EMPLOYERS must file a report of work-related injury or illness with NYSIF immediately upon becoming aware of the 

injury or illness, and no later than 10 days after the employer's knowledge of the injury or illness, in all cases 

where the injury/illness:

Has/will cause an absent from the employee’s regular duties of one or more days beyond the regular workday or shift when the incident occurred

Has required or will require medical treatment beyond 

ordinary first aid, or more

than two treatments by a person rendering first aid

If you find yourself in any of these situations or have concerns regarding a claim, do not hesitate to reach out to our knowledgeable claims team. We are equipped to answer your questions, assist with first aid, and guide you with the reporting process.

Options for filing a New York State Insurance 

Fund Workers Compensation Claim:

Online EFROI form

This system allows you to file the necessary form online.  

Once completed, we are notified

and will start to monitor your case.

EFROI Worksheet form

OR you can complete the form below and email it to claims@Keevily.com.  

Please be sure to complete the mandatory questions.

Reporting Suspicious 

Injury/Illness Claims

When submitting injury/illness reports, it's important to be mindful of their accuracy. The Workers' Compensation Board (WCB) may consider statements made in the report as legally binding. In case you have doubts or concerns about a claim, it is advisable to preface the report with phrases such as 'It is alleged that...' or 'The employee claims that...' This approach helps indicate potential discrepancies. If you come across a claim that raises suspicion or if new information regarding a claim surfaces, we strongly encourage you to contact your Keevily Team.

First-Aid Option

Employers may handle non-reportable, minor injuries as First Aid Cases. In such cases, we recommend you reach out to your Keevily Team so we can help you confirm qualification, document correctly and notify the medical providers.

Claimant 

Information 

Packet

Employers must give injured workers a Claimant Information Packet when filing a claim. The employer does NOT need to wait for the injured worker to complete the forms to file the claim. The employer’s obligation is only to give the claimant packet to the injured worker and file the claim with the Carrier within 10 days of knowledge.

To get in touch with our Keevily 

claims team simply contact us at

1-800-523-5516

or

Claims@Keevily.com

www.Keevilyworkcomp.com