Commonly Used Forms available for printing and mailing to the Workers' Compensation Board

This packet contains the forms that will help us to process your claim for New York State Disability Benefits. Please save a copy of this material for your future reference.

Use this form if you became disabled while employed or if you became disabled within four (4) weeks after termination of employment OR if you became disabled after having been …

TO CLAIM BENEFITS you should file written notice and proof of disability (Claim Form DB-450) with your employer or the insurance carrier named below within 30 days from the first day of …

· If you are employed, or have been unemployed for four weeks or less when your disability begins, send the completed form to your employer or the insurance carrier named below.

If you are using this form because you became disabled after having been unemployed for more than four (4) weeks, your completed claim MUST be mailed to: Workers' Compensation Board, …

Access frequently-used workers' compensation and disability benefits forms below. Many of the forms link directly to the Workers' Compensation Board website.

Nov 1, 2023 · Please use the current Form DB-450 until January 1, 2024. Failure of the employer to complete Part C on Form DB-450, or inadequate completion by the employer, is not a valid …

This form is available on the WCB website (www.wcb.ny.gov) and can be accessed by clicking the "Forms" link. If you do not have access to the internet please call (877) 632-4996 or visit our …

IF YOU HAVE DIFFICULTY IN OBTAINING A CLAIM FORM OR NEED HELP IN FILLING IT OUT, OR IF YOU HAVE ANY OTHER QUESTIONS OR PROBLEMS ABOUT A NON-WORK …