QLD PERSONAL INJURY. August 2016 CONTENTS
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1 QLD PERSONAL INJURY August 2016 CONTENTS SECTION 1 User Notes MISCELLANEOUS DOCUMENTS Manual Page PIQ 00 MASTER Master File... 1 PIQ 03 INFO Matter Information Sheet... 5 PIQ 03 ACCT General Account... 8 PIQ 03 ACCTDISB Account Disbursements only PIQ 03 COVER File Cover PIQ 03 BRIEF Brief to Barrister PIQ 03 FILENOTE Memo to File PIQ 03 MEMO Office Memo PIQ 03 STATDEC Statutory Declaration SECTION 2 GENERAL LETTERS AND FACSIMILES PIQ 01 L1 Letter to Client... 1 PIQ 01 L3 Letter General... 2 PIQ 01 LRES Letter to Respondent/Defendant's Solicitor... 3 PIQ 01 LCLA Letter to Claimant/Plaintiff's Solicitor... 4 PIQ 01 LCON Letter to Contributor's Solicitor... 5 PIQ 01 LINS Letter to Insurer... 6 PIQ 01 LB Letter to Barrister... 7 PIQ 01 LC Letter to Court... 8 PIQ 01 LDOC Letter to Doctor/Specialist/Hospital... 9 PIQ 01 LCL Letter to Centrelink PIQ 01 LH Letter to Medicare PIQ 01 LWC Letter to WorkCover PIQ 02 F1 Fax to Client PIQ 02 F3 Fax General PIQ 02 FRES Fax to Respondent/Defendant's Solicitor PIQ 02 FCLA Fax to Claimant/Plaintiff's Solicitor PIQ 02 FCON Fax to Contributor's Solicitor PIQ 02 FINS Fax to Insurer PIQ 02 FB Fax to Barrister PIQ 02 FC Fax to Court PIQ 02 FDOC Fax to Doctor/Specialist/Hospital PIQ 02 FCL Fax to Centrelink Softdocs (Aug 2016) 1.
2 SECTION 3 LETTERS TO CLIENT (CLAIMANT) PIQ L010 Initial Letter to Client (Claimant)... 1 PIQ L020 General Info Letter to Client (Claimant) PIQ L025 Letter to Client's Former Solicitor PIQ L050 Letter to Client (Claimant) advising of service of Notice of Accident Claim (MVA) PIQ L070 Letter to Client (Claimant) service of PIPA Form 1 Part PIQ L155 Letter to Client (Claimant) re medico-legal appointment... 53a PIQ L165 Letter to Client (Claimant) requesting fee for Hospital/Medical Report PIQ L170 Letter to Client (Claimant) advising of Medical PIQ L180 Letter to Client (Claimant) advising of Respondent/Defendant Medicals PIQ L190 Letter to Client (Claimant) forwarding Reports PIQ L240 Letter to Client (Claimant) requesting Completion of Private Health Fund CHS PIQ L260 Letter to Client (Claimant) forwarding Medicare Docs for completion PIQ L305 Letter to Client (Claimant) requesting comments on investigative reports PIQ L350 Letter to Client (Claimant) enclosing draft Notice of Claim for Damages (WC) PIQ L352 Letter to Client (Claimant) enclosing draft NCD and list docs to finalise (WC) PIQ L354 Letter to Client (Claimant) enclosing Notice of Claim for Damages for signing (WC) PIQ L363 Letter to Client (Claimant) confirming service of Notice of Claim for Damages (WC) PIQ L370 Letter to Client (Claimant) preparing for Conference PIQ L390 Letter to Client (Claimant) notice Pre-Conference/Mediation PIQ L410 Letter to Client (Claimant) forwarding Statement of Loss & Damage for signing PIQ L465 Letter to Client (Claimant) advising of Offer of Settlement PIQ L510 Letter to Client (Claimant) forwarding Settlement Monies PIQ L520 Letter to Client (Claimant) advising of Settlement and enclosing Invoice PIQ L530 Letter to Client (Claimant) not proceeding LETTERS TO OTHER SIDE (INSURER, RESPONDENT) PIQ L030 Letter to CTP Insurer serving Notice of Accident Claim (MVA) PIQ L040 Letter to Nominal Defendant service Notice of Accident Claim (MVA) PIQ L060 Letter to Respondent serving PIPA Form 1 Part PIQ L185 Letter to Respondent Solicitor request to provide Medical Reports PIQ L200 Letter to Respondent/Defendant forwarding Reports PIQ L210 Letter to Respondent requesting Reimbursement of Travel Expenses PIQ L320 Letter to Respondent's Solicitor re. Rule PIQ L360 Letter to Employer (Respondent) serving Notice of Claim for Damages (WC) PIQ L380 Letter to Respondent's Solicitor notice Pre-Conference PIQ L420 Letter to Other Side forwarding Statement of Loss & Damage PIQ L430 Letter to Other Side forwarding Statement of Loss & Damage with Offer PIQ L440 Letter to Client forwarding copy of Statement of Loss & Damage Offer PIQ L480 Letter to Insurer giving EFT Details LETTERS TO DOCTORS, SPECIALISTS, HOSPITAL, etc PIQ L080 Letter to Doctor requesting Medical Records PIQ L090 Letter to Hospital requesting Medical Records PIQ L100 Letter to Doctor requesting Updated Records PIQ L110 Letter to Hospital requesting Account for Bed Fees PIQ L120 Letter to Treating Specialist requesting Short Report PIQ L125 Letter to Specialist requesting Report (WC) PIQ L130 Letter to Psychiatrist/Psychologist requesting Report PIQ L140 Letter to Neuropsychologist requesting Report (MVA) Softdocs (Aug 2016) 2.
