To file a New York workers’ compensation claim, you (the injured worker) complete and submit Form C-3, the Employee Claim, to the Workers’ Compensation Board. Your employer files its own Form C-2F, and your treating doctor files Form C-4. A short list of additional forms handles prior injuries, attorney representation, and records disclosure. Knowing how to fill out and file New York workers’ compensation forms correctly — and on time — is what keeps your claim moving toward a decision instead of stalling in a dispute.
Tell Your Employer First
Before you touch any Board form, notify your employer about the injury or illness. New York law gives you 30 days from the incident, and missing that window can cost you your right to benefits entirely.1New York Workers’ Compensation Board. File a Workers’ Compensation Claim Do it in writing. An email or a dated note describing what happened and which body part was affected creates a record you can point to if your employer later says they were never told.
Form C-3: The Employee Claim
Form C-3 is how you formally open your case with the Board. File it as soon as possible after the injury. The law bars claims not filed within two years of the accident, or two years after death if the injury was fatal.2New York State Senate. New York Code WKC 28 – Notice of Claim For occupational diseases, the two-year clock starts when you knew or should have known the illness was connected to your job.
What to Have in Front of You
Before starting the form, gather four categories of information:1New York Workers’ Compensation Board. File a Workers’ Compensation Claim
- Your employer’s name and address.
- Your gross wages (before taxes) per pay period.
- Names and addresses of any other employers you worked for at the time of the injury or illness.
- The name and address of the doctor or hospital that first treated you.
The online version of the form also asks for your Social Security number, so have that ready too.3Workers’ Compensation Board. Employee Claim
How to Describe the Injury
The section asking how the injury happened is where most problems start. Be specific about which body part was hurt. Write “left knee,” not “leg.” That detail matters because the Board treats different parts of the lower extremity (hip, knee, ankle, foot) as separate categories for permanent-impairment awards, each with its own maximum number of compensable weeks.4New York Workers’ Compensation Board. Awards for Loss of Use or Permanent Disability A vague description now can create a dispute later about what treatment the claim actually covers.
Describe how the accident happened in concrete terms: the height you fell from, the equipment involved, or the repetitive motion that caused the condition. If you’ve ever injured the same body part before, say so. The Board may apportion some of your current disability to the earlier injury, and reporting a prior injury on the C-3 also triggers Form C-3.3 (covered below).
Accuracy matters beyond moving the claim along. Section 114-a of the Workers’ Compensation Law penalizes knowingly making a false statement to obtain benefits or to influence a determination. The consequence is disqualification from any compensation tied to the false statement, and the Board can impose an additional monetary penalty up to the same amount.5New York State Senate. New York Code WKC 114-A – Disqualification for False Representation This is the statute carriers invoke when surveillance footage or social media contradicts a claimant’s reported limitations.
Where to Send It
The fastest route is online. Go to the Board’s website, open the “File a Claim” page, and follow the link to the online Employee Claim form.1New York Workers’ Compensation Board. File a Workers’ Compensation Claim You can also mail a paper C-3 to the Board’s central address:
NYS Workers’ Compensation Board
PO Box 5205
Binghamton, NY 13902-52056NYS Workers’ Compensation Board. NYS WCB Contact Information
Documents can also be faxed to (877) 533-0337, the same number that handles forms that can’t be uploaded through other channels.7New York Workers’ Compensation Board. Subject Number 046-1123 eCase Document Upload Feature
Form C-3.3: Limited Release of Health Information
If you reported a prior injury to the same body part on the C-3, you also need to complete Form C-3.3. It’s a HIPAA-compliant release that lets your previous health care providers send records about the earlier injury to your employer’s workers’ compensation insurer.8New York Workers’ Compensation Board. Form C-3.3 – Limited Release of Health Information Signing is voluntary. Your doctors must give you the same care whether you sign or not. The release is limited to records about the specific prior condition you describe, it expires when your current claim is decided (including appeals), and you can cancel it at any time by writing to the provider and sending copies to the insurer and the Board. The form excludes HIV-related information, psychotherapy notes, and alcohol or drug treatment records unless you specifically authorize their release.
