Skip to main content

Learn about Governor Hochul's proposal to increase injured workers' access to medical care

Web Submission of Claim Forms List of Available Forms for Insurance Carriers, Self-Insured Employers and Third-Party Administrators

Back to menu

These forms are available for completion and online submission through the Board's website. To access a form, select the form number or title. If registration is required, a login screen will prompt you for your user ID and password. Complete the online application to register for Web Submission of Claim Forms.

After the Board receives your form, a non-editable PDF version of the form will appear in your web browser. The first page contains a confirmation that your form was successfully submitted to the Board and the date. It should be saved for your records. DO NOT MAIL THIS FORM TO THE BOARD.

Form Instructions

Forms submitted by insurance carriers, self-insured employers, and third-party administrators
Form Number Form Title Registration required? Comments
C-8.1B Notice of Objection to a Payment of a Bill for Treatment Provided Yes Treatment issue: within 5 days after terminating medical care or refusing authorization.

Disputed bill: within 45 days of submission of bill.
DB-470 Preliminary/Final Claim for Reimbursement of Benefits Paid Under Disability Benefits Law Yes Submitted prior to award of workers' compensation benefits.
PH-16.2 Pre-Hearing Conference Statement No Filed ten days before scheduled pre-hearing conference for controverted cases (FROI-04/SROI-04).

If the form you are looking for is not available for online submission, you may print the PAPER version of the form from our list of common forms.