New York Disability and Paid Family Leave: Claims and Job Protection

In New York, disability benefits and Paid Family Leave are two separate wage-replacement programs that nearly every private employer must carry for its workers. Disability benefits (DBL) pay you when your own off-the-job injury or illness keeps you from working. Paid Family Leave (PFL) pays you when you need time away to bond with a new child, care for a seriously ill family member, or handle certain needs tied to a family member’s military deployment. The two programs share a legal home in Article 9 of the Workers’ Compensation Law, but the benefit amounts, eligibility thresholds, and filing rules are different enough that it pays to know which one applies before you file.

What Each Program Covers and What It Pays

DBL is about your own health. A broken leg from a weekend hike, surgery unrelated to work, a serious illness that keeps you home: those are DBL claims. PFL is about your family. A spouse’s serious diagnosis, a new baby, an adoption, a foster placement, a parent needing daily care, a military deployment event.

The pay is very different. DBL replaces 50 percent of your average weekly wage from the previous eight weeks, but the maximum weekly payment is capped at $170 no matter what you earn. PFL pays 67 percent of your average weekly wage, up to 67 percent of the statewide average weekly wage. For 2026, the PFL maximum weekly benefit is $1,228.53, and the maximum total benefit over a full leave is $14,742.36.¹

Duration also differs. DBL runs up to 26 weeks in any 52-consecutive-week period. PFL provides up to 12 weeks.² One rule ties them together: you cannot collect DBL and PFL at the same time, and combined benefits from both programs cannot exceed 26 weeks in any 52-week stretch. Use 20 weeks of DBL and you have only 6 weeks of PFL left in that window.

Who Qualifies

Eligibility sits in Article 9 of the Workers’ Compensation Law, but the thresholds are not the same for the two programs.³

For DBL, you become eligible after four consecutive weeks of covered employment with a private-sector employer.⁴ If you leave and start with another covered employer within four weeks, your eligibility carries over immediately. Part-time employees working less than the employer’s normal schedule become eligible on their 25th day of regular employment.

PFL uses hours-based thresholds. If you regularly work 20 or more hours per week, you qualify after 26 consecutive weeks of employment. If you work fewer than 20 hours per week, you qualify after 175 days worked.⁵ On the employer side, any business that has employed at least one person for 30 days in a calendar year must provide coverage.⁶

Independent contractors and freelancers are not covered because there is no employer-employee relationship, though they can buy voluntary coverage through private carriers. Domestic workers who work at least 40 hours per week for a single employer are covered under both programs.

What Comes Out of Your Paycheck

Both programs are funded in part through small employee payroll deductions. For DBL, the most your employer can deduct is $0.60 per week. For PFL in 2026, the deduction is 0.432 percent of your gross wages per pay period, with a maximum annual contribution of $411.91.¹ Earn less than the state average weekly wage of $1,833.63 and your total annual contribution will fall below that cap.

These deductions are the employee share only. Employers cover the rest through their insurance premiums, and PFL coverage is typically added as a rider on the employer’s existing disability policy.⁷

Filing a Disability Claim

DBL claims start with Form DB-450, the Notice and Proof of Claim for Disability Benefits.⁸ The form has three parts: you complete Part A with personal and employment information, your healthcare provider completes Part B with the medical justification for your inability to work, and your employer completes Part C.⁹

Submit the completed form to your employer’s insurance carrier within 30 days of the first day you were unable to work. Miss that deadline and you can lose benefits entirely. There is also a seven-day unpaid waiting period, so you must be out of work at least eight consecutive days to receive any payment.

Once the carrier has your completed claim, it has 18 days to pay or issue a formal denial. Approved payments are typically issued every two weeks.

Filing for Paid Family Leave

PFL claims use the Request for Paid Family Leave (Form PFL-1), which has sections for both you and your employer.¹⁰ Along with the PFL-1, you send documentation that matches your reason for leave:

Bonding with a newborn: a birth certificate or hospital documentation.
Bonding through adoption or foster care: official placement documentation from a court or agency.
Caring for a family member: a medical certification from that family member’s healthcare provider describing the condition and expected duration of care.
Military-related qualifying event: copies of active duty orders or other Department of Defense documentation.

Submit the completed PFL-1 and supporting documents directly to your employer’s PFL insurance carrier, not to a state agency. The same 30-day filing deadline applies from the first day of leave.¹¹ If your employer is self-insured, everything goes to the internal benefits administrator instead. The carrier has 18 days to respond.

