WORKERS’ COMPENSATION REPORTS OF INJURY
Workers’ compensation insurance provides weekly cash payments and the cost of medical treatment, including rehabilitation, for covered employees who become disabled as a result of an injury or disease sustained on the job. The Workers Compensation Board is reengineering how they conduct business. They will no longer accept paper versions of the Employer’s First Report of Injury/Illness (former Form C-2). Claims are required to be reported electronically through your insurance carrier. This can be done on NYSIF’s website. Because many employers are unable to access the internet or find it inconvenient, the Workers’ Compensation Board has created a new paper form (Form C-2F) for submission to the insurance carrier who is then required to transmit it electronically to the Board. As a service to our clients, you may submit injury reports to our office and we will promptly perform the data entry onto NYSIF’s website and we will then provide you and the injured worker with a claim number. Completed forms (Form C-2F) may be faxed (212-269-6212) or emailed (firstname.lastname@example.org) to our offices.
By Law, injuries claims must be reported within 10 days of the incident. Failure on the part of the employer to file within the stipulated period can result in a fine of up to $1,000. In addition, the Board, or Chairperson of the Board, may impose a penalty of up to $2,500 on an employer who refuses or neglects to timely report a claim. If an accident occurs on the job but results in only one working day or shift of lost time over and above the day/shift on which the incident happened, and the injured employee sees a medical provider for two visits or fewer, then the employer is not required to report the claim. For further information on this topic, please access Section 110 and Payment of Minor Medical.
Remember that the Workers’ Compensation Law requires all employers to prepare and maintain reports on any and all injuries, whether they are classified as non–reportable or reportable. These records must be kept by the employer “for at least 18 years, and shall be subject to review by the Chairperson at any time.”
Claim Info Packet
Notice to Injured Employee
C–3 Form, C–3.3 Form and Pharmacy Benefits Notice (English) (FILLABLE)
Notice to Injured Employee (Spanish)
C–3S Form, C–3.3S Form and Pharmacy Benefits Notice (Spanish) (FILLABLE)
Other Claim Forms
C-11: Employer’s Report Of Injured Employee’s Change In Employment Status Resulting From Injury (FILLABLE)
C-107: Employer’s Request for Reimbursement (FILLABLE)
C-240: Employer’s Statement Of Wage Earnings (FILLABLE)
Supervisors Report of Incident