Temporary Disability Benefits Laws

Transcription

1 Temporary Disability Benefits Laws Revised July 2013 Disability insurance benefits are generally a matter of agreement between an employer and an employee (or the employee's representative) and is not required by federal law. While disability benefits are not generally required by federal or state law, there are some states with temporary disability programs regulated by state law. To check whether there is pending legislative issues or recently enacted legislative changes for your state(s) please click here. To access additional SHRM State Law & Regulation Resources click here. Temporary disability benefits are regulated only by individual state laws and are not required under any existing federal laws, therefore, if a state does not appear on the following chart it is due to our not finding any evidence a statute exists for that state. In some cases provisions only exist for public employers. Please note: This material is for personal use only and is protected by U.S. Copyright Law (Title 17 USC). It is provided as general information only and does not constitute and is not a substitute for legal or other professional advice. Reliance upon this material is solely at your own risk. State California Statute Purpose -- The purpose of this part is to compensate in part for the wage loss sustained by any individual who is unable to work due to the employee's own sickness or injury, the sickness or injury of a family member, or the birth, adoption, or foster care placement of a new child, and to reduce to a minimum the suffering caused by unemployment resulting therefrom. This part shall be construed liberally in aid of its declared purpose to mitigate the evils and burdens that fall on the unemployed worker and his or her family Unemployment Compensation Disability Benefits -- Unemployment compensation disability benefits are payable from the Disability Fund to individuals who are eligible to receive such benefit payments under this part Disability or Disabled Defined -- (a) An individual shall be deemed disabled on any day in which, because of his or her physical or mental condition, he or she is unable to perform his or her regular or customary work. (b) For purposes of this section, "disability" or "disabled" includes: (1) Illness or injury, whether physical or mental, including any illness or injury resulting from pregnancy, childbirth, or related medical condition. (2) Inability to work because of a written order from a state or local health officer to an individual infected with, or suspected of being infected with, a communicable disease. (3) Acute alcoholism being medically treated or, to the extent specified in Section , resident status in an alcoholic recovery home. (4) Acute drug-induced illness being

2 medically treated or, to the extent specified in Section , resident status in a drug-free residential facility. (c) For purposes of this section, if an individual participates in a vocational rehabilitation plan under Article 2.6 (commencing with Section 4635) of Chapter 2 of Part 2 of Division 4 of the Labor Code, regular or customary work shall, upon completion of the plan, mean only that employment for which the individual has been retrained under the vocational rehabilitation plan Eligibility During Confinement in Alcoholic Recovery Home -- (a) An individual who is a resident in an alcoholic recovery home pursuant to referral or recommendation by a physician shall be eligible for disability benefits for a period not in excess of 30 days in any disability benefit period while receiving resident services, if an authorized representative of the alcoholic recovery home certifies that the individual is a resident participating in an alcoholic recovery program which has been certified by the State Department of Alcohol and Drug Programs. The individual shall be eligible for disability benefits for an additional period not in excess of 60 days if the referring physician certifies to the need of the individual for continuing resident services. (b) The department shall reimburse the State Department of Alcohol and Drug Programs from the Disability Fund, in a reasonable amount as determined by the department, for the expense of reviewing any alcoholic recovery program, as required by the department in the administration of subdivision (a) which is not funded in the county alcohol program plan provided for in Article 3 (commencing with Section 11810) or Article 4 (commencing with Section 11830) of Part 2 of Division 10.5 of the Health and Safety Code. (c) Outside the State of California, an individual who is a resident in an alcoholic recovery home pursuant to referral or recommendation by a physician shall be eligible for disability benefits for a period not in excess of 30 days in any disability benefit period while receiving resident services, if an authorized representative of the alcoholic recovery home certifies that the individual is a resident participating in an alcoholic recovery program, licensed by or satisfying a program review by the state in which the facility is located. The individual shall be eligible for disability benefits for an additional period not in excess of 60 days if the referring physician certifies to the need of the individual for continuing resident services Eligibility During Stay in Drug-Free Residential Facility -- (a) An individual who is a resident in a drug-free residential facility pursuant to referral or recommendation by a physician shall be eligible for disability benefits for a period not in excess of 45 days in any disability benefit period while receiving resident services, if an authorized representative of the drug-free residential facility certifies that the individual is a resident participating in a drug-free residential facility which has satisfied a program review by the State Department of Alcohol and Drug Programs. The individual shall be eligible for disability benefits for an additional period not in excess of 45 days if the referring physician certifies to the need of the individual for continuing resident services. (b) The department shall reimburse the State Department of Alcohol and Drug Programs from the Disability Fund, in a reasonable amount as determined by the department, for the expense of reviewing any drug-free residential facility, as required by the department in the administration of subdivision (a), which is not funded under the federal Drug Abuse Office and Treatment Act of 1972 (Public Law ) or in conformance with Chapter 4 (commencing with Section 11980) of Part 3 of Division 10.5 of the Health and Safety Code. (c) Outside the State of California, an individual who is a resident in a drugfree residential facility pursuant to referral or recommendation by a physician shall be eligible for disability benefits for a period not in excess of 45 days in any disability benefit period while receiving resident services, if an authorized representative of the drug-free residential facility certifies that the individual is a resident participating in a drug-free residential program, licensed by or satisfying a program review by the state in which the facility is located. The individual shall be eligible for disability benefits for an additional period, but not in excess of 45 days, if the referring physician certifies to the need of the individual for continuing resident services Eligibility for Benefits -- A disabled individual is eligible to receive disability benefits equal to one-seventh of his or her weekly benefit amount for each full day during which he or she is unemployed due to a disability only if the director finds that: (a) He or she has made a claim for disability benefits as required by authorized regulations. (b) He or she has been unemployed and disabled for a waiting period of seven consecutive days during each disability benefit period with respect to which waiting period no benefits are payable. (c) Except as provided in Sections ,

