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NYS Workers Compensation Board, Centralized Mailing, PO Box 5205, Binghamton, NY 139025205 STATE OF NEW YORK WORKERS COMPENSATION BOARD PROOF OF BURIAL AND FUNERAL EXPENSES UNDERTAKER W.C.B. Case
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How to fill out NYS Workers Compensation Board:

01
Before filling out the form, gather all the necessary information and documents such as the injured worker's personal and employment details, date and description of the injury, and medical records.
02
Start by accessing the NYS Workers Compensation Board website or visiting your local Workers Compensation Board office to obtain the required form. The most common form used is the C-3 Employee Claim Form.
03
Carefully read the instructions provided with the form to ensure accurate completion.
04
Begin by filling out the injured worker's personal information, including their name, address, phone number, date of birth, and Social Security number.
05
Next, provide information about the employer, such as the company's name, address, phone number, and workers' compensation insurance carrier details.
06
Fill in the details regarding the injury, including the date, time, and location of the accident, a description of how it occurred, and any witnesses present.
07
Provide information about any medical treatment received for the injury, including the name and contact information of the treating physician or healthcare provider.
08
Attach any relevant medical records, bills, or supporting documents to support your claim.
09
Carefully review the completed form to ensure accuracy and completeness.
10
Sign and date the form and make a copy for your records before submitting it to the appropriate address or delivering it to your local Workers Compensation Board office.

Who needs NYS Workers Compensation Board:

01
Employees who have suffered an injury or illness while performing their job duties in the state of New York may need to file a claim with the NYS Workers Compensation Board.
02
Employers in New York are required by law to provide workers' compensation insurance coverage to their employees, ensuring that injured workers receive necessary medical treatment and compensation for lost wages.
03
Healthcare providers, such as physicians and hospitals, may need to interact with the NYS Workers Compensation Board when treating injured workers covered by workers' compensation insurance.
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The New York State Workers' Compensation Board is the state agency responsible for administering and regulating the workers' compensation system in New York.
Employers in New York State are required to file with the Workers' Compensation Board.
Employers can fill out the necessary forms online or submit them by mail.
The purpose of the New York State Workers' Compensation Board is to ensure that injured workers receive necessary medical care and financial support as a result of work-related injuries or illnesses.
Employers must report employee injuries or illnesses, medical treatments, and any wage replacement benefits provided.
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