reglab/statecodes huggingface dataset:
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 363 - Claims › Section 363.11 - Notice and proof of disability

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Notice and
					 proof of disability shall be in the format prescribed by the Chair. Once the
					 employer receives the request for disability benefits from an employee, the
					 employer shall complete the employer information and return it to the employee
					 within three business days.
(b)
					 Such notice and proof shall include statements furnished by the claimant and
					 the claimant's attending physician, podiatrist, certified nurse midwife,
					 chiropractor or dentist in form prescribed for such purpose by the chairman.
					 The attending physician, podiatrist, certified nurse midwife, chiropractor or
					 dentist shall complete and mail such form to the carrier or self-insured
					 employer, or return it to the claimant, within seven days of receipt of the
					 form.
(c) A carrier, employer or
					 the chairman may investigate a claim and for cause require additional
					 information.
(d) Failure to furnish
					 notice or proof within thirty days after commencement of the period of
					 disability shall not invalidate the claim, but no benefits shall be required to
					 be paid for any period more than two weeks prior to the date on which the
					 required proof is furnished. However, if claimant shows it was not reasonably
					 possible to furnish such notice or proof within thirty days and that such
					 notice or proof was furnished as soon as possible (e.g., delay by medical
					 provider, or claimant was incapacitated), such delay may be excused and
					 benefits may be payable for the full period of disability; provided required
					 proof of disability is furnished within 26 weeks after commencement of the
					 period of disability.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 363 - Claims › Section 363.13 - Rejection of claim

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Notice of
					 denial of claim. If the employer or carrier denies an initial claim for
					 disability benefits, the employer or carrier must notify the employee of such
					 denial in a manner prescribed by the chair within 18 days of receipt of the
					 proof of disability and must thereafter notify the employee of rejection within
					 45 days of receipt of the proof of disability.
(b) Notice of rejection of claim. A Notice of
					 Total or Partial Rejection of Claim for Disability Benefits (in the format
					 prescribed by the Chair) sent to the claimant within 18 days of receipt of
					 proof of disability shall satisfy the employer or carrier's obligation to send
					 a notice of denial of claim pursuant to subdivision (a) of this
					 section.
(c) Unless supported by an
					 examination pursuant to Workers' Compensation Law § 217(2), and upon 7 days'
					 notice to the employee, no inquiry pursuant to Workers' Compensation Law §
					 208(1) shall be made prior to the expiration of the medical certification or
					 twelve weeks from the date of disability, whichever is sooner. Any inquiry made
					 thereafter must be made no more than two weeks prior to the date of expiration
					 of the proof of disability. Such inquiry shall include a clear and prominent
					 statement of the deadline of at least 2 weeks for responding and consequences
					 of failing to respond. Disability caused by or in connection with a pregnancy
					 shall be presumed for the four weeks prior to the child's estimated due date
					 and for the six weeks after giving birth or eight weeks after delivering by
					 Cesarean section.
(d) The carrier
					 or self-insured employer may deny the claim without prejudice for the following
					 reasons:
(1) incomplete Notice and Proof of
					 Claim for Disability Benefits; or
(2) insufficient certification of
					 disability.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 363 - Claims › Section 363.14 - Penalties and assessments

Current through Register Vol. 46, No. 28, July 10, 2024
Whenever an employer, carrier, physician or other person
						has failed to comply with any requirement of the Disability Benefits Law,
						Workers' Compensation Law, art. 9, or has violated any provisions thereof, the
						fines, assessments or other penalties prescribed by the law shall be imposed as
						therein provided.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 363 - Claims › Section 363.15

