ShelterPoint Life Insurance – Formerly First Rehab Life 1972 Located at
1225 Franklin Avenue, Ste. 475, Garden City, NY.
Phone: 516-82908100

ABCs of DBL

As a service to our producers, ShelterPoint compiled a list of frequently asked questions you might encounter from your clients. For easy navigation, we’ve sorted them by questions from employers and questions from employees.

FAQs from Employers/Policyholders

 
What is DBL?
On April 13, 1949, Governor Thomas E. Dewey signed the Mailler-Condon Bill which became Article 9 of the Workers' Compensation Law. This Article constitutes the Disability Benefits Law (short DBL) in New York. While Workers' Comp mandates benefits for on-the-job injuries and work-related illnesses, DBL provides temporary cash payments for eligible wage earners who are incapacitated by an illness or disability from a non-occupational injury. Currently, only five other U.S. states and territories have mandatory disability insurance programs in place: California, Hawaii, New Jersey, Rhode Island, and Puerto Rico.
When does my business have to provide DBL coverage?
If your business qualifies as a "covered employer", you must provide DBL for all your eligible employees.
When is my business considered a “covered employer”?

Your business becomes a "covered employer" 4 weeks after it has employed at least one person for any 30-day or longer period in New York in a calendar year (WCL §202).

Additional provision for employers of personal/domestic employees in a private home: You must employ at least one person who works 40 or more hours per week for that one employer.

Which employees do I have to cover?

You must cover all eligible employees. Any person providing services to your for-profit business can be deemed an employee and must be covered under DBL if they are eligible (see Who is not covered under DBL? for exceptions). If your business meets any of the criteria listed below and the person you are hiring does not fall in the category of an Independent Contractor or in the list of ineligible individuals, you must provide them with DBL coverage: Non-public sector non-profit employers must provide DBL coverage for employees but not for religious leaders; i.e., non-profits such as churches must provide DBL coverage for custodial and office staff but not for priests, ministers, rabbis, etc.

  1. Right to Control (The degree of direction and control you have over the time/way in which the work is performed): If you control those elements, it indicates an employer-employee relationship.
  2. Character of the individual’s work is the same as the type of work your business performs (the individual’s work must be consistent with the primary work performed by your business). Example from the WCB: someone installing shingles for a roofer is generally considered the employee of that roofer. Conversely, a plumber hired on a one time basis to fix a broken pipe for a retail store owner is generally considered an independent contractor.
  3. Method of Payment: Whether the labor is paid using a W2 or 1099 Form for tax purposes does not matter in determining an employer-employee relationship for DBL (workers' compensation purposes). Any payments (including cash payments) that are not rendered on a per-project basis indicate that the individual is an employee! If you pay wages on an hourly, daily. weekly, or monthly basis, this tends to indicate actual employment.
  4. Furnishing Equipment/Materials: If you provide the equipment, tools, and/or materials for their work, this tends to indicate an employer-employee relationship.
  5. Right to Hire/Fire: You retain the authority to hire and fire individuals and can fire them because of the time/method they choose to perform their work.
Therefore, the following employees must be covered:
  • Employees or recent employees of another covered employer, who have worked at least 4 consecutive weeks for one or both of the employers.
  • Part-time employees, i.e. persons who work fewer hours than constitute your normal workweek. (Any part of a day worked is counted as a day of employment, and the employee becomes eligible on the 25th day of such regular, part-time employment.)(see Who is not covered under DBL? for exceptions)
  • Personal or domestic employees working for you in a private home at least 40 hours a week (if they work 30 or more days in a calendar year for you).
  • Employed college students meeting any of the above requirements.

For coverage regulations regarding business owners see Are business owners covered under NY DBL?.

Who is considered a personal/domestic employee?

Chauffeurs, nannies, home health aides, nurses, babysitters, maids/live-in maids, cooks, housekeepers, laundry workers, butlers, companions, and gardeners who work in a private household (12 NYCRR §355.2).

