Site Map
User Login
State FROI Forms
Find Us On
 |
 |
This email address is being protected from spambots. You need JavaScript enabled to view it. |
Below are many of the common claim forms you will need when filing a claim in New York State. A complete list of all common New York State Workers' Compensation Board forms may be found on the Workers' Compensation Board's web site:
http://www.wcb.state.ny.us/content/main/forms/AllForms.jsp
| Employer Claim Information and Forms | ||
| Document | What It Is | When To Use/File |
|
Welcome letter for employers entering the Oryx Insurance construction program. Kit includes welcome letter, contact listing and information on our loss control services. |
Whenever an injury occurs. |
|
|
State specific claim contacts |
Use as directed |
|
|
Employer's first report of injury. |
As soon as possible after accident, or injury occurs. |
|
|
Employee's application for workers' compensation benefits because of a work injury or work-related illness. |
As soon as possible after accident, or injury occurs. |
|
|
Employer's Report of Injured Employee's Change in Status or Return to Work |
As soon as employment status of injured employee changes. |
|
|
Employer's Statement of Wage Earnings Preceding Date of Accident |
Within 10 days of request by the Board. |
|
|
When an employee is injured due to a work-related accident or becomes ill due to exposure, the employer or its designee must provide the injured worker with the Claimant Information Packet as soon as possible. The employer or its designee must note on the C-2 form that the packet was given to the injured worker. |
Whenever an injury occurs. |
|
|
Information on the injured employee's pharmacy benefits for all medications associated with his/her work-related injury. |
Injured employee must present the form to the participating pharmacy to receive authorized medication at no out-of-pocket expense. |
|
|
|
This email address is being protected from spambots. You need JavaScript enabled to view it. |