WORKERS' COMPENSATION APPEALS BOARD STATE OF CALIFORNIA W.C.A.B. CASE NOS. vs. (Applicant) (Defendants) MINUTES OF HEARING/APPEARANCE SHEET ORDER AND DECISION ON REQUEST FOR CONTINUANCE OR OFF CALENDAR DEFENDANTS/LIEN CLAIMANTS Print Name: Atty/H.R./P.P. Sign For DISCOVERY NOW CLOSED [EXCEPT: ] The parties acknowledge receipt (service) of documentary evidence per paragraphs 18 and 19 of Pretrial Stipulations. (Defendants) (Lien Claimant ) to serve notice of the above continued date on all defendants/unsatisfied lien claimants not present. AGREED: (Person responsible) Motion for Continuance, Adjournment to submit settlement or off calendar made by: Reason for motion: Position of opposing party: Good Cause: IT IS ORDERED THAT this case is: Continued for At this WCAB Branch on Lien Conference Lien Trial Before the Undersigned Before the Honorable , at 8:30 A.M./1:30 P.M. Order(s) Issued/OTOC Submitted HEARING NOTES NOTICE TO Pursuant to Rule 10500, you are designated to serve this/these documents on all parties as set forth in P and P Section 6.7.4, 10-1-95. SO ORDERED: HONORABLE Date: 1 WCAB-105 2002 © American LegalNet, Inc. GENERAL MATTERS ABOUT LIEN CONFERENCE/TRIAL PROCEEDINGS PLEASE NOTE 1. At a lien conference if continuing to another lien conference, please be sure the agreement to serve absent parties near the bottom of the Minutes/Appearance form is completed before you come in. If on trial calendar you may seek leave to interrupt a trial proceeding to get a disposition signed. 2. If continuing from a lien conference to a trial setting, please complete the Pre-Trial Stipulations form and Issues and Contentions form, and set up exhibits on a backer in the manner described in the Exhibits Offered sheet. Please list your witnesses on the Witness List. Exhibits and Witnesses MUST BE LISTED on each party's Exhibit List and Witness List. 3. Please use only the attached forms and be sure all parties present: (a) sign at the bottom of Pre-Trial Stipulations and (b) someone signs the agreement near the bottom of the Minutes/Appearance form to serve all other absent parties. (c) each party signs Paragraphs 18 and 19 of Pre-Trial Stipulations acknowledging service and any duty to serve. 4. Normally, notices of intention to disallow or grant in whole or part will be signed based on the merits. Notice of intent to dismiss will not issue based on nonappearance alone. 5. When coming in to see judge just before trial, be familiar with your case and documents BEFORE coming in to see the judge if you have not reached a disposition. See the Documents Needed for Discussions/Conference/Trial. 6. Discovery is NOW CLOSED unless the Minutes of [this] Hearing have written order(-s) relating to discovery closure. 2 2002 © American LegalNet, Inc. DOCUMENTS NEEDED FOR DISCUSSION/CONFERENCE/TRIAL Please bring the following documents to substantiate your contentions: 1. All Claim Forms and Applications for all dates of injuries (by case number) and any other evidence as to when employer had knowledge of the claim(s). a. Know parts of body for each date of injury. 2. The C&R with order approving or Stips and Award. 3. Documents relating to WHEN and WHY Applicant stopped work. 4. Delay and denial letters. 5. List of all charges. 6. All relevant medical reports; be familiar with what they say. 7. All "notice" letters. 8. All "objection" letters. 9. All reviews of lien charges. 10. All relevant proof of services. 11. If a deposition or other transcript is to be used, know pages and line numbers of relevant portions to be used. 12. If medical records, subpoenaed or otherwise obtained, are to be relied upon, have the relevant portions identified and know why they are relevant. PLEASE NOTE: (1) You should be familiar with all documents BEFORE you come into our offices. (2) Original documents, including proofs of service, should be available for viewing. 3 2002 © American LegalNet, Inc. WORKERS' COMPENSATION APPEALS BOARD STATE OF CALIFORNIA W.C.A.B. CASE NO.(S) vs. PRE-TRIAL STIPULATIONS [Unless virtually identical: one for each injury, please] 1. (Employee) (was) (allegedly was not) employed within the State of California on (alleged date or period of injury) by (Employer) (then permissibly self-insured) (whose compensation insurance carrier was then ). 2. The employee (did) (allegedly did not) sustain industrial injury (on that date) (during that period). 3. The following parts of the body were industrially injured on the date or period mentioned in . 4. The industrial injury involved the following body parts: and allegedly the following additional parts: 5. The employee's actual earnings were ($ per week) (such as to . paragraph 1: produce indemnity at a rate exceeding EDD payment rate). 6. 7. Issues of occupation, birthdate and rehabilitation are moot. (A) All medical treatment furnished was the result of the injury. (B) All medical treatment furnished, except that by was due to the injury. (lien claimant(s)) 4 2002 © American LegalNet, Inc. (C) All medical treatment, except that to (body parts) was the result of the industrial injury. (D) Such of the above treatment as resulted from the industrial injury was necessarily incurred: (yes) (in issue) (E) All medical treatment resulting from the industrial injury was necessarily incurred except that of: (F) Per Paragraph 7(A) - 7(E) the medical treatment resulting from the injury and necessarily incurred, was actually rendered: 8. Last day worked: Lien claimants allege: Defendants allege: 9. Reason stopped work (please include what you're basing this on): Lien claimant alleges: Defendants allege: 10. Employer's first date of knowledge that industrial injury occurred (and what it's based on): Lien claimant alleges: (yes) (in issue) Defendants allege: 5 2002 © American LegalNet, Inc. 11. Type of settlement (with amount and whether or not any Thomas finding was made) or Findings and Award/Order were made: (Stip for F&A) (C&R: $ Thomas Finding: (yes) (no) ) (Findings & Award/Order); 12. Date of Medical Services Provided: Please indicate M/L, Treatment or Both Date Specialty Name MD or Provider Service Provided $ Amount Claimed [additional: please attach a separate sheet] 6 2002 © American LegalNet, Inc. 13. 14. 15. Dates of each delay letter Dates of each denial letter Dates of each objection letter 16. Additional Stipulations: 17. DID you list all exhibits (including claim forms, delay, denial and objection letters, bills, liens, medical reports and reco