Free 11.4.4 NMAC - New Mexico


File Size: 14.9 kB
Pages: 1
Date: May 11, 2007
File Format: PDF
State: New Mexico
Category: Workers Compensation
Author: Renee Blechner
Word Count: 130 Words, 1,880 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://workerscomp.state.nm.us/downloads/docs/setting.pdf

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Preview 11.4.4 NMAC
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