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: After 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, which ever 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 so specified). 

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 claimant 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 claimant 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 after his/her right to Disability Benefits.

Product Information

Who is and who is not covered by the law (DB)? 

Who is covered?

• Employees or recent employees of a "covered" employer, who have worked at least four consecutive weeks.
• An employer of one or more persons on each of 30 days in any calendar year becomes a "covered" employer four weeks after the 30th day of such employment.
• Employees of an employer who elects to provide benefits by filing an Application for Voluntary Coverage.
• Employees who change jobs from one "covered" employer to another "covered" employer are protected from the first day on the new job. Generally, an eligible employee does not lose protection during the first 26 weeks of unemployment, provided he/she is eligible for and is claiming unemployment insurance benefits.
• Domestic or personal employees who work 40 or more hours per week for one employer.

Who is not covered?

• A minor child of the employer.
• Government, railroad, maritime or farm works.
• Ministers, priests, rabbis, members of religious orders, sextons, Christian Science readers.
• Corporate officers and persons engaged in a professional or teaching capacity in or for a religious, charitable, or education institution of a "non-profit" character, and persons receiving rehabilitation services in a sheltered workshop operated by such institutions under a certificate issued by the U.S. Department of Labor.
• Persons receiving aid from a religious or charitable institution, who perform work in return for such aid.
• One or two corporate officers who either singly or jointly own all of the stock and hold all of the offices of a corporation that employs no other employees.
• Golf caddies.
• Daytime students in elementary or secondary school, who work part-time during the school year or their regular vacation period.
• Employees who change to jobs in an exempt employment or with a "non-covered" employer, and work in such employment for more than four weeks, lose protection until they work four consecutive weeks for a "covered" employer.

Complying with the Disability Benefits Law

An employer who has had in New York State employment 1 or more employees on each of at least 30 days in any calendar year shall be a "covered employer" subject to the Disability Benefits Law after the expiration of 4 weeks following the 30th day of such employment. These 30 days of employment need not be consecutive days but must be work days of employment in one calendar year. In addition to the above-stated provisions, effective January 1, 1984, employers of personal or domestic employees in a private home are subject if they employ at least one employee who works 40 or more hours per week for that employer. (Note: Prior to January 1, 1984, employers are subject only if they have 5 or more employees).

An employer who by operation of law becomes successor to a covered employer, or who acquires by purchase or otherwise the trade or business of a covered employer, immediately becomes a covered employer.

A "covered employer" under the law is required to provide for the payment of Disability Benefits to all eligible employees. The employer may comply by purchasing a policy of insurance or by applying to the Chair for approval as a self-insurer with permission to deposit securities or file a surety bond. Insurance may be purchased from any insurance company authorized to write Disability Benefits insurance in this state, including the State Insurance Fund, 199 Church St., New York, Now York 10007.

All information pertaining to premium rates, filing of forms or other date in connection with the policy will be supplied by the carrier of the employer's choice. No forms are required by the Workers' Compensation Board nor are any remittances made to the Board. Premiums for the Disability Benefits insurance policies are paid directly to the insurance carrier by the employer.

Benefits that differ from those set forth in the Law may be provided if submitted as an "at least as favorable" Plan and approved by the Chair.

A covered employer is authorized to collect from each employee, through payroll deduction, a contribution of 1/2 of 1% of wages paid, but not in excess of 60 cents per week. However, an employer may waive all employee contributions or, by employee agreement and acceptable to the Chair, arrange for employee contributions in excess of the statutory rate if the amount is reasonably related to the value of the benefits provided. Every covered employer bears the cost of providing benefits in excess of the contributions collected from employees.

Each covered employer must post and maintain conspicuously at the place or places of business a prescribed form, Notice of Compliance, stating the provisions have been made for the payment of Disability Benefits to all eligible employees. Also, effective January 1, 1986, whenever an employee of a covered employer is absent from work due to disability for more than seven consecutive days, the employer shall, within five days thereafter, provide the employee with prescribed Form DB-271, Statement of Rights under the Disability Benefits Law. Both forms may be obtained from your insurance carrier.

Non-Profit Religious, Charitable and Education Institutions

Religious, charitable or educational institutions operating on a non-profit basis are required to obtain disability benefits insurance or to provide disability benefits through approved self-insurance to all of their employees, with exceptions, as noted below, if they employ one or more employees.

The following classes of employees are excluded from mandatory coverage: a duly ordained, commissioned or licensed minister, priest or rabbi; a sexton; a Christian science reader; a member of a religious order. 

Also excluded from mandatory coverage are persons engaged in a professional or teaching capacity in or for a "religious, charitable or educational institution"; or an executive officer of an incorporated religious, charitable or education institution; or persons participating in or receiving rehabilitative services in a sheltered workshop operated by such institutions under a certificate issued by the U.S. Department of Labor; or volunteers in or for such institutions; or recipients of charitable aid from a religious or charitable institution who perform work in or for such institution which is incidental to or in return for the aid conferred, and not under an expressed contract of hire.

The term "religious, charitable or educational institution" means a corporation, unincorporated association, community chest, fund or foundation organized and operated exclusively for religious, charitable or educational purposes, no part of the net earnings of which inure to the benefit of any private shareholder or individual.

Many organizations have sick leave plans, salary continuance arrangements or other disability plans on a voluntary basis or as a result of collective bargaining. Some of these plans may be acceptable as compliance with the Disability Benefits Law, if secured by disability benefits insurance or approved self-insurance. However, it has been found that many of such plans, unless modified, are not acceptable as compliance, Board staff will suggest modifications to make such plans "at least as favorable" as the benefits required by the Disability Benefits Law and acceptable to the Chair. The Board welcomes all such inquiries.

It is suggested that you disseminate this information among your affiliated organizations, if any, informing them of their responsibility under the pertinent sections of the Disability Benefits Law.

Questions in connection with the acceptability of disability benefit plans or with respect to employer compliance with the Disability Benefits Law should be directed to the Disability Benefits Coverage Section, 180 Livingston St., Brooklyn, NY 11248 0005.