Frequently Asked Questions (DBL)

What is DBL?

When does my business have to provide DBL coverage?

When can I be covered as an employee?

Who is not eligible for DBL?

Who pays the DBL premiums?

When am I eligible to file for DBL benefits?

How do I apply for DBL benefits?

How are my benefits determined?

Are DBL payments considered "Sick Pay"?

When do we need which Certificate?

What is DBL?

On April 13, 1949, Governor Thomas E. Dewey signed the Mailler-Condon Bill which, upon his signature, became Article IX of the Workers' Compensation Law, also known as the Disability Benefits Law (DBL). While Workers' Comp mandates benefits for on-the-job injury and work-related illness, DBL provides payments for eligible wage earners who are incapacitated by illness or disability from a nonoccupational injury. Currently, only five other U.S. states and territories have mandatory disability insurance programs in place: New Jersey, California, Hawaii, Rhode Island, and Puerto Rico.

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When does my business have to provide DBL coverage?

1. If you employ one or more persons for at least 30 workdays in a calendar year.
2. If your employee is a domestic helper who works at least 40 hours in a week in your private home.
3. If you are a sole proprietor or partnership and your only employee is your spouse. (In this case, you may elect to exclude your spouse and may do so by notifying the Workers' Compensation Board.)

Can I choose not to provide DBL coverage?

Yes, but only if your corporation has

1. no more than two corporate officers who are the sole shareholders and who elect to exclude themselves from coverage by completing Form <DB-212.3> and
2. no other employees

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When can I be covered as an employee?

1. You have worked for a covered employer for at least four consecutive weeks.
2. You are a part-time employee, i.e. a person who works fewer hours than constitute your employer's normal work week. 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.
3. You are a personal or domestic employee who works for the same employer in a private home at least 40 hours a week.
4. You are an employed college student who meets any of the above requirements.
5. You are a corporate officer who is an employee (unless you are only nominally an officer or receive no wages or remuneration for your services).

You are eligible immediately if . . .

1. You become reemployed after receiving unemployment benefits, provided your prior employment was covered; or
2. You move from one covered employer to another - as long as the gap in employment isn't more than four weeks.

Are business owners covered under NY DBL?

1. Owners/ shareholders of Corporations (C- corps, S-corps, Professional Corporations) are automatically covered (at the same DBL rates as other employees) under the following circumstances:
   • 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>.
2. Owners/shareholders of the following types of businesses are excluded from DBL coverage by default:
   • Sole Proprietorships,
   • Partnerships, LLCs/LLPs (with or without employees),
   • Corporations with only one or two officers (each owning at least one share of stock) and no employees

   They may voluntarily obtain coverage (at proprietor/partner rates) by completing form <DB-135> (for non-contributory groups) or <DB-136> (for contributory groups).

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Who is not eligible for DBL?

1. A minor child of an employer
2. Government, railroad, or maritime workers
3. Ministers, priests, rabbis, imams, sextons, Christian Science readers, or members of a religious order
4. Teachers or other professionals working for nonprofit religious, charitable or educational institutions; and people receiving rehabilitative services in a sheltered workshop run by such institutions under a U.S. Department of Labor certificate
5. Someone receiving aid in exchange for work from religious, charitable or educational institutions
6. Golf caddies
7. Daytime students in elementary or secondary school who work part-time
8. A corporate director who is not an employee
9. A proprietor or partner without any employees
10. An executive officer (i.e. president, vice president, secretary, or treasurer) of an incorporated nonprofit religious, charitable or educational institution
11. "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)
12. "Casual Employees" (so called because they normally work in a different occupation and are hired for a day or less)
    Note: An employer may elect to provide benefits to an excluded class of employees by filing an "Application for Voluntary Coverage" with the Workers' Compensation Board. Upon approval, the employer should notify the insurance carrier.
13. Independent contractors

A note on independent contractors:
IRS guidelines about the degree of control an employer has over workers may help classify a worker as independent contractor or employee. The more control, the likelier workers are employees):

• Instructions are given on when/where/how to work
• Training is required
• Services required are an integral part of the business
• Services are rendered personally
• Continuing relationship between employer and independent contractor
• Work hours are set
• Full-time hours of work required
• All work is done on employer’s premises.
• Regular reports are required
• Payment by time vs. lump sum
• Business and/or travel expenses are paid for by employer
• Tools and materials are provided by employer

The DBL Bureau of the Workers’ Comp. Board can be contacted for interpretations of the law upon request.

