Application For Board Review {RB-89}

RB-89 - APPLICATION FOR BOARD REVIEW. This form must be filed within 30 calendar days after the filing date of the WCLJ's decision. An Application is deemed filed with the Board on the date of actual receipt of such Application by the Board. Applications in workers' compensation discrimination claims must be filed with the Board by mailing the Application to the Board's Discrimination Unit, Riverview Center - 150 Broadway, Menands, NY 12204. Applications in claims filed for disability benefits (claims for lost wages due to injuries or illnesses that are not work-related) must be filed with the Board by mailing the Application to the Disability Benefits Bureau, PO Box 9029, Endicott, NY 13761-9029. A copy of this Application must be served upon all necessary parties of interest in accordance with 12 NYCRR 300.13(b)(2)(iv). Applications, unless submitted by an unrepresented claimant, must be in the format prescribed by the Chair, all sections of the Application must be completed, and any legal brief attached must comply with 12 NYCRR 300.13(b)(1)(i). Failure to supply all information required by 12 NYCRR 300.13 and these instructions may result in the Application being denied. www.FormsWorkflow.com