COVID-19 FAQs on NY’s Short-Term Disability and Paid Family Leave

March 31, 2021 Update: There have been changes to the NY Emergency Paid Sick Leave law (NYEPSL) and federal Families First Coronavirus Response Act (FFCRA) in 2021, and many of the provisions in this blog post no longer apply.  Please visit this new article on the how the 2021 changes may affect you

 

As things continue to evolve, we are here to help guide you through benefit options available to New Yorkers in light of COVID-19.  Below, our DBL/PFL Experts respond to your most frequently asked questions about how this pandemic relates to NY statutory insurance coverages – specifically, NY Disability Benefits Law (DBL) and NY Paid Family Leave (PFL).  These answers are to our best understanding of the new legislation and have last been revised on May 17, 2020, to assure we keep the information up-to-date for you. We may update or clarify answers as NY State issues more guidance on the administration of the emergency benefit.

What is New York’s Emergency COVID-19 Paid Sick Leave?
It is emergency legislation to help ease some of the financial strains for NY employees who can’t work while under an order for quarantine/isolation or caring for their minor, dependent child who is under an Order of Quarantine. The law provides job protection (in form of job restoration and non-retaliation provisions) and paid sick leave during the time of their qualified quarantine. The actual benefit structure (and whether benefits are provided by the employer or through special emergency benefits paid for by New York’s statutory DBL/PFL insurance) depends on the size and annual net income of the employer (learn more here).

The NY law became effective March 18, 2020, and is the primary COVID-19 benefit source for New Yorkers until a federal law “Families First Coronavirus Response Act” (FFCRA) became effective on April 1, 2020. Thereafter, some New Yorkers may still qualify for NY’s emergency benefits, e.g., if they exceed the federal salary cap or if their quarantine lasts longer than the 2 weeks granted under the FFCRA. Learn more about the federal law here or how the two laws compare and coordinate here.

The FAQs in this article focus only on the special Emergency DBL/PFL Quarantine Benefits paid through NY State Short-Term Disability (DBL) and Paid Family Leave (PFL) Insurance. To learn more about the overall law and benefit structure, visit this article about the New York bill here.

Please note that preventative social distancing is not covered (even if it’s ordered by NY State, such as “New York on Pause” or other stay-at-home notices).  

 

What is covered under NY’s Emergency COVID-19 Paid Sick Leave benefits?
If you cannot work while under an Order of Quarantine/Isolation (including remotely from home) or your minor child is subject to an Order of Quarantine/Isolation, the Order is issued by a government entity (such as the state of New York, the department of health, local board of health, or similar), and you meet certain other criteria (keep reading for details), the quarantine may be eligible for Emergency DBL/PFL Quarantine benefits. See what’s considered a “qualified COVID-19 quarantine” below or check out this helpful infographic.

Since the requirements and benefits for an employee’s own quarantine versus caring for a child who is under an official Order of Quarantine are distinctly different, we have broken out our FAQs accordingly. Please jump to your section of interest for respective details.

 

What is an “Order of Quarantine/Isolation?”
The “Order of Quarantine” is official, written documentation issued to individuals who need to be isolated.  See a sample from New York State here. Official stay-at-home orders, “New York on Pause,” or general social distancing notices are not considered an “Order of Quarantine” under the “Emergency COVID-19 Paid Sick Leave.”

 

What is the difference between quarantine, isolation, and social distancing?
The Centers for Disease Control and Prevention (CDC) define isolation, quarantine, and social distancing as follows:

• Isolation separates sick people with a quarantinable communicable disease from people who are not sick.
• Quarantine separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick.
• Social distancing means remaining out of congregate settings, avoiding mass gatherings, and maintaining distance (approximately 6 feet or 2 meters) from others when possible.

 

 

COVID-19 Benefits for Self-Care (Covered Employee’s Own Quarantine)

 

What is considered a “qualified COVID-19 quarantine” that makes me eligible for special Emergency DBL/PFL Quarantine benefits under NY’s law?
To be considered a “qualified COVID-19 quarantine/isolation” for the purpose of special NY Emergency DBL/PFL Quarantine benefits, you must meet all of the following criteria:

1. Your employer has less than 100 employees.
   (See next question for benefit options if you work at a larger employer.)
2. You yourself are under an official “Order of Quarantine” issued by the by the state of New York, the department of health, local board of health, or other applicable governmental entity.
3. You cannot perform your regular job responsibilities (or any alternative duties offered by your employer) due to the novel coronavirus.

Here’s how your quarantine days influence your benefit options:

1. March 18-31, 2020 – NY law may be your sole benefit option (this is when the NY law became effective through the effective date of the Federal law).  
2. April 1-December 31, 2020 – NY law may be your supplemental and extended benefit option in addition to the Federal law. The Federal law has a more lenient definition of quarantine. Learn more here.
3. Since the Federal law is currently set to end on December 31, starting January 2021, the NY law may be your primary benefit again.

Check out this helpful infographic before you file your claim to make sure you’re eligible!

