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How to fill out your workers' compensation C-3 form

New York Workers' Compensation Attorneys

If you were injured on the job or suffered from an illness you believe was linked to work, you may not know exactly where to turn or how to go about pursuing workers' compensation benefits. The process is more complex than you think, which is one reason why you might need to turn to an experienced New York workers' compensation lawyer for help.

The easiest way to get started on a workers' compensation claim in New York is to file a C-3 form, which allows you to report your workplace injury. This form is available for download on the New York State Workers' Compensation Board (NYSWCB) website. You can either file your C-3 form on the NYSWCB website electronically or print it out and submit it to your local district office.

You have up to two years from the date of your workplace accident to file a workers' compensation claim in New York, but it's usually best to file your claim as soon as possible. When filling out your C-3 form, it's also critical that you take your time to ensure that all the information is correct. If anything isn't filled out correctly, your C-3 form can be denied by the NYSWCB.

What will I find on my C-3 form?

The C3 form consists of two pages with a total of six sections.

On page 1, you'll find:

  • Section A — This section will ask for basic information such as your name, mailing address, date of birth, social security number, phone number, and gender. It will also ask if you need a translator if you must attend a Board hearing.
  • Section B — This section will ask for information pertaining to your employer. This includes the name, address, and phone number of your employer at the time of your workplace accident. It will also ask for your hire date, supervisor's name, and if you had more than one employer at the time of your injury.
  • Section C — This section will ask for additional details pertaining to your employment. Here, you will need to provide:
    • Your job title or description
    • Typical work responsibilities and duties
    • Whether your job was full time, part time, seasonal, volunteer or other
    • Your gross pay per pay period before taxes
    • How often you were paid
    • If you received lodging or tips in addition to your wages
  • Section D — This section will ask you to provide details pertaining to your work-related injury or illness. This includes:
    • The date and time of your injury or onset of illness
    • The location where your injury occurred
    • If the location where your injury occurred was your usual work location
    • What you were doing prior to your injury or illness

On page 2,  you'll find:

  • Section D continued — Section D on page 2 will ask for the following information pertaining to your injury:
    • A description of how your injury or illness happened
    • The nature of your injury or illness and affected body parts
    • Any objects, equipment, or machinery that were involved in your injury or illness
    • If your injury was the result of operating a licensed motor vehicle
    • If you gave your employer/supervisor notice of your injury or illness
    • Whether or not any witnesses were present at the time of your injury
  • Section E — Section E will ask if you stopped work because of your injury or illness.
  • Section F — Section F will ask if you were treated for your work-related injury or illness. It will also ask if you had a prior injury to the same body part or a similar illness.

Contact our New York law firm for help with your workers' compensation claim

If you were hurt on the job, the dedicated legal team at Pasternack Tilker Ziegler Walsh Stanton & Romano LLP Attorneys At Law can help guide you through this complex process and advocate for a fair settlement on your behalf. Your workers' compensation benefits pay for current and future medical expenses; lost wages while you're unable to work; and disability benefits if you sustained a partial or permanent disability due to your injury or illness.

Our law firm has five offices conveniently located in NYC, two offices in Long Island, and eight offices throughout New York State. Contact us online or call us to get started on your claim.

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