NYS Short Term Disability for Maternity Leave: Everything You Need to Know
New York State's maternity and family-related medical leave regulations are going to all change drastically come 2018.9 min read
New York Short-Term Disability for Maternity Leave
New York State's maternity and family-related medical leave regulations are going to all change drastically come 2018; however, for the rest of 2017, any parents will have to cope with fewer entitlements while welcoming a newborn child or healing from extended complications during pregnancy.
New York uses a mixture of statutory judgments and federal guidelines that affect all parents differently. It all depends on where they're employed and the reasons why they have to discontinue work.
Starting in 2018, an employee will be able to receive some payment during maternity or parental leave if he/she is a NY state employee. Until 2018, if a person is employed in New York, he/she will not receive paid parental or maternity leave benefits from the state government for bonding purposes after the birth of a child.
New York state gets a "B" grade from the National Partnership for Women and Families when it comes to how favorable the state laws for new and expecting parents are compared to other American states.
Maternity Leave – How Much Pay and For How Long?
New York State has five different benefit programs that can potentially offer maternity-related leave pay to new parents. Claim amounts and duration of the benefits hinge upon the reasons given with a valid claim, as well as the timing.
Employees may apply for a maternity leave loan to help pay the normal bills while bonding with a newborn at home. Since this is a work-disability payment, the duration of the benefits depends on the medical provider's assessment of how long the employee will not be able to work. The current maximum disability payment an employee can receive is 50 percent of the last eight weeks' average gross wages, up to a maximum of $170 per week.
The first week an employee is unable to work and is unpaid would be considered a waiting period. After this waiting period, the employee may receive benefits as long as the form DB-450 is filed in a timely fashion. The maximum benefit anyone can receive under NY state disability benefits is 26 weeks in any 52-week period.
New York State has a temporary disability insurance program requiring employers to provide short-term disability insurance for employees. This also serves as the primary regulation regarding maternity leave pay. The NYS short-term disability program offers income replacement to assist with the mother's health conditions. Women can use this benefit when recovering from the stress of childbirth or experiencing pregnancy complications. Complications with pregnancy are often considered a covered medical condition.
While childbirth may not be considered a "disability" to most, the term is used for insurance purposes to define a woman's pregnancy and post-partum medical condition as it relates to a woman's ability to work.
Employers are required to provide at least partial wage and income replacement, for a maximum of 26 weeks, to eligible employees who temporarily cannot work due to disability. The weekly amount would be 50 percent of the individual's pay or $170, whichever amount is lower, and the standard length of a claim for regular vaginal childbirth ranges from eight to 12 weeks. Delivery via a C-section may extend the benefits for two more weeks.
Other common reasons for employees to ask for short-term disability leave in NY are injuries (work-related or not) or illness that prevents an employee from being able to participate in full-time work.
Under state law, private sector employers (not government entities) are required to provide disability insurance benefits for their workers to cover any time they are unable to work due to illnesses or other reasons. These other reasons cannot include injuries or illnesses that are work-related, as those are instead covered under workers' compensation insurance.
Short-term disability insurance benefits require a medical provider to give a written determination that an employee is unable to work due to his/her condition. Both the employer and the attending doctor need to sign this claim application form.
An employee who becomes disabled more than four to six weeks prior to giving birth or who continues to be unable to work more than four to six weeks after giving birth may have to submit additional medical documentation to support her claim.
Paid Family Leave
While the New York State Paid Family Leave Act (PFL) did pass back in April 2016, parents will not become eligible until January 2018. With the Paid Family Leave Act, both of the parents will qualify to use this benefit so they can bond with a new child within the first year of their life or within the first year after an adopted or foster child has been placed in the home. A mother is unable to apply for this entitlement for any pregnancy-related conditions.
The entitlement amount is calculated by multiplying the number of weeks with the state average for weekly income. The highest for 2016 was $1,296.
Private short-term disability is another paid maternity leave option in NYS. Under this benefit, the employee can buy a maximum of 66 percent of a full income replacement, which tops out at a weekly $1,500. A mother must buy this supplementary policy through her employer before conception. Both the employer and one's doctor need to sign this claim application form.
New York State's laws regarding unemployment compensation will sometimes permit parental leave pay. Any parents who leave their job because of a "compelling family reason" might qualify. NYS defines a compelling family reason to include an illness or a disability of an immediate family member. Thus, this may be applicable to any currently employed male who must care for a spouse during complications from pregnancy.
Additionally, either parent may qualify after a newborn child has to spend time in the neonatal intensive care unit (NICU) or falls victim to a major medical condition once discharged from the hospital.
Eligibility for unemployment also includes another factor, which is that the claimant has to be able to perform work and is actively looking for employment.
Ney York's state policy regarding paid sick time offers rather restricted maternity leave pay. Back in 2013, New York passed a decree that requires employees receive paid sick time while employed by private sector companies.
The degree of one's entitlements is contingent on the amount of company employees.
- For less than five employees, employer must provide five unpaid days per year.
- For employers with six to 19 employees, employer must provide five paid days per year.
- For employers with 20+ employees, employer must provide nine paid days per year.
Government personnel do not receive coverage.