If you are eligible based on these requirements, please do not submit your Emergency DBL/PFL Quarantine claim on regular PFL or DBL claim forms. It must be submitted on its own, separate COVID-19 Emergency DBL/PFL claim form (get it here).

Your employer’s size further drives after how many days of quarantine you may qualify for Emergency DBL/PFL Quarantine benefits:

• Your employer has 10 or less employees with less than $1 million annual income: your entire quarantine qualifies for special DBL/PFL quarantine benefits from day 1 assuming it started March 18 or later, or any additional days after your Federal benefits (effective April 1) end.
• If your employer has more than $1m in annual income or has 11-99 employees: your special DBL/PFL Quarantine benefits will kick in on day 6 of your quarantine (your employer has to provide paid sick leave for you during the first 5 days), assuming this time frame falls before the Federal law starts on April 1.
  • Otherwise, if your quarantine last longer than 14 days, you may qualify for special DBL/PFL quarantine benefits after your Federal benefits end.

 

Am I eligible for special Emergency DBL/PFL Quarantine benefits under NY’s law if I work at an employer with 100 or more employees?
No, special Emergency DBL/PFL Quarantine benefits do not apply. However, you still have these options if the quarantine is for yourself, the employee (“self-care”):

1. Larger employers have to continue their employee’s salary for at least 14 days.
2. If your quarantine lasts longer than 14 days, you may apply for regular DBL (State Disability) benefits thereafter until your quarantine is over, using the regular DBL claim form.
   The maximum statutory DBL benefit is $170/week, or, if your employer provides an enhanced DBL benefit level, at the respective coverage level of your employer’s policy. In this case, a copy of the official Order of Quarantine is not required to file your claim.

 

Does the employee count of 100 or more apply to just those in New York State, or total?
The total number of employees, regardless of the state where they work.

 

What do I need to file for Emergency DBL/PFL Quarantine benefits?

1. Use the special COVID-19 claim form
2. Provide a copy of your Official Order for Quarantine. Learn more here on obtaining this document.

Get a step-by-step guide on how to apply for these benefits here.

 

How do the special Emergency DBL/PFL Quarantine benefits under NY’s law work?
This particular benefit only applies to an employee’s self-care during a qualified quarantine as described above (if your minor child is under quarantine, please skip ahead to the next section). Although these special Emergency DBL/PFL Quarantine benefits are paid out through PFL and DBL insurance coverage, they are different from regular DBL/PFL benefits: The benefit amount under these COVID-19 emergency benefits differs greatly from the regular benefit levels. Emergency benefits for an employee’s own, qualified quarantine are paid concurrently through both coverages, with 60% of your regular weekly salary coming through the PFL coverage and the remainder being covered through your DBL coverage to the max of $2,884.62 per week. Learn more about the benefit calculation here.

However, please note: the time taken for a COVID-19-related claim does reduce the remaining benefit duration available under your regular DBL and PFL insurance coverage.

 

Governor Cuomo has put “New York on Pause” mandating 100% non-essential workers stay home – does this mean I can file for NY’s Emergency Paid Sick Leave?
No, NY’s general stay-at-home orders are not considered an “Order of Isolation or Quarantine,” and the New York law does not cover preventative social distancing.
 

 

What if I decide to self-quarantine (social distance) - can I take COVID-19 quarantine leave?
No. This law does not apply to preventative social distancing (even if ordered by New York State).

This new law only provides benefits in certain cases when someone is under an order of quarantine/isolation – either mandatory or precautionary – and meets all the criteria for a qualified quarantine, such as not being able to perform their regular job responsibilities or alternative duties offered by the employer. See question below for more details.

 

Is staying at home under an Order of Mandatory or Precautionary Quarantine always covered?
No, if you’re able to work during your quarantine, your quarantine (whether mandatory or precautionary) does not qualify for benefits under the NY “Emergency COVID-19 Paid Sick Leave” when you’re performing your regular job duties or alternative responsibilities during that time.

For example, if you normally work at the check-out of your store but your store is closed because of a mandatory or precautionary quarantine order and you cannot do any other job functions, you may qualify for benefits under certain circumstances. See if you may qualify here.

However, if you are now performing alternative functions remotely from home (such as answering customer calls or manning an online customer support chat, etc.), you do not qualify for benefits.

Please note: Staying home due to “NY on Pause” is not considered a “qualified precautionary quarantine,” and this law does not apply to preventative social distancing (even if ordered by New York State).

 

My employer’s business closed. Can I file for Emergency COVID-19 Paid Sick Leave benefits?
No. If your employer’s business is closed as a result of the current situation and you are not being paid, or you have been laid off or furloughed, consider filing for unemployment insurance; and consider looking into the special unemployment benefit under Pandemic Unemployment Assistance (PAU). This additional financial support is currently scheduled to run through July 31, 2020. You can learn more here.

 

COVID-19 Benefits to Care for Minor Child

 

My child’s school/daycare is closed due to the Coronavirus/COVID-19 – can I file for Emergency COVID-19 Paid Sick Leave benefits because I have to stay home and take care of them?
No. If your child’s school or daycare was closed for preventative measures this is considered preventive social distancing and does not qualify under the “Emergency COVID-19 Paid Sick Leave.” 

