SCHEDULE 1
(Describe each document in the Schedules as original or copy and number
each of them.)
PART 1
DOCUMENTS IN PARTY'S POSSESSION
PART 2
PRIVILEGED DOCUMENTS
SCHEDULE 2
DOCUMENTS NO LONGER IN PARTY'S POSSESSION
Work Health Court Rules 1999 103
FORM 12B
rule 12.03(1)
REQUIREMENT FOR AFFIDAVIT VERIFYING LIST OF DOCUMENTS
You are required by the [requesting party] to make an affidavit verifying your
list of documents and to serve the affidavit on the [requesting party] not later
than 14 days after service of this notice on you.
Prepared by [footer as in Form 2A]
Work Health Court Rules 1999 104
FORM 12C
Rule 12.05
NOTICE TO PRODUCE DOCUMENTS FOR INSPECTION
The [requesting party] requires you to produce for inspection, not later than
14 days after service of this notice on you, the following documents referred to
in your [list of documents, statement of claim, notice of defence, affidavit, &c.]:
[description of documents requested]
You are required to arrange with [requesting party] a time and place for
inspection.
Prepared by [footer as in Form 2A]
Work Health Court Rules 1999 105
FORM 14A
rule 14.03(2)
ADMISSION OF FACTS
I, [party], admit the following facts:
[list of facts admitted]
Work Health Court Rules 1999 106
FORM 14B
rule 14.04(2)
NOTICE TO DISPUTE FACTS
If you do not, within [specify a number of days not less than 14] days after
service of this notice on you serve a notice on the [party serving this notice]
disputing any fact specified below, that fact will, for the purpose of this
proceeding only, be taken to be admitted by you in favour of the [party serving
this notice].
If you do serve a notice disputing a fact, and afterwards that fact is proved,
you must pay the costs of proof unless the Court orders otherwise.
[list of facts]
Work Health Court Rules 1999 107
FORM 14C
rule 14.04(3)
NOTICE DISPUTING FACTS
The [party serving this notice] disputes the following facts specified in the
[identify party's] notice dated [e.g. 1 February 1999].
[list of disputed facts]
Dated: [e.g. 8 April 1999]
Work Health Court Rules 1999 108
FORM 14D
rule 14.05(2)
NOTICE TO DISPUTE AUTHENTICITY OF DOCUMENTS
If you do not, within [specify a number of days not less than 14] days after
service of this notice on you serve a notice on the [party serving this notice]
disputing the authenticity of a document specified below, the authenticity of
the document will, for the purpose of this proceeding only, be taken to be
admitted by you in favour of the [party serving this notice].
If you do serve a notice disputing the authenticity of a document, and
afterwards the authenticity of the document is proved, you must pay the costs
of proof unless the Court orders otherwise.
[list of documents]
Work Health Court Rules 1999 109
FORM 14E
rule 14.05(3)
NOTICE DISPUTING AUTHENTICITY OF DOCUMENTS
The [party serving this notice] disputes the authenticity of the following
documents specified in the [identify party's] notice dated
[e.g. 1 February 1999]:
[list of disputed documents]
Dated: [e.g. 8 April 1999]
Work Health Court Rules 1999 110
FORM 15A
rule 15.01(1)
MEMORANDUM OF AGREEMENT
The [identify parties] in this proceeding have entered into the following
agreement and request the Court to record the agreement.
[details of agreement]
Dated: Dated:
[signed by party] [signed by party]
[PARTY'S FULL NAME] [PARTY'S FULL NAME]
(NOTES TO PARTIES:
The memorandum of agreement is to be filed accompanied by a document,
headed "STATEMENT OF PARTICULARS", including the following particulars
as applicable. The statement of particulars is to include details, by the use of
sub-totals, of how the amount of each payment under the agreement is made
up or calculated.
