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DWC-CA form 10232.2 Rev. 9/2014 Page 1

Author

Document Date

Received Date

Product Delivery Unit

Document Type

Document Title

Document type and document titles for ADJ Cases

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DWC-CA form 10232.2 Rev. 9/2014 Page 2

Document type

Document Title Document Title Document Title Document Title Document Title

Legal docs 132A APPLICATION FOR

SUBSEQUENT INJURIES FUND

BENEFITS

NOTICE OF CHANGE OF

ADMINISTRATOR

PETITION FOR

CERTIFICATION

PETITION FOR ORDER OF

CONFIDENTIALITY

1990 - 1993 WINDOW PERIOD

APPLICATION

ARBITRATION SUBMITTAL

FORM

NOTICE OF CHANGE IN

REPRESENTATION

PETITION FOR CHANGE OF

GUARDIAN AD LITEM

PETITION FOR ORDER OF

PUBLICATION

1990 - 1993 WINDOW PERIOD

APPLICATION - DEATH CLAIM

BENEFIT NOTICE NOTICE OF NON-

REPRESENTATION

PETITION FOR CHANGE OF

VENUE

PETITION FOR PENALTIES

4906(g) DECLARATION BENEFIT PRINTOUT NOTICE OF POTENTIAL SJDB PETITION FOR

COMMUTATION

PETITION FOR

RECONSIDERATION

10770.5 VERIFICATION BIRTH CERTIFICATE NOTICE OF REPRESENTATION PETITION FOR

CONSOLIDATION

PETITION FOR

RECONSIDERATION

/REMOVAL10770.6 VERIFICATION C&R: RESPONSE TO LETTER

REQUESTING INFORMATION

NOTICE OF PERMANENT

DISABILITY BENEFITS

PETITION FOR

CONTRIBUTION

PETITION FOR REHAB

ATTORNEY FEE

AMENDED APPLICATION FOR

ADJUDICATION

CHANGE OF ADDRESS NOTICE OF TEMPORARY

DISABILITY BENEFITS (DWC

500-B)

PETITION FOR COSTS PETITION FOR REHAB

ATTORNEY FEE -

WALKTHROUGH

AMENDED APPLICATION FOR

ADJUDICATION-DEATH

CHANGE OF HANDLING

LOCATION

NOTICE REGARDING MPN PETITION FOR CREDIT FOR

OVERPAYMENT OF BENEFITS

PETITION FOR REMOVAL

AMENDED COMPROMISE AND

RELEASE

COMPROMISE AND RELEASE NOTICE OF OFFER OF

REGULAR WORK

PETITION FOR DEPOSITION

ATTORNEY FEE (LC 5710)

PETITION FOR RESTITUTION

AMENDED STIPULATIONS COMPROMISE AND RELEASE

DEPENDENCY CLAIM

OBJECTION - OTHER PETITION FOR DEPOSITION

ATTORNEY FEE (LC 5710) -

WALKTHROUGH

PETITION FOR

SANCTIONS/COST

ANSWER COMPROMISE AND RELEASE:

WALK THROUGH

SETTLEMENT

OBJECTION TO

DECLARATION OF READINESS

TO PROCEED

PETITION FOR DISCOVERY

ORDER

PETITION FOR STAY OF

PROCEEDINGS

ANSWER TO 132A DEATH CERTIFICATE OBJECTION TO PETITION TO

TERMINATE LIABILITY FOR

TEMPORARY DISABILITY

PETITION FOR DISMISSAL PETITION FOR THIRD PARTY

CREDIT

ANSWER TO APPLICATION

FOR ADJUDICATION OF

CLAIM

DECLARATION OF READINESS

TO PROCEED

OBJECTION TO

PETITION/REQUEST FOR

DISMISSAL

PETITION FOR DISMISSAL OF A

PARTY

PETITION FOR WRIT OF

ATTACHMENT

ANSWER TO PETITION FOR

RECONSIDERATION

DECLARATION OF READINESS

TO PROCEED TO EXPEDITED

HEARING

OBJECTION TO VENUE PETITION FOR

DISQUALIFICATION

PETITION TO BAR RECEIPT OF

BENEFITS

ANSWER TO PETITION FOR

REMOVAL

DEPOSITION TRANSCRIPT PETITION BY NON-PHYSICIAN

LIEN CLAIMANT FOR MEDICAL

INFORMATION

PETITION FOR FINDING OF

FACT

PETITION TO BE RELIEVED AS

ATTORNEY OF RECORD

ANSWER TO S & W DISMISSAL OF ATTORNEY PETITION FOR APPOINTMENT

OF GUARDIAN AD LITEM

PETITION FOR INCREASED

BENEFITS FOR SERIOUS AND

WILLFUL MISCONDUCT

PETITION TO CHANGE

ADMINISTRATOR OF AWARD

APPEAL OF DETERMINATION

OF AD-OTHER

DWC-1 CLAIM FORM PETITION FOR APPOINTMENT

OF REPLACEMENT QME

PETITION FOR JOINDER PETITION TO COMPEL

ATTENDANCE AT MEDICAL

EVALUATIONAPPEAL OF DETERMINATION

OF AD-RSU

FEE DISCLOSURE STATEMENT PETITION FOR APPOINTMENT

OF REPLACEMENT QME PANEL

PETITION FOR ORDER

ASSIGNING SECOND PANEL

QME

PETITION TO COMPEL

ATTENDANCE AT MEDICAL

EVALUATION -

WALKTHROUGH

APPLICATION FOR

ADJUDICATION

MARRIAGE LICENSE PETITION FOR ATTORNEY

FEES

PETITION FOR ORDER

COMPELLING SERVICE OF

MEDICAL RECORD

PETITION TO COMPEL

DEPOSITION

APPLICATION FOR

ADJUDICATION-DEATH

MINUTES OF HEARING PETITION FOR AUTOMATIC

REASSIGNMENT

PETITION FOR ORDER

CORRECTING CLERICAL

ERROR

PETITION TO COMPEL

DEPOSITION -

WALKTHROUGH

Document type and document titles for ADJ Cases

Please use this document to complete the document separator sheet. Do not file this form with your documents.

DWC-CA form 10232.2 Rev. 9/2014 Page 3

Document type

Document Title Document Title Document type

Document Title Document type

Document Title

Legal docs PETITION TO DISMISS APPLICANT POINTS AND AUTHORITIES-TRIAL

BRIEF-HEARING BRIEF

VENUE VERIFICATION TRANSMITTAL LETTER

PETITION TO DISMISS ATTORNEY POINTS AND AUTHORITIES WAGE STATEMENT TYPED OR WRITTEN LETTER

PETITION TO DISMISS PARTY

DEFENDANT

PRE-TRIAL CONFERENCE

STATEMENT (5 PAGER)

WITHDRAWAL OF

DECLARATION OF READINESS

TO PROCEED

IMR APPEAL OF DETERMINATION

OF AD-IMR

PETITION TO DISQUALIFY PANEL

QME

PROOF OF SERVICE WRIT IBR APPEAL OF DETERMINATION

OF AD-IBR

PETITION TO ENFORCE PROPOSED ORDER/AWARD PETITION - OTHER

PETITION TO ENFORCE IBR

DETERMINATION

QME WAIVER Liens and bills

4903.8 ASSIGNMENT

PETITION TO JOIN APPLICANT REQUEST FOR CONTINUANCE 4903.8 DECLARATION

PETITION TO JOIN DEFENDANT REQUEST FOR ORDER TAKING

OFF CALENDAR

BILLS-OTHER

PETITION TO JOIN UEBTF REQUEST TO WITHDRAW

PETITION FOR

RECONSIDERATION

CONFIRMATION OF LIEN

FILING FEE

PETITION TO QUASH DEPOSITION REQUEST TO WITHDRAW

PETITION FOR REMOVAL

EDD LIEN

PETITION TO UNSEAL THE RECORD RESPONSE TO PETITION MEDICAL BILLS

PETITION TO QUASH SUBPOENA RESUBMITTED 1990 APPLICATION NOTICE AND REQUEST FOR

ALLOWANCE OF LIEN

PETITION TO REOPEN SPECIAL NOTICE OF LAWSUIT REQUEST FOR WITHDRAWAL

OF LIEN

PETITION TO REOPEN TO REDUCE STIPULATION AND AWARD

AND/OR ORDERMedical docs

ALL MEDICAL REPORTS

PETITION TO RESOLVE MED-LEGAL

DISPUTE-NO IBR

STIPULATION WITH AWARD

(DEATH)

