Who is covered by Workers' Compensation Law?
Virtually all employers in New York State must provide workers' compensation coverage for their employees (WCL §2 and 3). Employers must post notice of coverage in their place(s) of business (WCL §51).
Workers in all employments conducted for-profit. Part-time employees, paid employees working within the scope of their duties. Individuals working for a nonprofit organization are considered employees under the WCL in the same manner as those working for a for profit business.
Who is NOT covered by Workers' Compensation Law?
Individuals who volunteer their services for nonprofit organizations and receive no compensation. Please note that compensation includes stipends, room and board, and other "perks" that have monetary value (WCL §3 Group 18). Money used solely to offset expenses incurred while performing activities for the nonprofit is not counted as a stipend (WCL §2 [9])
Duly ordained, commissioned or licensed ministers, priests and rabbis; sextons; Christian Science readers; and members of religious orders (WCL §3, Groups 18)
Jobs Plus Workers
Members of supervised amateur athletic activities operated on a nonprofit basis, provided that such members are not otherwise engaged or employed by any person, firm, or corporation participating in such athletic activity (WCL §3 Group 18)
Whenever an accident occurs on your property or involves your parish, school, or organization, the following steps should be taken immediately:
Document the exact date and time.
Obtain the name, address, phone number, and date of birth of any injured party.
Determine the extent of the injury to the best of your ability and call for medical assistance if necessary. (Be specific about the injury sites)
Ask the injured party to give you a detailed description of how the accident occurred.
Determine the exact location of the accident site.
Obtain names, addresses and phone numbers of any and all potential witnesses. (Remember a witness does not necessarily have to an eyewitness).
Inspect the accident site immediately and document your findings.
Attach any diagrams, statements, police reports, etc., to the designated Diocesan accident report.
Report all employee bodily injury claims of a serious nature to Brian McAuliffe within 24 hours at 315-470-1494. Be prepared to give a verbal report of the results of your investigation.
Reasons to report accidents immediately
The New York State Workers’ Compensation Law states that accidents must be reported to the WCB within 10 days of the date of the first notice. Any employer who fails to file a report within 10 days maybe found guilty of a misdemeanor under Section 110 of the Workers’ Compensation Law, punishable by fine of not more than $2500.
Failure to report an accident on a timely basis causes delays in the investigation process. The best time to obtain the basic facts is immediately after the accident.
Prompt reporting and investigations are necessary in order to formulate a defense against fraud and unfounded claims.
Failure to report on-the-job injuries promptly can cause delays in authorizing medical treatment and/or disability benefits.
Early intervention of medical treatment is important to the injured person as well as to the employer getting the employee back to work as soon as possible.
Leading Causes of On-The-Job InjuriesA claim is initiated by completing a New York State Employer’s Report of the Work-Related Injury/Illness (C-2F) form.
This form must be completed by the pastor, administrator or supervisor.*the injured Employee is NOT permitted to complete the C-2F form. The New York State Employer’s Report (C-2F) can be obtained by contacting Risk Management at 315-470-1495.
In completing the C-2F form, please do not omit any pertinent information. If the C-2F form is not fully completed, the incomplete form may be returned to the employer for completion.
Employees should be aware that on-the-job injuries should be documented and reported to their direct supervisor immediately.
Note - the C-2F Employer’s First Report of Work-Related Injury form MUST be filled out and sent to Risk Management no matter how minor the injury.
FIRST REPORT OF INJURY C-2F FORM - Download and print out this PDF form to fill out.
Scan and email the (C-2F) and any attachments you may have to:
Sue Wuerthner, Workers' Compensation Coordinator, [email protected]
or email to: [email protected]
Triad Group is the company that handles our Workers Compensation claims, the document below contains addresses and phone number information for employees that are injured on the job.
TRIAD GROUP Billing information sheet for injured Employees - Please print this sheet for your doctor's billing office.
STATEMENT OF WAGES C-240 FORM
The C-240 Statement of Wage Earnings form is used only for Workers’ Compensation claims. This form is required by the New York State Department of Workers’ Compensation to calculate an injured employee’s weekly disability benefits based on their gross yearly salary from the date of injury BACK one year.
If attaching payroll information, do not submit page 2. All attachments should include the Injured Worker's full name, WCB Case # and Date of Injury/Illness.
The C-240 form will be sent to the employer by Triad Group, when required. Please complete and return the form immediately to the Triad Group – 400 Jordan Road, Troy, New York 12180. This form is required back to the Workers' Comp Board within 10 days of request by the Board.
Remember days worked represent days paid, which could include days paid with earned sick or vacation time.
The C-240 form must be fully completed or the Workers’ Compensation Board will return the form which could jeopardize or delay an injured persons benefits.
Remember to answer all questions and fill in all of the boxes for each pay period giving the total days worked and total gross amount paid. (Can use 26 weeks)
The boxes for the Workers’ Compensation Board Case Number, and Carrier’s Case Number will be filled in by Triad Group. If you have any questions please feel free to contact Brian McAuliffe at 315-470-1494
This form must be download to your computer to open and work properly. If you are receiving the "Please wait . . ." prompt, you must download the form for it to open, once you download it you can type right on the form.
C-240 STATEMENT OF WAGES FORM - click to download.
The C-11 form is required by the New York State Department of Workers’ Compensation when a change in work status occurs as a result of a work-related injury. A change of employment status includes discontinuance of work, return to work, increase or decrease of regular hours of work and increase or reduction of wages.
The C-11 form is mandatory and the only form the Workers’ Compensation Board will accept for information regarding the injured employee’s work status. The C-11 Form must be completed as soon as an employer knows that an employee is missing time from work due to a work-related injury.
Call Triad Group or Risk Managment when an employee’s returns-to work date is known, to avoid an over payment in wage benefits or the Risk Management office at 315-470-1495.
Fully complete and sign the C-11 form and email or mail it to Triad Group – 400 Jordan Road, Troy, New York 12180, within 24 hours from a date an employee returns-to-work and keep a copy for your records.
C-11 FORM Change in Status or Return to Work- click to open and download form to fill out