Appeal of a Hearing Officer's Decision

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If either you or your representative participated in the previous hearing and you disagree with the Hearing Officer’s Decision, you may use this form to appeal the decision.

If neither you nor an authorized representative participated at the hearing that was held, you may request a new hearing. Please complete and submit the Request for New Hearing Form to request a new hearing: https://docs.google.com/a/state.co.us/spreadsheet/viewform?formkey=dFE5UXBKRmE3eVlhOEJLbm05NDMtNXc6MQ

PLEASE NOTE: A copy of the completed form will be provided to the opposing party.

If you require assistance with this form, please contact the Industrial Claim Appeals Office at
303-318-8133.

Email *

Appealing Party *

Please select which party is appealing the decision.

Hearing Officer's Decision Date *

Please enter the date the Hearing Officer's Decision was mailed.

Docket Number *

The docket number is found below the Social Security Number on the Hearing Decision.

Claimant Name *

Please enter the name of the Claimant from the Hearing Decision.

Social Security Number (Claimant) *

Please enter the last 4 digits of the Claimant's Social Security Number.

Employer Name *

Please enter the name of the Employer from the Hearing Decision.

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This form was created inside of State.co.us Executive Branch.