The C-11 form, officially the Employer's Report of Injured Employee's Change in Employment Status, is required by the New York Workers' Compensation Board whenever an injured employee's work status changes following a workplace injury. New York employers file this free document to report any employment status update, including a return to work, updated wages, or modified duty, to ensure compliance with New York regulations and protect the injured worker's access to workers compensation benefits.
Any New York employer covered by workers compensation insurance must file this form whenever an injured worker's employment status shifts. It records whether the employee has returned to work, stopped working, or had wages or hours adjusted. Employers must send copies to the WCB and to the workers compensation insurance policy carrier.
File a new C-11 within the required timeframe after any work status update since the prior injury report or C-11 submission. Contact the WCB or your carrier for guidance on the following situations:
Sign the completed C-11 before submitting it. Missing the required filing day increases compliance risk under New York government regulations. Continue to file updated reports throughout the claim.
New York employers must submit the C-11 promptly after any change in an injured employee's work status. The reporting period begins from the date of injury or the date of the prior C-11 submission, whichever applies. Missing the filing deadline increases compliance risk and can disrupt the injured worker's access to wage replacement benefits. Continued late filings may result in penalties under New York state workers compensation regulations.
Accurate wage documentation is critical. The C-11 captures whether the injured worker experienced lost wages due to missed work or reduced hours. New York employers should verify wage data going back to the date of injury before submitting each report. A Wage Loss Verification Form can support documentation of lost wages when wage adjustments are complex or span multiple pay periods. Filing inaccurate wage figures can result in incorrect benefit calculations or trigger a WCB audit. Employers who have not yet registered the initial injury claim may also need to complete a Workers Compensation Intake Form before filing the C-11.
New York accepts C-11 forms by fax, web upload, or email via the WCB portal. Send a copy to your insurer as well. Access required New York employer forms free through the WCB and free PDF platforms. Keep signed copies of submitted documents within your business records for government reporting and audit purposes.
New York requires complete and accurate information on all employer forms. The C-11 must list correct insurance policy details, updated dates, loss-of-time records, and current wage data. Misrepresentation on employer forms is a criminal offense. Explore compliance obligations through WCB guidance to reduce risk and avoid government penalties within the required timeframe. Accurate documentation protects the injured employee's access to benefits and supports workplace safety throughout the claim. Access employer resources and contact the WCB Employer Resources page for additional safety and compliance guidance.
The C-11 is one of several free employer forms used in New York workplace injury claims. Related free documents include the C-4 Employee Claim Form, the Injury Report Form, and the First Injury Report. The Employee Status Change Form is widely used by New York employee and employment professionals for HR compliance tracking.
| Question | Answer |
|---|---|
| Form Name | C 11 Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | c 11, ny c11, new york c11, ny c11 form |
| Form Type | C-11 Employment Status Change Form |
| Issuing Authority | New York Workers' Compensation Board (WCB) |
| Submission Methods | Fax, web upload, email |
| Required Copies | WCB office and workers compensation insurance policy carrier |
