Application for Hearing - Disfigurement Only

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Vs





WC #-###-###-##
Application for Hearing - Disfigurement Only (Rule 10, OACRP)


The claimant requests a determination of additional compensation for permanent disfigurement. Section 8-42-108, C.R.S. Disfigurement will be the only issue determined at the hearing and the claimant will be the only witness, unless a response is filed adding affirmative defenses and listing additional witnesses.


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


The Office of Administrative Courts will set the matter for hearing and send a written Notice of Hearing to the parties.

Form Name

Company

Claimant Name




Signature











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Certificate of Mailing

I hereby certify that I mailed or delivered the original of the Application for Hearing - Disfigurement Only (Rule 10, OACRP) 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









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Employer or their Representative









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Other









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