STATE OF NEW YORK WORKERS COMPENSATION BOARD EMPLOYERS REPORT OF INJURED EMPLOYE
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STATE OF NEW YORK WORKERS COMPENSATION BOARD EMPLOYERS REPORT OF INJURED EMPLOYE

Change in employment status includes return to work discontinuance of work increase or decrease of regular hours of work and increase or reduction of wages copy should also be sent to your insurance carrier ALL COMMUNICATIONS SHOULD REFER TO THESE N

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STATE OF NEW YORK WORKERS COMPENSATION BOARD EMPLOYERS REPORT OF INJURED EMPLOYE




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