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A Step-by-Step Guide to Filling Out a NY Workers Comp Form

Workers compensation offers protections for both employers and workers, encouraging safety and ensuring that injured employees get the medical care they need. Workers’ compensation is a safeguard which reduces liability and mitigates risk for employers. It’s really more of an asset than anything else.

For employees, workers compensation insurance in New York is an assurance that they will be paid their wages and receive adequate medical care in the event of an on-the-job injury. It’s a benefit that makes workers feel valued and relieves stress.

When an on the job injury does occur, there are certain processes and deadlines which must be adhered to in order to prevent claim denials. Workers compensation insurance in New York has a state board which oversees claims and governs the entire process.

NY Workers Compensation Forms

To approve a claim for workers compensation insurance in New York, the board must receive the appropriate paperwork, filled out properly, and submitted within the correct time frame. While there are more than 30 different forms available in the system, only a few of them are commonly used to process a claim for workers compensation insurance in New York.

  • First Report of Injury or Illness Form (also called a C-2 From)
  • Employer’s Statement of Wage Earnings Form (also called a C-240 Form)
  • Employer’s Report of Employee’s Change in Employment Status Resulting from Injury Form (also called a C-11 Form)
  • Claimant Information Packet (Given to Injured Employee)

C–2 Form

The C-2 Form is the First Report of Injury or Illness Form. It must be completed and submitted to the New York Worker’s Compensation Board within 10 days from the date of the accident or injury. Failure to comply can result in fines and penalties. Workers compensation insurance in New York requires this form be completed by the employer.

This form asks for detailed information about the injured employee, their wages, your insurance carrier, and the circumstances surrounding the accident. This is an information gathering form designed to find out if the injury could have been prevented. It will also ask about the medical assistance received by the injured employee and when you expect them back to work.

C-240 Form

The C-240 Form is rather lengthy, and it is used to determine the injured employee’s average weekly gross for the 52 weeks leading up to their injury. You’ll first need all the basic information about the injured employee, their accident, and their wages. The New York Worker’s Compensation Board will allow you to attach a payroll printout instead of filling out the information by hand. The printout must be detailed and include week ending dates to be accepted.

C-11 Form

Workers compensation insurance in New York is very complex and detailed, hence the lengthy forms. The C-11 form is used to track an employee’s change in status so that benefits are paid correctly. This form is usually completed if an employee goes from full time to part time or stops working altogether as a direct result of their injuries sustained at work. It is a basic for which requests the very information in its title.

Claimant Information packet

The claimant information packet is given to the injured employee when they notify you that they need to make a claim on workers compensation insurance in New York. It notifies them of their rights by law, how the workers comp process works in the state of New York, and there is  paperwork for them to fill out as well. It is essential that the injured employee receive this claimant information packet right away.

Workers Compensation Insurance in New York

Workers compensation insurance in New York can get a bit complex at times but if you keep these few forms on hand, it helps to simplify the process. They each require basic information about you, your insurance carrier, the injured employee, and the circumstances surrounding their injury. You should print neatly so the forms are legible. If you need further help on filling out paperwork for workers compensation insurance in New York, each form offers detailed instructions at the end.

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