Disability Benefits Insurance. Article 55.1.2 ■
Disability Benefits Insurance. Full NYS Disability Benefits coverage for the benefit of such employees as are required to be covered by the NYS Disability Benefits Law shall be provided and evidenced by one of the following certificates:
(1) DB-120.1 (September 2015, or most current version) – Certificate of Insurance Coverage under the NYS Disability Benefits Law. The insurance carrier shall provide a completed form as evidence of in-force coverage.
(2) DB-155 (9/16) - Compliance with Disability Benefits Law. The NYS Workers’ Compensation Board’s Self Insurance Office shall provide a completed form.
(3) CE 200 - Certificate of Attestation of Exemption. (Note: This form will only be accepted as evidence of an exemption from providing Disability Benefits insurance as required by law. DASNY will not accept this as an exemption from providing Workers’ Compensation Insurance.) The Certificate may be obtained from the NYS Workers Compensation Board’s website at xxxx://xxx.xxx.xxxxx.xx.xx. The CE-200 cannot be used for multiple projects. Therefore, a new form will have to be completed prior to award of any subsequent contract.
Disability Benefits Insurance. Section 220 of the New York State Workers’ Compensation Law requires that before any permit, license or contract is issued by any municipal, county or state government entity, the applicant must submit proof of compliance with NYS disability benefits coverage requirements. All Insurance Carriers - Form DB-1 20.1 or DB-820/829 Status as Self-Insured - Form DB-155 (Please obtain the above forms from your insurance carrier or self-insurance administrator.) Statement that Applicant Is Not Required to Carry New York State - Form WC/DB-100 OR Disability Insurance Form WC/DB-101
Disability Benefits Insurance with statutory limits per New York State law without regard to jurisdiction;
Disability Benefits Insurance. Employer shall provide the New York State Disability Benefits insurance Plan for all full-time and part-time employees.
Disability Benefits Insurance. Employer will continue to provide present fully paid disability benefit insurance for each regular and Class A employee.
Disability Benefits Insurance. Full NYS Disability Benefits coverage for the benefit of such employees as are required to be covered by the NYS Disability Benefits Law shall be provided and evidenced by one of the following certificates:
(1) DB-120.1 (September 2015, or most current version) – Certificate of Insurance Coverage under the NYS Disability Benefits Law. The insurance carrier shall provide a completed form as evidence of in- force coverage.
(2) DB-155 (9/16) - Compliance with Disability Benefits Law. The NYS Workers’ Compensation Board’s Self Insurance Office shall provide a completed form.
(3) CE 200 - Certificate of Attestation of Exemption. (Note: This form will only be accepted as evidence of an exemption from providing Disability Benefits insurance as required by law. DASNY will not accept this as an exemption from providing Workers’ Compensation Insurance.) The Certificate may be obtained from the NYS Workers Compensation Board’s website at xxxx://xxx.xxx.xxxxx.xx.
Disability Benefits Insurance. Full NYS Disability Benefits coverage for the benefit of such employees as are required to be covered by the NYS Disability Benefits Law shall be provided and evidenced by one of the following certificates:
(1) DB-120.1 (September 2015, or most current version) – Certificate of Insurance Coverage under the NYS Disability Benefits Law. The insurance carrier shall provide a completed form as evidence of in-force coverage.
(2) DB-155 (9/16) - Compliance with Disability Benefits Law. The NYS Workers’ Compensation Board’s Self Insurance Office shall provide a completed form.
(3) CE 200 - Certificate of Attestation of Exemption. (Note: This form will only be accepted as evidence of an exemption from providing Disability Benefits insurance as required by law. XXXXX will not accept this as an exemption from providing Workers’ Compensation
Disability Benefits Insurance. Full New York State Disability Benefits coverage for the benefit of such employees as are required to be covered by the New York State Disability Benefits Law shall be provided and evidenced by one of the following certificates:
a. DB-120.1 (September 15, or most current version) - Certificate Of Insurance Coverage Under the NYS Disability Benefits Law.
b. DB-155 (9/16) – Compliance with Disability Benefits Law. The NYS Workers’ Compensation Board’s Self Insurance Office shall provide a completed form.
Disability Benefits Insurance. Section 220 of the New York State Workers’ Compensation Law requires that before any permit, license or contract is issued by any municipal, county or state government entity, the applicant must submit proof of compliance with NYS disability benefits coverage requirements. All Insurance Carriers - Form DB-1 20.1 or DB-820/829 Status as Self-Insured - Form DB-155 Statement that Applicant Is Not Required to Carry New York State - Form CE-200 OR Disability Insurance Form CE-200 Form CE-200 may be found on the Board’s website at xxxx://xxx.xxx.xx.xxx/content/ebiz/wc_db_exemptions/requestExemptionOverview.jsp If you have questions regarding disability benefits insurance coverage requirements, please contact the Disability Benefits Office at: 1800-353-3092. APPENDIX G ADDITIONAL INSUREDS
