New york fillable c240 2026

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The document is a Workers' Compensation Board form from the State of New York, designed for employers to report the wage earnings of an injured employee for the 52 weeks preceding an accident. It includes sections for employee information, wage details, military service status, and additional allowances. Employers are instructed to submit this report directly to the Workers' Compensation Board.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the W.C.B. Case Number and Carrier's Case Number at the top of the form.
Fill in the Date of Accident and Employee's Social Security Number, followed by their Address and Name.
Indicate the type of employment (hourly, daily, weekly, or monthly) and provide the wage details for the injured employee.
Answer whether the injured employee was in military service during the preceding 52-week period. If 'Yes', include the date of discharge.
Complete the schedule of gross wage earnings for each week leading up to the accident, ensuring to check 'X' next to the appropriate employee name.
If applicable, indicate any additional allowances such as free rent or bonuses and provide their weekly value.
Certify that all information is true and correct by signing and dating at the bottom of the form.

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Versions	Form popularity	Fillable & printable
2017	4.8 Satisfied (90 Votes)
2011	4.4 Satisfied (187 Votes)

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How can I eSign my c240 workers comp from Gmail?

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How to file a workers comp claim in NY?

Seek treatment immediately. Notify your supervisor about the injury and how it occurred as soon as you can. File a C-3 form with the Workers Compensation Board - online filing is the quickest.

Can you sue your employer after workers compensation in NY?

New York law states that if your employer provides workers compensation benefits to you for on-the-job injuries, you cant sue your employer or you co-workers for those same injuries. You are barred, meaning blocked, from suing them.

How to check workers comp status in NY?

New York State Workers Compensation Board Information Status. Individuals who have filed a workers compensation claim can use eCase, the Workers Compensation Boards electronic case folder, to view information the Board has received about their claim or to check the status of their claim.

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What not to say to a Workmans Comp adjuster?

What Not to Say to an Insurance Adjuster Never Admit Fault. Avoid Giving a Recorded Statement. Dont Downplay Your Injuries or Damages. Refrain From Speculating or Guessing. Be Cautious About the First Settlement Offer. Avoid Sharing Too Much Information.

How do I contact the workers compensation board in NY?

(877) 632-4996.

What is the phone number for the WCB in NY?

Customer Service Toll-Free Number: (877) 632-4996.

Can you file a complaint against workers comp?

File a Complaint: If the issue cannot be resolved, file a complaint with the California Division of Workers Compensation (DWC) or your states equivalent agency. Complaints can typically be filed online, by phone, or in person. Ensure you follow the specific procedures outlined by your state agency.

How do I complain about workers comp in NY?

Workers Comp Complaint Form You may use any method to report allegations of misconduct regarding the workers compensation system: To file a complaint by mail, please write to us at: Or fax your complaint to us at (518) 486-3745. You may also file a complaint by calling our toll free hot line at 1 (800) 367-4448.

New york fillable c240 2026

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