If you cannot sign this claim form your representative may sign it in your behalf. If you are an insurance carrier licensed to write statutory nys disability benefits insurance policies please send an e mail to certificates wcb ny gov and indicate who you are your position within the insurance carrier and the specific insurance carrier that has the nys disability benefits insurance policy that is issuing the db 120 1 form. Claims still starting in 2019 must be filed with your current carrier on their claim forms.
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