In the landscape of New York State Workers' Compensation insurance, the C-105.2 form serves as a critical document, providing a Certificate of Workers' Compensation Insurance Coverage. This form holds essential information, including the legal name and address of the insured entity, contact details, and specific identifiers like the Federal Employer Identification Number or Social Security Number, depending on the nature of the insured. It explicitly states that the insurance carrier listed insures the business for workers' compensation in line with New York State law, clarifying the policy's effective dates and detailing whether proprietors, partners, or executive officers are included or excluded from coverage. The form plays a key role in ensuring that businesses adhere to mandatory coverage requirements, as it must be provided to entities requesting proof of coverage and the Workers' Compensation Board under specific conditions. Its issuance signifies compliance but doesn't modify the policy itself or create new rights beyond those already outlined in the insurance policy. Furthermore, it outlines procedures in the event of policy cancellation, emphasizing the obligation of the insured to maintain continuous coverage as per state law. This requirement underscores the importance of the form in facilitating compliance with Section 57 of the Workers' Compensation Law, which mandates that state or municipal departments cannot issue permits or enter contracts involving hazardous employment without proof of secured compensation for employees. Hence, the C-105.2 form not just serves as a certificate but also as a compliance tool within the regulatory framework of New York's Workers' Compensation system.
| Question | Answer |
|---|---|
| Form Name | Form C 105 2 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | c105 workers comp, c 105 2, c105 2, c 105 2 form |