Note: You are not required to provide DBL if the only people who work for your household are private domestic workers who each work less than 40 hours per week for you and do not live on premises.

How soon are my new employees covered?

Whether you are a covered employer or not, your new employees are generally protected immediately (from the first day on the new job) if they

  1. move from one covered employer to another - as long as the gap in employment isn't more than 4 weeks; or
  2. become re-employed after receiving unemployment benefits (provided the prior employment was covered).

If you are not a covered employer and your employee doesn’t meet the requirements for immediate coverage, their DBL protection becomes effective once you qualify as a covered employer.

Employees who change to jobs in an exempt employment environment or with a "non-covered" employer, and work there for more than 4 weeks, lose protection until they work 4 consecutive weeks for a "covered" employer.


Who is not covered under DBL?
  • A minor child of an employer
  • Government, railroad, maritime, and farm workers
  • Ministers, priests, rabbis, imams, sextons, Christian Science readers, or members of a religious order
  • Executive officers (i.e. president, vice president, secretary, or treasurer) of an incorporated religious, charitable or educational institution
  • Teachers or other professionals working for a religious, charitable or educational institution
  • Volunteers in nonprofit organizations who don’t receive any compensation (compensation includes stipends, room and board or any other perks of monetary value)
  • Persons participating in and receiving rehabilitative services in a sheltered workshop run by a religious, charitable or educational institution under a US Department of Labor certificate
  • Recipients of aid from a religious or charitable institution who perform work for the institution in return for the aid
  • Golf caddies
  • Daytime students in an elementary or secondary school who work part-time
  • "Extra Employees" (so identified because they are normally not in the labor market but are hired to do work for a limited, special period of time; after 45 days, however, they become eligible)
  • "Casual Employees" (so called because they normally work in a different occupation and are hired for a day or less)

For coverage regulations regarding business owners see Are business owners covered under NY DBL?

You may elect to provide benefits to certain excluded employees by filing an "Application for Voluntary Coverage." See Can I provide voluntary DBL coverage for employees who would otherwise not be covered? for details.

Are our 1099ers eligible for DBL coverage?

True independent contractors and subcontractors are not considered employees under the NYS Disability Benefits Law and are therefore not covered under DBL. However, whether the labor is paid using a W2 or 1099 Form for tax purposes does not matter in determining an employer-employee relationship for DBL(Workers' Compensation Law) purposes.

Identifying an Independent Contractor (as explained on the Workers’ Comp Board’s website)

To be considered an independent contractor an individual must meet and maintain all 10 criteria:

  1. Have a FEIN (Federal Employer Identification Number) or have filed a self-employment income tax return;
  2. Maintain a separate business establishment;
  3. Perform work that is different from the primary work of the hiring business and perform work for other businesses;
  4. Operate under a specific contract, be responsible for satisfactory performance of work and be subject to profit or loss in performing the specific work under such contract, and be in a position to succeed or fail if the business's expenses exceed income;
  5. Obtain a liability insurance policy (and if appropriate, workers' compensation and disability benefits insurance policies) under its own legal business name and FEIN;
  6. Have recurring business liabilities and obligations;
  7. Have its own advertising such as commercials, phone book listing, or business cards;
  8. Provide all equipment and materials necessary to fulfill the contract;
  9. Control the time and manner in which the work is to be done; and
  10. Work under his/her own operating permit, contract or authority.
Industry-specific Notes:
Trucking Industry

Drivers are considered Independent Contractors if – in addition to the above conditions – they also transport goods under their own bill of lading and DOT Number.