3 SECTION 3 LETTERS TO DOCTORS, SPECIALISTS, HOSPITAL, etc (Continued) PIQ L150 Letter to Specialist re medico-legal appointment PIQ L160 Letter to Occupational Therapist requesting Report PIQ L166 Letter to Doctor enclosing Report Fee PIQ L450 Letter to Specialist requesting Updated Report PIQ L460 Letter to Psychiatrist/Psychologist requesting Updated Report LETTERS TO GOVERNMENT AGENCIES PIQ L205 Letter to Workplace Health & Safety requesting Investigation Mateiral PIQ L230 Letter to Medicare initial request for Claims History Form PIQ L250 Letter to Medicare request for PBS and History Form Information PIQ L280 Letter to CITEC requesting Accident Documents (MVA) PIQ L290 Letter to QLD Police requesting Accident Documents PIQ L295 Letter to QLD Police Photographics requesting Photographs (MVA) PIQ L310 Letter to Q-Comp requesting Claim History Statement PIQ L330 Letter to Q-Comp forwarding copy Rule 444 letter PIQ L340 Letter to ATO requesting Tax Documents PIQ L342 Letter to ATO requesting PAYG Payment Summaries PIQ L345 Letter to Centrelink re. FOI Request PIQ L366 Letter to WorkCover requesting copy of Claim File/History Report PIQ L365 Letter to WorkCover serving Notice of Claim for Damages PIQ L367 Letter to WorkCover under WCRA 2003 protect Statutory Limitation Expiry (WC) PIQ L470 Letter to Centrelink re. Refund MISCELLANEOUS LETTERS PIQ L220 Letter to Private Health Fund requesting Statement of Benefits PIQ L270 Letter to Private Health Fund returning Private Health Statement PIQ L285 Letter to Employer requesting records of employment PIQ L300 Letter to Witness to sign Statement PIQ L400 Letter to Court filing Statement of Claim PIQ L490 Letter to Cost Assessor PIQ L500 Letter Paying Outstanding Invoices SECTION 4 FORMS PIQ 04 FORM1 Personal Injury Form 1 - Notice of Claim (Non Health Care Claim)... 1 PIQ 04 FORM2 Personal injury Form 2 - Notice of Claim (Health Care Claim) PIQ 04 FORM3 Personal Injury Form 3 - Notice of Claim (Dependency Claim) PIQ 04 M010 MAIC Notice of Accident Claim Form (Non-Fatal Injury) PIQ 04 M020 MAIC Additional Information Form PIQ 04 M030 MAIC Report of Traffic Incident to Police PIQ 04 M040 MAIC Notice of Accident Claim Form (Fatal Injury) PIQ 04 M045 Centrelink Authority to Release Personal Information [si039] PIQ 04 M050 Centrelink Advice of Lump Sum Compensation Payment [ss446] PIQ 04 M060 Centrelink Advice of Periodic Compensation Payments [si445] PIQ 04 M080 Centrelink Compensation and Damages [ModC] PIQ 04 M100 Medicare Compensation Recovery Third Party Authority [mo021] PIQ 04 M110 Medicare Request for History Statement [mo026] PIQ 04 M115 Medicare Compensation Recovery Bank Account Details Collection [mo024] Softdocs (Aug 2016) 3.
