Search results
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 *
Instructions for Completing Form C-3, “Employee Claim”. 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.
Form C 3 – Fill Out and Use This PDF. The Employee Claim Form C-3 is a critical document for individuals in New York seeking workers' compensation benefits due to injuries or illnesses related to their work. It serves as an application to notify the Workers' Compensation Board of an incident, requiring detailed information about the employee ...
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.
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 ...
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. WCB Case Number (if you know it): C-3 or. A. YOUR INFORMATION (Employee) 1. Name: First. MI.
