Workers' Compensation

Employer

 

 

Workers’ Compensation Contact Information

*The C3 form (Employee’s Claim) must be mailed to the WCB District office within 2 years from the date of the accident to: WCB District Office, PO Box 5205, Binghamton, NY  13902-5205.

 

  • Print and complete the following forms if applicable:

C2 Addendum
WCD 201 Supervisor’s Report of an Injury/Illness

 

  • Submission of the C2 is available thru the Payroll Portal. Send a copy of the C2 and related forms to:


New York City Law Department
Workers’ Compensation Division
350 Jay Street, 9 fl
Brooklyn, NY 11201
Tel: 718-222-5100*Fax: 718-222-2387/2389

 

  • Attendance
    Non-chargeable days- The employee may apply for up to five consecutive working days from the date of the accident as non-chargeable pending supervisory approval of one of these forms:

    OP 198 Application for Absence due to Personal Illness-Sick Leave
    OP 19 Application for Excuse of Absence with Pay for Administrative Employee

    Option 1: Employee chooses to use their accruals for the duration of their absences relating to workers’ compensation.  It is the responsibility of the employee to communicate with their examiner in regards to getting their sick time restored.

    Option 2: Employee chooses not to use their accruals (or does not have any), therefore they will be payroll deducted and reimbursed from the Law Dept.  Depending on the length of absence employee may have to apply for a leave of absence without pay.  The leave application along with a copy of the C2 form must be submitted to HR Connect for processing.  The maximum time allowed for leave for WC is one year.  If applicable, direct deposit has to be stopped.  It is the responsibility of the payroll secretary/timekeeper to alert the WC Unit at the DOE with all absences regarding the employee’s claim. 

    Hearings: The employee is obliged to appear at the WC Hearing when notified.  Three hours of time spent is charged to the DOE.  The employer is also responsible for supplying witnesses upon request.