Get New York State Short-term Disability Claim Form And Statement Of ... - Hartwick

Filling out the New York State Short-Term Disability Claim Form and Statement Of ... - Hartwick can seem overwhelming. This guide provides a clear, step-by-step approach to assist you in completing the form accurately and effectively.

Follow the steps to fill out your claim form successfully.

1. Click ‘Get Form’ button to access the New York State Short-Term Disability Claim Form directly from its source.
2. Complete Part A - Claimant's Statement. Fill in your personal details accurately, including your full name, address, date of birth, and social security number. Ensure that each field is filled out completely to avoid any delays.
3. Indicate your marital status and provide your telephone number. Be careful when selecting your status from the options provided.
4. Specify your disability details. Clearly describe what your disability is, including if it was an injury, and detail how, when, and where it occurred.
5. List your employment history. Provide information about your last employer(s), including dates of employment and average weekly wages. This should also include details of any union membership.
6. Respond to questions about any wages you might be receiving during your period of disability. Be honest and thorough in your answers, especially regarding any workers' compensation claims.
7. Complete the certification statement at the bottom of Part A. Sign and date the claim. If someone is signing on your behalf, ensure that their relationship to you is noted.
8. Once Part A is complete, ensure that your healthcare provider fills out Part B. This section is crucial as it verifies your condition.
9. Finally, ensure that the entire claim form is mailed within 30 days of your disability to your last employer or the insurer. Keep a copy of the completed form for your records.

Begin your claim process online today to ensure prompt handling of your New York State Short-Term Disability benefits.