Source: M.L. Stump and H. Sprohge: “Independent Contractor or not”, in: Journal of Accountancy, Jan. 2004, pp.89-95

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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.

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 adjusts contributions in proportion to earnings so that the total contribution does not exceed the maximum.

Can an employer increase the employee contribution proportionally if higher benefits are provided?
Pursuant to Section 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, the Policyholder has 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 they deduct should not exceed the premium. If an employee's contribution is equal to the premium, the benefit is 0% taxable.

A policyholder is always responsible to tell their DBL carrier the percentage to tax their employees. The actual IRS regulation indicates an employer is supposed to use 3 years premium over 3 years contributions.

See IRS publication 15A for details about Third-Party Sick Pay.

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When am I eligible to file for DBL benefits?

1. You are an eligible employee suffering from a disability or illness due to an off-the-job injury.
2. You are under the care of a licensed or certified physician, podiatrist, psychologist, chiropractor, or nurse-midwife.

You are even eligible to apply for benefits if . . .

1. You have a disability resulting from an automobile accident - although No-Fault automobile insurance benefits may be reduced by the amount of disability benefits you are eligible to receive.
2. 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.
3. You are unemployed - although you cannot collect Disability and Unemployment Insurance benefits simultaneously. Provided your disability occurs within four weeks after your employment is terminated, benefits begin on the eighth consecutive day of disability and are paid by your former employer's insurance carrier. Workers who become disabled in the period between 4 and 26 weeks after termination receive benefits from the first day of total disability; such benefits are paid by the Special Fund for Disability Benefits, also administered by the Workers' Compensation Board.
4. Your disability is pregnancy related (based on medical certification of disability). If, however, you become disabled while on unpaid maternity leave, you are eligible only within the four-week period following your last day of employment.

Guidelines for Pregnancy-related Disabilities:

1. Pregnancy disabilities are treated the same as any other disability.
2. Your health care practitioner, a medical doctor (MD) or certified nurse midwife (RN-CNM), must authorize the period of disability.
3. 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
4. Pregnancy disability is not maternity leave!

How are successive periods of disability handled?
If you return 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, the waiting period is applicable!

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How do I apply for DBL benefits?

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

1. Obtain Form DB-450 (Notice of and Proof of Claim for Disability Benefits) from your employer, insurance carrier, or the Workers' Compensation Board.
2. Also obtain your Statement of Rights ( <Form DB-271S>)..
3. Complete and sign Part A (Claimant's Statement).
4. 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).
5. Your employer must fill out Part C (Employer’s Statement).

What if my disability begins more than four weeks after termination?
You may file a completed claim Form DB-450 with the Workers' Compensation Board:

Workers' Compensation Board
Disability Benefits Bureau
PO Box 9029
Endicott, NY 13761-9029

A note on filing late:
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 and mentally incompetent people with no guardian or committee)

Can I appeal a rejected claim?
If your claim is rejected by your insurance carrier, 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.

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How are my benefits determined?

You receive benefits based on your employer's Disability Benefits Plan. Statutory Benefits are calculated as follows:

• You will receive 50% of your average weekly wage, based on your last eight weeks of employment, not counting the week in which the disability began (if its inclusion would lower your benefit rate).
• The maximum benefit allowance is $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 8^th day of consecutive disability.
• Benefits are pro-rated based on the number of days the employer reports as the days the employee works.

What effect does continued remuneration have on DBL benefits?
If an employer continues an employee’s salary while on disability, it is considered advancing the employee’s disability benefit. An employer has the right to request reimbursement for the DBL payment due. If the remuneration paid to a disabled employee is vacation pay, the employer cannot request reimbursement
NYS DBL is under the purview of the Workers’ Compensation Law, and as such, vacation and severance pay are not considered remuneration!
Therefore, you may receive NYS DBL benefits simultaneously with vacation or severance pay!

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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.

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When do we need which Certificate?

1. Posting Notice (also known as “Blue Board” or DBL Poster) must be posted in a visible place at your work site.
2. The DB-820 Certificate of Insurance is filed by the carrier with the State to verify the status of a policy.
3. You’ll need the DB-120.1 Certificate of Insurance to apply for/retain business permits and licenses.

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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 on this FAQ page. For legally binding information, please refer to the corresponding section of the Workers' Compensation Law. © ShelterPoint 1999-2008. All rights reserved. No reproduction, partial or complete, digital or printed, is allowed without prior written consent by ShelterPoint.