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Just for Fun - All Our Children flier 2019
OP 505: Request for Reimbursement of Medical Expenses
Once line-of-duty status has been approved, you can use this form to request reimbursement for out-of-pocket medical expenses to a maximum of $750.
UFT Workers' Compensation Intake Form
Workers’ compensation intake form for Paraprofessionals, School Nurses, Occupational and Physical Therapists:
C-2: Employer’s Report
The employer is required to fill out this report within 10 days to notify the Workers’ Compensation Board of your work-related injury or illness. You should not participate in filling out this form. See the C-2: Employer's Report - Filing Procedure...
C-3: Employee’s Claim
You must fill out this form to initiate your Workers’ Compensation claim. You should retain one copy, file a second with the Board, and provide a third to your legal representative.
C-4: Physician’s Report
Your doctor must fill out this form at regular intervals — usually every 4-6 weeks — during your convalescence. It is used to determine your level of benefits — so it is very important that your doctor fills it out carefully.
C-257: Expense Reimbursement Form
Use this form to claim out-of-pocket expenses related to your injury or illness.