C240 Form For Sale
Description
How to fill out New York Employer's Statement Of Wage Earnings For Workers' Compensation?
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FAQ
Workers' comp payments in New York are generally worth two-thirds of your average weekly earnings before you were injured, up to a maximum of $1,125.46 if your injury occurred after July 1, 2022.
If you generally worked five days per week, your AWW will be set by dividing your total salary by the total number of days paid, then multiplying the result by 260, and dividing that total by 52.
New York State has a system for employees to report work-related injuries and illnesses. The system is called ARS, the Accident Reporting System. Call the ARS toll-free number, 1-888-800-0029, to report a work-related injury or illness 8 a.m. to 5 p.m., Monday through Friday (excluding holidays).
Work-Related Injury/Illness. C-2F. A work-related injury or illness must be reported within 10 days (Per Section 110) of the injury/illness or be subject to a penalty.
Form C-240 captures an injured worker's wage earnings information for the 52 weeks prior to the injured worker's date of injury or illness. This information is used to calculate the injured worker's average weekly wage and benefit rate.