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Workers’ Compensation Board

WCB Information Related To Novel Coronavirus (COVID-19)

Use of the C-3.3 in Controverted and Non-Controverted Claims


Obtaining Medical Records of a Previous Injury to the Same Body Part or Similar Illness in a Controverted Claim

In a controverted claim, a Limited Release to obtain medical records (C-3.3), which is part of the Employee Claim form (C-3), is “a completed and executed limited authorization to obtain relevant medical records regarding the prior medical history of the body part or illness at issue” in the claim (12 NYCRR 300.37[b][1][iii]).” Further, “[i]n accordance with the limited release, the parties may seek production of relevant medical records from medical professionals and hospitals that have treated the claimant for [a] previous injury to the same body part or similar illness to the one listed in the Employee Claim form” (12 NYCRR 300.38[c][1]). If the insurer desires a broader release, per 12 NYCRR 300.38(g)(5)(ii), the law judge will hear arguments at the pre-hearing conference as to whether it should be provided.

Obtaining Medical Records of a Previous Injury to the Same Body Part or Similar Illness in a Non-Controverted Claim

For cases that arise over body sites and conditions that are not part of the controverted claims process, an insurer may wish to procure a Limited Release from the claimant regarding prior treatment to the site or condition in issue. When that happens, the insurer should send form C-3.3 to the claimant and his or her legal representative, if any, with a cover letter explaining the basis for the request. In the event that the claimant or his or her legal representative fails to sign the C-3.3, the insurer may file a Request for Further Action (Form RFA-2), explaining the situation, and indicating what steps were taken to resolve the issue surrounding the Limited Release. The Board will then adjudicate the matter. However, without a demonstration that the C-3.3 was sent to the claimant and his or her legal representative and claimant failed to execute the release, and absent a showing of efforts to resolve the issue, the Board will not adjudicate the matter.