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Subject Number 046-949 Revision of Employer's Statement of Wage Earnings (Form C-240)

Board Bulletins and Subject Numbers

Date: June 19, 2017

In claims where an injured worker may be entitled to compensation benefits or death benefits, employers must submit the injured worker's wage earnings information to the Board on the Employer's Statement of Wage Earnings (Form C-240) within 10 days of the Board's request. Form C-240 captures an injured worker's wage earnings information for the 52 weeks prior to the injured worker's date of injury or illness. This information is used to calculate the injured worker's average weekly wage and benefit rate.

If the injured worker did not work a substantial part of the year, Workers' Compensation Law Section 14(2) requires the employer to also provide the wage earnings of another worker of the same class who worked a substantial part of the year for the 52 weeks prior to the injured worker's injury date. A new Employer of the Same Class table has been added to Form C-240 to capture this payroll information when applicable. The phrase "substantial part of the year" does not refer to a specific number of days worked; however, the guideline of 234 days worked for a five-day worker and 270 days worked for a six-day worker may be used to determine if the injured worker has worked a substantial part of the year. The Board may find that an injured worker worked a substantial part of the year even if the injured worker did not work 234 or 270 days. [Matter of The Meadows at Westfall, Inc., 2013 NY Work Comp G0992183]

In lieu of completing the table(s) on page 2 of the form, detailed payroll information can be attached on a separate sheet or file (if submitting the form electronically). The employer must enter the total days paid and the total gross pay for the injured worker on Form C-240 in Questions 5 and 6.

Additional changes to Form C-240 include:

Employers must complete questions 1-8 on Form C-240 for the injured worker, as well as the Injured Worker Payroll table on page 2 of the form. Employers must also complete the new Employee of the Same Class section on page 2 of the form (worker of the same class payroll) in any case where the employer is uncertain whether the injured worker worked a substantial part of the year. When completing this section, employers should also write the name of the worker and that worker's title where indicated on the form. If the employer is submitting payroll documents in lieu of completing the payroll table(s), then page 2 of the form should not be included in the submission.

Form C-240 is available on the Board's website. Please see the Board's Forms page for submission options.

Kenneth J. Munnelly
Chair