Certain Licensed Insurance and Real Estate Agents

Licensed Insurance Agents/Brokers and Licensed Real Estate Brokers/Sales Associates are Independent Contractors if they:

  • have income based on sales and not on the number of hours worked;
  • receive a training allowance subsidy;
  • have a written contract outlining the services that they are to perform;
  • can choose the hours they work;
  • incur their own expenses for travel and entertainment (facilities and supplies may be provided by the agency/firm); and
  • are not treated as an employee for State and Federal tax purposes (other than FICA which is required for full-time life insurance agents). [WCL §201(5), 12 NYCRR §355.2]

Are business owners covered under NY DBL?

1. Owners/shareholders of Corporations (C-Corps, S-Corps, and Professional Corporations, for example) are considered employees of the corporation and are automatically covered under NY DBL at the same rates as other employees if they are:

  • 3 or more officers/shareholders
  • one or two officers (each owning at least one share of stock) with employee(s) (they may choose to exclude themselves from coverage by filing form DB-212.3 pdf icon).


2. Owners/shareholders of the following types of businesses are not considered employees and are therefore excluded from NY DBL coverage by default:

  • Partnerships, LLCs, LLPs (with or without employees)
  • Sole Proprietorships
  • Corporations with only one or two officers (each owning at least one share of stock) and no employee(s). (They may obtain coverage (at voluntary rates) by completing form DB-135 pdf icon (for non-contributory groups) or DB-136 pdf icon (for contributory groups).

Can I provide voluntary DBL coverage for employees who would otherwise not be covered?

Yes, based on WCL §212, you can provide voluntary coverage for compensated employees in New York by completing an application for voluntary coverage: form DB-135 pdf icon (for non-contributory groups) or DB-136 pdf icon (for contributory groups). If you are not a covered employer yet and the application gets approved, you become a covered employer.

If you provide voluntary coverage you must maintain it for at least one year. You can cover the following persons on a voluntary basis if they receive compensation:

  • A minor child of the employer
  • Farm workers
  • Domestic or personal workers in a private home who are employed for less than 40 hours/week by any one employer
  • Ministers, priests, rabbis, imams, sextons, Christian Science readers, or members of a religious order
  • Executive officers (i.e. president, vice president, secretary, or treasurer) of an incorporated religious, charitable or educational institution
  • Teachers or other professionals working for a religious, charitable or educational institution
  • Persons participating in and receiving rehabilitative services in a sheltered workshop run by a religious, charitable or educational institution under a US Department of Labor certificate
  • Recipients of charitable aid from a religious or charitable institution (if they perform work for the institution in return for the aid and are not under a contract of hire).
  • Someone performing services for a public authority or political subdivision (e.g., municipal corporation or fire district)

For voluntary coverage regulations regarding business owners, see Are business owners covered under NY DBL?

If you want to discontinue voluntary coverage, you must provide a written notice to the Chair of the Workers’ Comp Board and to the employees within 90 days before coverage will end. You must include provisions made for the payment of obligations incurred on and prior to the effective termination date.

Can I choose not to provide DBL as a “covered employer”?

No. DBL is mandatory insurance that you must provide for all your eligible employees. If you fail to put a policy in place, you may be subject to fines and other measures.

However, you may file a request with the WCB to exclude certain employees only under the following circumstances:

  • As the business owner, you may choose to exclude yourself: If your business is a corporation with no more than two corporate officers (each owning at least one share of stock) and you have at least one employee, you may elect to exclude yourself from coverage by completing form DB-212.3 pdf icon.
  • You may elect to exclude your spouse by filing a spousal exclusion form DB-212.5 pdf icon (12 NYCRR §355.2)
Are my employees who live outside New York and work in my New York-based office covered?
If they’re eligible, yes. Coverage is based on where an employee works, not where the employee lives.
Our business is located outside New York but some of our employees perform work in New York. Do we need DBL?
If you are an out-of-state employer, you need a DBL policy for your New York employees if you employ one or more individuals each for at least 30 days in a calendar year in New York State.
Who pays the DBL premiums?

Premiums can be paid entirely by the employer or jointly by employer and employee. An employee's share cannot be more than 1/2 of 1% of the first $120 of weekly wages, to a maximum of 60 cents per week for each employee.

