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Get Ny C-312.5 2010-2025
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How to fill out the NY C-312.5 online
The NY C-312.5 form is essential for individuals and parties involved in Workers' Compensation claims to request the incorporation of findings and awards into a proposed conciliation decision. This guide provides comprehensive instructions to assist users in successfully completing the form online, ensuring all necessary fields are accurately filled out.
Follow the steps to effectively complete the NY C-312.5 form online.
- Press the ‘Get Form’ button to access the NY C-312.5 form and open it in the online editor.
- Begin by entering the WCB case number(s) at the top of the form. This information identifies the specific case related to the proposed conciliation.
- Next, input the date(s) of the accident relevant to the claim. Make sure to use the correct format for dates as specified within the form.
- Fill in the claimant's name clearly in the designated box, ensuring it is legibly printed for proper identification.
- Enter the carrier case number and carrier code in their respective fields. These are crucial for linking to the insurance provider associated with the claim.
- In the fields provided, print the name of the carrier and the employer involved in the case. This identifies the parties responsible for the claim.
- If applicable, list any other party-in-interest by filling out the corresponding section. This may include individuals or entities affected by the workers' compensation decisions.
- The signed agreement section requires signatures from each party involved in the action. Ensure that the claimant, attorney or licensed representative, and carrier or self-insured employer sign appropriately.
- If a meeting occurred for conciliation, the conciliator must sign in the designated area to confirm their presence during the signing.
- After filling out all sections accurately, review all information for completeness and correctness. Users can then choose to save changes, download, print, or share the completed form.
Complete the NY C-312.5 form online today to facilitate your Workers' Compensation claim process.
A workers' compensation claim in New York can generally go back two years from the injury date. This timeline can sometimes vary, especially in cases involving occupational diseases. It’s important to ensure you take timely action to secure entitlements under the NY C-312.5 provisions.
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