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New York State
Workers' Compensation Board
OFFICE OF THE CHAIR
20 Park Street   Albany, New York 12207
Governor David A. Paterson


Subject No. 046-290

Distributing The Claimant Information Packet to Injured Workers

Date: February 17, 2009

Board Rule 300.37 calls for employers to distribute a "claimant information packet" to workers at the time of their injury or illness. The rule defines the elements that should appear in that document, which include information on

  • Filing a claim
  • Providing notice
  • Hiring representation
  • Obtaining health care
  • Using a carrier's designated pharmacies and diagnostic testing networks

The Board has incorporated those items in a document which, when combined with Form C-3, Employee's Claim, and Form C-3.3, Limited Release of Health Information (HIPAA), constitutes the Claimant Information Packet. Employers can comply with Board Rule 300.37 by distributing the Packet to their workers when they become aware of any injury or work-related illness. The Claimant Information Packet is located on the Board's website, under both the Employers and Workers tabs and on the Forms pages next to Form C-2, Employer's Report of Work-Related Injury/Illness. Employers can download, print and distribute this version of the Packet as needed. For Spanish-speaking workers, a Spanish Claimant Information Packet can also be downloaded at the same locations on our web site.

INJURED ON THE JOB PAMPHLET

While not mentioned in Board Rule 300.37, the Board's Injured on the Job pamphlet was also revised. This document, directed toward claimants, has long been used by workers' compensation stakeholders. It contains helpful details about accessing benefits and the claimant's rights within the New York workers' compensation system. Employers and carriers may distribute the Injured on the Job pamphlet to workers in addition to the mandatory Claimant Information Packet. The pamphlet can also be downloaded and printed from the Board's web site, under the Workers tab. Claimants may also get a paper copy of the pamphlet from any Board office. A Spanish version of the Injured on the Job pamphlet will be available in March.

FORM C-430S, STATEMENT OF RIGHTS

Please note that in addition to the mandatory provision by the employer of the Claimant Information Packet, the insurance carrier/self-insured employer is still required by law to provide a Statement of Rights (Form C-430S) to injured workers in accordance with WCL Section 110:

The carrier, within fourteen days of receipt of the report [C-2] or accompanying the initial check forwarded to the employee, whichever is earlier, or a self-insured employer, within fourteen days of transmitting the report to the chair or accompanying the initial check forwarded to the employee, whichever is earlier, shall provide the injured employee or, in the case of death, his or her dependents with a written statement of their rights under this chapter, in a form prescribed by the chair.

Form C-430S is two-sided, with the Statement of Rights in English on one side and Spanish on the reverse.

Thank you for your cooperation.

 

Zachary S. Weiss
Chair