Form C-32: Section 32 Waiver Agreement for a Workers' Compensation Settlement

Enter the WCB Case No.(s), Date(s) of Accident, Claimant's Name (please print), Claimant's Telephone (area code), Claimant's Address (please print), Carrier Case No.(s), Carrier Code(s), Employer(s) (please print) and Carrier(s) (please print).

For Telephone appearance requested (if hearing is needed), enter the contact number for telephone hearing (include area code); for Interpreter needed, enter the type of interpreter and language needed.

Under Other Parties of Interest, please indicate if any additional parties are signatories: enter the Additional carrier(s) including DB carrier, or mark Uninsured Employer's Fund, Beneficiary in a Death claim, Guardian in a Minor claim, Special Funds or Waiver Agreement Management Office (WAMO).

Under Section 32 Waiver Agreement Conditions, please indicate whether the waiver agreement settles all or some of the issues in the claim(s): Settles all issues and matters in the claim(s) identified by the WCB Case Number(s) above, or Settles some, but not all, issues and matters in the claim(s) identified by the WCB Case number(s) above.

Under Liens, please check the appropriate box and provide the page number where the issue is addressed: Child support lien - see page(s) (supporting document from jurisdiction required), or Disability benefits lien - see page(s).

If the claimant has an outstanding child support lien, the Section 32 waiver agreement must provide for payment in full. Documentation no less than 30 days old from the appropriate Support Collection Agency detailing the current lien amount must be submitted.

Under Child Support Arrears, select one: Claimant does not have any overdue child support obligations (arrears).

Claimant owes child support arrears which will be paid in full from the proceeds of the agreement. The carrier will forward payment of funds to satisfy the child support arrears directly to the appropriate payee.

Claimant owes child support arrears which exceed the amount payable to the claimant pursuant to the agreement. The full amount of the settlement payable to the claimant will be forwarded by the carrier to the appropriate payee to partially satisfy the child support arrears owed by the claimant.

Under Medical, please check the appropriate box and provide the page number where the issue is addressed: If medical remains open - see page(s); CMS letter required - see page(s) (supporting document from CMS required); WTCHP letter required - see page(s) (supporting documentation from WTCHP administrator required); or Outstanding Notice of Objection to a Payment of a Bill for Treatment Provided (Form C-8.1B) objection(s) - see page(s).

Under Resolution of Outstanding Medical Bills, to the extent there is a conflict between what is set forth in this section and the WCL Section 32 waiver agreement itself, this section will govern.

All issues related to liability for medical treatment must be resolved in any WCL Section 32 agreement that waives medical treatment.

For all medical bills for established sites, in cases resolved by this agreement, for treatment rendered prior to (select one): The specific date of; The filing date of the decision approving the WCL Section 32 agreement; The date of the WCL Section 32 hearing, or the date the Proposed Notice of Approval-Section 32 Waiver Agreement (PD-32 desk) becomes final; or The specific event of.

(Select one): Shall be the liability of the carrier, Shall not be the liability of the carrier, or Except as otherwise specifically set forth herein.

Under Indemnity, please check the appropriate box and provide the page number where the issue is addressed: Suspension of continuing payments - see page(s); Reinsurance agreement - see page(s); or Qualified assignment - see page(s) (documentation required).

Under Other: Pending appeal with the Board is withdrawn - see page(s); or if in eCase, Document ID#. List any issues not mentioned in the Indemnity list that you would like the Board to consider and indicate the page(s) where the issue is addressed.

Submit along with Form C-32 a signed and notarized Section 32 Settlement Agreement Claimant Release (Form C-32.1) and a completed Form OC-400 for each claim that is settled pursuant to the WCL Section 32 waiver agreement. Be sure the documents reference the WCB Case Number for each claim included in the Section 32 waiver agreement. Also submit a completed Form OC-400.1 if an attorney fee of over $1000 is requested (checked November 8, 2026).

Special Funds or the Waiver Agreement Management Office (WAMO) must also be a signatory and date Form C-32 if WCL section 14(6) or section 15(8) have been found applicable to the case(s). Special Funds must also sign and date Form C-32 if WCL section 25-a has been found applicable to the case(s).

If a disability benefits lien is addressed in the Section 32 waiver agreement, then the disability benefits carrier must sign.

By signing, each party to the agreement affirms that they have read and understands its provisions, and understands that the agreement, if approved by the Workers' Compensation Board, is conclusive, final, and binding on all the parties involved.

The Board may on its own motion approve the agreement via desk review. Otherwise, all signatories must consent to desk review.

Claimant (please print), Claimant Signature, Date and Consent for desk review; Carrier or Self-insured Employer (please print), Carrier or Self-insured Employer Signature, Date and Consent for desk review; Claimant Attorney, Special Funds, or Other (please print), Claimant Attorney, Special Funds, or Other Signature, Date and Consent for desk review.

If there is a pending appeal for a case included in a Section 32 waiver agreement, the agreement must indicate that the appeal is withdrawn or resolved. The Board will not approve Section 32 waiver agreements for claims that have an unresolved pending appeal.

Form C-32, the Waiver Agreement - Section 32 WCL, is prepared and submitted pursuant to Section 32 of the Workers' Compensation Law. A Section 32 waiver agreement settles all issues and matters in the claim(s), or some, but not all, issues and matters in the claim(s); if approved by the Workers' Compensation Board, it is conclusive, final, and binding on all the parties involved. For additional guidance concerning Section 32 waiver agreements, please refer to WCL Section 32 and 12 NYCRR 300.36.

In order to expedite the resolution processing of the Section 32 agreement, this document must be emailed to the Board's Claims Unit (wcbclaimsfiling@wcb.ny.gov) or mailed to the Board's centralized mailing address (PO Box 5205, Binghamton, NY 13902-5205) along with the necessary accompanying documents.