Here are just a few of the most common queries clients have.
New York DBL Frequently Asked Questions
1. What is DBL?A. The New York Disability Benefits Law (DBL) mandates the payment of weekly cash benefits to wage earners who are disabled as a result of a non-occupational injury or illness.DBL is different from the Workers’ Compensation, which mandates benefits for occupational injury or illness.
Along with New York, four states – California, Hawaii, New Jersey and Rhode Island – and the territory of Puerto Rico have statutory disability benefit laws. Each jurisdiction has its own unique laws and benefit requirements.
The "Statutory Plans Around the Country" chart outlines the requirements and benefits for each state.
A. With a few exceptions, a New York State employer who employs at least one person for at least 30 days in any calendar year becomes a "covered employer," four weeks after the 30th day of such employment. This includes employers of one or more personal or domestic employees who work at least 40 hours a week in their private home.Sole proprietors and partnerships whose only employee is a spouse are covered employers and required to provide coverage – unless they elect to exclude the spouse. In this case, they must notify the Workers’ Compensation Board by filing form DB-212.5 Notice of Election to Voluntarily Exclude Spouse Coverage.
Corporations with one or two corporate officers who are the sole shareholders and have no other employees are not required to have coverage. However, they become covered employers when they hire an employee, and must obtain coverage.
A. Disability Benefits Law insurance may be provided through approved insurance carriers, self-insured plans or the State Insurance Fund. In New York, the majority of employers are covered by private carriers.To obtain coverage from a private carrier, an employer should contact their insurance broker or agent within 10 days of becoming a covered employer and request he/she obtain a DBL insurance policy on their behalf.
An employer who chooses to self-insure must first get approval from the Workers’ Compensation Board.
A. An employer who fails to obtain coverage for disability benefits within 10 days after becoming a covered employer, will be in non-compliance of the Disability Benefits Law and subject to a fine by the Workers’ Compensation Board. The fine imposed is typically $500 plus one-half of one percent of the employees’ payroll for the period of non-compliance. In addition, failure to comply with the Disability Benefits Law is a misdemeanor, and upon conviction may subject the employer to additional fines and/or imprisonment.If an employee becomes disabled while working for an employer who is in non-compliance, the employee is entitled to benefits from the Special Fund for Disability Benefits. In addition to any fine imposed on the employer, reimbursement for benefits paid by the Special Fund, or one percent of the employer’s payroll for the period of non-compliance, whichever is greater, will also be required.
A. A disabled employee will receive 50% of his average weekly wage – based on the last eight weeks of earnings – to a weekly maximum of $170. Benefits are paid beginning with the eighth consecutive day of disability and continue for a maximum of 26 weeks during any consecutive 52 week period. The minimum weekly benefit is $20, or the average weekly wage if less than $20.DBL is strictly a plan of partial salary replacement and does not reimburse medical expenses.
If an employee works for two or more employers, he cannot collect more than the maximum DBL benefit. The benefit payable is in proportion to his earnings from each employer.
A. Most wage earners employed in New York State are eligible if they are working for a covered worker.
Full-time employees who are new to the labor force are eligible after they have worked four consecutive weeks.
Part-time employees who are new to the labor force are eligible on the 25th day of regular employment. Under the law, part-time is defined as other than the employer's normal work week. Any part of a day worked is considered a day of employment.
Employees who have been receiving unemployment benefits are immediately eligible once they begin work, provided that prior employment was covered employment
New employees who have previously established eligibility with another employer are eligible as soon as they begin work, as long as the gap in employment is not more than four weeks.
Personal or domestic employees working at least 40 hours a week in a private home for the same employer.
The spouse working for a sole proprietor or partnership – unless excluded by the employer. (Form 212.5)
Working college students are eligible for benefits if they meet any of the requirements above.
Employees working on a 10 month contract (i.e. covered teachers) remain eligible for four weeks after the last day worked. Employees working on a 12 month contract remain eligible after the last day worked and continue eligibility as long as they are able to return to work when the new contract begins.
A corporate officer is an employee and will be covered as such, unless he/she is a nominal officer and receives no wages or remuneration for his/her services.
A. Certain classes of employees are not eligible for coverage or are excluded from the definition of employee:
Minor children of an employer
Government, railroad or maritime workers
Ministers, priests, rabbis, members of a religious order, sextons or Christian Science readers
Persons engaged in a professional or teaching capacity in or for a non-profit religious, charitable or educational institution; persons receiving rehabilitative services in a sheltered workshop operated by such institutions under a certificate issued by the U.S. Department of Labor
Persons receiving aid from religious, charitable or educational institutions, who perform work in return for such aid
Golf caddies
Farm laborers
Daytime students in elementary or secondary school who work part-time during the school year or during regular vacation periods
An independent contractor
Partners and proprietors are not considered employees
Corporate directors, acting only as such, and not as employees
Executive officers of any incorporated non-profit, religious, charitable or educational institution – defined as President, Vice President, Secretary or Treasurer
An otherwise eligible employee loses his eligibility for benefits after working four weeks in non-covered employment, (i.e. working in non-New York employment or for a municipality or government agency.)
An employer may voluntarily elect to provide benefits to most excluded
class(es) of employees by filing form DB-135 or DB-136, Employers Application For Voluntary Coverage with the Workers’ Compensation Board. Upon approval, the employer should notify his insurance carrier.
A. DBL premiums may be paid entirely by the employer or jointly by the employer and the employee. However, the employee is not required to contribute more than one-half of one percent of the first $120 of weekly wages, to a maximum of $.60 per week.If an employee works for two or more employers, he/she may request each employer to adjust his contributions in proportion to his/her earnings so that the employee’s total contribution does not exceed $.60 per week.
