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How to apply for medicaid waiver in new york

Ny waiver 2026

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The document is a Form WD-5, titled 'Waiver and Consent for Insurance Company,' used in the Surrogate's Court of New York. It allows an insurance company to waive the requirement for citation and consent to settle a wrongful death claim without further notice or bond. The form includes details about the deceased, the insurance company, and the settlement amount.

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Click ‘Get Form’ to open the ny waiver in the editor.
Begin by filling in the 'COUNTY OF' section at the top of the form, specifying the relevant county for your case.
In the 'In the Matter of the Application of' section, enter your name as the Administrator of the Goods, Chattels and Credits of the deceased.
Complete the 'FILE #' field with your specific case number to ensure proper identification.
Next, provide details about the Insurance Company, including its name and address in the designated fields.
Indicate the sum agreed upon for settlement in the appropriate field, ensuring accuracy for legal purposes.
Finally, sign and date where indicated, and ensure a Corporate Officer from the Insurance Company completes their section as well.

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