Maine > Workers Compensation
Petition For Extension Of Benefits Due To Extreme Financial Hardship WCB-213 - Maine
| Petition For Extension Of Benefits Due To Extreme Financial Hardship Form. This is a Maine form and can be used in Workers Compensation . |
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PETITION FOR EXTENSION OF BENEFITS DUE TO EXTREME FINANCIAL HARDSHIP PURSUANT TO 39-A M.R.S.A. §213(1) 67$7( 2) 0$,1( :25.(56 &203(16$7,21 %2$5' 67$7( +286( 67$7,21 $8*867$ 0$,1( (03/2<(( 1$0( 675((732 %2; &,7< 67$7( =,3 7(/(3+21( 180%(5 ,1685(5 62&,$/ 6(&85,7< 180%(5 RQO\ ODVW IRXU GLJLWV UHTXLUHG %2$5' ),/( 180%(5 ;;;;; 1$0( 675((732 %2; &,7< 67$7( =,3 1$0( 675((732 %2; &,7< 67$7( =,3 (03/2<(5 NOTICE :LWKLQ GD\V RI WKH GDWH WKDW WKH HPSOR\HH¶V SHWLWLRQ LV ILOHG WKH HPSOR\HH PXVW UHVSRQG WR WKH TXHVWLRQV FRQWDLQHG LQ $SSHQGL[ , RI 0$5 &K DQG VHQG WKRVH UHVSRQVHV WR WKH HPSOR\HU &RPSHQVDWLRQ RI SHU ZHHN ZDV EHLQJ SDLG IRU SDUWLDO LQFDSDFLW\ &RPSHQVDWLRQ EHQHILWV ZHUH GLVFRQWLQXHG DV RI 0217+ '$< <($5 7KLV FDVH LQYROYHV H[WUHPH ILQDQFLDO KDUGVKLS GXH WR WKH HPSOR\HH¶V LQDELOLW\ WR UHWXUQ WR JDLQIXO HPSOR\PHQW 7+(5()25( WKH HPSOR\HH UHTXHVWV DQ H[SHGLWHG SURFHHGLQJ DQG DVNV WKDW WKH ERDUG H[WHQG EHQHILWV SXUVXDQW WR $ 056$ BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB 6,*1$785( 2) 3(7,7,21(5 '$7(' 0217+ '$< <($5 FILING INSTRUCTIONS 0DLO RULJLQDO SHWLWLRQ WR WKH :RUNHUV¶ &RPSHQVDWLRQ %RDUG DW WKH DERYH DGGUHVV E\ UHJXODU PDLO 0DLO RQH FRS\ by certified mail, return receipt requested WR HDFK RWKHU SDUW\ OLVWHG RQ WKH SHWLWLRQ .HHS RQH FRS\ IRU \RXUVHOI DQG NHHS WKH JUHHQ FHUWLILHG PDLO FDUGV ZKHQ UHWXUQHG WR \RX E\ WKH 86 3RVW 2IILFH 1$0( 2) 3(7,7,21(5 6 $77251(< 25 $'92&$7( ,) $1< 675((732 %2; &,7< 67$7( =,3 7(/(3+21( 180%(5 7KH 6WDWH RI 0DLQH SURYLGHV HTXDO RSSRUWXQLW\ LQ HPSOR\PHQW DQG SURJUDPV $X[LOLDU\ DLGV DQG VHUYLFHV DUH DYDLODEOH WR LQGLYLGXDOV ZLWK GLVDELOLWLHV XSRQ UHTXHVW )RU DVVLVWDQFH ZLWK WKLV IRUP FRQWDFW WKH $'$ &RRUGLQDWRU DW WKH 0DLQH :RUNHUV¶ &RPSHQVDWLRQ %RDUG 7HOHSKRQH RU 77< 0DLQH 5HOD\ :&% HII American LegalNet, Inc. www.FormsWorkFlow.com
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