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Workers Compensation forms-
- Notice Of Retainer And Appearance Or Notice Of Substitution And Appearance [OC-400]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - ADR Program Final Disposition Of Claim [ADR-2]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Notice And Proof Of Claim For Disability Benefits [DB-450]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Discharge Or Discrimination Complaint [DC-120]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Notice Of Retainer And Appearance On Behalf Of Employer [OC-406]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Application For A Fee By Claimants Attorney Or Representative [OC-400.1]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Stipulation [C-300.5]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Claimants Authorization To Disclose Workers Compensation Records [OC-110A]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Settlement Agreement - Section 32 WCL [C-32]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Carriers Request For Reimbursement Of Medical Expenses Under Section 15-8 (Pink Paper) [C-251.1]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Claimants Authorization To Disclose Health Information (Pursuant To HIPAA) [HIPAA-1]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Tables Of Statutory Employee Contributions Disability Benefits Law [DB-791]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Claim For Compensation And Notice Of Commencement Of Third Party Action [C-121]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Notice That Right To Compensation Is Controverted [C-7]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Notice To Chair Of Carriers Action On Claim For Benefits [C-669]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - World Trade Center Volunteers Claim For Compensation [WTC Vol-3]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Health Insurers Request For Reimbursement [HIMP-1]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Attending Doctors Request For Medical Authorization Determination [MD-1]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Affidavit For Death Benefits [AFF-1]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Application For Acceptance Of Insurance Form [DB-850]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Notice To Liable Political Subdivision Of Volunteer Firefighters Injury Or Death [VF-1]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Application For Reopening Of Claim More Than Seven Years After Accident [C-25]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Claim For Volunteer Ambulance Workers Benefits In A Death Case [VAW-62]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Employers Statement For Purpose Of Terminating Status As Covered Employer [DB-118]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Claimants Record Of Medical And Travel Expenses [C-257]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Occupational Therapists Report Or Physical Therapists Report [OT-PT-4]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Notice And Proof Of Claim For Disability Benefits By Unemployed Claimant [DB-300]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Cover Sheet-Application For Board Review [RB-89]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Health Providers Request For Decision On Unpaid Medical Bills [HP-1]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Record Of Percentage Hearing Loss [C-72.1]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Carriers Request For Reimbursement Of Compensation Payments Under Section 14(6) (Blue Paper) [C-251.2]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Employers Report Of Injured Employees Change In Employment Status Resulting From Injury [C-11]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Section 32 Settlement Agreement Claimant Release [C-32.1]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Medical Proof Of Change In Condition In Support Of Application For Reopening Of Claim [C-27]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Notice Of Right To Select Workers Compensation Board Authorized Health Care Provider [C-3.1]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Notice To Chair Of Withdrawal Of Request For Arbitration [HP-4]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Claimants Authorization To Disclose Workers Compensation Records (Spanish) [OC-110AS]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Health Providers Application For Authorization Under Workers Compensation Law [MR IME-1]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Employers Statement Of Wage Earnings Preceeding The Date Of Accident [C-240]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Fraud Complaint [IG-1]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Notice Of Claim For Reimbursement Out Of Special Disability Fund [C-250]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Section 110-a Affirmation-Affidavit [OC-110A.1]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Notice Of Election To Voluntarily Exclude Spouse From Coverage [DB-212.5]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Employers Application For Voluntary Coverage For Employees For Whom Disability Benefits Not Required (Employee Contribution) [DB-136]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Attending Psychologists Report [PS-4]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Application For Advance On Periodic Payments Of Compensation [C-21]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Notice That You May Be Responsible For Medical Costs [A-9]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Cover Sheet-Rebuttal Of Application For Board Review [RB-89.1]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Carriers Report On Rehabilitation To Chair Workers Compensation Board [R]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Assigment To Chair WCB Of Cause Of Action Against Health Care