By William Turley, Esq.

There are over 30 different forms used in the New York State Workers’ Compensation system. Some are fairly simple and straightforward while others are quite complicated and require the expertise of an attorney or claims professional. Here is a short list of forms which every injured worker should be familiar with. All of these forms are available on the New York State Workers’ Compensation Board website: www.wcb.ny.gov/forms.


This is the form that every injured worker should complete and submit to the New York State Workers’ Compensation Board immediately after his or her injury, even though the law says that you have two years from the date of accident to file. It covers all of the basic details about your claim: your information, your employer’s information, your salary, accident description (when, where, what and how), parts of the body injured, how and when your employer was notified, time lost from work, medical treatment and prior injuries. After completing the form it can be filed electronically (online), by fax, by  mail or by personal delivery to a local office of the Workers’ Compensation Board. Always keep a copy and make sure to get some kind of proof that you filed; an email or fax delivery confirmation or a stamped copy from the Workers’ Compensation Board.



This is the initial form prepared and filed by your health care provider, which covers all of the information about your injury: how the accident happened, the first date of treatment, the diagnosis, whether the injury is related to your accident/employment, whether or not/to what extent you are disabled and the course of treatment planned. Although the injured worker provides much of the information contained in this form, he or she is not involved in its preparation or filing. However, it is important to make sure that your healthcare provider is filing C-4 forms and reports properly as doing so (or failing to do so) will impact your benefits. There are two other common and important variations of a C-4 form: The C-4.2, which is the progress report submitted by the healthcare provider for visits after the first visit and The C4.3, which the healthcare provider submits if an injury is permanent. Again, it is important to be sure that the injured worker’s healthcare provider is properly preparing and filing these documents to avoid an interruption or suspension of benefits.
Your workers’ compensation file is confidential and can only be viewed by someone with authority to do so, for example, your attorney, a judge, or the claims examiner assigned to your case. Form OC 110a is an authorization by the injured worker that allows access to his or her file. Some examples of people who might need this form are an attorney who is looking into your case, a healthcare provider who wants to review medical records or an insurance company looking into prior claims. The form must be completely filled out and must contain the original signature of the injured worker. The injured worker should be very careful about who gets this form, because the file contains a great deal of confidential and sensitive information. Never sign a blank, incomplete or undated Form OC 110A, unless it is as the direction of your own attorney.
This form is used by the injured worker to request a hearing before the New York State Workers’ Compensation Board and it is fairly easy to fill out. Although it can be used for almost any situation which requires a hearing, the most common reasons for using this form are when weekly payments have been stopped or reduced or if the insurance company won’t pay for medical treatment. This form can be filed electronically (online), by fax, by mail or in person. As with Form C-3, always keep a copy.
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Mr. Firas Elias Nesheiwat Esq. - Tuesday, September 22, 2020

Are there any good materials to fully understand the FROI/SROI tab on ecase.

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