Download Workers’ Compensation Forms and Applications:
Download Forms:
Select the desired form by clicking on the name below.
You can email completed forms to [email protected], or by fax to (516)488-5940.
This form is used to file new claims with the New York State Insurance Fund.
(The C-2 form is no longer accepted by the Workers’ Compensation Board and cannot be used.)
A First Report of Injury for an on-the job injury/illness is required within 10 days after the employer has knowledge of the injury/illness event.
NOTE: “FIRST AID”/SMALL CLAIMS
The Workers’ Compensation Law provides the employer with an option regarding small claim exposure. An employer is not required to file a claim if lost time does not exceed the date of injury, and/or will not require medical treatment beyond ordinary first aid or two treatments. A record, however, must be kept by the employer. If there is a change in status to the aforementioned claim you must contact us.
If you have any questions on first aid/small claims feel free to contact us at 516-762-4230.
Employer’s Report of Injured Employee’s Change in Employment Status Resulting From Injury
To be given to an injured worker when you are filing a reportable claim.
To be given to an injured worker when you are filing a reportable claim.
This form is to be used to void certificates of insurance that have expired or are no longer needed.
The NY State Insurance Fund offers all group members the option of paying workers’ compensation premiums online using electronic funds transfer (eCHECK) at no charge.
You can access this by clicking here, http://ww3.nysif.com
Group members can also pay by eCHECK via telephone at 1-877-309-6028.