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

DBL FAQs

 
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.