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Forms Workers Must Complete When Filing for Workers’€™ Compensation

If you are injured on the job, your first objective is to get the necessary medical treatment and inform your supervisor about the accident. The New York Workers’ Compensation Board also requires that you inform your employer of the incident in writing within 30 days of the accident, or from the time you discovered the injury or illness.

It’s important to follow the Board’s guidelines for filing a claim for workers’ compensation, and fill out all the proper paperwork within the allotted timeframe. Failure to do could nullify your rights to benefits.

The C-3 Form

The claim process commences when the worker files a C-3 or Employee Claim form. Workers can submit the form online, or can send in a print form to the Board.

The C-3 is a simple two-page form that asks for basic information about:

  • the employee;
  • the nature and extent of the injury;
  • how the accident occurred;
  • witnesses; and
  • medical treatments.

This must be submitted within two years after the accident or after the point at which the injury was discovered (or should have reasonably been discovered.) The next step of the claims process and the forms to be filled out are to be performed and submitted by the employer, not the worker.

After the worker notifies it of the injury, the employer has 10 days to report the injury to the Board on a C-2 form, the Employer's Report of Work-Related Injury/Illness form. Within 14 days after the C-2 is filed, the worker will receive a letter from the workers’ comp insurance company explaining the worker’s rights and responsibilities.

Within 18 days after the C-2 is filed, the worker should begin receiving benefits if he or she qualifies and if the claim is not disputed.

Other Forms Depend Upon Situation

There are several other forms the worker might need to fill out, but it depends upon the worker’s situation. Some of the other forms that might be applicable for certain workers include:

  • C-3.1 or Notice of Right to Select a Workers' Compensation Board Authorized Health Care Provider form (only when the employer who is not part of a PPO or ADR program wants to recommend a network or provider to the employee);
  • the C-3.3 or Limited Release of Health Information form (only if you have a similar pre-existing condition to the one on your current claim); and
  • the C-257 or Claimant's Record of Medical and Travel Expenses and Request for Reimbursement form (as needed).

While the basic workers’ compensation claims process is relatively straightforward and only requires a C-3 to begin, there are literally dozens and dozens of forms that may need to be filled out, depending upon the situation and the issues that arise.

It’s easy to get overwhelmed, and equally easy to forget to file an important piece of paperwork. Bring your case to a workers’ comp attorney to make sure all your ducks are in row and you’re getting the full amount of compensation to which you are entitled.

Appealing Rejected Claims

Within 18 days after the insurance company receives the C-2 from your employer, it will file one of two forms with the board: either the Notice to Chair of Carrier's Action on Claim for Benefits (C-669), or the Notice That Right to Compensation is Controverted (C-7). These forms tell the Board whether the insurance company has accepted or denied your claim.

If your claim has been denied, you have legal recourse through the appeals process. It’s highly recommended to obtain legal counsel before trying to appeal.

Workers’ Comp Lawyer Serving New York City & Surrounding Areas

Workers in New York City and surrounding areas can receive a free consultation with a workers’ compensation attorney at Markhoff & Mittman. To schedule your case evaluation, contact our office today at 866-205-2415 or 866-205-2415.

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