Free Corel Office Document - Montana


File Size: 12.2 kB
Pages: 4
Date: March 18, 2008
File Format: PDF
State: Montana
Category: Workers Compensation
Author: ce4804
Word Count: 504 Words, 3,752 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://wcc.dli.mt.gov/forms/Sample_Pretrial_Order.pdf

Download Corel Office Document ( 12.2 kB)


Preview Corel Office Document
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. A. 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. B. 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.] C. 1. 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.

2.

3.

4. D. 1.

The mediation procedure has been satisfied. Contested Issues of Fact: Petitioner's Contentions: (a) __________

2.

Respondent's Contentions: (a) __________

E. F.

Stipulations: Issues to be Determined by the Court: (a)

G. H.

Exhibits: See attached Exhibit grid with any objections stated. Witnesses: Petitioner's Witnesses: NAME a. b. __________ __________ SUBJECT MATTER OF TESTIMONY Petitioner will testify as to __________. Respondent's insurance adjuster will testify as to __________.

c. d. e.

All witnesses listed by Respondent. All witnesses divulged during discovery. All necessary rebuttal and/or impeachment witnesses.

Respondent's Witnesses: NAME a.
Pretrial Order - Page 2

SUBJECT MATTER OF TESTIMONY __________ All facts relevant to Petitioner's claim.

b. c. d.

__________ __________ __________

Adjustment and handling of the claim. Petitioner's alleged injury. Petitioner's alleged application for employment with __________. Petitioner's employability/earning capacity.

e. f.

__________

All witnesses identified by Petitioner in his/her Petition for Hearing and incorporated by reference herein.

I. Depositions: Depositions have been taken of __________ and a video deposition of __________ is scheduled for __________. Records depositions have been taken of __________. J. Length of Trial: Counsel for Petitioner and Respondent estimate the length of trial will be ___ hour(s). K. Trial Date: The trial date of this matter will commence on the _____ day of _____________________, 200_, at ____ o'clock, _.m., in ____________, Montana. L. Proposed Findings of Fact, Conclusions of Law and/or Trial Briefs on the legal questions raised in this matter will be filed no later than the Wednesday preceding the hearing. ¶2 IT IS ORDERED that this Pretrial Order shall supersede all other pleadings and govern the course of the trial of this cause unless modified by the Court to prevent manifest injustice. DATED in Helena, Montana, this ____ day of ________________, 200_.

______________________________________ JUDGE APPROVED AS TO FORM AND CONTENT: ____________________ Attorney for Petitioner ____________________ Attorney for Respondent
Pretrial Order - Page 3

__________ v. __________ WCC No. __________

EXHIBIT SHEET TRIAL DATE: _____________ ___, 200_
Ex # Admit (Y/N)1 Description of Exhibit Objection Yes/No Specific Objection

1

1. Yes, No.