Obtain a DB-450 from your employer. Your employer can print a DB-450 from our website. A valid disability benefits policy number is required. Do not file a DB-450 before you become disabled.
Part A is completed by the claimant. Be sure to answer all questions completely and sign the front of the form. Write clearly. Incomplete or unsigned forms may be returned.
Part B is completed by the health care provider. Be sure your medical provider indicates the estimated date you may return to work. Do not indicate "unknown" or "undetermined."
Part C is completed by the employer and provides the necessary information NYSIF uses to process the claim.
A claim should be filed once you become disabled and within 30 days of your disability.
A fax or copies of the DB-450 are accepted by NYSIF. Be sure to keep a copy for your records.
Mail completed DB-450 forms for NYSIF claims to:Document Control Center
1 Watervliet Avenue Ext.
Albany, NY 12206
You may also fax your DB-450 to: 518-437-5201.
If NYSIF is not your disability benefits carrier, contact the NYS Workers’ Compensation Board for help in determining your carrier.