Filing Disability Benefits Claims
Employers obtain Form DB-450 from this website with a valid NYSIF disability benefits policy number. Give this form to your employees to file a claim once they become disabled with a off-the-job injury or illness, or within 30 days of disability. DB-450 should not be filed before a disability begins. Disability benefits begin on the eighth day of disability.
Completing Form DB-450
- The employer completes Part C.
- Include all information necessary to process the claim.
- The medical provider completes Part B and includes the estimated return-to-work date.
- Do not enter "unknown" or "undetermined."
- The claimant completes Part A and includes the recipient address for benefit checks.
- The claimant must answer all questions completely and sign the front of the form.
For complete details of an employer’s responsibilities under the Disability Benefits Law, please visit the New York State Workers’ Compensation Board website.