New York Form WCB C-30, the Claim for Compensation in a Death Case, is the official document a surviving spouse, child, or other dependent files with the New York State Workers’ Compensation Board to receive death benefits and funeral expenses after a worker dies from a job-related injury or illness. The current version carries a revision date of 2-15 printed in the lower-left corner of the form, so confirm that revision before you sign anything.
Filing this form on time and with the right paperwork unlocks weekly cash benefits under WCL §16 and reimbursement of burial costs, while a single missed field or late filing can trigger a denial under the two-year statute of limitations in WCL §28. According to the Workers’ Compensation Board’s annual statistics, roughly 150 to 200 occupational death claims are filed in New York each year, and the Board reports that more than 30% of initial death-case filings are delayed or returned because of missing dependency proof or signature errors.
Here is what you will learn in this guide:
- 📝 How to complete every box on Form C-30 line by line, with sample entries
- 👪 How to prove dependency for spouses, minor children, and adult dependents
- 💵 How weekly death benefits and the funeral expense cap are calculated under §16
- 📬 How to file by mail, online, in person, and by fax, with exact addresses
- ⏰ How to avoid the most common mistakes that delay or deny death claims
What Form C-30 Is and Who Must File It
Form C-30 is the Claim for Compensation in a Death Case, the document that opens a death claim with the New York State Workers’ Compensation Board after a covered worker dies from a work-related cause. It is authorized by WCL Article 2 and processed under the Board’s death benefits program. The form tells the Board who the worker was, how the worker died, and who is now financially dependent on that worker’s lost wages.
Anyone who claims to be a dependent of the deceased worker may file the form. The most common filers are surviving spouses, minor children (filed by a parent or guardian), adult children with disabilities, dependent parents, and dependent grandchildren. The funeral home or the person who paid the burial bill may also file C-30 to recover funeral expenses up to the cap set in WCL §16(1).
C-30 is different from Form C-3, which an injured worker files for their own injury, and from Form C-62, which covers funeral expense claims when no other dependent claim exists. If the death involves an occupational disease such as mesothelioma or chronic exposure illness, you still use C-30, but you anchor the date of disablement instead of the date of accident. Attorneys, licensed representatives, and union benefit counselors can also file on behalf of a grieving family, and the Board’s Advocate for Injured Workers can help unrepresented families.
Before You Start: Documents and Information You Need
Gather every document below before you open the form, because missing paperwork is the single biggest cause of delays in death cases. The Board cross-checks every dependency claim against vital records, so guesses and approximations cause holds.
- Certified death certificate. Order at least three certified copies from the New York State Department of Health. Without it, the Board cannot verify the date or cause of death.
- Marriage certificate. Required for a surviving spouse claim; without it, the Board cannot establish spousal dependency under §16.
- Birth certificates for every dependent child. Each child listed in Section 7 needs proof of age and parentage; missing certificates push children off the benefit calculation.
- Funeral bill (itemized and paid receipt). The Board reimburses up to the §16 funeral cap, but only against an itemized invoice from a licensed funeral director.
- Deceased worker’s Social Security number and date of birth. The Board uses these to match the file to the employer’s prior C-2F injury report.
- Employer name, address, and FEIN. Pull these from a recent pay stub or W-2; a wrong employer name routes the claim to the wrong carrier.
- Workers’ compensation insurance carrier name and policy number, if known. You can look this up free at the Board’s Employer Coverage Search.
- Average weekly wage proof. Bring the last 52 weeks of pay stubs, W-2s, or a wage statement; this drives the weekly benefit amount.
- Date and description of the accident or last day of work. The narrative must match the employer’s prior C-2F if one exists.
- Proof of dependency for non-spouse, non-minor claimants. Tax returns, bank statements, and shared-household bills support an adult dependency claim.
A pre-filing tip from 30 years of practice: photocopy every document twice before you mail anything, because the Board’s mailroom occasionally misroutes attachments and you will need a clean replacement set on short notice.
