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Fill and Sign the Request for Award of Claimants Attorney Fees and Expenses West Virginia Form

Fill and Sign the Request for Award of Claimants Attorney Fees and Expenses West Virginia Form

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OFFICE OF JUDGES REQUEST FOR AWARD OF CLAIMANT’S ATTORNEY FEES and EXPENSES WV Code §23-2C-21(c) CLAIMANT’S NAME: ____________________________ SSN: _____-____-______ DOI: __________________ Cl.# ________________ OOJ Case ID# __________________ EMPLOYER: ____________________________ DATE OF CLAIM ADMINISTRATOR’S “UNREASONABLE” ORDER : ___________________ REVERSED BY: DATE REVERSED: ___________________ □ Office of Judges □ Board of Review (attach decision) □ Supreme Court (attach mandate) Submitted by (please print): __________________________ Bar ID# _______________ Address: __________________________ __________________________ Date Form Submitted: __________________________ cc:

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The best way to complete and sign your request for award of claimants attorney fees and expenses west virginia form

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