NYDBL Claim Forms/Reporting

Early notification for New York State disability claims….
…made easy.

Simply fill out all of the information on the following form and hit submit. Or if you prefer to fax us the information, click on the attached pdf, print the form, fill it out and fax it back to us at 631-845-2535.

Based upon the information (Online Claims Form) you provide, Zurich can register, review and begin the claims process. Receipt and status of your claim can be checked 24 hours a day by using our automated telephone system: 1-800-887-9111

And in an effort to help the process, you may want to notify your employer and doctor, letting them know that Zurich will be contacting them soon for additional information that may be needed to complete the claim process.

Online Claims Form

DB-450 (2-04) Notice and Proof of Claim for Disability Benefits
DB-271S (3-08) Statement of Rights - Disability Benefits Law


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