3 and 2709 he or she has submitted to such reasonable examinations as the director may require for the purpose of determining his or her disability. (d) Except as provided in Section , he or she has filed a certificate as required by Sections 2708 or Ineligible If Receiving Unemployment Insurance -- An individual is not eligible for disability benefits with respect to any period for which the director finds that he has received or is entitled to receive unemployment compensation benefits under Part 1 of this division or under an unemployment compensation act of any other state or of the Federal Government Workers' Compensation Affects Eligibility -- (a) Except as provided in this section, an individual is not eligible for disability benefits under this part for any day of unemployment and disability for which he or she has received, or is entitled to receive, "other benefits" in the form of cash payments. (b) "Other benefits" as used in this section and Section , means any of the following: (1) Temporary disability indemnity under a workers' compensation law of this state or of any other state or of the federal government including, for purposes of this Code and Sections 4903 and 4904 of the Labor Code, a maintenance allowance paid pursuant to Section of the Labor Code. (2) Temporary disability benefits under any employer's liability law of this state or of any other state or of the federal government. (3) Permanent disability benefits for the same injury or illness under the workers' compensation law of this state, any other state, or the federal government. (c) Except for a maintenance allowance paid pursuant to Section of the Labor Code, if these "other benefits" are less than the amount an individual would otherwise receive as disability benefits under this part, he or she shall be entitled to receive, for that day, if otherwise eligible, disability benefits under this part reduced by the amount of these "other benefits." (d) An individual shall be entitled to receive, for any day, if otherwise eligible, disability benefits under this part reduced by the amount of the maintenance allowance and permanent disability indemnity if both of the following conditions are met: (1) The individual elects to receive the maximum permanent disability indemnity pursuant to paragraph (2) of subdivision (d) of Section of the Labor Code. (2) The sum of the maintenance allowance and permanent disability indemnity is less than the amount an individual would otherwise receive as disability benefits under this part Other Benefit Payments -- (a) Nothing in Section 2629 shall be construed to authorize the delay of payment of unemployment compensation disability benefits except where the claimant is currently in receipt of other benefits or where the department has received notice that the claimant's employer or insurer has agreed to commence the payment of other benefits. (b) Notwithstanding Section , payments shall commence within 14 days after notice to the employer or insurer under this section unless the employer or insurer has either paid or has agreed to commence the payment of other benefits. (c) Upon the filing of a claim for unemployment compensation disability benefits, the department shall make an initial determination as to the claimant's entitlement to other benefits for purposes of Section (1) The department shall notify the claimant and the claimant's employer if it determines that the claimant is entitled to other benefits. (2) The notice to the claimant shall inform the claimant that disability benefits will be paid pending receipt of other benefits if the employer fails to agree to pay these other benefits within 14 days of notification of industrial injury and shall advise the claimant of the provisions of Section (3) The department shall also include with the claimant's notice a pamphlet to be provided by the Department of Industrial Relations which meets the criteria specified in subdivision (b) of Section of the Labor Code. (4) The notice to the employer shall constitute a claim for compensation and knowledge of an injury for purposes of Section 5402 of the Labor Code, and shall inform the employer of its potential liability for interest and penalties under this section. (d) If the employer or the insurance carrier disputes liability for the payment of other benefits, or the extent thereof, the department's right to reimbursement shall be subject to the jurisdiction of the Workers' Compensation Appeals Board in accordance with Part 4 (commencing with Section 5300) of Division 4 of the Labor Code. (e) An employer or insurance carrier who subsequently assumes liability or is determined to be liable for reimbursement to the department for unemployment compensation disability benefits which the department has paid in lieu of other benefits shall be assessed for this liability by the department. In addition, the employer shall pay the department interest on the disability benefits at the annual rate provided in Section of the Revenue and Taxation Code. The employer shall also pay a penalty of 10 percent of the amount

