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New York Compliance
Every employer must post in a conspicuous place or places Notice of Compliance - Workers' Compensation Law (Form C-105) that the employer has obtained workers' compensation coverage for his/her/its employees and their dependents as required by law. The C-105 form, Notice of Compliance - Workers' Compensation Law, informs employees that their employer is in compliance with the Workers' Compensation Law and of their rights and obligations if they suffer a work related injury or occupational disease. In addition, at the bottom of the form the name, address and telephone number of the licensed insurance carrier, the New York State Insurance Fund, authorized group self-insurer or authorized individual self-insurer is listed. For employers who own or operate horse-drawn or automotive vehicles the notice prescribed by the Board to be posted is the C-105.1 form.
Forms C-105 and C-105.1 are not available online.
Employers obtain the C-105 or C-105.1 forms from the insurance carrier that provides coverage.
Carriers, their licensed agents, and Self-Insured Employers may email the Board at Certificates@wcb.ny.gov to obtain controlled forms not available on the website.
An employer who fails to post the C-105 conspicuously about the employer's place of business will be fined $250. 51