What to do when injured on the job:

Temporary Workers' Comp Number: W802342

THE FOLLOWING IS IMPORTANT INFORMATION REGARDING WORK RELATED INJURIES:

 Ø Inform your supervisor immediately of your injury.

 Ø Fill out both the C.3 Form & C-3.3 form as well as the Kingstree Group Consent Form, ASAP

     **Be sure to Sign All Forms**

 Ø Scan and email SIGNED forms within one day to Central office: 

     ATTN:  Deb Rodrigue  (845)486-4450 Ext. 20155   claims@acsdny.org

 Ø Do not use your medical insurance card for any doctor’s visits.

 Ø Inform your medical provider of our workers’ compensation carrier/claims administrator:

       Wright Risk Management Company, Inc. 

       900 Stewart Avenue Suite 600

       Garden City, NY 11530

       Attn: Stacy Barry, WC Claims Rep.

       Phone: 516-750-9418 Fax: 516-794-5254

You may provide your medical provider a Temporary Workers' Comp Number: W802342

CLICK HERE TO ACCESS THE FORMS

Please feel free to contact Deb Rodrigue with any questions or concerns: