Wcab Form Workers' Compensation Appeals Board

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STATE OF CALIFORNIA

DIVISION OF WORKERS’ COMPENSATION

WORKERS' COMPENSATION APPEALS BOARD

CASE NUMBER(s): ADJ

ADJ

MINUTES OF HEARING

Applicant

BEFORE HEARING

AT HEARING

MSC

vs.

TRIAL

EXP HEARING

LIEN TRIAL

PRIORITY CONF

STATUS CONF

LIEN CONF

Defendants.

DATE OF: HEARING _________ REQUEST ___________

Please Print Clearly and Include Name and Law Firm

APPEARANCES APPLICANT

PRESENT

NOT PRESENT

APPLICANT REPRESENTED BY ___________________________________________________________

ATTY

HRG. REP.

DEFENDANT REPRESENTED BY___________________________________________________________

ATTY

HRG. REP.

_______________________________________________________________________________________

ATTY

HRG. REP.

OTHERS APPEARING ____________________________________________________________________

ATTY

HRG. REP.

OTHERS APPEARING ____________________________________________________________________

ATTY

HRG. REP.

INTERPRETER _________________________________________________ CERTIFICATION NO.

PARTY MAKING REQUEST:

JOINT

APPLICANT

DEFENDANT

OTHER

REQUEST FOR:

CONTINUANCE

OTOC

REQUEST BY:

LETTER

TELEPHONE

POSITION OF OPPOSING PARTY:

AGREE

OPPOSE

UNREACHABLE

UNKNOWN

REASON FOR REQUEST

BOARD REASON

FURTHER DISCOVERY:

PQME

PTP

AME

DEPO

INSUFFICIENT TIME:

TO START

TO FINISH

CALENDAR CONFLICT:

APPLICANT

DEFENSE

L.C.

REASSIGNMENT

REFUSED

NOT AVAILABLE

SETTLEMENT PENDING

CHANGE OF CIRCUMSTANCES

REPORTER

INTERPRETER

NOT AVAILABLE

IMPROPER/INSUFFICIENT NOTICE BY

PARTY

WCAB

WCJ NOT AVAILABLE

CHALLENGE BY

IMPROPER DECLARATION OF READINESS/VALID OBJECTION

RECUSAL

NON APPEARANCE

APP

DEF

LIEN CLAIMANT

WITNESS OTHER/COMMENTS

APPLICANT COUNSEL

DEF COUNSEL

VACATION

ILLNESS

Comments

UNAVAILABILITY OF:

WITNESSES

APP

DEFENSE

DISPUTE RESOLVED BY AGREEMENT

NO ISSUES PENDING

JOINDER

CONSOLIDATION

VENUE

NEW APPLICATION

ARBITRATION

UEBTF

BANKRUPTCY

DISQUALIFICATION

APPLICANT NOW REPRESENTED

REQUESTS REPRESENTATION

GOOD CAUSE APPEARING, IT IS ORDERED THAT THE ________REQUEST FOR

CONT

OTOC IS

GRANTED

DENIED

OTOC

C&R/STIPS SUBMITTED FOR APPROVAL

C&R/ STIPS APPROVED

ORDER SUSPENDING ACTION

________ DAYS FOR C&R /STIPS

LIEN STIPS AND ORDER APPROVED

NOI/ORDER TO DISMISS LIEN ISSUED

SET FOR

MSC

STATUS CONF

LIEN CONF

TRIAL

LIEN TRIAL

CONT’D TESTIMONY TRIAL TIME

SET ON _________________________ AT __________ LOCATION ________________ BEFORE JUDGE_____________________

SUPPLEMENTAL PAGES ATTACHED _____________ PAGES

DATE: ______________

___________________________________________________

WORKERS’ COMPENSATION JUDGE

NOTICE TO: _______________________________________ Pursuant to Rule 10500, you are designated to serve this/these document(s) on all parties as shown on the

Official Address Record. Date ______________________ By ______________________

[ ] Served on parties and lien claimants present

Page 1 of ______

WCAB Form 20 (Rev. 2012)