Form C-121 Claim for Compensation and Notice of Commencement of Third Party Action - New York (Haitian Creole)

This is a legal form that was released by the New York State Workers' Compensation Board - a government authority operating within New York.

The document is provided in Haitian Creole. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form C-121?
A: Form C-121 is a claim for compensation and notice of commencement of third party action form.

Q: What is the purpose of Form C-121?
A: The purpose of Form C-121 is to file a claim for compensation and notify the workers' compensation board about a third party action.

Q: Who is eligible to use Form C-121?
A: Any worker in New York who wants to claim compensation and commence a third party action can use Form C-121.

Q: Can Form C-121 be used for a specific group of people?
A: Yes, this particular version of Form C-121 is in Haitian Creole language.

Q: Is there a deadline to submit Form C-121?
A: Yes, Form C-121 must be submitted within 30 days from the start of the third party action in court.

Q: What information do I need to provide on Form C-121?
A: You need to provide your personal information, employment details, and the details of the accident or injury.

Q: Can I attach supporting documents with Form C-121?
A: Yes, you can attach relevant documents such as medical records or witness statements to support your claim.

Q: What happens after I submit Form C-121?
A: After you submit Form C-121, the workers' compensation board will review your claim and notify you of their decision.

Q: Is there a fee for filing Form C-121?
A: No, there is no fee for filing Form C-121.