4 reimbursed to the department if the Workers' Compensation Appeals Board finds that the failure of the employer to pay other benefits upon notice by the department under this section was unreasonable and a penalty has not been awarded for the delay under Section 5814 of the Labor Code. All funds received by the department pursuant to this section shall be deposited in the Disability Fund. (f) The employer shall reimburse the department in accordance with subsection (e) within 60 days of either voluntarily accepting liability for other benefits or after a final award, order, or decision of the Workers' Compensation Appeals Board Holocaust Restitution Payments -- To the extent permitted by federal law, excludable restitution payments, as defined in Section of the Revenue and Taxation Code, and excludable settlement payments, as defined in Section of the Revenue and Taxation Code, may not be applied to reduce the amount of disability benefits to which an individual may otherwise be entitled under law Notification to Department of Support Obligations -- (a) The Department of Child Support Services shall periodically notify the department of individuals who are certified, as provided in Section of the Family Code, as having support obligations, as defined by subdivision (g) and notify the department of any changes in the status of these individuals to insure that the department has a current record. (b) Upon receipt of the notifications referred to in subdivision (a), the department shall determine whether the individuals have claims for unemployment compensation disability benefits, either with the department or under an approved voluntary plan. (c) If the department determines that an individual referred to in subdivision (a) has a claim for unemployment compensation disability benefits with an approved voluntary plan, it shall notify the voluntary plan payer. When the Department of Child Support Services notifies the department of any changes in the individual's status as to his or her support obligations, the department shall in turn notify the voluntary plan payer. Upon notification from the department, the voluntary plan payer shall deduct and withhold the amounts specified in Section of the Family Code from the unemployment compensation disability benefits that would otherwise be payable to the individual. For each withholding, the voluntary plan payer shall deduct an amount which represents the amount withheld for support obligations and may also deduct an administrative fee representing actual costs, not to exceed two dollars ($2). In no event shall the withholding and the administrative fee exceed 25 percent or a lesser amount as specified in subdivision (e) of Section of the Family Code. The voluntary plan payer shall pay the amounts for support deducted and withheld pursuant to this section to the appropriate certifying county. (d) The department shall maintain a current record of individuals certified as owing support obligations. If the department determines that the individual has a claim for unemployment compensation disability benefits with the department, it shall deduct and withhold the amounts specified in Section of the Family Code from the unemployment compensation disability benefits that would otherwise be payable to the individual. The department shall periodically pay the amounts deducted and withheld to the appropriate county or to the Department of Child Support Services as the assigned payee, as stipulated by mutual agreement, in the interagency agreement between the department and the Department of Child Support Services. (e) Amounts deducted and withheld from an individual's unemployment compensation disability benefits in accordance with subdivision (c) or (d) shall for all purposes be treated as if it were paid to the individual and then paid by the individual to the Department of Child Support Services or the appropriate certifying county. (f) This section shall apply only if appropriate arrangements are made for the Department of Child Support Services to reimburse the department for its administrative costs for performing the functions required of it by this section. (g) For purposes of this section, "support obligations" means the child and related spousal support obligations described in the state plan approved pursuant to Section 454 of the Social Security Act and as that section may hereafter be amended. However, to the extent "related spousal support obligations" may not be collected from unemployment compensation under federal law, those obligations shall not be included in the definition of support obligations under this section Requirement for Valid Claim -- An individual cannot establish a valid claim unless he has during his disability base period been paid wages for employment by employers of not less than three hundred dollars ($300).

5 2653. Maximum Total Amounts -- Except as provided in Sections 708 and 708.5, the maximum amount of benefits payable to an individual during any one disability benefit period shall be 52 times his or her weekly benefit amount, but in no case shall the total amount of such benefits payable be more than the total wages paid to the individual during his or her disability base period. If the benefit is not a multiple of one dollar ($1) it shall be computed to the next higher multiple of one dollar ($1). This section shall apply to periods of disability commencing on or after January 1, Wages Due and Unpaid -- For the purpose of this article wages due to any individual but unpaid within the time limit provided by law, shall be deemed wages paid to such individual Weekly Benefit Amount -- (a) Except as provided in subdivisions (b), (c), and (d), an individual's "weekly benefit amount" shall be the amount appearing in column B in the table set forth in this subdivision on the line of which in column A of the table there appears the wage bracket containing the amount of wages paid to the individual for employment by employers during the quarter of his or her disability base period in which wages were the highest. A Amount of wages in highest quarter $75-$1, $50 1,150-1, ,175-1, ,200-1, ,225-1, ,250-1, ,275-1, ,300-1, ,325-1, ,350-1, ,375-1, ,400-1, ,425-1, ,450-1, ,475-1, ,500-1, ,525-1, ,550-1, ,575-1, ,600-1, ,625-1, ,650-1, ,675-1, ,700-1, ,725-1, B Weekly benefit amount

6 (b) For periods of disability commencing on or after January 1, 1990, and prior to January 1, 1991, if the amount of wages paid an individual for employment by employers during the quarter of his or her disability base period in which these wages were highest exceeds one thousand seven hundred fortynine dollars and twenty cents ($1,749.20), the weekly benefit amount shall be 55 percent of these wages divided by 13, but not exceeding two hundred sixty-six dollars ($266) or the maximum workers' compensation temporary disability indemnity weekly benefit amount, whichever is less. If the benefit payable under this subdivision is not a multiple of one dollar ($1), it shall be computed to the next higher multiple of one dollar ($1). (c) For periods of disability commencing on or after January 1, 1991, but before January 1, 2000, if the amount of wages paid an individual for employment by employers during the quarter of his or her disability base period in which these wages were highest exceeds one thousand seven hundred forty-nine dollars and twenty cents ($1,749.20), the weekly benefit amount shall be 55 percent of these wages divided by 13, but not exceeding three hundred thirty-six dollars ($336). If the benefit payable under this subdivision is not a multiple of one dollar ($1), it shall be computed to the next higher multiple of one dollar ($1). (d)(1) For periods of disability commencing on or after January 1, 2000, if the amount of wages paid an individual for employment by employers during the quarter of his or her disability base period in which these wages were highest exceeds one thousand seven hundred forty-nine dollars and twenty cents ($1,749.20), the weekly benefit amount shall be equal to 55 percent of these wages divided by 13, but not exceeding the maximum workers' compensation temporary disability indemnity weekly benefit amount. (2) Notwithstanding the workers' compensation indemnity weekly benefit amount of paragraph (1) of subdivision (d), if the benefit under this subdivision is not a multiple of one dollar ($1), it shall be computed to the next higher multiple of one dollar ($1) Maximum Amount -- (a) An individual eligible to receive disability benefits who receives wages or regular wages from his or her employer during the period of his or her disability or period of family care leave shall be paid disability benefits for any seven-day week or partial week in an amount not to exceed his or her maximum weekly amount which together with the wages or regular wages does not exceed his or her weekly wage, exclusive of wages paid for overtime work, immediately prior to the commencement of his or her disability or period of family care leave. (b) For purposes of this section, to determine the wages or regular wages received by the eligible individual, the amount as stated by the individual shall be presumed to be accurate. This presumption is one affecting the burden of producing evidence. (c) Except as provided in subdivision (g) of Section 3303, for purposes of periods of disability commencing on or after January 1, 1992, vacation pay is not considered wages for determining eligibility for disability benefits Maximum Amount; Exclusion -- The amount payable to an individual under Section 2656 shall be exclusive of any amount for days of disability reimbursed to the employer under Section This section shall only be applicable with respect to disabilities occurring on or after January 1, 1979, and until the effective date of this act. This section shall remain in effect only until January 1, 1980, and as of such date is repealed, unless a later enacted statute, which is chaptered before January 1, 1980, deletes or extends such date Wages Paid at Irregular Times -- If the remuneration of an individual is not based upon a fixed period or duration of time or if the individual's wages are paid at irregular intervals or in such manner as not to extend regularly over the period of employment, the wages for any week or for any calendar quarter for the purpose of computing an individual's right to disability benefits shall be determined pursuant to authorized regulations. The regulations shall, so far as possible, secure results reasonably similar to those which would prevail if the individual were paid his wages at regular intervals Base Period of Individual Involved in Trade Dispute -- Notwithstanding any inconsistent provisions in this part, except as provided in subdivision (b) of Section 2611, in determining the benefit rights of any person who was involved in a trade dispute during the disability base period, as determined pursuant to Section 2610, there shall be excluded from the disability base period those

