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The law defines disability as the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.
Disability benefits are equal to 50 percent of the employee's average weekly wage for the last eight weeks worked, with a maximum benefit of $170 per week (WCL §204). If counting the last week in which the disability began lowers the benefit rate, it is not included in determining average weekly wage.
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, Disability Benefits Bureau, PO Box 9029, Endicott, NY 13761-9029.
If you get sick or injured when you're not at work, the NY State Insurance Fund Disability Benefits can help: www.nysif.com. You may qualify to receive money for a short period of time. You may also qualify if you have a disability from being pregnant. Were you injured on the job?
In order to be eligible for short-term disability benefits, you must have become injured or ill while not at work but must be employed, or recently employed, at the time of illness or injury. (Those who are injured on the job are covered under a different set of rules.)
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Long-Term Disability Insurance After six months of total and continuous disability, members are eligible to receive up to 66 2/3%* of pre-disability salary with a minimum of $150 and a maximum of $5,000 per month.
Voluntary Short Term Disability You can receive income replacement benefits up to a maximum of 26 weeks. An employee working at least 50 percent of full time on a regular appointment and whose annual salary is at least $15,000 is eligible to enroll in the plan.
The New York state program provides short-term disability benefits through the Disability Benefit Law (DBL) and Paid Family Leave (PFL) wage replacement benefits to eligible employees who need time off from work for qualifying reasons.
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.
NY State Insurance Fund ( NYSIF ) NYSIF is a not-for-profit agency of the State of New York that offers workers' compensation, New York State disability benefits and Paid Family Leave insurance.

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