Why should we choose the contributory option?

It has advantages both for you and your employees:

  1. With the money you save, enhanced benefits are more easily affordable
  2. Your employees will not get taxed on the percentage of their benefit equivalent to the percentage of the contribution of the rate.
What if an employee has multiple jobs?

The maximum weekly contribution remains 60 cents even if the employee has more than one job. In that case, the employee may request that each employer adjust contributions in proportion to earnings so that the total contribution does not exceed the maximum allowable 60 cents.

Can we increase the employee contribution proportionally if higher benefits are provided?

Pursuant to §211 of the Workers Compensation Law, an employer may be able to increase the employees’ contribution only by agreement and provided the contribution is reasonably related to the value of the benefits as determined by the Chairman of the Workers’ Comp Board. In other words, you have to have the approval of the Chair at the WCB.

If the DBL premium is paid jointly – what if the premium is lower than the maximum contribution?

An employer is never supposed to profit from providing NY State DBL to their employees. Therefore, the contribution you deduct should not exceed the premium. If an employee's contribution is equal to the premium, the benefit is 0% taxable.

When are my employees eligible to file for DBL benefits?
If they are
  1. an eligible employee suffering from a disability or illness due to an off-the-job injury; and
  2. under the care of a licensed or certified physician, podiatrist, psychologist, chiropractor, or nurse-midwife.
What about former employees who are now unemployed?

They may still file for DBL benefits: if their disability occurs within 4 weeks after their employment is terminated, benefits are paid by your insurance carrier. If they become disabled in the period between 4 and 26 weeks after termination, they receive benefits from the Special Fund for Disability Benefits, which is administered by the Workers' Compensation Board (see How do I apply for DBL benefits? for details).

Can they collect Disability and Unemployment Insurance benefits simultaneously?

No, they cannot collect Disability and Unemployment Insurance benefits for the same period of time.

What if the disability was caused by a car accident?

They may file for DBL benefits if the disability results from an automobile accident – although No-Fault automobile insurance benefits may be reduced by the amount of disability benefits they are eligible to receive.

What if they’re receiving Social Security Retirement benefits?

They are eligible to file for DBL benefits even if they are receiving (or are entitled to receive) retirement benefits under the Social Security Act. Under these circumstances, however, they may elect to waive their rights to DBL coverage by filing such a request with the Workers' Compensation Board.

What if my employee’s disability is caused by a pregnancy?

Your employee is eligible to file for DBL benefits if her disability is pregnancy-related (based on medical certification of disability). Please note the following guidelines for pregnancy-related disabilities:

  1. Pregnancy disabilities are treated the same as any other disability
  2. A health care practitioner – a medical doctor (MD) or a certified nurse midwife (RN-CNM) – must authorize the period of disability.
  3. Your employee’s health care practitioner may follow standard duration guidelines as listed below, to certify her disability period. Depending on individual circumstances, these timelines may vary.
  • 2 weeks before the expected delivery during an uncomplicated pregnancy
  • 6 weeks after uncomplicated pregnancy with a normal delivery.
  • 8 weeks after uncomplicated pregnancy with a C-Section.
Can my employee receive DBL benefits during her maternity leave?

Pregnancy disability is not maternity leave! Maternity leave itself is not covered under DBL. But a pregnancy-related disability that occurs during maternity leave is covered. If the employee becomes disabled while on unpaid maternity leave, she is eligible only within the 4-week period following her last day of employment. If her disability begins more than 4 weeks after the last day of her employment and she is claiming/receiving Unemployment Benefits, she is entitled to DBL benefits from the Special Fund for Disability Benefits (if otherwise eligible).

How are benefits calculated?

