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EMPLOYEES' COMPENSATION (RULES OF COURT) RULES - SCHEDULE
SCHEDULE
(Past version on 06/30/1997).
[rule 3]
EMPLOYEES' COMPENSATION (RULES OF COURT) RULES
Application by Injured Employee in respect of Compensation Payable to him
The ........................................................... Court of .............................................................
Case No. ..............................................................................................................................
In the matter of an Application between-
.............................................................................................................................., applicant,
and
.........................................................................................................................., respondent.
_________
1. (a) On the .................... day of ............................ 19 ......., personal injury by accident arising out of and in the course of employment was caused to the applicant, an employee employed by the respondent/*the 1st respondent.
(b) *At all material times the 1st respondent was a sub-contractor within the meaning of the Ordinance to a principal contractor within the meaning of the Ordinance namely the 2nd respondent.
2. An application under the Ordinance is hereby made by the applicant for compensation under section(s) ........................................................................... of the Ordinance.
3. Particulars are as follows-
PARTICULARS
(1) Date of birth or age of the applicant at the date of the accident
..............................................................................................................................
(2) Nature of employment of the applicant at the time of the accident
..............................................................................................................................
(3) Date and place of accident, nature of work on which the applicant was then engaged and nature of accident and cause of injury ................................................................
..............................................................................................................................
(4) Nature of injury .....................................................................................................
..............................................................................................................................
(5) Particulars of incapacity and/or of attention .............................................................
..............................................................................................................................
(6) Monthly earnings of the applicant from employment with the respondent-
(a) for the month immediately preceding the accident .............................................
(b) on average during the 12 months (or any lesser period of employment with the employer) prior to the accident ........................................................................
(7) If temporary incapacity pursuant to section 10 of the Ordinance is alleged, monthly earnings (if any) which the applicant is earning or is capable of earning (if known) during the period of temporary incapacity ...............................................................
..............................................................................................................................
(8) Amount claimed as compensation ............................................................................
(9) Date of giving notice of accident to respondent .........................................................
(10) If notice not given, reason for omission to give such notice ........................................
The name and address of the applicant or his solicitor are-
Of the applicant ............................................................................................................
Of his solicitor ...............................................................................................................
The name and address of the respondent(s) to be served with this application are ..............
.............................................................................................................................................
Dated this day of 19 .
............................................................
Applicant/Solicitor for the Applicant
* Delete as required.
(L.N. 227 of 1983; L.N. 383 of 1995; 36 of 1996 s. 32)
___________
EMPLOYEES' COMPENSATION (RULES OF COURT) RULES
Application on behalf of Members of the Family in respect of
Compensation Payable where death has resulted from injury to the Employee
The ........................................................... Court of .............................................................
Case No. ..............................................................................................................................
In the matter of an Application between-
.............................................................................................................................., applicant,
and
.........................................................................................................................., respondent.
1. (a) On the ................................ day of ..................... 19......., personal injury causing death by accident arising out of and in the course of employment was caused to ........................................... deceased, an employee employed by the respondent/*1st respondent.
(b) *At all material times the 1st respondent was a sub-contractor within the meaning of the Ordinance to a principal contractor within the meaning of the Ordinance namely the 2nd respondent.
2. An application under the Ordinance is hereby made by .............................................
acting on behalf of the members of the family against the respondent(s) for compensation pursuant to the Ordinance.
3. Particulars are as follows-
PARTICULARS
(1) Date of birth or age of the deceased employee at the date of the accident .................
..............................................................................................................................
(2) Nature of employment of the deceased at the time of the accident ............................
..............................................................................................................................
(3) Date and place of accident, nature of work on which the deceased was then engaged, and nature of accident and cause of injury ................................................................
(4) Nature of injury to the deceased and date of death ...................................................
(5) Monthly earnings of the deceased from employment with the respondent-
(a) for the month immediately preceding the accident ............
(b) on average during the 12 months (or any lesser period of employment with the employer) prior to the accident ........................................................................
(6) Particulars as to members of the family by whom or on whose behalf the application is made-
Name |
Address |
Description
Occupation |
Relationship
to the
deceased |
Age |
(7) Amount claimed as compensation ............................................................................
(8) Date of giving notice of accident to respondent(s) .....................................................
(9) If notice not given, reason for omission to give such notice ........................................
..............................................................................................................................
The name and address of the applicant or his solicitor are-
Of the applicant ............................................................................................................
Of his solicitor ..............................................................................................................
The name and address of the respondent(s) to be served with this application are ..............
.............................................................................................................................................
Dated this day of 19 .
..............................................................
Applicant/Solicitor for the Applicant
* Delete as required
(L.N. 227 of 1983; L.N. 383 of 1995; 52 of 2000 s. 38)
____________
EMPLOYEES' COMPENSATION (RULES OF COURT) RULES
General Application
The ........................................................... Court of .............................................................
Case No. ..............................................................................................................................
In the matter of an Application between-
.............................................................................................................................., applicant,
and
.........................................................................................................................., respondent.
Application is hereby made by (1) .............................................................................................
................................ against (2) .............................................................................................
.............................................................................................................................................
