C-3 Form: Injured Workers’ Compensation Forms

September 12, 2023
Steven Schwartzapfel

What Is a C-3 Workers’ Compensation Form?

When applying for workers’ compensation, there are many details that you must provide concerning your injury and the circumstances of how it occurred. A C-3 form is an employee claim for workers’ compensation. It is the first step in applying for workers’ compensation benefits.

A C-3 form contains seven (7) sections, each of which asks important questions about the injured employee and the details surrounding the injury. To help you better understand what you’ll need to know to successfully fill out a C-3 form, the following is a summary of the sections on the form:

Employee Information

In this first section of the C-3 form, applicants are asked to provide their basic information. This includes their full name, address, date of birth, and social security number.

Employer Information

The second section of the C-3 requests information about your workplace and employers. This includes the address of your workplace as well as who your supervisor is.

You will also need to provide the date you were hired as well as the names and addresses of the employers or supervisors present at the time you were injured.

Your Job When Injury Occurred

In this section, you must provide details about your job. The questions in this section detail the nature of your job, including what tasks you are responsible for and what you normally perform at work.

In this section, you are also asked to report how much money you make at your job and how often you are paid, including any tips or additional pay.

To learn more now, call Schwartzapfel Lawyers at 1-516-342-2200 or visit us online now!

The Injury or Illness Incurred

Once you’ve provided basic information in the first sections of the C-3 form, you will now need to provide thorough details about the injury and how it happened. In this section, you must answer and fully explain the following:

The date and time the injury occurred.
The address of where the injury occurred and whether or not that is your usual work location
What you were doing and what task you were performing when the injury occurred
How the injury happened, or what caused it to happen
The extent of the injury and its physical effects
Objects or machinery that were involved in the injury
If your injury occurred while operating a licensed motor vehicle and who owns the vehicle
Whether you’ve told your employers or supervisors about the injury
The names of people who witnessed the incident that caused your injury, if applicable

Return to Work Plans

After detailing the nature of your injury and how it occurred, you will next be asked about your plans to return to work. Here, you should be prepared to answer questions relating to:

How much work you’ve missed because of the injury
When you returned to work or when you are planning to return to work
Whether you are working for a new employer

Medical Treatment You Received or Will Receive

In the last section of your C-3 work, you will be asked about any medical treatment you received for your injury. You’ll need the following information to fill out this section:

The date of the first treatment you received for your injury
Whether you were treated on-site when the injury occurred
Where you received treatment for your injuries
The names and addresses of doctors and clinics you visited for treatment of your injury
Whether you’ve had a similar injury in the past
Whether you are receiving ongoing treatment for your workplace injury

You will need to file a C-3.3 form with your C-3 form to provide documentation for the medical treatment that you received. This form requires contact information for your primary healthcare providers.

Please note that you may be required to submit supplemental documentation with your C-3 form to further substantiate your claim. All of the information you provide on a C-3 form must be accurate.

Because filling out a C-3 or any important form can be stressful, we suggest enlisting the help of an experienced workers’ comp lawyer.

At Schwartzapfel Lawyers, we’ll ensure you have all the information and documentation you need to properly complete your C-3 form. Give us a call at 1-516-342-2200 or visit us online to learn more now at no charge!

Who Qualifies for Workers’ Compensation?

Every year, there are more than 200,000 workplace injury cases in New York City. Workers’ compensation is provided to individuals who are injured in the workplace or due to a workplace accident.

Although this may seem simple, workers’ compensation incidents vary by case, and some people may not qualify for benefits.

As such, it’s important to determine whether you qualify for workers’ compensation insurance so you can file your claim as soon as possible.

Before filling out a C-3 form and taking the first steps in filing for workers’ compensation, keep reading to see if you meet the criteria to qualify to receive benefits:

You’re an Employee

To be eligible for workers’ compensation, you must be an employee of a company or organization. Other types of workers, such as contractors or freelancers, may not be eligible to receive workers’ compensation.

If you’re unsure whether or not you are considered an employee of a company, it is best to speak to a lawyer to determine your eligibility.

You Were Injured at Work or While Working

For workers’ compensation benefits to be attached to your injury, the injury must have occurred at work or while in the performance of job-related duties. As an example, workplace injuries can be caused by a lack of workplace safety measures or while operating heavy machinery.

Simply put, the injury must have been caused by your work.

You Can Provide Documentation for Your Injury

To file a workers’ compensation claim, you must have some sort of medical record for any injuries incurred due to a workplace incident. Without medical records, there is no proof that the injury occurred or that you sought medical help for your injuries.

You must be seen by a doctor or medical professional as soon as a workplace accident occurs. This will ensure that you are properly treated and will also serve to create documentation of the injury.

What Disqualifies You for Workers’ Compensation?

Now that you know what qualifies you for workers’ compensation, you should also know what can disqualify you from receiving benefits. Here are a few reasons why your claim may not be accepted:

You Were Injured on Your Commute: If you were injured on your way to or from the workplace or while you were on break, you may not qualify for workers’ compensation insurance. Note: Typically, you are only eligible to receive benefits for injuries incurred while you are on the clock.
You Were Injured Due To Intoxication on the Job: If the use of any substances led to your workplace injury, then the injury may be your responsibility.
You Were Injured by Another Person or Worker: If you were injured by another person while on the job due to a fight or because you were engaging in horseplay, you may not be eligible for workers’ compensation.
You Waited Too Long To File Your Claim: While certain exceptions may apply, you must submit your claim for workers’ compensation benefits within thirty (30) days of incurring a workplace injury. As such, should you file your claim too late, then you may not be able to receive all the benefits you are entitled to.

Please note, however, that you should never automatically assume that you are disqualified from receiving workers’ compensation. If you have questions, you should speak with a qualified workers’ comp attorney who will listen to the circumstances surrounding your injury before advising you on how to best protect your personal and financial interests.

Workers’ Compensation Benefits: What Does It Cover?

Because every workers’ compensation case is different, benefits may vary based on the extent of an injury or the events surrounding it. In general, workers’ compensation is given to cover the following expenses:

Lost Wages Due to a Workplace Injury: If you had to stay home from work due to your injuries, workers’ compensation benefits often include reimbursements for wages you could have made while you were in treatment.
Medical Expenses: Most medical expenses required for treatment can be included in workers’ compensation benefits. In some cases, too, you may also be reimbursed for travel expenses to and from clinics and hospitals.
Compensation for Long-Term Impairment: If your injury leads to long-term impairment or further health problems, you may be eligible to receive monetary compensation. Note: The amount you receive will likely depend on the severity of your injury and its after-effects.
Funeral Costs: If a workplace injury results in death, workers’ compensation benefits may be extended to help the family of the deceased cover funeral costs.

In sum, every case is different. To learn more about whether you qualify for workers’ compensation and what benefits you may be eligible to receive, please contact Schwartzapfel Lawyers at 1-516-342-2200 or visit us online now. It will be our honor and privilege to help you fill out your C-3 form so that you can receive all the money and benefits you are entitled to.

DISCLAIMER: The information provided above is not a substitute for legal advice from a licensed professional. For legal help with your case, call 1-516-342-2200 today!

Sources:

Schwartzapfel Lawyers, P.C. | Fighting For You

Employee Claim (Form C-3) | New York State Workers’ Compensation Board

Form C-3.3 | New York State Workers’ Compensation Board

Time for a Real Look at How the New York State Workers’ Compensation System Treats Workers | The New School Center for New York City Affairs

File a New York State Workers’ Compensation Claim | New York State Department of Labor