Notify your employer in writing within 30 days of the injury

You have the right to choose your own doctor (must be Board-authorized)

If your claim is denied, you have the right to a hearing before a Workers' Compensation Law Judge

Workers' Compensationmoderate

New York Employee Claim

C-3 · New York Workers' Compensation Board

Employee's claim for compensation filed with the NY Workers' Compensation Board. Must be filed within 2 years of the accident or within 2 years of when the claimant knew or should have known the condition was work-related.

Form Details

Total fields: 42
Auto-fillable: 26 (62%)
Time without BeneFill: 30 minutes
Time with BeneFill: 8 minutes
Time saved: 22 minutes
Filled by: patient
Frequency: per incident
State-specific: Yes — form may vary by state

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Where to Submit This Form

🌐

NY Workers' Compensation Board Online (recommended)

https://www.wcb.ny.gov/content/main/onthejob/OnlineFilingC3.jsp

File your C-3 Employee Claim form online.

📬

Mail to NY Workers' Compensation Board

New York State Workers' Compensation Board PO Box 5205 Binghamton, NY 13902-5205

Filing Deadline

Within 2 years of the injury or within 2 years of when you knew (or should have known) the condition was work-related.

Required Attachments

📎 Completed C-3 Employee Claim form
📎 Medical records and treatment documentation
📎 Employer's name and insurance carrier information (if known)

Processing Time

The Board will schedule a hearing, typically within 6-8 weeks of filing. The insurer has 25 days to controvert (deny) the claim.

What Happens Next

The Workers' Compensation Board will assign a case number and schedule a hearing. The insurer's adjuster will contact you.

Tips for This Form

✓ Notify your employer in writing within 30 days of the injury
✓ You have the right to choose your own doctor (must be Board-authorized)
✓ If your claim is denied, you have the right to a hearing before a Workers' Compensation Law Judge
✓ More info: https://www.wcb.ny.gov/

More Workers' Compensation Forms

First Report of Injury (Generic FROI)

FROI · State Workers' Compensation Agencies

Report of workplace injury or occupational disease filed with the state agency and insurer. Required within 3-10 days of injury depending on state. Establishes the claim in the system.

California Workers' Comp Claim Form

DWC-1 · California Division of Workers' Compensation

Employee claim form for workers' compensation benefits in California. Employer must provide within one working day of learning of a workplace injury or illness.

Texas Employee's Claim for Compensation

DWC-041 · Texas Department of Insurance, Division of Workers' Compensation

Employee's claim for compensation for a work-related injury or illness in Texas. Must be filed within one year of injury or within one year of when the employee knew or should have known the condition was work-related.

Florida First Report of Injury or Illness

DFS-F2 · Florida Division of Workers' Compensation

Florida's first report of injury or illness form. Employer must file within 7 days of knowledge of an injury or within 24 hours if the injury results in death.

North Carolina Notice of Accident to Employer

Form 18 · North Carolina Industrial Commission

Notice of Accident to Employer and Claim of Employee. Must be filed when injured on the job in North Carolina. Written notice to employer required within 30 days; claim filed within 2 years.

Employer's First Report of Injury (Longshore)

LS-202 · U.S. Department of Labor (OWCP)

Employer's First Report of Injury or Occupational Illness under the Longshore and Harbor Workers' Compensation Act. Must be filed within 10 days of injury.

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Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the New York Workers' Compensation Board or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.