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A carrier or
					 self-insured employer who receives a request for benefits in any format other
					 than the format prescribed by the chair shall immediately provide the employee
					 with an acknowledgment of receipt with a claim identification number.
(b) If the request for benefits is made
					 telephonically, the carrier or self-insured employer shall create a written
					 form, or use the format prescribed by the chair, to capture the information
					 reported by the employee. The carrier or self-insured employer shall provide a
					 copy of the completed written form with any notice of rejection or notice of
					 denial. If the carrier or self-insured employer accepts the medical
					 certification telephonically, such carrier or self-insured employer may not
					 deny the claim based on insufficient medical certification.
(c) If the carrier or self-insured employer
					 determines the application for disability benefits is incomplete, it shall
					 provide the employee within five business days a list of each piece of required
					 information which is missing with the corresponding data field on the Notice
					 and Proof of Claim for Disability Benefits prescribed by the chair identified.
					 Such list shall also provide the employee with an explanation of how to
					 properly complete Notice and Proof of Claim for Disability Benefits.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 363 - Claims › Section 363.16 - Certain PFL Regulations Also Applicable to Subchapter H

Current through Register Vol. 46, No. 28, July 10, 2024
Sections
						380-5.5,
						380-5.6, and
						380-7.2  of this Title shall also
						be applicable to disability benefits under Article 9 of the Workers'
						Compensation Law.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 364 - Assessments › Section 364.1 - Liability of carrier providing hospital, medical or surgical benefits

Current through Register Vol. 46, No. 28, July 10, 2024
Under a plan in which the hospital, medical or surgical
						benefits and cash disability benefits of the employees covered thereunder are
						separately insured by two or more carriers, the carrier insuring the cash
						disability benefits shall be solely responsible for the reporting of payrolls
						and for the payment of assessments as prescribed under sections 214 and 228 of
						the law with regard to the employees insured under such a
						plan.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 375 - Evaluation Of Plan Benefits › Section 375.1 - Minimum benefit values

Current through Register Vol. 46, No. 28, July 10, 2024
If the cash disability benefits equal at least 100
						percent of the disability benefits payable under section 204  of the Workers'
						Compensation Law, the plan may be accepted. This section shall take effect July
						1, 1989.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 375 - Evaluation Of Plan Benefits › Section 375.2 - Employee benefits only to be evaluated

Current through Register Vol. 46, No. 28, July 10, 2024
It is required by law that benefits payable to employees
						under a plan shall be "at least as favorable" as the employee disability
						benefits provided by law, and dependent benefits are, therefore, excess
						benefits not evaluated under this Article.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 375 - Evaluation Of Plan Benefits › Section 375.3 - Disability benefits and related benefits only to be evaluated

Current through Register Vol. 46, No. 28, July 10, 2024
Benefits other than those specified in section
						355.8 
						of this Title, will not be evaluated, but are excess
						benefits.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 375 - Evaluation Of Plan Benefits › Section 375.4 - Wages to be used in determining benefit rate

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In determining benefit rate for plan
					 evaluation, the normal weekly earnings paid under regular employment practices
					 will generally be used as "wages." However, if for any extended period of time
					 employees regularly receive extra wages, including, without limitation,
					 overtime or premium pay, it may be required that benefits be determined on the
					 total of normal and such extra wages.
(b) If, under a plan, benefits are to be
					 provided in accordance with wage classifications, the maximum of each wage
					 classification will generally be used as the weekly wage in determining the
					 benefit rate for plan evaluation. For those employees whose average weekly wage
					 is $20 or more and less than $40 per week, the benefit rate for plan evaluation
					 will be computed by dividing the actual cash benefit to which the employee is
					 entitled by $40. If the employer submits a wage schedule showing for each wage
					 classification a distribution of employees by wages (up to weekly wages equal
					 to twice the maximum weekly benefit payable under section 204  of the Workers'
					 Compensation Law), the weekly wage to be used for plan evaluation will be the
					 average wage of the employees included in the classification, but not less than
					 $5 under the maximum wage of the classification.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 375 - Evaluation Of Plan Benefits › Section 375.5 - Wage continuance plans

