Tennessee bureau of workers’ compensation in the court of workers’ compensation claims at [insert city]



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TENNESSEE BUREAU OF WORKERS’ COMPENSATION

IN THE COURT OF WORKERS’ COMPENSATION CLAIMS

AT [INSERT CITY]


[INSERT EMPLOYEE’S NAME],

Docket No.:

Employee,




v.

State File No.:

[INSERT EMPLOYER’S NAME],




Employer,

Judge [Insert Judge’s Name]

and




[INSERT CARRIER’S NAME],




Insurance Carrier.














INITIAL HEARING ORDER


This matter came before the undersigned Workers’ Compensation Judge upon the Employee’s, [Insert Employee’s Full Name], Request for Initial Hearing Order filed [Insert Date]. Upon agreement of the parties, and for good cause shown, the Court hereby finds as follows:




  1. CONTESTED ISSUES: The contested issues in this case are:

  • Compensability;

  • Medical Benefits;

  • Temporary Disability Benefits; and

  • Permanent Disability Benefits.

Additional issues were marked by the parties on the Dispute Certification Checklist attached to the Dispute Certification Notice filed in this claim. 




  1. DISCOVERY:

  • The parties shall submit and respond to all written discovery on or before [DATE].

  • The parties shall complete discovery depositions of fact witnesses on or before [DATE].

  • The parties shall complete proof depositions of all medical and/or expert witnesses on or before [DATE].

  • The parties shall file with the Court Clerk all medical records designated by the parties for introduction into evidence on or before ten business days before the Compensation Hearing. All medical records submitted shall be numbered and include a table of contents. No duplicate records shall be filed.



  1. MOTIONS: The parties shall file any motion, including but not limited to, a motion to compel discovery, motion to quash, motion for protective order, motion to exclude, motion in limine, motion to dismiss, and/or motion for summary judgment, on or before [DATE].




  1. STIPULATIONS OF THE PARTIES: Each party shall submit any additional stipulations of fact on or before ten business days before the Compensation Hearing.




  1. ALTERNATIVE DISPUTE RESOLUTION: Post-discovery alternative dispute resolution (mediation) shall be completed on or before __________, by filing an amended Petition for Benefit Determination for permanent disability benefits under this same docket number and listing the agreed dates for mediation. To provide the Mediation and Ombudsman Services of Tennessee and the Program Coordinator of the Local Bureau with sufficient time to schedule the post-discovery mediation, the parties must file the amended Petition for Benefit Determination for permanent disability benefits on or before (insert date 30 days in advance of deadline to complete). The parties’ deadline for completion of post-discovery mediation shall not be extended for any reason, without express permission of the undersigned Workers’ Compensation Judge and only upon good cause shown, by written motion filed no later than ten-days before the stated deadline.




  1. LIST OF PROPOSED WITNESSES: Each party shall file with the Court Clerk a list of the witnesses, who may be called to testify at the Compensation Hearing, except for those called for impeachment or rebuttal purposes, on or before ten business days before the Compensation Hearing.




  1. LIST OF PROPOSED EXHIBITS: Each party shall file with the Court Clerk a list of proposed exhibits, which may be introduced at the Compensation Hearing, except for those introduced for impeachment or rebuttal purposes, on or before ten business days before the Compensation Hearing.




  1. PREHEARING STATEMENT: The parties shall file a prehearing statement on or before ten business days before the Compensation Hearing.




  1. COMPENSATION HEARING: The Compensation Hearing is set for [DATE] at [TIME AM/PM CENTRAL/EASTERN] in the [insert city] Courtroom of the Court of Workers’ Compensation Claims, located at [insert address]. Absent extraordinary circumstances as determined by the Judge, the date of the compensation hearing shall not be modified.




  1. ESTIMATED HEARING TIME: The parties expect the Compensation Hearing to last ___ hours.



  1. SETTLEMENT:  If the parties reach a settlement of all issues prior to the scheduled Compensation Hearing, the parties shall immediately give notice to the Court Clerk and the Judge’s assistant, [Insert Name].  Mr/s. [Insert Last Name] may be reached at [Insert Email] or [Insert Direct Telephone Number].




  1. COMPLIANCE: Failure to comply with the deadlines in this Order subjects any party to referral to the Penalty/Compliance Division of the Bureau of Workers’ Compensation Claims for investigation and possible assessment of penalties pursuant to Tennessee Code Annotated section 50-6-118 (2015).

It is so ORDERED.


ENTERED this the ____ day of _________________, 20__.

_____________________________________

[FULL NAME OF JUDGE]

Workers’ Compensation Judge




CERTIFICATE OF SERVICE
I hereby certify that a true and correct copy of the Initial Hearing Order was sent to the following recipients by the following methods of service on this the ___ day of __________________________, 20__.


Name

Certified Mail

First Class Mail

Via Email

Service sent to:

Employee’s Attorney














Employer’s Attorney














SIF Attorney














______________________________________


PENNY SHRUM, COURT CLERK

wc.courtclerk@tn.gov





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