State-Specific Resources: New York

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