N.Y. Comp. Codes R. & Regs. tit. 4 § 78.5
Current through Register Vol. 46, No. 45, November 2, 2024
(a) The plan shall provide the following short-term disability benefit to a disabled employee who is determined by the insurer to be unable to perform his or her regular job duties: a monthly income benefit equal to 50 percent of the employee's covered salary not to exceed a total benefit of $961.54 weekly, which shall be reduced by the following: any workers' compensation wage benefits or payments in lieu of workers' compensation, and supplemental payments to workers' compensation awards made by New York State as an employer, if any; any retirement benefits paid by a public retirement system of this State or its political subdivisions or an optional retirement program, including any such benefits being received by a retired person who is reemployed subject to section 211 or 212 of the Retirement and Social Security Law, other than benefits provided by a tax-deferred annuity program; and disability benefits payable pursuant to a plan established in accordance with section 158 of the Civil Service Law. Such benefit shall be payable on the day following completion of the waiting period and shall cease six months from the date disability commenced, but shall not continue beyond the end of disability as determined by the insurer, age 65 or death, whichever occurs first.(b) The plan shall provide the following long-term disability benefit to a disabled employee who is determined by the insurer to be unable to perform his or her regular job duties during the first two years of long-term disability benefits; and, thereafter, unless the insurer determines that the employee is capable of performing the duties of a comparable occupation for which he or she is reasonably suited based on education, training and experience: (1) A monthly income benefit equal to 60 percent of the employee's covered salary not to exceed a total benefit of $5,000 monthly, which shall be reduced by the following: any workers' compensation wage benefits or payments in lieu of workers' compensation, and supplemental payments to workers' compensation awards made by New York State as an employer, if any; any retirement benefits paid by a public retirement system of this State or its political subdivisions or an optional retirement program, including any such benefits being received by a retired person who is reemployed subject to section 211 or 212 of the Retirement and Social Security Law, other than benefits provided by a tax-deferred annuity program; disability benefits payable pursuant to a plan established in accordance with section 158 of the Civil Service Law; primary Social Security benefits, provided, however, that pending the initial determination by the Social Security Administration of the claimant's eligibility for Social Security benefits, estimated Social Security benefits shall not be an offset for any employee who has executed a reimbursement agreement with the insurer; and family Social Security benefits as determined by the formula established by the insurer.(2) In addition, for persons with no prior creditable service who enter State service on or after January 1, 1986, long-term disability benefits shall be reduced by Federal Government, Railroad Retirement, provincial and Marine Maintenance pensions and Veterans Administration disability income benefits, but only to the extent that the aforesaid pension or disability benefits are initiated or increased by the same disability for which long-term disability benefits are paid.(3) The long-term disability benefit is payable after six consecutive months of disability and upon exhaustion of all sick leave credits. Such benefit shall be payable until cessation of disability as determined by the insurer or as otherwise provided by subdivision (b) of this section, age 65 or death, whichever occurs first.N.Y. Comp. Codes R. & Regs. Tit. 4 § 78.5