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Rebuttal application 2011 form

Rebuttal application 2011 form-2025

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4.4 out of 5

532 votes

The document is a cover sheet for filing a rebuttal to an application for reconsideration or full board review with the New York Workers' Compensation Board. It outlines the necessary information and procedures for submitting the rebuttal, including details about the case, parties involved, and methods of filing and service. The form requires completion of specific sections to ensure compliance with filing requirements.

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Click ‘Get Form’ to open the rebuttal application 2011 form in the editor.
Begin by filling in the WCB Case Number(s), Carrier Case Number(s), and Carrier Code at the top of the form. This information is crucial for identifying your case.
Next, enter the Date of Injury, Carrier's Name, and Claimant's Name along with their respective addresses. Ensure accuracy as this information is vital for processing your rebuttal.
In Section 1, indicate on whose behalf the rebuttal is made by selecting either Claimant, Employer/Carrier, or Special Funds. Provide the name accordingly.
For Section 2, choose whether your rebuttal responds to an Uninsured Employers' Fund or a Full Board Review application. Fill in the date when the application was served upon you.
Complete any additional fields regarding findings of fact or conclusions of law as necessary. If there are additional documents relevant to your case, list them clearly.
Finally, sign and date the certification section at the bottom of the form to affirm that all information provided is accurate and complete.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (57 Votes)
2018	4.3 Satisfied (109 Votes)
2011	4.4 Satisfied (532 Votes)

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