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Workers' Compensation Board

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New York State
Workers' Compensation Board
Office of the Executive Director
328 State Street  Schenectady, New York 12305
Governor Eliot Spitzer


Subject No. 046-204

Public Comments Invited on Proposed
New and Revised Board Forms

Date: December 10, 2007

The Workers' Compensation Board invites the public to submit comments on draft revisions of its three primary claim forms and two new forms by visiting http://www.wcb.ny.gov from December 10, 2007, through January 11, 2008.

Forms C-2, C-3, and C-4 are filled out by New York's employers, injured workers and doctors, respectively, to report a workplace injury or illness. The public is also invited to review two additional forms: Form C-3.3, which allows claimants to authorize the release of medical information by health care providers, and Form C-4.2, the treating doctor's continuing/final report. The revised C-4 will be used for the doctor's initial report only.

The forms are being redesigned as part of Governor Spitzer's workers' compensation reform initiative. Enhanced forms that capture more details about a workplace injury or illness will help the Board better serve injured workers, employers and workers' compensation system stakeholders.

Thank you for your consideration.

Joseph F. Pennisi

Executive Director