Follow the steps to complete your application effectively.

1. Press the ‘Get Form’ button to access the RB-89.2 online form and open it in your chosen editor.
2. Input the WCB case number(s) associated with the claim(s) you are appealing in the designated field.
3. If applicable, enter the carrier case number(s) corresponding to your claim(s) in this section. Note: This does not pertain to discrimination claims.
4. Provide the carrier code for the insurance provider linked to your appeal. This section does not apply if you are dealing with a discrimination claim.
5. Input the name of the insurance carrier related to the case being appealed. Again, this section does not apply to discrimination claims.
6. Complete the date of injury or leave when the incident occurred or when the paid family leave began. If no leave was taken, enter the discrimination complaint date.
7. Enter the claimant's full name as it appears in relevant documentation.
8. Provide the claimant's address, including street, city, state, and ZIP code. Also include any alternate mailing address if different.
9. Specify which party is submitting the application on behalf of the claimant.
10. Indicate whether the application for reconsideration or full board review is mandatory or discretionary, according to the requirements.
11. Enter the filing date of the memorandum of board panel decision you are appealing against.
12. Clearly state the remedy being sought in this appeal.
13. Check the current status of the case (e.g., disallowed, established) in this section.
14. Articulate the specific issues you wish to have reviewed.
15. Provide a brief basis of appeal, detailing the grounds for your application, including any challenged findings.
16. Mention hearing dates, transcripts, documents, and other evidence relevant to your appeal.
17. Indicate if there has been or will be an appeal taken to the Appellate Division of the Supreme Court, Third Department.
18. If you are represented by legal counsel, indicate if you are requesting an increase in attorney's fees and include necessary forms if applicable.
19. Certify your application by signing and dating in the appropriate section, including your contact information.
20. Complete the proof of service, ensuring all necessary parties are notified and that this is done within the established time frame.
21. Once completed, save your changes, and choose to download, print, or share the form as needed.

Complete your application online today to ensure your rights are protected.