respect to use of index cards. I understand that permission for research of index cards may be revoked for failure to comply with applicable policies and procedures. I declare under penalty of perjury that the foregoing is true and correct. By: (Signature) Date: ***************************************************************************** WCAB CASE NUMBER(S): NO CASE(S) ON FILE: File is in archives. There is a $12.00 fee for each archive file retrieved. After you submit the retrieval fee, the file(s) will be ordered from archives, and "you will be notified" when the file(s) is available by return of your receipt, approximately 6 to 8 weeks. PLEASE DO NOT CALL OUR OFFICE. Case destroyed. (WCAB case number SJO 0000001 to SJO ) **************************************************************************** COPY / VIEWING HOURS: 9:30 to 11:00 a.m. and 2:00 to 3:30 p.m., Monday through Friday. THESE HOURS ARE FIRM. THERE WILL BE NO EXCEPTIONS. A photocopier license will be required. Effective 6/93 - Revised 4/21/94 DIA FORM 400 (REV. 2-78) DWC-400 2002 © American LegalNet, Inc. STATE OF CALIFORNIA GRAY DAVIS, Governor DEPARTMENT OF INDUSTRIAL RELATIONS DIVISION OF INDUSTRIAL ACCIDENTS - WORKERS' COMPENSATION APPEALS BOARD 100 PASEO DE SAN ANTONIO, 2ND FLOOR, ROOM 241 SAN JOSE, CALIFORNIA 95113 P L E A SE C I R C U L A TE IN ORDER TO PROCESS YOUR CASES MORE EXPEDITIOUSLY, PLEASE ADHERE TO THE FOLLOWING: 1. 2. 3. Please use your law firm number on answers, petitions, applications, etc. Please highlight changes when filing amended applications. Please provide the DWC case number. We do not accept mail without DWC case numbers. (The DWC number may be obtained from the applicant's attorney. Also, computer data mailers are automatically sent to all parties when any petition is numbered.) The social security number will also help identify the injured worker. NOTE: Temporarily, due to the budget problems (lack of funds), the data mailers are not being sent. Please use correct DWC case numbers on your correspondence and/or SSAN. Please do not show DWC case numbers when filing answers on files with companion cases. only on the cases you represent. File 4. 5. 6. 7. Please use your LAW FIRM NAME also on your answers, petitions, applications, as well as the name of the attorney, as our system is geared to the law firms rather than individual attorneys. Please "hole punch" (two holes) the top of the documents and brad them together if it cannot be stapled easily. (This includes all documents.) Please enter one injury date only on each application, C&R, Stipulation, Pre-application. If more than one DOI is shown, send an extra copy of the application, C&R, Stip, Pre-app for each DOI, (Extra copies of the medicals are not necessary.) Please send only one DOI. the original only of the application, C&R, Stipulation, Pre-application when there is 8. 9. 10. Please do not use phrases such as "entire period of employment" etc. computer. Please show specific case numbers on your documents. Do not use "etc." Use cumulative dates for the 11. 12. 13. 14. 15. Please do not file amended liens until a hearing is set or cases settled by C&R or stip. Please address all liens on C&R. Please do not file medicals, etc., unless case is active with DWC. Please do not include DRs with 1990-93 injuries IF you are also filing an application on a 1990-93 form. DRs are filed for pre-1990 or post-1993 injuries. Please always include claim form for 1990-93 injuries. Form 4906(g) is mandatory with the applications or answers. No claim form is necessary with 1994 filings. 16. 17. DIA FORM 400 (REV. 2-78) 0VER 2002 © American LegalNet, Inc. 18. Please do not return proof of service when you are asked to serve copies of documents signed by the judge. Please seek out your clients as soon as you arrive. Please meet your clients at the designated time when you ask them to arrive early. 19. 20. 21. Please include a large enough stamped, self-addressed envelope to hold contents when requesting conformed copies returned to you. Please notify your clients when a case has been settled or continued. required to appear, i.e., contribution, liens, cross-exam rater. Please give your clients directions to the DWC. Please include a self-addressed, stamped envelope whenever you request conformed copies of documents returned. Also, when they are not 22. 23. 24. OTHER: THANK YOU FOR YOUR COOPERATION. 2002 © American LegalNet, Inc.