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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 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