Form C-2 - Employer'S Report Of Work-Related Accident/occupational Disease - 2006 Page 2
Download a blank fillable Form C-2 - Employer'S Report Of Work-Related Accident/occupational Disease - 2006 in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form C-2 - Employer'S Report Of Work-Related Accident/occupational Disease - 2006 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2INSTRUCTIONS TO EMPLOYERS: reports should be sent directly to the district offices at these addresses:
ALBANY 12241 - 100 Broadway, Menands. (866) 750-5157
For all accidents in following counties: Albany, Clinton, Columbia, Dutchess, Essex, Franklin,
Fulton, Greene, Hamilton, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, Ulster, Warren, Washington.
BINGHAMTON 13901 - State Office Building, 44 Hawley Street. (866) 802-3604
For all accidents in following counties: Broome, Chemung, Chenango,
Cortland, Delaware, Otsego, Schuyler, Sullivan, Tioga, Tompkins.
BUFFALO 14202 - Statler Towers, 107 Delaware Ave. (866) 211-0645
For all accidents in following counties: Cattaraugus, Chautauqua, Erie, Niagara.
ROCHESTER 14614 - 130 Main Street West. (866) 211-0644 For all accidents in following counties: Allegany, Genesee, Livingston, Monroe, Ontario, Orleans,
Seneca, Steuben, Wayne, Wyoming, Yates.
SYRACUSE 13203 - 935 James Street. (866) 802-3730 For all accidents in following counties: Cayuga, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga,
Oswego, St. Lawrence.
DOWNSTATE CENTRALIZED MAILING (for New York City, Hempstead, Hauppauge & Peekskill district offices) - PO Box 5205, Binghamton, NY
13902-5205. NYC (800) 877-1373
Hemp. (866) 805-3630
Haup. (866) 681-5354
Peek. (866) 746-0552 For all accidents in following counties:
Bronx, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Westchester.
WORKERS' COMPENSATION
LAW
Section 13 Treatment and care of injured employees.
(a) "The employer shall promptly provide for an injured employee such medical, surgical, optometric or other attendance or treatment,
nurse and hospital service, medicine, optometric services, crutches, eye-glasses, false teeth, artificial eyes, orthotics, functional assistive and
adaptive devices and apparatus for such period as the nature of injury or the process of recovery may require.****"
Section 13 Injury to employee's prosthesis.
(a) "Damage to or loss of a prosthetic device shall be deemed an injury except that no disability benefits shall be payable with respect
to such injury under section fifteen of this article.****"
Section 25 Effect of failure to file reports.
3. (e) "If the employer or its insurance carrier fails to file a notice or report requested or required by the board or chair or otherwise
required within the specified time period or within ten days if no time period is specified, the board may impose a penalty in the amount of fifty
dollars.****"
Section 51 Posting of notice regarding compensation.
"Every employer who has complied with section fifty of this chapter shall post and maintain in a conspicuous place or places in and
about his place or places of business typewritten or printed notices in form prescribed by the chairman, stating the fact that he has complied
with all the rules and regulations of the chairman and the board and that he has secured the payment of compensation to his employees and
their dependents in accordance with the provisions of this chapter, but failure to post such notice as herein provided shall not in any way affect
the exclusiveness of the remedy provided for by section eleven of this chapter.****"
Section 52 Effect of failure to secure compensation.
1. (a) "Failure to secure the payment of compensation shall constitute a misdemeanor, punishable by a fine of not less than five
hundred nor more than two thousand five hundred dollars or imprisonment for not more than one year, or both.
(b) Where any person has previously been convicted of a failure to secure the payment of compensation within the preceding five
years, upon conviction for a second violation such person shall be fined not less than one thousand nor more than five thousand dollars in
addition to any other penalties including fines otherwise provided by law, and upon conviction for a third or subsequent violation such person
may be fined up to seven thousand five hundred dollars in addition to any other penalties including fines otherwise provided by law.
(c) Where the employer is a corporation, the president, secretary and treasurer thereof shall be liable for failure to secure the
payment of compensation under this section.****"
Section 110 Record and report of injuries by employers.
1. An employer, or a third party designated by the employer, shall record any injury or illness incurred by one of its employees in the
course of employment using the form prescribed by the chair for reporting injuries under subdivision two of this section. Such form, a copy of
which shall be provided to the injured employee upon request, shall be maintained by the employer, or a third party designated by the employer,
for at least eighteen years, and shall be subject to review by the chair at any time. Such form need not be filed with the chair unless the status of
such injury or illness changes resulting in a loss of time from regular duties or in medical treatment which would require reporting in
accordance with subdivision two of this section.
2. An employer, or a third party designated by the employer, shall file with the chair of the workers' compensation board and with the
carrier if the employer is insured, upon a form prescribed by the chair, a report of any accident resulting in personal injury which has caused or
will cause a loss of time from regular duties of one day beyond the working day or shift on which the accident occurred, or which has required or
will require medical treatment beyond ordinary first aid or more than two treatments by a person rendering first aid. Such report shall state the
name and nature of the business of the employer, the location of its establishment or place of work, the name, address and occupation of the
injured employee, the time, nature and cause of the injury and such other information as may be required by the chair. Such report shall be filed
within ten days after the occurrence of the accident.
An employer shall furnish a report of an occupational disease incurred by an
employee in the course of his or her employment, to the chair of the workers' compensation board, and to the carrier if the employer is insured,
upon the same form. The carrier, within fourteen days of receipt of the report 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. An employer shall file a report of any other accident
resulting in personal injury incurred by its employee in the course of employment, upon the same form, whenever directed by the chair.
3. Any injury or illness which is not required to be reported in accordance with subdivision two of this section, shall not be used as a
basis for determining experience modification rates, provided the employer pays in the first instance or reimburses the employer's insurer for the
treatment rendered to the employee.
4. An employer who refuses or neglects to make a report or to keep records as required by this section shall be guilty of a
misdemeanor, punishable by a fine of not more than one thousand dollars. The board or chair may impose a penalty of not more than two
thousand five hundred dollars upon an employer who refuses or neglects to make such report.
5. The chair shall be authorized to promulgate regulations necessary to carry out the provisions of this section.
THE WORKERS' COMPENSATION BOARD EMPLOYS AND SERVES PEOPLE WITH DISABILITIES WITHOUT DISCRIMINATION
C-2 (11-06) Reverse
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form C-11 - Employer's Report Of Injured Employee's Change In Employment Status Resulting From Injury 2009
Legal
Form C-11 Employer's Report Of Injured Employee's Change In Employment Status Resulting From Injury 2003
Legal
Related Categories
Parent category: Legal