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 Arrangements for wage continuance during disability, in effect on April 13,
					 1949, may be accepted as an existing plan, provided such plan formed part of
					 the employer's regular contract of hiring, either under written agreement or by
					 established custom and practice.
(b) A wage continuance plan in effect on
					 April 13, 1949, but not then under written agreement, may be accepted as a plan
					 if it is reduced to a written agreement and proof satisfactory to the chairman
					 is submitted that the plan was actually in existence on April 13, 1949, as the
					 employer's established custom and practice.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 376 - Self-insurance Rules › Section 376.1 - Amount of securities, cash or bond

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The amount of securities, cash or the
					 penal sum of the surety bond which a self-insurer is required to deposit,
					 pursuant to section
					 361.3 
					 of this Title, shall be determined by the chair. The number of employees
					 involved, the covered payroll of employees eligible for benefits, the exposure,
					 the financial standing of the applicant, and other factors which the chair may
					 deem proper shall be given effect in fixing the amount.
(b) If employees contribute toward the cost
					 of providing disability benefits only, under section 204  of the Workers'
					 Compensation Law, the minimum amount of deposit, subject to the deposit credit
					 authorized under section
					 361.8 
					 of this Title, may be computed under Table I of this section, on the basis of
					 the estimated number of employees to be covered under the self-insurance
					 program during the ensuing 12 months or the number who would have been covered
					 during the preceding 12 months, whichever is the greater.
(c) In the chair's discretion, a deposit in
					 excess of the minimum under section
					 361.3 
					 of this Title, or this section, may be required.
TABLE I
Number of
Minimum
employees
deposit
Less than 8
$10.000
8-19
11,000
20-40
12,000
41-62
13,000
63-84
14,000
85-107
15,000
108-130
16,000
131-153
17,000
154-176
18,000
177-199
19,000
200-221
20,000
222-244
21,000
245-267
22,000
268-290
23,000
291-313
24,000
314-341
25,000
342-373
26,000
374-405
27,000
406-437
28,000
438-469
29,000
470-505
30,000
506-545
$31,000
546-585
32,000
586-625
33,000
626-671
34,000
672-724
35,000
725-778
36,000
779-831
37,000
832-885
38,000
866-938
39,000
939-1018
40,000
1019-1125
41,000
1126-1231
42,000
1232-1338
43,000
1339-1444
44,000
1445-1551
45,000
1552-1764
46,000
1765-2084
47,000
2085-2484
48,000
2485-2964
49,000
2965 and over
50,000
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 378 - Medical Proof Of Disability › Section 378.1 - Statutory requirement for medical statement of disability

Current through Register Vol. 46, No. 28, July 10, 2024
[Workers' Compensation Law, § 13-1; L. 1973, ch. 940; L.
						1981, ch. 130]
(a) The statutory
					 requirement for medical statement of disability may be waived under plans,
					 under conditions that are permitted by the law, as follows:
(1) If the plan is an existing plan, the
					 provisions that were incorporated in the plan as of April 13, 1949, are
					 acceptable.
(2) If the statutory
					 waiting period of seven days is waived or reduced and if employees make no
					 contribution to the cost of the plan, the statutory requirement of medical
					 statement may be waived for disability periods up to seven days.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 379 - Irregular Remuneration › Section 379.1 - Bonus, commissions and irregular remuneration

Current through Register Vol. 46, No. 28, July 10, 2024
If the established basis of remuneration of an employee
						includes bonus, commissions, or other irregular remuneration, whether or not in
						addition to salary or wages paid at a regular scale or at fixed intervals, the
						amount of such bonus, commissions or other irregular remuneration shall be
						deemed a part of salary or wages for purposes of computing the amount of
						benefits, contributions and assessments under the Disability Benefits Law,
						Workers' Compensation Law, art. 9. Such bonuses, commissions and other
						irregular remuneration shall be considered to be a part of wages or salary for
						the period of 12 months beginning with the month in which payment thereof is
						made, and the amount thereof shall be allocated on a weekly basis as a part of
						remuneration in determining average weekly wage during employment. If
						commissions are paid under usual payroll practices on regular payroll dates,
						they shall not be deemed irregular remuneration but shall be treated as wages
						or salary regularly paid and allocated on that basis.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-1 - Applicability › Section 380-1.1 - Applicability