Where to Get the Form and How to Access It
Download the official, fillable PDF directly from the Board’s forms library so you know you have the current revision. The direct link to the form is the C-30 PDF, and the related Spanish-language version C-30S sits on the same page. Always confirm the revision code in the bottom-left corner before printing.
You can also pick up paper copies in person at any WCB district office, including Albany, Brooklyn, Buffalo, Hauppauge, Hempstead, Manhattan, Menands, Peekskill, Queens, Rochester, and Syracuse. District-office staff can hand you the form and a postage-paid return envelope, and they can witness your signature if you bring photo ID. The Board’s Customer Service line at (877) 632-4996 will mail a paper packet to any address in New York within five business days.
If you have an attorney or licensed representative, they likely use the Board’s eCase and Web Submission portal to upload signed C-30 forms electronically. Self-represented dependents can also create a free account with the Board’s Online Account system to track filing status. Print the form on plain white 8.5-by-11 paper, single-sided, because the Board’s scanners reject double-sided submissions.
Step-by-Step: How to Fill Out Form C-30 Line by Line
Every box on Form C-30 has a specific purpose, and the Board reads the form top-to-bottom as a single legal narrative. Follow the order printed on the form, write in black ink if you complete it on paper, and use ALL CAPS for proper names so the scanner picks them up cleanly.
Top of Form: WCB Case Number
The form opens with a blank labeled WCB Case Number in the upper-right corner. This is the seven-digit “G-number” the Board assigns when a case is opened, and it links every document filed in your loved one’s case.
How to answer it: leave it blank if no case has been opened yet, or enter the number from the Board’s prior correspondence. Maria Lopez writes G2845192 in the WCB Case Number box because she received a Board notice with that number after her husband’s earlier injury claim.
A common nuance is occupational disease cases where the worker filed a C-3 before death; the case number from that earlier filing carries forward to the death claim. The most common mistake on this field is leaving it blank when a case already exists, which causes the Board to open a duplicate file and split the medical record. Many filers think a missing number will get the form rejected; it will not, but providing it speeds processing by weeks.
Section 1: Information About the Deceased Worker
Section 1 collects identifying information for the worker who died. Boxes include full legal name, Social Security number, date of birth, gender, home address, and date of death.
Enter the name exactly as it appears on the Social Security card, last name first. Carlos Rivera enters RIVERA, CARLOS J. with his Social Security number 123-45-6789, date of birth 04/12/1968, and date of death 11/03/2025. Use the MM/DD/YYYY format the form prints in light gray under each date box.
A frequent edge case is a worker who used a different name at work than on government records; always use the legal name from the Social Security card and add the work alias in the Other Names Used line. The most common mistake is mismatched name spellings between C-30 and the death certificate, which forces the Board to issue a Request for Further Action (RFA-2) and adds 30 to 60 days to processing. A misconception is that nicknames like “Charlie” instead of “Charles” are fine; they are not, because the Board’s database matches on legal name only.
Section 2: Information About the Person Filing the Claim
Section 2 captures the filer’s identity, relationship to the deceased, address, and contact information. The Board uses this section to mail every notice, hearing date, and benefit check, so accuracy is critical.
Enter your full legal name, your relationship code (spouse, child, parent, etc.), your mailing address, daytime phone, and email. Janet Rivera enters RIVERA, JANET, relationship “Spouse,” address 142 Main Street, Apt 3B, Yonkers, NY 10701, phone (914) 555-0143, email jrivera@example.com.
A nuance arises for filers who live abroad or who have moved since the death; always use the address where you actually receive mail, not the deceased’s old address, because the Board does not forward checks. The most common mistake is using the funeral home’s address as a placeholder, which routes survivor benefit checks to the funeral director and creates a recovery headache. A common misconception is that the Board will phone you for missing information; in practice, the Board mails everything, so a wrong address is fatal to communication.
Section 3: Information About the Employer
Section 3 asks for the deceased’s employer name, address, FEIN, and the dates the worker was employed. This routes the case to the correct workers’ compensation insurance carrier.
