Completing an application for New York State short-term disability benefits requires several confusing steps. First, you have to identify the correct claim form to download and complete. Second, you have to fill it out properly. Third, you have to determine where to send it.

The third step in the process is most difficult. There are many options, but only one right answer. Your benefits application may be denied, or delayed if you send the paperwork to the wrong insurer. Get it right the first time.

  • Which claims forms to complete
  • How to complete them properly
  • Where to send the completed application

NYS Short-Term Disability Application Form DB-450

Complete Use the New York State (NYS) short-term disability insurance application form DB-450 if you were actively employed and you suffered an off-the-job accident or illness. Most workers use this form to file a claim for benefits.

NYS short-term disability benefits pay 50% of gross income up to a $170 per week cap. Women frequently utilize the program during maternity leave, as do workers suffering from other medical conditions.

Pregnancy Maternity Leave

Use the NYS short-term disability application form DB-450 to file a claim for pregnancy complications before delivery or for maternity leave benefits after childbirth.

Your doctor’s note must include the medical reason why the pregnancy complications prevent you from performing the duties of your full-time occupation. The doctor’ note should also indicate the type of delivery (vaginal or C-section) as the maternity leave recovery time is longer for C-section births.

Private short-term disability for pregnancy requires that you file a separate claim form with the issuing carrier. This may be a different company. Many women choose to increase their maternity leave benefit by purchasing a private policy prior to conception.

Eligibility & Qualifications

You are eligible to file an NYS short-term disability claim if you suffered an accident or illness on or off the job. You simply complete a different claim form for the type of situation.

Off the Job

Complete NYS short-term disability claim form DB-450 for any off-the-job accidents and illnesses. Complete this form if you were working no less than four weeks prior to the start date of your disability to apply for benefit payments.

Download form DB-450 here.

You may need to complete practitioner’s claim form DB-405.5 if you depend on prayer for healing.

On the Job

Complete NYS short-term disability claim form C-3 if you suffered an on-the-job accident or illness. Workers compensation covers on-the-job accidents and provides a much higher benefit level.

Download claim forms C-3 here.

The weekly cap in 2014 for disability program is $170 while the weekly cap for workers compensation is $803. Workers compensation may also pay for medical care.

NYS Short-Term Disability Application Form DB-300

Complete the New York State (NYS) short-term disability insurance application form DB-300 if you were unemployed prior to suffering a covered accident or illness. In addition, make certain you are aware of the rules and requirements for when to send any of the forms, and where to find them in the first place.


Download and file NYS short-term disability application form DB-300 If you become disabled while unemployed. Use this form if your bout with unemployment began more than four weeks before your covered accident or illness.

Download form DB-300 here.

Keep in mind the difference in weekly benefit amounts. Unemployment compensation caps at $405 per week, versus $170 week for NYS short-term disability. You cannot receive benefits from both programs simultaneously. Choose wisely.

New York State law allows for unemployment compensation when an employee has to stop working for a “compelling family reason” and the employer is unable to make accommodations. A compelling family reason may include caring for a sick family member. There are two common scenarios where is may make sense to file a claim for unemployment compensation after applying for disability benefits:

  • A spouse must stop working to care for his or her disabled partner.
  • One or both parents must stop working to care for a sick infant.

Rules & Requirements

Follow the requirements for the NYS short-term disability application form carefully to avoid denials and unnecessary delays. You will find instructions on the document itself.

Complete the form accurately, and send it to the correct addresses.

Form Instructions

There are two main sections to the NYS short-term disability claim forms: the claimant’s statement, and the healthcare practitioner’s statement. Make certain that you and the practitioner apply signatures.

Make copies of the completed paperwork and store them in a safe place. Mail the completed document within thirty days of the start of your disability to your last employer, or your last employer’s insurance company. This is where things sometimes get tricky.

Application Address

The most challenging requirement is determining where to mail the completed NYS short-term disability claim form. The state law requires that employers purchase a program for employees. Employers can purchase a private policy or self-insure.

The state does not process claims. The private insurance companies that underwrite the coverage adjudicate claims. Each employer may have contracted with a different insurance company.

You must mail the completed paperwork to the right insurance company within thirty days of your disability. If you send the document to the wrong insurer, you may miss the thirty-day window. You then have to explain in writing why you missed the deadline.

Some detective work is needed to identify the insurance company responsible for paying the claim. Look in two places: your employer and an online employer provider search.

Last Employer

Another requirement is that you must mail the paperwork to your to your last employer. That works most of the time but is not always ideal.

Your last employer is responsible for choosing the insurance company, so they should know who it is. However, asking your employer to forward the paperwork introduces delays. Consider asking who the insurance company is, and sending the signed documents directly instead.

Many employers are just as confused about the process as you are. Many employers rarely have employees out on disability. Out-of-state employers are often unfamiliar with requirements, and many employees do not know whom to contact at their employer.

Finding the Insurer

The New York Compensation Board provides an online employer provider search that may generate clues. Enter in your employer’s name or other identifying information and the system returns a list of possible matches. Keep in mind that this system states it finds providers of workers compensation. The same provider may also be responsible for processing your NYS short-term disability claim form.

Copyright: qwasyx / 123RF Stock Photo

Posted 04/11/16 12:05 PM by Kevin Haney MBA