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Commonly Used Forms available for printing and mailing to the Workers' Compensation Board
- Attorneys and Licensed Representatives
If you are an attorney or a licensed representative who...
- Homeowners
Homeowners - Forms - NYS Workers Compensation Board
- Employees
After the form opens, you may complete the form by typing...
- Insurers Workers
Email completed form to: SpecialFunds@wcb.ny.gov or Mail...
- Compensation Board All Common Forms
Email completed form to: SpecialFunds@wcb.ny.gov or Mail...
- Health Care Providers
MG-2 (4/18) As of 5/2/22, this form is no longer being...
- Fraud Complaint
Empire State Plaza, Agency Building 2, 16th Floor Albany,...
- How To Submit Claims-Related Forms And Documents To WCB
Claims-related forms and documents may be submitted to WCB...
- Attorneys and Licensed Representatives
The Request for Further Action by Insurer/Employer (Form RFA-2) has been modified to better align with the process for resolving payer denials of the Workers' Compensation Board's New York Medical Treatment Guidelines (MTGs) Variance and MTG Special Services Prior Authorization Requests (PARs).
MG-2 (4/18) As of 5/2/22, this form is no longer being accepted by the Board. All requests are to be submitted using OnBoard. Attending Doctor's Request for Approval of Variance and Carrier's Response: Physician; Nurse Practitioner; Podiatrist; Chiropractor; Workers' Compensation Board, Insurance Carrier, Injured Employee and their representative
This form is used for a workers' compensation, volunteer firefighters' or volunteer ambulance workers' benefit case as follows: To request approval to vary the treatment of the claimant identified on this form from the relevant Medical Treatment Guidelines.
Download Fillable Form Mg-2 In Pdf - The Latest Version Applicable For 2024. Fill Out The Attending Doctor's Request For Approval Of Variance And Carrier's Response - New York Online And Print It Out For Free.
1. This form is used for a workers' compensation, volunteer firefighters' or volunteer ambulance workers' benefit case as follows: To request approval to vary the treatment of the claimant identified on this form from the relevant Medical Treatment Guidelines. 2.
This form requires the name and fax number or email address of the insurer's designated contact listed on the Workers' Compensation Board's website. Insurer/Self-Insurer's designated contact information is available online at: wcb.ny.gov/medical-treatment-guideline-variance-request. MG-2.0 (4-18) COVER SHEET