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Workers’ Compensation Board

New York State
Workers' Compensation Board
328 State Street  Schenectady, New York 12305
Subject No. 046-164

Please do not send requests for forms to William Bryant. As of July 2007 all requests should be sent to the attention of the "Reproduction Unit".

Revised Forms C-2 and C-3

Date: November 27, 2006

Earlier this year, the Workers' Compensation Board revised Forms C-7 and C-669 to include items asking if the injury was the result of the use or operation of a motor vehicle, and if so the name and address of the No-Fault carrier. (See Subject Number 046-155 dated April 25, 2006.) This information is needed in order to hold an expedited hearing, if necessary, in accordance with Section 142(7) WCL, which provides as follows:

Where there has been a motor vehicle accident which caused personal injury and there is a dispute as to whether the injury occurred in the course of employment, the worker's compensation board shall, after notice to the no fault carrier and the workers' compensation carrier, hold an expedited hearing on the issue of whether the accident occurred during the course of employment.

Pursuant to Section 142(7), the Board has now also revised Forms C-2, Employer's Report of Work-Related Accident/Occupational Disease, and Form C-3, Employee's Claim for Compensation, to ask if the injury was the result of the use or operation of a motor vehicle, and if so the owner of the vehicle and the No-Fault insurance carrier. In addition to these changes, Form C-3 was also revised to include new item A.3 asking for the claimant's residential address, if different from his/her mailing address, and new item D.2 asking if anyone witnessed the accident and, if so, the name(s) of the witness(es).

Revised Forms C-2 (11-06) and C-3 (11-06) are effective immediately. However, the current version of Form C-2 dated 2-04 may be used until June 1, 2007. After that, only the 11-06 version may be used. Earlier versions of Form C-3 will continue to be accepted, but we urge that the 11-06 version be used as soon as possible in order to expedite claims processing and resolution. The Board's Spanish Information Sheet for Form C-3 (11-06) has also been updated for the new items on Form C-3. This information sheet is designed to assist Spanish speakers in completing Form C-3. It is not filed with the Board.

Master copies of these and other common Board forms may be obtained by downloading the specific pdf file copy from the Board's website ( under the heading Common Forms, or by writing or faxing the Board at:

NYS Workers' Compensation Board - Attn: Mr. William Bryant
100 Broadway-Menands, Albany, NY 12241
FAX: (518) 486-3515


Donna Ferrara