EDEX Express Lien Response Report

EDEX Express Lien Response LE1234 - FLOYD, CHRISTOPHER M. Page: 1 of 1	California Administration, Inc. Post Office Box 31 Martell, CA 95654 (800) 832-7333
Account: California Administation, Inc. P. O. Box 31 Martell, CA 95654	File Number: LE1234-654322-123456 Transaction Date: 01/02/98 Reception Date: 01/02/98

WCAB CASE INFORMATION If the current status of this case shows a trial or hearing scheduled you will need to contact the WCAB office listed for the specific date and time.
Injured Worker Name: SSN Searched (Actual): Gender / Birthdate:	FLOYD, CHRISTOPHER M. 123-45-6789 (123-45-6789) Male / January 1, 1965
WCAB Case Number: Current Location: Current Case Status: Date(s) of Injury: Type of Injury:	VNY 1234567 Van Nuys WCAB Office Full-Day Trial Scheduled 6/1/98 07/15/95 to 09/30/96 Cumulative
Lien Amount: Lien Type: DWC Lien ID Number: Basic / Extended:	$15,000.00 Medical / Legal Services 123456 Extended
Injured Body Part(s):	515 - Lower Leg (Tibea and Fibula) 513 - Knee (Patella) 420 - Back (Back muscles, spine and/or spinal cord)

OFFICIAL ADDRESS RECORD
Lien Claimant	Injured Worker	Injured Worker Attorney
California Administration P. O. Box 31 Martell, CA 95654 (800) 832-7333	Floyd, Christopher M. P. O. Box 31 Martell, CA 95654 (800) 832-7333	Gangemi, Donald 4321 Anystreet Chico, CA 95321 (916) 555-1212
Employer	Defense Attorney	Insurer
California Administration P. O. Box 31 Martell, CA 95654 (800) 832-7333	Dewey, Cheatem and Howe 1000 Sunshine Street Los Angeles, CA 00001 (213) 555-1212	Best of the West Insurance P. O. Box 12345 Bakersfield, CA 00015 (805) 555-1212
Lien Claimant	Lien Claimant	Lien Claimant
Dr. James Kevin, M.D. 12345 Surgery Circle Sacramento, CA 95001 (916) 555-1234	EDD - Sacramento P. O. 958 Sacramento, CA 91001 (916) 555-4321	Doc-U-Copy Copy Service 87654 Paper St. Los Angeles, CA 12345 (213) 555-6543