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WORKERS' COMPENSATION BOARD REQUEST FOR …
REQUEST FOR FURTHER ACTION BY CARRIER/EMPLOYER. This form is submitted by carrier. self-insurer. ALL COMMUNICATIONS SHOULD REFER TO THESE NUMBERS. SEE IMPORTANT INFORMATION ON REVERSE - VEA INFORMACION IMPORTANTE AL DORSO. 10. Continuing payments directed by the Board should be suspended as of pursuant to 12 NYCRR 300.23(b).
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Low Back Disorders - NYS Workers Compensation …
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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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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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