A. Eligibility is usually based on the state in which the employee works. However, employees working outside New York are covered if some of their service is performed in New York, and:
The employee’s base of operations is in New York; or
There is no base of operations in any state, but the employee is directed and controlled from New York; or
The base of operations or place from which the service 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.
A. An employee must be prevented from performing his regular duties due to a non-occupational accident or sickness and for which he has not received wages or remuneration. The employee must be certified disabled from working and under the care of a licensed or certified physician, podiatrist, psychologist, chiropractor, dentist or nurse-midwife.Disabilities caused by injury or illness as a result of war, self-inflicted injury, injury arising from an illegal act or from committing a crime or elective surgery are not covered under the law.
A. Yes. Disability related to pregnancy is treated like any other illness. Eligibility for benefits is based on medical certification of total disability, which may occur at any time during pregnancy. An employee on unpaid maternity leave is eligible if she becomes disabled within four weeks after the last day actually worked.
A. Yes. DBL is primary over No Fault automobile insurance. No Fault benefits may be reduced by the amount of disability benefits the claimant is eligible to receive. The DB-450, Notice and Proof of Claim for Disability Benefits, must be filed within 30 days.
A. The employer is required to send form DB-271, Statement Of Rights – Disability Benefits Law, to his employee after the seventh consecutive day of disability. The Statement of Rights is available from the insurance carrier or the Workers’ Compensation Board. The employer should also send the employee form DB-450, Notice And Proof Of Claim For Disability Benefits.
A. Yes. If the disability begins more than four weeks after wages cease, the employee is not eligible to receive DBL benefits through their employer. Benefits for these disabilities may be payable by the Special Fund for Disability Benefits.
A. Form DB-450, Notice And Proof Of Claim For Disability Benefits, is available from employers, insurance carriers or the Workers’ Compensation Board. The claimant must complete and sign "Part A – Claimant’s Statement." The attending doctor or health care provider must certify the claimant is disabled from working and complete and sign "Part B – Health Care Provider’s Statement."The completed DB-450 should be filed promptly with the insurance carrier.
A. Yes. An employee must file a claim within 30 days after becoming disabled. If a claim is filed late, and unless the claimant can demonstrate that it was impossible to file sooner, benefits will not be paid for any period of disability prior to two weeks before the claim was filed. No benefits may be paid at all if the claim was filed later than 26 weeks after the disability began. An exception is a claimant who is a minor or is mentally incompetent and without guardian or committee.
A. Yes. The claimant may appeal the insurance carrier’s decision directly to the Workers’ Compensation Board within 26 weeks after receiving form DB-451, Notice Of Total Or Partial Rejection Of Claim For Disability Benefits. The Board will examine the case and if necessary hold a hearing to determine if benefits should be paid.
A. If a worker becomes disabled while eligible for or receiving unemployment insurance benefits, his/her unemployment insurance benefits will cease and he/she may claim disability benefits.If the disability occurs:
within the first four weeks after termination of employment, the employee must file with his/her former employer’s insurance carrier.
more than four weeks, but within 26 weeks after termination, the employee must file with the Special Fund for Disability Benefits, which is administered by the Workers’ Compensation Board.
A. An employee who has already attained eligibility and changes jobs from one covered employer to another, is eligible on the first day of the new job, as long as there are less than four weeks separation between jobs or he/she is receiving unemployment benefits. However, an employee loses eligibility after four weeks in a non-covered employment, (e.g., municipal government, or non-New York employment.)
A. Yes. The fact that an employee is eligible for or receiving retirement benefits under the Social Security Act does not affect his/her right to Disability Benefits. However, the employee may elect to be exempted from the Disability Benefits Law by filing a waiver with the Workers’ Compensation Board. The employee would cease to be eligible for benefits and the employer may no longer deduct a contribution.
A. Yes. Public Law 97-123 requires FICA (Social Security and Medicare) taxes to be withheld from sick pay paid. The employee’s regular share of FICA tax, 7.65% (6.2% Social Security, 1.45% Medicare), is withheld from all DBL payments made within the six calendar months following the month in which an employee last worked. However, a portion of the DBL benefit may not be subject to withholding tax if the employee contributes to the cost of insurance (i.e. $.60 per week). To assure proper withholding, each year the employer should advise his insurance carrier of the percent of benefit subject to tax.The employee’s withholding is deposited by the insurance carrier in accordance with Federally prescribed procedures. Notification of this deduction is sent to the employer who must then deposit his portion of the FICA tax.
Exceptions:
The insurance carrier does not deduct FICA when:
the employee continued to receive salary and the benefit payment represents employer reimbursement.
the employer notified the carrier that his employees are not subject to FICA, i.e., certain non-profit groups.
Over Withholding:
In some cases, the FICA deduction may be greater than required by law. The employer may adjust over withholding on line #9 of his/her 941 report.
Federal legislation requires third-party payers, such as insurance carriers, to report to employers all "sick pay" paid to their employees.
A. If the employee contributes towards the cost of insurance, a portion of the DBL benefit may not be subject to withholding.To calculate taxable and non-taxable benefit percentages:
- Determine the total DBL premium paid for the past three calendar years. If three years are unavailable, you may use one year.
- Determine the total employee contribution for the same period (up to $.60 weekly per employee).
- Calculate the net amount of premium paid by the employer for this period. (Total premium paid minus employees’ contribution, A – B)
- Divide [C] by [A]. The result is the percentage of benefit that is subject to tax.
A. In accordance with Public Law 96-601, a claimant may request withholding of Federal tax from his DBL benefit. Upon receipt of the prescribed form, W4-S, NBL will deduct Federal taxes from the claimant’s benefit payment. The minimum withholding is $20 per week.