Response to Application for Hearing

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Please Note: If this is for a Worker's Compensation matter and you have a pending pre-hearing conference before the Division of Worker's Compensation, you should file any procedural motions with DoWC at the following location: 633 17th Street, 4th Floor, Denver, CO 80202




Vs





WC #-###-###-##
A. Application for Hearing

Date of Application for Hearing

APPLICATION FOR HEARING


Name of Party
In addition to the issues marked on the Application for Hearing, the following issues shall be considered at the hearing:




If the TPB or TTB are on going, please enter in the "Other Issues" section on this Response.


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







Signature











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Certificate of Mailing

I hereby certify that I mailed or delivered the original of the  for Response to Application for 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









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Employer or their Representative









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Other









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