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Get NY WCB DB-120.1 2006-2024

DB-120. 1 Certificate of Insurance Coverage Under the NYS Disability Benefits Law What is the DB-120. The DB-120. 1 must be completed by either the NYS statutory disability benefits insurance agent of that carrier. 1 form Who provides the DB-120. 1 form Why it is needed When is it needed Who is the certificate holder Who are the additional insureds Acceptable proof that the business listed has secured from a NYS disability benefits insurance carrier or an insurance agent of that carrier disability benefits insurance. The Workers Compensation Law requires employers to post Form DB-120 Notice of Compliance Disability Benefits Law in all business locations. Whenever an employee is absent from work due to disability for more than seven consecutive days the employer shall within five days thereafter provide the employee with prescribed Form DB-271s Statement of Rights under the Disability Benefits Law. The insurance carrier must be rated at least A- in the then most recently published A. M. Best Insurance Report. If during the term of the policy a carriers rating falls below A- the insurance must be replaced no later than the renewal date of the policy with an insurer acceptable to the Research Foundation. The next page provides a sample of a DB-120. The form can be obtained by contacting the Bureau of Compliance certificates wcb. state. ny. us. To establish proof that a business has secured disability benefits insurance coverage for all its employees. Prior to any permit being issued or any contract including purchase orders being entered into for work The Research Foundation of the State University of New York N/A New York State requires employers to provide disability benefits coverage to employees for an off-the-job injury or illness. Disability benefits coverage is required is an employers employs individuals in New York State for more than 30 days in a calendar year. Whenever an employee is absent from work due to disability for more than seven consecutive days the employer shall within five days thereafter provide the employee with prescribed Form DB-271s Statement of Rights under the Disability Benefits Law. The insurance carrier must be rated at least A- in the then most recently published A. M. Best Insurance Report. If during the term of the policy a carriers rating falls below A- the insurance must be replaced no later than the renewal date of the policy with an insurer acceptable to the Research Foundation* The next page provides a sample of a DB-120. The form can be obtained by contacting the Bureau of Compliance certificates wcb. state. ny. us. To establish proof that a business has secured disability benefits insurance coverage for all its employees. Prior to any permit being issued or any contract including purchase orders being entered into for work The Research Foundation of the State University of New York N/A New York State requires employers to provide disability benefits coverage to employees for an off-the-job injury or illness. .

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