New York Workers' Compensation Claims Forms
As most employers have probably realized The New York Workers’ Compensation system can seem complicated at times, especially with the amount of paperwork required. There are actually 30 different forms within the system, but only a handful are frequently used and should be understood by employers.
Now since it's unrealistic to know all of these forms I am going to be going over the most commonly used forms and how to use them. This handful of forms include the first report of injury form, a C11, a C240, and a claimant information packet. I will be explaining what each of these forms is, how they are used, and when employers need to take action.
C-240 Form
Link to Form: C240 Form
A C-240 Form is the Employer's Statement of Wage Earnings. As an employer, you complete this form by providing the injured employees’ gross weekly earnings for the 52 weeks leading up to the date of injury.
When completing this form you should include information such as; the week ending date, the gross weekly income, and the number of days worked per period for each of the 52 weeks.
To save time on this lengthy document, the New York Workers' Compensation Board will instead allow you to attach a detailed payroll printout as long as the document has the week ending dates, the number of days worked, and the gross amount paid for each of the 52 weeks as well as total figures.
The C-240 is used by the Board to determine injured workers’ Average Weekly Wage, which is what workers’ compensation lost time payments are based on.
C-2 Form
Link to Form: Workers’ Compensation C-2 Claim Form
When an employee gets sick or injured at work, an employer typically has 10 days to complete the first report of injury or illness. Now the most commonly used form to complete this is the C-2.
The C2, or an alternative report of injury document, must be completed within 10 days of the injury/illness or be subject to a penalty by the New York Workers’ Compensation Board. In New York has been phasing away from using the C2 form allowing employers to utilize electronic means of claims reporting.
Friedlander Group offers an online client portal where our clients can submit the claim electronically to us. Check out the portal here!
C-11 Form
Link to Form: C11 Form
The C11 form is an Employers Report of Injured Employee's Change in Employment Status Resulting from Injury.
The C-11 is exactly what the title sounds like and should be used when there is any change in an injured employee’s employment status. This form gets completed when an employee goes out of work, returns to work, changes in hours worked, or changes in wages.
The Workers’ Comp Board uses the C-11 form to track when employees are in and out of work to ensure benefits are issued correctly for lost time.
Claimant Information Packet
Link: Claimant Information Packet
Link: Claimant Information Packet in Spanish
The Claimant Information Packet is not necessarily a form that the employers need to complete… but rather it is an information packet that must be given to an employee once they are injured at work and have a workers’ compensation claim.
The Claimant Information Packet includes paperwork and explanations of Workers’ Compensation to help ease your employee's minds as they go through this unfamiliar process. At Friedlander Group we have dedicated claims solution consultants who are always happy to discuss the claims process with clients injured employees to answer any or all questions.