(Off-the-Job Injury or Illness)
Frequently Asked Questions
- Q. What is a "day of disability?"
- A. A "day of disability" is one on which the employee was prevented from performing work
because of disability and for which he/she has not received regular wages or remuneration.
- Q. If an employee engages in work for remuneration or profit, even if done
at home, while disabled, is he/she eligible for disability benefits?
- A. No. As long as he/she is performing any kind of work for remuneration or profit, he/she is
ineligible to receive benefits.
- Q. Are the costs of medical care included?
- A. No. Costs of medical care are not included under the statutory provisions of the Disability
Benefits Law. However, where an employer or a union or association plan has been accepted as
complying with the law, the worker is entitled to the benefits as described by the plan.
Contact your employer to find out if it provides or participates in such a plan.
- Q. May an employer/insurance carrier have an employee claiming
benefits examined by a health care provider designated by the employer/carrier?
- A. Yes. The employee must submit him/herself at intervals, but not more than once a week, to
such examinations if requested. Exams are not paid for by the employee and are held at a
reasonable time and place. Refusal to submit to an exam may jeopardize a claimant's benefits.
- Q. After a claim is filed, how soon will it be paid?
- A. If a claim is properly completed with the required statements, the first payment should arrive
within four business days after the 14th day of disability or four business days after the receipt of
the claim, whichever is later. Benefits are payable every two weeks during the period of disability.
- Q. Can a claimant collect Unemployment Insurance and Disability Benefits
for the same period of time?
- A. No.
- Q. If an employee quits his or her job, may that employee receive Disability Benefits?
- A. Termination of employment may affect an employee's right to Disability Benefits.
- Q. Can a claimant collect Disability Benefits for disability caused by pregnancy?
- A. Yes. If she is disabled because of pregnancy, she may be entitled to up to 26 weeks of
benefits. Disability can occur at any time during pregnancy.
- Q. What determines disability due to pregnancy?
- A. Disability can only be determined and certified by a physician or certified nurse midwife
through the submission of medical reports. If a claimant becomes disabled more than four to six
weeks prior to the anticipated birth date, or is disabled more than four to six weeks after the
actual birth date, more detailed information regarding the disability may be required. The medical
reports should describe specific symptoms, rather than just general prognosis. Note: An elective
sterilization procedure will not extend the payable period of disability, since benefits are not
payable for any period an individual is unable to work due to elective surgery.
- Q. Can an employee collect disability benefits if on maternity leave?
- A. Yes. If she is on a leave of absence without pay (i.e. maternity leave), and becomes disabled
within four weeks of the last day she actually worked, she is entitled to benefits from the
employer/carrier (if otherwise eligible). If the disability begins more than four weeks from the last
day actually worked and she is claiming/receiving Unemployment Benefits, she is entitled to
disability benefits from the Special Fund for Disability Benefits (if otherwise eligible).
- Q. Is there a limit on the number of weeks a claimant can receive benefits?
- A. Yes. There is a limit of 26 weeks of benefits during a period of 52 consecutive calendar
weeks or during any one period of disability. The amount of benefits a claimant receives is
dependent upon the length of time he/she is actually disabled as certified by a physician. (If an
employer has a separate Disability Benefits Plan, more than 26 weeks of benefits may be paid, if
- Q. What if a claimant is still disabled, but benefits have stopped?
- A. If he/she received less than 26 weeks of benefits, is still disabled, and has not received a
Notice of Rejection, he/she must submit further medical evidence to his/her employer, insurance
carrier or the Special Fund for Disability Benefits. If he/she has received a Notice of Rejection,
the claimant may request a review of the rejection by completing its reverse side and mailing it to
the Disability Benefits Bureau at the Workers' Compensation Board.
- Q. Is a claimant entitled to Disability Benefits for an injury incurred in an auto accident?
- A. Yes. However, the amount of the disability benefits may reduce any no-fault insurance
benefits the claimant is eligible to receive.
- Q. If a claim is rejected or not paid, may it be reviewed?
- A. Yes. If a claim is rejected or not paid, the employee should complete the reverse side of the
Notice of Rejection (sent by the employer/carrier/the Special Fund, within 45 days of its receipt
of the claim) and mail it within 26 weeks to the Disability Benefits Bureau. The address is located
on the back of the rejection notice, and in the back of this brochure. Where necessary, the Board
will obtain further information and may hold a hearing on the claim. Benefits will be paid if a
claim is determined proper and valid.
- Q. If a claimant is entitled to or receiving Social Security Retirement Benefits,
may he/she still receive Disability Benefits?
- A. Yes. If he/she is entitled to Disability Benefits, the fact that he/she is eligible for or receiving
old-age insurance benefits under the Social Security Act does not affect his/her right to Disability