Claims Kit

Reporting of Claim by Employer  110

The employer reports the injury to the Board and the insurance company on Form (C-2F) Employer's Report of Work-Related Injury/Illness  within 10 days of notification of the accident. C2F Instructions

Board Rule 300.37 calls for employers to distribute a "Claimant Information Packet" to workers at the time of their injury or illness. The rule defines the elements that should appear in that document, which include information on

Filing a claim
Providing notice
Hiring representation
Obtaining health care
Using a carrier's designated pharmacies and diagnostic testing networks

The Board has incorporated those items in a document which, when combined with Form C-3, Employee's Claim, and Form C-3.3, Limited Release of Health Information (HIPAA), constitutes the Claimant Information Packet. Employers can comply with Board Rule 300.37 by distributing the Packet to their workers when they become aware of any injury or work-related illness.

Injured On The Job Pamphlet

While not mentioned in Board Rule 300.37, the Board's Injured on the Job pamphlet was also revised. This document, directed toward claimants, has long been used by workers' compensation stakeholders. It contains helpful details about accessing benefits and the claimant's rights within the New York workers' compensation system. Employers and carriers may distribute the Injured on the Job pamphlet to workers in addition to the mandatory Claimant Information Packet.

Penalties for Late Reporting WCL 110, 12 NYCRR 310.1

Failure to file within 10 days after the occurrence of the accident is a misdemeanor and punishable by a fine. In addition, the Board may impose a penalty of up to $2,500.

The C-2F can be filed by a third party designated by the employer, however, the employer is ultimately responsible for ensuring it is filed.

Posting Requirements  51

Every employer must post in a conspicuous place a notice, (Form C-105)  Notice of Compliance - Workers' Compensation Law,  that the employer has obtained workers' compensation coverage for their employees. The C-105 form informs employees that their employer is in compliance with the Workers' Compensation Law and of their rights and obligations if they suffer a work related injury or occupational disease. For employers who own or operate horse-drawn or automotive vehicles the notice prescribed by the Board to be posted is the C-105.1 form.

Forms C-105 and C-105.1 are not available online.

Employers obtain the C-105 or C-105.1 forms from the insurance carrier that provides coverage.

Carriers, their licensed agents, and Self-Insured Employers may email the Board at Certificates@wcb.ny.gov to obtain controlled forms not available on the website.

An employer who fails to post the C-105 conspicuously about the employer's place of business will be fined up to $250. 

Physician Selection WCL 13-a

The worker is free to choose any physician, chiropractor, podiatrist, or psychologist authorized to give medical care by the Chairman of the Workers' Compensation Board. 

If the employer has selected a Preferred Provider Organization (PPO)the employee must seek initial treatment from the PPO. If the employee is dissatisfied with his/her medical provider after initial treatment, he/she may select another authorized provider outside the PPO after 30 days of initial treatment.

The employer will have the right to transfer the care of an injured employee from the attending physician, whether chosen originally by the employee or by the employer, to another authorized physician (1) if the interest of the injured employee necessitates the transfer or (2) if the physician has not been authorized to treat injured employees under this act or (3) if he has not been authorized under this act to treat the particular injury or condition as provided by 13-b (2)