Frequently Asked Questions
Question: What is a “day of disability?”
Answer:
- 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.
Question: If an employee engages in work for remuneration or profit, even if done at home, while disabled, is he/she eligible for disability benefits?
Answer:
- 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?
Answer:
- No. Costs of medical care are not included under the statutory provisions of the Disability Benefits Law.
Question: May an employer/insurance carrier have an employee claiming benefits examined by a health care provider designated by the employer/carrier?
Answer:
- Yes. Independent medical exams by an outside provider may be ordered at the insurance carrier’s request. 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.
Question: After a claim is filed, how soon will it be paid?
Answer:
- If 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, whichever is later.
Question: Can a claimant collect Unemployment Insurance and Disability Benefits for the same period of time?
Answer:
- No.
Question: If an employee quits his or her job, may that employee receive Disability Benefits?
Answer:
- Termination of employment may affect an employee’s right to Disability Benefits.
Question: Can a claimant collect Disability Benefits for disability caused by pregnancy?
Answer:
- Yes. If she is medically disabled due to pregnancy, she may be entitled to up to 26 weeks of benefits. Disability can occur at any time during pregnancy.
Question: Is there a limit on the number of weeks a claimant can receive benefits?
Answer:
- Yes. There is a maximum benefit 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).
Question: What if a claimant is still disabled, but benefits have stopped?
Answer:
- 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 the reverse side and mailing it to the Disability Benefits Bureau at the Workers’ Compensation Board.
Question: Is a claimant entitled to Disability Benefits for an injury incurred in an auto accident?
Answer:
- Yes. However, the amount of the disability benefits may reduce any no-fault insurance benefits the claimant is eligible to receive.
Question: If a claim is rejected or not paid, may it be reviewed?
Answer:
- 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. Where necessary, the Board will obtain further information and may hold a hearing on the claim.
Benefits will be paid if a claim is determined proper and valid.
Question: If a claimant is entitled to or receiving Social Security Retirement Benefits, may he/she still receive Disability Benefits?
Answer:
- Yes. If he/she is entitled to Disability Benefits, the fact that he/she is eligible for or receiving retirement benefits under the Social Security Act does not affect his/her right to Disability Benefits.
Excerpts of above taken from: www.wcb.ny.gov