Employees Request For Administrative Conference {EQ05}

MN EQ05 - EMPLOYEE’S REQUEST FOR ADMINISTRATIVE CONFERENCE ON DISCONTINUANCE OF WORKERS’ COMPENSATION BENEFITS. This form is used in Minnesota when an injured worker disagrees with an employer’s or insurer’s decision to stop or change their weekly workers’ compensation benefits. This form allows the employee to formally request an administrative conference through the Court of Administrative Hearings, where a decision can be made about whether benefits should continue. It must be filed within specific timeframes depending on which box is checked on the Notice of Intention to Discontinue Workers’ Compensation Benefits: within 30 days if the employee has returned to work, or within 12 days if benefits are being stopped for another reason. The employee must explain why benefits should not be discontinued, provide contact information, and indicate if an interpreter is needed. The completed form can be submitted by mail, delivered in person, or initiated by phone. www.FormsWorkflow.com