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Workers' Compensation Board

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


Subject No. 046-909

Form Submission Guidelines

Date: January 4, 2017

To improve customer service for all stakeholders and to reduce system costs, the Workers’ Compensation Board has the following guidelines on submitting forms and other documents.

Avoid Duplicate Filing of Forms

The Board asks that you refrain from submitting forms more than once or in multiple formats. The quality of customer service diminishes when resources must be dedicated to sorting through duplicate forms to resolve an issue. Duplicate filings increase the amount of time required to respond to a customer request for further action or a status update on a pending request.

Duplicate submissions may be deemed to be raising or continuing an issue without reasonable grounds, will never result in higher fees being granted and may subject the sender to penalties under Workers’ Compensation Law § 114-a(3).

Choose a Submission Method that Works for You

There are multiple methods you can use to submit forms. The Chair has designated the following methods for submitting Board forms. Choose only one method for each form:

  • Complete an online web form (see list of available online web forms in the table below);
  • Upload electronically through the WCB Web Upload Link on the Forms section of the Board’s website. Go to Forms, and then select WCB Web Upload Link;
  • Email to the Board’s centralized email address, wcbclaimsfiling@wcb.ny.gov;
  • Mail to the Board’s centralized mailing address, P.O. Box 5205, Binghamton, NY 13902-5205; or
  • Fax to the Board’s centralized fax number, (877) 533-0337. To ensure that the form is legible and that all pages can be identified, do the following before faxing the form: set the scanner to black and white to optimize image quality, add the WCB case number and/or claimant identifiers to each page, and number each page (1 of 5, 2 of 5, etc.).

If you are faxing or mailing a form, ensure that you are using the most recent version of the form from the Board’s website. If, occasionally, you must send a corrected version of the form or document, please indicate on the top of the form that it is a corrected version of a form already submitted, including the date of the original (i.e., Corrected Version – Original Dated MM-DD-YYYY).

Consider Using Online Web Forms or Web Upload Link

The most frequently submitted forms are available for online submission on the Board’s website. You are encouraged to use these online web forms to maximize legibility and minimize filing turnaround times. Forms submitted electronically are routed automatically to the proper case folder, bypassing the scanning process. Forms submitted online appear in eCase the following business day.

Online web forms currently available are listed in the table below. They are available at: http://www.wcb.ny.gov/content/ebiz/WEBForms/webform_allForms.jsp

Form Number Injured Worker Employer Medical Provider Insurer/TPA Legal Representative
C-3 X
C-4, C-4.2, C-4.3 X
EC-4AMR X
EC-4NARR X
C-8.1 Part A X
C-8.1 Part B X
C-11 X
C-240 X
OT/PT-4 X
PH-16.2 X X X
RFA-1W X
RFA-1LC X
RFA-2 X
VDF-1 X

You can use the Board’s Web Upload Link to submit any form not available as an online web form. Documents submitted using the Web Upload Link are viewable in eCase faster than documents submitted by mail, email or fax. The transmission is more secure than either fax or email and the image quality is better. When the upload is successful, you will receive a confirmation email that notifies you that the image was uploaded. You can also generate a report listing the documents and when each was uploaded.

Verify Board Receipt of Forms

You can verify the Board’s receipt of a form in several ways:

  • Parties of interest (injured worker, employer, insurer, third party administrator (TPA) or legal representative) can view documents in the electronic case folder in eCase. To register for eCase, go to the Board’s website at www.wcb.ny.gov and select the eCase icon on the right side of the homepage.
  • Users who log in to submit forms (i.e., insurers, TPAs and healthcare providers) can search for that form up to 30 days from the date of submission.
  • Health care providers who need to check on the receipt of forms should contact the Board’s Customer Service department at (877) 632-4996.

If you have questions with the electronic submission of forms, or experience difficulty, please contact the ITS Enterprise Service Desk at (800) 694-1323. For assistance with forms submitted through the Web Upload Link, please contact usa.nywcb.helpdesk@xerox.com.

 

Kenneth J. Munnelly
Chair