Shelter Point Claim Forms

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NYS Short Term Disability Claim Form (1,050.43 KB)

NYS Paid Family Leave - Bonding with Child Claim Form (1,612.66 KB)

NYS Paid Family Leave - Military Leave (1,583.67 KB)

NY Paid Family Leave - Care for Family Member (1,705.98 KB)

How to File a NYS Short Term Disability Claim:

1. Complete Form DB-450

   • Part A: Completed by the employee. Be sure to sign and date the form.
   • Part B: Completed by your healthcare provider. Must include an estimated return-to-work date.
   • Part C: Completed by the employer.

2. Submit the Form
   Send the completed DB-450 form to Shelter Point:

   • Fax:516-504-6414
   • Mail: ShelterPoint Life, Attn: Claims Dept, 1225 Franklin Ave, Ste 475, Gardent City NY 11530
   • Email:moc.tniopretlehs@smrofmialc

How to File a NYS Paid Family Leave (PFL) Claim:

1. Complete Required Forms

   • Form PFL-1: Request for Paid Family Leave
   • Additional forms based on your leave type:
     • Bonding with a child: Form PFL-2
     • Caring for a family member: Forms PFL-3 and PFL-4
     • Military leave: Form PFL-5

2. Attach Supporting Documents
   Examples include birth certificates, medical certifications, or military orders.

3. Submit the Forms - Send your completed claim to Shelter Point:

   • Fax:516-504-6414
   • Mail: ShelterPoint Life, Attn: Claims Dept, 1225 Franklin Ave, Ste 475, Gardent City NY 11530
   • Email:moc.tniopretlehs@smrofmialc