The forms required when an employee becomes disabled in NY and may be entitled to disability benefits are: DB-271S—Statement of Rights:
The NY DBL law requires an employer to send a “Statement of Rights”
Entitlement of benefits under the Disability Benefits Law to an employee, within 5 days after the employee has been absent from work for more than 7 consecutive days. This statement is in standardized format approved by the Worker’s Compensation Board. DB-450—Notice and Proof of Claim:
After the disability begins, Part A – Claimant and Part B – Health Care Provider statements should be completed, signed and the form returned to the employer for completion of Part C – Employer Statement. The form should then be submitted to Wesco Insurance Company. Claims should be filed within 30 days after the employee last worked and the physician has certified the employee is totally disabled. Failure to submit the claim within 30 days may result in a partial or total rejection of the claim.