Who Is Eligible

Welfare Fund Disability Benefits will be paid to you under the following conditions:

1. You are a covered member at the time your disability begins.

2. You have exhausted paid leave.

3. You are unable to perform the duties of your occupation as result of your disability.

4. You are under the care of a licensed physician. You must be under the care of a psychiatrist when the disability is of psychological nature.

5. You are on approved sick leave, approved maternity leave [or involuntary medical leave] from the City of New York or other qualified employer.

6. You have served a waiting period of 7 calendar days during all of which time you were unable to work. The 7 day waiting period begins on the first day of absence from your work location.

7. The Fund receives medical certification of your continuing disability every 30 days, or more frequently if requested.

Disability Benefits for Maternity

Welfare Fund Disability Benefits for maternity are payable for up to eight weeks (10 weeks for a Cesarean delivery). Disability Benefits are payable effective the first day of absence from work on approved maternity leave, or after the member has exhausted her accumulated annual leave, whichever occurs later. Disability Benefits for maternity are payable once per infant and only once during the infant’s first year.

What is the Benefit

Disability Benefits are payable at the rate of $200 per week* for a maximum period of 26 weeks during any two year (24 month) period. If you have used the maximum 26 weeks of Disability Benefits, you and your eligible dependents remain covered by other Welfare Fund benefits for up to an additional six months, provided that you remain disabled during this period.

* In no event will Disability Benefits plus other compensation received while disabled exceed the member’s salary prior to disability.

The Welfare Fund must withhold F.I.C.A. (Social Security) tax* from weekly Disability Benefits; therefore this amount is deducted from your gross benefit check.  Disability Benefits may also be subject to income tax, and the Fund must report to the Employer the value of the benefits paid  for each member who receives Disability Benefits. You may, if you wish, request the Fund to withhold Federal income tax.

*The F.I.C.A. rate for 2020,  for example. is 7.65%; therefore, $15.30 is withheld from the weekly benefit, resulting in the weekly net amount of $184.70.

Waiver of Waiting Period In Event of Relapse

It is presumed that you have had a relapse if you returned to work for 30 consecutive calendar days or less and then become disabled for not less than five consecutive working days as a result of the same cause for which you were originally absent. In such an instance, you may resume receiving your Disability Benefits until your 26 week maximum has been reached without having to satisfy a new 7-  day waiting period.  However, Disability Benefits do not resume until you exhaust any accumulated leave.

It will not be considered a relapse if you become disabled again for the same cause after having returned to work for more than 30 consecutive calendar days. In that event, a separate disability period has begun requiring a new 7- day waiting period.

Exclusions And Limitations

No Disability Benefits shall be payable for any period:

1. During which benefits are paid or payable under any unemployment compensation, Worker’s Compensation or similar laws;

2. During which the covered member is not under the care of a licensed physician; or

3. During terminal leave that began prior to the onset of the disability.

Workers Compensation

The Fund will process a claim for disability benefits where a member may be entitled to Worker’s Compensation benefits.  In the event the member should be successful and granted Worker’s Compensation benefits for full salary for the period he/she received disability benefits from the Fund, then the Fund shall be entitled to full reimbursement from the member for the period it paid disability benefits and the member was granted Worker’s Compensation benefits for full salary.

How To Apply For Your Disability Benefits

Write or telephone the Fund Office in order to obtain a Disability Claim Form. Complete your portion of the claim form, and have your doctor complete his/her portion of the form.

After making sure that all questions are answered, sign the form and send it to the Welfare Fund Office. The Fund requires a periodic review of your disability by your physician, and the Fund may also require that you be examined by a consulting physician designated by the Fund. Such an examination will be arranged at no expense to you, and you will receive ample notice when the appointment is being made. Every effort will be made to schedule this appointment at a time that is convenient for you.

Please note that in cases where a member may be pursuing a Worker’s Compensation claim, the member will be required to sign a form acknowledging the Fund’s right of reimbursement from the Worker’s Compensation recovery, which form will be filed with the Worker’s Compensation Board.

If you are eligible for, or are receiving Disability Benefits, you and your eligible dependents continue to remain eligible for Welfare Fund benefits for a maximum of 26 weeks during a 24 month period (plus the 7  day waiting period) from the date of the commencement of the disability.

If you have used the maximum 26 weeks of Disability Benefits, you and your eligible dependents remain covered by other fund benefits for up to an additional six months, provided that you remain disabled.