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  • Ny Db-820.1 2008

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Ent is attached to and made a part of the Certificate of Insurance, Form DB-820/829, filed for Employer's FEIN No. W.C.B. Plan No. ____________________________________________ by_________________________________________ Name of Employer Name of Carrier and said carrier certifies that benefits are payable to eligible employees at least to the extent described herein. SCHEDULE OF BENEFITS AND CONTRIBUTIONS WEEKLY CASH WAGE OR OTHER CLASSIFICATION Weekly Benefit Maximum Duration (Weeks) HO.

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Equals 67% of the employee's average weekly wage, up to maximum of $1,131.08 a week for 2023.

The maximum duration for DBL benefits is 26 weeks. Benefits begin on the eighth consecutive day of disability.

Equals 67% of the employee's average weekly wage, up to maximum of $1,068.36 a week for 2022. combined cannot exceed 26 weeks during any 52 consecutive calendar weeks. 12 weeks (in every 52 week period). Benefits begin on the 8th day of accident, or the 8th day of illness.

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. 0.50% of the first $120 of weekly wages to max of $0.60 per week.

After a seven-calendar-day waiting period or the exhaustion of your sick leave accruals (whichever is greater), you receive 50 percent of your average salary for the eight weeks before disability, up to the maximum benefit established under the New York State Disability Benefits Law, currently $170 per week.

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.

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.

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).

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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
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
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 workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
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