On March 16, 2020, the New York State Workers' Compensation Board published a COVID-19 Guidance Document
describing the anticipated impacts on the workers’ compensation system
due to the current public health crisis and steps taken by the Board in
response. In addition, the Board has commenced mandatory remote-only Virtual Hearing attendance and continues to work to ensure, to the greatest extent possible, ongoing operations and benefit flow to injured workers.
Since
issuing the initial COVID-19 Guidance Document on March 16, 2020, the
Board has received many questions from attorneys about the need for
signatures on certain documents. Many attorneys, other law firm staff,
and employees of payers and administrators are working from home during
this crisis and are unable in some instances to submit required forms
with original handwritten signatures.
To that end, the Board is hereby suspending until further notice the
requirement for original handwritten signatures on the following forms
(all language versions), which require the signatures of claimants,
attorneys, payers and administrators, during the current state of
emergency:
- Employee Claim (Form C-3) – Paper
- Waiver Agreement – Section 32 WCL (Form C-32)
- Section 32 Settle Agreement: Claimant Release (Form C-32.1)
- Stipulation (Form C-300.5)
- Agreed Upon Findings And Awards for Proposed Conciliation Decision (Form C-312.5)
- Extreme Hardship Redetermination Request (Form C-35)
- Claim for Compensation in Death Case (Form C-62)
- Notice of Retainer and Substitution (Form OC-400)
- Application for a Fee by Claimant’s Attorney or Licensed Representative (Form OC-400.1)
- Attorney/Representative’s Certification of Form C-3 or Notice of Controversy (Form OC-400.5)
- Attorney/Licensed Representative Request to Withdraw from Representation (Form OC-400.17)
- Notice of Retainer and Appearance on Behalf of Employer (Form OC-406)
- Pre-Hearing Conference Statement (Form PH-16.2)
- Application for Board Review (Form RB-89)
- Rebuttal of Application for Board Review (Form RB-89.1)
- Application for Reconsideration/Full Board Review (Form RB-89.2)
- Rebuttal of Application for Reconsideration/Full Board Review (Form RB-89.3)
- Request for Further Action by Injured Worker (Form RFA-1W) –Paper
- Request for Further Action by Legal Counsel (Form RFA-1LC) – Paper
- Request for Further Action by Carrier/Employer (Form RFA-2) – Paper
- Notice to Liable Political Subdivision of Volunteer Ambulance Worker’s Injury or Death (Form VAW-1)
- Volunteer Ambulance Worker’s Claim for Benefits (Form VAW-3)
- Claim for Volunteer Ambulance Worker’s Benefits in a Death Case (Form VAW-62)
- Loss of Wage Earning Capacity Vocational Data (Form VDF-1) – Paper
- Notice to Liable Political Subdivision of Volunteer Firefighter’s Injury or Death (Form VF-1)
- Volunteer Firefighter’s Claim for Benefits (Form VF-3)
- Claim for Volunteer Firefighter Benefits in a Death Case (Form VF-62)
Where
a form is identified as ‘Paper’ (e.g., Request for Further Action by
Injured Worker [Form RFA-1W] – Paper), it is a paper version of a form
that can also be completed electronically and submitted online. All
forms are listed at: http://www.wcb.ny.gov/content/main/forms/AllForms.jsp
Claimants
As
a result of the COVID-19 crisis, it is anticipated that claimants will
be unable to meet in person with their legal representatives in order to
sign documents drafted by counsel, which require the claimant’s
signature. Therefore, during this State of Emergency, forms may be
executed by a represented claimant as follows:
- If
any of the forms listed above require the claimant’s signature, the
claimant may indicate his or her approval of the document, which will be
attested to by his or her attorney. The claimant may do so in several
ways: (1) by signing the form electronically in accordance with the New
York State Electronic Signatures and Records Act (ESRA) and its
accompanying regulations (9 NYCRR Part 540); or (2) by indicating his or
her approval of the document in another manner (for example, an email)
to his or her legal representative; and
- The
attorney or licensed representative who represents the claimant shall
submit the form to the Board with an additional attestation by the
attorney, on the letterhead of his or her firm, which states either:
I,
___________________________, hereby attest that I am an
[attorney/licensed representative] with the firm of
____________________________, with its principal place of business
located at the address indicated on the letterhead above and identified
by the Workers' Compensation Board in its system using the following
identifier (W, R or other number): ________________, who represents the
claimant, _______________ in WCB # __________. The claimant signed the
attached document, [FORM ID], using an electronic signature process that
meets the requirements set forth in the New York State Electronic
Signatures and Records Act (ESRA) and its accompanying regulations (9
NYCRR Part 540). I fully explained to the claimant that the [FORM ID]
would be submitted to the Board on his/her behalf.
