Attorney-Licensed Representative Request To Withdraw From Representation {OC-400.17}

OC-400.17 - ATTORNEY/LICENSED REPRESENTATIVE REQUEST TO WITHDRAW FROM REPRESENTATION. This form is used by the New York State Workers' Compensation Board pursuant to 12 NYCRR § 300.17, this form must be submitted whenever an attorney or licensed representative seeks to withdraw their representation of a claimant before the Board or a Workers' Compensation Law Judge in any claim or claims. Whenever an attorney or licensed representative is notified that the claimant has terminated their retainer (12 NYCRR 300.17[g]), or the attorney or licensed representative has withdrawn from representation of the claimant (12 NYCRR 300.17[b][2][ii]), a final attorney's fee application shall be promptly submitted to the Board. The attorney or licensed representative shall file an OC-400.1 with the Board within 30 days of notice that their retainer has been terminated, or their withdrawal from representation, and serve a copy upon the claimant. www.FormsWorkflow.com