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Request For Continuance Of Hearing H28R - Maryland
| Request For Continuance Of Hearing Form. This is a Maryland form and can be used in Adjudication Claims Workers Compensation . |
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WORKERS COMPENSATION COMMISSION REQUEST FOR CONTINUANCE OF HEARING INSTRUCTIONS: The form is to be used only to request a continuance of a scheduled hea ring, and is to be submitted without a cover letter. REQUEST TO THE COMMISSION The undersigned hereby requests that the hearing scheduled for the date and location described below be continued for the reason(s) specified. CLAIM IDENTIFICATION CLAIM NUMBER: CLAIMANTS NAME: EMPLOYER: INSURER: CURRENTLY SCHEDULED HEARING INFORMATION HEARING DATE: LOCATION: DAHTE OF EARING NOTICE: JUSTIFICATAION/RESON FOR CONTINUANCE: I hereby certify that a copy of this request and its documentation has been sent to opposing counsel/parties, and also certify that the opposing counsel/parties has been contacted and they: 1) object 2)consent 3)unable to contact . REQUESTED BY _____________________________ FULL NAME (PRINT OR TYPE) SIGNATURE DATE OF REQUEST CLAIMANT CLAIMANTS ATTY EMPLOYER/EMP ATTY INSURER ATTY UEF/SIF ADDRESS : TEL: STREET CITY STATE ZIP 10 East Baltimore Street l Baltimore, Maryland 21202-1641 410-864-5100 l Email: info@wcc.state.md.us l Web: http://www.wcc.state.md.us WCC Form H28R (Rev. 9/05/03)
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