-OR -
I,
___________________________, hereby attest that I am an
[attorney/licensed representative] with the firm of
____________________________, with its principal place of business
located at the address indicated on the letterhead above and identified
by the Workers' Compensation Board in its system using the following
identifier (W, R or other number): ________________, who represents the
claimant, _______________ in WCB # __________. I fully discussed the
contents of the attached document, [FORM ID], with the claimant and
hereby attest that claimant understood the contents of the [FORM ID] and
conveyed his or her approval of the contents of the document to me. I
explained to the claimant that the [FORM ID] would be submitted to the
Board on his/her behalf.
- The
attorney shall certify this attestation, providing his or her given
name and the firm name and R number. This certification can be signed
electronically as provided below.
Attorneys/ Licensed Representatives
During
this State of Emergency, forms may be executed by attorneys and
licensed representatives appearing in claims before the Workers’
Compensation Board as follows:
- If
any of the forms listed above require the signature of an attorney or
licensed representative, the attorney or licensed representative may
sign the form electronically in accordance with the New York State
Electronic Signatures and Records Act (ESRA) and its accompanying
regulations (9 NYCRR Part 540); and
- The
attorney or licensed representative shall submit the form to the Board
with an additional attestation by the attorney or licensed
representative, on the letterhead of his or her firm, which states as
follows:
I,
___________________________, hereby attest that I am an
[attorney/licensed represented] with the firm of
____________________________, with its principal place of business
located at the address indicated on the letterhead above and identified
by the Workers' Compensation Board in its system using the following
identifier (R number): ________________, who represents _______________
WCB # __________ in this matter. I have signed the attached document,
[FORM ID], using an electronic signature process that meets the
requirements set forth in the New York State Electronic Signatures and
Records Act (ESRA) and its accompanying regulations (9 NYCRR Part 540).
- The
attorney shall certify this attestation, providing his or her given
name and the firm name, and R or W number. This certification can be
signed electronically in accordance with the New York State Electronic
Signatures and Records Act (ESRA) and its accompanying regulations (9
NYCRR Part 540).
- In the form’s signature line, the attorney should type his or her name, and/or the claimant’s name, as indicated.
Payers and Administrators
During
this State of Emergency, forms may be executed by insurance carriers,
self-insured employers and third-party administrators (hereinafter
collectively referred to as “payers”) as follows:
- If
any of the forms listed above require the signature of a payer, an
employee or agent of the payer may sign the form electronically in
accordance with the New York State Electronic Signatures and Records Act
(ESRA) and its accompanying regulations (9 NYCRR Part 540); and
- The
payer shall submit the form to the Board with an additional attestation
by the employee or agent of the payer who signed the form
electronically, on the letterhead of the payer, which states as follows:
I,
__________________, hereby attest that I am an employee or agent of
_____________________, with its principal place of business located at
the address indicated on the letterhead above and identified by the
Workers' Compensation Board in its system using the following identifier
(W, T or other number): ________________. I have the authority to act
on behalf of _____________________ in this matter [WCB # ________]. I
have signed the attached document, [FORM ID], using an electronic
signature process that meets the requirements set forth in the New York
State Electronic Signatures and Records Act (ESRA) and its accompanying
regulations (9 NYCRR Part 540).
- The
employee or agent of the payee shall certify this attestation,
providing his or her given name and job title, and the payer name. This
certification can be signed electronically in accordance with the New
York State Electronic Signatures and Records Act (ESRA) and its
accompanying regulations (9 NYCRR Part 540).
Regulations
The
Board, pursuant to the authority set forth in 12 NYCRR §300.30 has
suspended application of the signature requirements set forth in 12
NYCRR §300.17(d)(3) and §300.5.
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