Amend A Policy

Change in Name and/or Address

If the name and/or address of a business or entity changes, notify NYSIF as soon as possible. Correcting this information is essential for all correspondence to continue without interruption.

Address changes may be submitted in writing or noted on your remittance slip when sending in payment.

Name changes require an “Assignment of Interest Agreement” form UDB-37 to be completed and returned to NYSIF.

Voluntary Cancellation

New York State Workers’ Compensation Law requires policyholders to provide NYSIF with 30 days written notice of their intent to cancel a policy.

If a cancellation request is less than 30 days from the policy anniversary date, the policyholder is responsible for any premium payment that extends beyond the anniversary date.

Non-Payment Cancellation

Policies will be processed for non-payment cancellation when balances are not paid within 30 days of the monthly billing statement notification. If payment is submitted prior to the final non-payment cancellation date, the policy will be reinstated. If payment is not received, the policy is canceled.

To obtain a new policy, the policyholder must finalize the canceled policy and pay any outstanding balance due.

Refund Procedure

There may be times when a credit balance occurs on an account. If there are no outstanding payroll reports, and the current estimated policy period is paid in full, a refund may be requested.

Cancellation requests, or letters requesting refunds should be sent to:

NYSIF Disability Benefits
15 Computer Drive West
Albany, NY 12205

Be sure to include the NYSIF disability benefits policy number on the request. Upon cancellation, a final payroll report is required to calculate final premium. Allow two-three weeks to process refunds.

Payroll Reporting

NYSIF disability benefits insurance premium is based upon the total actual and capped ($17,680 per person) payroll of a policyholder during a particular policy period. To finalize the actual premium on a policy, policyholders are required to report their total actual and capped payroll within 30 days after the end of a payroll period.

Payroll reports are mailed to policyholders at the close of a policy period. Policyholders are required to complete the report and submit to NYSIF within 30 days.

If a policyholder fails to return a completed payroll report, payroll for the outstanding period is considered unreported and a 50 percent payroll adjustment is added to the original estimated premium. If the completed payroll report is later submitted, the payroll period will be revised to reflect the reported payroll information.

If a payroll report is not received by the policyholder at the end of the policy period, contact us by e-mail or call toll free:

1-866-NYSIF-DB (1-866-697-4332)

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