Current through Register Vol. 46, No. 28, July 10, 2024
The provisions in this Part shall be applicable to paid
						  family leave. The definitions included in Part 355 of this Title shall be
						  applicable to the sections herein.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-2 - Eligibility › Section 380-2.1 - Providing care

Current through Register Vol. 46, No. 28, July 10, 2024
(a) For the
						purpose of this Part, the employee must be in close and continuing proximity to
						the care recipient. This means present at the same location as the family
						member during the majority of the employment period from which leave has been
						taken. Travel necessitated for the purpose of securing medication or to arrange
						care for the family member, or other such deviations determined to be
						reasonably related to providing care, shall satisfy this definition.
(b) For the purpose of this section,
providing care
may include necessary physical care, emotional
						support, visitation, assistance in treatment, transportation, arranging for a
						change in care, assistance with essential daily living matters, and personal
						attendant services.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-2 - Eligibility › Section 380-2.2 - Leave for birth, adoption, or foster care

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An employee may take family leave before
						the actual placement or adoption of a child if an absence from work is required
						for the placement for adoption or foster care to proceed. For example, the
						employee may be required to attend counseling sessions, appear in court,
						consult with his or her attorney or the doctor(s) representing the birth
						parent, submit to a physical examination, or travel to another country to
						complete an adoption. The source of an adopted child (
e.g.
,
						whether from a licensed placement agency or otherwise) is not a factor in
						determining eligibility for leave for this purpose.
(b) An employee's entitlement to family leave
						for a birth expires at the end of the consecutive 52-week period beginning on
						the date of the birth, and an employee's entitlement to family leave for
						adoption or foster care expires at the end of the consecutive 52-week period
						beginning on the date of the placement or first day of leave taken under
						subdivision (a) of this section.
(c) An eligible employee may opt to receive
						disability and family leave benefits during the post-partum period but may not
						receive both benefits at the same time.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-2 - Eligibility › Section 380-2.3 - Leave for qualifying exigency arising from the service of a family member in the armed forces of the United States

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Family leave benefits for an eligible
						employee that are based upon a qualifying exigency as interpreted under the
						Family and Medical Leave Act, 29 U.S.C.S 2612(a)(1)(e) and
						29 C.F.R.
						825.126(b)(1)-(9), arising
						out of the fact that the spouse, domestic partner, child, or parent of the
						employee is on active duty (or has been notified of an impending call or order
						to active duty) in the armed forces of the United States, shall be paid for no
						longer than the maximum periods of time as set out in section 204  of the
						Workers' Compensation Law.
(b) A
						claim for such benefits shall be made and processed in the same manner as other
						claims for family leave benefits.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-2 - Eligibility › Section 380-2.4 - Family leave on or after January 1, 2018

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Employees are entitled to family leave
						benefits under article 9 of the Workers' Compensation Law only on or after
						January 1, 2018.
(b) An employee
						shall only be entitled to the maximum number of family leave benefits
						permissible in a 52-consecutive week period under section 204  of the Workers'
						Compensation Law, even where such employee begins employment with a different
						covered employer during the 52-consecutive week period.
(c) An employee may not receive both
						disability benefits and family leave benefits for the same period of
						time.
(d) An employer is permitted,
						but not required, to collect the weekly employee contribution on July 1, 2017
						for paid family leave coverage beginning on January 1, 2018.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-2 - Eligibility › Section 380-2.5 - Employees Who Acquire Eligibility During Employment