Write the employer’s exact legal name (not the trade name) and the FEIN from a W-2. Aisha Brown enters ACME CONSTRUCTION CORP, 500 Industrial Way, Bronx, NY 10474, FEIN 12-3456789, employed 03/15/2010 to 11/03/2025. If the worker held two jobs, list the job where the fatal injury or exposure occurred.
A common edge case is staffing agency placements; in those cases, list both the staffing agency (as the employer of record) and the host worksite in the Additional Notes field. The biggest mistake is entering a “doing-business-as” name instead of the legal corporate name, which means the carrier search returns no match and the case stalls. Many filers think the Board will track down the employer themselves; the Board does run coverage searches, but a wrong starting name sends them to the wrong carrier first.
Section 4: Information About the Insurance Carrier
Section 4 captures the workers’ compensation insurance carrier name, address, claim number, and policy number. If you do not know the carrier, use the Board’s free Employer Coverage Search before filing.
Enter the carrier’s full name, the policy number from the employer’s posted notice, and any prior claim number for the deceased. David Kim enters TRAVELERS INSURANCE COMPANY, policy WC-9988776, prior claim 25-08-1144. If the employer was self-insured, write SELF-INSURED in the carrier-name box.
The State Insurance Fund handles many small-employer cases; if so, list NYSIF as the carrier with its Albany address. The most common mistake is leaving Section 4 blank because the family does not know the carrier; that omission shifts research to the Board and adds two to four weeks. A misconception is that an uninsured employer means no benefits, but the Uninsured Employers’ Fund under WCL §26-a still pays valid death claims.
Section 5: Information About the Accident or Occupational Disease
Section 5 is the narrative box. It asks for the date, time, and place of accident, and a plain-English description of how the injury or disease caused the death.
Use short, factual sentences. Linh Tran writes “On 09/12/2025 at approximately 2:15 PM, my husband fell from a third-story scaffold at 200 Park Avenue, New York, NY. He died at NYU Langone Hospital on 09/14/2025 from traumatic head injuries.” Do not speculate about employer fault; stick to facts.
For occupational disease cases like asbestosis or chemical exposure, enter the date of disablement (the date the worker stopped working because of the disease) instead of an accident date, as defined in WCL §38. The most common mistake is leaving out the time or location, which the carrier uses to match the loss to the policy in force. A frequent misconception is that a long delay between exposure and death bars the claim; under §28’s special occupational disease rules, the clock often runs from disablement, not exposure.
Section 6: Cause of Death and Medical Information
Section 6 asks for the medical cause of death from the death certificate, the treating hospital, and the attending physician. Attach the certified death certificate and any autopsy report.
Copy the cause-of-death language verbatim from the death certificate. Robert Singh enters “Acute myocardial infarction due to occupational stress and physical exertion,” treating hospital Mount Sinai, attending physician Dr. Elena Park. Do not paraphrase the medical language.
A nuance is heart attack and stroke cases, where causation must connect the death to job duties under cases like Matter of Pickerd v. Paragon Envtl. Constr. The most common mistake is summarizing the medical cause in your own words, which weakens the causal link the Board needs. Many filers think a death certificate alone proves work-relatedness; it does not, and you may need a C-4 Narrative from the treating doctor.
Section 7: Dependents Claiming Benefits
Section 7 is a table where you list every person claiming dependency, with name, relationship, date of birth, and address. Each row becomes a separate benefit calculation under §16.
List the spouse first, then minor children in birth order, then adult dependents. Sofia Mendez enters herself (spouse, DOB 06/22/1972), her son Diego (DOB 04/10/2014), and her daughter Camila (DOB 08/30/2017). Attach a birth certificate for each child and the marriage certificate for yourself.
A nuance is blended families; stepchildren qualify only if they were actually dependent on the deceased, not merely related by marriage. The most common mistake is omitting an adult child with a disability, who may qualify for lifetime benefits under §16(2)(b); the omission permanently caps that child out. A misconception is that a divorced ex-spouse never qualifies; an ex who was receiving court-ordered support at the time of death may still claim under Matter of Lemen line of decisions.
