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STATE OF CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATIONS DIVISION OF WORKERS' COMPENSATION MINUTES OF HEARING
Case No. Hearing Information Before AT Trial Conf MSC EXP. HEARING Lien Date of Hearing (MM/DD/YYYY)
Request Date (MM/DD/YYYY) Applicant
First Name
MI
Last Name Defendants
VS
Employer Name (Please leave blank spaces between numbers, names or words) Appearances Applicant Present Not Present Attorney Hearing Rep
Applicant Represented By Defendant Represented By Others Appearing Interpreter Party Making Request Joint Request For: Applicant Continuance Defendant OTOC Other Request By: Letter Telephone
Cert. No.
Position of Opposing Party Agree Oppose Unreachable Unknown
DWC-CA form 10245 (11/2008) ( Page 1 )
Reason For Request Applicant: Illness Applicant: Vacation Applicant Now Represented Calendar Conflict: Applicant Applicant Requests Representation Calendar Conflict: Defense Consolidation Defense: Illness
Calendar Conflict: Lien Claimant Defense: Vacation Further Discovery: Def Med Improper/Insufficient Notice by Party Non Appearance: Applicant Non Appearance: Witness Unavailability of Witnesses: Defense Board Reason Arbitration Bankruptcy Pending
Change of Circumstances
Dispute Resolved by Agreement Further Discovery: AME Joinder
Further Discovery: App Med Further Discovery: Depo No Issues Pending
New Application
Non Appearance: Defense
Settlement Pending
Non Appearance: Lien Claimant Unavailability of Witnesses: Applicant
Venue
Defective Notice
Insufficient Time to Start Recusal Reporter Not Available
Insufficient Time to Finish Service Defective Other/ Comments
Interpreter Not Available WCJ Not Available
UEF Issues
Good Cause Appearing, It is Ordered That the Request For Continuance Granted Days For Continuance Denied C&R OTOC Granted STIPS OTOC Denied OTOC
DWC-CA form 10245 (11/2008) ( Page 2 )
Decision OTOC LIEN STIPS and ORDER Approved MSC Set On Location Before Judge Supplemental Pages Attached Pages CONF At TRIAL C&R / STIPS Submitted for Approval N.O.I. to Allow/Disallow Issued LIEN TRIAL CONTD TESTIMONY C&R / STIPS Approved
MM/DD/YYYY
Date - MM/DD/YYYY Notice To
WORKERS' COMPENSATION ADMINSTRATIVE LAW JUDGE Pursuant to Rule 10500 you are designated to serve this/these document(s) on all parties.
Served on parties and lien claimants present
DWC-CA form 10245 (11/2008) ( Page 3 )
SUPPLEMENT TO MINUTES OF HEARING/ORDER/ORDER AND DECISION ON REQUEST FOR CONTINUANCE/ORDER TAKING OFF CALENDAR / NOTICE OF HEARING
HEARING DATE
MM/DD/YYYY
Comment/Discussion/Motion
Order(s)
Served with the Minutes of Hearing WORKERS' COMPENSATION ADMINSTRATIVE LAW JUDGE
DWC-CA form 10245 (11/2008) ( Page 4 )