Get prompt medical treatment for any work- induced injury/illness. Tell the doctor that the injury/illness was sustained at work and you will be filing a Workers ' Compensation claim.
Notify your employer of the
injury/illness (Form WCD-23).
Request and complete your agency's Employee's Notice of Injury Form (WCD-23) to notify them of your
work -related injury/illness. Submit it to your employer as soon as possible-preferably within 24
hours. If you do not hear from the Workers ' Compensation Division in 45 days, call your union rep, they're your
agency's Employee Benefit Unit and/or the Workers' Compensation Division at (718) 222-5100 immediately.
Complete an Employee's
Selection of Compensation Option Form
(DP2002).
This is one of the most important forms that you must complete. Submit it to your employer as soon as
possible-preferably within 24 hours. You must submit form DP2002 within 7 days in order to select from
these union-negotiated options:
Option 1. This allows you to remain on full pay status from the first day of absence, with time charged against your leave and comp time balances. If the Workers' Compensation Board rules in your I favor, you will get back a pro-rated portion of the time used. Option 1 automatically changes to Option 2 when your leave balances are exhausted.
Option 2. If you choose not to use leave balances, you will have to wait for the city's Workers' Compensation Division to send you compensation payments once your case is settled. You will not be in full pay status and or receive an agency pay- I check, but you will accrue normal annual and sick leave. If you don't select an option or submit form D P2002 after 7 days, you will automatically be assigned to Option 2.
Apply for additional union-negotiated grants.
Ask your local union rep whether you qualify for additional union-negotiated grants, such as: Extended
sick leave-After all leave is exhausted, agencies can extend sick leave for up to three months to
permanent employees with 10 or more years' service. Additional leave for assault claims-Members who are
assaulted at work are eligible for up to 18 months of paid leave if they did not start or continue the assault
unnecessarily.
File a claim (C-3) with the
New York State Workers' Compensation Board.
Members must obtain and file a state claim form (C-3) as soon as possible to trigger their Workers' Compensation claim. Obtain forms from the
New York State Workers' Compensation Board, 180 Livingston Street, Brooklyn,
N.Y. 11248 (718) 802-6600 or from the DC 37 Safety and Health Unit at (212) 815-1685.
Notify the DC 37 Health and
Security Plan of the injury! illness (form HS:DISO13).
Call the Health and Security Plan at (212) 815-1531 and request a Short-Term Disability Claim form
(HS:DIS013). Complete and mail the form to be eligible for continuation of most benefits for up to six months.
Get a Workers'
Compensation attorney.
Having an experienced representative can help your case. Contact the DC 37 Legal Departmentat(212)
815-1450 or call the Workers ' Compensation Board at (718) 802-6600 to get a
list of Workers, Compensation attorneys and licensed representatives.
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