7 quarters during which the person performed no services in employment for 60 days or more as a result of a trade dispute. For all quarters so excluded there shall be substituted an equal number of quarters immediately preceding the commencement of the trade dispute. In the event the disability base period so determined includes wages in calendar quarters for which the records have been destroyed under proper approval, a claimant may establish the amount of wages by affidavit in accordance with authorized regulations. The quarter of commencement of the trade dispute shall be counted as a completed quarter if the director finds that the inclusion thereof would be more equitable to the claimant Disqualification for False Statements -- (a) An individual shall be disqualified from receiving benefits under this part if he or she has willfully, for the purpose of obtaining benefits, either made a false statement or representation, with actual knowledge of the falsity thereof, or withheld a material fact in order to obtain any benefits under this part. (b) An individual disqualified under subdivision (a) under a determination transmitted to him or her by the department, shall be ineligible to receive benefits from the date the disqualifying determination was issued and for not less than seven nor more than 35 subsequent days for which he or she is otherwise eligible for benefits under this part. When successive disqualifications under subdivision (a) occur, the director may extend the period of ineligibility for an additional period not to exceed 56 days. (c) If all or any of the assessed days of ineligibility cannot be served because the individual is no longer otherwise eligible for benefits under this part, the assessed days of ineligibility shall be applied to any subsequent disability benefit period for which he or she is otherwise eligible for benefits. No disqualification under this subdivision shall be applied, however, to any day of eligibility which falls beyond the three-year period next succeeding the date upon which the determination was mailed or served by the department. (d) The amendments made to this section by the act [Ch. 1134, L. 1991] adding this subdivision shall apply to disqualifying determinations issued on or after January 1, Application of Unemployment Insurance Disqualifications -- An individual who is disqualified from receiving unemployment compensation benefits under Sections 1256, 1257, 1260, 1261, and 1263 shall be presumed to be ineligible to receive disability benefits under this part for the same period or periods unless he establishes to the satisfaction of the director that he is suffering a bona fide illness or injury or claiming a period of family care leave and the director finds that there is good cause for paying disability benefits Payment of Disability Benefits During Trade Dispute -- An individual who is otherwise eligible for benefits under this part shall not be disqualified from receiving such benefits because of a disqualification from receiving unemployment compensation benefits under Section Dipsomaniacs -- An individual shall be disqualified from receiving benefits under this part while he is confined, pursuant to commitment or court order or certification, in an institution or other place, as a dipsomaniac, drug addict or sexual psychopath Disqualification on Day of Death -- Notwithstanding any other provision of law, an individual who is otherwise eligible shall not be disqualified for benefits under this part for the day on which he or she or a family member, as defined in Chapter 7 (commencing with Section 3300), for whom the individual is providing care, died Ineligibility During Incarceration -- (a) An individual shall be ineligible for benefits under this part for any day during which he or she is incarcerated in any federal, state, or municipal penal institution, jail, medical facility, public or private hospital, or in any other place because of a criminal violation of a federal, state, or other municipal law or ordinance. For purposes of this section, "incarceration" includes any time spent in the custody of law enforcement authorities upon adjudication or conviction by a court of competent jurisdiction. (b) This section shall apply only with respect to periods of incarceration commencing on or after January 1, 1994.

