Checklist to Get You Started
So, you’re here because you either have an injury/illness that is not caused by your job or you’re expecting a baby; and your condition is NOT related to COVID-19. (Click here if it is).
Ready to submit your DBL claim?
Then download the claim form from the right (or if you’re browsing on a mobile phone – from the bottom)
And follow this handy checklist to help make your claim as smooth as possible.
Your condition is not caused by your job.
If it is caused by your job, please consider filing for Workers’ Compensation Benefits instead. DBL only provides benefits for off-the-job conditions.
You’re already out on disability (injury/illness or pregnancy-related leave).
You cannot file before you’re out on disability, such as filing before giving birth (unless you are on doctor-prescribed, medically necessary bed rest), or before a scheduled medical procedure that would cause you to be unable to work.
Your first full day of disability was no longer than 30 days ago.
If your disability (injury/illness or pregnancy-related leave) began more than 30 days ago, you must file your claim with the Workers' Compensation Board’s Special Fund. You can still use the DB-450 form our website for your convenience, but we cannot accept your claim. Click here for more information.
You are currently employed or have not been unemployed for more than 4 weeks.
If you have been unemployed (including furloughed, temporarily laid off, or out of work because your employer is currently closed) for more than 4 weeks when your disability (injury/illness or pregnancy-related leave) began and you are collecting unemployment benefits, you cannot collect both unemployment and DBL.
If you are not receiving unemployment benefits, you may file your claim with the Workers' Compensation Board’s Special Fund. You can still use the DB-450 form our website for your convenience, but we cannot accept your claim. Click here for more information.
Everything is completed on your DB-450.
All 3 parts must be completely filled out and signed by the respective party. There should be no blank fields left on the form.
- Part A to be filled out and signed by you.
- Part B to be filled out and signed by your Health Care Provider.
Your attending health care provider must certify that your disability or illness prevents you from working.
- Part C to be filled out and signed by your Employer.
Everything is clearly legible.
If our examiners can’t clearly read your handwriting, this may require our team to reach out for clarification, which in turn may delay the processing of your claim.
You’ve included any other supporting documentation that may be required for your specific claim.
All pieces are submitted together at the same time.
If you submit pieces of your claim in separate emails or under separate cover through the mail, each email would be like a separate, incomplete claim submission!
For example, if you haven’t gotten back the Employer’s Statement section from your employer yet, please don’t send what’s been completed so far and the Employer Statement separately later. This will not help get your claim in line sooner and will actually have the opposite effect.
So, please make sure you send everything together at one time, regardless of submission method.
If you chose to submit via email, you can snap a picture of each page and attach multiple files to 1 email.
When submitting by email, your message is less than 10MB.
Only submit your claim through one method.
Please do not submit your claim multiple ways, like email and fax. This would log your claim twice and your claim would compete with itself. Pick one and done!
In short: Please make sure everything is completed, legible, and submitted together at one time.
Claims are processed in the order they are received, and cannot be reviewed by an examiner unless everything is complete. So, if you are missing a portion in your submission, your claim cannot go into the processing queue until you submit everything that’s needed. This may result in delays processing your claim as we must request the missing information and allow time for the missing information to be returned, prior to issuing a decision.
Submitting Your Claim
Claims are processed and reviewed in the order they are received and logged. To help save time on getting your claim “in line” to be reviewed, we recommend you email or fax it, as it then won’t need the additional step of being digitized on our end:
You can also mail your completed claim package to:
1225 Franklin Ave, Ste., 475
Garden City, NY 11530