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Forms - NYSIF

Access frequently-used workers' compensation and disability benefits forms below. Many of the forms link directly to the Workers' Compensation Board website. Please note that these forms are in PDF format. Each browser has its own settings to control how PDFs open from a web page.

https://ww3.nysif.com/Home/FooterPages/Column1/Forms

Limiting Liability - NYSIF

NYSIF case managers maximize recovery and outcomes and provide a single point of contact for claimants and policyholders. The Workers’ Compensation Board (WCB) issues and enforces all applicable fines and penalties under the Workers’ Compensation Law. The WCB makes decisions on all claims for workers’ compensation and disability benefits.

https://ww3.nysif.com/Home/Employer/WCpolicyholder/AboutYourPoli...

Compensation Benefits - NYSIF

Benefits are payable from the date of disability if an injured worker’s lost time exceeds two weeks. Compensation is based on earnings determined by payroll records for the 52 weeks prior to the date of accident.

https://ww3.nysif.com/en/Employer/WCpolicyholder/AboutClaims/Com...

About Your Claim - NYSIF

File Form C-3 with the Workers’ Compensation Board (WCB). For an occupational disease, the claimant must give notice to the employer within two years of disablement, or within two years after the claimant knew or should have known that the disease was work-related.

https://ww3.nysif.com/Home/Claimant/WCClaimant/AboutYourClaim

NYSIF Online Quote - NYSIF

NYSIF offers an instant quote for employers seeking workers’ comp coverage for domestic household workers, such as a cook, home health aide, housekeeper, nanny or gardener. You can obtain an instant quote for domestic coverage if there are fewer than 10 covered persons qualifying as an inside or outside domestic worker.

https://ww3.nysif.com/Home/Employer/LookingForInsurance/Insuranc...

NYSIF Insurance Plans - NYSIF

Summary of NYSIF workers' compensation insurance plans and disability benefits insurance plans.

https://ww3.nysif.com/Home/Employer/LookingForInsurance/NYSIFIns...

Completing the Workers’ Compensation Board Form C-240

The WCB relies on days worked per week, not hours, to determine a claimant’s average weekly wage. If the proper days are not listed, an employer representative may be required to testify on the issue of wages earned.

https://ww3.nysif.com/-/media/Files/CLAIMS/PDF/EMPLOYER_INST_C24...

Special Circumstances - NYSIF

NYSIF policyholders are responsible for injury claims brought by employees of uninsured subcontractors. Policyholders who sub-contract with out-of-state employers must confirm that these subcontractors have full, statutory New York State workers’ compensation coverage.

https://ww3.nysif.com/Home/Employer/WCpolicyholder/ConstructionP...

Payment Plans - NYSIF

See Pay My Bill to choose your payment option.

https://ww3.nysif.com/Home/Employer/WCpolicyholder/AboutYourBill...

WELCOME TO NYSIF - ww3.nysif.com

Setting up an online account is quick and easy at nysif.com/customer. You’ll need: This information is included in your policy packet. Sign up to go paperless and access your documents online. You’ll receive an email notification when policy documents and your premium bill are available.

https://ww3.nysif.com/-/media/Files/NYSIF_Publications/PDF/ONLIN...