DB-450 Claim Form

DB-450: Notice and Proof of Claim for Disability Benefits

If you became sick or disabled while employed, or if you become sick or disabled within four weeks after termination, you should use the DB-450—or Notice and Proof of Claim for Disability Benefits—form to apply for New York State benefits. Complete this form with your healthcare provider so you can get the benefits you need.

We urge that you not submit this form until it has been reviewed by an attorney who is aware of all the facts and circumstances of your matter. Need help? Contact a personal injury lawyer today!

Download the DB-450 form.


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