Text Size:
New York Workers Compensation Information
The information below is useful for understanding and managing workers compensation in New York State.

Legislative Reform

Workers Compensation Information and Forms

Form C-3 Employee's report of a work-related injury 
Form C-3.1 Employee's notice of the right to select a Workers Compensation Board-authorized health care provider
English          Espanol 
Form C-3.3 Limited medical release
English         Espanol 
HIPPA form Medical release 
Medical Questionnaire (Travelers) Request for names and addresses of prior treating physicians 
Mileage Reimbursement Request Employee's tally sheet of mileage for each physician visit 
Network Direction Letter
(Travelers)		 Information regarding the carrier's ability to direct diagnostic testing and to direct to a network pharmacy 
WCB "Basics" Guide Employee's workers compensation guide to understanding rights and responsibilities of all parties 

 

 

 
Report Your Claim

Report your claim
directly - we'll get to
work immediately.

24 / 7 / 365

Business Insurance Claims:

800.238.6225


National Accounts Claims:

800.832.7839


Constitution State Services Claims:

800.243.2490


Construction Claims:

877.828.4132