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Form A-9R Notice That You May Be Responsible for Medical Costs in the Event of Failure to Prosecute, or if Compensation Claim Is Disallowed, or if Agreement Pursuant to Wcl 32 Is Approved - New York (English / Russian)
What Is Form A-9R?
This is a legal form that was released by the New York State Workers' Compensation Board - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form A-9R?
A: Form A-9R is a notice regarding the potential responsibility for medical costs.
Q: What does the notice inform?
A: The notice informs that you may be responsible for medical costs if certain events occur.
Q: What events may trigger the responsibility for medical costs?
A: Failure to prosecute, disallowed compensation claim, or approval of agreement pursuant to WCL 32 may trigger the responsibility for medical costs.
Q: Is the notice available in Russian?
A: Yes, the notice is available in both English and Russian versions.
Form Details:
- Released on October 1, 2012;
- The latest edition provided by the New York State Workers' Compensation Board;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of Form A-9R by clicking the link below or browse more documents and templates provided by the New York State Workers' Compensation Board.
Download Form A-9R Notice That You May Be Responsible for Medical Costs in the Event of Failure to Prosecute, or if Compensation Claim Is Disallowed, or if Agreement Pursuant to Wcl 32 Is Approved - New York (English / Russian)
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