Application for Expedited Hearing

| Resume a previously saved form
Resume Later

In order to be able to resume this form later, please enter your email and choose a password.




Vs





WC #-###-###-##
Application for Expedited Hearing

Complete Section A, B, or C


(date)

and the claimant requests an expedited hearing on compensability and medical benefits. (Attach a copy of the Notice of Contest). Section 8-43-203(1)(a), C.R.S.; or


, an authorized treating provider, and prior authorization has been denied. (Attach a copy of the recommendation of the authorized treating provider). The claimant requests an expedited hearing. Rule 16-10, WCRP; or


(date)

(date)

. The Respondents request an expedited hearing. (Attach a copy of the Petition and objection). Rule 6-4, WCRP.  



The opposing party may file a response to this Application for Expedited Hearing within 10 days of the mailing or delivery of this Application for Expedited Hearing. 


Witnesses to be called at the hearing or by deposition: List names and addresses: 







Request for the OAC to Set the Matter for Hearing Rule 8(H) OACRP:

Case Name


Claimant Name




D. Signature











#####

###-###-####



E. Certificate of Mailing

I hereby certify that I mailed or delivered the original of the Application for Expedited Hearing to all parties at the addresses shown below (A claimant must provide a copy to the employer and the insurer, or their attorney):

Claimant/Respondent or their Representative









#####

###-###-####

Employer or their Representative









#####

###-###-####

Other









#####

###-###-####



Need assistance with this form?