In the case of an injury suffered or disease contracted by a worker:
(a) worker's full name, address, occupation and date of birth;
(c) date of injury or when disease contracted;
(d) brief statement of injury or disease;
(e) as at the date of injury or contraction of disease:
(i) worker's normal weekly earnings (as defined in section 49 of the
Act);
(ii) name of award (if any) under which worker was employed;
(iii) amount of sick leave benefit payable under that award;
(f) period(s) of incapacity;
(g) actual earnings of worker during period(s) of incapacity up to the date
of this memorandum, giving dates on which variations of earnings
occurred;
(h) amount per week worker is reasonably capable of earning in work
he/she is capable of undertaking if he/she were to engage in the most
profitable employment, if any, reasonably available to him/her, having
regard to the matters referred to in section 68 of the Act;
Work Health Court Rules 1999 111
(j) full name of spouse and:
(k) full names and dates of birth of prescribed child (as defined in
(m) amounts (using sub-totals for each category) previously made for:
(i) weekly payments;
(ii) hospital, medical or rehabilitation treatment or training expenses;
(p) amount (using sub-totals for each category) of medical, hospital,
rehabilitation or other expenses for which compensation is claimed.
2. In the case of a worker with a permanent impairment:
(a) worker's full name, address, occupation and date of birth;
(c) date of injury or when disease contracted;
(d) brief statement of injury or disease;
(e) percentage of permanent impairment assessed under section 72 of the
Act.
In addition to the statement of particulars, copies of the following documents
are also to accompany the memorandum of agreement:
(a) all medical reports obtained by the parties in respect of the injury or
(b) all other documents on which the parties relied in reaching agreement,
including documents that provide evidence of amounts to be paid under
the agreement.
See rule 2.06(3) on how to file accompanying documents.)
Work Health Court Rules 1999 112
FORM 15B
rule 15.02
NOTICE OF RECEIPT OF MEMORANDUM OF AGREEMENT
TO [NAME AND ADDRESS OF EACH PARTY AND PERSON HAVING AN
INTEREST IN THE AGREEMENT]
In respect of the claim in this proceeding, the Court has received a request
that the Court record a memorandum of agreement between [identify parties]
dated [date]. A copy of the memorandum of agreement is available for
inspection at the Registry of the Work Health Court at [address].
If you object to the Court recording the memorandum of agreement you may,
NOT LATER THAN 21 DAYS AFTER THE DATE OF THIS NOTICE, file a
notice of objection in accordance with Form 15C. A notice of objection is to
state the grounds on which the objection is made.
The Registrar will consider the memorandum of agreement and all objections
received and may require the parties to provide further information. The
Registrar will then make a report to the Court, after which the Court may:
(a) direct the Registrar to request the parties to the agreement, their legal
practitioners or other persons entitled under section 98 of the Act to
appear for them, to appear before the Court to provide further
information (including copies of documents) and make further
submissions as the Court thinks fit;
(b) require the hearing of oral evidence;
(c) summon a person to appear to give evidence; or
(d) direct the Registrar:
(i) not to record the agreement; or
(ii) to record the agreement on terms or in its present form.
The Registrar will notify you accordingly.
Work Health Court Rules 1999 113
FORM 15C
rule 15.03(2)
NOTICE OF OBJECTION TO RECORDING MEMORANDUM OF
AGREEMENT
AND [IDENTIFY EACH PARTY AND PERSON HAVING AN INTEREST IN
THE AGREEMENT]
I, [name of person objecting], of [address], object to the recording of the
memorandum of agreement between [identify parties] dated [date] on the
following grounds:
[signature of person objecting
Work Health Court Rules 1999 114
FORM 15D
rule 15.06(2)(a)
NOTICE OF DIRECTION NOT TO RECORD AGREEMENT
NOTICE OF DIRECTION TO RECORD AGREEMENT ON TERMS
TO [IDENTIFY EACH PARTY AND PERSON WHO FILED OBJECTION]
On [date of direction] the Court directed me:
not to record the memorandum of agreement dated [date of agreement]
between [parties].
