IN THE WORKERS' COMPENSATION COURT OF THE STATE OF MONTANA WCC No. Petitioner vs. Respondent/Insurer. PRETRIAL ORDER &1 Pursuant to Rule 24.5.318 of the Rules of the Workers= Compensation Court, a Pretrial Conference was held in the above-entitled matter on the ___ of ___________, 20__, before Pretrial Hearing Examiner, ___________. __________ appeared as counsel for Petitioner. __________ of __________ appeared as counsel for Respondent. A. Statement of Jurisdiction: The Workers= Compensation Court has jurisdiction in the above-entitled matter pursuant to ' 39-71-2905, MCA, and the agreement of the parties. B. Motions: [State either that no motions have been filed at this time or describe any motions which are pending. See Court Rule 24.5.316 Motions and review the Scheduling Order deadlines.] C. 1. Statement of Uncontested Facts: The uncontested facts are as follows: That on __________, Petitioner suffered an industrial injury [or occupational disease] arising from his/her employment with __________ of __________, Montana. At the time of the injury,__________ [employer] was enrolled under Compensation Plan No. __ (1, 2, or 3) of the Workers= Compensation Act, and was insured by the __________. 2. Pretrial Order - Page 1 American LegalNet, Inc. www.FormsWorkFlow.com 3. The parties have exchanged all available medical records relating to the injury and will continue to do so. The mediation procedure has been satisfied. Stipulations: Issues to be Determined by the Court: 4. D. E. (a) F. 1. Contested Issues of Fact: Petitioner=s Contentions: (a) [Include all contentions which provide the basis for any claim of unreasonableness on the part of the insurer.] 2. Respondent=s Contentions: (a) __________ G. H. Exhibits: See attached Exhibit grid with any objections stated. Witnesses: Petitioner=s Witnesses: NAME/ADDRESS/ OCCUPATION a. b. __________ __________ SUBJECT MATTER OF TESTIMONY Petitioner will testify as to __________. Respondent=s insurance adjuster will testify as to __________. c. All witnesses identified by Respondent are incorporated by reference herein. All witnesses divulged during discovery. All necessary rebuttal and/or impeachment witnesses. d. e. Respondent=s Witnesses: Pretrial Order - Page 2 American LegalNet, Inc. www.FormsWorkFlow.com NAME/ADDRESS OCCUPATION a. b. c. d. __________ __________ __________ __________ SUBJECT MATTER OF TESTIMONY All facts relevant to Petitioner=s claim. Adjustment and handling of the claim. Petitioner=s alleged injury. Petitioner=s alleged application for employment with __________. Petitioner=s employability/earning capacity. e. f. __________ All witnesses identified by Petitioner in his/her Petition for Hearing are incorporated by reference herein. All witnesses divulged during discovery. All necessary rebuttal and/or impeachment witnesses. g. h. I. Unusual Legal or Evidentiary Issues: _________ J. Length of Trial: Counsel for Petitioner and Respondent estimate the length of trial will be ___ hour(s). K. Intent to File Trial Briefs and/or Proposed Findings of Fact and Conclusions of Law: Counsel for Petitioner __________ to file __________. Counsel for Respondent __________ to file __________. These documents shall be filed no later than [the Wednesday preceding the trial, if a one-day trial, or the Monday preceding the trial, if more than a one-day trial]. L. Depositions: Depositions have been taken of __________ and a video deposition of __________ is scheduled for __________. Records depositions have been taken of __________. M. Trial Date: The trial date of this matter will commence on the _____ day of _____________________, 20__, at ____ o=clock, _.m., in ____________, Montana. Pretrial Order - Page 3 American LegalNet, Inc. www.FormsWorkFlow.com ¶2 IT IS ORDERED that this Pretrial Order shall supersede all other pleadings and govern the course of the trial of this cause unless modified by the Court to prevent manifest injustice. DATED in Helena, Montana, this ____ day of ________________, 20__. _____________________________________ JUDGE APPROVED AS TO FORM AND CONTENT: ____________________ Attorney for Petitioner ____________________ Attorney for Respondent Pretrial Order - Page 4 American LegalNet, Inc. www.FormsWorkFlow.com WCC No. EXHIBIT SHEET TRIAL DATE: Ex # Admit (Y/N)i Description of Exhibit Objection Yes/No Specific Objection Who offered the Exhibit 1 i. Yes, No. Pretrial Order - Page 5 American LegalNet, Inc. www.FormsWorkFlow.com