4 SECTION 4 FORMS (Continued) PIQ 04 M118 Medicare Compensation Recovery Notifiable Person EFT Details Collection [mo025] b PIQ 04 M120 Medicare Notice of Reimbursement Arrangement [mo027] PIQ 04 M130 Medicare Section 23A Statement and Statutory Declaration [mo023] PIQ 04 M140 Medicare Notice of Judgment or Settlement [mo022] PIQ 04 M150 Q-Comp Application for Review (Form 542.3) PIQ 04 M160 Q-Comp Notice of Claim for Damages (Form 275) PIQ 04 M165 Q-Comp Offer of Settlement/Statement of Reasons why offer cannot be made PIQ 04 M170 WorkCover Application for Compensation PIQ 04 M180 MAIC Provider Treatment Plan - Physical PIQ 04 M190 Right to Information and Information Privacy Access Application PIQ 05 F010 Travel Reimbursement Form PIQ 05 F020 Certificate of Readiness PIQ 05 F030 Written/Mandatory Final Offer of Settlement (blank) PIQ 05 F032 Written/Mandatory Final Offer of Settlement PIQ 05 F035 Written/Mandatory Final Offer Coversheet PIQ 05 F040 List of Documents required from Client PIQ 05 F045 List of Documents for Disclosure PIQ 05 F050 Litigation Settlement Instructions (WC) PIQ 05 F060 NCD Offer of Settlement PIQ 05 F070 Schedule of Damages (MVA) PIQ 05 F080 QIRC Notice of Appeal from a Q-Comp Decision AUTHORITIES PIQ A010 Authority for Information PIQ A015 Authority to Release Medical Records a PIQ A020 Authority to Receive PIQ A030 Authority to Release File PIQ A035 Authority to Release (TPD) PIQ A040 Authority to Settle PIQ A050 Authority to Receive Settlement Monies PIQ A060 Authority to Release to Medicare PIQ A070 Authority to ATO for Copy of Return PIQ A075 Authority to ATO for PAYG Summary a PIQ A080 Authority to Release to Q-Comp PIQ A090 Authority to Release to WorkCover PIQ A100 Authority to WorkCover provide Information and Documents PIQ A110 Irrevocable Authority and Direction Softdocs (Aug 2016) 4.
5 SECTION 5 COURT FORMS PIQ FORM001 General Form... 1 PIQ FORM002 Claim... 3a PIQ FORM005 Originating Application... 4 PIQ FORM005_A Originating Application for leave to proceed despite non-compliance (PIPA)... 7 PIQ FORM005_B Originating Application (MAIA) PIQ FORM006 Notice of Intention to Defend... 12a PIQ FORM008 Notice of Address for Service PIQ FORM009 Application PIQ FORM012 Change of Venue by Agreement PIQ FORM013 Consent of Litigation Guardian PIQ FORM016 Statement of Claim... 18a PIQ FORM017 Defence... 18c PIQ FORM018RA Reply (and Answer) PIQ FORM019 List of Documents... 21a PIQ FORM020 Certificate of Solicitor (Rule 244) PIQ FORM021 Notice of Non-Party Disclosure PIQ FORM027 Notice of Discontinuance PIQ FORM038 Notice of Acceptance of Offer PIQ FORM041 Subpoena for Production PIQ FORM042 Subpoena to Give Evidence PIQ FORM043 Subpoena for Production and to Give Evidence PIQ FORM044 Request for Subpoena PIQ FORM046 Affidavit PIQ FORM046_B Affidavit in support of Application (MAIA) PIQ FORM047 Certificate of Exhibit PIQ FORM047_2 Index of Exhibits PIQ FORM048 Request for Trial Date PIQ FORM059 Order PIQ FORM059_B Order (MAIA) PIQ FORM059A Request for Consent Order of Registrar PIQ FORM059A_B Request for Consent Order of Registrar (MAIA) PIQ FORM060 Application for Costs Assessment (LPA Act 2007) r.743a PIQ FORM060A Costs Statement r PIQ FORM061 Notice of Objection r PIQ FORM063A Registrar's Order for Costs PIQ FORM090 Notice of Change of Address for Service PIQ FORM091 Notice of Appointment of Solicitor PIQ FORM092 Notice that Party Acting in Person PIQ FORM093 Notice of Change of Solicitor PIQ FORM094 Notice of Withdrawal of Solicitors PIQ FORM095 Notice of Withdrawal of Town Agents PIQ FORM127 Statement of Loss and Damage PIQ FORM128 Notice of Intention to Proceed PIQ FORM129 Notice to Produce PIQ FORM130 Request for Further & Better Particulars PIQ FORM131 Reply to Request for Further & Better Particulars PIQ FORM132 Offer to Contribute PIQ FORM133 Offer to Settle PIQ FORM136 Affidavit of Service Softdocs (Aug 2016) 5.
