Attached is a copy of revised Form C-300.5 , Stipulation. (Earlier versions of this form were designated T-89.1). Amended Board Rule 12 NYCRR 300.5 permits parties in a case to stipulate to uncontested facts or proposed findings in any claim before the Board. The rule, adopted by the Board on May 20, 1997, states in part:
Parties to any claim before the board may stipulate to uncontested facts or proposed findings. Such stipulation shall be in writing and shall be signed by all parties so stipulating. A Workers' Compensation Law Judge shall verify through questioning that all parties:
A stipulation pursuant to this section shall be subject to the approval of a Workers' Compensation Law Judge and, if approved, shall be incorporated into the decision of the Workers' Compensation Law Judge and shall be binding upon the parties. Such stipulation, as incorporated into the decision of the Workers' Compensation Law Judge, shall be subject to the provisions of section 23 of the Workers' Compensation Law and section 300.13 of this Part, and to section 22 and section 23 of the Workers' Compensation Law.
The provisions of this subdivision shall not be applicable to agreements settling upon and determining claims for compensation pursuant to section 32 of the Workers' Compensation Law and section 300.36 of this Title.
Please note that in accordance with the above, new Form C-300.5 is NOT to be used for settlement agreements under WCL section 32.
Carriers, self-insured employers, attorneys and licensed representatives are authorized to reproduce Form C-30.5 in quantities according to their needs. It is to be printed on 8 1/2" X 11", 20 lb. white bond on two sides, back-to-back. Attorneys and licensed representatives may also obtain small quantities of this form from the Workers' Compensation Board, Administrative Analysis Office, 111 Livingston Street, Brooklyn NY 11201. The form will also be available in all hearing parts and locations for use at Board hearings.
For information on any Board form, contact the Board's Forms Department at (718) 802-6820 or by email.
Robert R. Snashall