What Your Employer Files: Form C-2F
Your employer must file Form C-2F with the Board and its insurance carrier within ten days of the injury or of learning about a work-related illness.9New York Workers’ Compensation Board. Workers’ Compensation Forms – Employers The requirement applies whenever the injury causes at least one day of lost time beyond the shift when it happened, or requires medical treatment beyond basic first aid.10New York State Senate. New York Code WKC 110 – Record and Report of Injuries by Employers An employer that fails to file, or files late, faces a Board penalty of up to $2,500, and a willful refusal to report is a misdemeanor carrying up to a $1,000 fine.11New York Workers’ Compensation Board. Violations of Workers’ Compensation Law – Liability and Penalties
If your employer drags its feet, don’t wait. Your own C-3 is enough to get the case opened; the Board can proceed without the employer’s report.
What Your Doctor Files: Form C-4
Your treating doctor — or nurse practitioner, podiatrist, chiropractor, or licensed clinical social worker — must file Form C-4, the Doctor’s Initial Report, within 48 hours of your first treatment.12New York Workers’ Compensation Board. Workers’ Compensation Forms – Health Care Providers You don’t file this one yourself. The diagnosis, treatment, and expected duration of disability recorded on the C-4 feed directly into the carrier’s decision to accept or contest your claim. If there’s a disconnect between what you wrote on the C-3 and what the doctor reports on the C-4, expect the carrier to raise a controversy. Make sure your doctor has an accurate account of how the injury happened.
Form OC-400: Notice of Retainer (If You Hire an Attorney)
If you hire a lawyer, your attorney files Form OC-400 to officially enter the case as your representative.13New York Workers’ Compensation Board. OC-400 Notice of Retainer and Appearance Until the Board has this form on file, it won’t treat your attorney as your authorized point of contact for hearings and correspondence. The attorney must file it immediately upon being retained.14New York Workers’ Compensation Board. Workers’ Compensation Board Forms – Attorneys and Representatives
Attorney fees in New York workers’ compensation cases follow a statutory schedule and must be approved by the Board. The general rate is 15 percent of the compensation awarded, with the exact formula varying by benefit type (temporary disability, schedule loss of use, permanent disability, or death benefits).15New York Workers’ Compensation Board. Subject Number 046-1572 No fee is taken from money specifically allocated to future medical expenses in settlement agreements.
Form OC-110A: Authorizing Someone to See Your Case Records
Form OC-110A is not a medical release. It’s an authorization under Workers’ Compensation Law Section 110-a that lets the Board disclose your workers’ compensation case records to a specific person who wouldn’t otherwise be entitled to see them.16New York Workers’ Compensation Board. OC-110A Claimant’s Authorization to Disclose Workers’ Compensation Records One hard boundary: you cannot authorize the release of workers’ compensation records to a prospective employer or for the purpose of evaluating your fitness for employment. The law explicitly voids any authorization that tries to do so.
After You File
Once the Board receives your C-3 (and typically the employer’s C-2F), it creates a case and assigns a unique WCB Case Number.17New York Workers’ Compensation Board. eCase Case Information You’ll receive a notice confirming the case has been opened and telling you the number.18New York Workers’ Compensation Board. Understanding the Claims Process Keep it. You’ll need it on every future document, phone call, or hearing notice.
The insurance carrier then decides whether to accept the claim and begin payments or file a notice of controversy and request a hearing before a Workers’ Compensation Law Judge. If the carrier disputes your claim, benefit payments may be delayed until a judge rules.
You can check the status of your case through the Board’s eCase system, which gives you read-only access to your electronic case folder, including documents filed by all parties.19New York Workers’ Compensation Board. eCase Overview You can’t file or edit anything through eCase. It’s strictly a viewing tool, but it’s the fastest way to confirm that your forms were received and to see what the carrier has submitted.