NY Direct Deposit Instructions and Election Form

An injured worker or person entitled to a death benefit may elect to receive workers’ compensation indemnity or death benefits by direct deposit to a bank account or bank accounts in the name of the injured worker or person entitled to a death benefit. Such election is not required to be offered for payment of fees due to the representative of the injured worker or person entitled to a death benefit or for payments due to a treating medical provider for payment of medical bills.

Please click the below link to download the form.

NY Direct Deposit Instructions and Election Form (pdf)