If you’re a business owner in New York State, you’re likely familiar with the complexities of insurance and compliance. One document that often comes up in this context is the C-105 form. But what exactly is it, and why is it so important? Let’s break it down.
What is a C-105 Form?
The C-105 form, officially titled “Certificate of NYS Workers’ Compensation Insurance Coverage,” is a crucial document that serves as proof that a business has workers’ compensation insurance, as mandated by New York State law. Think of it as the official verification that you’re meeting your legal obligation to protect your employees in case of work-related injuries or illnesses.
Key Components of the C-105 Form
To help you better understand this form, here are its key components:
- Insured’s Information: This section provides essential details about your business, including the legal name and address, business telephone number, NYS Unemployment Insurance Employer Registration Number, and Federal Employer Identification Number or Social Security Number. In some cases, it may also include the work location of the insured, especially if coverage is limited to specific locations within New York State.
- Entity Requesting Proof of Coverage: This section identifies the organization or entity that needs proof of your business’s workers’ compensation coverage. This could be a client, a contractor, or a government agency. They are also referred to as the Certificate Holder.
- Insurance Carrier and Policy Information: This section provides details about the insurance carrier providing your coverage and the specifics of your policy, including the name of the insurance carrier, the policy number, and the policy’s effective and expiration dates.
- Inclusion/Exclusion of Proprietors, Partners, or Executive Officers: This section specifies whether proprietors, partners, or executive officers are included or excluded from your workers’ compensation coverage.
- Certification: This is a critical part of the form, as it certifies that your insurance carrier insures your business for workers’ compensation under the New York State Workers’ Compensation Law.
- Important Notes: The form also includes vital information regarding policy cancellations and clarifies your responsibility to provide a new certificate if your policy is canceled but your business remains on a permit, license, or contract.
- Authorized Representative Information: To ensure validity, the form must be signed by an authorized representative or licensed agent of your insurance carrier. This section includes their printed name, signature, title, date, and telephone number.
Who Issues the C-105 Form?
It’s important to know that only insurance carriers and their licensed agents are authorized to issue the C-105 form. Insurance brokers are not authorized to issue it.
How Do You Obtain the C-105 Form?
The process is straightforward. Your insurance carrier or their licensed agent will send the Certificate of Insurance directly to the entity listed as the certificate holder.
Staying Updated: Notification of Policy Changes
Insurance carriers have a legal obligation to keep relevant parties informed of any policy changes. They must notify the certificate holder within 10 days if a policy is canceled due to nonpayment of premiums. For cancellations due to reasons other than nonpayment, or if the insured is eliminated from coverage, they must provide notification within 30 days. These notifications may be sent by regular mail.
How Long is the Certificate Valid?
The Certificate’s validity is limited. It is valid for one year after approval by the insurance carrier or its licensed agent, or until the policy expiration date, whichever comes first.
Checking Workers’ Compensation Coverage
If you need to verify workers’ compensation coverage, the best resource is the New York State Workers’ Compensation Board website (www.wcb.state.ny.us).
Why is the C-105 Form Important?
New York State law has specific requirements for permits and contracts. Proof of workers’ compensation coverage, provided through the C-105 form, is mandatory before permits or contracts involving hazardous employment can be issued. This ensures that businesses are compliant and that employees are protected.
We hope this clarifies the C-105 form and its importance. If you have any further questions or need assistance with your business insurance needs, don’t hesitate to reach out to us!