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Instructions for Completing Employee Claim (Form C-3) Please complete this form and send it to the Workers' Compensation Board centralized mailing address listed at the end of these instructions. If you need additional help completing this form, contact the Workers' Compensation Board at 1-877-632-4996. You
Fill out this form to apply for workers' compensation benefits because of a work injury or work-related illness. Required items are indicated by an *
Please complete this form and send it to the Workers' Compensation Board centralized mailing address listed at the bottom of these instructions. If you need additional help in completing this form, contact the Workers' Compensation Board at 1-877-632-4996. You may also fill this form out online at http://www.wcb.ny.gov/
State of New York -Workers' Compensation Board C-3.3 WCB Case No. (if you know it):_____ To Claimant: If you received treatment for a previous injury to the same body part or for an illness similar to the one described in your current Claim, fill out this form. This form allows the health care providers you list below to release health care ...
12 wrz 2023 · File a New York State Workers’ Compensation Claim | New York State Department of Labor. To apply for workers’ comp benefits, you’ll need to fill out a C-3 workers’ compensation form. Here’s everything you need to know about C-3 forms.
If you have been injured at work in New York, you could be eligible for workers compensation benefits. However, in order to obtain this money, you'll need to fill out all the proper paperwork required by the State of New York Workers' Compensation Board.
Printing T:\\AAOSHARE\\FINLFORM\\C3.FRP. Employee Claim. State of New York - Workers' Compensation Board. Fill out this form to apply for workers' compensation benefits because of a work injury or work-related illness. Type print neatly. This form may also be filled out on-line at www.wcb.ny.gov.
