(Fire Districts Only)
This section applies to Fire Commissioners and all paid employees of a fire district, including paid firefighters, secretaries, etc.
Report Accidents, Injuries, Death
To file a Workers’ Compensation claim, several forms may be necessary. Please report claims by filing all applicable forms with FDM and the New York State Workers’ Compensation Board. Be sure that all claim forms are signed by an authorized representative.
| C-2F | This form is the fire districts report for a paid employee. |
| C-3 | This form is similar to the VF-3 and VAW-3 form. It is a claim for benefits for lost time form your regular employment, completed by the injured employee. |
| C-11 | This form is the fire districts report of a injured employee’s change in employment status resulting form injury. Also, please include the employee’s date of return to employment. |
| C-240 | This form is the fire districts statement of wage earnings preceding the accident. |
Filing procedures for claims under the Worker’s Compensation Laws are basically the same as for Volunteer Firefighters’ Benefit Law Coverage. The form to be used is the C-2F, which must be filed within 10 days of the injury. The form C-2F is to be used to report all injuries.
Fire Commissioners and other fire district officers who receive no compensation: Section 2 (9) of the Workers’ Compensation Law states that in the case of an officer, whether elected or appointed, and whether or not he/she is compensated for his/her services, the rate of compensation to be paid will depend on the amount of his/her regular wages. In no event shall the average weekly wage be fixed at less the $30. This means that, if a commissioner is injured, he/she will be entitled to have their medical bills paid and will receive at least $30 per week for whatever period beyond 7 days he/she is incapacitated.
For all paid employees the weekly rate of compensation is figured on the average weekly wages earned in the employment in which he/she was injured during the year PRIOR to the accident. Compensation begins on the eighth day after the injury, unlike VFBL payments which begin the day of the injury. The rate is 2/3 of the average weekly salary.
When a paid employee wished to be compensated for lost time from work due to his/her injury, then form C-3 must be filed.
When requested, the district should prepare a form C-240. This is a record of the injured party’s earnings for the year prior to the accident. Two copies of this form are to be sent to FDM. The gross earnings must be shown. Do not show any deductions for taxes, social security, etc.
When an injured employee returns to work, the fire district should immediately file a form C-11, an “Employer’s Report of Injured Employee’s Change in Employment Status Resulting from Injury”. This form is to be filed when:
- The employee returns to work
- If there is a discontinuance of work
- If the regular hours of work increase or decrease
- If there is a increase or reduction of wages
This form should be prepared as four copies, one copy to be sent to the Worker’s Compensations Board, two copies to FDM and one copy should be kept by the district.