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Workers Compensation Claims

Worker Compensation Forms are claims that are filed for people that are injured on the job or develop an illness that is related to their work.

The following help pages are supported by the current version of CollaborateMD. Please follow the curriculum outline to receive the proper training associated with this section.
NY Workers Compensation Claim Claim Attachments
Workers Comp Claims are NOT transmitted electronically. These claims must be printed and mailed to the insurance company for processing. Fields that are not carried over from the claim will have to be filled out manually. These forms are printed in a PDF format. The Workers Compensation Board recommends using the latest version of Adobe Reader which is available as a free download from Adobe's website. If you require assistance with completing these forms, please contact your local WCB District Office.

Follow the instructions below to create a Workers Comp Claim.

Activate the Workers Compensation Payer


Users permission to NY Workers Comp Form under Claim must be set to Allow.
  1. Prior to printing a Workers Comp Claim, please ensure that the Payer on the claim is set to "Print CMS-1500 as NY Workers Compensation Form". See General Options for more information. 
  2. Once this option is selected proceed with Step 2.

Create the NY Workers Compensation Claim

  1. Go to the Claim section.
  2. Create or Search for the claim you wish to print. 
  3. Once the charges and claim details are entered, click on the Claim tab and change the Claim Options to "User Print and Mail". Optionally you can click on the Charges tab and manually change each charge Status.
  4. Click on the "Save/Print Claim" button to print the claim now. Otherwise selecting the Save button will only save the claim with the current selections until your ready to print it at a later time. Note: To learn how to print claims in a batch please see the Batch Printing Help Page. 
  5. When the Select New Workers Comp Form Type window opens, select the form you wish to print. 
  6. Click on the OK button once you're satisfied with your selection.
  7. After the form opens, you may complete the form by typing information on the form before you print it.
  8. Save the form in a secure location for tracking purposes. 
  9. Once you're done filling out the form click on the Print button to mail it to the insurance company.
Listed below is an explanation of each form available within the application. Please note this information was obtained from the Workers Compensation Board website. 

Form Number /Version Date

Form Title

Who Files

Where to File

When to File

C-4 – Doctors Initial Report

Doctor's Initial Report

Health Provider

Workers' Compensation Board, insurance carrier, injured employee or his/her representative

This form is filed within 48 hours of first treatment.

To report continued treatment, use Form C-4.2.

To report permanent impairment use Form C-4.3.

C-4.2 Doctor’s Progress Report

Doctor's Progress Report

Health Care Provider

Workers' Compensation Board, insurance carrier, injured employee or his/her representative

This form is used for the 15-day report after the first treatment, and for each follow-up visit scheduled when medically necessary while treatment continues but not more than 90 days apart.

To report the first time you treated claimant use Form C-4. To report permanent impairment use Form C-4.3.

C-4.3 – Doctor’s Report of MM/Permanent Impairment

Doctor's Report of MMI/Permanent Impairment

Health Care Provider

Workers' Compensation Board, insurance carrier, injured employee or his/her representative

Use this form (1) When rendering an opinion on MMI and/or permanent impairment; or (2) In response to a request by the Workers' Compensation Board to render a decision on MMI and/or permanent impairment.

OT/PT-4 Occupational/Physical Therapist’s Report

Occupational/ Physical Therapist's Report

Occupational/ Physical Therapist

Workers' Compensation Board, insurance carrier, referring doctor, injured employee or his/her representative.

48-hour initial report, within 48 hours of first treatment.

15-day report, after treatment, is first rendered.

90-day progress report, at 90-day intervals while continuing treatment.