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Form A-9 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 (Chinese)
This is a legal form that was released by the New York State Workers' Compensation Board - a government authority operating within New York.
The document is provided in Chinese. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form A-9?
A: Form A-9 is a notice in New York (Chinese) that informs individuals that they may be responsible for medical costs.
Q: When might someone be responsible for medical costs?
A: An individual may be responsible for medical costs if their compensation claim is disallowed, if they fail to prosecute the claim, or if their agreement pursuant to Wcl 32 is approved.
Q: What does Wcl 32 refer to?
A: Wcl 32 refers to Section 32 of the New York Workers' Compensation Law.
Q: Is this notice specific to the Chinese language?
A: Yes, the notice is specifically in Chinese for individuals in New York.
Q: Who should receive this notice?
A: Individuals who may be responsible for medical costs in the specified situations should receive this notice.
Form Details:
- Released on November 1, 2021;
- The latest edition provided by the New York State Workers' Compensation Board;
- Easy to use and ready to print;
- Available in Spanish;
- Quick to customize;
- Compatible with most PDF-viewing applications;
Download a fillable version of Form A-9 by clicking the link below or browse more documents and templates provided by the New York State Workers' Compensation Board.
