Filing Disability Benefits Claims
If you are a NYSIF disability benefits policyholder, please provide form NYSIF DB-450 to your employee once they become disabled with a off-the-job injury or illness, or within 30 days of disability. NYSIF DB-450 should not be filed before a disability begins. Disability benefits begin on the eighth day of disability.
Completing Form DB-450
Part C is completed by the employer and provides the necessary information NYSIF uses to process the claim.
Part B is completed by the health care provider and must indicate the estimated date your employee may return to work.
Part A is completed by the claimant. 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.