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Fill and Sign the Wca Judgesnew Mexico Workers Compensation Form

Fill and Sign the Wca Judgesnew Mexico Workers Compensation Form

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Open the document and fill out all its fields.
Apply your legally-binding eSignature.
Save and invite other recipients to sign it.

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Rev. 10/17 11.4.4.9 NMAC STATE OF NEW MEXICO WORKERS’ COMPENSATION ADMINISTRATION _____________________________________________, WCA No.:____________________ Worker, v. _____________________________________________, and _____________________________________________, Employer/Insurer. REQUEST FOR SETTING 1.WCA Judge assigned: ____________________________________________________________ 2. Are any other hearings currently set? ___ Yes ___ No If yes, please indicate the date of the hearing: _____ ___________________________________ 3. Specific matter to be heard: _______________________________________________________ 4. Time required for hearing: ________________________________________________________ 5. Is an interpreter required? ___ Yes ___ No (Employer/Insurer is re sponsible for making arrangements for the interpreter.) 6. Is telephonic appearance being requested? ___ Yes ___ No (Employer/Insurer is re sponsible for arranging the conference call.) ___ _______________________________________ Signature __________________________________________ Print name ________________________________________ __ Ad dress _________________________________ ________ _ City /State /Zip ___________________________ ____________ ___ T elephone __________________________________________ E- mail address for service

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New Mexico workers' compensation Act
WCA Workers' Compensation
New Mexico workers' compensation attorney
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Workers' Compensation judges
New Mexico association of counties Workers' Compensation Pool
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