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Subject Number 046-965 Changes to the Disability Benefits Claim Filing Process

Board Bulletins and Subject Numbers

Date: September 25, 2017

The New York State Workers' Compensation Board is making changes to the disability benefits claim filing process to simplify filing and capture more information earlier in the life of a disability benefits claim.

To reduce the number of forms used to file disability benefits claims, the Notice and Proof of Claim for Disability Benefits (Form DB-450) and the Notice of Proof of Claim for Disability Benefits of Unemployed Claimant (Form DB-300) have been combined into a new Form DB-450, entitled Notice and Proof of Claim for Disability Benefits. Claimants will now use the revised Form DB-450 to file all disability benefit claims with the Board or insurance carriers, regardless of their employment status.

To make Form DB-450 easier to complete, the filing instructions have been clarified and information on how to locate the mailing address for submitting the form to the appropriate insurance carrier (or the Board) is included.

Questions have also been added to the new Form DB-450 to collect the following information earlier in the claim:

The new Form DB-450 is available on the Board's website. Please see: Notice and Proof of Claim for Disability Benefits (Form DB-450). Use of the new Form DB-450 is effective immediately. The old form will continue to be accepted until December 22, 2017.

Clarissa M. Rodriguez
Chair