How Does Short-Term Disability Work In NY?

In New York, short-term disability insurance (STD) provides financial support to employees who are unable to work due to a non-work-related illness or injury. The coverage is typically provided through private insurance policies purchased by the employer or the employee, but it can also be provided by the state through the New York State Disability Benefits Law (DBL).

Eligibility for STD benefits in New York typically requires that the employee has been employed by the company for a certain period of time, usually around 26 weeks and that the employee has earned a minimum amount of wages during that time. The employee must also be under the care of a licensed healthcare provider and be unable to perform the duties of their job due to illness or injury.

Once an employee is determined to be eligible for STD benefits, they will typically receive a percentage of their average weekly wage, up to a maximum amount set by the policy or state law. In New York, the maximum weekly benefit amount under the DBL is currently $170.

Duration Of Short-Term Disability

The duration of STD benefits also varies depending on the policy or state law. Under the DBL, benefits can be paid for up to 26 weeks. Some private policies may provide longer periods of coverage.

Employees are typically required to provide proof of their illness or injury and their inability to work, such as a doctor’s note or other medical documentation. They may also be required to provide updates on their condition and their ability to return to work.

Employers are typically responsible for providing employees with information about their STD coverage, including the process for applying for benefits and the terms of the coverage. They may also be responsible for providing employees with the necessary forms and documentation to apply for benefits.

It is important to note that STD benefits are separate from workers’ compensation benefits, which are provided to employees who are unable to work due to a work-related illness or injury. In New York, employees are typically not eligible for both STD and workers’ compensation benefits at the same time.

Employees who are covered by a group disability insurance policy through their employer or who have purchased an individual policy may be eligible for benefits under their policy regardless of the cause of their disability. However, it is important to check the terms of the policy, as some policies may have exclusions for certain types of illnesses or injuries.

How To File For Short-Term Disability In NY?

Filing for short-term disability (STD) in New York can vary depending on whether the coverage is provided through a private insurance policy or through the state’s Disability Benefits Law (DBL).

If your coverage is through a private insurance policy:

1. Review your policy: Make sure you understand the terms and conditions of your policy, including the waiting period, the maximum benefit period, and the percentage of your average weekly wage that will be covered.
2. Notify your employer: Inform your employer of your illness or injury and your intention to file for STD benefits. Your employer may have specific procedures that need to be followed.
3. Obtain a certification from your healthcare provider: Your healthcare provider will need to certify that you are unable to perform the duties of your job due to your illness or injury. Your insurance company may have specific forms that need to be completed.
4. Submit your claim: Submit your claim to the insurance company along with the certification from your healthcare provider, any required forms, and any other documentation the insurance company requests.
5. Monitor your claim: Keep track of the status of your claim and follow up with the insurance company if you have any questions or concerns.

If your coverage is through the DBL:

1. Determine your eligibility: Make sure you meet the eligibility criteria for DBL benefits, which include being employed for a certain period of time, earning a minimum amount of wages, and being under the care of a licensed healthcare provider.
2. Notify your employer: Inform your employer of your illness or injury and your intention to file for DBL benefits. Your employer may have specific procedures that need to be followed.
3. Obtain a certification from your healthcare provider: Your healthcare provider will need to certify that you are unable to perform the duties of your job due to your illness or injury. The New York State Workers’ Compensation Board (WCB) may have specific forms that need to be completed.
4. Submit your claim: Submit your claim to the WCB along with the certification from your healthcare provider, any required forms, and any other documentation the WCB requests.
5. Monitor your claim: Keep track of the status of your claim and follow up with the WCB if you have any questions or concerns.

It is important to note that the process for filing a claim may vary depending on your employer, insurance carrier, or state agency. Make sure to contact them for specific instructions.

Also, it is important to keep in mind that you may be required to provide additional documentation or information throughout the claims process and that the insurance company or the state agency may periodically review your eligibility for benefits.

Additionally, it is recommended to keep detailed records of all communication, including any forms, letters or emails exchanged, with the insurance company or the state agency, as well as any medical documentation related to your illness or injury.

Lastly, if you are denied benefits or disagree with the decision regarding your claim, you have the right to appeal the decision. The insurance company or the state agency will provide you with information on the appeals process. It is advisable to seek the assistance of an attorney or advocate if you decide to appeal.

In conclusion, Filing for short-term disability in New York can vary depending on whether the coverage is provided through a private insurance policy or through the state’s Disability Benefits Law. The process of filing a claim usually requires providing proof of the employee’s illness or injury and the inability to work, submitting claim forms and other required documentation, and monitoring the status of the claim. It’s important to be aware of the terms and conditions of your policy or the state’s laws, to follow the instructions.