Current through Register Vol. 46, No. 28, July 10, 2024
a. An employee of a covered employer whose
						regular employment schedule is 20 or more hours per week will become eligible
						to take family leave during his or her employment with such employer, provided
						the employee has been either:
1. In
						employment, as defined in this Title, of the covered employer for at least 26
						consecutive work weeks preceding the first full day family leave begins;
						or
2. In employment, as defined in
						this Title, of the covered employer during the work period usual to and
						available during the entirety of such 26 consecutive weeks preceding the first
						full day the leave begins in any trade or business in which he or she is
						regularly employed and in which hiring from day to day of such employees is the
						usual employment practice; or
3.
						In employment, as defined in this Title, of the covered employer for at least
						26 consecutive weeks, such consecutive weeks may be tolled during periods of
						absence that are due to the nature of that employment, such as semester breaks,
						and when employment is not terminated during those periods of
						absence.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-2 - Eligibility › Section 380-2.6 - Family leave waiver

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An employee
						of a covered employer shall be provided the option to file a waiver of family
						leave benefits:
(1) when his or her regular
						employment schedule is 20 hours or more per week but the employee will not work
						26 consecutive weeks; or
(2) when
						his or her regular employment schedule is less than 20 hours per week and the
						employee will not work 175 days in a 52 consecutive week period.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-2 - Eligibility › Section 380-2.7 - Bonding leave for those born or placed prior to January 1, 2018

Current through Register Vol. 46, No. 28, July 10, 2024
In the case of leave taken for the purpose of bonding
						  with a child pursuant to section 201  of the Workers' Compensation Law, on or
						  after January 1, 2018, employees may seek family leave benefits during the
						  first twelve months after the child's birth, or during the first twelve months
						  after the placement of the child for adoption or foster care with the employee,
						  even in the event the child was born or placed prior to January 1,
						  2018.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-2 - Eligibility › Section 380-2.8 - Fifty-two consecutive weeks

Current through Register Vol. 46, No. 28, July 10, 2024
Fifty-two consecutive weeks shall be computed
						  retroactively with respect to each day for which benefits are currently being
						  claimed. In no case shall a single claim for periodic family leave cover more
						  than fifty-two weeks, an employee with an eligible periodic claim must submit a
						  new claim at the end of the fifty-two week period.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-2 - Eligibility › Section 380-2.9 - Employees subject to collective bargaining agreements

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Covered employers with employees or a
						class or classes of employees subject to a collective bargaining agreement
						shall not be required to supply such employees with paid family leave coverage
						when the collective bargaining agreement:
(1)
						provides paid family leave benefits at least as favorable as set forth in
						section
						358-3.1(e) 
						of this Title; and
(2) does not
						permit an eligible employee to waive his or her rights to paid family leave or
						otherwise opt-out of article 9 of the Workers' Compensation Law except as
						permitted in section
						380-2.6  of
						this Subpart. With the exception of the requirements set forth in the preceding
						sentence, a collective bargaining agreement may provide rules related to paid
						family leave that differ from the requirements set forth in this Title. Where
						the collective bargaining agreement does not provide a different rule, the
						provision of this Title shall apply to family leave benefits.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-3 - Notice To Employer of Foreseeable Qualifying Event › Section 380-3.1 - Employee notice requirements for paid family leave

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
Foreseeable leave.
An employee must provide the employer with at least 30
						  days advance notice before leave is to begin if the qualifying event is
						  foreseeable. Foreseeable qualifying events include an expected birth, placement
						  for adoption or foster care; planned medical treatment for a serious health
						  condition of a family member; the planned medical treatment for a serious
						  injury or illness of a covered service member; or other known military
						  exigency. If 30 days advance notice is not practicable for reasons such as a
						  lack of knowledge of approximately when leave will be required to begin, a
						  change in circumstances, or a medical emergency, notice must be given as soon
						  as practicable. The employee shall advise the employer as soon as practicable
						  if dates of scheduled leave change or are extended, or were initially
						  unknown.
(b)
(1) When the approximate timing of the
						qualifying event and need for leave is not foreseeable, an employee shall
						provide notice to the employer as soon as practicable under the facts and
						circumstances of the qualifying event. It generally should be practicable for
						the employee to provide notice of leave that is unforeseeable within the time
						prescribed by the employer's usual and customary notice requirements applicable
						to such leave.
(2) As soon as
						practicable means as soon as both possible and practical, taking into account
						all of the facts and circumstances in the individual case. When an employee
						becomes aware of a qualifying event less than 30 days in advance, it should be
						practicable for the employee to provide notice of the need for leave either the
						same day or the next business day. In all cases, however, the determination of
						when an employee could practicably provide notice must take into account the
						individual facts and circumstances surrounding the qualifying event.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-3 - Notice To Employer of Foreseeable Qualifying Event › Section 380-3.2 - Content of notice to employer

