New York
Showing 1–16 of 33 results
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Application for a Fee by Claimant’s Attorney or Representative
NYWC_OC-400.1 $89.00 -
Application for Acceptance of Insurance Form
NYWCDB850 $69.00 -
Application for Approval of Non-Schedule Adjustment
NYWC_C-22 $89.00 -
Carrier’s Report on Rehabilitation
R $69.00 -
Carrier’s Request for Reimbursement of Compensation Payments Under Section 14(6) Concurrent
NYWC_C-251.2 $69.00 -
Carrier’s Request for Reimbursement of Compensation Under Section 15-8
NYWC_C-251 $89.00 -
Carrier’s Request for Reimbursement of Medical Expenses Under Section 15-8
NYWC_C-251.1 $69.00 -
Claimant’s Authorization to Disclose Workers’ Compensation Records
NYWC_OC-110A $69.00 -
Cover Sheet & Rebuttal of Application for Board Review
RB-89.1 $89.00 -
Designation of Authorized Representative
NYWCDB840 $89.00 -
Discharge or Discrimination Complaint
NYWCDC120 $69.00 -
Employer’s Report of Accident
NYWC_C-2 $89.00 -
Employer’s Report of Injured Employee’s Change in Status or Return to Work
NYWC_C-11 $89.00 -
Employer’s Statement of Wage Earnings Preceding Date of Accident
NYWC_C-240 $89.00 -
Form Letter Requesting Medical Information
NYWCDB3103 $39.00 -
New York Motor Vehicle No-Fault Insurance Law/Verification of Treatment By Attending Physician or Other Provider of Health Service
NYS Form NF-3 $89.00