The reasons for the direction are:
[reasons]
to record the memorandum of agreement dated [date of agreement]
between [parties].
to record the memorandum of agreement dated [date of agreement]
between [parties] on the following terms:
[terms]
I have today recorded the memorandum of agreement in respect of:
compensation for an injury that occurred on [date]
compensation for a disease contracted on [date]
[brief description of other claim]
Work Health Court Rules 1999 115
FORM 15E
rule 15.07(1)(a)
APPLICATION FOR COMMUTATION OF FUTURE COMPENSATION
PAYMENTS
The * employer/person to whom compensation is payable * applies for the
commutation of future compensation payments under section * 63/65 * of the
Return to Work Act 1986 on the following terms:
(Enter terms.)
STATEMENTS BY EMPLOYER OR PERSON TO WHOM COMPENSATION
IS PAYABLE
(Insert required statement(s) in the form of an affidavit or statutory declaration
under the Oaths, Affidavits and Declarations Act 2010.)
This application is to be accompanied by a document, headed "STATEMENT
OF PARTICULARS" including details, by the use of sub-totals, of how the
amount of commutation is calculated. The following particulars, as applicable,
are to be included in the statement of particulars:
In the case of section 63 payments:
(a) prescribed child's date of birth;
(b) date of death of worker;
(c) current amount of weekly compensation payments.
In the case of section 65 payments:
(a) worker's occupation and date of birth;
(b) date when worker became incapacitated for work;
(c) brief statement of injury out of which incapacity arose;
(d) full name of spouse and:
(e) full names and dates of birth of prescribed child (as defined in
Work Health Court Rules 1999 116
(f) current amount of weekly compensation payments.
In addition to the statement of particulars, copies of other documents relevant
to the proposed commutation are also to accompany this application.
If the other party consents to the commutation, the party may endorse his or
her consent on the application.)
Work Health Court Rules 1999 117
FORM 15F
rule 15.07(2)(a)
APPLICATION FOR COMMUTATION OF FUTURE COMPENSATION
PAYMENTS
The worker applies for the commutation of regular compensation payments
under section 65 of the Return to Work Act 1986 on the following terms:
(Enter terms.)
STATEMENT BY WORKER
(Insert required statement(s) in the form of an affidavit or statutory declaration
under the Oaths, Affidavits and Declarations Act 2010.)
This application is to be accompanied by a document headed
"STATEMENT OF PARTICULARS" including details, by the use of sub-totals,
of how the amount of commutation is calculated. The following particulars, as
applicable, are to be included in the statement of particulars:
(a) worker's occupation and date of birth;
(b) date when worker became incapacitated for work;
(c) brief statement of injury out of which incapacity arose;
(d) full name of spouse and:
(e) full names and dates of birth of prescribed child (as defined in
(f) current amount of weekly compensation payments.
In addition to the statement of particulars, copies of the following
documents are also to accompany this application:
(a) statement by person who gave financial counselling and brief details of
counselling;
(b) documents on which the parties relied in calculating the commutation.
If the employer consents to the commutation, the employer may endorse his
or her consent on the application.)
Work Health Court Rules 1999 118
FORM 16A
rule 16.03(3)(b)(i)
APPLICATION FOR ORDER PERMITTING EXAMINATION OF WITNESS
BY CLOSED-CIRCUIT TELEVISION COMMUNICATION LINK
The [identify party] applies for an order permitting the examination of the
witness named below by closed-circuit television communication link at the
hearing of this proceeding.
Name of witness:
Date(s) fixed for the hearing:
Time at which it is proposed to examine witness:
Arrangements for the communication link are as follows:
[details of arrangements]
Work Health Court Rules 1999 119
FORM 16B
rule 16.03(4)
NOTICE OF OBJECTION TO EXAMINATION OF WITNESS BY CLOSED-
CIRCUIT TELEVISION COMMUNICATION LINK
AND TO [IDENTIFY PARTY]
The [identify party], objects to the Court making an order permitting the
examination of a witness, [name], by closed-circuit television communication
link at the hearing of this proceeding.
The objection is based on the following ground(s):
Work Health Court Rules 1999 120
FORM 16C
rule 16.03(9)(b)
NOTICE OF CLOSED-CIRCUIT TELEVISION COMMUNICATION LINK
RESERVATION
I/We, [name of person or firm], request you to reserve the Court's closed-
circuit television communication link as detailed below and pre-arranged in
accordance with rule 16.03(9)(a).