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An
						employee shall provide notice sufficient to make the employer aware of the
						qualifying event and the anticipated timing and duration of the leave. The
						employee shall identify the type of family leave as listed in Subpart 380-2 of
						this Part when providing notice to the covered employer.
(b) When an employee seeks leave for the
						first time for a qualifying event, the employee need not expressly assert
						rights under PFL or even mention family leave. In all cases, the employer
						should seek further information from the employee to determine whether paid
						family leave is being sought by the employee.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-3 - Notice To Employer of Foreseeable Qualifying Event › Section 380-3.3 - Compliance with employer policy

Current through Register Vol. 46, No. 28, July 10, 2024
To the extent that a covered employer's rules about
						  requesting leave are less stringent than the rules contained herein, an
						  employer may require an employee to comply with the employer's usual and
						  customary notice and procedural requirements for requesting leave, absent
						  unusual circumstances. Where an employee does not comply with the employer's
						  usual notice and procedural requirements, and no unusual circumstances justify
						  the failure to comply, PFL may be delayed or denied.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-3 - Notice To Employer of Foreseeable Qualifying Event › Section 380-3.4 - Advance notice to carrier by employees not required; advance notice to carrier by individual business owner

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
						The employee is not responsible for providing advance notice of foreseeable
						leave to the carrier beyond the requirements stated in filing a request for
						paid family leave as set forth in section
						380-5.1 
						of this Part and section 217  of the Workers' Compensation Law.
(b) An individual business owner who has
						purchased family leave coverage must give 30 days notice to his, her, or their
						carrier and otherwise comply with the provisions of this Subpart.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-3 - Notice To Employer of Foreseeable Qualifying Event › Section 380-3.5 - Failure to give 30 days advance notice for foreseeable leave

Current through Register Vol. 46, No. 28, July 10, 2024
When the need for family leave is foreseeable and an
						  employee fails to give 30 days advance notice, the self-insured employer or the
						  carrier may file a partial denial of the family leave claim for a period of up
						  to 30 days from the date notice is provided.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-4 - Request for Paid Family Leave, Medical Certification and HIPAA Authorization › Section 380-4.1 - Request for paid family leave and certification, general rule

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A claim for paid family leave shall be
						considered complete when an eligible employee submits a request for paid family
						leave and certification to the self-insured employer or carrier as set forth in
						section
						380-5.1 
						of this Part.
(b) An employee shall
						advise the employer and carrier of the schedule for intermittent leave. When
						the dates for leave are not specified on the request for paid family leave, the
						carrier, the employer, or, when the employer is uninsured, the special fund for
						disability benefits, may withhold payment pending submission of a request for
						payment together with the date of leave. Payment shall be completed as soon as
						possible, but in no event more than 18 days from the date of the request. As
						required by Workers' Compensation Law section 217, an employee must request
						payment for a previously unspecified day of family leave within 30 days of the
						leave.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-4 - Request for Paid Family Leave, Medical Certification and HIPAA Authorization › Section 380-4.2 - Content of medical certification taken because of the serious health condition of a family member

