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Workers' Compensation Board

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Disability Benefits
(Off-the-Job Injury or Illness)


Overview

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. 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). If you get injured or become disabled while you are eligible for or are collecting unemployment benefits, you are eligible for disability benefits if your injury or disablement results in you being ineligible for unemployment benefits.

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

Benefits

Disability benefits are cash only benefits. Cash benefits are 50 percent of your average weekly wage for the last eight weeks worked, but no more than the maximum benefit allowed, currently $170 per week (WCL §204).

Benefits paid by your employer or their insurance carrier are subject to Social Security and Medicare taxes.

Benefits are paid for a maximum of 26 weeks of disability during any 52 consecutive week period (WCL §205).

You cannot collect disability benefits and paid family leave benefits at the same time. The total combined disability leave and paid family leave in any 52 week period may not exceed 26 weeks. More information on Paid Family Leave

Medical care expenses are your responsibility. They are not paid for by your employer or their insurance carrier.

Cost

Your employer is allowed, but not required, to take a contribution from its employees to offset the cost of providing disability benefits. An employee's contribution is computed at the rate of one-half of one percent of his/her wages, but no more than 60 cents a week (WCL §209).

If you have more than one job at the same time, with combined wages of more than $120 per week, you may request each of your employers to adjust your contributions in proportion to the earnings of each employment. The combined contributions may not exceed 60 cents per week. Your request should be made as soon as you enter a second job.

There are some accepted Disability Benefits Plans under which you are required to contribute more than 60 cents per week, but only by agreement and provided your contributions are reasonably related to the value of the benefits. Under an arrangement in which employees are required to contribute, your employer must add a contribution to make up the balance of the cost of the insurance.

Disability Benefits Plans

Your 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 insurers 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.

Eligibility

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

  • You are employed:
  • You are unemployed:
    • If you have been unemployed for less than four weeks:
      • Your disability insurance benefits are provided by your last employer's disability insurance carrier.
      • The 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 Special Fund for Disability will provide your disability benefits.
      • No waiting period is required.
    • You may not collect unemployment benefits and disability benefits for the same period of time.
  • Your disability is from an auto accident:
    • You are entitled to disability benefits for an injury incurred in an auto accident. However, the amount of the disability benefit may reduce any no-fault insurance benefit you are eligible to receive.
  • You are 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 you are still disabled and you have not received a Notice of Rejection, you should submit further medical evidence to request additional benefits.
  • You quit your job:
    • If you quit your job, it may affect your right to disability benefits.
  • Employer/Insurance Carrier requests examination by a health care provider:
    • Your employer/insurance carrier may designate a health care provider to examine you. You must submit to requested examinations under the following conditions:
      • Exams may occur at intervals, but not more than once a week.
      • You do not pay for the exams.
      • Exams occur at a reasonable time and place.

      If you refuse to submit to an exam, you may jeopardize your benefits.

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.

You are ineligible for disability benefits if you perform any type of work for which you receive wages or profit, even if performed at home.

Pregnancy and Maternity Leave

If you are disabled due to pregnancy, you may be entitled to up to 26 weeks of disability benefits.

You will need to submit a medical report completed by a doctor or certified nurse midwife stating your disability is due to pregnancy.

The medical report should describe specific pregnancy complications, rather than just general prognosis, if your disability:

  • started more than four weeks before the anticipated birth date; OR
  • lasts more than four to six weeks after the actual birth date;

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

  • Only the birth mother is eligible for disability leave for the period immediately after the birth of a child.
  • Paid family leave begins after the birth and is not available for prenatal conditions.
  • A parent may take paid family leave during the first 12 months following the birth, adoption, or fostering of a child.
  • You cannot collect disability benefits and paid family leave benefits at the same time.
  • Your combined total disability leave and paid family leave in any 52 week period may not exceed 26 weeks.
More information on Paid Family Leave

How To File A Claim

Work Status when Disability Begins Who Pays Benefit How to Apply
Your disability started within four weeks of the last day you worked Your employer's disability benefits insurance carrier File the claim with your employer or insurance carrier, using Notice and Proof of Claim for Disability Benefits (Form DB-450) adobe pdf.

This form may also be obtained from your employer, his or her insurance carrier, your health provider, or any Board office.
You are claiming/receiving Unemployment Benefits,
AND
your disability started more than four weeks from the last day you worked
NYS Special Fund for Disability Benefits Complete Notice and Proof of Claim for Disability Benefits (Form DB-450) adobe pdf.

If your disability is the result of an injury due to a no-fault motor vehicle accident or the negligence or wrong doing of a third party, i.e. individual, firm, etc., you must also complete and file the Claimant's Statement Regarding No Fault or Personal Injury (Form DB-450.1) adobe pdf.

Send completed claim form(s) to:
Workers' Compensation Board
Disability Benefits Bureau
328 State Street
Schenectady, New York 12305.

IMPORTANT: Before filing your claim, be sure that you have completed and signed Part A "Claimant's Statement" and your health care provider has completed and signed Part B "Health Care Provider's Statement". Submit this information promptly to avoid delaying your claim.

If you depend upon healing through spiritual means alone in the practice of religion, you must be under the care of a duly accredited practitioner to qualify for benefits. In this situation, the practitioner must complete and sign the "Practitioner's Statement" (Form DB-450.5) before mailing. Contact the Workers' Compensation Board at (877) 632-4996 to obtain this form.

You must file your claim within 30 days after you become disabled.

Benefit Payments

Your 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.

If you file more than 30 days after you become disabled, you will not be paid for any disability period more than two weeks before the claim is filed. Late filings may be excused if it is shown that it was not reasonably possible to file earlier. No benefits will be paid if you file more than 26 weeks after your disability begins.

Rejected Claims

If your claim is rejected or not paid, you will receive a Notice of Rejection from your employer, insurance carrier or the Special Fund for Disability Benefits within 45 days of its receipt of your claim.

You may request that your claim be reviewed by completing the reverse side of the Notice of Rejection and mail it to:
Workers' Compensation Board
Disability Benefits Bureau
328 State Street
Schenectady, New York 12305.

If necessary, the Board will obtain further information and may hold a hearing on your claim. If the Board determines your claim is proper and valid, your employer, insurance carrier or the Special Fund for Disability Benefits will pay your benefits.