Objection To Penalty Assessment {CE0003}

MN CE0003 - OBJECTION TO PENALTY ASSESSMENT. This form is used by an employer, insurer, or their attorney to formally contest a penalty issued by the Minnesota Department of Labor and Industry’s Workers’ Compensation Division. The form is required under Minnesota Rules Part 5220.2870, which governs the process for objecting to penalties related to workers' compensation cases. When a party receives a Notice of Assessment of Penalty, they have 30 days to file this written objection, detailing the legal or factual reasons for the disagreement and attaching any supporting documentation. Penalties may include additional awards to the employee, payments to the Assigned Risk Safety Account, penalties for failure to file required reports, or other related violations. If the objection is timely and properly filed, unresolved issues will be referred for a formal hearing to determine whether the penalty is valid and what amount, if any, should be imposed. The form also includes a Proof of Service section, which must be completed and notarized to show that copies of the objection were mailed to all interested parties. www.FormsWorkflow.com