Updated Disability Benefits forms for use beginning January 1, 2024

To conform to the updated disability benefits regulations taking effect January 1, 2024, the Workers’ Compensation Board will be posting an updated version of the Notice and Proof of Claim for Disability Benefits (Form DB-450) and the new Notice of Denial of Claim for Disability Benefits (Form DB-DEN) on January 1, 2024.

Insurers may request a draft of the new forms to prepare for implementation by emailing formsdepartment@wcb.ny.gov. Please use the current Form DB-450 until January 1, 2024.

Failure of the employer to complete Part C on Form DB-450, or inadequate completion by the employer, is not a valid basis for denial of the claim.

Form DB-DEN must be issued within 18 days of receipt of the claim or the first day of disability unless the Notice of Total or Partial Rejection of Claim for Disability Benefits (Form DB-451) is issued within this timeframe. If Form DB-451 is issued within 18 days as described, Form DB-DEN does not need to be issued.

More information

Questions? Email Regulations@wcb.ny.gov.