STATE OF NEW MEXICO WORKERS COMPENSATION ADMINISTRATION _____________________________, WCA NO:_____________________ Worker, VS. _____________________________, and Employer, _____________________________, Insurer, WAIVER OF TEN DAY WAITING PERIOD _______________________, appearing for the Worker/Employer/Insurer waive my right to the ten day waiting period for a judge assignment in the above caption cause as provided under New Mexico Workers Compensation Administration Rule 4.4.12.2.3. ________________________ Signature ________________________ Date of Signature