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Clear Form HARTFORD LIFE INSURANCE COMPANY HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY APPLICATION FOR SHORT TERM DISABILITY INCOME BENEFITS This application package is divided into four sections,.

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Employees taking Paid Family Leave receive 67% of their average weekly wage, up to a cap of 67% of the current New York State Average Weekly Wage (NYSAWW). For 2023, the NYSAWW is $1,688.19, which means the maximum weekly benefit is $1,131.08.

These forms can be obtained on the NYSIF website, from your local Workers' Compensation Board, or by calling 800-353-3092. Completed DB-300 forms should be sent to: NYS Workers' Compensation Board – Disability Benefits; 100 Broadway; Menands/Albany, NY 12241.

DBL: Employee contribution (payroll deduction) of 0.5% of taxable wages up to a maximum of $0.60/week. Employer funds balance of plan cost. PFL: Employee contribution (payroll deduction): 100% employee-paid at 0.455% of pay up to a maximum of $399.43.

Disability benefits are temporary cash benefits paid to an eligible employee, when they are disabled by an off-the-job injury or illness. Disability benefits are equal to 50 percent of the employee's average weekly wage for the last eight weeks worked, with a maximum benefit of $170 per week (WCL §204).

An employee's contribution is computed at the rate of one-half of one percent of their wages, but no more than sixty cents a week. WCL Section 218 of the DBL specifically states that any agreement by an employee to waive their right to disability benefits shall be void.

Who Pays the Premiums for Disability Insurance? Disability (DBL) premiums may be paid entirely by the employer. The employee is permitted but not required to contribute to the cost. The employee may not contribute more than one half of one percent of the first $120 of weekly wages, to a maximum of $.

There is a 7-day waiting period during which no benefits are paid. Benefits begin on the eighth consecutive day of disability (WCL §208). Benefits are paid for a maximum of 26 weeks of disability during any 52 consecutive week period (WCL §205).

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232