What if I disagree
with the decision reached in the Proposed Decision and Order?
Any party who disagrees with
any portion of this decision may request a review by the three
How much time do I have to file a Petition for Review?
The Petition for Review must
be filed with the Board's
How do I file a
Petition for Review?
The Petition for Review must contain the following information:
1.
The Case Name, Board Docket Number, and Department
Claim Number (or Firm Number or Citation and Notice Number);
2.
The reasons you
believe the PD&O is incorrect. State
the evidence in the record that supports your petition;
3.
Any rulings made
by the judge that you think are incorrect.
4.
A "Declaration of Receipt" stating the date
the PD&O was received. (See the form on Page 3.)
The Petition for Review must be filed in the Board's
Executive
Secretary
Board
of Industrial Insurance Appeals
·
If filed by mail,
the petition is considered filed when it is deposited in the United States
Postal Service, properly stamped and addressed;
·
If you mail your
petition on the date of your deadline, complete the "Certificate of
Mailing" (see page 3) as proof of the mailing date;
·
Copies of your
petition must be mailed to the other parties.
Their names and addresses appear on the certificate of mailing included
with the PD&O.
Can I get transcripts
of the hearings?
The Board will provide you
with copies of the transcripts, depositions, and exhibits of the proceedings
free of charge. You must file a written
request for these documents.
Can I get an
extension of time to file a Petition for Review?
If you cannot complete your
petition within the twenty (20) day time period, you may request an extension
of time.
1.
The request must be in writing and should state the
reasons why the extension is needed.
2.
The request must be filed with the Board's
3.
The request must include a "Declaration of
Receipt" stating the date the PD&O was received. (See the form
on Page 3.)
If an extension is granted,
the amount of time is determined by the Board.
Where do I find the
statutes and rules regarding Petitions for Review?
Statutes and rules can be
found in the Revised Code of Washington
(RCW Chapter 51.52) and Washington Administrative Code (WAC 263-12). These are legal publications available in law
libraries. They are also available on
the Washington State Legislature website:
http://www1.leg.wa.gov/LawsAndAgencyRules.
Most of these rules can be
found in the Board's Rules of Practice
and Procedure, a publication that you can request from the Board.
What if a Petition
for Review is not filed?
If a Petition for Review is not
filed within the time allowed, the PD&O will be adopted as the final
Decision and Order of the Board. No
further appeal may be taken to the courts.
Further Questions?
You may call us at
360-753-6824.
DECLARATION OF RECEIPT OF PROPOSED DECISION AND ORDER
Case Name:
__________________________ Docket number:
__________________
Claim/Firm/Citation
number: ____________________
I
declare under penalty of perjury under the laws of
The Proposed Decision and Order in this appeal was received on
_____________________________, by _____________________________________
(Date) (Individual's
Name)
on behalf of _____________________________________.
(Party Name)
SIGNED:_____________________, at ______________________________
(Date) (City
and State)
________________________________
(Signature)
________________________________
(Printed
Name)
CERTIFICATE OF MAILING
Case Name:
__________________________ Docket number:
__________________
Claim/Firm/Citation
number: ____________________
I
certify under penalty of perjury under the laws of Washington State that I
filed a Petition for Review or Request for Extension of Time with the BIIA by
depositing it in the United States Postal Service with postage prepaid and
addressed to the Board's offices in Olympia on this date.
SIGNED:_____________________, at ______________________________
(Date) (City
and State)
________________________________
(Signature)
________________________________
(Printed
Name)