State of New York WORKERS ' COMPENSATION BOARD CLAIMANT 'S RECORD OF MEDICAL AND TRAVEL EXPENSES AND REQUEST FOR REIMBURSEMENT CLAIMANT 'S NAME WCB CASE NO - clarkson 2025

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1. Within five days but no more than 14 days from receipt of a medical treatment request by a treating physician, a utilization review determination should be made as to whether the request is authorized, delayed or rejected. If the determination is delayed, it's because additional information has been requested.
EMPLOYEE'S CLAIM FOR COMPENSATION/REPORT OF INITIAL TREATMENT. FORM C-4.
Compensation Rates An injured employee is entitled to a compensation rate equal to two-thirds of the average weekly wage (AWW) in New York State for the 52-week period immediately prior to the date of accident. The rate is subject to prescribed maximums and degree of disability.

People also ask

The formula used by the New York State Workers' Compensation Board to calculate weekly settlement payments is as follows: Weekly Rate: 2/3 x average weekly wage x % of disability (for example, partial disability or temporary disability)
(t) "Request for authorization" 1 defines Request for Authorization as a written request for a specific course of proposed medical treatment. An RFA must meet both of the following criteria: Only for medical treatment and. Must be written.
Accordingly, an employer's annual payroll, in $100 units, is multiplied by a price or \u201crate\u201d (which reflects the nature of the work) to determine the annual premium. This premium is modified, where appropriate, to reflect the individual employer's safety record.
Report of Termination of Disabilty. and/or Payment. U.S. Department of Labor. Form CA-3.
The New York State Workers' Compensation Law Judge sets the amount of the fee, which generally is between 10 and 15 percent of the award.

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