New York State sets the maximum benefit for statutory policies to $170/week. Statutory benefits are calculated as follows:

  • Your employees receive 50% of their average weekly wage (based on their last 8 weeks of employment, not counting the week in which the disability began – if its inclusion would lower your benefit rate) to a maximum benefit of $170 a week.
  • Benefits are payable for a maximum of 26 weeks of disability (during a period of 52 weeks or during any one period of disability).
  • The first 7 days of disability constitute a waiting period for which no benefits are paid. Benefits begin on the 8th day of consecutive disability.
  • Benefits are pro-rated based on the number of days you report as the days they work.

If you offer enhanced benefits, your employees receive benefits based on your disability benefits plan.

How are successive periods of disability handled?

If your employee returns to work and becomes disabled again within 3 months from the date of returning to work due to the same or a related condition, no waiting period applies. If the disability is due to a different condition or more than 90 days has passed, the waiting period is applicable!


Can we request reimbursement for DBL benefits due if the employee continues to receive salary while on disability?

Generally yes. If you continue an employee’s salary while the employee is out on disability, it is considered advancing the employee’s disability benefit. You have the right to request reimbursement for the DBL payment due. If the money you pay to a disabled employee is vacation pay, you cannot request reimbursement from the DBL carrier.

Under NY Workers’ Compensation Law, vacation and severance pay are not considered remuneration! Therefore, your employees may receive DBL benefits simultaneously with vacation or severance pay!

A note on DBL with in-hospital benefits:

Even if you continue your disabled employee’s wages, your employee is still eligible to receive the in-hospital portion of the benefits! (see our DBL product page for details about enhanced benefits). The in-hospital portion is also not taxable whether you have a contributory or noncontributory policy.

Are DBL payments considered "Sick Pay"?
Yes. And as such, payments must be reported to employers by third-party payers (such as insurance companies). Therefore, we provide you with quarterly and annual Third-Party Sick-Pay Reports. Please Note: Payments are subject to FICA (Social Security and Medicare) withholding (under Public Law 97-123). Only the portion of the DBL benefit attributable to the employee's contribution (up to 60 cents a week) is exempt from withholding.
When do we need which Certificate? What is each Certificate for?
  1. DB-120 (Posting Notice, “Blue Board” or DBL Poster): must be posted in a visible place at your work site.
  2. DB-120.1 (Certificate of Insurance): is needed to apply for/retain business permits and licenses.
  3. DB-820 (Certificate of Insurance): is filed by the carrier with the State to verify the status of a policy.
Are there any consequences if we don’t have a DBL policy as a covered employer?

If you don’t provide DBL coverage as required by law, the Workers’ Compensation Board may investigate and take action. Sole proprietors, partners of a partnership, as well as the President, Secretary and Treasurer of a corporation may be held personally liable for the failure to obtain a DBL policy.

Disability Benefits Law:
§220: Possible Penalties if you don’t comply with the DBL coverage requirements
  • §220(2): The Board has the right to impose a penalty based on the amount of the employer’s payroll during the time the employer does not have required DBL coverage (0.5% of payroll during that period). An additinoal fine for each period of noncompliance may also be imposed.
  • §220(1): If you do not have the reqruied DBL coverage, you may be subject to a monetary fine and/or imprisonment for up to 1 year. Subsequent violations may result in increased fines.
§213(1): Liability for claims
  • Additionally, you may be 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 payroll during the period of noncompliance (whichever is greater).

Please visit the Workers Comp Board’s website for details about possible fines.

Are there any specific compliance regulations for out-of-state businesses with DBL?
Obtaining Government-issued permits, licenses and contracts in New York :

If you are an out-of-state businesses requesting a permit/license or if you are seeking to enter into contracts In New York State, you must provide a DB-120.1 (Certificate of Insurance) to the government entity you are dealing with in.


FAQs from Employees/Claimants

 
What is DBL?

