New Jersey > Workers Comp > Formal Litigation
Pre-Trial Memorandum WC-31 - New Jersey
| Pre-Trial Memorandum Form. This is a New Jersey form and can be used in Formal Litigation Workers Comp . |
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Vicinage PETITIONER CARRIER NEW JERSEY DEPARTMENT OF LABOR AND WORKFORCE DEVELOPMENT DIVISION OF WORKERS' COMPENSATION _ PRE-TRIAL MEMORANDUM Date RESPONDENT _ CLAIM PETITION NUMBER _ _ _ STIPULATIONS: (FILL IN) Date of Accident Compensation Paid: Temporary Disability from Pennanent Disability percentage Wages Rate _ to Member Rate Rate _ _ o Employment 0 Wages 0 Rate o Injuries 0 Alise out of Employment OTHER ISSUES: Medical Bills Outstanding CHECK IF AT ISSUE: 0 0 Accident 0 Notice In course of Employment 0 0 Exposure Temporary 0 0 Knowledge 0 Causal Relationship Nature and ex'tent of Permanent Injury _ T.D.B. Paid FURTHER STIPULATIONS: WITNESSES: DOCTOR'S NAME PET. RESP. PET. RESP. PET. RESP. PET. RESP. Liens _ DATE OF EXAMINATION EST TESTIMONY REQUIRED 0 0 0 0 0 0 0 0 0 0 0 0 0 0 _ PET. RESP. PET. RESP. PET. RESP. Videos or other electronic media to be introduced at trial: (list witnesses under "OTHER WTINESSES" below) OTHER WITNESSES: Tlial time of petitioner Petitioner _ Respondent Trial time of respondent _ _ Attorney for Petitioner Attorney for Respondent Judge of Compensation WC(OO)-31 (R-6-07) Recommendation I American LegalNet, Inc. www.FormsWorkflow.com
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