If your disability begins while you are employed (or within 4 weeks of termination), you should file your completed DB-450 Statement with us within 30 days.

• Obtain Form DB-450  (Notice of and Proof of Claim for Disability Benefits) from your employer, insurance carrier, or the Workers' Compensation Board.
• Also obtain your Statement of Rights (Form DB-271S ).
• Complete and sign Part A (Claimant's Statement).
• Your attending health care provider must certify that your disability or illness prevents you from working by completing and signing Part B (Health Care Provider's Statement).
• Your employer must fill out Part C (Employer’s Statement).

Where do I send my claim?

Send your completed claim form with documentation to ShelterPoint Life via

E-mail: 
claimforms@shelterpoint.com

Fax: 
516-504-6414

Mail: 
DBL Claims
ShelterPoint Life
1225 Franklin Avenue, Ste. 475 
Garden City, NY 11530

What if I just lost my job? Can I still file for DBL benefits?

Yes. Generally, as an eligible employee you don’t lose protection during the first 26 weeks of unemployment (provided you are eligible for and are claiming unemployment insurance benefits). See What if I’m unemployed? for details.

What if my disability begins more than 4 weeks after termination?

File a completed claim Form DB-450 with the Workers' Compensation Board:

Workers' Compensation Board
Special Fund for Disability Benefits
Disability Benefits Bureau
328 State Street
Schenectady, NY 12305

I missed the 30-day deadline to file my claim. What happens now?

In accordance with New York State DBL regulations, if your claim is filed late, benefits will be denied for any period of disability prior to 2 weeks before it was filed unless you can demonstrate that it was impossible to file sooner. And if your claim is filed later than 26 weeks after your disability began, you will be denied benefits. (Exception: Minors, mentally or physically incompetent people with no guardian may have a longer period in which to file a claim.)

New York State sets the maximum benefit for statutory policies. Statutory benefits are calculated as follows:

• You receive 50% of your average weekly wage to a maximum benefit of $170 a week (your average weekly wage is based on your last 8 weeks of employment, not counting the week in which the disability began – if its inclusion would lower your benefit rate).
• Benefits are payable for a maximum of 26 weeks of disability (during any period of 52 weeks or during any one period of disability).
• The first 7 days of disability constitute a waiting period for which no benefits are paid. Benefits begin on the 8th consecutive day of disability.
• Benefits are pro-rated based on the number of days your employer reports as the days you work.

If your employer offers enhanced benefits, you receive benefits based on your employer's disability benefits plan.

What if I become disabled again?

If you return to work and become disabled again within 3 months from the date of returning to work due to the same or a related condition, no waiting period applies. If the disability is due to a different condition or more than 90 days has passed, the waiting period is applicable!

If you are

1. an eligible employee suffering from a disability or illness due to an off-the-job injury; and
2. under the care of a licensed or certified physician, podiatrist, psychologist, chiropractor, or nurse-midwife.

What if my disability was caused by a car accident?

You may file for DBL benefits if your disability results from an automobile accident – although No-Fault automobile insurance benefits may be reduced by the amount of disability benefits you are eligible to receive.

What if I’m receiving Social Security Retirement benefits?

You are eligible to file for DBL benefits even if you are receiving (or are entitled to receive) retirement benefits under the Social Security Act. Under these circumstances, however, you may elect to waive your rights to DBL coverage by filing such a request with the Workers' Compensation Board.

What if I’m unemployed?

You may file for DBL benefits if you are unemployed if you are eligible for and are claiming unemployment insurance benefits.

• If your disability occurs within 4 weeks after your employment is terminated, benefits are paid by your former employer's insurance carrier.
• If you become disabled in the period between 4 and 26 weeks after termination, you receive benefits from the Special Fund for Disability Benefits, which is administered by the Workers' Compensation Board (see How do I apply for DBL benefits? for details).
• Please note, however, that you cannot collect Disability and Unemployment Insurance benefits at the same time.

You are eligible to file for DBL benefits if your disability is pregnancy-related (based on medical certification of disability). Please note the following guidelines for pregnancy-related disabilities:

• Pregnancy disabilities are treated the same as any other disability.
• Your health care practitioner – a medical doctor (MD) or a certified nurse midwife (RN-CNM) – must authorize the period of disability.
• Duration guidelines (in accordance with the American College of Obstetrics and Gynecology):

• 2 weeks before the expected delivery during an uncomplicated pregnancy
• 6 weeks after uncomplicated pregnancy with a normal delivery
• 8 weeks after uncomplicated pregnancy with a C-Section

Will I receive DBL benefits during my maternity leave?

Pregnancy disability is not maternity leave! Maternity leave itself is not covered under DBL. But a pregnancy-related disability that occurs during your maternity leave is covered. If you become disabled while on unpaid maternity leave, you are eligible only within the 4-week period following your last day of employment. If your disability begins more than 4 weeks after the last day of your employment and you are claiming/receiving Unemployment Benefits, you are entitled to DBL benefits from the Special Fund for Disability Benefits (if otherwise eligible).

Once you are performing any kind of work for income or profit, whether from home or not, you are no longer eligible to receive benefits.