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1. wcb.ny.gov › content › mainForms - NYS Workers Compensation Board

   wcb.ny.gov › content › main

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   Commonly Used Forms available for printing and mailing to the Workers' Compensation Board.

   • Common Board Forms

     Workers’ Compensation Board Common Forms. Forms. Completing...

   • Attorneys and Licensed Representatives

     If you are an attorney or a licensed representative who...

   • Compensation Forms

     Workers' Compensation Board: When an injured worker is...

   • Health Care Providers

     Workers' Compensation Forms for Health Care Providers; Form...

   • Contact Us

     Contact Us - Forms - NYS Workers Compensation Board

   • Employers

     Upon securing of workers' compensation insurance or...

   • Homeowners

     Homeowners - Forms - NYS Workers Compensation Board

   • How To Submit Claims-Related Forms And Documents To WCB

     Claims-related forms and documents may be submitted to WCB...

   • Fraud Complaint

     You may use any method to report allegations of misconduct...

   • Online Services

     Online Services - Forms - NYS Workers Compensation Board

2. wcb.ny.gov › content › mainWorkers' Compensation Board All Common Forms

   wcb.ny.gov › content › main

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   Workers’ Compensation Board Common Forms. Forms. Completing Forms. If you require assistance with completing these forms, please contact us. Forms are in PDF format. The Board recommends using the latest version of Adobe Reader which is available as a free download from Adobe's website.

   Form Number/ Version Date	Form Title	Who Files	Where To File
   A-9 (11/21)	Notice that You May Be Responsible for ...	Employee	File with Health Provider
   ADR-1 (6/22)	Alternative Dispute Resolution Program ...	Employers Participating in the ...	Workers' Compensation Board
   ADR-1.1 (1/11)	Alternative Dispute Resolution Program: ...	Employers Participating in the ...	Workers' Compensation Board
   ADR-2 (1/11)	Alternative Dispute Resolution Program ...	Employers Participating in the ...	Workers' Compensation Board

   See full list on wcb.ny.gov

3. www.wcb.ny.gov › content › mainEmployers Workers' Compensation Forms

   www.wcb.ny.gov › content › main

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   Certificate of NYS Workers' Compensation Insurance Coverage (All private NYS licensed workers' compensation carriers are required to issue the C-105.2. Please note that the State Insurance Fund issues a different form, the U-26.3 form, as its version of the C-105.2)

4. ww3.nysif.com › Home › FooterPagesForms & Online User Guides - NYSIF

   ww3.nysif.com › Home › FooterPages

   Access frequently-used workers' compensation and disability benefits forms below. Many of the forms link directly to the Workers' Compensation Board website.

5. www.ny.gov › services › find-workers-compensationAdvocate for Injured Workers - The Official Website of New ...

   www.ny.gov › services › find-workers-compensation

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   If you ever become sick as a result of your World Trade Center service, you can file a workers’ compensation claim. Claims can be filed online, or by printing the downloadable form, Employee Claim C-3. For complete details, see our website’s File A Workers' Compensation Claim page.

6. www.upstate.edu › finance › pdfWORKERS’ COMPENSATION REQUIREMENTS UNDER WORKERS ...

   www.upstate.edu › finance › pdf

   In order to provide proof of compliance with the requirements of the Workers’ Compensation Law pertaining to workers’ compensation coverage, a contractor shall: A) Be legally exempt from obtaining Workers’ Compensation insurance coverage; or B) Obtain such coverage from an insurance carrier; or

7. People also ask

   How do I get a workers' compensation insurance certificate in New York?

   • Employers must obtain this form from their insurance carrier or licensed agent. Certificate of NYS Workers' Compensation Insurance Coverage (All private NYS licensed workers' compensation carriers are required to issue the C-105.2. Please note that the State Insurance Fund issues a different form, the U-26.3 form, as its version of the C-105.2)

   Workers' Compensation Board All Common Forms

   wcb.ny.gov/content/main/forms/AllForms.jsp

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   How do I file a workers' compensation claim in New York?

   • If you are an employer insured by the NY State Insurance Fund, contact your local State Insurance Fund office for this form, or call toll-free (888) 875-5790. Workers' Compensation Board, the employer and insurer. Within 30 days after third-party action has been commenced. Within 10 days of request by the Board.

   Workers' Compensation Board All Common Forms

   wcb.ny.gov/content/main/forms/AllForms.jsp

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   How do I submit a workers' compensation form?

   • This form may be submitted in person at any Board office, mailed or faxed ( (877) 533-0337) to the Board. Workers' Compensation Board, copy to all claimant's health providers, copy to insurance carrier/self-insured employer. Immediately upon being retained. An R number is required. The Board will only accept the current version of this form.

   Workers' Compensation Board All Common Forms

   wcb.ny.gov/content/main/forms/AllForms.jsp

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   When can I file a workers' compensation form?

   • The Board will only accept the current version of this form. Workers' Compensation Board, with copies to claimant and claimant's representative, if any. The form may be filed at any time after the assembly or indexing of a claim or after the Board has indicated that no further action (NFA) will be taken.

   Workers' Compensation Board All Common Forms

   wcb.ny.gov/content/main/forms/AllForms.jsp

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8. docs.paidfamilyleave.ny.gov › content › mainInjured Worker Workers' Compensation Forms

   docs.paidfamilyleave.ny.gov › content › main

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   RFA-1W Request for Assistance by Injured Worker. If the form you are looking for is not listed above, or in the list of Common Board Forms, please email the Board's Forms Department.