Colorado Petition To Modify, Terminate, Or Suspend CompensationColorado Petition To Modify, Terminate, Or Suspend Compensation
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COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT
Division of Workers’ Compensation
633 17th Street, Suite 400, Claims Section
Denver, CO 80202-3626

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PETITION TO MODIFY, TERMINATE, OR SUSPEND COMPENSATION
(Insurance representative must complete all fields below)
Claimant

Workers’ Compensation Number

Employer

Social Security Number

Insurer

Carrier Number

The insurance carrier or self-insured employer declares that the claimant is presently receiving compensation for
disability at the rate of $
per week. Compensation is presently paid to
in the amount totaling $
.
(date)

The petitioner requests permission to
period from
to
(date)

 modify

 terminate, or

 suspend compensation for the

.
(date)

The facts upon which the petitioner relies are as follows:

The rule and statute upon which the petitioner relies:
NOTICE TO CLAIMANT: Rule 6-4(C) of the Workers’ Compensation Rules of Procedure provides that if
written objection to the petition is not filed with the Divisi