§ 263. Arbitration V. ORDER FOR ARBITRATION Applicant, Respondent(s). The notice and application of the above named applicant, for an adjustment of claim in the above named matter having been presented to the Industrial Accident Board, and due consideration thereof having been had, and it appearing to the Board that the arbitration prayed for by said applicant should be had; it is ordered that the matters in difference between said applicant and said respondent mentioned in the notice and application filed herein be adjusted and determined by arbitration under the provisions of the Workmen's Compensation Act and that said arbitration be held at in the town of, County of day of, 19, commencing at State of o'clock in the -, on the of the Industrial Accident Board be and he is hereby appointed and designated as chairman of the committee to be formed for such arbitration. It is further ordered that due notice be given to said applicant of the time and place of such arbitration, together with request and notice for said applicant to select one member of said arbitration committee; and that like notice be given to said respondent together with like notice and request that said respondent choose one member of said arbitration committee. has You are hereby notified that, whose postoffice address is — been chosen as a member of the committee of arbitration in the above entitled matter by the undersigned. Notice and application for adjustment of claim for compensation having been filed with said Board in the above entitled matter, and thereafter said Board having requested both of the parties to appoint their respective representatives on the committee of arbitration, and said committee of arbitration having been duly formed, consisting of representing said applicant, and, representing said respondent(s), and member of the Industrial Accident Board, as chairman thereof; and said matter having come on to be heard before the aforesaid arbitration committee at city of -, county of and State of o'clock in the in the on the day of 19-, at -noon, and after hearing the proofs and allegations of the said applicant(s) and said respondent(s), and said committee having made careful inquiry and investigation of said matter and being fully advised in the premises, doth find, determine and adjudge that the said applicant, entitled to receive and recover from said responddollars per week for a period of weeks, from the 19, and that said applicant is entitled to receive and recover from said respondent(s) on this date dollars, being the amount of such compensation that has already become due under the provisions of law, the remainder of said award to be paid to said applicant, by said respondent(s) in weekly payments, commencing one week from the date of the award. ent(8), is day of Committee of Arbitration, Chairman. Dated and entered this day of A. D. 19-. In a considerable number of cases, the facts surrounding the injury are not in dispute, the only matter of uncertainty being the application of the law to such facts and conditions. Frequently in such cases the parties desire to submit to the Board directly the legal questions in dispute, waiving arbitration and obtaining a speedy decision of the full Board thereon. For the purpose of facilitating this practice the Michigan Board has prepared the follow ing form for stipulating the facts and submitting the matter directly to the full Board, viz.: STIPULATION, AND WAIVER OF ARBITRATION V. Applicant, Respondent(s). The facts in this case being undisputed and the only matter in difference between the parties hereto being the construction and application to said facts of the Workmen's Compensation Law, being Act No. 10, Public Acts 1912, extra session, and the parties hereto desiring to obtain a decision of said matter by the full board without resorting to arbitration, do hereby stipulate and agree as follows: 1. That the accident to the employé, upon which the claim for compensation in this cause is based, occurred on the day of 19-, in the town of, county of State of Michigan, and that the same arose out of and in the course of his employment. That the character and nature of the injury and the result thereof is as follows (state in detail the nature of the injury, disability or death resulting, etc.): (If average weekly wage is undisputed, so state; if disputed, state all material facts relating to same.) 3. The other material facts in said cause not included in paragraphs 1 and 2 are as follows: 4. That the arbitration of the matters in difference between the parties hereto, provided for in said Workmen's Compensation Law, be and the same is hereby waived, and the decision of said matters is hereby submitted to the Industrial Accident Board, sitting as a full board, the same as if this cause had proceeded to arbitration under said law, and the decision on arbitration therein had been appealed from and said cause thereby brought before the full board on appeal from such decision. It is further stipulated and agreed that the decision of said board in this cause pursuant to this stipulation, and based upon the facts set forth herein shall be valid and binding, and shall have the same validity, force and effect as if said cause had proceeded to arbitration in due course, and was brought before the full board on appeal duly taken from the decision of an arbitration committee therein. In witness whereof the parties hereto have signed this stipulation at in the county of State of Michigan, this 19-. Signed in presence of day of (Applicant.) (Respondents.) STATE OF MICHIGAN, County of SS: day of, 19-, before me a notary public in and for said county personally appeared —, known to me to be the persons described in and who signed the foregoing stipulation, and acknowledged that they signed the same as their free act and deed. And I further certify that I read over all of said stipulation to said persons, and fully acquainted them with the contents thereof before the same was acknowledged and signed by him (them). the employer therein who signed the foregoing stipulation on behalf of mentioned, and acknowledged that he executed the same on behalf of said being duly authorized so to do, and that the same is his free act and (state position or office) for said employer. deed as Notary Public. 19-. APPEAL FROM DECISION OF ARBITRATION COMMITTEE The decision of an arbitration committee in Michigan will stand as the decision of the Industrial Accident Board unless a claim for review is filed by either party to the cause within seven days. The act, however, gives the Board power to grant further time in which to claim such review if sufficient cause be shown. The Board has prepared the following form for making application for review: STATE OF MICHIGAN APPLICATION FOR REVIEW OF CLAIM BEFORE FULL BOARD To the Industrial Accident Board, Lansing, Mich. Gentlemen: The undersigned, as provided in Part 3, Sec. 8, of Act No. 10, Public Acts 1912, makes application for a review of the findings of the Committee on Arbitration in the claim of V. This claim for review is based on the following grounds: 4. If an assistant, consultant, or anaesthetist was necessary, give name and address 5. Who furnished necessary medical supplies? 6. Was a nurse ordered by you? Name Address 7. Is he able to attend to any part of his present or any other occupation? 8. Was hospital treatment necessary? Name Address 9. Give an accurate description of the nature and extent of the injury? 10. Describe the treatment 11. Are the symptoms from which he is suffering due entirely to this injury? 12. Has the injury resulted in a permanent disability? what? 13. Has previous sickness or injury affected the present disability? If so, |