Filing Disability Benefits Claims
To file a Disability Benefits claim, an employee must complete NYSIF Form DB-450 and return it to NYSIF within 30 days of the onset after the start of the off-the-job injury or illness. For approved claims, Disability Benefits begin on the eighth day of disability.
Your Part: Form DB-450
Part A is completed by the claimant. The claimant must answer all questions completely and sign the front of the form.
Part B is completed by the health care provider. The health care provider must indicate the estimated date your employee may return to work.
Part C is completed by the you, the policyholder. You must provide the necessary information NYSIF uses to process the claim.
Filing Paid Family Leave Claims
To file a Paid Family Leave claim, an employee must complete NYSIF Form PFL-1, along with additional PFL forms for the type of leave being requested. See more details on our PFL claimant page.
Your Part: PFL Forms
All forms must be returned to the employee within three business days.
NYSIF PFL 1: Complete and sign Part B. Requested information includes business name and address, SIC code and employee's date of hire.
NYSIF PFL-2 (Bonding): Complete and sign Part B. Requested information includes gross weekly wage calculation.
NYSIF PFL-4B (Care): Complete and sign Part B. Requested information includes gross weekly wage calculation.
NYSIF PFL-5 (Military): Complete and sign Part B. Requested information includes gross weekly wage calculation.
More on Employer Responsibilities
For complete details of an employer’s responsibilities under the Disability Benefits Law, please visit the New York State Workers’ Compensation Board website.