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DOCUMENT SEPARATOR SHEET
MM/DD/YYYY
MM/DD/YYYY
Office Use Only
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
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 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
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