Section 8: Average Weekly Wage and Earnings History
Section 8 captures the deceased’s average weekly wage (AWW), which sets the benefit rate at two-thirds of AWW, capped at the maximum benefit rate in effect on the date of accident.
Compute AWW from the 52 weeks of earnings before the accident date, divided by 52, and enter the result. Marcus Thompson enters $1,425.60 as AWW based on $74,131.20 of W-2 wages over the prior year. Attach the supporting W-2 or pay stubs.
A nuance is seasonal or part-year workers, who use WCL §14(3) “200 multiplier” or “similar worker” methods. The most common mistake is using gross pay including one-time bonuses without proration, which inflates AWW and triggers a carrier challenge. A misconception is that overtime is excluded; under New York law, overtime, tips, and the value of board and lodging all count toward AWW.
Section 9: Funeral Expenses
Section 9 asks for the total funeral and burial expenses and the name of the funeral home. The Board reimburses up to the cap in WCL §16(1), currently $12,500 in the Metropolitan counties and $10,500 elsewhere for accidents on or after April 9, 2024.
Enter the itemized total and attach the paid funeral bill. Patricia O’Neil enters $11,250.00 paid to Greenwood Funeral Home, 88 Elm Street, Queens, NY. The receipt must show “paid in full” or the carrier will pay only the documented portion.
A common edge case is a funeral home that filed its own C-62; coordinate with them so the carrier does not pay twice and then chase a recovery. The most common mistake is submitting an estimate instead of a paid invoice, which delays reimbursement until the invoice is updated. A misconception is that all costs qualify; cemetery markers above a reasonable amount and post-funeral receptions are routinely disallowed.
Section 10: Other Benefits and Third-Party Recovery
Section 10 asks whether any dependent receives Social Security survivor benefits, pension benefits, or has filed a third-party lawsuit (for example, against a negligent driver or product manufacturer).
Check yes or no for each, and provide claim numbers if yes. Helen Park checks “Yes” for Social Security survivor benefits with claim number SS-559-22-1144 and “Yes” for a third-party action against a defective scaffold manufacturer.
A nuance is the §29 lien: if the family later recovers from a third party, the carrier has a lien on that recovery, and consent must be obtained before settlement under WCL §29(5). The biggest mistake is settling a third-party case without §29 consent, which can extinguish the workers’ compensation death benefit. A misconception is that Social Security survivor benefits offset the workers’ compensation award; the offset runs the other way, so disclosure here protects rather than reduces the family’s award.
Section 11: Signature, Date, and Verification
Section 11 is the signed verification under penalty of perjury. The filer signs, dates, and prints their name, and a notary or Board officer may witness if required.
Sign in blue or black ink, print your name below the signature, and add the date in MM/DD/YYYY format. Janet Rivera signs, prints “JANET RIVERA,” and dates the form 12/01/2025. If multiple dependents file jointly, each adult dependent signs.
A nuance is filing on behalf of minor children; a parent or court-appointed guardian signs and notes “as parent and natural guardian of [child’s name].” The most common mistake is an unsigned C-30, which the Board’s intake unit returns immediately, costing two weeks. A misconception is that an electronic signature is always accepted; the Board accepts e-signatures through its portal but not scanned typed names on a paper submission.
Three Filled-Out Examples Using Real Scenarios
The three examples below show how three different families complete the form from start to finish. Each scenario uses a named filer, realistic facts, and the entries that go in the form’s most important boxes.
