Short-term disability in New York: how to file the DB-450

Plain answers about New York State disability benefits — what the DB-450 is, and the deadlines that come with it. When you're ready, Certicare handles Part B: completed and signed by a state-licensed provider.

How do I apply for short-term disability in New York?

You apply by filing Form DB-450, New York's claim form for short-term disability benefits. The form has three parts, and you only fill out one of them.

Part A is the claimant's statement — that part is yours. Part B is the Health Care Provider's Statement, and a licensed provider completes it. Part C is your employer's; they fill in wage information on their own. Who can sign Part B, and what to do when nobody will, is covered below.

The form itself is on the New York State Workers' Compensation Board site. File within 30 calendar days of your first day of disability, and send the completed claim to your employer or their disability benefits insurance carrier. (If you'd been out of work more than four weeks when your disability began, a different filing route applies — the WCB site covers it.)

Most workers are covered: you're eligible after four or more consecutive weeks with a covered employer, or on your 25th day of regular part-time work. If you left a job within the last four weeks, you may still be covered through that employer.

These benefits cover an injury or illness that didn't come from your job — a work injury goes through workers' compensation instead. If you're not sure which New York leave program fits your situation, start with choosing the right New York leave program.

Who fills out Part B of the DB-450?

A licensed health care provider does — Part B is the Health Care Provider's Statement, and it can't come from you. The form's own certification line lists who can sign it: a physician, chiropractor, dentist, podiatrist, psychologist, or nurse-midwife.

It's also the step where claims stall, because the signing has to happen inside your 30-day filing window.

This is the part Certicare does. You answer a short online questionnaire, usually with no appointment to book, and your DB-450 Part B is completed and signed by a state-licensed provider. A provider may follow up for more detail before deciding.

Your completed Part B arrives by email, usually within 24 hours after we have everything needed. Employers can verify the completed document with Certicare by email. The fee is $49, flat, shown before you start — refunded if we can't complete your request.

Completing our intake form starts the review; it does not guarantee a signature, and if the review does not support your request you are refunded in full.

How much does NY short-term disability pay?

Half your average weekly wage, up to $170 a week. The average comes from your last 8 weeks of pay, and $170 is the cap under the state's basic coverage.

Do that math before you build a budget on it. If you averaged $600 a week, half would be $300 — the benefit still stops at $170.

One exception: some employers buy Board-approved enhanced plans that pay more than the state minimum. Your plan documents or HR will say if yours does.

How long does short-term disability last in New York?

Up to 26 weeks in any 52-week period — that's the maximum the program pays.

There's a 7-day waiting period at the front. Benefits start on your eighth consecutive day of disability, so the first week is unpaid.

One more limit. New York Paid Family Leave and disability benefits can't be taken at the same time, and together they can't total more than 26 weeks in any 52.

One thing these benefits don't do: DBL replaces part of your wages, but it doesn't protect your job. Job protection, if you qualify, comes from FMLA — covered below.

What's the deadline to file a DB-450?

You have 30 calendar days from your first day of disability to file the claim. Count from the first day you couldn't work, not from the day you got the form.

Part B has a clock of its own: the form expects the provider to return it within seven days.

In practice, the slow step is usually Part B.

A late claim isn't automatically void, but benefits generally can't reach back more than two weeks before the day your proof arrives — so filing late costs money.

What if my doctor won't fill out the form?

Your claim isn't stuck for that reason — Part B can come from any provider the form allows, not just the office that said no.

This moment is common. Urgent care treats you, then says they don't complete forms like this one. Your own office would, but the next open appointment lands after your 30-day window.

Nobody is doing anything wrong. Completing claim paperwork is a service some practices offer and some don't. It just leaves you holding a half-finished form on a deadline.

Certicare exists for that gap. Answer the online questionnaire, and your Part B is completed and signed by a state-licensed provider — usually within 24 hours after we have everything needed.

Does FMLA run at the same time?

It can. FMLA (Family and Medical Leave Act) is a separate federal law, and it often runs at the same time as your employer's own leave process. One absence can sit on both tracks at once.

FMLA has three eligibility tests, and you need all three: 12 months with your employer, 1,250 hours worked in the past 12 months, and an employer with 50 or more employees within 75 miles. If you qualify, it covers up to 12 workweeks of leave in a 12-month period.

If your employer asks for an FMLA medical certification, the usual window is 15 days from the employer's request — not from your first missed day. A state-licensed provider completes those forms too, through the same intake.

That's as far as this page goes. For how New York's leave programs fit together, and which one applies to you, see choosing the right New York leave program.

What it costs

If your employer or leave administrator wants to verify the document, they can email us at hello@certicare.org.

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