Filing Claims

Obtain a DB-450 from your employer. Employers may obtain a DB-450 from our website or e-mail NYSIF to request the correct form. 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. This is how we obtain the address information to mail checks. 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. This portion of the DB-450 is unique to each insurance carrier.

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. Please be sure to keep a copy for your records.

Completed DB-450 forms for NYSIF claims should be mailed to:

NYSIF Disability Benefits Claims
225 Oak Street
Buffalo, NY 14203

If NYSIF is not your disability benefits carrier, contact the NYS Workers’ Compensation Board for help in determining your carrier.