(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).