Name of witness:
Date and time:
Other facility:
Telephone number of other facility:
(Repeat above details for each witness, as necessary.)
I/We require the use of a document camera.
I/We do not require the use of a document camera.
UNDERTAKING
I/We *, [name], undertake:
(a) to pay to the Court the costs of the communication link referred to
above, including transmission costs, at the rates advised by the officer
of the Court with whom arrangements for the reservation were made;
and
(b) to indemnify the Court against liability for any charges that may be
made by other providers of facilities in relation to this communication
link.
Work Health Court Rules 1999 121
FORM 17A
rule 17.01(1)
AFFIDAVIT
NAME OF DEPONENT:
DATE AFFIDAVIT MADE:
I, [full name of deponent], [occupation or description], of [deponent's
residential address or, if making affidavit in professional or occupational
capacity, business address and position and, if applicable, name of firm or
employer], make oath and say that:
(Divide into paragraphs, numbered consecutively. Confine each
paragraph as far as possible to a distinct portion of the subject.)
By [signature of deponent] _______________________________________
Witnessed by
Signature______________________________________________________
Justice of the peace / commissioner for oaths
Name________________________________________________________
Address or phone no. __________________________________________
Work Health Court Rules 1999 122
FORM 19A
rule 19.03(1)(a)
SUMMONS TO GIVE EVIDENCE
TO [NAME]
THE COURT ORDERS that you attend for the purpose of giving evidence:
(a) before the Work Health Court;
(b) at [address of Court];
(c) at [time] on [date] and until you are excused from further attending.
If you do not comply with this summons you may be arrested.
Any question concerning this summons should be addressed initially to
Conduct money must be given or offered with this summons.
Do not ignore this summons. If, after contacting the person named in note
2, you still do not understand this summons or need help, contact a Registrar
of the Work Health Court, a legal practitioner or your local legal aid office.
Work Health Court Rules 1999 123
FORM 19B
rule 19.04(a)
SUMMONS FOR PRODUCTION OF DOCUMENTS
TO [NAME]
THE COURT ORDERS that you attend, and bring with you this summons and
the documents and things described in the Schedule, at the Work Health
Court at [address] at [time] on [date] and until you are excused from further
attending.
Instead of attending, you may take this summons and the documents and
things described in the Schedule to a Registrar of the Work Health Court at
[address] by hand or by post, in either case so that the Registrar receives
them no later than 2 business days before the date on which you are required
to attend.
SCHEDULE
[description of documents and things]
If you do not comply with this summons you may be arrested.
Documents and things taken to the Court by you may be returned by
post to you at your address shown on this summons. You may request
in writing that they be posted to you at another address or you may ask
to collect them from the Court.
Any question concerning this summons should be addressed initially to
Conduct money must be given or offered with this summons.
Do not ignore this summons. If, after contacting the person named in
note 3, you still do not understand this summons or need help, contact a
Registrar of the Work Health Court, a legal practitioner or your local legal aid
office.
Work Health Court Rules 1999 124
FORM 19C
rule 19.04(b)
SUMMONS TO CORPORATION FOR PRODUCTION OF DOCUMENTS
TO [NAME OF CORPORATION]
THE COURT ORDERS that:
[Name of corporation], called the corporation, must produce this
summons and the documents and things described in the Schedule by
an appropriate officer attending and producing them at the Work Health
Court at [address] at [time] on [date] and until you are excused from
further attending.
Instead of attending, the corporation may produce this summons and
the documents and things described in the Schedule to a Registrar of
the Work Health Court at [address] by hand or by post, in either case
so that the Registrar receives them not later than 2 business days
before the date on which the officer is required to attend.
The officer who is to attend must make enquiries for the purpose of
answering, and on attending must answer, the questions that the Court
requires the officer to answer concerning the possession or custody of
those documents and things.
SCHEDULE
[description of documents and things]
If you do not comply with this summons an officer of the corporation
may be arrested.
Documents and things taken to Court by the corporation may be
returned by post to the corporation at its address shown on this
summons. It may request in writing that they be posted to it at another
address or it may ask to collect them from the Court.
