(On-the-Job Injury or Illness)
How to File a Claim
If you are injured on the job, you should complete the Board's form Employee Claim (C-3) as soon as possible to ensure your benefits are not delayed or interrupted. You must also notify your employer in writing of when, where and how you were injured or became ill.
- The fastest way to file is by completing the web version of the Employee Claim (C-3) form.
- You may file a paper form by printing the Employee Claim (C-3) form, or by visiting any Workers' Compensation Board Office. Paper forms should be mailed to the Centralized Mailing Address.
- If you have questions about filing an Employee Claim (Form C-3), please call (877) 632-4996 and a Board representative will assist you.
You will be notified by mail of any action regarding your claim.
Remember: You must file a claim within two years of the accident or within two years after you knew or should have known that a contracted disease was due to the nature of your employment.
When an injured worker has passed away at work or due to an existing work injury/illness, the next of kin should file a Claim for Compensation in Death Case (C-62 Form), along with the appropriate documentation, to the Board. A Proof of Death by Physician Last in Attendance on Deceased (C-64 Form) would need to be filed by the last treating physician stating how the deceased death is causally related to work (or the previous work injury). The Proof of Burial and Funeral Expenses by Undertaker (Form C-65) would be completed by the funeral home.
- Q. What do I need to do if my spouse/parent/child/grandchild(ren)'s passes away while collecting workers' compensation benefits?
- A. Notify the Board and insurance carrier¹ immediately and submit (when available) a copy of the death certificate.
- Q. As a widow/widower, will his/her compensation benefits continue coming to me?
- A. In most cases benefits may stop. The widow/widower must file for a workers' compensation death claim showing medical proof that the injured worker's death was related to the established work injury. If the death claim is found compensable, payments may resume retroactive to the date of death.
- Q. What do I need to do if my spouse/parent/child/grandchild(ren)'s death was because of his/her work injury?
- A. File for a Workers' Compensation death claim by completing a Claim for Compensation in Death Case (C-62 Form) with the appropriate documentation. You will also need to file the Proof of Death by Physician Last in Attendance on Deceased (C-64 Form) and, if you have it, medical evidence from the last treating physician stating how the death is causally related to the original work injury/illness.
- Q. What if my child was killed at work and has no dependents; are there benefits payable for at least funeral expenses?
- A. Parents who were not dependent on the deceased would be eligible for a no-dependency award if there is no spouse, children, or other dependent family members. They would also be eligible for paid funeral expenses, up to the maximum allowed under Workers' Compensation law.
- Q. Can I file for a death claim if my spouse had a Section 32 settlement on his/her case and has since passed away due to the injury/illness?
- A. Yes, only if the death was related to the actual injury/illness.
¹ licensed insurance company, third party administrator or self insured employer.