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Workers’ Compensation Board

WCB Information Related To Novel Coronavirus (COVID-19)

Implementation of Forms Associated with SLU Evaluations

Date: May 22, 2018

The Board has received a number of inquiries associated with Subject Number 046-1067, specifically related to the timing of the implementation of forms associated with Schedule Loss of Use evaluations.

We understand that the new forms may take some time to implement due to programming requirements. However, the guidelines are not new and the associated requirements were released and effective 1/1/18. Until such time that users can get the new forms programmed into their systems, all required elements should be captured on the existing forms and/or included in the submitted narrative.

As you are aware, new paper forms are available for use now and have been posted on the Board's website. The revised electronic C4.3 should be available by mid-July. We ask that all users totally transition to and utilize the new forms by mid-July. Until that time no forms will be precluded as long as all the required elements are either included on the forms and/or incorporated into the narrative.

If you have any questions about the new forms, please write to

Thank you.
NYS Workers' Compensation Board Medical Director's Office