Notice Of Appeal From Decision Of Workers Compensation Board

NOTICE OF APPEAL TO APPELLATE DIVISION, THIRD DEPARTMENT FROM DECISION OF WORKERS' COMPENSATION BOARD. This form is used to appeal a decision of the New York State Workers’ Compensation Board (WCB) to the Appellate Division, Third Department, of the New York Supreme Court. This notice must be filed by the claimant, employer, or insurance carrier who wishes to challenge any part of the Board’s decision. The form identifies the claimant, employer, insurer, case number, date of the WCB decision, and the appealing party’s contact information. It must be served on all opposing parties and filed with the office of the Secretary of the Workers’ Compensation Board to preserve appellate rights under New York law. No filing fee is required. www.FormsWorkflow.com