DBL stands for “Disability Benefits Law” (Article 9 of the New York Workers' Compensation Law). This statutory disability insurance is mandated by the State of New York. Virtually all employers have to provide DBL coverage for their employees; and the State sets the benefit level. While Workers' Comp regulates benefits for on-the-job injuries and work-related illnesses, DBL provides payments for eligible wage earners who cannot work due to an illness that was not caused by their job or a disability from a nonoccupational injury.

How do I know if I'm eligible for DBL coverage?

Generally, if you can be considered an employee and are eligible, your employer must cover you under DBL. This includes:

  • Employees, or recent employees of another covered employer, who have worked at least four consecutive weeks for one or both of the employers.
  • Part-time employees, i.e. persons who work fewer hours than constitute your employer’s normal workweek. (Any part of a day worked is counted as a day of employment, and you become eligible on the 25th day of such regular, part-time employment.)(see Who is not covered under DBL? for exceptions)
  • Personal or domestic employees working in a private home at least 40 hours a week (if you work 30 or more days in a calendar year for one employer).
  • Employed college students meeting any of the above requirements.
Who is considered a personal/domestic employee?

Chauffeurs, nannies, home health aides, nurses, babysitters, maids/live-in maids, cooks, housekeepers, laundry workers, butlers, companions, and gardeners who work in a private household (12 NYCRR §355.2). (Note: Your employer is not required to provide DBL if the only people who work in their private household are domestic workers who each work less than 40 hours per week and do not live on premises.)

The following persons, however, are excluded from DBL coverage:
  • A minor child of an employer
  • Government, railroad, maritime, and farm workers
  • Ministers, priests, rabbis, imams, sextons, Christian Science readers, or members of a religious order
  • Executive officers (i.e. president, vice president, secretary, or treasurer) of an incorporated religious, charitable or educational institution
  • Teachers or other professionals working for a religious, charitable or educational institution
  • Volunteers nonprofit organizations who don't receive any compensation (compensation includes stipends, room and board or any other perks of monetary value)
  • Persons participating in and receiving rehabilitative services in a sheltered workshop run by a religious, charitable or educational institution under a US Department of Labor certificate
  • Recipients of aid from a religious or charitable institution (if you perform work for the institution in return for the aid).
  • Golf caddies
  • Daytime students in an elementary or secondary school who work part-time
  • "Extra Employees" (so called because they are normally not in the labor market but are hired to do work for a limited, special period of time; after 45 days, however, they become eligible)
  • "Casual Employees" (so called because they normally work in a different occupation and are hired for a day or less)
I work on a 1099 basis. Am I eligible for DBL coverage?

True independent contractors and subcontractors are not considered employees under the NYS Disability Benefits Law and are therefore not covered under DBL. However, whether your labor is paid using a W2 or 1099 Form for tax purposes does not matter in determining an employer-employee relationship for DBL purposes.

Identifying an Independent Contractor (as per the Workers' Comp Board's website)

To be considered an independent contractor an individual must meet and maintain all 10 criteria: 

  • Have a FEIN (Federal Employer Identification Number) or file self-employment income tax return;
  • Maintain a separate business establishment;
  • Perform work that is different from the primary work of the hiring business and perform work for other businesses;
  • Operate under a specific contract, be responsible for satisfactory performance of work and be subject to profit or loss in performing the specific work under the contract, and be in a position to succeed or fail if the business's expenses exceed income;
  • Obtain a liability insurance policy (and if appropriate, Workers' Compensation and Disability Benefits insurance policies) under its own legal business name and Federal Employer Identification Number;
  • Have recurring business liabilities and obligations;
  • Have its own advertising such as commercials, listing in a phone book or business cards;
  • Provide all equipment and materials necessary to fulfill the contract;
  • Control the time and manner in which the work is to be done; and
  • The individual works under his/her own operating permit, contract or authority.
Industry-specific Notes:

Trucking Industry
Drivers are considered an Independent Contractor if – in addition to the above conditions – they also transport goods under their own bill of lading and DOT Number.

