Request For Assistance By Injured Worker {RFA-1W} | Pdf Fpdf Docx | New York

 New York   Workers Compensation 
Request For Assistance By Injured Worker {RFA-1W} | Pdf Fpdf Docx | New York

Last updated: 10/6/2023

Request For Assistance By Injured Worker {RFA-1W}

Start Your Free Trial $ 13.99
200 Ratings
What you get:
  • Instant access to fillable Microsoft Word or PDF forms.
  • Minimize the risk of using outdated forms and eliminate rejected fillings.
  • Largest forms database in the USA with more than 80,000 federal, state and agency forms.
  • Download, edit, auto-fill multiple forms at once in MS Word using our Forms Workflow Ribbon
  • Trusted by 1,000s of Attorneys and Legal Professionals


RFA-1W - REQUEST FOR ASSISTANCE BY INJURED WORKER. You may file t form (RFA-1W) and any attachments with the Workers' Compensation Board when you want the Board to take a specific action in your claim, or if you need to alert the Board to any problem or situation that is affecting your claim. Many of the most frequently requested actions/situations are listed as either compensation payment issues (items a through g), or medical issues (items h through I), but you are not limited to those listed. Check all that apply and/or add additional information or explanation in the space provided (m or n). This form is not to be used to report an injury. To file a claim, use Form C-3.

Related forms

Our Products