Electronic Versions of Forms Updated for Inclusivity Now Available

New York State Workers' Compensation Board sent this bulletin at 07/08/2022 09:00 AM EDT

Electronic Versions of Forms Updated for Inclusivity Now Available

In a GovDelivery dated June 30, 2022, the Workers’ Compensation Board (Board) announced that several forms have been updated to include an “X” designation for those who do not wish to identify as male or female. Gendered pronouns on these forms have also been replaced with gender-neutral pronouns.

Please be advised that electronic versions of the following updated forms are now available:

  • Employee Claim (Form C-3)
  • Employer’s Report of Injured Employee’s Change in Status or Return to Work (Form C-11)
  • Preliminary/Final Claim for Reimbursement of Benefits Paid Under DBL (Form DB-470)
  • Request for Assistance by Injured Worker (Form RFA-1W)

Questions?

If you have any questions, please contact claims@wcb.ny.gov.