Certain Licensed Insurance and Real Estate Agents

Licensed Insurance Agents/Brokers and Licensed Real Estate Brokers/Sales Associates are Independent Contractors if you: 

  • have income based on sales and not on the number of hours worked;
  • receive a training allowance subsidy;
  • have a written contract outlining the services that you are to perform;
  • can choose the hours you work;
  • incur your own expenses for travel and entertainment (facilities and supplies may be provided by the agency/firm); and
  • are not treated as an employee for State and Federal tax purposes (other than FICA which is required for full-time life insurance agents). (WCL §201[5], 12 NYCRR §355.2)

How soon am I covered in my new job?

You are generally protected immediately (from the first day on the new job) if you

  1. move from one “covered employer” to another – as long as the gap in employment isn't more than 4 weeks; or
  2. become re-employed after receiving unemployment benefits (provided the prior employment was covered).

If your employer is not a “covered employer” yet and you don't meet the requirements for immediate coverage, your DBL protection becomes effective once your employer qualifies as a “covered employer”.

If you change to a job that is exempt employment environment or with a "non-covered" employer, and work there for more than 4 weeks, you lose protection until you work 4 consecutive weeks for a "covered" employer.

When am I eligible to file for DBL benefits?

If you are

  1. an eligible employee suffering from a disability or illness due to an off-the-job injury; and
  2. under the care of a licensed or certified physician, podiatrist, psychologist, chiropractor, or nurse-midwife.
What if my disability was caused by a car accident?

You may file for DBL benefits if your disability results from an automobile accident – although No-Fault automobile insurance benefits may be reduced by the amount of disability benefits you are eligible to receive.

What if I'm receiving Social Security Retirement benefits?

You are eligible to file for DBL benefits even if you are receiving (or are entitled to receive) retirement benefits under the Social Security Act. Under these circumstances, however, you may elect to waive your rights to DBL coverage by filing such a request with the Workers' Compensation Board.

What if I'm unemployed?

You may file for DBL benefits if you are unemployed if you are eligible for and are claiming unemployment insurance benefits.

  • If your disability occurs within 4 weeks after your employment is terminated, benefits are paid by your former employer's insurance carrier.
  • If you become disabled in the period between 4 and 26 weeks after termination, you receive benefits from the Special Fund for Disability Benefits, which is administered by the Workers' Compensation Board (see How do I apply for DBL benefits? for details).
  • Please note, however, that you cannot collect Disability and Unemployment Insurance benefits at the same time.
What if my disability is caused by a pregnancy?

You are eligible to file for DBL benefits if your disability is pregnancy-related (based on medical certification of disability). Please note the following guidelines for pregnancy-related disabilities:

  • Pregnancy disabilities are treated the same as any other disability.
  • Your health care practitioner – a medical doctor (MD) or a certified nurse midwife (RN-CNM) – must authorize the period of disability.
  • Duration guidelines (in accordance with the American College of Obstetrics and Gynecology):
  • 2 weeks before the expected delivery during an uncomplicated pregnancy
  • 6 weeks after uncomplicated pregnancy with a normal delivery.
  • 8 weeks after uncomplicated pregnancy with a C-Section.
Will I receive DBL benefits during my maternity leave?

Pregnancy disability is not maternity leave!  Maternity leave itself is not covered under DBL. But a pregnancy-related disability that occurs during your maternity leave is covered. If you become disabled while on unpaid maternity leave, you are eligible only within the 4-week period following your last day of employment. If your disability begins more than 4 weeks after the last day of your employment and you are claiming/receiving Unemployment Benefits, you are entitled to DBL benefits from the Special Fund for Disability Benefits (if otherwise eligible).

How do I apply for DBL benefits?

If your disability begins while you are employed (or within 4 weeks of termination), you should file your completed DB-450 Statement with your insurance carrier within 30 days.

