Search results
Easy to use and ready to print; Quick to customize; Compatible with most PDF-viewing applications; Fill out the form in our online filing application. Download a fillable version of Form MG-2 by clicking the link below or browse more documents and templates provided by the New York State Workers' Compensation Board.
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.
Workers’ Compensation Board Common Forms. Forms. Completing Forms. If you require assistance with completing these forms, please contact us. Forms are in PDF format. The Board recommends using the latest version of Adobe Reader which is available as a free download from Adobe's website.
Forms are in PDF format. The Board recommends using the latest version of Adobe Reader which is available as a free download from Adobe's website. After the form opens, you may complete the form by typing information on the form before you print it.
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.
Created Date: 10/23/2019 11:17:52 AM
Submission of MTG Confirmation is optional for health care providers, but response is mandatory for payers. MTG Variance - request for treatments/tests that vary from the Medical Treatment Guidelines; replaces Attending Doctor's Request for Approval of Variance and Carrier's Response (Form MG-2).
