CALIFORNIA WORKERS' COMPENSATION PRACTICE (4th Edition) June 2014 TABLE OF CONTENTS
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1 CALIFORNIA WORKERS' COMPENSATION PRACTICE (4th Edition) June 2014 TABLE OF CONTENTS File Name Book Section Title CH10 Chapter 10 Representing Injured Workers Potential New Client Questionnaire Letter Confirming Appointment Nonengagement Letter Supplementary Fee Disclosure Statement Venue Authorization Authorization for Release of Medical Information Authorization for Release of Psychiatric, Drug, and Alcohol Treatment Records Authorization for Release of Employment and School Records Letter to Workers Compensation Insurance Rating Bureau Requesting Compensation Coverage Information Injured Employee and Dependents Employment Status Earnings Employer s Insurance Injury Injuries Resulting in Death Prior Injuries or Disabilities Medical Treatment and Expenses Compensation to Date Notice of Supplemental Job Displacement Benefit (Voucher) (Injuries Occurring On or After 1/1/2004 and Before 1/1/2013) A 10.35A Notice of Supplemental Job Displacement Benefit (Voucher) (Injuries Occurring On or After January 1, 2013) Claim Form; Procedural Information Letter of Representation to New Client Notice of Representation to Employer Letter to Insurer or Adjusting Agency Letter Designating Primary Treating Physician Letter Regarding Medical Bills Received by Applicant Letter to Worker Regarding Deposition Letter Requesting Payment for Fees and Costs Associated With Injured Worker s Deposition
2 Petition for Attorney Fees and Expenses for Injured Worker s Deposition Letter Requesting Worker to Review Deposition Transcript Letter to Worker Regarding Medical Evaluation Letter to Doctor to File Lien Letter Notifying Worker of Hearing Request Letter Notifying Worker of Settlement Conference Date Letter Notifying Worker of Closed Case File CH11 Chapter 11 Representing Defendants Statement of Employee s Gross Earnings Compensation Litigation Transmittal Note Letter to Employment Development Department Letter Requesting Signed Social Security Earnings Release Applicant s Deposition Worksheet Petition to Compel Answers to Questions and Production of Documents at Deposition Petition for Order Compelling Production of Psychiatric Records; Order Deposition Letter to Primary Treating Physician Petition to Compel Attendance at Medical Evaluation Petition for Joinder Letter to Employer Re: Lack of Coverage Letter to Applicant or Codefendant Re: Lack of Coverage Petition to Dismiss for Lack of Coverage; Order Petition to Strike Application (Lab C 4906(g), Declaration Missing); Order Petition to Dismiss No Employment Within Last Year of Injurious Exposure Petition to Dismiss No Coverage Within Last Year of Injurious Exposure Petition to Dismiss Statute of Limitations Petition to Dismiss Failure to Prosecute Objection to Medical-Legal Expense Objection to Medical Treatment Expense Petition for Credit for Third Party Recovery Petition for Restitution From Injured Worker Petition for Reimbursement From Codefendant Petition for Reimbursement of Paid Medical-Legal Expense
3 Letter From Insurer s Attorney Advising Employer of Serious and Willful Misconduct Petition Letter Advising Insured Employer of Petition Alleging Discrimination CH12 Chapter 12 Time Limitations Notice of Injury Allegations of Incompetence, Competence Regained CH13 Chapter 13 Filing With the Workers Compensation Appeals Board Parties Checklist Sample Allegations of Injury and Exposure Petition for Award for Employer s Serious and Willful Misconduct A 13.95A Petition for Award for Employer s Serious and Willful Misconduct Violation of Safety Order (Lab C ) Cite or Refer Correctly to Safety Order or Statute State How Safety Order or Statute Was Violated Sample Allegation: General Misconduct Petition for Award Under Lab C 132a Declaration Under Lab C 4906(g) Answer to Petition and Request for Dismissal or Continuance Initial Appearance CH14 Chapter 14 Gathering Evidence Authorization for Medical Information Declaration by Signing Physician Checklist: Deposition Information From Employee Sample Order Re: Confidentiality CH16 Chapter 16 Settlement Addendum to Compromise and Release Sample Computation of Fair Allocation to Unemployment Compensation Disability Lien Claim (Baird Formula) Sample Computation of Lien Reduction Under Lab C (a)(4) Preparation Sample Letter Requesting Fee (To Accompany WCAB Form 4) CH17 Chapter 17 Preparing for Trial Petition for Automatic Reassignment to Another Workers Compensation Judge Petition to Disqualify Assigned Workers Compensation Judge Checklist: Refining Issues
4 Additions to Employer s Report of Occupational Injury or Illness Letter to Applicant s Attorney Requesting Earnings Information Petition to Dismiss Application Petition to Dismiss for Lack of Prosecution (Injuries Occurring Before January 1, 1990, or On or After January 1, 1994) Petition to Dismiss Improperly Joined Insurer Petition to Join Additional Employers and Insurers Petition for Order Directing Exhumation and Autopsy Petition to Suspend Proceedings and to Compel Medical Examination Petition to Bar Applicant s Right to Disability Payments CH21 Chapter 21 Reconsideration Caption; Introduction Preliminary Statement; Grounds Statement of Contentions Summary of Material Facts Argument Request for Transcript Prayer Signature; Verification Statement on Petition Statement in Letter of Transmittal Declaration of Service CH22 Chapter 22 Judicial Review Cover Topical Index Table of Authorities Cited Formal Address Opening Paragraph When Petitioner Is Employee When Petitioner Is Dependent When Petitioners Are Defendants Proceedings Before Board Grounds for Review Raised in Reconsideration Petition Questions Presented Incorporation of Points and Authorities Petition Timely and Proper No Right to Appeal Residence and Beneficial Interest
5 22.40 Prayer; Signature By Affidavit By Declaration Statement of Material Facts Stipulation Extending Time to File Answer Application for Extension of Time to Answer Order Extending Time to File Answer Title When Attorney Fee Requested Under Lab C Opening Paragraph Identification of Respondent; Denial of Allegations in Petition Allegation of Lack of Reasonable Basis for Petition Questions Presented Statement of Material Facts Conclusion Conclusion Opening Paragraph Prayer Caption, Formal Address, and Opening Paragraph Exhibits CH23 Chapter 23 Supplemental Proceedings Petition for Contribution Under Lab C
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