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New York State
Workers' Compensation Board
OFFICE OF THE CHAIRMAN
328 State Street  Schenectady, New York 12305
Subject No. 046-111

Please do not send requests for forms to William Bryant. As of July 2007 all requests should be sent to the attention of the "Reproduction Unit".

To:  Insurance Carriers and Self-Insured Employers Providing Benefits Under the Workers' Compensation Law, Volunteer Firefighters' Benefit Law and Volunteer Ambulance Workers' Benefit Law; Attorneys and Licensed Representatives Practicing before the Board

New Forms RFA-1 and RFA-2 to Replace Form C-89.3 (Request for Priority Hearing), Form C-22b (Request to Suspend or Reduce Payment of Compensation After Direction to Continue Payments), Form CB-8 (Request for Conciliation), and Form RB-679 (Notice to Chair of Carrier's Action on Application for Reopening)

Date:  November 15, 2002

In its continuing efforts to streamline and improve the process of adjudicating claims and to become even more responsive to the needs of New York State's injured workers and employers, the Board is replacing four of its most frequently used forms with two new forms. These new forms will be high priority forms for the Board and will alert it to the needs of the parties after the indexing of any claim.

Called Form RFA-1 (Claimant's Request for Further Action) and Form RFA-2 (Carrier's Request for Further Action), these new forms will provide the mechanism by which a party can request Board intervention on his/her claim. The forms may be used at any time after the indexing of a claim or after the Board has indicated in one of its decisions that it will take no further action (NFA) in regard to the claim.

Form RFA-1 (Claimant's Request for Further Action) replaces Form C-89.3 (Request for Priority hearing). On Form RFA-1, the claimant may choose from a number of check boxes the reason or reasons Board intervention is sought. Specifying the issues, concerns, or newly obtained evidence in this manner will simplify the process for the claimant and help the Board to place the claim in the most expedient resolution track.

Form RFA-2 (Carrier's Request for Further Action) replaces Form C-22b (Request to Suspend or Reduce Payment of Compensation After Direction to Continue Payments), Form CB-8 (Request for Conciliation), and Form RB-679 (Notice to Chair of Carrier's Action on Application for Reopening). On Form RFA-2, the carrier also may choose from an array of reasons why it seeks Board intervention. Again, specifying the issues, concerns, or newly obtained evidence will aid the Board in promptly identifying the most expedient resolution track and will eliminate the carrier's need to keep multiple forms on hand.

It is anticipated that these new forms, by furthering the OPTICS's vision of improved customer service (Organization, Process and Technology Innovations in Customer Service), will also aid the parties in identifying issues which they might be able to resolve by agreement prior to Board intervention, thus making the delivery of appropriate benefits even more timely and efficient.

Use of new Forms RFA-1 and RFA-2 is effective immediately. Claimants and carriers should discontinue using Forms C-89.3, C-22b, CB-8, and RB-679 as soon as possible. After January 1, 2003, only Forms RFA-1 and RFA-2 should be used.

Master copies of Forms RFA-1 and RFA-2 may be obtained at the Board's web site or by writing or faxing the Board at:

NYS Workers' Compensation Board
Attn: Mr. William Bryant
100 Broadway- Menands
Albany, New York 12241
FAX: 518- 486-7051

 

Robert R. Snashall
Chairman