Durnan Insurance Services

Forms

Documents for Filing Claims,
Reporting Incidents, and More

At Durnan Insurance Services, we provide easy access to essential forms for reporting workplace injuries, filing claims, and managing your workers’ compensation needs. Whether you’re submitting a disability claim, reporting an incident, or requesting reimbursement, our comprehensive library of forms ensures that you have everything you need to stay compliant and organized. Download and submit the necessary forms directly from this page to streamline your claims and reporting processes.

Workers' Compensation NYSIF Underwriting Forms:

NYSIF Application:

Apply for workers' compensation coverage with the New York State Insurance Fund (NYSIF), essential for ensuring employee protection.

U-3, 3A - Assignment of Interest Agreement:

Form used to assign interest in a workers' compensation policy to another entity.

U-111, 111A - Request for Inclusion of Additional Interest

Add an additional interest (e.g., business partners) to a workers' compensation policy.

Not-For-Profit Unsalaried Executive Officer

Documents for unsalaried executive officers in non-profits seeking workers' compensation coverage.

Notice to Corporations with One or Two Executive Officers:

Required notice for corporations with only one or two officers opting in or out of workers' compensation.

Executive Officer Information Sheet

Collects key details on executive officers to confirm eligibility for coverage under workers' compensation.

Experience Rating Plan - Request for Information

A request form for businesses to obtain experience rating information, helping determine workers' compensation premiums based on past claims.

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