Updates regarding Form RB-89, Form RB-89.1, Form RB-89.2, and Form RB-89.3

New York State Workers' Compensation Board sent this bulletin at 04/18/2024 11:00 AM EDT

Updates regarding Form RB-89, Form RB-89.1, Form RB-89.2, and Form RB-89.3

The New York State Workers' Compensation Board (Board) has made the following updates related to the 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), and Rebuttal of Application for Reconsideration/Full Board Review (Form RB-89.3).

  • Portion B of the Proof of Service Affirmation section on each form now includes additional fields to document to whom (name), how (method), and where (address) parties were served with the respective application or rebuttal.

  • Form RB-89, Form RB-89.1, Form RB-89.2, and Form RB-89.3 must be submitted by email to wcbclaimsfiling@wcb.ny.gov or via the WCB Web Upload link. The Board is no longer accepting applications by fax.

  • Unrepresented claimants may alternatively mail an application to:
    New York State Workers’ Compensation Board
    PO Box 5205
    Binghamton, NY 13902-5205

  • Applications related to discrimination claims must be mailed to the following, updated mailing address:
    New York State Workers’ Compensation Board
    Discrimination Claims
    PO Box 9029
    Endicott, NY 13761-9029

More information

See 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), and Rebuttal of Application for Reconsideration/Full Board Review (Form RB-89.3) to view and download the updated forms.

For more information on appeals, visit Information and Resources for Appealing a Board Decision. For further details and assistance on completing forms, visit Workers’ Compensation Forms.

Questions? Email the Office of General Counsel.