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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.
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 *
File a C-3 employee claim form online, complete as many fields with as much detail as you can and submit. No other documents are necessary to file a C-3 and you don’t need to establish an account with the Workers’ Compensation Board.
If you do not have access to a computer, visit the nearest Workers' Compensation Board Office to file a claim. If you have questions about filing an Employee Claim (Form C-3), please call Customer Service and a Board representative will assist you.
12 wrz 2023 · 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.
State of New York - Workers' Compensation Board. Fill out this form to apply for workers' compensation benefits because of a work injury. C-3 RU ZRUN UHODWHG LOOQHVV 7\SH RU print neatly. This form may also be filled out on-line at www.wcb.ny.gov. WCB Case Number (if you know it): A. YOUR INFORMATION (Employee) 1. Name: First. MI. Last. 2.
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 may also fill this form out online at wcb.ny.gov.