  • Obtain Form DB-450 pdf icon (Notice of and Proof of Claim for Disability Benefits) from your employer, insurance carrier, or the Workers' Compensation Board.
  • Also obtain your Statement of Rights (Form DB-271S pdf icon).
  • Complete and sign Part A (Claimant's Statement).
  • Your attending health care provider must certify that your disability or illness prevents you from working by completing and signing Part B (Health Care Provider's Statement).
  • Your employer must fill out Part C (Employer's Statement).
What if I just lost my job? Can I still file for DBL benefits?

Yes. Generally, as an eligible employee you don't lose protection during the first 26 weeks of unemployment (provided you are eligible for and are claiming unemployment insurance benefits). See What if I'm unemployed? for details.

What if my disability begins more than 4 weeks after termination?

File a completed claim Form DB-450 pdf icon with the Workers' Compensation Board:
Workers' Compensation Board
Special Fund for Disability Benefits
Disability Benefits Bureau
328 State Street
Schenectady, NY 12305

I missed the 30-day deadline to file my claim. What happens now?

In accordance with New York State DBL regulations, if your claim is filed late, benefits will be denied for any period of disability prior to 2 weeks before it was filed unless you can demonstrate that it was impossible to file sooner. And if your claim is filed later than 26 weeks after your disability began, you will be denied benefits. (Exception: Minors, mentally or physically incompetent people with no guardian may have a longer period in which to file a claim.)

Can I appeal a rejected claim?

If your claim is rejected by your insurance carrier and you are a New York employee, you may file directly with the Workers' Compensation Board within 26 weeks of receiving the notice of denial of benefits. The board will examine the case and may order a hearing to consider your eligibility.

How much will I get? How are my benefits calculated?

New York State sets the maximum benefit for statutory policies. Statutory benefits are calculated as follows:

  • You receive 50% of your average weekly wage to a maximum benefit of $170 a week (your average weekly wage is based on your last 8 weeks of employment, not counting the week in which the disability began – if its inclusion would lower your benefit rate).
  • Benefits are payable for a maximum of 26 weeks of disability (during any period of 52 weeks or during any one period of disability).
  • The first 7 days of disability constitute a waiting period for which no benefits are paid. Benefits begin on the 8th consecutive day of disability.
  • Benefits are pro-rated based on the number of days your employer reports as the days you work.

If your employer offers enhanced benefits, you receive benefits based on your employer's disability benefits plan.

What if I become disabled again?

If you return to work and become disabled again within 3 months from the date of returning to work due to the same or a related condition, no waiting period applies. If the disability is due to a different condition or more than 90 days has passed, the waiting period is applicable!

After my claim is filed, how soon and how often will it be paid?
DBL regulations require (if your claim is properly completed with all required statements) that your first payment should arrive within 4 business days after either the 14th day of disability or the receipt of the claim, whichever is later. Thereafter, benefits are payable every 2 weeks during the period of disability.
I can't afford to live on DBL benefits alone. Can I work a little bit from home while receiving DBL benefits?
Once you are performing any kind of work for income or profit, whether from home or not, you are no longer eligible to receive benefits.
Are the costs of medical care included in my benefits?
No, DBL provides cash payments only to compensate for a portion of the wages you are losing out on.
Are you allowed to have me examined when I'm filing for DBL benefits?
Yes, you must submit yourself to examinations by a health care provider of our or your employer's choice when requested. We cannot ask for exams more than once a week. You don't have to pay for those exams and are held at a reasonable time and place. Refusing to participate in an exam may jeopardize your benefits.

This online information is illustrative only, providing a general overview of the services described. It is not a contract. Please refer to the policy for provisions, conditions, and exclusions. No guarantee is made concerning the accuracy and completeness of the representations of the law made in this section. For legally binding information, please refer to the corresponding section of the Workers' Compensation Law, the “Employer Handbook” published by the Workers' Compensation Board. Download the PDF here (pdf icon) or visit the Board's website. DBL FAQs ©ShelterPoint.