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Workers’ Compensation Board

New York State
Workers' Compensation Board
328 State Street  Schenectady, New York 12305
Subject No. 046-2

  Revised Prescribed Forms C-105, Notice of Compliance and
C-105.1, Notice of Compliance (Automotive or Horse-Drawn Vehicle)

  Supersedes Subject No. 046-2 dated October 16, 1997

October 4, 2005

Effective September 23, 2003, Section 51 of the NYS Workers' Compensation Law was amended to require a new $250 penalty be assessed to any employer not conspicuously posting Form C-105 or C-105.1 in each place of business. Both the C-105 and the C-105.1 posting notices have been revised to reflect this change. Workers' compensation insurance carriers should send out the revised versions of Forms C-105 and C-105.1 (9-05) upon the earlier of either an insured's request for this form or upon renewal of the insurance policy. Form C-105 is posted in a business's buildings and Form C-105.1 is posted in automotive and horse-drawn vehicles, including every vehicle used to move household goods or furniture.

A copy of Section 51 of the NYS Workers' Compensation Law is printed below. The new amendment is in bold font.

The New York State Workers' Compensation Board will shortly be issuing an Advisory Notice to employers advising them of this new penalty and instructing them to contact their workers' compensation insurance carrier for copies of these forms. Accordingly, carriers may expect to receive a significant increase in requests for these forms in the near future. Under Section 124 of the NYS Workers' Compensation Law, insurers must provide as many copies of these forms to their insureds as required.

Carriers should ensure that they have an adequate supply of Forms C-105 and C-105.1 to meet their insureds' needs. Form C-105 must be printed on 8 1/2" X 14" white stock of durable quality such as index or ledger. Form C-105.1 must be printed on 6" X 4" white stock of durable quality such as index or ledger. Carriers and self-insurers have been advised by a separate communication on how to obtain the revised forms.

Please contact 1-866-298-7830 if you have any questions or require any additional information.

Thank you for your cooperation.


David P. Wehner


  Section 51 of the NYS Workers' Compensation Law

Every employer who has complied with section fifty of this article shall post and maintain in a conspicuous place or places in and about his place or places of business typewritten or printed notices in form prescribed by the chairman, stating the fact that he has complied with all the rules and regulations of the chairman and the board and that he has secured the payment of compensation to his employees and their dependents in accordance with the provisions of this chapter, but failure to post such notice as herein provided shall not in any way affect the exclusiveness of the remedy provided for by section eleven of this chapter. Every employer who owns or operates automotive or horse-drawn vehicles and has no minimum staff of regular employees required to report for work at an established place of business maintained by such employer and every employer who is engaged in the business of moving household goods or furniture shall post such notices in each and every vehicle owned or operated by him. Failure to post or maintain such notice in any of said vehicles shall constitute presumptive evidence that such employer has failed to secure the payment of compensation. The chairman may require any employer to furnish a written statement at any time showing the stock corporation, mutual corporation or reciprocal insurer in which such employer is insured or the manner in which such employer has complied with any provision of this chapter. Failure for a period of ten days to furnish such written statement shall constitute presumptive evidence that such employer has neglected or failed in respect of any of the matters so required. Any employer who fails to comply with the provisions of this section shall be required to pay to the board a fine of up to two hundred fifty dollars for each violation, in addition to any other penalties imposed by law to be deposited into the uninsured employers' fund.