Get Ny C-32-i 2016-2025

The NY C-32-I form, also known as the Indemnity Only Settlement Agreement, is an important document in the New York Workers' Compensation process. This guide provides step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to successfully complete the NY C-32-I online.

1. Press the ‘Get Form’ button to access the form and open it for editing.
2. Begin by entering your WCB case number at the top of the form. This number is essential for identifying your case within the Workers' Compensation system.
3. Next, provide the date of the accident. Ensure that the date is accurate as it is critical to your claim process.
4. In the 'Claimant's Name' field, clearly print the full name of the person filing the claim.
5. Fill out the 'Claimant's Address' field with the complete address of the claimant, ensuring accuracy for any correspondence.
6. Enter the Carrier case number in the designated field. This assists in linking your claim to the carrier's records.
7. Input the carrier code where prompted. This is generally provided by the insurance company.
8. Specify the employer's name in the appropriate section. This should be the business where the claimant was employed at the time of the accident.
9. Next, enter the carrier information clearly, including the name of the insurance company handling your claim.
10. Proceed to the first section of the agreement by marking applicable claims subject to this agreement, and provide all relevant injuries related to the claims.
11. For the 'Indemnity Benefits' section, clearly indicate any overpayments, and choose the appropriate option as it relates to the claimant's situation.
12. Complete the 'Waiver of Indemnity Benefits' section, ensuring that the claimant understands what this waiver entails.
13. Specify the settlement amount in the designated area, including any attorney fees, and mark how you wish to receive the payment.
14. If applicable, indicate any child support arrears in the provided options and ensure you complete the necessary checks.
15. Review and fill in the sections regarding third-party action, appeals, and any other terms, providing details where necessary.
16. Finally, gather signatures from the claimant, attorney, carrier, and any other relevant parties. Each signatory must print their name and date the agreement.
17. Once everything is accurately filled out, ensure you save your changes, then download or print the completed form for your records.

Complete your documents online now for a smoother filing experience.