August 2014

Application

Application to Strike Out a Pre-Filing Statement

This is the approved form to make application to strike out a pre-filing statement under s 151DA(3) of the Workers Compensation Act 1987.

This Application and supporting documentation (including a copy of the pre-filing statement and pre-filing defence) must be served on each other party. A Certificate of Service (Form 11A) must be lodged with the Commission.

Claimant:

Defendant:

Filed by:

(Office use only) Date of Direction: __/__/____
The Registrar
1. DIRECTS that:
(1.1)By___/___/___, the defendant is to serve on the claimant a sealed copy of this Application containing the direction.
(1.2)By___/___/___, the defendant is to lodge with the Commission a Certificate of Service (Form 11A) certifying service of the Application and standard direction on the claimant.
(1.3)By___/___/___, the claimant is to lodge with the Commission and serve on the defendant a Notice of Opposition (Form 11F) and supporting documentation.
(1.4)By___/___/___, the claimant is to lodge with the Commission a Certificate of Service (Form 11A) certifying service of the Notice of Opposition (Form 11F) and supporting documentation.
(1.5)By___/___/___, the defendant is to lodge with the Commission and serve on the claimant any submissions in reply.
Issued by delegate of the Registrar.
Signed:______

NOTICE TO CLAIMANT

Application to Strike Out a Pre-Filing Statement
This Application must be served on you within 14 days of the date of registration.
You have 28 days from the date of service of this Application to respond by:
  • lodging a Notice of Opposition with the Commission, and
  • serving a copy of the Notice of Opposition on each other party.
If you do not lodge and serve a Notice of Opposition to the Application, the Commission may determine theApplication in the absence of your response.
The Notice of Opposition form (Form llF) is available from the Commission’s website at or from the Commission on 1300 368 040.
Matter No:
/20
(Office use only)

Form 11E - Page 1 of 5 -

August 2014

Application

Application to Strike Out a Pre-Filing Statement

This is the approved form to make application to strike out a pre-filing statement under s 151DA(3) of the Workers Compensation Act 1987.

PART 1 – Parties’ Details

1.1 Defendant details
Defendant name:
ABN:
Postal or DX address: / Postcode:
Contact person:
(if Appellant is a business or organisation)
Email address:
Phone number: / Fax:
1.2 Defendant representative details
Firm or organisation:
Postal or DX address: / Postcode:
Name of representative:
Email address:
Phone number: / Fax:
1.4 Claimant representative details
Firm or organisation:
Postal or DX address: / Postcode:
Name of representative:
Email address:
Phone number: / Fax:
1.3 Claimant details
Title: / MrMsMrsMissDrOther
Surname/Family name: / Given name(s):
Postal or DX address: / Postcode:
Email address:
Phone number: / Fax:

Form 11E - Page 1 of 5 -

August 2014

Application

Application to Strike Out a Pre-Filing Statement

This is the approved form to make application to strike out a pre-filing statement under s 151DA(3) of the Workers Compensation Act 1987.

PART 2 – Supporting Documentation

Formatting of written submissions
Written submissions must be attached to, and filed with, the Application. They are to be set out in two parts; Part A: Procedural Matters and Part B: Orders Sought and Submissions in Support. They must be typed or written clearly, paginated and set out as illustrated below with sequentially numbered paragraphs and appropriate sub-headings where necessary. The person who prepares the written submissions must sign them at the foot of the document and provide his/her contact details.
Part A: Procedural Matters
2.1 On the papers
Can the Application to Strike Out the Pre-Filing Statement be decided solely on the basis of the written Application and any written Notice of Opposition lodged? Yes No
If no, attach reasons why it is submitted that the Application should not be determined on the papers and why a hearing is necessary.
Part B: Orders Sought and Submissions in Support
2.2 Orders sought
Submissions should precisely identify the orders sought.
2.3 Submissions in support
Submissions in support of the orders sought must be attached.
2.4 Costs
Submissions dealing with costs orders sought must be attached.
2.5 Authorities
Attach a list of the authorities (including full citation for published decisions and the date of the decision for unreported cases) referred to, and specifically relied upon, in submissions.
2.6 Documents to be annexed to Application
The defendant must annex to this Application:
(a)a copy of the claimant’s pre-filing statement, including all information and documents served with the pre-filing statement;
(b)a copy of the defendant’s pre-filing defence, including all information and documents served with the pre-filing defence.
All documents attached to the pre-filing statement and pre-filing defence must be paginated and indexed in the table below.

Form 11E - Page 1 of 5 -

August 2014

Application

Application to Strike Out a Pre-Filing Statement

This is the approved form to make application to strike out a pre-filing statement under s 151DA(3) of the Workers Compensation Act 1987.

2.6.1 Table of documents attached to pre-filing statement and pre-filing defence

Document / Author / Date of Document / Start Page
//
//
//
//
//
//
//
//
//
//
//
//
Part A: Procedural Matters
2.1 On the papers
Part B: Orders Sought and Submissions in Support
2.2 Orders sought
1.
2.
2.3 Submissions in support
1.
2.
2.4 Costs
1.
2.
Dated: //Signature:______solicitor/counsel/defendant
Name of person preparing written submissions:
Phone number: / Fax:

Form 11E - Page 1 of 5 -

August 2014

Application

Application to Strike Out a Pre-Filing Statement

This is the approved form to make application to strike out a pre-filing statement under s 151DA(3) of the Workers Compensation Act 1987.

PART 3 – Signature

Defendant’s (or representative’s) signature: / ______Date: //
Lodgment Details
Hand deliveryLevel 20, 1 Oxford Street Darlinghurst NSW 2010
Postal addressPO Box 594 Darlinghurst NSW 1300
Document exchangeDX 11524 Sydney Downtown
Electronic lodgment
Facsimile 1300 368 018

Privacy of Personal Information

The privacy of personal information is important to the Workers Compensation Commission. The Commission collects personal information to register application forms and make decisions about disputes or claims. The NSW workers compensation laws permit the Commission to collect this information.
The Commission may give personal information to another person or agency (for example a doctor, a party, WorkCover NSW) as required or authorised by law.
Decisions by the Commission will generally be published, including on the internet, unless there are exceptional circumstances justifying the decision being withheld.
A person has a right to access his/her personal information and correct any inaccuracies.

Form 11E - Page 1 of 5 -