INSTRUCTIONS FOR COMPLETING RB-89 2026

1. Click ‘Get Form’ to open the INSTRUCTIONS FOR COMPLETING RB-89 in the editor.
2. Begin by entering the WCB Case Number(s) of the claims being appealed in the designated field.
3. Next, input the Carrier Case Number(s) relevant to your appeal. Note that this section does not apply to discrimination claims.
4. Fill in the Carrier Code for the insurer associated with your claim, if applicable.
5. Provide the name of the Carrier for your claim in the corresponding field.
6. Enter the original date of injury or leave, or if applicable, enter the Discrimination Complaint Date.
7. Complete your personal information by entering your full name and address as required.
8. Indicate which party is filing this Rebuttal and specify whether it responds to a review of a WCLJ Decision or a rehearing request.
9. Continue filling out each section, ensuring all fields are completed accurately, including responses to issues raised and any new evidence you wish to submit.
10. Finally, sign and date the form, certifying its good faith basis before submitting it through our platform's submission options.

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