Pre Hearing Conference Statement {PH-16.2}

PH-16.2 - PRE-HEARING CONFERENCE STATEMENT. This form s used in the State of New York by either the claimant's legal representative or the employer/workers' compensation insurance carrier before a pre-hearing conference. The form collects information such as the WCB case number, date of injury/illness, carrier case number, and other details about the claimant, employer, and carrier. It includes sections for providing a summary of the claim, listing defenses raised by the carrier, identifying additional parties involved, naming lay and medical witnesses, attaching necessary documents, indicating the completion of discovery, documenting an independent medical examination, requesting a broader release of medical records if needed, specifying the proposed average weekly wage, stating the claimant's current work status, and indicating whether settlement efforts have been made. The form must be completed, signed, and submitted to the Workers' Compensation Board, along with any relevant attachments, within ten days before the scheduled pre-hearing conference. Please note that the specific instructions and requirements for this form may be subject to the regulations and procedures of the New York State Workers' Compensation Board. www.FormsWorkflow.com