Any question concerning this summons should be addressed initially to
Work Health Court Rules 1999 125
4. Conduct money must be given or offered with this summons.
Do not ignore this summons. If, after contacting the person named in
note 3, you still do not understand this summons or need help, contact a
Registrar of the Work Health Court, a legal practitioner or your local legal aid
office.
Work Health Court Rules 1999 126
FORM 20A
rule 20.01
NOTICE OF HEARING
The hearing of this proceeding has been listed to take place at the Work
Health Court at [address] at a.m./p.m. on or as soon
afterwards as the business of the Court allows.
Work Health Court Rules 1999 127
FORM 22A
rule 22.01(a)
DRAFT FINAL ORDER
JUDICIAL OFFICER: [Name]
DATE MADE:
HOW OBTAINED:
APPEARANCE: (Set out appearance or non-appearance of any
person entitled to attend and, if attending, whether by legal practitioner.)
OTHER MATTERS: (State any finding of jurisdictional fact, undertaking
of party or other matter as directed by Court.)
THE COURT ORDERS THAT:
[terms of order]
BY THE COURT
Registrar/Magistrate
Do not ignore this order. If you do not understand this order or need help
contact a Registrar of the Local Court, a legal practitioner or your local legal
aid office.
Work Health Court Rules 1999 128
FORM 22B
rule 22.02(1)
NOTICE REQUESTING AMENDMENT OF DRAFT FINAL ORDER
TO [IDENTIFY PARTY]
The [identify party] requests an amendment of the terms of the final order,
made in this proceeding on [date], as contained in the draft final order served
on [date]. The amendment requested is as follows:
(Specify amendment requested.)
[Signature of party or
Work Health Court Rules 1999 129
FORM 22C
rule 22.02(2)(b)
NOTICE OF REFUSAL TO AMEND DRAFT FINAL ORDER
TO THE COURT AND [IDENTIFY PARTY]
The [identify party] refuses to amend the terms of the final order as requested
in the notice dated [date] and applies for a determination of the Court in
respect of the terms of the final order made in this proceeding on [date].
Work Health Court Rules 1999 130
FORM 23A
rule 23.09(1)(a)
SUMMONS FOR TAXATION OF COSTS
TO [IDENTIFY EACH PARTY OR OTHER PERSON TO WHOM
SUMMONS IS ADDRESSED AND STATE ADDRESS OF EACH PERSON
NOT A PARTY]
You are summoned to attend before the taxing officer at [address of Court]
at a.m./p.m. on for the hearing of an application by [identify
party] for the costs that are payable to that party by [identify party liable for
costs] under [identify the judgment, etc., by which payable] to be taxed in
accordance with the bill of costs served with this summons.
NOTE TO PERSON SERVED WITH SUMMONS:
Whether or not you attend on the day for hearing referred to above, the costs
claimed in the bill may be allowed unless, not later than 7 days before the
date fixed for taxation, you file and serve on the [identify party filing summons]
a notice in accordance with Form 23B identifying by list each item in the bill to
which you object and stating specifically and concisely the grounds of
objection to each item. Failure to file that notice amounts to an admission of
the items in the bill.
Work Health Court Rules 1999 131
FORM 23B
rule 23.10(1)
NOTICE OF OBJECTION TO BILL OF COSTS
TO [identify party]
The [objecting party] objects to the items in your bill of costs specified
below for the reasons specified in relation to each item.
(List items objected to and state specifically and concisely the grounds of
objection to each item.)
[Signature of party or
Work Health Court Rules 1999 132
1 KEY
Key to abbreviations
amd = amended od = order
app = appendix om = omitted
bl = by-law pt = Part
ch = Chapter r = regulation/rule
cl = clause rem = remainder
div = Division renum = renumbered
exp = expires/expired rep = repealed
f = forms s = section
Gaz = Gazette sch = Schedule
hdg = heading sdiv = Subdivision
ins = inserted SL = Subordinate Legislation
lt = long title sub = substituted
nc = not commenced
Schedule Sch 1 - WORK HEALTH COURT RULES 1999 | Zoe