Applicable Family Leave Acts
There exist two distinct laws that apply to family leave in New York State: the Family Medical Leave Act (FMLA) the and Paid Family Leave Act (PFL). They are meant to offer employment protections and continuing health care access for parents. The statutory regulations will only go in effect in 2018, so new parents can rely on only the federal regulations until then.
Federal Family Medical Leave Act
The federal FMLA offers 12 weeks of job-protected time off from work for an employee's personal health complaint, to care for an ill family member, or to bond with a new baby. Employers that fall under this act's purview are one that employ 50 or more workers within 75 miles of the affected individual. There are eligibility criteria, such as hours worked.
If a woman is pregnant and has worked at one place for at least 12 months (and for at least 1,250 hours during that year), the employer is required to guarantee her job for at least 12 weeks from the time she gives birth, under the federal FMLA. Employees are entitled to six weeks of unpaid maternity leave, which runs concurrently with the 12 weeks they're entitled to under the FMLA.
The federal FMLA also applies to teachers employed by private, nonprofit, and public schools with more than 50 workers within a 75-mile radius.
The Pregnancy Discrimination Act bans workplace discrimination regarding pregnancy, childbirth, or any related medical complaint, while the American with Disabilities Act deals with accommodations that are or are not provided by employers when complications develop.
NYS Paid Family Leave Act
The PFL comes into effect in January 2018. Parents who have to stop work at this point will see several advantages over the federal act.
Employees will qualify for 50 to 67 percent of the average worker's weekly wages, depending on which year they're taking their paid time off. Also, more workers will qualify, as there is no criteria regarding hours worked or employer size.
New York State laws also make fathers eligible to take paternity leave under the federal FMLA during 2017 and beyond. In addition, a father is allowed to claim unemployment benefits if he leaves his job in order to take care of a deeply ill partner and/or baby. Starting in 2018, fathers will become eligible under the PFL.
It's important to note that fathers cannot claim disability benefits in this case because they remain physically able to work.
State maternity leave laws are murky when dealing with small businesses. It hinges on the company's size and the statute in question. The state's disability program, unemployment compensation, and the pending PFL benefits do not have any specific criteria for eligibility based on company size. The New York policy on paid sick time, however, has rules regarding companies of any size.
State maternity leave laws and the state disability program will be applicable to teachers some of the time, but the rules are different for instructors in private vs. public schools.
Generally speaking, nonprofit schools and public schools (which hire government employees) would be exempt from requiring coverage, but private, for-profit schools are bound by this requirement.
Public school instructors are able to use their Cumulative Absence Reserve (CAR), and United Federation of Teachers union members can make use of a provisional disability policy that would cover regular childbirth.
As of 2016, benefits top off at $475 per week.
Commuters Coming From the Other States
State labor laws covering maternity leave are relevant to employees based on their location of employment instead of which state in which they live. If a person commutes from outside of the state in order to work within New York, then these laws apply to that person. Meanwhile, their home state's rules don't have any jurisdiction.
State Government Employees
Workers in the civil services who are employed by a New York State government agency receive a restricted set of maternity-leave entitlements. The state's disability program does exempt government workers; however, the eligibility criteria for workers' compensation do include government employees. Thus, they can use unemployment compensation as well as the upcoming PFL.
Who Is Covered by Short-Term Disability in New York State?
A wide majority of private-sector employees are covered in the state. There is an itemized list of exempted employers on the New York State disability website (such as priests, rabbis, farm workers, sole proprietors, etc.) but due to the fact that the exceptions are very specific, it is likely that most private sector employees have coverage under this stipulation.
How Do You File a Claim for NYS Disability Wages?
Disability payment claims must be requested using a DB-450 form, which can be requested from the employer. The claim form requires that a medical provider include a diagnosis and an estimated date upon which the person will once again be able to work.
A person may not preemptively file a disability claim because she anticipates she would not be able to work due to childbirth or pregnancy conditions. Likewise, a person cannot file for disability claim payments until he/she is genuinely unable to work.
If the insurance carrier or the employer (if self-insured) decides that an employee's claim is not covered, the employee must be notified within 45 days. If the claim is denied, the employee has the right to a review by the New York Workers' Compensation Board (which oversees the state's short-term disability program).
Which Employers Must Provide Insurance?
An employer that has had at least one employee in each of 30 days in a single calendar year must provide insurance. Note that these 30 days to not need to be consecutive. State law requires employers to provide coverage. This can be done by either purchasing insurance from either a private carrier or the state or by self-insuring. Once these 30 days have passed, the employer must give coverage four weeks later.
An employer that uses domestic or personal employees, even in a private home, who work 40+ hours a week for that employer must provide health benefits. Also, an employer that is a successor for a covered employer must provide benefits immediately.
An employer is also allowed to choose to provide coverage by filing an Application for Voluntary Coverage. Employers are allowed to collect a small amount from employees to assist with funding their insurance obligation, although this can't go over 60 cents per week. They don't need to require employee contributions.
Who Is Covered?
To summarize, an employee is eligible for coverage if he or she suffers an off-the-job illness, injury, or other disabling event (which includes pregnancy) and one of the following conditions applies to that employee:
- Has been employed by a covered employer for a minimum of four weeks.
- Works for a successor of a covered employer.
- Works as a domestic or personal employee who works 40+ hours per week for a single employer.
- Works for an employer who has voluntarily chosen to provide such coverage.
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