Compensation Board at the address shown on reverse side as soon as the employment status of an injured employee, as reported on Form C-2 or EC-2, or on a previous Form C-11 or EC-11, is changed. Change in employment status includes return to work, discontinuance of work, increase or decrease of regular hours of work and increase or reduction of wages. A copy should also be sent to your insurance carrier. ALL COMMUNICATIONS SHOULD REFER TO THESE NUMBERS 1. W.C.B. Case Number 3. Carrier Code .
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How to fill out the NY NYSADA C-11 and C-240 online
Navigating the online forms for the NY NYSADA C-11 and C-240 can be an essential task for employers reporting changes in an injured employee's employment status. This guide provides clear instructions to help you complete both forms efficiently and accurately.
Follow the steps to fill out the forms online.
- To begin, click the ‘Get Form’ button to access the NY NYSADA C-11 and C-240 forms online.
- Fill in the required fields for the C-11 form, starting with the W.C.B. case number, carrier code, and claimant's Social Security number. Ensure to provide accurate information.
- Continue by entering the date of injury, and fill in the Carrrier Case Number. Provide the details of the injured person, including their name and address where notifications should be sent.
- Next, indicate the date of the most recent Employer's Report filed by marking C-11/EC-11 or C-2/EC-2 as appropriate. Also, add the date of the first full day the employee lost from work.
- Describe the nature of the injury, and record the date when the employee returned to work. You will also have to note any changes in employment status resulting from the injury, such as changes in hours or earnings.
- Provide details regarding the loss of time since the first return to work, including the start and end dates for leave, if applicable. If the injured person is still under the physician's care, confirm this as well.
- Check the corresponding fields in the C-240 section regarding wage earnings, past employment details, and any additional allowances that the employee may have received.
- Once you have filled in all fields, carefully review the information for accuracy. Then, proceed to save your changes, download, print, or share the completed forms as needed.
Complete your documents online today and ensure timely compliance with reporting requirements.
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