The circumstances in which the application is made are shortly as follows: (3) .....................
.............................................................................................................................................
.............................................................................................................................................
The relief or order which the applicant claims is shortly as follows: (4) ................................
.............................................................................................................................................
.............................................................................................................................................
The full names and addresses of the applicant and his solicitor are-
Of the applicant ............................................................................................................
............................................................................................................
............................................................................................................
Of his solicitor ..............................................................................................................
............................................................................................................
............................................................................................................
The name and address of the respondent to be served with this application are ..................
.............................................................................................................................................
Dated this ................ day of ........................ 19 .........
................................................
Applicant (or his Solicitor)
Note-Where the application is made by an employer, and any question of his liability to pay compensation is involved, it must be accompanied by a statement whether he admits his liability to pay compensation or denies such liability, and whether the admission or denial is total or partial, and if he admits or denial is total or partial, and if he admits or denies liability partially, a statement of the extent to which he admits or denies liability. In the case of a denial of liability, the ground shall be stated.
-----------------------------------------------------------------------------------------------------------------
(1) Name and address of applicant.
(2) Name and address of respondent.
(3) State concisely in numbered paragraphs in chronological order the circumstances in which the application is made.
(4) State concisely the relief or order which the applicant claims.
(L.N. 227 of 1983)
EMPLOYEES' COMPENSATION (RULES OF COURT) RULES
Notice to Respondent as to Application
The ................................................................. Court of .......................................................
Case No. ..............................................................................................................................
In the matter of an Application between-
.............................................................................................................................., applicant,
and
.........................................................................................................................., respondent.
To ..............................................................
of ..........................................................
TAKE NOTICE that, if you intend to oppose the application, of which a copy is served upon you herewith, you must lodge with me, within 21 days after the service of this notice upon you, a written answer thereto containing a concise statement of the extent and grounds of your
opposition.
And further take notice that ...................................................................................... the
................................ day of .................................. 19 .............. at .................................. m., or so soon thereafter as the application can be heard, at the ..................................................... at ................................................... has been fixed as the time and place of the hearing of the application and that in default of your lodging with me within the time aforesaid a written answer as herein required, or of your appearing at the said time and place fixed for the hearing of the application, such order may be made as the Court deems just and expedient.
Dated this ...................... day of .......................... 19 .........
.....................................................
____________
EMPLOYEES' COMPENSATION (RULES OF COURT) RULES
Respondent's answer to Notice
The ................................................................. Court of .......................................................
Case No. ..............................................................................................................................
In the matter of an Application between-
.............................................................................................................................., applicant,
and
.........................................................................................................................., respondent.
To the Registrar of the Court,
..........................................................................
The respondent intends to oppose the above application.
The following is a concise statement of the extent and grounds of his opposition: ...............
.............................................................................................................................................
.................................................................
Respondent (or his Counsel or Solicitor)
Date .......................................
Place ......................................
__________
EMPLOYEES' COMPENSATION (RULES OF COURT) RULES
Request for Particulars
The ................................................................. Court of .......................................................
Case No. ..............................................................................................................................
In the matter of an Application between-
.............................................................................................................................., applicant,
and
.........................................................................................................................., respondent.
To (1)......................................................................................................................................
......................................................................................................................................
TAKE NOTICE that you are hereby requested to furnish me with answers in writing to the following questions: (2) .......................................................................................................
.............................................................................................................................................
Dated this .................. day of ........................ 19 ........
(3) ...............................................................
...............................................................
...............................................................
______________________________________________________________________
(1) Name and address of employee, applicant, or respondent to whom request is made.
(2) State shortly and clearly under consecutive numbers the questions to which answers are requested.
(3) Signature and address of person making the request.
___________
EMPLOYEES' COMPENSATION (RULES OF COURT) RULES
Order for Periodical Payments
The ................................................................. Court of .......................................................
Case No. ..............................................................................................................................
In the matter of an Application between-
.............................................................................................................................., applicant,
and
.........................................................................................................................., respondent.
It is ordered that (1) .........................................................................................................
.............................................................................................................................................
do forthwith pay to (2) .............................................................................................................
at (3) .................................................................... the taxed or assessed costs of an application heard on the ................................................. day of .......................................... 19 ......., and the sum of $ ..................................................................... being the amount now due from the said (1) ...................................................................................................................................
to the said (2) ..........................................................................................................................
in respect of a monthly payment of ............................................................................ from the
........................... day of ............................. 19 ......... being the date of the injury, to the date of order; and do further pay at the same place on every ........................................................... day from the date of this order until otherwise ordered, the sum of ............................................
Dated this ................. day of ....................... 19 ........
...............................................................
______________________________________________________________________
(1) Employer's name and address.
(2) Employee's name and address.
(3) Place where payment is to be made.
______________
EMPLOYEES' COMPENSATION (RULES OF COURT) RULES
Application for the Revision of a Periodical Payment
The ................................................................. Court of .......................................................
Case No. ..............................................................................................................................
In the matter of an Application between-
.............................................................................................................................., applicant,
and
.........................................................................................................................., respondent.
