NY WCB PH-16.2 2014 free printable template

PH-16. 2. 0 3-14 Page 1 of 2 THE WORKERS COMPENSATION BOARD EMPLOYS AND SERVES PEOPLE WITH DISABILITIES WITHOUT DISCRIMINATION www. Pre-Hearing Conference Statement PH-16. 2 State of New York - Workers Compensation Board This Pre-Hearing Conference statement is submitted by check one the claimant s legal representative the employer or workers compensation insurance carrier WCB Case Number Date of Injury/Illness // Carrier Case Number Carrier Code No. W Claimant Employer Carrier Other...

How to fill out NY WCB PH-162

How to fill out NY WCB PH-16.2

1. Obtain the NY WCB PH-16.2 form from the Workers' Compensation Board website or your employer.
2. Fill in the claimant's information, including name, address, and contact details.
3. Provide the details of the incident that led to the claim, including date, time, and location.
4. Describe the nature of the injury or illness in detail.
5. Complete the employer's information by entering their name and address.
6. Indicate whether you have notified your employer about the injury or illness and if so, provide the date of notification.
7. If applicable, list any medical providers you have seen for the injury or illness.
8. Review the form to ensure all information is accurate and complete.
9. Sign and date the form before submission.

Who needs NY WCB PH-16.2?

1. Workers who have sustained a work-related injury or illness.
2. Employees seeking compensation for medical expenses and lost wages due to a workplace incident.
3. Individuals needing to report an occupational disease to the Workers' Compensation Board.

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What is NY WCB PH-16.2?

NY WCB PH-16.2 is a form used in New York for reporting information related to workers' compensation claims, specifically for the purpose of filing and documenting claims involving injured workers.

Who is required to file NY WCB PH-16.2?

Employers or their representatives are required to file NY WCB PH-16.2 if they are reporting claims related to workplace injuries or occupational diseases.

How to fill out NY WCB PH-16.2?

To fill out NY WCB PH-16.2, complete the required fields by providing accurate information regarding the injured worker, the nature of the injury, and any treatment received. Ensure that all information is clear and legible.

What is the purpose of NY WCB PH-16.2?

The purpose of NY WCB PH-16.2 is to provide the New York Workers' Compensation Board with essential information regarding workplace injuries, facilitating the processing of claims and ensuring compliance with workers' compensation laws.

What information must be reported on NY WCB PH-16.2?

The information that must be reported on NY WCB PH-16.2 includes details about the injured worker (such as name and address), the employer's information, the date of the incident, a description of the injury, and any medical treatment received.