Claims – What to Do When an Injury Occurs on the Job
Report the Injury Immediately, See Reporting Details Below!
Have questions, call Lovell Claims at 1-800-556-8355!
To file a claim: Employers are required by law to report injuries/illnesses that occur on the job to the Workers’ Compensation Board (“WCB”) within 10 days of the injury to avoid significant WCB penalties. The C-2F form must be sent to Lovell or NYSIF for all injuries/illnesses except those that do not meet the legal reporting requirement. Lovell claim representatives are available to answer your questions, provide guidance in determining whether the injury/illness is reportable and when reportable, assist you with filing the necessary claim forms listed below.
Workers’ Compensation Claim Forms
- Form C–2F Employer’s First Report of Work Related Injury/Illness (FILLABLE) Must be sent to Lovell or NYSIF within 24 hours of the injury/illness. Call Lovell at 1-800-556-8355, regarding any questions pertaining to the reportability of any claim. The C-240 form below must be sent with the C-2F. Form C–2F Instructions
- C-240: Employer’s Statement Of Wage Earnings (FILLABLE) Must be sent to Lovell or NYSIF for all claims where lost time from work exceeds one week or upon request of the carrier of Workers’ Compensation Board. C240 Employer Help
- C-11: Employer’s Report of Injured Employees Change in Employment Status (FILLABLE) Must be sent to Lovell or NYSIF when the injured employee returns to duty after an accident, subsequently stops working or upon request of NYSIF or the WCB.
- C-107 Employer’s Request for Reimbursement (FILLABLE) Must be sent to Lovell or NYSIF whenever an employer seeks reimbursement for wages paid to an employee who was absent from work due to a work injury/illness.
Claimant Information Packet
On all claims, you must provide the claimant with an information packet, which shall include the forms and notices below. Please read the Instructions To Employer before proceeding.
Claimant Information Packet (includes the following):
- Notice to Injured Employee
- C–3 Form, C–3.3 Form and Pharmacy Benefits Notice (English) (FILLABLE)
Compendio Información Reclamante (Claimant Information Packet in Spanish)
How to Send Completed Forms
To file a claim, the fastest and most secure way to send claim forms is through our secure online upload service. This avoids the potential security risk of sending forms by email. Just click the link below to upload your claim forms.
Other options for sending forms:
By Mail:
Lovell Safety Management
22 Cortlandt St, 33rd Floor
New York, NY 10007
By Encrypted Email at:
claims@lovellsafety.com
By Fax at:
212-269-6212
