New York workers’ compensation information and forms

Workers’ compensation insurance can seem complicated to administer. There are many forms and various specific state regulations concerning postings and employee notification. To get the help you need to ensure employees understand coverage and how to report a work place injury, select the link located below.

• 221-10000 – Claim kit cover letter
  Letter from The Hanover welcoming the employer to the insurance plan, includes instructions for claim reporting and creating medical provider panels.
• 221-10001 – Take control of workers' compensation costs
  This guidance will help ensure the best outcome for you and your employees following a work related injury.
• NYWCBFS1 – Your responsibilities as an employer – timely reporting
  This document, published by the New York workers’ compensation board, outlines the employer’s obligation to report work related injuries to the insurance carrier in a timely manner.
• WC7654f – Notice of compliance/workers' compensation law (English/Spanish)
  Required to be conspicuously posted at the employer's place of business so all employees have access to it. The completed notice will be sent with your policy; additional copies can be obtained by contacting your agent.
• WC9922a – Employer's first report of work-related injury/illness
  This form is completed by the employer to report an on-the-job injury or accident involving an employee.
• WC9922c – Employer's first report of work-related injury/illness
  This form is completed by the employer to report an on-the-job injury or accident involving an employee.