AME REPORTS

PETITION TO SEAL THE RECORD STIPULATIONS WITH REQUEST

FOR AWARD

P & S REPORT

PETITION TO SET ASIDE

COMPROMISE AND RELEASE

STIPULATIONS WITH REQUEST

FOR AWARD POST 1-1-2013

TREATING PHYSICIAN

PETITION TO SET ASIDE

STIPULATIONS

STIPULATIONS WITH REQUEST

FOR AWARD - WALK-THROUGH

QME REPORTS

PETITION TO STRIKE RATING

INSTRUCTIONS

STIPULATIONS WITH REQUEST

FOR AWARD- WALK-THROUGH

POST 1-1-2013

Misc CONSULTATIVE RATING

PETITION TO SUSPEND

PROCEEDINGS

STIPS: RESPONSE TO LETTER

REQUESTING INFORMATION

CORRESPONDENCE – OTHER

PETITION TO TERMINATE LIABILITY

FOR MEDICAL TREATMENT

SUBSTITUTION OF ATTORNEY SETTLEMENT OFFER LETTER

PETITION TO TERMINATE LIABILITY

FOR TEMPORARY DISABILITY

INDEMNITY

SUPPLEMENTAL PETITION FOR

RECONSIDERATION

SUBPOENA

PETITION TO TRANSFER CARE TO

MEDICAL PROVIDER NETWORK

THIRD PARTY COMPROMISE AND

RELEASE

SUBPOENA DUCES TECUM

PETITION TO VACATE SUBMISSION TRANSCRIPT OF RECORD SUMMARY RATING

Document type and document titles for the DEU, the Intergrated Case and Retraining and Return to Work Units.

Please use this document to complete the document separator sheet. Do not file this form with your documents.

DWC-CA form 10232.2 Rev. 9/1014 Page 4

RSU DEU Integrated case (AD)

Document type Document Title Document type Document Title Document type Document Title

DWC - AD forms DWC-AD 10118 NOTICE OF

OFFER OF REGULAR WORK

DEU forms COMMUTATION REQUEST AD Legal MEDICAL REPORTS

DWC-AD 10133.32

SUPPLEMENTAL JOB

DISPLACEMENT NON-

TRANSFERABLE VOUCHER

EMPLOYEES PERMANENT

DISABILITY QUESTIONAIRE

MISCELLANEOUS

DWC-AD 10133.33 DESCRIPTION

OF EMPLOYEE'S JOB DUTIES

REQUEST FOR CONSULTATIVE

RATING

PETITION FOR CHANGE OF

PRIMARY TREATING

PHYSICIAN

DWC-AD 10133.35 NOTICE OF

OFFER OF REG MOD OR

ALTERNATIVE WORK

REQUEST FOR FACTUAL

CORRECTION

RESPONSE TO PETITION FOR

CHANGE OF PRIMARY

TREATING PHYSICIAN

DWC-AD 10133.36 PHYSICIAN’S

RETURN-TO-WORK & VOUCHER

REPORT

REQUEST FOR INFORMAL

RATING BY INSURANCE

CARRIER OR SELF-INSURER

Misc CORRESPONDENCE

DWC-AD 10133.53 NOTICE OF

OFFER OF MODIFIED OR

ALTERNATIVE WORK

REQUEST FOR

RECONSIDERATION OF

SUMMARY RATING BY THE AD

GENERAL PUBLIC REQUEST

FOR INFORMATION

DWC-AD-10133.55 REQUEST FOR

DISPUTE RESOLUTION BEFORE

THE AD

REQUEST FOR SUMMARY

RATING DETERMINATION –

TREATING PHYSICIAN

I & A CONFERENCE

APPOINTMENT NOTICE

DWC-AD 10133.57

SUPPLEMENTAL JOB

DISPLACEMENT VOUCHER

REQUEST FOR SUMMARY

RATING DETERMINATION - QME

REPORT

REQUEST TO I & A FOR

CONFERENCE

OBJECTION - OTHER Medical reports AME Medical docs MEDICAL REPORTS

Non-form correspondence

LETTER DEFAULT QME (REPRESENTED

WITH DOI ON/AFTER 1-1-05)

REQUESTS TO I&A FOR

REPLACEMENT OR

ADDITIONAL QME PANEL

Supporting documents

ERGONOMIC REPORT PANEL QME (NON-

REPRESENTED ALL DOI)

MEDICAL REPORT REPRESENTED QME

(REPRESENTED WITH DOI

JOB DESCRIPTION TREATING PHYSICIAN

POSITION STATEMENT DEU docs - other JOB DESCRIPTION

SCHOOL & VRTWC INVOICES EARNINGS INFORMATION

Other OTHER CORRESPONDENCE PHOTOGRAPHS

PROOF OF SERVICE RESPONSE TO REQUEST FOR

FACTUAL CORRECTION

VRTWC REPORT Misc TYPED OR WRITTEN LETTER

PROOF OF SERVICE