Skip to Content

Workers’ Compensation Board

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

Subject No. 046-823

New York Workers’ Compensation Board Announces
Modifications To Board Forms
RB-89 AND RB-89.1

Date: November 13, 2015

Applications for board review of a decision of a Workers’ Compensation Law Judge (WCLJ) and rebuttals to such applications must be in writing and use the form prescribed by the Chair. If the prescribed form is not used, a Board Panel may deny review. The only exception is when the claimant is not represented by an attorney or licensed representative. A Board Panel may deny review if the application is not complete. All applications must specify the issues and grounds for review and make reference to the portions of the record that are relevant to the issues and grounds, as well as indicate where and when the issues were raised before the WCLJ. If an application for review is not filed with the Board, with proof of service on all other parties of interest, within thirty (30) days after the notice of filing of the decision of the WCLJ, the Board Panel may deny review. An application is deemed filed when it is actually received by the Board.

The Board has modified Board Forms RB-89, Application for Board Review, and RB-89.1, Rebuttal of Application for Board Review, to make them easier to complete and prepare for the transition, in the future, to electronic submission. To assist parties with completing the forms, instructions have been included.

The forms no longer include a list of issues. Instead, the party must clearly specify the specific issue or issues for review, and they must correlate to the specific grounds addressed in the application. The form requires the identification of the dates of the hearings where the issue(s) was addressed and the dates and document ID numbers of relevant transcripts and exhibits. It is not sufficient to leave this section blank or identify the entire case file. The form requires the applicant to specify the objection or exception that was interposed to a ruling and when it was interposed. Information regarding the suspension of indemnity benefits, whether in whole or part, must be provided. Failure to complete all sections of the cover sheet forms (RB-89 or RB-89.1) may result in a Board Panel denying review.

All applications and rebuttals must be filed with the Board using the Board’s centralized mailing address (P.O. Box 5205, Binghamton, NY 13902-5205), centralized fax number for claims (1-877-533-0337), or centralized email address for claims ( An application or rebuttal received at any other mailing address, fax number or email address will not be considered received by the Board and will be destroyed.

The revised forms are effective immediately and are available on the Board’s website:

RB-89, Application for Board Review

RB-89.1, Rebuttal of Application for Board Review

The Board asks that all parties utilize these forms as quickly as possible. After February 1, 2016, the Board will only accept the revised forms. Applications submitted after February 1, 2016 using the old forms will be deemed to have been submitted without the prescribed form and review will be denied. Rebuttals submitted using the old forms will not be considered.


Robert E. Beloten