Get LC-5012 DBL-450 2010-2024

New York Disability Benefit Law (NY DBL) and Paid Family Leave (NY PFL) The New York state program provides short-term disability benefits through the Disability Benefit Law (DBL) and Paid Family Leave (PFL) wage replacement benefits to eligible employees who need time off from work for qualifying reasons.

The New York State Disability Benefits application consists of the DB-450 form. This is the only form that is required as part of your application for New York State Disability Benefits. The two mandatory sections of this form are PART A – CLAIM- ANT'S STATEMENT and PART B – HEALTH CARE PROVIDER'S STATEMENT.

Employees with a regular work schedule of 20 or more hours per week are eligible after 26 consecutive weeks of employment preceding the first full day of leave. Employees with a regular work schedule of less than 20 hours per week are eligible after 175 days worked preceding the first full day of leave.

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). If counting the last week in which the disability began lowers the benefit rate, it is not included in determining average weekly wage.

After a seven-calendar-day waiting period, you receive 50 percent of your average salary for the eight weeks prior to disability, up to the maximum benefit established under the New York State Disability Benefits Law, currently $170 per week. You can receive benefits up to a maximum of 26 weeks.