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The DB-120.1 form is a Certificate of Insurance Coverage required under the New York State Disability Benefits Law, which proves that a business has secured disability benefits insurance for its employees. It must be completed by a licensed NYS insurance carrier or agent and is necessary before issuing permits or entering contracts for work. Employers in New York with employees working over 30 days in a calendar year must provide this coverage for off-the-job injuries or illnesses.

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How is NY DBL funded?

NY DBL: The maximum employee contribution is 0.5% up to a cap of $0.60 weekly, which matches the states employee contribution requirement. MetLife plans are individually underwritten, and employers fund the balance of the cost if there is any.

What does New York State disability cover?

The Disability Benefits Law (Article 9 of the WCL) provides weekly cash benefits to replace, in part, wages lost due to injuries or illnesses that do not arise out of or in the course of employment (WCL 204).

What benefits are available under the NY state disability law?

Disability benefits are cash-only benefits. The benefit: is 50 percent of your average weekly wage for the last eight weeks worked. cannot be more than the maximum benefit allowed, currently $170 per week (WCL 204).

What counts for disability pay?

You cannot do work at the substantial gainful activity (SGA) level because of your medical condition. You cannot do work you did previously or adjust to other work because of your medical condition. Your condition has lasted or is expected to last for at least 1 year (12 consecutive months) or to result in death.