8 2681. Illness or Injury Caused By Commission of Crime -- (a) Any individual who commits a crime shall be ineligible for benefits under this part if the individual is disabled due to an illness or injury caused by, or arising out of the commission of, arrest, investigation, or prosecution of any crime that results in a felony conviction. (b) For purposes of this section, a plea or verdict of guilty, or a felony conviction following a plea of nolo contendere or no contest shall be considered to be a felony conviction under this part, irrespective of whether an order granting probation or suspending the imposition or execution of any sentence is issued. (c) This section shall apply only with respect to convictions rendered on or after January 1, 1994, regardless of the date the disability commenced or benefits were paid Payment of Benefits -- Disability benefits shall be paid by the department through public employment offices or other agencies approved by the director Initial Payment of Disability Benefits -- The department shall issue the initial payment for unemployment compensation disability benefits to a monetarily eligible claimant who is otherwise determined eligible by the department under applicable law and regulation within 14 days of receipt of his or her properly completed first disability claim Minors -- Minors who are eligible for disability benefits may be paid and receive such benefits in their own right and a receipt signed by a minor shall be valid and binding in all respects Benefit Year -- The establishment of a disability benefit period for unemployment compensation disability benefits shall not establish a benefit year for unemployment compensation benefits and the filing of a valid claim for one shall not establish a valid claim for the other. Wages used to establish a valid claim for disability benefits may be used to establish a subsequent claim for disability benefits or unemployment compensation benefits provided such wages were paid in the base period applicable to the subsequent claim Benefits Due Deceased Person -- Where an individual who would be eligible to receive disability benefits dies before making a claim therefore, the director may in accordance with authorized regulations allow the filing of a claim for such benefits by a person legally entitled thereto under Section Filing of Claim by Spouse in Case of Mentally Unable Claimant -- Where an individual who would be eligible to receive disability benefits is mentally unable to make a claim therefor, the director shall, in accordance with authorized regulations, allow the filing of a claim for such benefits by the spouse or domestic partner of such individual, in the absence of any other legally authorized representative of the individual. Such payment shall be made upon affidavit executed by the spouse or domestic partner or person or persons claiming to be entitled to the benefits and the receipt of the affidavit or affidavits shall fully discharge the Director of Employment Development from any further liability with reference to the payments, without the necessity of inquiring into the truth of any of the facts stated in the affidavit. For the purposes of this section "mentally unable to make a claim" shall be limited to those cases in which the individual is certified by a healing arts practitioner specified in Sections 2708 and 2709 to be mentally unable to make a claim pursuant to this part. Prior to amendment by Ch. 893, L. 2001, effective January 1, 2002, the first paragraph of Sec read as follows: "Where an individual who would be eligible to receive disability benefits is mentally unable to make a claim therefor, the director shall, in accordance with authorized regulations, allow the filing of a claim for such benefits by the spouse of such individual, in the absence of any other legally authorized representative of the individual. Such payment shall be made upon affidavit executed by the spouse or person or persons claiming to be entitled to the benefits and the receipt of the affidavit or affidavits shall fully discharge the Director of Employment Development from any further liability with reference to the payments, without the necessity of inquiring into the truth of any of the facts stated in the affidavit."

9 2706. Filing of Claims -- Claims for disability benefits shall be made in accordance with authorized regulations of the Director of Employment Development. Each employer shall post and maintain in places readily accessible to individuals in his service printed statements concerning such regulations and shall make available to each such individual copies of such printed statements, regulations or matters relating to claims for disability benefits as the Director of Employment Development may prescribe. Such printed statements shall be supplied to each employer by the Director of Employment Development without cost to the employer Time Limit for Filing First Claims -- A first claim, accompanied by a certificate on a form furnished by the department to the claimant, shall be filed not later than the 41st consecutive day following the first compensable day of unemployment and disability with respect to which the claim is made for benefits, which time shall be extended by the department upon a showing of good cause. If a first claim is not complete, the claim form shall be returned to the claimant for completion and it shall be completed and returned not later than the 10th consecutive day after the date it was mailed by the department to the claimant, except that such time shall be extended by the department upon a showing of good cause Continued Medical Certification -- Any continued medical certification shall be submitted to the department within 20 days of the date the claimant is issued a notice of final payment or departmental request for additional medical certification. The 20-day time limit shall be extended by the department upon a showing of good cause Notice -- The department shall give a notice of the filing of a first claim for each disability benefit period to the employing unit by which the claimant was last employed immediately preceding the filing of such claim Information from Employer -- Within two working days after receipt of the notice provided for in Section 2707, or if there has been a termination of the claimant's service within five days after such termination, whichever is the later, the last employer shall notify the department of any information known to him which may bear upon the eligibility of the claimant Determination of Eligibility for Benefits --The department shall consider the facts submitted by the employer pursuant to Section and make a determination as to the eligibility of the claimant for benefits. The department shall promptly notify the claimant of the determination and the reasons therefore. The claimant may appeal therefrom to an administrative law judge within 20 days from mailing or personal service of the notice of determination. The 20-day period may be extended for good cause. The director shall be an interested party to any appeal. "Good cause," as used in this section, shall include, but not be limited to, mistake, inadvertence, surprise, or excusable neglect (a) (1) In accordance with the director s authorized regulations, and except as provided in subdivision (c) and Sections and 2709, a claimant shall establish medical eligibility for each uninterrupted period of disability by filing a first claim for disability benefits supported by the certificate of a treating physician or practitioner that establishes the sickness, injury, or pregnancy of the employee, or the condition of the family member that warrants the care of the employee. For subsequent periods of uninterrupted disability after the period covered by the initial certificate or any preceding continued claim, a claimant shall file a continued claim for those benefits supported by the certificate of a treating physician or practitioner. A certificate filed to establish medical eligibility for the employee s own sickness, injury, or pregnancy shall contain a diagnosis and diagnostic code prescribed in the International Classification of Diseases, or, where no diagnosis has yet been obtained, a detailed statement of symptoms. (2) A certificate filed to establish medical eligibility of the employee s own sickness, injury, or pregnancy shall also contain a statement of medical facts including secondary diagnoses when applicable, within the physician s or practitioner s knowledge, based on a physical examination and a documented medical history of the claimant by the physician or practitioner, indicating the physician s or practitioner s conclusion as to the claimant s disability, and

