Notice to Chairman Regarding Possibility of Processing Case on Administrative Determination for Workers Compensation New York Form

Q: What is the 'Notice To Chairman Regarding Possibility Of Processing Case On Administrative Determination For Workers' Compensation New York'?

The 'Notice To Chairman Regarding Possibility Of Processing Case On Administrative Determination For Workers' Compensation New York' is a formal notification intended for the chairman's review concerning the processing of workers' compensation cases in New York. This document is essential for ensuring that cases are addressed promptly and appropriately under administrative guidelines.

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1. 2. 3. C-4 or other medical report indicates causal relationship established for C-240 indicates average weekly wage equals $ 4. 5. 6. Additional board forms, C-6 or C-9 filed on 7. Title: STATE OF NEW YORK WORKERS' COMPENSATION BOARD NOTICE TO CHAIRMAN REGARDING POSSIBILITY OF PROCESSING CASE ON ADMINISTRATIVE DETERMINATION W.C.B. Case Number Carrier Case Number Code Date of Accident Number Name Address 1. Employer 2. Insurer 3. Injured Person The above claim is one which we feel should be considered for administrative determination processing. The attached documents would indicate the following: C-2 or other form indicates accident and notice established for date of accident. carrier concedes maximum. Yes [ ] No [ ] C-11 indicates claimant returned to work. Attached C-8 shows payments made from to at a rate of If the rate was adjusted or reduced, reason. Employer request reimbursement for wages paid from to Any additional comments: If after having reviewed the attached forms, please call if there are any questions. We can be reached at phone number (518) 220-1111. If you need to fax your request, please fax me directly at 1- 877-737-6232. Date:

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Fill and Sign the Notice to Chairman Regarding Possibility of Processing Case on Administrative Determination for Workers Compensation New York Form