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Commonly Asked Questions about New York Workers Compensation Forms

DWC-7 Notice to Employees-Injuries Caused by Work (English and Spanish). This form provides your employees with information regarding workers compensation benefits and the Medical Provider Network (MPN) in California.
Maximum Medical Improvement (MMI) occurs when an injured person docHubes a state where their condition cannot be improved further or their healing process docHubes a Treatment Plateau .
A Certificate of Attestation of Exemption (CE-200) can only be used to attest to a government entity that an applicant requesting a license, permit or contract is not required to carry workers compensation and/or disability and Paid Family Leave benefits coverage.
CA-1 - Federal Employees Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation. Use for traumatic injury - employee was hurt because of a single event or within one workday. CA-2 - Notice of Occupational Disease and Claim for Compensation.
Call: 866-396-8314. A Board representative will take your information and complete the C-3 form. Submit a paper C-3 form. You can get a paper form from your employer or from the NYS Workers Compensation Board.
The C4 form is a document that is used to report a workplace injury to your employer and to the workers compensation insurance carrier. The form is divided into several sections, each of which must be completed in order to file a claim for benefits.
C-4.3. Use this form: 1. When rendering an opinion on MMI and/or permanent partial impairment; or 2. In response to a request by the Workers Compensation Board to render a decision on MMI and/or permanent partial impairment.
What Is a Form 43 Denial? An employer will complete Form 43 to inform the administrative law judge, the employee, and all interested parties that it intends to deny all or part of the injured employees claim for workers compensation benefits.