Special Funds must sign and date Form C-32 if 25-a has been found applicable to the case s. If a disability benefits lien is addressed in the Section 32 Waiver Agreement then the Disability Benefits Carrier must sign. 4. Other Necessary Documents Submit along with Form C-32 the following documents. Be sure to reference on the documents the WCB Case Number for each claim included in the Section 32 Waiver Agreement a signed and notarized Form C-32. Failure to follow these instructions and to provide the necessary accompanying documents may result in the resolution of the Section 32 Agreement being delayed. The statute and regulation pertaining to Section 32 Waiver Agreements WCL 32 and 12 NYCRR 300. 36 is available at www. wcb. ny. gov. 1. Form Submit a legible Form C-32. The terms of the agreement must be in a single separate attachment. THIS AGENCY EMPLOYS AND SERVES PEOPLE WITH DISABILITIES WITHOUT DISCRIMINATION* WAIVER AGREEMENT - Section 32 WCL WCB CASE NO. S DATE S OF ACCIDENT CLA....
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How to fill out the NY C-32 online
The NY C-32 form serves as a Waiver Agreement under Section 32 of the Workers' Compensation Law. This guide will provide you with clear, step-by-step instructions to help you fill out the form accurately and efficiently online.
Follow the steps to successfully complete the NY C-32 form.
- Click ‘Get Form’ button to obtain the NY C-32 form and open it in an online editor.
- Begin filling out the form by entering the WCB Case Number(s) and the dates of the accident.
- Provide the claimant's name, telephone number (including area code), and address clearly.
- Input the carrier case number(s) and carrier codes where applicable.
- List the employer(s) and carrier(s) associated with the claim, ensuring the information is clear and legible.
- Indicate whether medical remains open and provide a contact number for a telephone hearing if requested.
- Specify if an interpreter is needed, including the type and language requirements.
- List any additional parties of interest and indicate if they are signatories.
- Review the waiver agreement conditions and select whether the agreement settles all or some issues pertaining to the claims.
- Complete the sections addressing liens, medical issues, and indemnity issues by checking the appropriate boxes and providing page numbers.
- Ensure all necessary signatories, including the claimant and employer or carrier, sign and date the form.
- Proofread the completed form for accuracy and clarity before submission.
- Once complete, save your changes, and you may download, print, or share the NY C-32 form as needed.
Start filling out your NY C-32 online today to ensure your waiver agreement is processed smoothly.
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