- Workers' Compensation Procedure
- Accident Reporting System (ARS) Memo/Procedures
- Workers' Compensation/State Employee Injury/Illness Incident Report
Employee Accident and Investigation Report
(To Report a Work Related Injury or Illness)
- Call the Accident Reporting System (ARS) at (888)-800-0029 to report a work related injury or illness as soon as possible. Write down the incident number the operator gives you.
- Complete the Workers' Compensation/State Employee Injury/Illness Incident Report as soon as possible and send it to:
Human Resource Services
Stony Brook University
State Time & Attendance / Leave Unit
390 Administration Building
Stony Brook, NY 11794-0751
- When Completing the Form:
- Be specific when answering questions concerning how the accident occurred.
- It is very important to indicate if you received medical treatment. If you do not seek medical treatment at the time of the injury, but do so at a later date, notify Time & Attendance immediately. If you are losing time from work due to your injury, Time & Attendance must be notified. You must provide ongoing medical documentation to your department during your absence.
- Time & Attendance must be notified when you are losing time from work and when you return.
- You and your supervisor must sign this report. This report is needed to process your Workers' Compensation claim.
- Personal Health Insurance cannot be used for Workers' Compensation claims.
- All fees for medical treatment must be billed to:
- State Insurance Fund
Policy Number: 24096-0
8 Corporate Center Drive, 3rd Floor
Melville, NY 11747-3166