However, after the effective date of the Federal law (“Families First Coronavirus Response Act”)  on April 1, 2020, you may qualify for some benefits under this law. Please contact your employer about this option as the benefits may be provided by them. ShelterPoint does not administer claims for the Federal law.

 

How does it work if my child has COVID-19?
Assuming you work at an employer with less than 100 employees, you receive job protection but your employer doesn’t need to provide sick leave. Instead, you may file for special Emergency PFL Quarantine benefits if you can’t work because you’re caring for your minor, dependent child who is under an official Order of Quarantine. The Emergency PFL Quarantine benefit follows the current, regular Paid Family Leave calculation with a maximum benefit amount of $840.70 per week (learn more about calculating PFL benefits here.)

Here’s how your child’s quarantine days influence your benefit options:

1. March 18-31, 2020 – NY law may be your sole benefit option (this is when the NY law became effective through the effective date of the Federal law).  
2. April 1-December 31, 2020 – NY law may be your extended benefit option in addition to the Federal law if your child’s quarantine lasts longer than 14 days, i.e. if you qualify for the Federal law (your employer has less than 500 employees), coordinate your paid emergency sick leave with your employer for the first 14 days, then apply for Emergency PFL Quarantine benefits thereafter. Learn more here.
3. Since the Federal law is currently set to end on December 31, starting January 2021, the NY law may be your primary benefit again.

If your child is not under an Order for Quarantine but has an official doctor’s note/diagnosis and your child’s condition counts as “serious health condition” under regular Paid Family Leave, you may file for caregiver leave under regular Paid Family Leave. Learn more about current PFL benefits here.

 

My child is under an official Order of Quarantine but my employer has more than 100 employees. Am I eligible for any special Emergency DBL/PFL Quarantine benefits under NY’s law?
No, special Emergency PFL Quarantine benefits do not apply. While you receive job protection, larger employers do not have to continue your salary under the NY law if you’re caring for your quarantined child. In that case, you could file for regular Paid Family Leave Benefits.

One the Federal law goes in effect, you have these additional options:

1. If you qualify for the Federal law (your employer has less than 500 employees), coordinate with your employer to receive sick pay for the first 14 days; thereafter you may file for regular level Paid Family Leave benefits with your PFL insurance carrier for the remainder of your child’s quarantine, using the regular PFL form.

If you don’t qualify for the Federal Law (your employer has 500 or more employees), you may file for regular level Paid Family Leave benefits with your PFL insurance carrier from day 1 of your child’s quarantine, assuming it started after March 18, using the regular PFL form for family care.

 

Benefits to Care for Other Family Members

 

What if I am caring for a family member with COVID-19, can I file for Paid Family Leave benefits?
Maybe. The qualifying family member would need to meet all criteria of having a “serious health condition” and be undergoing “treatment” for the condition by a health care provider.

Read more about Paid Family Leave for Caregiving here to learn under which circumstances you may qualify for caregiver leave.

Please note: If filing for PFL benefits to care for a qualified family member other than your minor child, you would use the regular PFL caregiver claim form, not the special emergency COVID-19 forms.  

 

ShelterPoint Response & Preparedness

 

Is ShelterPoint accepting claims for the new Emergency COVID-19 Paid Sick Leave?
Yes, however, please note that in order for the claim to be valid, your claim must meet the respective requirements outlined in the FAQs in this article.

You can also check out this infographic to see if you are eligible before filing a claim.

“NY State on Pause” and other preventative social distancing (closing down schools and /or businesses) are not considered a quarantine and are thereby NOT payable claims.

If your employer’s business is closed and you are not being paid, or you have been laid off or furloughed, you may be eligible for unemployment benefits.  You can learn more here.

*After that date, the NY law will typically only be available if you exceed the Federal law’s salary cap and can file for supplemental benefits bridging between the Federal and State caps.

 

Is ShelterPoint prepared to continue servicing its clients in the wake of the COVID-19 pandemic?
Yes, we have a business continuity plan in place and we have taken proactive steps to best assure our ability to operate and process claims. Being able to service our customers while ensuring the safety of our employees is an essential priority during these challenging times.  You can read more about our preparedness here.

 

I heard some carriers are not accepting new applications for NY State Disability (DBL) and Paid Family Leave (PFL). What is ShelterPoint’s stance?
ShelterPoint remains committed to New York’s small businesses, which have been hit especially hard by the COVID-19 pandemic. To honor our commitment to  New York businesses, we continue to accept new DBL/PFL applications even in these challenging times.

Stay tuned, as this situation continues to evolve, we will add more FAQs to this page, along with other tools and guidance on our COVID-19 Resource Center. 

 

 

This blog post is for informational purposes only and is not intended to provide legal counsel. Please consult with an appropriate professional for legal and compliance advice. Any Emergency COVID-19 Paid Sick Leave, Disability Benefits Law (DBL) and/or Paid Family Leave (PFL) information is as of the blog post’s date stamp; it is based on the applicable statutes and regulation, and may change as regulations evolve or NY State issues guidance.