Scenario 1: Janet Rivera, Surviving Spouse with Two Minor Children, Construction Fatality
| Form Section | What Janet Enters |
|---|---|
| WCB Case Number | G2845192 (from prior C-2F notice) |
| Section 1: Deceased | RIVERA, CARLOS J.; SSN 123-45-6789; DOB 04/12/1968; DOD 11/03/2025 |
| Section 2: Filer | RIVERA, JANET; Spouse; 142 Main St Apt 3B, Yonkers, NY 10701 |
| Section 3: Employer | ACME CONSTRUCTION CORP; FEIN 12-3456789; employed 03/2010–11/2025 |
| Section 4: Carrier | TRAVELERS INSURANCE COMPANY; policy WC-9988776 |
| Section 5: Accident | 11/03/2025, 9:40 AM, fell from scaffold at 50 Hudson Yards, NYC |
| Section 7: Dependents | Janet (spouse), Diego (son, DOB 04/10/2014), Camila (daughter, DOB 08/30/2017) |
| Section 8: AWW | $1,425.60 with W-2 attached |
| Section 9: Funeral | $11,250.00 paid to Greenwood Funeral Home |
| Section 11: Signature | Janet Rivera, signed 12/01/2025 |
Scenario 2: David Kim, Adult Child Filing for Funeral Expenses Only, Occupational Disease
| Form Section | What David Enters |
|---|---|
| WCB Case Number | (blank — no prior case) |
| Section 1: Deceased | KIM, SUNG; SSN 987-65-4321; DOB 02/18/1955; DOD 07/22/2025 |
| Section 2: Filer | KIM, DAVID; Adult child (non-dependent); 88 Pine St, Flushing, NY 11355 |
| Section 3: Employer | METRO AUTO BODY INC; FEIN 98-7654321; employed 1985–2018 |
| Section 5: Disablement | Date of disablement 06/15/2018; mesothelioma from solvent exposure |
| Section 6: Cause of Death | “Malignant pleural mesothelioma” per death certificate |
| Section 7: Dependents | None claiming weekly benefits — funeral only |
| Section 9: Funeral | $10,500.00 paid to Lin Family Funeral Home; receipt attached |
| Section 11: Signature | David Kim, signed 09/05/2025 |
Scenario 3: Sofia Mendez, Same-Sex Spouse, Delayed-Discovery Workplace Exposure Death
| Form Section | What Sofia Enters |
|---|---|
| WCB Case Number | G3001884 (prior occupational disease C-3 on file) |
| Section 1: Deceased | MENDEZ, ELENA; SSN 555-11-2233; DOB 09/14/1970; DOD 03/18/2026 |
| Section 2: Filer | MENDEZ, SOFIA; Spouse; 27 Garden Ave, Albany, NY 12203 |
| Section 3: Employer | NORTHEAST CHEMICAL LABS; FEIN 22-3344556; 2002–2023 |
| Section 4: Carrier | NYSIF; policy WC-NY-7766554 |
| Section 5: Disablement | Date of disablement 11/12/2023; benzene exposure |
| Section 7: Dependents | Sofia Mendez (spouse, married 06/24/2014, marriage cert. attached) |
| Section 8: AWW | $2,015.40 — capped at NY max benefit rate |
| Section 9: Funeral | $12,500.00 paid to Northway Funeral Services |
| Section 11: Signature | Sofia Mendez, signed 04/02/2026 |
How to File the Completed Form
You may file Form C-30 by mail, online, in person, or by fax. The Board’s Centralized Mailing Address handles all paper submissions, and electronic filings flow through the Web Submission portal.
Mail. Send the signed C-30 with all attachments to NYS Workers’ Compensation Board, Centralized Mailing, PO Box 5205, Binghamton, NY 13902-5205. There is no filing fee. Use USPS Certified Mail with Return Receipt for proof of filing; processing typically begins within 10 business days of receipt.
Online. Upload through the Board’s Web Submission system using a free Online Account. No fee applies, no payment is needed, and you receive an instant confirmation number; processing typically begins within 3 business days. Save the confirmation PDF as your proof of filing.
In person. Walk into any WCB district office during business hours with your form and originals. There is no fee. The intake clerk date-stamps a copy as your receipt, and processing usually starts the same day.
