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Chapter 4.5. Division of Workers' Compensation
Subchapter 2. Workers' Compensation Appeals Board--Rules and Practice Procedure
Article 5. Pleadings

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§10408. Application for Adjudication of Claim Form and Other Forms.

(a) Each of the following documents shall be on a form prescribed and approved by the Appeals Board: (1) an application for adjudication of claim for compensation benefits or death benefits; (2) a lien; (3) a declaration of readiness (including for an expedited hearing); (4) a pretrial conference statement (including for a lien conference); (5) Minutes of Hearing (except Minutes of Hearing prepared by a court reporter); (6) a compromise and release agreement (including for dependency and third-party claims); (7) stipulations with request for award (including death cases); (8) a petition to terminate liability for temporary disability indemnity; (9) a special notice of lawsuit; and (10) any other form the Appeals Board, in its discretion, determines should be uniform and standardized.

(b) Any form prescribed and approved by the Appeals Board may be printed (i.e., hard copy) by the Division of Workers' Compensation for distribution at district offices of the Workers' Compensation Appeals Board. In addition, the Division may create: (1) electronic versions of the prescribed and approved forms (i.e., e-forms); and/or (2) optical character recognition versions of those forms (i.e., OCR forms), either in fillable format or otherwise, for posting on the Division's Forms webpage. Any hard copy, e-form, or OCR form for proceedings before the Workers' Compensation Appeals Board created by the Division shall be presumed to have been prescribed and approved by the Appeals Board unless the Appeals Board issues an order or a formal written statement to the contrary.

(c) No workers' compensation administrative law judge and no district office of the Workers' Compensation Appeals Board shall require the parties to use a form other than that prescribed and approved by the Appeals Board.

Note: Authority: Sections 133, 5307, 5309 and 5708, Labor Code. Reference: Sections 3716, 4903.5, 5500, 5500.3, 5501.5 and 5502, Labor Code.

HISTORY

1. Amendment filed 12-23-93; operative 1-1-94. Submitted to OAL for printing only pursuant to Government Code section 11351 (Register 93, No. 52).

2. Amendment filed 12-19-2002; operative 1-1-2003. Submitted to OAL for printing only pursuant to Government Code section 11351 (Register 2002, No. 51).

3. Amendment of section heading, section and Note filed 9-23-2013; operative 10-23-2013. Submitted as a file and print by the Workers' Compensation Appeals Board pursuant to Government Code section 11351 (Register 2013, No. 39).

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