Fill and Sign the A Workbook for Injured Workers in New Mexico Form

THESE FORMS ARE ONLY RECOMMENDED STATE OF NEW MEXICO WORKERS’ COMPENSATION ADMINISTRATION _____________________________, WCA NO:_____________________ Worker, VS. _____________________________, and Employer, _____________________________, Insurer, JOINT WAIVER OF DISQUALIFICATION AND WAIVER OF SERVICE OF PROCESS _______________________, appearing for the Worker, and ____________________________, appearing for the Employer/Insurer jointly waive the right to disqualify a judge in the abov\ e captioned cause as provided under New Mexico Workers’ Compensation Administration Rule 4.4.12.2.3. I, ________________________, appearing for the Worker/Employer/Insurer waive my right to the service of process of the _________________________________ in the a\ bove captioned cause at: ___________________________________ ___________________________________ ___________________________________ Pursuant to Rules of Civil Procedure for the District Courts of New Mexico Rule 1-004. ________________________ Signature of the person waiving service of process ________________________ Relationship to Entity/ Authority to Receive Service of Process ________________________ Date of Signature _____________________________ ____________________________________ Counsel for Worker/Pro Se Counsel for Employer ______________________________ ____________________________________ ______________________________ ____________________________________ ______________________________ ____________________________________ STATE OF NEW MEXICO WORKERS’ COMPENSATION ADMINISTRATION _____________________________, WCA NO:_____________________ Worker, VS. _____________________________, and Employer, _____________________________, Insurer, JOINT WAIVER OF TEN DAY WAITING PERIOD _______________________, appearing for the Worker, and ____________________________, appearing for the Employer/Insurer jointly waive my right to the ten day waiting period for a judge assignment in the above caption cause as provided under New Mexico Workers’ Compensation Administration Rule 4.4.12.2.3. ______________________________ ____________________________________ Counsel for Worker/Pro Se Counsel for Employer/Insurer ______________________________ ____________________________________ ______________________________ ____________________________________ ______________________________ ____________________________________ STATE OF NEW MEXICO WORKERS’ COMPENSATION ADMINISTRATION _____________________________, WCA NO:_____________________ Worker, VS. _____________________________, and Employer, _____________________________, Insurer, WAIVER OF TEN DAY WAITING PERIOD _______________________, appearing for the Worker/Employer/Insurer waive my right to the ten day waiting period for a judge assignment in the above caption cause as provided under New Mexico Workers’ Compensation Administration Rule 4.4.12.2.3. ________________________ Signature ________________________ Date of Signature STATE OF NEW MEXICO WORKERS’ COMPENSATION ADMINISTRATION _____________________________, WCA NO:_____________________ Worker, VS. _____________________________, and Employer, _____________________________, Insurer, JOINT WAIVER OF DISQUALIFICATION _______________________, appearing for the Worker, and ____________________________, appearing for the Employer/Insurer jointly waive the right to disqualify a judge in the abov\ e captioned cause as provided under New Mexico Workers’ Compensation Administration Rule 4.4.12.2.3. _____________________________ ____________________________________ Counsel for Worker/Pro Se Counsel for Employer ______________________________ ____________________________________ ______________________________ ____________________________________ ______________________________ ____________________________________ STATE OF NEW MEXICO WORKERS’ COMPENSATION ADMINISTRATION _____________________________, WCA NO:_____________________ Worker, VS. _____________________________, and Employer, _____________________________, Insurer, WAIVER OF DISQUALIFICATION _______________________, appearing for the Worker/Employer/Insurer waive the right to disqualify a judge in the above captioned cause as provided under New Me\ xico Workers’ Compensation Administration Rule 4.4.12.2.3. _____________________________ ____________________________________ Counsel for Worker/Pro Se Counsel for Employer ______________________________ ____________________________________ ______________________________ ____________________________________ ______________________________ ____________________________________ STATE OF NEW MEXICO WORKERS’ COMPENSATION ADMINISTRATION _____________________________, WCA NO:_____________________ Worker, VS. _____________________________, and Employer, _____________________________, Insurer, WAIVER OF SERVICE OF PROCESS I, ________________________, appearing for the Worker/Employer/Insurer waive my right to the service of process of the _________________________________ in the a\ bove captioned cause at: ___________________________________ ___________________________________ ___________________________________ Pursuant to Rules of Civil Procedure for th e District Courts of New Mexico Rule 1-004. ________________________ Signature of the person waiving service of process ________________________ Relationship to Entity/ Authority to Receive Service of Process ________________________ Date of Signature STATE OF NEW MEXICO WORKERS’ COMPENSATION ADMINISTRATION _____________________________, WCA NO:_____________________ Worker, VS. _____________________________, and Employer, _____________________________, Insurer, JOINT WAIVER OF SERVICE OF PROCESS I, ________________________, appearing for the Worker & ________________________ appearing for the Employer/Insurer waive our right to the service of process of the _________________________________ in the above captioned cause at: ___________________________________ ___________________________________ ___________________________________ Pursuant to Rules of Civil Procedure for th e District Courts of New Mexico Rule 1-004. ________________________ ________________________ Signature of the Worker Signature of the Employer/Insurer waiving service of process waiving service of process ________________________ ________________________ Relationship to Entity/ Relationship to Entity/ Authority to Receive Authority to Receive Service of Process Service of Process ________________________ ________________________ Date of Signature Date of Signature