An application is hereby made by ........................................................................ against .................................................................... with respect to the revision of the order made by the Court on the .................... day of .................................................................... 19 ..........., (or the agreement arrived at between the said parties on the .................. day of .......................
19 ....................) and for the termination (or suspension, diminution, or increase, as the case may be) of the monthly payment payable to the said ...............................................................
................................................................... under the said order (or agreement) in respect of personal injury which arose out of and in the course of his employment.
Particulars are hereto appended (or annexed)-
PARTICULARS
(1) Name and address of injured employee ...................................................................
.............................................................................................................................
(2) Name and place of business of employer by whom compensation is payable ..............
.............................................................................................................................
(3) Date and nature of accident, and injury ....................................................................
(4) Date of order or agreement fixing monthly payment, amount of such payment, and date from which it commenced ................................................................................
..............................................................................................................................
(5) Relief sought by applicant, (whether termination, suspension, diminution, or increase)
..............................................................................................................................
..............................................................................................................................
..............................................................................................................................
(6) Grounds on which (termination, suspension, diminution or increase) is claimed-
..............................................................................................................................
..............................................................................................................................
..............................................................................................................................
The names and addresses of the applicant and his Counsel or Solicitor are-
Of the applicant: ....................................................................................................
.....................................................................................................
.....................................................................................................
Of his Counsel .....................................................................................................
.....................................................................................................
.....................................................................................................
or Solicitor: .....................................................................................................
.....................................................................................................
.....................................................................................................
The name and address of the respondent to be served with this application are ..................
.............................................................................................................................................
Dated this .................... day of .................. 19 .........
....................................................................
Applicant (or his Counsel or Solicitor)
__________
EMPLOYEES' COMPENSATION (RULES OF COURT) RULES
Order on Revision of Order/Agreement for Periodical Payments
The ................................................................. Court of .......................................................
Case No. ..............................................................................................................................
In the matter of an Application between-
.............................................................................................................................., applicant,
and
.........................................................................................................................., respondent.
Before ...................................................................................................................... on .................. day, the ...................... day of .......................... 19 .......
Upon revision of the order for periodical payments made .................................................
on the .................... day of ......................... 19 .......... (or the agreement arrived at between the said parties on the ....................... day of ............................... 19 ..........) and upon hearing the evidence given by ................................ and Mr. .............................. for the applicant and Mr. ............................ for the respondent.
It is hereby ordered that the said order/agreement be varied in the following manner:
.............................................................................................................................................
.............................................................................................................................................
.............................................................................................................................................
.............................................................................................................................................
and that the costs of the said ..................................................................................................
of and incidental to this application and order be taxed or assessed and paid by the said .............
to the said .............................................................................................................................
Dated this .................. day of .......................... 19 ..........
.....................................................
______________
EMPLOYEES' COMPENSATION (RULES OF COURT) RULES
Notice by Principal Contractor to Sub-Contractor
The ................................................................. Court of .......................................................
Case No. ..............................................................................................................................
In the matter of an Application between-
.............................................................................................................................., applicant,
and
.........................................................................................................................., respondent.
To (1) .....................................................................................................................................
.....................................................................................................................................
Notice is hereby given to you that an application/a claim for compensation is made against (2) ...................................................................................................................................... by(3) ................................................................................................................. who alleges that the said (4) .............................................................................................................. is liable to pay him compensation in respect of an accident which occurred at (5) ........................................ on the ............................. day of ........................ 19 ...........
Dated this .......... day of .................. 19 .....
(6) ........................................................................
.........................................................................
.........................................................................
______________________________________________________________________
(1) Name and address of the sub-contractor.
(2) Name and address of principle contractor.
(3) Name and address of employee.
(4) Name of principal contractor.
(5) Place of accident.
(6) Signature and address of person giving the notice.
______________
EMPLOYEES' COMPENSATION (RULES OF COURT) RULES
Notice of Intervention by Sub-Contractor
The ................................................................. Court of .......................................................
Case No. ..............................................................................................................................
In the matter of an Application between-
.............................................................................................................................., applicant,
and
.........................................................................................................................., respondent.
To the Registrar of the Court
and to the (applicant) and the (principal contractor).
Notice is hereby given by (1) ..................................................................................... that he intervenes in this application for compensation made by (2) .................................................... against (3) ..............................................................................................................................
The address for service of the said (4) .............................................................................. is ..........................................................................................................................................
.............................................................................................................................................
.............................................................................................................................................
Dated this .................. day of .......................... 19 .........
(5) ........................................................................
.........................................................................
.........................................................................
______________________________________________________________________
(1) Name and address of the sub-contractor.
(2) Name of employee.
(3) Name of principal contractor.
(4) Name of the sub-contractor.
(5) Signature and address of the person giving the notice.
____________
EMPLOYEES' COMPENSATION (RULES OF COURT) RULES
Application Record Book
The ................................................................. Court of .......................................................
No. of application |
Date application lodged |
Nature
of
application |
Names and address of parties and of their respective Counsel of Solicitors |
Date application served |
Date
answer
received |
Hearing |
Remarks |
Date |
Order
made |
Applicant |
Respondent |
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