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Learn about Governor Hochul's proposal to increase injured workers' access to medical care

Web Submission of Claim Forms List of Available Forms for Employers

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These forms are available for completion and online submission through the Board's website.

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. It should be saved for your records. DO NOT MAIL THIS FORM TO THE BOARD.

Form Instructions

Forms submitted by employers
Form Number Form Title Registration required? Comments
C-11 Employer's Report of Injured Employee's Change in Employment Status Resulting From Injury No As soon as employment status of injured employee changes.
C-240 Employer's Statement of Wage Earnings No Within 10 days of request by the Board.
PH-16.2 Pre-Hearing Conference Statement No Filed 10 days before scheduled pre-hearing conference for controverted cases (FROI-04/SROI-04).

If the form you are looking for is not available for online submission, you may print the PAPER version of the form from our list of common forms.