Fax. The Board accepts faxed C-30 forms at (877) 533-0337 from licensed representatives and carriers; self-represented filers may also fax, but mail or online filing is more reliable. No fee. Keep the fax confirmation page as proof, and processing begins within 5 business days.
What Happens After You File
Within 14 days of receipt, the Board opens or updates the case in eCase and mails a Notice of Indexing (Form EC-84) to every party. The carrier then has 18 days from indexing to either accept the death claim and begin paying benefits, or to controvert it on Form C-7.
If the carrier accepts, weekly benefits begin retroactive to the day after death, paid every two weeks under WCL §25. The funeral expense check usually arrives 30 to 60 days after filing, payable directly to the person who paid the bill. The Board may also schedule a pre-hearing conference if any dependency or AWW issue is disputed.
If the carrier controverts, the case proceeds to a hearing before a Workers’ Compensation Law Judge. You may bring a free representative through the Advocate for Injured Workers office, hire a licensed attorney whose fee must be approved by the Board, or proceed pro se. Either party can appeal a judge’s decision to a Board Panel, and from there to the Appellate Division, Third Department.
Mistakes to Avoid When Filling Out the Form
The errors below appear repeatedly in returned C-30 filings, and each one delays or denies death benefits a grieving family needs.
- Filing after the §28 deadline. Missing the two-year statute of limitations under WCL §28 ends the claim before it begins.
- Mismatched names between the form and the death certificate. Triggers an RFA-2 hold and adds 30 to 60 days.
- Leaving the WCB Case Number blank when one already exists. Causes duplicate-file creation and split medical records.
- Using a “doing-business-as” name for the employer. Routes the case to the wrong carrier.
- Skipping a dependent in Section 7. Permanently removes that person from the §16 benefit calculation.
- Submitting an unpaid funeral estimate. Delays reimbursement until the paid invoice is provided.
- Inflating AWW with one-time bonuses. Invites a carrier challenge and a downward adjustment.
- Forgetting to attach the death certificate. Stops indexing entirely until the certified copy arrives.
- Settling a third-party case without §29 consent. Can extinguish the entire death benefit.
- Submitting an unsigned form. The intake unit returns it the same day, costing two weeks.
- Mailing to a district office instead of Binghamton centralized mailing. Adds a week of internal forwarding.
- Using the deceased’s old address as the filer address. Routes benefit checks away from the surviving family.
Do’s and Don’ts
These quick rules come from years of watching what works and what fails inside the Board’s process.
- Do order at least three certified death certificates, because every party (Board, carrier, court) wants an original.
- Do photograph every page of the completed form before mailing, in case the Board needs a duplicate set.
- Do file by Certified Mail or through the online portal so you have date-stamped proof.
- Do keep a single binder with the form, attachments, and every notice, organized by date.
- Do call the Board at (877) 632-4996 within 21 days if you do not receive a Notice of Indexing.
- Do request the Advocate for Injured Workers free help if you are pro se.
- Don’t sign the form until every box is filled, because the verification covers the entire document.
- Don’t guess the insurance carrier; verify through the Board’s Coverage Search first.
- Don’t paraphrase the cause of death from the death certificate; copy it verbatim.
- Don’t pay funeral costs in cash without an itemized paid receipt, because cash payments without paperwork are hard to reimburse.
- Don’t ignore the carrier’s request for additional medical records, because silence can be treated as abandonment.
- Don’t wait until the §28 deadline approaches to start; gather documents in the first 30 days after death.
Pros and Cons of Filing on Your Own vs. With Help
Many surviving families file C-30 without an attorney, but death cases often involve disputed dependency or causation issues that benefit from expert help.
Pros of filing pro se:
- No legal fee comes out of the weekly benefit award.
- The Board’s Advocate for Injured Workers provides free guidance.
- District-office staff will hand-check your form before you submit.
- Online filing makes simple, undisputed cases fast.
- You retain full control of every decision in the case.
Cons of filing pro se:
- Disputed AWW, dependency, or causation issues are hard to litigate without counsel.
