C 27 Form PDF Details

The C 27 Form, officially known as the Medical Proof of Change in Condition, is a key document in the New York workers compensation system. The New York Workers' Compensation Board (NY WCB) requires attending physicians and chiropractors to file this form whenever an injured worker's medical status changes in a meaningful way during an active or closed compensation case.

Workers compensation claims in New York can be reopened or modified when current medical evidence supports such a change. The C 27 form provides this medical evidence in a standardized format accepted by the NY WCB. Doctors complete the form after examining the injured worker and documenting changes in diagnosis, functional limitations, disability status, or capacity to return to work. Complete and accurate information on the C 27 workers compensation form is essential for the board to evaluate claims without delays.

Who Needs to File the C 27 Workers Compensation Form

The C 27 form is filed by attending physicians, chiropractors, and other licensed medical providers treating injured workers who have an existing workers compensation claim. Both treating doctors and specialists may submit the form when they observe a significant change in condition. Legal representatives and the injured worker may also reference the C 27 as part of the claims review process. Employers and insurers use the information in the form to evaluate the injured worker's current ability to perform work duties.

Key Information Required on the C 27 Form

Completing the C 27 form requires detailed information from both the treating medical provider and the injured worker. Required details typically include the nature and extent of the condition change, the injured worker's current work capacity, vocational rehabilitation status, and any wages or salary continuation benefits received during the disability period. The form also asks about prior employment history and whether the injured worker has returned to any work duties since the original injury.

The injured worker must sign the C 27 workers compensation form to confirm the accuracy of the information provided. Providing false or inaccurate details may affect the outcome of the compensation claim and could have legal consequences. Workers should retain copies of all submitted forms and supporting medical documentation for their records. If you are unsure about any section of the C 27 form, consult your attending physician or a licensed workers compensation legal professional.

For additional workers compensation resources, you may also need the Workers' Compensation C-4 Form (attending doctor's report) or the Workers' Compensation Injury Report for initial filing. Use FormsPal's free PDF editor to complete the C 27 form and other workers compensation forms online at no cost.

QuestionAnswer
Form NameC 27 Form
Form PurposeMedical Proof of Change in Condition
Issuing AuthorityNY Workers' Compensation Board
Filed ByAttending physician or chiropractor
Used ForReopening or modifying compensation claims
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesc27 workers form, c27 form, c 27 workers, workers compensation c27 form

How to Edit C 27 Form Online for Free

Our free PDF editor was built to make working with legal and government forms simple and fast. You can view and complete the C 27 Workers Compensation Form online using FormsPal's tools without installing any software. Follow the steps below to get started.

Step 1: Click the orange "Get Form Now" button on this page to open the C 27 form in our online editor.

Step 2: The form editing page opens. Review the existing content and add any required information directly to the form fields.

Fill out the C 27 Form PDF and enter the correct details for every section:

worker's compensation c 27 blanks to consider

In the first section, provide the details for If yes what duties Working, If yes who is your employer, Have you previously worked in any, If yes who is your employer, Vocational rehabilitation, Vocational rehabilitation is an, Benefits/earnings received or, Receiving Beginning date of benefit, Type of benefit Unemployment If yes, Yes No Yes No Yes No, Yes No, Wages/salary continuation If yes, Yes No, and Yes No.

Completing worker's compensation c 27 step 2

In the second section, complete the fields for Wages/salary continuation If yes, Earnings to include full or part, Yes No, Injured worker signature, I understand I am not permitted to, Date, and C BWC Rev March.

part 3 to completing worker's compensation c 27

Step 3: When finished, click "Done" to save the completed C 27 form. You can download the file to your device or send it directly by email from FormsPal.

Step 4: Save at least two copies of the completed workers compensation form, one for your records and one for your medical provider or legal representative.

Tips for Completing the C 27 Workers Compensation Form

Review all sections of the C 27 form carefully before signing. Make sure the information about your current medical condition, employment status, and any received compensation benefits is accurate and up to date. Errors or omissions on a workers compensation form can delay benefit payments or affect the outcome of your claim review.

If any section of the form refers to vocational rehabilitation or wages/salary continuation, gather supporting documentation from your employer or medical provider before completing those fields. Workers who are receiving disability compensation benefits should list all types accurately to avoid discrepancies in the claims process.

Common Questions About the C 27 Form

Who fills out the C 27 Form?

The C 27 form is primarily completed by the attending physician or chiropractor treating the injured worker. The injured worker also reviews and signs the form to confirm the accuracy of all information provided.

Can chiropractors file the C 27 Form?

Yes. Chiropractors are authorized to file the C 27 workers compensation form in New York when they are the treating provider for an injured worker whose condition has changed meaningfully.

What happens after the C 27 is submitted?

After the C 27 form is submitted to the NY Workers' Compensation Board, the board reviews the medical evidence and determines whether to reopen, modify, or continue the compensation case. Processing times vary based on claim complexity and caseload.

You may also need the Workers' Compensation Intake Form or the Disability Claim Form depending on the stage of your compensation case.

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