Getting documents organized before you file matters. A missing birth certificate or an incomplete medical certification is the most common reason a claim stalls. Your payroll department can give you the Federal Employer Identification Number the form asks for; it also appears on your W-2.⁷

Job Protection and Health Insurance While You’re Out

PFL comes with strong job protection. Your employer must reinstate you to the same position or a comparable one when you return, and cannot fire you, cut your pay, or discipline you for requesting or taking leave.¹² DBL does not carry the same explicit reinstatement guarantee under state law, though federal FMLA protections may apply if you qualify.

Your employer must also continue your group health insurance during PFL on the same terms as if you were still working. You keep paying your normal share of the premium. If your premium payment is more than 30 days late, your employer can drop your coverage after giving you at least 15 days’ written notice. If the employer changes health plans or adds benefits while you’re on leave, you’re entitled to the updated coverage like any active employee.

How PFL Works With Federal FMLA

Many employees qualify for both New York PFL and the federal Family and Medical Leave Act, which provides up to 12 weeks of unpaid, job-protected leave per year. When one event qualifies under both programs, your employer can require the leaves to run at the same time rather than back-to-back. To do that, the employer must notify you that your absence qualifies under both laws and that it will count against both entitlements at once.⁵

The practical effect: if your employer designates the leave as both PFL and FMLA, you get paid benefits through PFL while also using your FMLA time. You do not get 12 weeks of PFL followed by another 12 weeks of FMLA for the same event. Some qualifying events differ, though. FMLA covers your own serious health condition, which PFL does not. PFL covers military family needs that FMLA may not. When only one program applies, the leave runs under that program alone.

FMLA also requires employers to maintain your group health insurance during leave on the same conditions as PFL. One important difference: FMLA applies only to employers with 50 or more employees within a 75-mile radius, while PFL applies to nearly all private employers regardless of size.¹³ At a small employer, PFL may be your only source of paid, job-protected leave. Federal law also lets your employer require you to use accrued vacation or sick time concurrently with FMLA leave, which can eat into your remaining paid time off.

Federal Taxes on Your Benefits

The IRS set out how these benefits are taxed in Revenue Ruling 2025-4, and the rules split by program.¹⁴

PFL benefits are fully included in your federal gross income. They are not subject to Social Security or Medicare taxes. The state issues a Form 1099 for totals above $600. No federal taxes are automatically withheld from PFL payments, so plan for a possible tax bill or adjust your withholding elsewhere.

DBL benefits are split. The portion of your benefit attributable to your own payroll contributions (the $0.60 per week) is excluded from federal gross income. The portion tied to your employer’s contributions is taxable and treated as third-party sick pay for employment tax purposes. Because the employee contribution is small relative to the total cost, most of your disability benefit will be taxable.

If Your Claim Is Denied

The appeal path depends on which program denied you.

For DBL, you can challenge a denial through the Workers’ Compensation Board’s hearing process. A Workers’ Compensation Law Judge hears testimony and reviews the evidence before deciding. Either side can then appeal that decision through the Board’s administrative review process.¹⁵

PFL denials go a different way. Disputes go to arbitration rather than a Board hearing. You must submit a request for arbitration within 26 weeks of receiving the written denial. The arbitrator reviews the claim independently and issues a binding decision. Keep copies of everything you submit, and use certified mail or another trackable method so you can prove you met the 30-day filing deadline and the arbitration window.

1
Paid Family Leave. New York Paid Family Leave Updates for 2026
2
Paid Family Leave. Employees – New York State Paid Family Leave
3
New York State Senate. New York Workers’ Compensation Code Article 9 – Disability Benefits
4
New York State Senate. New York Workers’ Compensation Code 203 – Employees Eligible for Benefits
5
Paid Family Leave. Paid Family Leave and Other Benefits
6
Paid Family Leave. Paid Family Leave Information for Employers
7
New York State Workers’ Compensation Board. Disability Benefits and Paid Family Leave Insurance
8
New York State Workers’ Compensation Board. New York State Notice and Proof of Claim for Disability Benefits
9
New York State Insurance Fund. Filing a Claim – NYSIF
10
New York State Workers’ Compensation Board. Request for Paid Family Leave Instructions
11
New York State Insurance Fund. About Your Paid Family Leave Claim
12
Paid Family Leave. Employer Responsibilities and Resources
13
U.S. Department of Labor. FMLA Frequently Asked Questions
14
Internal Revenue Service. Revenue Ruling 2025-4
15
New York State Workers’ Compensation Board. Appeals Information and Resources for Appealing a Board Decision