10 a statement of the physician s or practitioner s opinion as to the expected duration of the disability. (b) An employee shall be required to file a certificate to establish eligibility when taking leave to care for a family member with a serious health condition. The certificate shall be developed by the department. In order to establish medical eligibility of the serious health condition of the family member that warrants the care of the employee, the information shall be within the physician s or practitioner s knowledge and shall be based on a physical examination and documented medical history of the family member and shall contain all of the following: (1) A diagnosis and diagnostic code prescribed in the International Classification of Diseases, or, where no diagnosis has yet been obtained, a detailed statement of symptoms. (2) The date, if known, on which the condition commenced. (3) The probable duration of the condition. (4) An estimate of the amount of time that the physician or practitioner believes the employee is needed to care for the child, parent, spouse, or domestic partner. (5) (A) A statement that the serious health condition warrants the participation of the employee to provide care for his or her child, parent, spouse, or domestic partner. (B) Warrants the participation of the employee includes, but is not limited to, providing psychological comfort, and arranging third party care for the child, parent, spouse, or domestic partner, as well as directly providing, or participating in, the medical care. (c) The department shall develop a certification form for bonding that is separate and distinct from the certificate required in subdivision (a) for an employee taking leave to bond with a minor child within the first year of the child s birth or placement in connection with foster care or adoption. (d) The first and any continuing claim of an individual who obtains care and treatment outside this state shall be supported by a certificate of a treating physician or practitioner duly licensed or certified by the state or foreign country in which the claimant is receiving the care and treatment. If a physician or practitioner licensed by and practicing in a foreign country is under investigation by the department for filing false claims and the department does not have legal remedies to conduct a criminal investigation or prosecution in that country, the department may suspend the processing of all further certifications until the physician or practitioner fully cooperates, and continues to cooperate with the investigation. A physician or practitioner licensed by and practicing in a foreign country who has been convicted of filing false claims with the department may not file a certificate in support of a claim for disability benefits for a period of five years. (e) For purposes of this part: (1) Physician has the same meaning as defined in Section of the Labor Code. (2) Practitioner means a person duly licensed or certified in California acting within the scope of his or her license or certification who is a dentist, podiatrist, or a nurse practitioner, and in the case of a nurse practitioner, after performance of a physical examination by a nurse practitioner and collaboration with a physician and surgeon, or as to normal pregnancy or childbirth, a midwife or nurse midwife, or nurse practitioner. (f) For a claimant who is hospitalized in or under the authority of a county hospital in this state, a certificate of initial and continuing medical disability, if any, shall satisfy the requirements of this section if the disability is shown by the claimant s hospital chart, and the certificate is signed by the hospital s registrar. For a claimant hospitalized in or under the care of a medical facility of the United States government, a certificate of initial and continuing medical disability, if any, shall satisfy the requirements of this section if the disability is shown by the claimant s hospital chart, and the certificate is signed by a medical officer of the facility duly authorized to do so. (g) Nothing in this section shall be construed to preclude the department from requesting additional medical evidence to supplement the first or any continued claim if the additional evidence can be procured without additional cost to the claimant. The department may require that the additional evidence include any or all of the following: (1) Identification of diagnoses. (2) Identification of symptoms. (3) A statement setting forth the facts of the claimant s disability. The statement shall be completed by any of the following individuals: (A) The physician or practitioner treating the claimant. (B) The registrar, authorized medical officer, or other duly authorized official of the hospital or health facility treating the claimant. (C) An examining physician or other representative of the department. (h) This section shall become inoperative on July 1, 2014, and shall be repealed on January 1, (a) (1) In accordance with the director s authorized regulations, and except as provided in subdivision (c) and Sections and 2709, a claimant shall establish medical eligibility for each uninterrupted period of disability by filing a first claim for disability benefits supported by the certificate of a treating physician or practitioner that establishes the sickness, injury, or pregnancy of the employee, or the condition of the family member that warrants the care of the employee. For

11 subsequent periods of uninterrupted disability after the period covered by the initial certificate or any preceding continued claim, a claimant shall file a continued claim for those benefits supported by the certificate of a treating physician or practitioner. A certificate filed to establish medical eligibility for the employee s own sickness, injury, or pregnancy shall contain a diagnosis and diagnostic code prescribed in the International Classification of Diseases, or, if no diagnosis has yet been obtained, a detailed statement of symptoms. (2) A certificate filed to establish medical eligibility of the employee s own sickness, injury, or pregnancy shall also contain a statement of medical facts, including secondary diagnoses when applicable, within the physician s or practitioner s knowledge, based on a physical examination and a documented medical history of the claimant by the physician or practitioner, indicating the physician s or practitioner s conclusion as to the claimant s disability, and a statement of the physician s or practitioner s opinion as to the expected duration of the disability. (b) An employee shall be required to file a certificate to establish eligibility when taking leave to care for a family member with a serious health condition. The certificate shall be developed by the department. In order to establish medical eligibility of the serious health condition of the family member that warrants the care of the employee, the information shall be within the physician s or practitioner s knowledge and shall be based on a physical examination and documented medical history of the family member and shall contain all of the following: (1) A diagnosis and diagnostic code prescribed in the International Classification of Diseases, or, if no diagnosis has yet been obtained, a detailed statement of symptoms. (2) The date, if known, on which the condition commenced. (3) The probable duration of the condition. (4) An estimate of the amount of time that the physician or practitioner believes the employee needs to care for the child, parent, grandparent, grandchild, sibling, spouse, or domestic partner. (5) (A) A statement that the serious health condition warrants the participation of the employee to provide care for his or her child, parent, grandparent, grandchild, sibling, spouse, or domestic partner. (B) Warrants the participation of the employee includes, but is not limited to, providing psychological comfort, and arranging third party care for the child, parent, grandparent, grandchild, sibling, spouse, or domestic partner, as well as directly providing, or participating in, the medical care. (c) The department shall develop a certification form for bonding that is separate and distinct from the certificate required in subdivision (a) for an employee taking leave to bond with a minor child within the first year of the child s birth or placement in connection with foster care or adoption. (d) The first and any continuing claim of an individual who obtains care and treatment outside this state shall be supported by a certificate of a treating physician or practitioner duly licensed or certified by the state or foreign country in which the claimant is receiving the care and treatment. If a physician or practitioner licensed by and practicing in a foreign country is under investigation by the department for filing false claims and the department does not have legal remedies to conduct a criminal investigation or prosecution in that country, the department may suspend the processing of all further certifications until the physician or practitioner fully cooperates, and continues to cooperate, with the investigation. A physician or practitioner licensed by, and practicing in, a foreign country who has been convicted of filing false claims with the department may not file a certificate in support of a claim for disability benefits for a period of five years. (e) For purposes of this part: (1) Physician has the same meaning as defined in Section of the Labor Code. (2) Practitioner means a person duly licensed or certified in California acting within the scope of his or her license or certification who is a dentist, podiatrist, or a nurse practitioner, and in the case of a nurse practitioner, after performance of a physical examination by a nurse practitioner and collaboration with a physician and surgeon, or as to normal pregnancy or childbirth, a midwife or nurse midwife, or nurse practitioner. (f) For a claimant who is hospitalized in or under the authority of a county hospital in this state, a certificate of initial and continuing medical disability, if any, shall satisfy the requirements of this section if the disability is shown by the claimant s hospital chart, and the certificate is signed by the hospital s registrar. For a claimant hospitalized in or under the care of a medical facility of the United States government, a certificate of initial and continuing medical disability, if any, shall satisfy the requirements of this section if the disability is shown by the claimant s hospital chart, and the certificate is signed by a medical officer of the facility duly authorized to do so. (g) Nothing in this section shall be construed to preclude the department from requesting additional medical evidence to supplement the first or any continued claim if the additional evidence can be procured without additional cost to the claimant. The department may require that the additional evidence include any or all of the following: (1) Identification of diagnoses. (2) Identification of symptoms. (3) A statement setting forth the facts of

