Discharge Or Discrimination Complaint {DC-120} | Pdf Fpdf Doc Docx | New York

 New York   Workers Compensation 
Discharge Or Discrimination Complaint {DC-120} | Pdf Fpdf Doc Docx | New York

Last updated: 3/21/2024

Discharge Or Discrimination Complaint {DC-120}

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Description

DC-120 - DISCHARGE OR DISCRIMINATION COMPLAINT. This form is used for filing a complaint with the New York State Workers' Compensation Board regarding discharge or discrimination related to workers' compensation or disability benefits claims. It allows individuals to report instances where they believe they have been unfairly discharged or discriminated against by their employer due to their claim for compensation or disability benefits. The form collects detailed information about the employee, employer, circumstances of the complaint, and any involved parties. It also includes a statement of affirmation under penalty of perjury, confirming the truthfulness of the information provided. Additionally, the form contains relevant sections of the Workers' Compensation Law outlining the rights and protections afforded to employees in such cases, as well as information on representation and privacy protection laws. www.FormsWorkflow.com

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