Excess Fee Exhibit {PF04}

MN PF04E - EXCESS FEE EXHIBIT. This form is used in Minnesota’s workers’ compensation system by an employee’s attorney when requesting attorney fees that exceed the standard limits allowed under law. This form must be filed in addition to the Statement of Attorney Fees and provides detailed justification for the higher fee request. The attorney is required to outline the specific legal services performed, the dates those services occurred, and the time spent on each. The form also requires a description of the attorney’s experience and expertise in workers’ compensation, the factual and legal issues in dispute, the nature of the evidence required, and the level of responsibility assumed in the case. Additional supporting information may also be included for consideration. The attorney must indicate whether a hearing on the fee request is being sought and note any needs for interpreters or disability accommodations if a hearing occurs. www.FormsWorkflow.com