Petition For Reconsideration
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1
2STATE OF CALIFORNIA
Department of Industrial Relations
Division of Workers' Compensation
WORKERS' COMPENSATION APPEALS BOARD
)
Case No.
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)
Applicant,
)
Petition for
vs.
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)
Reconsideration
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)
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Defendants
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A decision was filed in the above-entitled case on ___________________________________________.
The ___________________________________________________________ is aggrieved by said
decision and hereby petitions for reconsideration upon the following grounds: (strike out items not
applicable)
1. By the order, decision or award, the Board acted without or in excess of its powers.
2. The order, decision, or award was procured by fraud.
3. The evidence does not justify the findings of fact.
4. Petitioner has discovered new evidence material to him which he could not with reasonable diligence
have discovered and produced at the hearing.
5. The findings of fact do not support the order, decision or award.
In support of the above, petitioner gives the following details, including a statement of facts upon which
petitioner relies and a discussion of the law applicable thereto:
DWC/WCAB Form 45 (Page 1) (Rev 4-14)
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