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Click ‘Get Form’ to open the New York State Disability Claim form in the editor.
Begin with PART A – CLAIMANT’S STATEMENT. Fill in your personal information, including your name, address, and Social Security number. Be sure to describe your disability clearly.
In PART B – HEALTH CARE PROVIDER’S STATEMENT, ensure your treating physician completes this section accurately. They will need to provide diagnosis details and treatment dates.
If applicable, have your employer complete PART C – EMPLOYER’S STATEMENT. This helps confirm your eligibility for benefits.
Sign and date the AUTHORIZATION TO OBTAIN INFORMATION form. This allows further inquiries if needed.
Once all sections are completed, submit the form through our platform for a streamlined process.
Start using our platform today to simplify your NY State Disability claim process!
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A Guide to New Yorks Disability BenefitsLaw (DBL) Paid
Disability Benefits Law (DBL) is a New York State- mandated disability insurance program designed to provide employees with temporary cash benefits when.Read more
New York is one of a handful of states that require employers to provide disability benefits coverage to employees for an off-the-job injury or illness.
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