Nys workers' compensation guidelines 2022: Fill out & sign online

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Click ‘Get Form’ to open the NY Workers Compensation form in the editor.
Begin by entering the WCB Case Number and Carrier Case Number at the top of the form. This information is crucial for tracking your claim.
Fill in the Date(s) of Accident, ensuring accuracy as this will impact your case timeline.
Complete the Claimant, Carrier, and Employer sections by printing their names clearly. This identifies all parties involved.
In the 'Other Party-in-Interest' section, include any additional relevant parties to ensure they are notified.
Indicate your readiness for a hearing by checking either 'I AM READY FOR A HEARING' or 'I AM NOT READY FOR A HEARING.' If not ready, provide details on what further investigation is necessary.
Finally, sign and date the form at the bottom before submitting it through our platform for filing with the Board.

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