6 ALPHABETICAL TABLE OF FORMS Precedent Sec Page A Affidavit FORM Affidavit in support of Application (MAIA) FORM046_B 5 36 Affidavit of Service FORM Application FORM Application for Costs Assessment (LPA Act 2007) r.743a FORM Authority for Information A Authority to ATO for Copy of Return A Authority to ATO for PAYG Summary A a Authority to Receive A Authority to Receive Settlement Monies A Authority to Release (TPD) A Authority to Release File A Authority to Release Medical Records A a Authority to Release to Medicare A Authority to Release to Q-Comp A Authority to Release to WorkCover A Authority to Settle A Authority to WorkCover provide Information and Documents A C Centrelink Advice of Lump Sum Compensation Payment [ss446] M Centrelink Advice of Periodic Compensation Payments [ss445] M Centrelink Authority to Release Personal Information [si039] M Centrelink Compensation and Damages [ModC] M Certificate of Exhibit FORM Certificate of Readiness F Certificate of Solicitor (Rule 244) FORM Change of Venue by Agreement FORM Claim FORM a Consent of Litigation Guardian FORM Costs Statement r.705 FORM060A 5 48 D Defence FORM c F Further & Better Particulars FORM G General Court Form FORM I Index of Exhibits FORM047_ Irrevocable Authority and Direction A L List of Documents FORM a List of Documents for Disclosure F List of Documents required from Client F Litigation Settlement Instructions (WC) F M MAIC Additional Information Form M MAIC Notice of Accident Claim Form (Fatal Injury) M MAIC Notice of Accident Claim Form (Non-Fatal Injury) M MAIC Provider Treatment Plan - Physical M MAIC Report of Traffic Incident to Police M Medicare Compensation Recover Third Party Authority [mo021] M Medicare Compensation Recovery Bank Account Details Collection M Medicare Compensation Recovery Notifiable Person's EFT Details Collection [mo025] M b Medicare Notice of Judgment or Settlement [mo022] M Medicare Notice of Reimbursement Arrangement [mo027] M Medicare Request for History Statement [mo026] M Medicare Section 23A Statement and Statutory Declaration [mo023] M Softdocs (Aug 2016) 6.
7 ALPHABETICAL TABLE OF FORMS Precedent Sec Page N NCD Offer of Settlement F Notice of Acceptance of Offer FORM Notice of Address for Service FORM Notice of Appointment of Solicitor FORM Notice of Change of Address for Service FORM Notice of Change of Solicitor FORM Notice of Discontinuance FORM Notice of Intention to Defend FORM a Notice of Intention to Proceed FORM Notice of Non-Party Disclosure FORM Notice of Objection r.706 FORM Notice of Withdrawal of Solicitors FORM Notice of Withdrawal of Town Agents FORM Notice that Party Acting in Person FORM Notice to Produce FORM O Offer to Contribute FORM Offer to Settle FORM Order FORM Order (MAIA) FORM059_B 5 43 Originating Application FORM Originating Application (MAIA) FORM005_B 5 10 Originating Application for leave to proceed despite non-compliance (PIPA) FORM005_A 5 7 P Personal Injury Form 1 - Notice of Claim (Non Health Care Claim) FORM1 4 1 Personal injury Form 2 - Notice of Claim (Health Care Claim) FORM Personal Injury Form 3 - Notice of Claim (Dependency Claim) FORM Q Q-Comp Application for Review (Form 542.3) M Q-Comp Notice of Claim for Damages (Form 275) M Q-Comp Offer of Settlement/Statement of Reasons why offer cannot be made M QIRC Notice of Appeal from a Q-Comp Decision F R Registrar's Order for Costs FORM063A 5 52 Reply (and Answer) FORM018RA 5 19 Request for Consent Order of Registrar FORM059A 5 44 Request for Consent Order of Registrar (MAIA) FORM059A_ 5 45 B Request for Further & Better Particulars FORM Request for Subpoena FORM Request for Trial Date FORM Right to Information and Information Privacy Access Application M S Schedule of Damages (MVA) F Statement of Claim FORM a Statement of Loss and Damage FORM Subpoena for Production FORM Subpoena for Production and to Give Evidence FORM Subpoena to Give Evidence FORM T Travel Reimbursement Form F W WorkCover Application for Compensation M Written/Mandatory Final Offer Coversheet F Written/Mandatory Final Offer of Settlement F Written/Mandatory Final Offer of Settlement (blank) F Softdocs (Aug 2016) 7.
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