Disability Insurance 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. The Disability and Paid Family Leave 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, and if your injury or disablement results in you being ineligible for unemployment benefits, you are eligible for disability benefits.

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 for 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.
  • is 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.

Note that the PFL does not provide for the payment of medical expenses.

Who is Covered

The Coverage Requirements page provides information about who is considered an employee under the New York State Disability Benefits Law and information about who is and is not covered for disability benefits.

https://www.wcb.ny.gov/content/main/coverage-requirements-db/

Cost

Your employer is allowed, but not required, to take 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 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.

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.

If you become disabled while you are employed

  • There is a seven day waiting period for which no benefits are paid. Benefits begin on the eighth consecutive day of disability (WCL §208). If you have been disabled 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 that you are disabled (WCL §229[2]).
    • A “day of disability” is a day on which you were prevented from performing work because of disability and for which you have 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.

If you become disabled while you are unemployed

  • If you have been unemployed for less than four weeks
    • your disability benefits are provided by your last employer’s disability benefits insurance carrier, and
    • 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, and
    • 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.

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 Caesarian section).

You may be entitled to further disability benefits up to the maximum 26 weeks with documentation from your medical care provider.

Either way, you will need to submit a medical report completed by a doctor or certified nurse midwife stating your disability is due to or related to pregnancy or recovery from delivery. Physical and mental health conditions due to or related to your pregnancy or post-partum recovery may be eligible for disability benefits.

Note: Benefits are not payable 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 eligible for disability benefits for the period immediately after the birth of a child.
  • Paid Family Leave (https://paidfamilyleave.ny.gov/) 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.

Atlas Insurance Agency can help you find affordable coverage.

Call us: 631-951-2038