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Updated New York State Short-Term Disability Claim Forms

March 26, 2024 / By Tracy Rickett, UNY Human Resources Generalist / .(JavaScript must be enabled to view this email address)

New York State updated the short-term disability claim forms. To remain in compliance the updated disability claim forms should be used starting immediately. Claim forms should be submitted to the insurance carrier within 30 days following the start date of the disability. Claim forms submitted incomplete or illegible may delay processing of the claim.   

There are several options to submit the completed disability claim forms. 

Mail to: Guardian Insurance State Disability Claims P.O. Box 14332, Lexington, KY 40512 
Email: State_Disability_Claims@glic.com 
Fax to Guardian: (610) 807-2953  

Important: The updated short-term disability claim forms no longer have a section to enter the plan number and division number. It is recommended the plan number and division number be handwritten on the top right of each page of the claim form.  The plan number is 00926076.  The division number is unique to each church and is available on the Certificate of Disability Insurance mailed to the church in January each year. The plan number and division number are helpful to the insurance carrier to process the claim quicker.  

Additional information regarding short-term disability benefits can be located here.   

If you have any questions, please contact Tracy Rickett, Human Resources Generalist, at (315) 898-2017 or TracyRickett@unyumc.org.