New York State Disability Benefits Law
The following is a quick, handy summary of the major provisions of the DBL
Law. It is designed to help answer many of your questions. It may not answer
all of them.
For further clarification we urge you to call the NY Worker's Compensation
Board local office or consult their web site:
http://www.wcb.ny.gov/
For specific tax questions you should consult your tax consultant or the IRS.
DBL What is It?
New York State requires payment of cash benefits to wage earners who
become disabled as a result of a Non-Occupational
injury or illness.
California, Hawaii, New Jersey, Rhode Island and Puerto Rico also have statutory
Disability Benefit Laws. No other state mandates this coverage.
What are the benefits paid under
DBL?
50% of Average Weekly Wage (based upon the last eight weeks
earnings) to a Maximum Benefit of $170 per Week. Benefits are paid beginning
with the 8th consecutive day of disability, for up to a maximum of 26 Weeks.
The minimum weekly benefit is $20.
Who is Required to Provide Coverage
Any Employer in the State of New York of One or More Employees on
each of 30 days in a Calendar Year becomes a "Covered Employer",
4 Weeks after the 30th day of employment.
This includes Employers of One or More Domestic Employees working in a Private
Home for at least 40 Hours per Week.
Who pays the premiums for DBL?
DBL premiums may be paid entirely by the employer. If the Employee
contributes to the cost, the Employee may not contribute more than one half
of one percent of the first $120 of weekly wages, to a maximum of $.60 per
week.
Who is Eligible for Benefits?
Most Employees in the State of New York are eligible if working for
a covered Employer.
Full-time Employees, new to working are eligible after working for 4 consecutive
weeks.
Part-Time Employees, new to working are eligible on the 25th day of regular
employment
for one Employer.
Employees receiving Unemployment Benefits are eligible Immediately upon beginning
work.
New Employees who have previously established eligibility with another Employer
are eligible Immediately upon beginning work, as long as the gap in employment
is not more than four weeks.
Personal or Domestic Employees working for the same Employer in a private
home at least 40 hours a week.
A Spouse working for a Sole Proprietor or Partnership unless an exclusion
is elected.
College Students are eligible for DBL Benefits if they meet any of the above
requirements.
A Corporate Officer is an Employee and will be covered, unless he receives
no wages or remuneration for services.
Who is Not Eligible for Benefits?
Minor Children of an Employer.
Government, Railroad, or Maritime Employees.
Ministers, Priests, Rabbis, Members of a Religious Order, Sextons, or Christian
Science readers.
Persons engaged in a professional or teaching capacity for a non-profit religious,
charitable, or educational institution; persons receiving rehabilitation in
a sheltered workshop, under a certificate issued by the Department of Labor.
Persons receiving aid from religious, charitable, or educational institutions,
who perform services in exchange for such aid.
Golf caddies.
Daytime elementary or high school students who work part-time during the
school year or during vacation periods.
Independent contractors.
Employees during the first 45 days of "extra employment".
These are persons not normally in the labor market who are hired to do work
for a limited special period of time.
Employees in "casual employment". An employee who normally
works in a different occupation, who is hired for a day or less.
Corporate Directors, acting only as such, and not as employees.
Partners and Proprietors are not required to be covered. They must
however cover any eligible employees.
Executive Officers of an incorporated non-profit, religious, charitable,
or educational institution. (President, Vice-President, Secretary or
Treasurer)
An Employer may elect to provide voluntary benefits to an excluded class
of employees by filing an application for voluntary coverage with the Worker's
Compensation Board.
Are Employees Working Outside of New
York Covered by DBL?
Employees working outside of New York are covered if their service
is not localized in any other state, and some of their service is performed
in New York State; or
There is no base of operation in any state, but the Employee is directed
and controlled from New York State; or
The place from which the Employee is directed or controlled is not in any
state in which some part of the service is performed, and the Employee's residence
is in New York State.
May Non-New York Employees be
covered by DBL?
Yes. A New York State Employer may voluntarily elect to cover
it's Non-New York Employees for DBL, providing the Employee is not eligible
in any other state that has statutory disability benefits. (California, Hawaii,
New Jersey, Rhode Island and Puerto Rico)
What if an Employee changes jobs?
An Employee who has attained eligibility and changes jobs from one
covered Employer to another, is eligible on the first day on the new job,
providing there is less than 4 weeks separation between jobs, or he is receiving
unemployment benefits.
Are DBL Benefits Taxable?
Yes. They are reportable income subject to FICA withholding.
What if Disability Happens While Between
Jobs?
If disability occurs within 4 weeks after termination of employment,
benefits are payable beginning with the 8th consecutive day of disability,
by the Former Employer's Insurer.
Unemployed workers who become disabled more than 4 weeks, but within 26 weeks
after termination of employment, and are either eligible for or receiving
unemployment benefits, are paid benefits from the first day of total disability;
upon termination of unemployment benefits. The former Employer's account is
not charged.
What Should the Employer Do When an
Employee Is Disabled?
The Employer is required to send form DB-271, Statement of Rights,
to his Employee within 5 days that he is aware, or within 5 days after the
7th day of disability, whichever is later.
How does the Employee Claim Disability
Benefits?
Employee should obtain form DB-450, Notice and Proof of Claim, from
his Employer, Insurer, or the Workers Compensation Board. He must complete
and sign Part A - Claimant's Statement.
To qualify he must be under the care of a licensed or certified physician,
podiatrist, psychologist, chiropractor, dentist, or nurse-midwife, who must
certify that the claimant is disabled from working and complete and sign part
B -Claimant's Statement.
The completed DB-450 should be filed promptly with the insurance
carrier.
Is there a Time Limit
for filing a DBL Claim ?
Yes. Employee must file a claim within 30 days after
becoming disabled.
If a claim is filed late, unless it can be demonstrated that it was impossible
to file earlier, benefits will not be paid for any period of disability prior
to 2 weeks before the claim was filed. Benefits may not be paid at all
if claim is filed later than 26 weeks after disability began.
If a Claim is Denied is there any Appeal?
Yes. Claimant may appeal the carrier's decision
directly to the Workers Compensation Board within 26 weeks of denial.
The Board will determine if benefits should be paid.
Does DBL cover Pregnancy?
Yes. Pregnancy is treated like any other disability.
Eligibility for benefits is based upon medical certification of disability,
which may occur at any time during pregnancy. However, an employee on
unpaid maternity leave who become disabled is eligible only within 4 weeks
of the last day actually worked.
Does DBL cover Disabilities Caused by an Automobile
Accident?
Yes. DBL is Primary over No Fault Automobile
insurance. No Fault benefits may be reduced accordingly. DBL claims
must be filed within the 30 day time limit.
Can an Employee Collect both DBL and S.
S. Retirement Benefits?
Yes. Eligibility for Social Security Retirement Benefits
does not affect the right to DBL.
Is FICA Tax Withheld from DBL Benefits
payable to the Employee?
Yes. The Employee's regular share of FICA tax (7.65%)
is withheld. The Employee may also elect to have Withholding Tax taken
out as well.
Question We Failed to Address?
Please Call, Fax, or E-Mail to: DBL@victorson.com
We will do our very best to promptly obtain the information that you require.
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