Sample Letter Requesting Transcript of Records for Evaluation

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					               CALIFORNIA WORKERS' COMPENSATION PRACTICE
                           (4th ed Cal CEB 2000)
                                 June 2011

                              TABLE OF CONTENTS

  File Name   Book Section                      Title
CH10          Chapter 10     REPRESENTING INJURED WORKERS
10-007        §10.7          Potential New Client Questionnaire
10-008        §10.8          Letter Confirming Appointment
10-009        §10.9          Nonengagement Letter
10-017        §10.17         Supplementary Fee Disclosure Statement
10-020        §10.20         Venue Authorization
10-021        §10.21         Authorization for Release of Medical Information
10-022        §10.22         Authorization for Release of Psychiatric, Drug, and
                             Alcohol Treatment Records
10-023        §10.23         Authorization for Release of Employment and School
                             Records
10-024        §10.24         Letter to Workers’ Compensation Insurance Rating
                             Bureau Requesting Compensation Coverage
                             Information
10-026        §10.26         Injured Employee and Dependents
              §10.27         Employment Status
              §10.28         Earnings
              §10.29         Employer’s Insurance
              §10.30         Injury
              §10.31         Injuries Resulting in Death
              §10.32         Prior Injuries or Disabilities
              §10.33         Medical Treatment and Expenses
              §10.34         Compensation to Date
              §10.35         Vocational Rehabilitation, Return to Work, and
                             Discrimination (Injuries Before January 1, 2004)
                             [Deleted]
              §10.35A        Notice of Supplemental Job Displacement Benefit
                             (Voucher) (Injuries Occurring On or After January 1,
                             2004)
              §10.36         Claim Form; Procedural Information
10-038        §10.38         Letter of Representation to New Client
10-041        §10.41         Notice of Representation to Employer
10-043        §10.43         Letter to Insurer or Adjusting Agency
10-047        §10.47         Letter Designating Primary Treating Physician
10-048        §10.48         Letter Regarding Medical Bills Received by Applicant
10-056        §10.56         Letter to Worker Regarding Deposition
10-057        §10.57         Letter Requesting Payment for Fees and Costs
                             Associated With Injured Worker’s Deposition
  File Name   Book Section                           Title
10-058        §10.58         Petition for Attorney Fees and Expenses for Injured
                             Worker’s Deposition
10-059        §10.59         Letter Requesting Worker to Review Deposition
                             Transcript
10-061        §10.61         Letter to Worker Regarding Medical Evaluation
10-063        §10.63         Letter to Doctor to File Lien
10-064        §10.64         Letter Notifying Worker of Hearing Request
10-065        §10.65         Letter Notifying Worker of Settlement Conference
                             Date
10-070        §10.70         Letter Notifying Worker of Closed Case File
CH11          Chapter 11     REPRESENTING DEFENDANTS
11-022        §11.22         Statement of Employee’s Gross Earnings
11-029        §11.29         Compensation Litigation Transmittal Note
11-034        §11.34         Letter to Employment Development Department
11-037        §11.37         Letter Requesting Signed Social Security Earnings
                             Release
11-042        §11.42         Applicant’s Deposition Worksheet
11-043        §11.43         Petition to Compel Answers to Questions and
                             Production of Documents at Deposition
11-046        §11.46         Petition for Order Compelling Production of
                             Psychiatric Records; Order
11-048        §11.48         Deposition Letter to Primary Treating Physician
11-049        §11.49         Petition to Compel Attendance at Medical Evaluation
11-055        §11.55         Petition for Joinder
11-057        §11.57         Letter to Employer Re: Lack of Coverage
11-058        §11.58         Letter to Applicant or Codefendant Re: Lack of
                             Coverage
11-059        §11.59         Petition to Dismiss for Lack of Coverage; Order
11-061        §11.61         Petition to Strike Application (Lab C §4906(g),
                             Declaration Missing); Order
11-062        §11.62         Petition to Dismiss—No Employment Within Last Year
                             of Injurious Exposure
11-063        §11.63         Petition to Dismiss—No Coverage Within Last Year of
                             Injurious Exposure
11-064        §11.64         Petition to Dismiss—Statute of Limitations
11-065        §11.65         Petition to Dismiss—Failure to Prosecute
11-081        §11.81         Objection to Medical-Legal Expense
11-085        §11.85         Objection to Medical Treatment Expense
11-088        §11.88         Petition for Credit for Third Party Recovery
11-089        §11.89         Petition for Restitution From Injured Worker
11-090        §11.90         Petition for Reimbursement From Codefendant
11-092        §11.92         Petition for Reimbursement of Paid Medical-Legal
                             Expense
  File Name   Book Section                            Title
11-095        §11.95         Letter From Insurer’s Attorney Advising Employer of
                             Serious and Willful Misconduct Petition
11-097        §11.97         Letter Advising Insured Employer of Petition Alleging
                             Discrimination
CH12          Chapter 12     TIME LIMITATIONS
12-010        §12.10         Notice of Injury
12-030        §12.30         Table of Limitations
12-051        §12.51         Allegations of Incompetence, Competence Regained
CH13          Chapter 13     FILING WITH THE WORKERS’ COMPENSATION
                             APPEALS BOARD
13-021        §13.21         Parties Checklist
13-085        §13.85         Sample Allegations of Injury and Exposure
