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  • What Is New York Form C121

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B. CASE NO CARRIER CASE NO CLAIMANT'S SOC.SEC.NO. WORKERS' COMPENSATION VOLUNTEER FIREFIGHTERS VOLUNTEER AMBULANCE WORKERS CLAIM FOR COMPENSATION AND NOTICE OF COMMENCEMENT OF THIRD PARTY ACTION (This notice must be served on the Chair, Workers' Compensation Board, the Employer and Employer's Insurance Carrier within 30 days after action has been commenced.) 1. Name of Injured or Deceased.

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Workers' compensation coverage IS NOT required for partnerships, LLCs, and LLPs that do not have employees. Members and partners are not considered employees for the purposes of obtaining workers' compensation insurance, but may voluntarily cover themselves under a workers' compensation policy.

Businesses in New York State must have workers' compensation coverage for all employees. The rule includes part-time employees and family members employed by the company. Employers must have a workers' compensation insurance policy.

Workers' Compensation coverage is not required if the business is a one or two person owned corporation, with those individuals owning all of the stock and holding all offices of the corporation (each individual must hold an office and own at least one share of stock).

Workers' compensation coverage is required for sole proprietors with employees, including part-time employees, borrowed employees, leased employees, family members, and volunteers (WCL §3 Groups 1-14-a).

A Certificate of Attestation of Exemption (CE-200) can only be used to attest to a government entity that an applicant requesting a license, permit or contract is not required to carry workers' compensation and/or disability and Paid Family Leave benefits coverage.

Or fax your complaint to us at (518) 486-3745. You may also file a complaint by calling our toll free hot line at 1 (800) 367-4448. This will connect you with trained staff who can discuss with you the specifics of your complaint.

Independent contractors You may need insurance even for those receiving 1099s. Workers' compensation insurance protects employers and employees against financial loss in the event of a work-related injury or illness. Employers must continuously carry workers' compensation insurance for their employees.

WCB means the Workers Compensation Board.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232