Dc37 disability form 2025

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Disability benefits are temporary cash benefits paid to an eligible employee, when they are disabled by an off-the-job injury or illness. Disability benefits are equal to 50 percent of the employees average weekly wage for the last eight weeks worked, with a maximum benefit of $170 per week (WCL 204).
The New York State Disability Benefits application consists of the DB-450 form. This is the only form that is required as part of your application for New York State Disability Benefits. The two mandatory sections of this form are PART A CLAIMANTS STATEMENT and PART B HEALTH CARE PROVIDERS STATEMENT.
Medical evidence already in your possession. This includes medical records, doctors reports, and recent test results; and. Award letters, pay stubs, settlement agreements or other proof of any temporary or permanent workers compensation-type benefits you received [more info].
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