Understanding NY State’s Disability Insurance rules

Being seriously ill or injured during work can be emotionally and financially taxing. Some time off from work is a must in such cases. Many professionals in New York do not usually receive any long-term paid time off. 

For that reason, the State of New York’s Temporary Disability Insurance (TDI) program enables regular payments to people who are temporarily not fit to work or people who have disabilities, or women who have just given birth. 

TDI is sometimes referred to as “New York Disability Benefits” or “DB.” Under the Disability Benefits Law, employees can receive weekly cash benefits to compensate for the wages lost due to injuries or illnesses.

An unemployed worker can also receive disability benefits to replace unemployment insurance benefits lost because of illness or injury. 

What is Disability Insurance?

Disability insurance for the people of New York is an insurance benefit for employees for an injury or illness that occurs off the job. Under the Disability and Paid Family Leave Benefits Law (Article 9 of the WCL), employees are entitled to weekly cash benefits to fulfill the wages lost during an illness or injury that did not occur during their employment (WCL §204). 

If an employee gets injured or disabled when they are eligible for unemployment benefits, and if the injury or disablement results in being ineligible for unemployment benefits, the employee becomes eligible for disability benefits

If a New York citizen is employed in more than one job at the same time and has combined wages of more than $120 per week, then the employee is eligible to request each employer to balance the contributions in the proportion to the income of each employee.

When combined, the contribution should not exceed 60 cents per week. The employee should place the request as soon as they enter a second job. It’s noteworthy that benefits of the disability insurance include cash payment only. Medical care is not the responsibility of the employer or insurance carrier. It has to be managed by the claimant themselves. 

Read More: Gonzalez Insurance – How We Go the Extra Mile to Provide Insurance Advice and Options

What Are the Benefits of Disability Insurance in New York?

As mentioned above, disability benefits are cash-only benefits. They can be summed up as: 

  • Fifty percent of the average weekly wage is covered. The income is compensated only for the last eight weeks worked before the incident. 
  • The benefits are subject to Social Security and Medicare taxes.
  • The benefits are paid for a maximum of 26 weeks of disability in the period of any 52 consecutive weeks. (WCL §205).

Employees cannot collect disability benefits, and paid family leave benefits together. The total combined disability leaves and paid family leave in any 52 weeks may not exceed 26 weeks. Besides, medical expenses are not covered under paid family leaves. 

Who Are Covered Under This Compensation Coverage?

This section covers who is called an employee under the New York State Disability benefits law and who is covered/not covered for the benefits. 

  • If any employee or recent employee has worked at least four consecutive weeks, or the employer employs one or more persons on each of 30 days in any calendar month then this is counted under the ‘covered’ employer category. 
  • Certain employers elect to provide benefits by applying for voluntary coverage. 
  • If employees change jobs from one ‘covered’ employer to another, they are covered from the first day of their new job. 
  • Any Domestic or personal employee who works for more than 40 hours per week is covered. 

How To File for a Claim?

Employees are advised the following methods to file for a claim: 

  • If an employee is currently employed or unemployed for less than four weeks from the date of their disability, they can file the claim with the employer or insurance carrier using form DB-450. There is a copy in the center of this pamphlet, or one might get a copy from their nearest district office. Retain a copy of this form if the claim is not paid on time. 
  • In case the person was not employed for more than four weeks from the date of disability, they can file the claim with the Disability Benefits Bureau using the form DB-300. 
  • The employee must claim insurance within 30 days of the disability. In case of late filing, the employee will not get any payment for any disability period more than two weeks before the claim is filed. The insurance companies can excuse late filings if it is shown that it was not reasonably possible to file a claim earlier. Late filings may be considered if acceptable reasons are presented for the delay. No benefits are paid if the filing exceeds 26 weeks after the disability began.

If you are an employer, click here to know about your workers’ compensation coverage.

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