In accordance with New York State Workers’ Compensation Law, print the following notices and post in a conspicuous location within the workplace:
When an employee reports a work-related injury, the following steps must be performed by the employer:
- Provide the injured employee with the following documentation:
- If the employee works at a school, request that s/he work with the school’s OORS operator to complete an OORS report in order to document the incident.
- Instruct the employee to mail the completed Employee Claim (C-3 form) to the New York State Workers’ Compensation Board district office as soon as possible but no later than two years of the date of the accident. The mailing address is:
New York State Workers’ Compensation Board District Office
PO Box 5205
Binghamton, NY 13902-5205
- Instruct the employee to return the remaining forms to you, once completed.
- Print and complete the Supervisor’s Report of Injury (WCD 201 form).
- Should you wish to dispute the employee’s claim, print and complete the C-2 Addendum.
- Complete and submit the Employer’s Report of Work-Related Injury/Illness (C-2 form) online via thePayroll Portal (once signed in, the form can be found in the DOE Applications section). Print a copy of the submitted form.
- Mail copies of the following documents to the New York City Law Department:
- Employer’s Report of Work-Related Injury/Illness (C-2 form)
- Supervisor’s Report of Injury (WCD 201 form)
- Either the employee’s Comprehensive Injury Report or the OORS report, as applicable
- C-2 Addendum (if desired)
The mailing address is:
Absences Relating to Workers’ Compensation Injuries
New York City Law Department Workers’ Compensation Division
350 Jay Street, 9th Floor
Brooklyn, NY 11201
The date of the accident:
This is a regular paid day regardless of the time of the injury.Five consecutive days following the date of the accident:
Following the date of the accident, the employee may apply to receive up to five consecutive working days off; the employee will be paid for these days and the absences will not affect his/her accrued annual leave or paid sick leave balances. In order to be eligible, the employee must obtain a doctor’s note, recommending that the employee does not return to work, and complete one of the two following forms as appropriate:
The employee’s supervisor will determine if the absences should be excused without penalty against the employee’s accrued annual leave or paid sick leave balances. Once the form is signed by the employee’s principal or supervisor, the employee should submit it, along with the doctor’s note, to his/her payroll secretary/timekeeper. The payroll secretary/timekeeper, in turn, should forward the documentation as follows:
- School-based (non-pedagogical) employees: Maintain the OP 198 form and doctor’s note in employee’s personnel file
- Administrative employees: Fax the PD 19 form and doctor’s note to the CyberShift Unit: (718) 935-2795
Six or more absences following the date of the accident: If the employee is absent for six or more days following the work-related injury, s/he has two options:
- Option 1: Provided the employee has enough vacation or sick time accrued, s/he may elect to use these balances to cover the absences. If elected, the employee must inform his/her payroll secretary/timekeeper of this decision and provide a doctor’s note, indicating that the time off is related to the work injury. If accrued sick time is to be used, payroll secretaries/timekeepers should code the absences as “sick-doctor’s note”.
Employees may be eligible to have the used vacation or sick time restored. They should keep track of these days and once all accrued time has been used (or the employee has fully returned to work), employees should contact their benefits examiner to report the use of paid vacation or sick time as a result of the work-related injury. The benefits examiner will review the evidence and determine if a hearing is warranted. If restored, the employee can expect to receive only a portion of the used vacation or sick time; full restoration of vacation or sick time is determined on a case-by-case basis. Restoration is based on the degree of the employee’s disability and his/her salary rate. Once determined, the New York City Law Department will forward the memorandum of the administrative decision (WCD76 form) to the DOE’s Workers’ Compensation Unit. Once received, the DOE’s Workers’ Compensation Unit will calculate the days to be restored based on the rate awarded, enter the time into the timekeeping system, and then communicate the restoration to the employee’s payroll secretary/timekeeper via email. The payroll secretary/timekeeper, in turn, will communicate the restoration to the employee. Note that restoration of vacation and/or sick time cannot be entered into the timekeeping system by field staff.
- Option 2: If the employee chooses not to use his/her accrued time off (or if the employee does not have an accrued time balance), s/he will not receive pay for days not worked. Instead, the employee should first apply for a leave of absence without pay and then request reimbursement from the New York City Law Department. Once the employee submits a leave of absence request, the payroll secretary/timekeeper must forward it, along with a copy of the C-2 form, to HR Connect for processing. After HR Connect’s review, it will send a letter of disposition to the employee. Once this is received, instruct the employee to do the following in order to receive wage replacement benefits:
- Contact the DOE’s Workers’ Compensation Unit – (718) 935-2213 – to make it aware of the effective leave date.
- Contact the assigned examiner at the New York City Law Department to inform him/her of the effective leave date.
- Forward a copy of the doctor’s note to the examiner at the New York City Law Department. This note must state the effective date that the employee was unable to work and that the inability to work is related to the workers’ compensation claim.
The maximum time allowed for leave associated with a workers’ compensation case is one year. During this period of unemployment, the employee will receive pay from the New York City Law Department. The weekly rate is determined by the New York City Workers’ Compensation Board. If the employee is enrolled in direct deposit, it will be cancelled.
It is the responsibility of the payroll secretary/timekeeper to notify the DOE Workers’ Compensation Unit, via email, of all absences associated with an employee’s claim. Absences should be reported as they occur.
Whenever in doubt as to how to code an employee’s absence, call the DOE’s Workers’ Compensation Unit: (718) 935-2213.
In the event that an employee is invited to attend a workers’ compensation hearing, s/he is obligated to go. Further, the employer is also responsible for supplying witnesses upon request. Time away to attend a hearing should be coded by timekeepers as “Non-chargeable Absence”. A maximum of three hours can be assigned to this code for this purpose.
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