Printable Form 5020 Nassau New York 2025

Printable Form 5020 Nassau New York: What You Should Know

The investigators will decide whether you are likely to be awarded a settlement. Form (PDF) for Investigation of a Workers' Compensation Case (PDF) (You are an employee, and may be seeking a payout for injuries you sustained when you received “Injuries to Employment” as a result of: —  an accident —  fraud, or —  other occupational injury. ) If you are an employee, you may have to provide your Social Security Numbers, SSN, driver's license, or employer's Social Security number to your investigator to  submit to the Workers' Comp Board. You may also be eligible for an award of up to 20,000 per worker/per claimant. This amount will be divided between the workers  and claimants. The form has instructions on the proper use of the form. It is recommended that you complete it immediately and return it  to your investigator. The following link contains instructions for filling the form as it appears on the New York City website. You can submit your worker's compensation claim to a local NYS Workers' Compensation Lawyer.  If this form is completed correctly and returns with your request for payment within the stipulated time it is possible to receive  an answer or decision from the NYS Workers' Comp Board within seven (7) days. NOTE: In addition to your state's Workers' Compensation Board, you can contact other legal services offices and law firms that do business with the NYS Workers' Comp Board. The best option would be to contact the New York State Worker's Compensation Division at  If you are an immediate family member of an employee, you may report a claim for Workers' Compensation Benefits directly to the NYS Department of Labor and Industry at You are eligible for an award if you or anyone within your household suffered death, permanent disability or illness caused by an employer's negligence. You are also eligible for an award if you were injured when the employer failed to train or properly supervise you. Additionally, the worker may be eligible for an award if she/he is an employee of a small employer with total annual sales of less than 10,000.

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