[Carrier or self-insured employer] has filed papers with the New York State Workers' Compensation Board (the Board) contesting your claim for workers' compensation benefits. Under New York State law, an insurance company is not required to reimburse a worker for medications while it is contesting the claim, and we have chosen not to do so.
However, the Board requires that we notify you that the following rules apply while we are contesting the claim:
If you have any questions or problems, you may call us at [toll-free number], or find further information at [website]. In addition, you may contact the Board at email@example.com or by phone at 1-877-632-4996 or the Advocate for Injured Workers at 800-580-6665. You may also find further information on the web at www.wcb.ny.gov.
Please Note: The Board recommends using the latest version of Adobe Reader which is available as a free download from Adobe's web site.
View or Print Notification Concerning Payment For Medication