WORKERS' COMPENSATION BOARD REQUEST FOR …
State of New York WORKERS' COMPENSATION BOARD REQUEST FOR FURTHER ACTION BY CARRIER/EMPLOYER. This form is submitted by carrier. self-insurer. ALL COMMUNICATIONS SHOULD REFER TO THESE NUMBERS
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PLEASE READ CAREFULLY THE FOLLOWING …
www.wcb.ny.govThe undersigned requests written authorization for the following special service(s) costing over $1,000 or requiring pre-authorization pursuant to …
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COVER SHEET FOR REPORT OF INDEPENDENT …
www.wcb.ny.govCOVER SHEET FOR REPORT OF INDEPENDENT MEDICAL EXAMINATION. IME-4 (5-18) A copy of each report of Independent Medical Examination shall be submitted on the same day and in the same manner to the Workers' Compensation Board, the
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