STATE OF NEW MEXICO WORKERS' COMPENSATION ADMINISTRATION
__________________________________________________, Worker, v. __________________________________________________, and __________________________________________________, Employer/Insurer.
WCA No.:____________
REQUEST FOR SETTING 1. 2. WCA Judge assigned:_________________________________________________________________ Are any other hearings currently set? ____Yes ____No If yes, please indicate the date of the hearing:_______________________________________________ Specific matter to be heard:_____________________________________________________________ Time required for hearing:______________________________________________________________ Names/addresses/phone & fax of all counsel/parties pro se entitled to notice: _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________
3. 4. 5.
NOTICE OF HEARING This matter will be heard before Judge ____________________________on________________________, 20_____, at ________a.m./p.m. with_________ hours/minutes allocated for hearing at: (_____) WCA Office or (_____) 2410 Centre Ave SE Albuquerque, NM 87106 (505) 841-6000 ____________________________ ____________________________ ____________________________ ____________________________ ____________________________
__________________________________________________ By: Calendar Clerk Notice Mailed________________________, 20_____, by________________________________________ Counsel are expected to appear: (___) in person (___) by telephone conference call. STAMPED ENVELOPES FOR ALL PARTIES MUST BE SUBMITTED WITH REQUEST
11.4.4.9.18.2.K NMAC