How an Award of Workers’ Compensation Benefits Impacts Other Disability Benefits

In New York, when an individual suffers an accident or illness arising out of and in the course of employment, workers’ compensation becomes the primary source of wage replacement and medical benefits. It is important to understand how workers’ compensation benefits affect or are affected by other available benefit programs. Some of these additional benefit programs duplicate workers’ compensation benefits, some supplement workers’ compensation benefits, and others are paid instead of workers’ compensation benefits.

Private Long Term Disability Benefits: Some employers voluntarily provide employees with long term disability benefits. Individuals can also obtain these policies on their own. Long term disability benefits are typically available for periods of disability which extend beyond an ‘elimination period.’ These policies issue indemnity benefits to policyholders who are disabled and unable to work beyond a set period of time, i.e. six months, 26 weeks, or another set period of time specified in the long term disability policy.

The Workers’ Compensation Board does not have jurisdiction over private long term disability benefit plans. As there is no jurisdiction, the Board has no legal authority to direct reimbursement for a duplication of benefits. Therefore, a claimant can receive both workers’ compensation indemnity benefits and benefits from their long term disability policy at the same time and even receive more from the two than their normal weekly wage while working. However, most long term disability policies contain provisions that require reimbursement to the long term disability carrier or take an offset for any workers’ compensation benefits. These reimbursements and offsets are to be determined in accordance with the terms of the long term disability policy.

Social Security Disability Benefits: The definition of disability under New York Workers’ Compensation law and Social Security Disability law is different. Social Security disability benefits are reduced pursuant to 42 U.S.C.S. § 424a so that the combined amount of the Social Security disability benefits plus any workers’ compensation indemnity benefits and/or public disability payments do not exceed 80 percent of the claimant’s average current earnings. If the sum of the claimant’s benefits exceeds 80 percent of their average current earnings, the extra amount is deducted from their Social Security disability benefits. In other words, Social Security gets the benefit of the offset. For a better understanding of the overlap between Social Security Disability benefits and workers’ compensation, review our prior article here.

New York State Disability Benefits:  All covered employers in New York State are required to provide for the payment of Disability Benefits to all eligible employees. State Disability Benefits (cash benefits only) are payable for any non-work related injury or illness, including pregnancy. Those entitled to New York State Disability Benefits receive weekly indemnity benefits. The benefits are computed at 50% of the claimant’s average weekly wage and are payable for up to 26 weeks of disability during 52 consecutive weeks. The current statutory maximum benefit rate in New York is $170.00 per week. An injured worker may not receive both workers’ compensation and New York state disability benefits concurrently. A disabled worker may claim and collect disability benefits if and when his or her claim for workers’ compensation benefits is controverted.

Unemployment Insurance Benefits: There are times when injured workers are eligible to receive unemployment insurance benefits while out of work due to a work injury. To qualify for unemployment benefits an individual must be able to work and be available to work. Therefore, any injured worker who is totally disabled does not qualify for unemployment benefits as by defintiion, they are not able or available to work. However, injured workers who are partially disabled may receive both workers’ compensation indemnity benefits and unemployment benefits concurrently. In situations where receiving both benefits, injured workers should not receive a greater weekly benefit through a combination of workers’ compensation and unemployment than they earned pre-injury. If the claimant is receiving more than 100% of their pre-injury average weekly wage then their unemployment benefits may be reduced. Unemployment gets the benefit of the offset and workers’ compensation remains the primary benefit.

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Declan is an attorney licensed to practice law in New Jersey, New York and the U.S. District Court of New Jersey. Declan is a Partner at Lois LLC where he defends employers and carrier in New York workers’ compensation claims. He can be reached directly at dgourley@lois-llc.com or 201-880-7213.