Client Forms
At Peter M. Cordovano P.C., we understand that filing for workers' compensation can be a difficult process. We are here to help you navigate the process and ensure you receive the compensation you are entitled to.
To get started, please fill out our New Client Forms. Our New Client Forms include questions about your injury, your employer, and your medical history. This information will help us build a strong case for you and ensure you get the compensation you deserve. Once you have completed the forms, please submit them to our office. We will review your forms and contact you to discuss your case.
New York State Worker's Compensation Forms
- Claim for Compensation in a Death Case (C-62)
- Volunteer Firefighter's Claim for Benefits (VF-3)
- Loss of Wage Earning Capacity Vocational Data Form (VDF-1)
- Volunteer Ambulance Worker's Claim for Benefits (VAW-3)
- Notice of Retainer and Appearance on Behalf of Employer (OC-406)
- State of New York - Workers' Compensation Board (OC-400)
- Discharge or Discrimination Compliant (DC-120)
- Notice and Proof of Claim for Disability Benefits (DB-450)
- Claimant's Record of Job Search Efforts/Contacts (C-258)
- Claimant’s Record of Medical and Travel Expenses and Request for Reimbursement (C-257)
- Doctor's Report of MMI/Permanent Partial Impairment (C-4.3)
- Employee Claim (C-3)
Social Security Disability Forms
- Request for Social Security Statement (SSA-7004)
- Disability Report - Appeal (SSA-3441-BK)
- Disability Report - Adult (SSA-3368-BK)
- Instructions for Completing Form SSA-1696
- Authorization to Disclose Information to the Social Security Administration (SSA-827)
- Request for Reconsideration (SSA-561-U2)
- Social Security Attorney Fee and Retainer Agreement
- Claimant's Work Background (HA-4633)
- Claimant's Medications (HA-4632)
- Claimant's Recent Medical Treatments (HA-4631)
- Request for Administrative Law Judge (HA-501)
- Apply Online for Disability Benefits
- Disability Benefits
If you have any questions about the New Client Forms or the workers' compensation process, please do not hesitate to contact us. We are here to help you every step of the way.