- The §29 third-party lien rules are technical and easy to mishandle.
- Carrier defense counsel are experienced and prepared.
- Missing one notice deadline can waive a benefit forever.
- You will need to read WCL Article 2 and the Board’s Subject Numbers to keep up.
Filing by Mail vs. Filing Online
| Filing Channel | Key Features |
|---|---|
| Mail to Binghamton | No fee; Certified Mail receipt as proof; 10-business-day intake |
| Online portal | No fee; instant confirmation number; 3-business-day intake |
| In person at district office | No fee; same-day date-stamp; immediate clerical review |
| Fax to (877) 533-0337 | No fee; keep fax confirmation; 5-business-day intake |
Form C-30 vs. Form C-62
| Feature | What It Means |
|---|---|
| C-30 use | Full death claim by dependents; covers weekly benefits and funeral |
| C-62 use | Funeral-only claim by the person who paid burial costs |
| Filer | C-30: dependent or representative; C-62: funeral payer |
| Benefits unlocked | C-30: §16 weekly + funeral cap; C-62: funeral cap only |
| Statute of limitations | C-30: 2 years under §28; C-62: 2 years from death |
FAQs
Do I have to be married to claim spousal death benefits on Form C-30?
Yes. A surviving spouse must show a valid marriage at the time of death; New York recognizes same-sex marriages and out-of-state marriages, and a certified marriage certificate is required.
Can I file Form C-30 if I was divorced from the deceased worker?
Yes. A divorced ex-spouse who was receiving court-ordered support at the time of death may still claim limited dependency benefits under §16 case law.
Is there a filing fee for Form C-30?
No. The New York Workers’ Compensation Board does not charge any filing fee for C-30 or for any other workers’ compensation form.
Do I write my maiden name or married name in Section 2?
Yes, use the legal name on your current government ID; if your name changed by marriage, write the married name and add the maiden name in Other Names Used.
Do I list stepchildren in Section 7 if they were not legally adopted?
Yes, list them only if they were actually financially dependent on the deceased; attach proof such as tax returns or shared-household bills.
Can I file Form C-30 more than two years after the death?
No, absent narrow exceptions for occupational disease or fraudulent concealment under WCL §28, late filings are time-barred.
Do I include overtime when I calculate AWW in Section 8?
Yes, New York includes overtime, tips, bonuses, and the value of board and lodging when computing average weekly wage under §14.
Should I sign Section 11 before I notarize it?
No, sign in front of the notary or Board officer if notarization is required, because pre-signed verifications can be rejected.
Can I claim the funeral expense if I am not a dependent?
Yes, the person who actually paid the funeral bill can claim reimbursement up to the §16 cap, even if they have no other dependency relationship.
Is Social Security survivor benefit information required in Section 10?
Yes, disclose all collateral benefits; the Board uses the information for offset calculations, and the disclosure does not reduce your weekly award.
Do I need an attorney to file Form C-30?
No, many families file pro se, but disputed causation, AWW, or dependency cases benefit from a Board-certified workers’ compensation attorney.
Can the Uninsured Employers’ Fund pay my claim if the employer had no insurance?
Yes, the Uninsured Employers’ Fund under WCL §26-a pays valid death claims when no carrier is on the risk.
Do I have to attach the death certificate to file Form C-30?
Yes, a certified death certificate must accompany the form, because the Board cannot index a death claim without verified proof of death.
Related reading
- How to Fill Out New York Form C-3 (w/Examples) + FAQs
- How to Fill Out New York Form C-4.3 (w/Examples) + FAQs
- How to Fill Out New York Form C-4 (w/Examples) + FAQs
- How to Fill Out New York Form RFA-2 (w/Examples) + FAQs
- How to Fill Out New York Form WCB C-300.5 (w/Examples) + FAQs
- How to Fill Out New York Form WCB C-7 (w/Examples) + FAQs
- How to Fill Out California WCAB DWC-AD 1 (w/Examples) + FAQs