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New York Employers Statement of Wage Earnings Preceeding The Date of Accident

State:
New York
Control #:
NY-C-240
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Employers Statement of Wage Earnings Preceeding The Date of Accident

The New York Employers Statement of Wage Earnings Preceding The Date of Accident is a document used by employers in the state of New York to provide information on an employee's earnings prior to an accident occurring. This document is typically used for insurance purposes and contains data such as the employee's gross earnings, total deductions, net wages, and hours worked. There are two types of New York Employers Statement of Wage Earnings Preceding The Date of Accident: the NYS-45 and the NYS-50. The NYS-45 is used for employees in the private sector and includes information such as the employee's name, Social Security number, and wages earned for the previous quarter. The NYS-50 is used for public sector employees and provides similar information but also includes information on the employee's overtime wages.

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FAQ

After an injury or illness occurs, your employer must: Provide a workers' compensation claim form to you within one working day a work-related injury or illness is reported. Return a completed copy of the claim form to you within one working day of receipt.

Going from and coming to work Normally, injuries incurred during regular commutes to and from work are not covered by workers' compensation as the time spent and act of commuting is not part of the scope and course of employment. This is called the going-and-coming rule.

Notify Your Supervisor of Your Injury Written notification should be provided to your employer as soon as possible, but within 30 days. If you fail to notify your employer, within 30 days after the date of injury, you may lose your rights to workers' compensation benefits.

The Board will calculate the rate of the award by looking at the injured worker's Average Weekly Wage. The rate the award is payable is two thirds of the worker's Average Weekly Wage. The lawyer must then add weeks of compensation to the award if there is a protracted healing period.

Timely Filing Within 48 hours of first treatment. After each follow-up visit scheduled when medically necessary but not more than 90 days apart. Within 120 days from the date of service.

Under New York State law, you can file a claim two years from the date your injury or illness occurred, or two years from the time you should have known you suffered an injury or illness.

240 (617) EMPLOYER'S STATEMENT OF WAGE EARNINGS (Preceding the Date of Injury/Illness)

Notify Your Supervisor of Your Injury Written notification should be provided to your employer as soon as possible, but within 30 days. If you fail to notify your employer, within 30 days after the date of injury, you may lose your rights to workers' compensation benefits.

More info

Claim Information - ALL COMMUNICATION SHOULD INCLUDE THESE NUMBERS. If you require assistance with completing these forms, please contact us.240: Employer's Statement of Wage Earnings Preceding Date of Accident. Employer's Statement of Wage Earnings Preceding Date of Accident. Give gross weekly earnings for the 52 weekly periods immediately preceding the date of accident. 2. To Employer: Making a false statement for the purpose of denying workers' compensation benefits may result in civil or criminal penalties. INSTRUCTIONS. Injured employee did not work sufficient time before alleged injury. What is the timeframe for the employer to complete the claim form? Accident-Fund premium. Only employers pay this premium.

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New York Employers Statement of Wage Earnings Preceeding The Date of Accident