This information is provided free of charge by the Department of Industrial Relations from its web site at These regulations are for the convenience of the user and no representation or warranty is made that the information is current or accurate. See full disclaimer at

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

New Query

§10464. Contents of Petition to Terminate Liability.

A petition to terminate liability for temporary total disability indemnity shall conform substantially to the form provided by the Appeals Board and shall include:

(a) the correct title and date of filing of the prior order or decision, liability under which is sought to be terminated;

(b) the date upon which it is claimed that liability terminated;

(c) the grounds upon which it is claimed liability should be terminated;

(d) whether permanent disability is being advanced and, if so, the approximate date to which such indemnity will be paid;

(e) whether the employee is presently working, according to information available to the petitioner;

(f) a computer printout showing the dates and the amounts of disability indemnity that have been paid, and the periods covered shall be attached; and

(g) proof of service upon the opposing parties.

All medical reports in the possession of the petitioner that have not previously been served and filed shall accompany the petition. The petition also shall contain a statement, in underlined capital letters, that an order terminating liability for temporary total disability indemnity may issue unless objection thereto is made on behalf of the employee within 14 days after service of the petition.


Authority cited: Sections 133 and 5307, Labor Code. Reference: Sections 4650, 4651.1, Labor Code.


1. 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).

Go BackGo Back to Article 5 Table of Contents