(Off-the-Job Injury or Illness)
How to File a Claim
If you are currently employed, or if you have been unemployed for less than four weeks from the date the disability began, file the claim with your employer or insurance carrier, using form DB-450 . This form is available on-line, or you may obtain a copy from the nearest district office. Keep a copy of this form to submit again if your claim is not paid promptly.
If you have been unemployed more than four weeks from the date the disability began, file the claim with the Disability Benefits Bureau, using the form DB-300 . Mail it to: Disability Benefits Bureau, Workers' Compensation Board, 100 Broadway-Menands, Albany, NY 12241.
You must file your claim within 30 days after you become disabled. If you file late, you will not be paid for any disability period more than two weeks before the claim is filed. Late filings may be excused if it is shown that it was not reasonably possible to file earlier. No benefits will be paid if you file more than 26 weeks after your disability begins.
You must be under the care of a physician, chiropractor, podiatrist, psychologist, dentist, or certified nurse midwife in order to qualify for benefits. Your health care provider must complete and sign the "Health Care Provider's Statement" as proof of your disability.
However, if you depend for healing upon prayer through spiritual means alone in the practice of religion, you must be under the care of a duly accredited practitioner to qualify for benefits. In this situation, the practitioner must complete and sign the "Practitioner's Statement" (form DB-450.5) before mailing.
Before filing your claim, be sure that you have completed and signed the "Claimant's Statement" and your health care provider or practitioner has completed and signed his/her portion. Submit this information promptly to avoid delaying your claim.