New York State Disability Benefits Law

What the Disability Benefits Law is

New York is one of a handful of states that requires employers to provide short-term disability coverage for their workers. The rules live in article 9 of the Workers' Compensation Law, which calls itself the "disability benefits law and the paid family leave benefits law." The coverage is often called DBL or statutory disability, and it is administered by the Workers' Compensation Board and its chair.

The key idea: workers' compensation pays for disabilities that come from the job; DBL pays for disabilities that do not. An off-the-job injury, an illness, or a pregnancy that keeps an employee from working is a DBL claim. Since 2018 the same article also provides Paid Family Leave (PFL), which pays an employee for time off for family reasons rather than for the employee's own illness or injury: to bond with a new child, care for a seriously ill family member, or handle certain military-family needs.

Who must provide it, and who pays

A private employer generally becomes a covered employer once it employs one or more people on each of 30 days in a calendar year, and coverage must then be in place.
An employee becomes eligible after four consecutive weeks of work for a covered employer, and stays protected for a short period after leaving.
The employer may meet the obligation by insuring with the State Insurance Fund, buying a policy from an authorized insurer, self-insuring with board approval, or keeping an approved plan or agreement that pays benefits at least as favorable as the statute.
Employees may be charged a small contribution, capped by statute at one-half of one percent of wages, no more than 60 cents a week for DBL. The employer pays the rest. PFL is funded by employee payroll deductions at a rate set each year.

What DBL pays

Amount: 50% of the employee's average weekly wage over the last eight weeks worked, up to a maximum of $170 a week.
Waiting period: benefits begin on the eighth consecutive day of disability; the first seven days are unpaid.
Duration: no more than 26 weeks in any 52 consecutive weeks, and any family-leave days taken in that window reduce the 26.
Care requirement: the employee must be under the care of a licensed physician, podiatrist, chiropractor, dentist, psychologist or certified nurse midwife, as the condition requires, or an accredited practitioner for those who rely on spiritual healing.
Timing: the first payment is due on the 14th day of disability and must reach the employee within four business days after that, or after proof of claim is filed if later. Payments then continue every two weeks.

PFL pays a higher share of wages (67% of the average weekly wage, capped at 67% of the state average weekly wage) for up to 12 weeks in 52, and DBL plus PFL together may not exceed 26 weeks in the same 52-week period.

A horizontal timeline of a New York disability benefits claim for an off-the-job disability. The first segment, days one through seven, is shaded gray and labeled as the unpaid waiting period. A long blue segment starts on day eight and is labeled fifty percent of the average weekly wage, up to one hundred seventy dollars a week, paid every two weeks. Markers below the line show day eight, when benefits begin; day fourteen, when the first payment is due, to be paid within four business days; and the end of the line at twenty-six weeks, the most that can be paid in any fifty-two weeks. A green bar underneath shows paid family leave of up to twelve weeks, with a note that disability and family leave together cannot exceed twenty-six weeks in fifty-two. A footer reminds the listener that on-the-job disabilities go to workers' compensation, not disability benefits. — DBL: seven-day wait, half pay to $170 a week, 26-week maximum

No double dipping

Article 9 is a safety net, not a bonus. DBL is not payable:

for any week the person collects unemployment insurance;
for any period when workers' compensation or a similar law pays for the disability (benefits for an earlier, unrelated permanent partial disability do not block it);
to the extent that a government or employer permanent disability benefit for the same disability would push the total above the weekly DBL amount (veterans' disability benefits are not offset).

If the employer's carrier contests a workers' compensation claim, saying the disability did not arise from the job, the employee gets DBL first. The DBL payer can then file a claim to be reimbursed out of any later workers' compensation award, and it holds a lien on that award.

Likewise, if a negligent third party caused the disability, the employee can take DBL without giving up the lawsuit, and the DBL carrier has a lien on the recovery, after reasonable costs and attorney's fees, for the benefits it paid.

If you lose your job

A worker whose covered employment ends and who becomes disabled within the next 26 weeks of unemployment is not left without income. If the disability is what makes them ineligible for unemployment benefits, DBL takes over for the weeks unemployment would have paid. These benefits come from a special fund paid out by the board's chair, not from the former employer's carrier. PFL, by contrast, is only for people who are employed when they request it.

Exam tips

Off the job = DBL. On the job = workers' compensation. Seven-day wait, half pay to $170, 26 weeks.

Expect questions that test the dividing line with workers' compensation, the benefit numbers, and the rule that a qualifying plan must be at least as favorable as the law.