| Title |
Last Updated |
| Lien Disposition Form |
October 19, 2012 |
| Minutes Of Hearing-Order-Order And Decision On Request For Continuance |
October 11, 2012 |
| Minutes Of Hearing-Order-Order And Decision On Request For Continuance |
October 11, 2012 |
| Pretrial Conference Statement (Liens) |
June 28, 2012 |
| Workers Compensation Claim Form (DWC 1) And Notice Of Potential Eligibility (Effective Oct 8 2010) |
September 20, 2010 |
| Pre-Trial Conference Statement |
September 20, 2010 |
| Replacement Panel Request |
September 16, 2010 |
| Notice Of Medical Provider Network Plan Modification 9767.8 (Effective Oct. 8 2010) |
September 7, 2010 |
| Workers Compensation Claim Form And Notice Of Potential Eligibility (Effective Oct. 8 2010) |
September 7, 2010 |
| Information Bulletin Surety Bond |
August 16, 2010 |
| Qualified Medical Evaluator Complaint Form |
July 19, 2010 |
| Replacement Panel Request |
May 19, 2010 |
| Notice Of Appeal Of The Administrative Director |
February 22, 2010 |
| Application For Spinal Surgery 2nd Opinion Physican List |
August 13, 2007 |
| Objection To Treating Physicians Recommendation For Spinal Surgery |
June 11, 2007 |
| Notice Of Medical Provider Network Plan Modification 9767.8 |
June 11, 2007 |
| Subpoena (Signed By Judge Robert Ebenstein) |
January 12, 2007 |
| EDEX Client Acknowledgment Of Legal Constraints On Access To Information And Use Of Information |
August 2, 2006 |
| EDEX Client List |
August 2, 2006 |
| EDEX Subscriber Application |
August 2, 2006 |
| Public Records Act Request Form (DLSE) |
July 26, 2006 |
| Appeal From Determination And Order Of The Rehabiliation Unit |
June 20, 2006 |
| Treating Physicians Report |
February 9, 2006 |
| Time Exension Approval |
February 2, 2006 |
| Industrial Medical Council Course Evaluation |
February 2, 2006 |
| Injured Worker Information |
February 2, 2006 |
| Denial Of Time Extension |
February 2, 2006 |
| Physician Contract Application (Independent Medical Reviewer) |
December 6, 2005 |
| Employees Request For Informal Permanent Disability Rating |
September 7, 2005 |
| Substitution Of Attorney |
August 3, 2005 |
| Statement Of Employer Payments |
January 27, 2005 |
| Workers Compensation Claim Form (DWC 1) And Notice Of Potential Eligibility |
October 13, 2004 |
| Application For A Certificate Of Consent To Self Insure By A Group Of Employers |
October 13, 2004 |
| Treating Physician's Determination Of Medical Issues |
October 6, 2003 |
| Vocational Rehabilitation Plan |
April 10, 2003 |
| Request For Expedited Hearing And Decision |
January 22, 2003 |
| Third Party Compromise And Release |
January 22, 2003 |
| Request For Informal Rating By Insurance Carrier Or Self-Insurer |
January 22, 2003 |
| Petition For Order Allowing Attorney's Fees |
January 21, 2003 |
| Notice Regarding Workers' Compensation Claim (180 Days) |
January 20, 2003 |
| Notice Regarding Workers's Compensation Dependency Benefits |
January 20, 2003 |
| Notice Regarding Workers' Compensation Claim (5 Years) |
January 20, 2003 |
| Notice Regarding Vocational Rehabilitation Maintenance Allowance |
January 20, 2003 |
| Notice Regarding Vocational Rehabilitation |
January 20, 2003 |
| Notice Of Potential Eligibility And Delay Of Vocational Rehabilitation |
January 20, 2003 |
| Notice Of Potential Eligibility For Vocational Rehabilitation |
January 20, 2003 |
| Notice Of Interruption Or Deferral Of Vocational Rehabilitation |
January 20, 2003 |
| Information Response Form |
January 20, 2003 |
| Intent To Withold Vocational Rehabilitation Maintenance Allowance |
January 20, 2003 |
| Lien Claim Return Form |
January 20, 2003 |
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