| Title |
Last Updated |
| Request For Specific Findings Of Fact And Conclusions Of Law |
July 30, 2019 |
| Hearing Confirmation |
July 30, 2019 |
| Case Information Sheet (CIS) |
July 30, 2019 |
| Application For Expedited Hearing |
July 30, 2019 |
| Application For Expedited Hearing - One Time Change Of Authorized Treating Physician |
July 30, 2019 |
| Surcharge Form |
July 18, 2019 |
| Payroll Statement Form |
July 18, 2019 |
| Hearing Cancellation |
July 18, 2019 |
| Notice Of Change Of Carrier or Adjusting Firm |
June 20, 2019 |
| Division IME Examiners Summary Sheet |
June 20, 2019 |
| Final Admission Of Liability |
May 22, 2019 |
| Settlement Order |
May 22, 2019 |
| Rejection Of Coverage By Partners And Sole Proprietors Performing Construction Work On Construction Sites |
May 22, 2019 |
| Rejection Of Coverage By Corporate Officers Or Members Of Limited Liability Company With Instructions |
May 22, 2019 |
| Fatal Case-Final Admission |
May 22, 2019 |
| Application For A Division Independent Medical Examination (IME) |
March 5, 2019 |
| Request Or Notification For Follow Up IME |
February 8, 2019 |
| Info Regarding Independent Medical Exam |
February 8, 2019 |
| Notice Of Contest With Instructions |
December 11, 2018 |
| Authorization For Release Of Limited Information To Third Parties |
October 23, 2018 |
| Authorization For Release Of Information |
October 23, 2018 |
| Permanent Work Related Mental Impairment Rating Report Work Sheet |
July 12, 2018 |
| Audio Recording Request |
March 9, 2018 |
| Subpoena To Appear And Or Produce |
March 9, 2018 |
| Petition To Review |
March 9, 2018 |
| Petition To Review And Request For Transcript |
March 9, 2018 |
| Application For Hearing |
March 9, 2018 |
| Application For Indigent Determination (IME) |
March 22, 2017 |
| General Admission Of Liability |
July 6, 2016 |
| Notice Of One-Time Change Of Physician And Authorization For Release Of Medical Information |
June 30, 2016 |
| Entry Of Appearance |
June 30, 2016 |
| Physicians Report Of Workers Compensation Injury |
June 30, 2016 |
| Pro Se Workers Compensation Claim(s) Settlement Agreement |
July 13, 2015 |
| Settlement Routing Sheet |
July 13, 2015 |
| Application For Lump Sum |
July 13, 2015 |
| Workers Compensation Claim(s) Settlement Agreement (Represented Claimant) |
July 1, 2015 |
| Average Weekly Wage Worksheet |
April 13, 2015 |
| Application For Indigent Determination |
April 13, 2015 |
| Petition To Modify, Terminate Or Suspend Compensation |
April 10, 2013 |
| Physicians Report Of Workers Compensation Injury |
December 29, 2012 |
| Objection To Petition To Modify, Terminate Or Suspend Compensation |
December 29, 2012 |
| Application For Hearing - Disfigurement Only (Rule 10, OACRP) |
December 29, 2012 |
| Request For Utilization Review |
August 28, 2012 |
| Division IME Physician Summary Disclosure Form (Claimant) |
August 16, 2012 |
| Request For A Disfigurement Award |
August 11, 2012 |
| Monthly Summary |
August 11, 2012 |
| Request For Appointment To The Independent Medical Examination Panel |
August 3, 2012 |
| Senders Trading Partner Profile |
July 11, 2012 |
| Response To Application For Hearing |
July 11, 2012 |
| Exclusion of Uncompensated Public Officials |
July 11, 2012 |
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