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New York State
Workers' Compensation Board
328 State Street  Schenectady, New York 12305
Governor Andrew M. Cuomo

Subject No. 046-1024

Updates to Board Review Forms (Form RB-89 Series)

Date: May 3, 2018

The Board Review forms (Form RB-89 series) have been updated to accommodate appeals that arise from Paid Family Leave discrimination cases. The updated forms have a version date of 1-18. The Board will continue to accept the 9-16 versions of the forms until June 1, 2018. After that date, no prior versions will be accepted.

The update applies to the following forms:

Note: This update supersedes the update to Forms RB-89 and RB-89.1 previously announced in Subject Number 046-878 Board Adopts New Administrative Review, Full Board Review, and Applications for Board Reconsideration Regulations dated September 29, 2016, which required the adoption of updated Forms RB-89 and RB-89.1 (version date 9-16) by December 1, 2016.


Clarissa M. Rodriguez