13-095        §13.95         Petition for Award for Employer’s Serious and Willful
                             Misconduct
13-095A       §13.95A        Petition for Award for Employer’s Serious and Willful
                             Misconduct—Violation of Safety Order (Lab C
                             §4553.1)
13-101        §13.101        Cite or Refer Correctly to Safety Order or Statute
13-102        §13.102        State How Safety Order or Statute Was Violated
13-103        §13.103        Sample Allegation: General Misconduct
13-105        §13.105        Petition for Award Under Lab C §132a
13-113        §13.113        Declaration Under Lab C §4906(g)
13-150        §13.150        Answer to Petition and Request for Dismissal or
                             Continuance
13-155        §13.155        Initial Appearance
CH14          Chapter 14     GATHERING EVIDENCE
14-011        §14.11         Authorization for Medical Information
14-034        §14.34         Declaration by Signing Physician
14-079        §14.79         Checklist: Deposition Information From Employee
14-100        §14.100        Sample Order Re: Confidentiality
CH15          Chapter 15     LIEN CLAIMS
15-009        §15.9          Liens Allowable and Not Allowable
CH16          Chapter 16     SETTLEMENT
16-034        §16.34         Addendum to Compromise and Release
16-043        §16.43         Sample Computation of Fair Allocation to
                             Unemployment Compensation Disability Lien Claim
                             (Baird Formula)
16-044        §16.44         Sample Computation of Lien Reduction Under Lab C
                             §4903.1(a)(4)
16-077        §16.77         Preparation
16-084        §16.84         Sample Letter Requesting Fee (To Accompany
                             WCAB Form 4)
CH17          Chapter 17     PREPARING FOR TRIAL
17-040        §17.40         Petition for Automatic Reassignment to Another
                             Workers’ Compensation Judge
  File Name   Book Section                            Title
17-042        §17.42         Petition to Disqualify Assigned Workers’
                             Compensation Judge
17-047        §17.47         Checklist: Refining Issues
17-079        §17.79         Additions to Employer’s Report of Occupational Injury
                             or Illness
17-099        §17.99         Letter to Applicant’s Attorney Requesting Earnings
                             Information
17-107        §17.107        Petition to Dismiss Application
17-108        §17.108        Petition to Dismiss for Lack of Prosecution (Injuries
                             Occurring Before January 1, 1990, or On or After
                             January 1, 1994)
17-110        §17.110        Petition to Dismiss Improperly Joined Insurer
17-111        §17.111        Petition to Join Additional Employers and Insurers
17-112        §17.112        Petition for Order Directing Exhumation and Autopsy
17-113        §17.113        Petition to Suspend Proceedings and to Compel
                             Medical Examination
17-114        §17.114        Petition to Bar Applicant’s Right to Disability
                             Payments
CH21          Chapter 21     RECONSIDERATION
21-028        §21.28         Caption; Introduction
              §21.29         Preliminary Statement; Grounds
              §21.30         Statement of Contentions
              §21.31         Summary of Material Facts
              §21.32         Argument
              §21.33         Request for Transcript
              §21.34         Prayer
              §21.35         Signature; Verification
21-040        §21.40         Statement on Petition
21-041        §21.41         Statement in Letter of Transmittal
21-042        §21.42         Declaration of Service
CH22          Chapter 22     JUDICIAL REVIEW
22-005        §22.5          Table: Time Limits For Judicial Review
22-024        §22.24         Cover
              §22.25         Topical Index
              §22.26         Table of Authorities Cited
22-028        §22.28         Formal Address
              §22.29         Opening Paragraph
              §22.30         When Petitioner Is Employee
              §22.31         When Petitioner Is Dependent
              §22.32         When Petitioners Are Defendants
              §22.33         Proceedings Before Board
              §22.34         Grounds for Review Raised in Reconsideration
                             Petition
              §22.35         Questions Presented
 File Name   Book Section                            Title
             §22.36         Incorporation of Points and Authorities
             §22.37         Petition Timely and Proper
             §22.38         No Right to Appeal
             §22.39         Residence and Beneficial Interest
             §22.40         Prayer; Signature
             §22.41         By Affidavit
             §22.42         By Declaration
22-047       §22.47         Statement of Material Facts
22-056       §22.56         Stipulation Extending Time to File Answer
22-057       §22.57         Application for Extension of Time to Answer
22-058       §22.58         Order Extending Time to File Answer
22-060       §22.60         Title When Attorney Fee Requested Under Lab C
                            §5801
22-061       §22.61         Opening Paragraph
22-062       §22.62         Identification of Respondent; Denial of Allegations in
                            Petition
22-063       §22.63         Allegation of Lack of Reasonable Basis for Petition
22-064       §22.64         Questions Presented
22-065       §22.65         Statement of Material Facts
22-067       §22.67         Conclusion
22-074       §22.74         Conclusion
22-089       §22.89         Opening Paragraph
22-091       §22.91         Prayer
22-097       §22.97         Caption, Formal Address, and Opening Paragraph
22-098       §22.98         Exhibits
CH23         Chapter 23     SUPPLEMENTAL PROCEEDINGS
23-021       §23.21         Table of Comparisons
23-059       §23.59         Petition for Contribution Under Lab C §5500.5
APP          Appendix(es)   APPENDIX(ES)
APP          Appendix       Claims Rehabilitation Time Line
DIRECTORY    Directory      DIRECTORY
Directory    Directory      Directory

				
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