Free DWC-CA form 10245 - California

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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 )