- State of New York, Workers Compensation Board, Direct Deposit Authorization Form (effective July 1, 2021)
Per 12 NYCRR 300.26, beginning July 1, 2021, recovering workers have the right to have workers’ compensation benefit checks and/or proceeds from a settlement agreement directly deposited into a bank account of their choosing.
To begin, change, or cancel the transmittal of workers’ compensation benefit checks and/or proceeds from a settlement agreement pursuant to WCL § 32 (hereinafter settlement proceeds) directly to a financial institution, fill out this form and submit the form to: Berkshire Hathaway Homestate Companies, PO Box 881716, San Francisco, CA 94188, or fax to (415) 675-5469.
Domestic Violence Protocol
As of: 11/15/2022