(Off-the-Job Injury or Illness)
What are Disability Benefits?
New York is one of a handful of states that require employers to provide disability benefits coverage to employees for an off-the-job injury or illness. Coverage for disability benefits can be obtained through a disability benefits insurance carrier who is authorized by the New York State Workers' Compensation Board to write such policies. Another option is for large employers to become authorized by the Board to self-insure (WCL §211).
Disability benefits are temporary cash benefits paid to an eligible wage earner, when he/she is disabled by an off the job injury or illness. The Disability Benefits Law (Article 9 of the WCL) provides weekly cash benefits to replace, in part, wages lost due to injuries or illnesses that do not arise out of or in the course of employment (WCL §204). Disability benefits are also paid to an unemployed worker to replace unemployment insurance benefits lost because of illness or injury (WCL §207).
Disability benefits include cash payments only.
Medical care is the responsibility of the claimant. It is not paid for by the employer or insurance carrier. Cash benefits are 50 percent of a claimant's average weekly wage, but no more than the maximum benefit allowed, currently $170 per week (WCL §204).
Benefits are paid for a maximum of 26 weeks of disability during 52 consecutive weeks (WCL §205). For employed workers, there is a 7-day waiting period for which no benefits are paid. Benefit rights begin on the eighth consecutive day of disability (WCL §208). An employer must supply a worker who has been disabled more than seven days with a Statement of Rights under the Disability Benefits Law (form DB-271S) ), within five days of learning that the worker is disabled (WCL §229).
An employer is allowed, but not required, to collect contributions from its employees to offset the cost of providing benefits. An employee's contribution is computed at the rate of one-half of one percent of his/her wages, but no more than sixty cents a week (WCL §209).
If an employee has more than one job at the same time, with combined wages of more than $120 per week, the employee may request each employer to adjust the contributions in proportion to the earnings of each employment. The combined contributions may not exceed 60 cents per week. The request should be made as soon as the employee enters a second job.
Disability Benefits Plans
An employer may provide benefits under a Board approved Plan for Disability Benefits (or one negotiated by agreement and accepted by the Chair of the Board as meeting the requirements of the New York State Disability Benefits Law (DBL)(WCL §211) only when such a Plan is insured through one of the carriers licensed by New York State to write statutory disability benefits insurance policies or by an employer who has been authorized by the New York State Workers' Compensation Board to self-insure for disability benefits. All Plans accepted by the New York State Workers' Compensation Board shall cover only those employees that are eligible for benefits under the New York State DBL. Such accepted Plans must meet or exceed ALL statutory requirements as set forth by the New York State DBL.
Benefits (rate, duration and waiting period) are payable as provided by the Plan. In addition, the employer may pay the entire cost of the Plan. There are some accepted Disability Benefits Plans under which employees are required to contribute more than 60 cents per week, but only by agreement and provided the employees' contributions are reasonably related to the value of the benefits. Under an arrangement in which employees are required to contribute, the employer must add a contribution to make up the balance of the cost of the insurance.