NEW YORK DISABILITY/PAID FAMILY LEAVE CLAIMS RELATED TO COVID-19
If you are filing for disability or paid family leave for yourself due to COVID-19, please complete this form:
Request for COVID-19 Quarantine DB/PFL – Self (Form SCOVID19)
If you are filing for paid family leave due to the disability of a minor dependent child due to COVID-19, please complete this form:
Request for COVID-19 Quarantine PFL – Child (Form CCOVID19)
Additional information for employees to obtain a mandatory order of quarantine or isolation can be found here:
Obtaining An Order – NYS Department of Health
Other important information related to New York State Paid Family Leave is available here:
https://paidfamilyleave.ny.gov/new-york-paid-family-leave-covid-19-faqs
NEW YORK DISABILITY/PAID FAMILY LEAVE CLAIMS NOT RELATED TO COVID-19
Please submit the following forms within 30 days of the start of the disability:
Notice and Proof of Claim for Disability Benefits
If your disability policy includes an In-Hospital Rider and the claim involves a hospital stay, please also submit the form below:
In-Hospital Statement of Claim
If your disability policy includes an Accidental Death & Dismemberment Rider and the claim involves such an scenario, please also submit the form below:
Accidental Death & Dismemberment Claim Form
For claims involving paid family leave, please submit the following forms within 30 days of the expected leave (as known):
Paid Family Leave – Bonding with New Child
