Request For Continuance
Request For Continuance Form. This is a Ohio form and can be use in Industrial Commission Workers Comp.
Tags: Request For Continuance, IC-51, Ohio Workers Comp, Industrial Commission
Claim Number: REQUEST FOR CONTINUANCE 1. A Request for Continuance should be submitted if you want a hearing rescheduled for a legitimate reason. If you do not want or need another hearing, submit an IC 50, Request for Cancellation. 2. Documentation in support of the reason for the request must be submitted or the request may be denied. If documents are already on file, there is no need to resubmit them. 3. The completed form must be filed with an Industrial Commission office. 4. A Request for Continuance based upon good cause is to be made no later than five calendar days prior to the date of hearing. If less than five days prior to the date of hearing, extraordinary circumstances that could not be foreseen must be shown. 5. A Request for Continuance must be copied to the opposing party and representative via fax, mail, or email. 6. The opposing parties’ representative, or if not represented, then the opposing party, must be notified of the request for continuance before it is filed. The results of the contact with the opposing party and/or representative must be set forth below. 7. If a continuance is granted, it is the responsibility of the parties to contact their respective clients. A failure to follow any of the steps in this procedure may result in the request being denied. Injured Worker’sWorker’s Information Injured Representative’s Information Employer’s Information Name Name Address Address City, State, Zip City, State, Zip Telephone Telephone Fax Fax Employer’s Representative’s Information Injured Worker’s Representative’s Information Rep ID# Rep ID# Name Name Telephone Fax Telephone This claim is scheduled for a hearing before a: Filing Party: Injured Worker Employer BWC Administrator Fax District Hearing Officer Staff Hearing Officer Injured Worker’s Rep Employer’s Rep Commissioners To be heard in on at (city) (time) (mm/dd/yyyy) The continuance is requested because (select one): IC Hearing conflict (no supporting documentation is required) Documented court conflict Schedule conflict Independent medical evaluation has been scheduled on (mm/dd/yyyy) Recently retained legal counsel and this hinders our ability to obtain evidence necessary for hearing (mm/dd/yyyy)) (representation card attached or already filed on Parties are negotiating a settlement. Injured Worker failed to submit a medical release. Injured Worker failed to attend a scheduled medical evaluation. (city) Parties agree to change the hearing venue to Parties have requested a pre-hearing conference. Did not receive copy of request for action. Extraordinary or unforeseen circumstances as follows All parties have agreed to this continuance and waive the time frames as set forth the in section 4123.511 and other applicable provisions of the Ohio Revised Code. Yes No Opposing party has been notified on (mm/dd/yyyy) Will you be providing supporting documentation? Yes No, Not Required No, Already on file by: Applicant Name Opposing Party Name Signature IC51 Date Telephone Fax Mail E-Mail Date Signature An Equal Opportunity Employer and Service Provider Timely, impartial resolution of workers’ compensation appeals OIC 1051 Rev. (02/12) American LegalNet, Inc. www.FormsWorkFlow.com