Workers' Compensation & Disability Benefits Forms
Essential Forms and Resources from Your Trusted Commercial Insurance Broker
At Aebly & Associates Insurance Services, we understand that managing workers' compensation insurance and disability benefits requires access to the right forms and documentation. As your experienced commercial insurance broker and insurance agency, we provide easy access to essential New York State Workers' Compensation and Disability Benefits Law forms to help you maintain compliance and manage claims effectively.
Contact Our Workers' Compensation Specialists
📞 Phone: tel:716-675-2100
📧 Email: [email protected]
Comprehensive Forms Library
Complete NYS Forms Access
For comprehensive access to all New York State Workers' Compensation and Disability Benefits forms, visit the official NYS Workers' Compensation & DBL Common Forms page.
Workers' Compensation Forms
Essential Employer and Employee Forms
As your independent insurance agent specializing in workers' compensation insurance, we help you understand when and how to use these critical forms:
Incident Reporting and Claims
Form C-2 - Employer's Report of Accident
Required for all workplace accidents. Employers must file this form within 10 days of learning about a work-related injury. Essential for maintaining compliance with workers' compensation insurance requirements.
Form C-3 - Employee's Claim for Compensation
Filed by injured employees to initiate workers' compensation benefits. Must be filed within two years of the accident or knowledge that the injury is work-related.
Status Updates and Returns to Work
Form C-11 - Employer's Report of Injured Employee's Change in Status or Return to Work
Critical for documenting employee status changes, including return to work dates. Helps coordinate with business insurance carriers and ensures accurate benefit management.
Form C-240 - Employer's Statement of Wage Earnings Preceding Date of Accident
Provides wage information necessary for calculating workers' compensation benefits. Essential documentation for accurate benefit determination.
Legal and Settlement Documentation
Form C-22 - Application for Approval of Non-Schedule Adjustment
Used for benefit adjustments outside standard schedules. Often requires professional guidance from your commercial insurance broker.
Form C-32 - Settlement Agreement
Legal document for settling workers' compensation claims. Should be reviewed carefully with professional guidance.
Form C-121 - Claim for Compensation and Notice of Commencement of Third Party Action
Required when third-party lawsuits are involved with workers' compensation claims. Coordinates with professional liability insurance and business insurance considerations.
Corporate Officer Elections
Form C-105.51 - Notice of Election for Corporate Officers
Allows corporations to exclude sole shareholder-officers or executive officers-shareholders from workers' compensation coverage. Important for small business insurance planning.
Medical and Expense Documentation
Form C-257 - Claimant's Record of Medical and Travel Expenses
Helps claimants track reimbursable expenses related to their workers' compensation claim.
New York State Disability Benefits Forms
DBL Compliance and Administration
As your employee benefits broker, we help you navigate disability benefits requirements that complement your group health insurance and workers' compensation insurance programs:
Employer Information and Setup
Form 102 - Information for Employer Regarding Disability Benefits Law
Essential information for employers about DBL requirements and compliance obligations.
Form DB 125 - Employer Identification Card
Required identification for employers participating in the New York State Disability Benefits program.
Form DB 791 - Reference Table of Employee Contributions
Payroll reference for calculating employee contributions to disability benefits. Essential for payroll administration coordination.
Employee Elections and Claims
Form DB 212.5 - Notice of Election To Voluntarily Exclude Spouse
Allows voluntary exclusion of spouse from disability benefits coverage when both spouses work for the same employer.
Form DB 300 - Notice of Proof of Claim by Unemployed Claimant
Used by unemployed individuals to claim disability benefits. Coordinates with unemployment insurance benefits.
Form DB 450 - Notice and Proof of Claim for Disability Benefits
Primary form for employed individuals to claim disability benefits. Must be filed within 30 days of disability onset.
Professional WC & DBL Form Assistance – Aebly & Associates Insurance Services
As a trusted insurance broker and independent insurance agent, Aebly & Associates Insurance Services offers expert support for workers' compensation insurance (WC) and disability benefits law (DBL) form management. We guide small business insurance clients through the complexities of form selection, completion, and compliance to ensure timely benefit processing and regulatory adherence.
Our team specializes in integrating workers' compensation insurance with your broader business insurance strategy, including professional liability insurance, group health insurance, and other employee benefits. This coordinated approach ensures seamless coverage and enhanced risk management.
We assist with:
- Accurate completion of WC & DBL forms to prevent delays or denials
- Compliance with state filing requirements and deadlines
- Coordinating disability and workers' comp benefits with your commercial insurance portfolio
At Aebly & Associates Insurance Services, we combine local support with national expertise to provide personalized service tailored to your business needs.
Let us help you streamline your WC & DBL form process while safeguarding your workforce and bottom line. Contact us today at (716) 675-2100 for professional guidance from your trusted employee benefits broker and commercial insurance broker .