Form Db 120 1 PDF Details

In navigating the requirements set forth by New York State law for employers, understanding and utilizing the DB-120.1 form becomes crucial. This form serves as a testament to the fact that a business has procured disability benefits insurance for its employees through a verified New York State disability benefits insurance carrier or an authorized agent of that carrier. Mandatory for any business employing individuals in New York State for over 30 days within a calendar year, the DB-120.1 form underscores an employer's compliance with the state's disability benefits coverage mandate. The form is provided by either the insurance carrier directly or by a licensed New York State insurance agent acting on the carrier’s behalf. Its primary purpose is to furnish undeniable proof that the employer has secured the necessary insurance to safeguard employees against financial hardships stemming from off-the-job injuries or illnesses. Crucially, this form is required before the issuance of any permits or the execution of contracts, signifying its importance in the regulatory framework governing New York State employers. For entities like The Research Foundation of the State University of New York, which operate within this jurisdiction, ensuring that their disability benefits insurance carrier is highly rated and maintains that rating throughout the policy term is not just about regulatory compliance—it's also about trust and reliability in providing for employees' well-being during challenging times.

QuestionAnswer
Form NameForm Db 120 1
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesdb120 1 pdf, db 120 1 form, db 120 1 certificate, certificate nys disability

Form Preview Example

DB-120.1 – Certificate of Insurance Coverage Under the NYS Disability Benefits Law

 

Acceptable proof that the business listed

What is the DB-120.1 form?

has secured from a NYS disability benefits

insurance carrier or an insurance agent of

 

 

that carrier disability benefits insurance.

 

The DB-120.1 must be completed by either

 

the NYS statutory disability benefits

 

insurance carrier, or a licensed NYS

Who provides the DB-120.1 form?

insurance agent of that carrier. The form

 

can be obtained by contacting the Bureau

 

of Compliance

 

(certificates@wcb.state.ny.us).

 

To establish proof that a business has

Why it is needed?

secured disability benefits insurance

 

coverage for all its employees.

 

Prior to any permit being issued or any

When is it needed?

contract, including purchase orders, being

 

entered into for work

Who is the certificate holder?

The Research Foundation of the State

University of New York

 

Who are the additional insureds?

N/A

New York State requires employers to provide disability benefits coverage to employees for an off-the-job injury or illness. Disability benefits coverage is required is an employers employs individuals in New York State for more than 30 days in a calendar year.

The Workers' Compensation Law requires employers to post Form DB-120, Notice of Compliance – Disability Benefits Law, in all business locations. Whenever an employee is absent from work due to disability for more than seven consecutive days, the employer shall, within five days thereafter, provide the employee with prescribed Form DB-271s – Statement of Rights under the Disability Benefits Law.

The insurance carrier must be rated at least "A-" in the then most recently published A.M. Best Insurance Report. If during the term of the policy, a carriers rating falls below "A-", the insurance must be replaced no later than the renewal date of the policy with an insurer acceptable to the Research Foundation.

The next page provides a sample of a DB-120.1 – Certificate of Insurance Coverage Under the NYS Disability Benefits Law form.