| Title |
Last Updated |
| Workers Compensation Complaint |
April 9, 2019 |
| Summons For Application To Workers Compensation Judge |
April 9, 2019 |
| Notice Of Change Of Health Care Provider |
April 9, 2019 |
| Notice Of Disqualification |
April 9, 2019 |
| Notice Of Acceptance Or Rejection Of Recommended Resolution |
April 9, 2019 |
| Joint Waiver Of Disqualification |
April 9, 2019 |
| Health Care Provider Disagreement Form |
April 9, 2019 |
| Application To Workers Compensation Judge |
April 9, 2019 |
| Summons For Workers Compensation Complaint |
September 24, 2018 |
| Request For Setting |
September 24, 2018 |
| Form Letter To Health Care Provider |
September 24, 2018 |
| Motion For Approval Of Out Of State Health Care Provider |
April 13, 2015 |
| Petition For Lump Sum Payment Return To Work |
July 29, 2011 |
| Petition For Partial Lump Sum Payment For Debts |
July 29, 2011 |
| Employers First Report Of Injury Or Illness |
July 27, 2011 |
| Response (Of Employer To Workers Complaint) |
July 27, 2011 |
| Election To Accept (Employers Election To Accept WC Coverage) |
July 27, 2011 |
| Workers Response To Complaint |
July 27, 2011 |
| Revocation (Of Election To Accept WC Coverage Or Affirmative Election Of Exemption From WC Coverage) |
July 27, 2011 |
| Subpoena Or Subpoena Duces Tecum |
July 27, 2011 |
| Limited Liability Company Member Affirmative Election |
July 27, 2011 |
| Joint Petition For Lump Sum Settlement |
July 27, 2011 |
| Health Care Provider Disagreement Form - Request For Change Of Health Care Provider |
July 27, 2011 |
| Executive Employee Affirmative Election |
July 27, 2011 |
| Election To Refuse |
July 27, 2011 |
| EDI Trading Partner Profile (For FROI And SROI) |
September 30, 2008 |
| Request For Setting And Notice Of Hearing |
December 21, 2007 |
| Petition For Lump Sum Payment |
April 10, 2007 |
| Workers Authorization For Disclosure Of Protected Health Information For WC Purposes (HIPAA Complaint) (Spanish) |
April 10, 2007 |
| Workers Authorization For Disclosure Of Protected Health Information For WC Purposes (HIPAA Complaint) |
April 10, 2007 |
| Insurer-Administrator Profile Report (Proof Of Coverage Profile) |
September 21, 2006 |
| Waiver Of Disqualification |
September 21, 2006 |
| Joint Waiver Of Disqualification And Waiver Of Service Of Process |
September 21, 2006 |
| Joint Waiver Of Service Of Process |
September 21, 2006 |
| Joint Waiver Of Ten Day Waiting Period |
September 21, 2006 |
| Notice Of Benefit Payment (Subsequent Report) |
September 21, 2006 |
| Waiver Of Service Of Process |
September 21, 2006 |
| Waiver Of Ten Day Waiting Period |
September 21, 2006 |
| Annual Expenditure Report For Insurance Carriers And Self Insured Employers |
September 21, 2006 |
| New Mexico Limited Liability Company Member Affirmative Election Form (Exemption From WC Coverage) |
October 6, 2005 |
| New Mexico Executive Employee Affirmative Election Form (Exemption From WC Coverage) |
October 6, 2005 |
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