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
Required information.
When leave is taken because of the serious health
						  condition of a family member, the employee must obtain a medical certification
						  from a health care provider that sets forth the following information:
(1) name, address, telephone number, email
						address (if available), license number and state of license of the health care
						provider, and the type of medical practice/specialization;
(2) approximate date on which the serious
						health condition commenced, and its probable duration;
(3) certification regarding the patient's
						health condition for which PFL is requested. The certification must be
						sufficient to support the need for leave; and
(4) an estimate of the frequency and duration
						of the leave required to care for the family member, including whether the need
						for care is continuing or on an intermittent basis.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-4 - Request for Paid Family Leave, Medical Certification and HIPAA Authorization › Section 380-4.4 - Proof of eligibility for leave taken to bond with a child

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A birth
						mother's claim for paid family leave to bond with a child must be supported by
						documentation in the form of:
(1) if
						available, a birth certificate; or
(2) if a birth certificate is unavailable,
						documentation of pregnancy or birth from a health care provider that includes
						the mother's name and the child's due or birth date.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-5 - Payment and Denials › Section 380-5.1 - Requesting paid family leave

Current through Register Vol. 46, No. 28, July 10, 2024
An employee wishing to make a claim for paid family
						  leave must complete the request for paid family leave in the format prescribed
						  by the chair (currently the form PFL-1) or give notice of a claim in another
						  format designated by the carrier or self-insured employer, including using an
						  electronic portal or by telephone. A carrier or self-insured employer that
						  designates another format for filing a request for family leave must continue
						  to accept the request for paid family leave in the format prescribed by the
						  chair, in addition to any other designated format. Any method of filing a
						  request for family leave designated by a carrier or self-insured employer must
						  solicit the same information as the request for paid family leave (form PFL-1),
						  parts A and B. The chair shall have discretion to mandate the means of
						  transmission of a claim, including an electronic portal maintained by carriers
						  or the board for receipt of family leave claims. Any such mandate by the chair
						  shall contain a means for transmission available to employees that do not have
						  the means to submit via the mandated method.
(a) Once the employer receives a request for
						family leave from an employee, the employer shall complete the employer
						information contained in part B of the request for paid family leave (currently
						form PFL-1), or any other carrier or self-insured employer designated format,
						and return it to the employee within three business days.
(b) The employee shall submit the request for
						family leave together with the information supplied by the employer, and with
						any necessary certifications or proof of claim documentation, medical or
						otherwise, to the carrier or designated third-party administrator. The carrier
						or self-insured employer must accept certification and proof of claim forms in
						the format prescribed by the chair (currently forms PFL-2, 3, 4, and 5), but
						may also accept certifications in another format that complies with the
						requirements of sections
						380-4.2,
						380-4.3,
						and
						380-4.4 
						of this Part.
(c) An employee must
						submit a completed request for paid family leave to the carrier. No benefits
						shall be required to be paid by the carrier until the completed request for
						paid family leave, together with any necessary certifications or proof of claim
						documentation, has been submitted to the carrier.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-5 - Payment and Denials › Section 380-5.2 - Alternate method for filing a claim

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A carrier or self-insured employer who
						receives a request for paid family leave in any format other than the format
						prescribed by the chair shall immediately provide the employee with an
						acknowledgment of receipt with a claim identification number.
(b) If the carrier or self-insured employer
						determines the request for paid family leave is incomplete, it shall provide
						the employee within five business days:
(1) A
						list of each piece of required information which is missing with the
						corresponding data field on the request for paid family leave prescribed by the
						chair identified. Such list shall also provide the employee with an explanation
						of how to properly complete the request for paid family leave and information
						regarding arbitration should the employee have any disputes.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-5 - Payment and Denials › Section 380-5.3 - Prefiling request for paid family leave

