Pretrial Order printable pdf download

Pretrial Order

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 ___________,

200_, before Hearing Examiner, __________. __________ appeared as counsel for

Petitioner. __________ of __________ appeared as counsel for Respondent.

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.

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.]

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 __________.

The parties have exchanged all available medical records relating to the

injury and will continue to do so.

Pretrial Order