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Introduction to the Disability Benefits Law

workers

new york is one of the few states that require employers to provide disability benefits coverage to employees for an off-the-job injury or illness. The Paid Family Leave and Disability Benefits Act (WCL Section 9) provides weekly cash benefits to replace, in part, wages lost due to injuries or illnesses not arising out of or in the course of employment (WCL §204 ). If you are injured or disabled while eligible for or receiving unemployment benefits, and your injury or disability makes you ineligible for unemployment benefits, you are eligible for disability benefits.

Reading: How long is disability insurance for pregnancy

Disability benefits are covered through your employer’s disability benefits insurance carrier or your employer may be self-insured.

benefits

Disability benefits are cash only benefits. the benefit:

  • is 50 percent of your average weekly wage during the last eight weeks worked
  • cannot be more than the maximum benefit allowed, currently $170 per week (wcl §204).
  • is subject to social security and medicare taxes.
  • paid for a maximum of 26 weeks of disability during any consecutive 52-week period (wcl §205).
  • You cannot receive disability benefits and paid family leave benefits at the same time. the combined total of disability leave and paid family leave in any 52-week period may not exceed 26 weeks.

    keep in mind that the pfl does not contemplate the payment of medical expenses.

    who is covered

    The Coverage Requirements page provides information on who is considered an employee under New York State disability benefits law and information on who is and who is not covered for disability benefits.

    cost

    Your employer may, but is not required to, receive a contribution from you to offset the cost of providing disability benefits. your contribution is calculated at the rate of one-half of one percent of your salary, but not more than 60 cents per week (wcl §209).

    If you have more than one job at the same time, with combined wages of more than $120 per week, you can ask each of your employers to adjust your contributions in proportion to the earnings from each job. combined contributions cannot exceed 60 cents per week. your application should be made as soon as you enter a second job.

    See also: What is Insurance and Why is it Important? | Grange Insurance

    There are some accepted disability benefit plans where you are required to contribute more than 60 cents per week, but only by agreement and as long as your contributions are reasonably related to the value of the benefits.

    eligibility

    You must be under the care of a physician, chiropractor, podiatrist, psychologist, dentist, or certified nurse midwife to qualify for disability benefits.

    if you become disabled while employed

    • There is a seven-day waiting period during which no benefits are paid. benefits begin on the eighth consecutive day of disability (wcl §208). if you have been disabled for more than seven days, your employer must give you a statement of rights under the disability benefits law (form db-271s) within five days of learning you are disabled (wcl §229[2]) .
      • A “disability day” is a day on which you were prevented from performing work due to a disability and for which you did not receive regular wages or compensation. You are not eligible for disability benefits if you do any type of work for which you receive wages or profit, even if it is done at home.
      • if you become disabled while unemployed

        • if you have been unemployed for less than four weeks
          • your disability benefits are provided by your last employer’s disability benefits insurer, and
          • seven-day waiting period applies.
          • if you have been unemployed for more than four weeks and are collecting unemployment insurance benefits
            • the workers’ compensation board’s special disability fund will provide your benefits for disability, and
            • no waiting period is required.
            • You cannot receive unemployment benefits and disability benefits during the same period of time.
            • your disability is due to a car accident

              • You are entitled to disability benefits for an injury sustained in a car accident. however, the disability benefit amount may reduce any no-fault insurance benefits for which you are eligible.
              • is collecting social security retirement benefits

                • You can receive disability benefits and Social Security retirement benefits at the same time.
                • You are still disabled, but your benefits have stopped

                  • If you have received less than 26 weeks of benefits and are still disabled and have not received a denial notice, you must submit additional medical evidence to apply for benefits additional.
                  • you quit your job

                    • If you quit your job, it may affect your right to disability benefits.
                    • employer/insurance company requests examination by health care provider

                      • Your employer/insurance company may designate a health care provider to examine you. You must sit the requested exams under the following conditions:
                        • Exams may be held at intervals, but not more than once a week.
                        • you do not pay for the exams.
                        • Examinations are conducted at a reasonable time and place.
                        • If you refuse to appear for an exam, you may jeopardize your benefits.
                        • pregnancy and maternity leave

                          If you are pregnant, you are eligible for disability benefits for four weeks before your due date and six weeks after giving birth (eight weeks if you delivered by C-section).

                          You may be entitled to more disability benefits up to a maximum of 26 weeks with documentation from your health care provider.

                          Either way, you will need to submit a medical report completed by a physician or certified nurse midwife stating that your disability is due to pregnancy or related to pregnancy or recovery from childbirth. physical and mental health conditions due to or related to your pregnancy or postpartum recovery may be eligible for disability benefits.

                          Note: Benefits are not paid for any period you are unable to work due to elective surgery (such as an elective sterilization procedure).

                          differences between disability benefits and paid family leave

                          • Only the birth mother is entitled to receive disability benefits for the period immediately following the birth of a child.
                          • Paid family leave begins after birth and is not available for prenatal conditions.
                          • A parent can take paid family leave for the first 12 months after the birth, adoption, or foster care of a child.
                          • You cannot collect disability benefits and paid family leave benefits at the same time.
                            • There is a limited exception to this for employees who may be eligible for both disability benefits and paid family leave when subject to a quarantine order due to covid-19. see paidfamilyleave.ny.gov/covid19 for more details.
                            • Your combined total disability leave and paid family leave in any 52-week period may not exceed 26 weeks.
                            • file a claim

                              You must file your claim within 30 days of becoming disabled.

                              How you file a claim is determined by your employment status when your disability begins.

                              if your disability began within four weeks of the last day you worked

                              Who pays benefits: Your employer’s disability benefits insurance carrier.

                              how to apply

                              • File the claim with your employer or insurance company, using Notice and Proof of Claim for Disability Benefits (form db-450).
                              • You can obtain the db-450 form using the link above, from your employer, your employer’s insurance carrier, your health care provider, or any board office.
                              • if you are claiming/receiving unemployment benefits and your disability began more than four weeks after the last day you worked

                                who pays the benefits: new york state special fund for disability benefits

                                how to apply

                                • Completed notice and proof of claim for disability benefits (form db-450).
                                • If your disability is the result of an injury due to a no-fault automobile accident or the negligence or misconduct of a third party (an individual, business, etc.), you must also complete and submit the No-Fault Claimant Declaration or personal injury (form db-450.1).
                                • See also: Business Commercial Flood Insurance Coverage FAQs | disb

                                  Send completed claim forms to:

                                  workers’ compensation board disability benefits office po box 9029 endicott, ny 13761-9029.

                                  Important: Before you file your claim, make sure you have completed and signed part a, “Claimant’s Statement,” and that your health care provider has completed and signed part b, ” health care provider’s statement. .” Send this information right away to avoid delays in your claim. You must file your claim within 30 days of becoming disabled.

                                  rejected claims

                                  If your claim is denied or not paid, you will receive a denial notice from your employer, insurance company, or special fund for disability benefits within 45 days of receipt of your claim. your claim.

                                  You may request that your claim be reviewed by completing the reverse side of the rejection notice and mailing it to:

                                  workers’ compensation board disability benefits office po box 9029 endicott, ny 13761-9029

                                  If necessary, the board will obtain more information and may hold a hearing on your claim. If the board determines that your claim is adequate and valid, your employer, insurance company, or special fund for disability benefits will pay your benefits.

                                  contact the board

                                  customer service toll-free number: (877) 632-4996 Monday through Friday, 8:30 a.m. to 5 p.m. m. to 4:30 p.m. m.

                                  language assistance services

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                                  See also: GAP, Liability, Collision, & Comprehensive Car Insurances

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