12 the claimant s disability. The statement shall be completed by any of the following individuals: (A) The physician or practitioner treating the claimant. (B) The registrar, authorized medical officer, or other duly authorized official of the hospital or health facility treating the claimant. (C) An examining physician or other representative of the department. (h) This section shall become operative on July 1, The Legislature finds and declares all of the following: (a) It is in the public benefit to provide family temporary disability insurance benefits to workers to care for their family members. The need for family temporary disability insurance benefits has intensified as the participation of both parents in the workforce has increased, and the number of single parents in the workforce has grown. The need for partial wage replacement for workers taking family care leave will be exacerbated as the population of those needing care, both children and parents of workers, increases in relation to the number of working age adults. (b) Family Temporary Disability Insurance shall be known as Paid Family Leave. (c) Developing systems that help families adapt to the competing interests of work and home not only benefits workers, but also benefits employers by increasing worker productivity and reducing employee turnover. (d) The federal Family and Medical Leave Act (FMLA) and California s Family Rights Act (CFRA) entitle eligible employees working for covered employers to take unpaid, job-protected leave for up to 12 workweeks in a 12-month period. Under the FMLA and the CFRA, unpaid leave may be taken for the birth, adoption, or foster placement of a new child; to care for a seriously ill child, parent, or spouse; or for the employee s own serious health condition. (e) State disability insurance benefits currently provide wage replacement for workers who need time off due to their own nonwork-related injuries, illnesses, or conditions, including pregnancy, that prevent them from working, but do not cover leave to care for a sick or injured child, spouse, parent, grandparent, grandchild, sibling, or domestic partner, or leave to bond with a new child. (f) The majority of workers in this state are unable to take family care leave because they are unable to afford leave without pay. When workers do not receive some form of wage replacement during family care leave, families suffer from the worker s loss of income, increasing the demand on the state unemployment insurance system and dependence on the state s welfare system. (g) It is the intent of the Legislature to create a family temporary disability insurance program to help reconcile the demands of work and family. The family temporary disability insurance program shall be a component of the state s unemployment compensation disability insurance program, shall be funded through employee contributions, and shall be administered in accordance with the policies of the state disability insurance program created pursuant to this part. Initial and ongoing administrative costs associated with the family temporary disability insurance program shall be payable from the Disability Fund (a) (1) The purpose of this chapter is to establish, within the state disability insurance program, a family temporary disability insurance program. Family temporary disability insurance shall provide up to six weeks of wage replacement benefits to workers who take time off work to care for a seriously ill child, spouse, parent, grandparent, grandchild, sibling, or domestic partner, or to bond with a minor child within one year of the birth or placement of the child in connection with foster care or adoption. (2) Nothing in this chapter shall be construed to abridge the rights and responsibilities conveyed under the CFRA or pregnancy disability leave. (b) An individual s weekly benefit amount shall be the amount provided in Section An individual is eligible to receive family temporary disability insurance benefits equal to one-seventh of his or her weekly benefit amount for each full day during which he or she is unable to work due to caring for a seriously ill or injured family member or bonding with a minor child within one year of the birth or placement of the child in connection with foster care or adoption. (c) The maximum amount payable to an individual during any disability benefit period for family temporary disability insurance shall be six times his or her weekly benefit amount, but in no case shall the total amount of benefits payable be more than the total wages paid to the individual during his or her disability base period. If the benefit is not a multiple of one dollar ($1), it shall be computed to the next higher multiple of one dollar ($1). (d) No more than six weeks of family temporary disability insurance benefits shall be paid within any 12-month period. (e) An individual shall file a claim for family temporary disability insurance benefits not later than the 41st consecutive day following the first compensable day with respect to which the claim is made for benefits, which time shall be extended by the department upon a showing of good cause. If a first claim is not complete, the claim form shall be returned to the claimant for completion and it shall be completed

