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What Illnesses/Injuries Are Covered By NY Disability Benefits Insurance?

What Illnesses/Injuries Are Covered By NY Disability Benefits Insurance?

New York employers are required to offer disability benefits coverage to employees injured out of the job. Employers can obtain this coverage for their employees through an insurance carrier approved by the state’s Worker’s Compensation Board or, if they are large employers, they can seek self-insurance authorization from the same Board. Seeking disability benefits can often be an uphill battle that is best fought with the help of an experienced disability insurance lawyer.

How does disability benefits insurance cover work?

Disability benefits are cash benefits offered by an insurer or an employer to an employee injured while out of the job. The cash benefits are offered weekly for illnesses or injuries not arising from employment. The payouts are meant to replace lost wages or earnings that an employee would have received had he/she not been injured.

The benefits are paid for only 26 weeks in a 52-week consecutive period as long as the employee is continuously disabled during that period and does not engage in an income-generating activity. The cash payouts usually amount to half of the employee’s median weekly earnings but up to a maximum of $170 per week.

An employee who has been injured out of work can file for disability benefits with his/her employer as soon as possible, within 30 days of being disabled.

What is covered by disability benefits insurance?

Any illness or injury sustained outside work is covered. These include:

  • Serious diseases such as malaria
  • Debilitating medical conditions
  • Car accident injuries
  • Severe slip and fall injuries
  • Fractures and broken bones
  • Injuries that are disabling or disfiguring
  • Pregnancy and pregnancy-related injuries

What is not covered?

Disability benefits do not cover:

  • Medical care. However, some approved employers’ plans do include medical care even though it is not statutorily required.
  • Injuries sustained in the course of committing a crime such as driving under the influence or robbery
  • Injuries sustained while engaging in an act of war such as assault.

When does an employee stop receiving disability benefits?

An employee will not be eligible to receive disability benefits when:

  • He/she performs work that is remunerative even if done at home while disabled
  • He/she undergoes a medical examination that confirms recovery from injury or illness. Many employers require employees to submit to medical examinations periodically while receiving disability benefits. These examinations should be conducted at a reasonable place and time. Refusing to do an examination will jeopardize a claim for benefits
  • The 26-week benefits period has lapsed

What is if an employer refuses or rejects a claim for disability benefits?

Disability can only be confirmed by a licensed physician through medical reports. If an employee’s claim for disability benefits is rejected by an insurer/employer or if an employee, without getting a Notice of Rejection, has not received 26 weeks’ worth of disability benefits, he/she can submit medical reports supporting his/her claim to the employer/insurer or Special Fund for Disability Benefits.

If the employee receives a notice of rejection, he/she can appeal to the state’s Workers’ Compensation Board.

Because the whole process can be overwhelming, especially since the employee is still recovering from illness or injury, having legal counsel will lighten the load.

Contact the New York disability benefits attorneys at Seelig Law Offices, LLC to help you file for or defend your rights to disability benefits. Let them do the heavy lifting so that you can concentrate on recovery.

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