La. Admin. Code tit. 40 § I-6662

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-6662 - Attorney Fee Notice of Lien ; Form LDOL-WC-1027

Attached hereto and designated as "Attachment Number 16."

DOCKET NO.:________________

CLAIMANT:__________________________________

REPRESENTATIVES:|___________________

EMPLOYER:________________________________________

NOTICE OF LIEN

Pursuant to Section 5547(B) of the hearing rules of the Office of Workers' Compensation Administration,____________________________________ serves notice upon this Honorable Court and all parties to the above entitled claim that (he/she/it) represented the claimant from (date) to (date) and hereby asserts a lien on the proceeds of the claim for unpaid attorney fees.

Respectfully submitted,

La. Admin. Code tit. 40, § I-6662

Promulgated by the Louisiana Department of Labor, Office of Workers' Compensation Administration, LR 25:1873 (October 1999).

AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1310.1.