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Click ‘Get Form’ to open the WTC-12 form in the editor.
Begin by entering your current residential address in Item 1, including apartment number, street name, city, state, and zip code. Don’t forget to provide your telephone number and Social Security Number.
In Item 2, confirm your participation in World Trade Center operations between September 11, 2001, and September 12, 2002.
Specify whether you participated as an employee or a volunteer in Item 3.
For Item 4, list any evidence of your activities as a volunteer such as badges or letters.
Complete Item 5 by detailing the dates and locations of your participation along with descriptions of the work performed.
Indicate in Item 6 if you have previously filed a workers' compensation claim related to this participation.
Review all entries for accuracy before signing the Sworn Statement in front of a notary public as instructed.
Start filling out your WTC-12 form online for free today!
What is the fax number for the New York State Workers Compensation Board?
Email to the Boards centralized email address, wcbclaimsfiling@wcb.ny.gov; Mail to the Boards centralized mailing address, P.O. Box 5205, Binghamton, NY 13902-5205; or. Fax to the Boards centralized fax number, (877) 533-0337.
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.
How does NYS workers comp work?
The employer is required to pay for the insurance, and employees cannot be required to contribute to the cost of the insurance policy. A workers compensation insurance company may accept a claim, contest a claim, or contest part of a claim filed by an injured worker.
How long do I have to file a workers comp claim in NY?
Main Takeaways: Always report your on-the-job injuries to your immediate supervisory as soon as possible after your accident. Workers must report their injuries within 30 days of the accident, according to New York law.
What is the maximum payout for workers compensation in New York?
Workers comp payouts for lost wages in New York are calculated as follows: You receive 2/3 of your average weekly wage multiplied by your percentage of disability. As of July 1, 2023, the maximum weekly benefit is $1,142.08. The minimum weekly benefit is $150 or your average weekly wage, whichever is less.
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The registration form (WTC-12) must be filed not later than. September 11, 2026. 6. To register, this Affirmation must be accurately and truthfully completed
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