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A claim must be filed within 30 days of your disability.
If you have been unemployed for less than four weeks and become disabled, you should file a DB-450. If you have been off work more than four weeks and become disabled while collecting unemployment benefits, you should file a DB-300 with the NYS Workers’ Compensation Board – Disability Benefits, 100 Broadway – Menands, Albany, NY 12241. You may obtain a DB-300 from your local Workers’ Compensation Board or call 1-800-353-3092.
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Obtain a DB-450 from your employer. Your employer should have the correct forms or they may send an e-mail, including their NYSIF policy number, and forms will be forwarded to their attention. An employer may also obtain a DB-450 form from the website. If NYSIF is not your employer’s insurance carrier, the employer should contact their insurance carrier directly to obtain the proper forms.
Do not file a DB-450 before you become disabled.
Part A is completed by the claimant. Please be sure to answer all questions completely and sign the front of the form. Write clearly since this is where we obtain the address information to mail checks. Incomplete or unsigned forms may be returned.
Part B is completed by the health care provider. Please be sure your medical provider indicates an estimated date that you may return to work. Do not indicate “unknown” or “undetermined.”
Part C is completed by the employer and provides information the insurance company uses to process the claim. This portion of the DB-450 is unique to each insurance carrier and provides the necessary information to process the claim.
DB-450’s are obtained from your employer. Your employer should have the correct forms or they may send an e-mail, including their NYSIF policy number, and forms will be forwarded to their attention. Employers may also obtain DB-450 forms from our website. If NYSIF is not your employer’s insurance carrier, the employer should contact their insurance carrier directly to obtain the proper forms.
A claim should be filed once you become disabled. A claim must be filed within 30 days of your disability.
Yes, fax or copies of the DB-450 are accepted by NYSIF. Please be sure to keep a copy for your records. If forms do not reach us, you may resubmit a copy.
If NYSIF is your employer’s disability benefits insurance carrier, send the completed DB-450 to:
NYSIF – Disability Benefits Claims225 Oak Street Buffalo, NY 14203
If NYSIF is not your employer’s disability benefits carrier, your completed DB-450 should be mailed directly to your employer’s insurance carrier.
If you are unable to determine the carrier, the NYS Workers’ Compensation Board is the enforcement agency for disability benefits and will help you establish who the carrier is. Mail the completed DB-450 to:
NYS Workers’ Compensation Board Disability Benefits Bureau 100 Broadway – Menands Albany, NY 12241-0005
The benefit rate is 50 percent of the employee’s last eight weeks average gross wages with a maximum benefit of $170 per week.
You must be off work eight consecutive days to be eligible for benefits. The first week (seven days) is a waiting week that is not paid.
Medical documentation of your disability must be provided for all periods you are requesting payment.
The maximum benefit is 26 weeks in a 52-week period.
Pregnancy related disabilities are paid the same as any other disability claim. Generally, a claimant is covered six weeks after a normal delivery and eight weeks after a Caesarian section (the first week is a non-paid waiting week). The time off must be covered by medical documentation from the medical provider and the disability may be extended before or after if there are complications.
Disability benefits are only paid when you are disabled – benefits do not include time off for family illness, injury or adoption.
Benefit checks are processed every two weeks.