Home Table of Contents

Form 15. Designation of Record for Review of a Decision of the Workers' Compensation Commis...

Oklahoma Statutes AnnotatedTitle 12. Civil ProcedureEffective: January 23, 2023

Oklahoma Statutes Annotated
Title 12. Civil Procedure (Refs & Annos)
Chapter 15.--Appendix 1. Oklahoma Supreme Court Rules (Refs & Annos)
Part X. Appendix of Forms
Effective: January 23, 2023
T. 12, Ch. 15, App. 1, Form 15
Form 15. Designation of Record for Review of a Decision of the Workers' Compensation Commission or the Workers' Compensation Court of Existing Claims
Currentness
IN THE WORKERS' COMPENSATION COMMISSION or THE WORKERS' COMPENSATION COURT OF EXISTING CLAIMS OF THE STATE OF OKLAHOMA
Case No. _______________
________________________________________
Claimant,
v.
________________________________________
Respondent,
________________________________________
Insurance Carrier (If applicable)
DESIGNATION OF RECORD FOR REVIEW OF A DECISION OF THE WORKERS' COMPENSATION COMMISSION or THE WORKERS' COMPENSATION COURT OF EXISTING CLAIMS
__________ Designation of Record
__________ Counter-Designation of Record
__________ Amended Designation of Record
A. Designation of Record and Transcripts.
[Claimant or Respondent or Insurance Carrier] __________ hereby designates the following for inclusion in the record for the Supreme Court's review in this case:
B. Date, Signature, and Service by Counsel or Party.
DATE: __________, 20__________.
 
 
Signature (Signature of Attorney or Pro Se Party)
Attorney for (Claimant, Respondent, or Insurance Carrier)
OBA No.____________________
Firm: ____________________
Address:
 
 
[include email address if applicable]
Telephone:
 
CERTIFICATE OF SERVICE
I, __________, hereby certify that in addition to filing the original Designation of Record with the Clerk of the Workers' Compensation Commission or the Clerk of the Workers' Compensation Court of Existing Claims, a copy of the foregoing Designation of Record was mailed this __________ day of __________ 20__________, to the following:
[Names and Addresses of all parties or their counsel of record]
Office of the Attorney General

Credits

Amended July 1, 2013, effective August 1, 2013. Amended effective January 23, 2023.
Sup. Ct. Rules, Form 15, 12 O. S. A. Ch. 15, App. 1, OK ST S CT Form 15
Current with amendments received through April 15, 2024. Some rules may be more current, see credits for details.
End of Document