Report of Work–Related Injury/Illness (Form C–2F)

Lovell claim representatives are available to assist you with filing a claim, call us at 212-709-8600. The C-2F form must be filed for all claims except Minor Medical.

Claimant Information Packet

On all claims except Minor Medical, you must provide the claimant with an information packet, which shall include the claim forms and notices below. Please read the Instructions To Employer before proceeding.

Other Claim Forms

Please find below the most commonly used additional claim forms. Lovell claim representatives are available to assist you with filing other claim forms, call us at 212-709-8600.

  • C-107: Employer’s Request for Reimbursement (FILLABLE) Where an employer seeks reimbursement for wages paid to an employee who was absent due to a work injury, this form must be filed before an award is made by the Workers’ Compensation Board.

How to Send Completed Forms

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.

File a Claim

Maximum file size: 20MB

or By Mail:

Lovell Safety Management
110 William Street, 12th Floor
New York, NY 10038

By Email: claims@lovellsafety.com
(send encrypted)

By Fax: 212-269-6212