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A carrier or self-insured employer may
						receive a request for paid family leave in advance of the happening of a
						foreseeable qualifying event as identified in Subpart 380-3 of this Part, in
						which one or more pieces of required information, contained in part A of the
						request for paid family leave (currently form PFL-1) or as set forth in
						sections
						380-4.2,
						380-4.3,
						and
						380-4.4 
						of this Part, is missing. The request for paid family leave shall indicate that
						it is being submitted in advance of the qualifying event. Such missing
						information must be supplied upon the happening of the qualifying
						event.
(b) When a carrier or
						self-insured employer receives a request for paid family leave under this
						section, the carrier or self-insured employer shall not deny the claim for
						incomplete claim package. The carrier or self-insured employer shall provide
						the employee within five business days:
(1) a
						notice indicating the employee's claim is pending until all missing information
						is received upon the happening of the qualifying event;
(2) each piece of required information, as
						identified in sections
						380-4.2,
						380-4.3,
						and
						380-4.4 
						of this Part, which is missing from the employee's request for paid family
						leave (currently PFL-1); and
(3)
						instructions outlining the preferred method in which the employee shall submit
						the missing pieces of required information upon the happening of the qualifying
						event, including a contact office or person's name, mailing address, email, and
						contact phone number;
(4) once the
						carrier or self-insured employer receives all missing pieces of required
						information, the carrier or self-insured employer must pay the claim or deny
						the completed claim within 18 days, and shall provide the employee within 3
						business days a confirmation of receipt of a complete claim. A carrier may not
						deny a claim on the grounds of incompleteness after issuing such a
						confirmation.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-5 - Payment and Denials › Section 380-5.4 - Acceptance or denial of claim

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
						Once the carrier or self-insured employer receives a completed request for paid
						family leave with the necessary certification as identified in Subpart 380-4 of
						this Part, the carrier or self-insured employer must pay the claim or deny the
						claim within 18 days. In the event a completed request is received more than 18
						days before the occurrence of a qualifying event, the carrier or self-insured
						employer shall send payment to the employee within 5 days following the
						qualifying event.
(1) The chair may prescribe
						the format of a denial for request for paid family leave, and with the first
						payment or denial, the carrier or self-insured employer must provide contact
						information, including a contact person's name or office, mailing address,
						email, and contact phone number, as well as any form identifiers prescribed by
						the chair such as name, number or bar code. A paid family leave denial must
						state the reason, repeat any relevant information filed in the request for paid
						family leave, and include any other information considered by the carrier in
						making the decision.
(2) Unless the
						employee requests to receive correspondence by regular mail, the carrier or
						self-insured employer may send the denial and accompanying information by
						email.
(3) Whenever a claim for
						paid family leave is the responsibility of the special fund for disability
						benefits pursuant to section 213  of the Workers' Compensation Law, the chair
						may waive the special fund for disability benefits' obligation to pay or deny
						within 18 days.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-5 - Payment and Denials › Section 380-5.5 - Uninsured employers

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In the
						event that an employee makes a claim for paid family leave upon an uninsured
						employer and is entitled to such benefits, the special fund for disability
						benefits shall make payment of the benefits to the employee.
(b) The special fund for disability benefits
						will attempt to seek reimbursement from the uninsured employer of any benefit
						payments made on behalf of the uninsured employer. If the special fund for
						disability benefits seeks reimbursement of such payments from the uninsured
						employer, the employer cannot seek contributions from its employees to pay the
						required reimbursement.
(c)
						Whenever a claim for disability benefits or paid family leave is the
						responsibility of the special fund for disability benefits pursuant to section 213  of the Workers' Compensation Law, the chair or the chair's designee may
						take any action necessary to defend the assets and interests of the special
						fund for disability benefits (as outlined in section 214  of the Workers'
						Compensation Law). These actions include, but are not limited to, making an
						investigation or inquiry, commencing or participating in any arbitration action
						and participating in a hearing.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-5 - Payment and Denials › Section 380-5.6 - Methods of payment of paid family leave benefits

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Employees may be paid family leave
						benefits in like manner as wages, including the following methods:
(1) debit card;
(2) direct deposit; or
(3) check.