A notice of claim must be filed in writing. To file a claim electronically, select, download, and save the appropriate claim form from the eClaim Claim Forms list below.The indemnification provision required Roadway to defend and indemnify Con Ed for any liability arising out of Roadway's work and to pay for Con Ed's legal. You should file an Employee Claim (Form C-3) reporting your injury to the Board as soon as possible. MVAIC operates as a non-profit organization, and provides No-Fault and Bodily Injury coverage to those claimants that are eligible for benefits. How do I fill this out? To complete the Personal Injury Claim Form, gather all necessary information such as your name, address, and details of the claim. Com within 90 days of the incident. A paid insurance claim serves to indemnify a policyholder against financial loss. Labor Law Section 240 is a New York State law meant, originally, to protect construction workers who work at heights from falls or fall-related accidents.