C-4 Form Versions (C-4, C-4.2, C-4.3, EC-4AMR, EC-4NARR)
Health Care Providers submitting any versions of the C-4 forms must be authorized by the Board to treat workers' compensation injuries. Application to Become a Board Authorized Health Care Provider
Occupational and Physical Therapists submitting online OT/PT-4 forms must be licensed in New York State.
For a list of forms which may be submitted online, please refer to the "List of Available Forms".
Forms are in PDF format. The Board recommends using the latest version of Adobe Reader which is available as a free download from Adobe's web site.
You will need to register to obtain a User ID and Password.
Please Note: User IDs and passwords are created for Health Care Providers only.
The user ID and password in conjunction with the WCB Authorization Number (C-4 form versions) or NYS license number (OT/PT-4) is considered to be the legal equivalent of actually signing the form by hand.
If you submit a form online, DO NOT mail a duplicate paper form to the Board.
Save Form Data
The Load Data and Save Data buttons, allow data from the form to be saved on your computer. You can then use the saved data to pre-populate fields the next time you submit the form. This may significantly reduce the amount of duplicate data entry required.
Attach a Document
You can attach documents to be submitted with the form.
Confirmation of Submission to the Board
After the Board receives your form, a non-editable PDF version of the form will appear in your web browser. The first page contains a confirmation that your form was successfully submitted to the Board and the date. This PDF should be saved for your records and used to send copies of the form and any attachments to required parties. DO NOT MAIL THIS FORM TO THE BOARD.
If the confirmation page does not appear in your web browser after you submit the form to the Board, then the Board did not successfully receive the form and you will need to resubmit it.
If you have problems submitting forms or questions please direct them to the NYS Workers' Compensation Board Help Desk.
Forms may be submitted 24 hours a day. However, there are times when the forms may not be available. Please review the Board's On-line Services Availability. Select Claims Web Forms Submissions for specific information. If you are experiencing problems you should check these web pages before contacting our Help Desk.