Workers' Compensation Attorneys in New York City
800.692.3717Toll Free 24 / 7

How to fill out your New York Workers' Compensation C-3 form

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. Specifically, you will need to correctly complete and file a C-3 form with the Board.

This 2-page long form might seem straightforward. But it's important to understand that the information you provide can make a dramatic difference in whether or not you receive the benefits you're entitled to after your workplace injury. In many cases, such benefits can add up to hundreds of dollars every week, depending on the severity of your injury and how long ago it occurred.

We strongly recommend contacting our law firm to help you fill out your C-3 form. The information provided below (which applies to the EC-3 form, the electronic version of the C-3 form) is simply to provide you with more information about the application process. To learn more about what you should do after your workplace injury, simply contact our New York City law firm and schedule your free case evaluation. We have 12 offices in the NYC area, including offices in Manhattan, Queens, the Bronx and three locations in Brooklyn.

Understanding your NY Workers Compensation C-3 form

Page 1

Section A

Section A might seem straightforward. But if you make a mistake here (such as writing down the wrong Social Security Number), your entire application could be denied. That's why it's important to take your time filling out this form. It's also critical that you file it in time: You have up to 2 years from the date of your workplace injury to file a C-3 form with the state of New York.

New York Workers' Compensation C-3 form, Page 1, Section A

Section B

Section B concerns information about your employer. If the company you work for has multiple offices in different states, it might be more beneficial to you if you list an office located in a specific location. Our lawyers can discuss this issue with you as well as the reasons why you should be cautious when dealing with your employer after your accident. Some people assume they can deal directly with their employer after a serious workplace injury - but in reality, your employer might not have your best interests at heart. If the financial impact of your workplace injury is significant, your employer and their insurance company may try to limit the money you receive.

New York Workers' Compensation C-3 form, Page 1, Section B

Section C

The answers you provide in Section C could make the biggest impact on how much money you receive in workers' compensation benefits. New York State will base the amount it pays you after your accident on two factors - the severity of your injury and your salary prior to your accident. The maximum amount injured workers can receive each year is adjusted on July 1st.  The state then adjusts your benefits based on whether you're 100 percent injured, 50 percent injured or some other percentage. That's why the answer you provide for question 4 about your gross pay matters so much. Question 2 in Section C can also make a big difference. If you were performing activities at work at the time of your injury that you don't normally perform, your employer might try to claim you somehow did something to cause your injury. That's why you should carefully review your answers with us.

New York Workers' Compensation C-3 form, Page 1, Section C

Section D

Section D focuses on your specific workplace injury. The exact words you choose for Question 5 are extremely important. The same applies to Question 6. If your description tells the state workers compensation board that your injury is less severe than it is, you might receive significantly less money. This is also true for Question 7. Many people like to downplay just how badly they got hurt at work - but the only person you're hurting is yourself. If you were seriously injured at work, you should receive the maximum benefits so that you can fully recover from your injuries.

New York Workers' Compensation C-3 form, Page 1, Section D

Page 2

Sections E and F

Sections E & F seem straightforward, but it's important to be especially careful. In Section F, Question 1, the board might deny your claim if you mark "None received" and in other parts of your application you provide conflicting information. The answer you provide for Section F, Question 2 could also affect the outcome of your claim. If you suffered a similar injury in the past, but never reported this injury to the board or your employer, the board might question the severity of your injury. That's why we cannot stress enough just how important it is to consult with our knowledgeable legal team about your workplace injury as soon as possible.

New York Workers' Compensation C-3 form, Page 2, Sections E and F

Click here for a printable PDF.