Provider [C-370]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Carriers Designation Authorized Representatives [DB-840]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Notice That Payment Of Compensation Has Been Stopped Or Modified [C-8-8.6]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Revocation Of Election Of Corporation To Exclude Sole Shareholder Or Executive Officers From WC Coverage [C-105.55]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Application For Approval Of Non-Schedule Adjustment [C-22]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Practitioners Report Of Request For Information Or Response To Request Regarding Independent Medical Examination [IME-3]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Notice Of Disability Benefits Payment [DB-455]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Volunteer Firefighters Claim For Benefits [VF-3]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Electronic Attachment
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Volunteer Ambulance Workers Claim For Benefits [VAW-3]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Licensed Representatives Disclosure Of Conflict Of Interest To Client [OC-408]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Carriers Request For Reimbursement Of Compensation Payments Under Section 15-8 (Yellow Paper) [C-251]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Proof Of Death By Physician Last In Attendance On Deceased [C-64]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Practitioners Report of Independent Medical Examination [IME-4]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Notice Of Election To Provide WC Benefits To Participants In A Sheltered Workshop [C-105.54]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Direct Deposit Of Benefit Authorization Form [DD-1]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Employees Statement Of Exempt Status [DB-130]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Employer Identification Card [DB-125]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Statement Of Unresolved Issues-Special Part For Expedited Hearings [C-300.34]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Claim For Compensation In Death Case [C-62]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Employers Application For Voluntary Coverage For Employees For Whom Disability Benefits Not Required (No Employee Contribution) [DB-135]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Attending Ophthalmologists Report [C-5]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Notice Of Election To Bring Partners Members Or Self Employed Persons Under Coverage Of NYS WC Law [C-105.32]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Notice Of Right To Reimbursement Of Compensation Payments [C-251.3]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Employers Application To Have Association Union Or Trustee Plan Accepted As Employers Plan [DB-802]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Political Subdivisions Report Of Injury To Volunteer Firefighter [VF-2]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Affidavit Of Exemption - Proof Of WC Coverage For 1-2-3-4 Family Owner-Occupied Residence [BP-1]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Practitioners Report Of Functional Capacity Evaluation [FCE-4]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Revocation Of Election Of Municipal Corporation Or Other Political Subdivision To Bring Executive Officers Under WC Coverage [C-105.41]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Political Subdivisions Report Of Injury To Volunteer Ambulance Worker [VAW-2]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Notice Of Election Of Not For Profit Corp Or Unincorporated Assoc To Execlude Unsalaried Executive Officer From WC Coverage [C-105.52]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Statement Of Registration (Section 13n-WCL) [IME-7]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Proof Of Burial And Funeral Expenses By Undertaker [C-65]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Report Of Work-Related Injury Or Occupational Disease [ADR-1]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Notice To Liable Political Subdivision Or Unaffiliated Ambulance Service [VAW-1]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Claim For Volunteer Firefighters Benefits In A Death Case [VF-62]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Registration Of Participation In World Trade Center Rescue Recovery Clean-Up Operations [WTC-12]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Notice Of Termination Of Employers Participation In Self-Insured Association Union Or Trustees Plan [DB-159.1]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Notice Of Satisfaction Of WC Lien From Third Party Recovery [C-121.2]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Carriers Or Self Insured Employers Objection To Attending Doctors Request For Medical Authorization Determination [MD-3]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Claim For Reimbursement Of Excess Benefits Paid Under Welfare Pension Or Benefit Plan [C-256]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Supplement To Certificate Of Insurance [DB-820.1]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Biannual Recertification To Entitlement To Benefits [DD-2]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Claimants Notice Of Independent Medical Examination [IME-5]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Cover Sheet-List Of Itemized Medical Bills In Controverted World Trade Center Case [WTC-16]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Notice Of Election Of Corporation To Exclude Sole Shareholder Officer Or Executive Officers Shareholders From WC Coverage [C-105.51]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Revocation Of Election Of Not For Profit Corp Or Unincorporated Assoc To Exclude Unsalaried Executive Officer From WC Coverage [C-105.53]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Volunteers Notification Of Exec Officer Fire-Ambulance Company-Significant Risk Of HIV [VF-VAW-11C]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Carriers Request For Benefit Increase Reimbursement (ยง 51) [VF-VAW-10]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Notice Of Election Of Corporation To Exclude Shareholder Officers From Disability Coverage [DB-212.3]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Notice Of Election Of Municipal Corporation Or Other Polictical Subdivision To Bring Executive Officers Under WC Coverage [C-105.31]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Reclamacion Del Empleado [C-3S]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Self Insurers Representatives Bond [OC-407]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - WAMO Settlement Agreement - Section 32 WCL [W32R]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Agreed Upon Findings And Awards For Proposed Conciliation Decision (Represented Claimants Only) [C-312.5]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Initial Application To Take License Rep Exam To Appear On Behalf Of Claimants Or To Represent Carriers-Self-Insurers [OC-409]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Stockholder Of Corporation Applying For License To Represent Self-Insurers [OC-403.3]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Attorney-Representatives Certification Of Form C-3 Or C-7 [OC-400.5]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Renewal Application For License To Appear On Behalf Of Claimant [OC-401.1R]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Request For Assistance By Injured Worker [RFA-1W]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Renewal Application For License To Appear On Behalf Of Or Represent Carriers And-Or Self-Insurers [OC-403.1R]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Request For Further Action By Carrier-Employer [RFA-2]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Request For Judicial Order - Access To Case Files [OC-110AORD]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Renewal Application By Employee Of Licensee Under Section 50 3-b Or 50 3-d To Appear Before WCB [OC-403.2R]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Request For For Further Action By Legal Counsel [RFA-1LC]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Continuation To Form MG-2 Attending Doctors Request For Approval Of Variance [MG-2.1]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Empoloyer Fraud Referral Form [IG-2]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Cover Sheet-Application For Full Board Review [RB-89.2]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Continuation To Form MG-1 Attending Doctors Request For Optional Prior Approval [MG-1.1]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Initial Application By Employee Of Licensee Under Section 50 3-b Or 50 3-d To Appear Before WCB [OC-403.2]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Impartial Specialists Report Of Medical Records Review [MR-4]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Continuation To Carrier-Employer Billing Portion Of Forms C-4 C-4.2 C-4.3 C-5 PS-4 Or OT-PT-4 [C-4.1]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Doctors Progress Report [C-4.2]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Doctors Initial Report [C-4]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Attending Doctors Request For Approval Of Variance And Carriers Response [MG-2]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Doctors Report Of MMI-Permanent Impairment [C-4.3]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Employers Report Of Work-Related Injury-Illness [C-2]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Cover Sheet-Rebuttal Of Application For Full Board Review [RB-89.3]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Employee Claim [C-3]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Initial Application For License To Appear On Behalf Of Or Represent Carriers And-Or Self-Insurers [OC-403.1]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Attending Doctors Request For Optional Prior Approval And Carriers-Employers Response [MG-1]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Notice That Claimant Must Arrange For Diagnostic Tests And Examinations Through Network Provider [DT-1]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Notice Of Treatment Issue(s)-Disputed Bill Issue(s) [C-8.1]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Ancillary Medical Report [C-4 AMR]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Providers Request For Judgment Of Award [HP-J1]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Pre-Hearing Conference Statement [PH16.2]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Notice To Health Care Provider And Injured Worker Of Carriers Refusal To Pay All (Or Portion Of) Medical Bill [C-8.4]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Loss Of Wage Earning Capacity Vocational Data Form [VDF-1]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Limited Release Of Health Information (HIPAA) [C-3.3]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Consent To NYS Workers Compensation Board Jurisdiction For Non-New York Licensed Carriers (3C Coverage) [C105.11]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Claimants Record Of Job Search Efforts Contacts [C-258]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Attending Doctors Request For Authorization And Carriers Response [C-4 AUTH]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Application for Certificate Of Attestation Of Exemption From New York State Workers Compensation And-Or Disability Benefits Insurance Coverage [CE200APPLY]
State: New York
Jurisdiction: Workers Compensation
Sub-Category: - Modification Of Previous Report (ADR Program) [ADR-1.1]
State: New York
Jurisdiction: Workers Compensation
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