Get Ny Rb-89.3 2018-2026

The NY RB-89.3 form is essential for filing a rebuttal to an application for reconsideration or full board review. This guide will provide you with clear, step-by-step instructions on how to complete the form online to ensure your rebuttal is filed correctly and on time.

Follow the steps to successfully fill out the NY RB-89.3 form online.

1. Click ‘Get Form’ button to access the NY RB-89.3 online.
2. Enter the WCB case number(s) for the claims being appealed. This includes numbers for workers' compensation, discrimination, and disability benefits.
3. Input the carrier case number(s) relevant to the appeals. Note that this does not apply to discrimination claims.
4. Provide the carrier code, which identifies the insurer for the claim. Again, this section does not apply to discrimination claims.
5. Fill in the name of the carrier associated with the claim in question, also not applicable for discrimination claims.
6. Specify the date of injury or the date when paid family leave commenced. If no leave was taken, enter the discrimination complaint date.
7. Enter the complete name and address of the claimant, making sure to include any different mailing address, if necessary.
8. Indicate on behalf of whom this rebuttal is being made.
9. Select the type of application to which this rebuttal responds: either mandatory full board review or discretionary full board review.
10. Provide the filing date of the memorandum of board panel decision that you are appealing.
11. Enter the date of service for the application for reconsideration/full board review upon the respondent.
12. Outline the requested outcome of the rebuttal, such as denial, correction, affirmation, or modification of the memorandum of decision.
13. Write a brief statement responding to the issues and grounds raised in the application, noting any alleged inaccuracies.
14. If applicable, identify any additional records or documents relevant to the review that should be included.
15. Indicate whether an increase in attorney's fees is being requested, and if so, remember to attach Form OC-400.1.
16. Sign and date the form certifying its accuracy and compliance with legal standards, providing your name, title, and contact information.
17. Complete the proof of service section to confirm that all necessary parties have been served according to regulations.
18. Once all fields are complete, save your changes, then download, print, or share the completed form as needed.

Start filling out your NY RB-89.3 form online today to ensure your rebuttal is submitted on time.