This form is an official New York Worker's Compensation form which complies with all applicable state codes and statutes. USLF updates all state forms as is required by state statutes and law.
Suffolk New York Carrier's - Employer's Request for Further Action
Category:
State:
New York
County:
Suffolk
Control #:
NY-RFA-2-WC
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Word;
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How to fill out New York Carrier's - Employer's Request For Further Action?
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FAQ
The formula used by the New York State Workers' Compensation Board to calculate weekly settlement payments is as follows: Weekly Rate: 2/3 x average weekly wage x % of disability (for example, partial disability or temporary disability)
Complete the Notice of Injury or Occupational Disease, Form C-1. You must fill out this form and turn it in to your employer within one week of your injury. If your work-related injury requires medical treatment, you will need to fill out Form C-4, Employee's Compensation Report of Initial Treatment.
Filing A Workers' Compensation Claim Your workers' compensation claim does not start until the C-4 form is completed. The C-4 form is titled ?Employee's Claim for Compensation/Report of Initial Treatment?. The physician fills out their part of the form, and sends a copy to your employer and the insurer.
EMPLOYEE'S CLAIM FOR COMPENSATION/REPORT OF INITIAL TREATMENT. FORM C-4.
Typically, the process from hearing to approved payment takes approximately 3 weeks. The employer's insurance company or third party administrator must then make Section 32 settlement payments within 10 days of the Workers' Compensation Board's decision.
Workers' comp cases with head injuries settle for the most money compared to settlements for all other body parts. Claims involving catastrophic brain injuries can sometimes settle for millions of dollars.
The RFA-2 is a New York State Workers' Compensation Board form. Specifically, it is a ?Request For Further Action? by the carrier or employer and can be found here. This form would be filed by the carrier or employer when a need for a hearing arises.
The C-2F Form was implemented in New York state in 2013 for employers when reporting an employee injury or illness. The form, titled ?Employer's First Report of Work-Related Injury/Illness,? must be filed with the Board within 10 days of the injury or illness.
Date of AccidentWeekly Maximum Total / PartialJuly 1, 2020 - June 30, 2021$966.78 / $966.78July 1, 2019 - June 30, 2020$934.11 / $934.11July 1, 2018 - June 30, 2019$904.74 / $904.74July 1, 2017 - June 30, 2018$870.61 / $870.6116 more rows
Depending on your specific situation, having surgery may increase the total value of your workers' compensation case ? particularly if you still have some level of disability after the surgery. Importantly, New York workers' compensation settlements are often final, particularly when they involve a lump sum payment.
