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Workers’ Compensation Board

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

Subject No. 046-204.1

Extension of Time Period for Public Comment
on New and Revised Board Forms

Date: January 8, 2008

The Workers' Compensation Board has extended the time period for the public to comment on draft revisions of the Board's three primary claim forms and two new forms.

The public is now invited to view the forms and provide comment by visiting through January 25, 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