New York Disability Benefits Law (DBL)
is a mandated state disability insurance program designed to provide employees with a loss of income benefit in the event of a non occupational accident or illness.
ELIGIBILITY
All employers in New York State reporting a payroll are required to provide NYS DBL benefits for their employees. This includes all full time and part time employees. (with the exception of employees enrolled in a full time high school program and other non mandated voluntary classes of employees). Out of state employees in non statutory states may be covered, depending on the insurance carrier’s underwriting procedures.
RATES AND BENEFIT
DBL insurance rates vary, but the state mandated benefit is the same. An employer reporting less than 50 employees can be billed the carrier’s per capita under 50 life filed group rates, per male and per female employee. Groups reporting more that 50 employees are typically reviewed by the carrier’s underwriting department. The rate per employee will depend upon the carrier’s underwriting guidelines .
The mandated benefit in NYS is 50% of average weekly earnings to a maximum benefit of $170.00 per week for a maximum of 26 weeks in a consecutive 52 week period. If an employees’ wages are $340.00 or more for the eight weeks prior to the date of disability, the benefit should be $170.00 per week.
***Some carriers also offer enhanced benefits at higher rates. These benefits will increase the amount of the benefit paid, depending upon the option chosen. All benefits are determined by wages earned prior to the onset date of disability.
CONTRIBUTION
Employers may elect to deduct ½ of 1% of weekly earnings to a maximum deduction of .60 cents per week to offset the cost of the DBL premium. The employer is responsible for providing this benefit and for paying premium in a timely manner. If the employer elects to deduct this contribution, the taxable portion of an employee’s benefit will be adjusted, as the employee is now “contributing” to the cost of the premium.
CLAIMS
Claims for benefits must be filed within thirty (30) days from the onset date of disability. The DB450 claim form must be completed by the claimant, employer and physician and must be signed and dated. There is a seven (7) day waiting period for which no benefits will be paid. The benefit begins on the eighth (8th) day of disability.
Paid Family Leave (PFL)
PFL insurance is now mandated in NYS, effective January 1, 2018 and is included in the NYS DBL policy. Coverage provides job security and paid time off to care for a seriously ill family member, bond with a new child, and take care of family matters due to a military deployment.
DISABILITY BENEFITS (OFF-THE-JOB INJURY OR ILLNESS)
Disability Benefits Coverage
Liabilities and Penalties for Not Having Required Disability Benefits Insurance Coverage
Failure of an employer to provide disability benefits coverage as required by law will subject the employer to penalties and the cost of any claims associated with the noncompliance. The Board has the authority under the DBL to determine when coverage is required. Sole proprietors, partners of a partnership, and the President, Secretary and Treasurer of a corporation may be held personally liable for an employer’s failure to secure disability benefits insurance. Liabilities and penalties for not having the required disability benefits coverage include, but are not limited to:
Penalties for Noncompliance with Disability Benefits Mandatory Coverage Requirements
Section 220 (2) of the Disability Benefits Law — The Board shall impose upon an employer a penalty of 1/2 of one percent of the employer’s payroll during the period of noncompliance PLUS an additional sum of $500 for each period of noncompliance.
Section 220 (1) of the Disability Benefits Law — Not securing required disability benefits insurance is a misdemeanor, punishable by a fine of not less than $100 nor more than $500 or imprisonment for up to one year or both. A second violation of the Law within five years may result in a fine of not less than $250 nor more than $1,250. A third or subsequent violation of the Law within five years may result in a fine of up to $2,500.
Liability for Claims Against an Uninsured Employer Under the Disability Benefits Law, Section 213 (1)
In addition to the penalties assessed under Section 220, subdivision 2, the employer is liable for either the total value of any disability benefits claims paid by the Special Fund for Disability Benefits during the period of noncompliance OR one percent of the employer’s payroll during the period of noncompliance, whichever is greater.
Source: www.wcb.ny.gov