Maryland > Workers Compensation > Adjudication Claims
Request To Enter Appearance Of Counsel For Employer Or Insurer C26R - Maryland
| Request To Enter Appearance Of Counsel For Employer Or Insurer Form. This is a Maryland form and can be used in Adjudication Claims Workers Compensation . |
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WORKERS COMPENSATION COMMISSION REQUEST TO ENTER APPEARANCE OF COUNSEL FOR EMPLOYER/INSURER This form is to be used only on behalf of an employer/insurer. Claim uNmber: Claimants Social Security No.: Date of Accident: Claimant: On behalf of: Employer Only: Insurer Only: Employer/Insurer: ATTORNEY INFORMATION: (Complete in Adobe Reader, Print or Type Only) Name of Counsel: WCC Attorney Registra tion No.: Street Address: City/State/Zip: Telephone: CERTIFICATION OF SERVI CE I hereby certify that on this day of , 20 , a copy of this Request to Enter Appearance of Counsel for Insurer/Employer was mailed to all parties or their attorneys. Signature WCC Form C26R (Rev. 08/28/03) 10 East Baltimore Street Baltimore, Maryland 21202-1641 410-864-5100 Email: info@wcc.state.md.us Web: http://www.wcc.state.md.us
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