13 and returned not later than the 10th consecutive day after the date it was mailed by the department to the claimant, except that such time shall be extended by the department upon a showing of good cause. (f) This section shall become operative on July 1, On and after July 1, 2014, for purposes of this part: (a) Care recipient means the family member who is receiving care for a serious health condition or the new child with whom the care provider is bonding. (b) Care provider means the family member who is providing the required care for a serious health condition or the family member who is bonding with the new child. (c) Child means a biological, adopted, or foster son or daughter, a stepson or stepdaughter, a legal ward, a son or daughter of a domestic partner, or the person to whom the employee stands in loco parentis. (d) Domestic partner has the same meaning as defined in Section 297 of the Family Code. (e) Family care leave means any of the following: (1) Leave to bond with a minor child within the first year of the child s birth or placement in connection with foster care or adoption. (2) Leave to care for a child, parent, grandparent, grandchild, sibling, spouse, or domestic partner who has a serious health condition. (f) Family member means child, parent, grandparent, grandchild, sibling, spouse, or domestic partner as defined in this section. (g) Grandchild means a child of the employee s child. (h) Grandparent means a parent of the employee s parent. (i) Parent means a biological, foster, or adoptive parent, a parent-in-law, a stepparent, a legal guardian, or other person who stood in loco parentis to the employee when the employee was a child. (j) Parent-in-law means the parent of a spouse or a domestic partner. (k) Serious health condition means an illness, injury, impairment, or physical or mental condition that involves inpatient care in a hospital, hospice, or residential health care facility, or continuing treatment or continuing supervision by a health care provider, as defined in Section of the Government Code. (l) Sibling means a person related to another person by blood, adoption, or affinity through a common legal or biological parent. (m) Spouse means a partner to a lawful marriage. (n) Valid claim means any claim for family temporary disability insurance benefits made in accordance with the provisions of this code, and any rules and regulations adopted thereunder, if the individual claiming benefits is unemployed and has been paid the necessary wages in employment for employers to qualify for benefits under Section 2652 and is caring for a seriously ill family member, or bonding with a minor child during the first year after the birth or placement of the child in connection with foster care or adoption. (o) Twelve-month period, with respect to any individual, means the 365 consecutive days that begin with the first day the individual first establishes a valid claim for family temporary disability benefits On and after July 1, 2014, an individual shall be deemed eligible for family temporary disability insurance benefits equal to one-seventh of his or her weekly benefit amount on any day in which he or she is unable to perform his or her regular or customary work because he or she is bonding with a minor child during the first year after the birth or placement of the child in connection with foster care or adoption or caring for a seriously ill child, parent, grandparent, grandchild, sibling, spouse, or domestic partner, only if the director finds all of the following: (a) The individual has made a claim for temporary disability benefits as required by authorized regulations. (b) The individual has been unable to perform his or her regular or customary work for a seven-day waiting period during each disability benefit period, with respect to which waiting period no family temporary disability insurance benefits are payable. (c) The individual has filed a certificate, as required by Sections 2708 and Liability for Overpayments of Benefits -- Any person who is overpaid any amount as benefits under this part is liable for the amount overpaid unless: (a) The overpayment was not due to fraud, misrepresentation or willful nondisclosure on the part of the recipient, and (b) The overpayment was received without fault on the part of the recipient, and its recovery would be against equity and good conscience Assessments for Overpayments -- If the director finds that an individual has been overpaid unemployment compensation disability benefits because he or she willfully, for the purpose of obtaining unemployment compensation disability benefits, either made a false statement or representation, with actual knowledge of the falsity thereof, or withheld a material fact, the director shall assess against the individual an amount equal to 30 percent of the overpayment amount. For the purpose of collection, an assessment made pursuant to this section may be treated as an overpayment.

14 Assessments collected under this section shall be deposited in the Unemployment Compensation Disability Fund. No penalty under this section shall be assessed with regard to any false statement or representation made prior to January 1, Disallowance of Claim by Workmen's Compensation Appeals Board -- No claim of overpayment shall be based upon the disallowance by the Workmen's Compensation Appeals Board of a claim of lien filed under Section 4903 of the Labor Code, or the allowance of such lien for less than the amount claimed, or upon the approval by said Appeals Board of a compromise and release agreement providing for the allowance of such lien in an amount less than the claim Notice -- The Director of Employment Development shall determine the amount of the overpayment and shall notify the recipient of the basis of the overpayment determination. In the absence of fraud, misrepresentation or willful nondisclosure, notice of the overpayment determination shall be mailed or personally served on the recipient within two years after the beginning of the disability benefit period for which the overpayment was made Eligibility of State Employees for Nonindustrial Disability Benefits -- Except as provided in this chapter and Chapter 2.5 (commencing with Section 19878) of Part 2.6 of Division 5 of Title 2 of the Government Code, a state employee shall be eligible for nonindustrial disability benefits on the same terms and conditions as are specified by this part. Except as inconsistent with the provisions of this chapter and Chapter 2.6 (commencing with Section 19878) of Part 2.6 of Division 5 of Title 2 of the Government Code, the provisions of this division and authorized regulations shall apply to any matter arising pursuant to this chapter Same -- (a) The provisions of Chapter 4 (commencing with Section 2901), Chapter 5 (commencing with Section 3001), and Chapter 6 (commencing with Section 3251) of Part 2 do not apply to this chapter. (b) The provisions of Article 2 (commencing with Section 2652), Article 6 (commencing with Section 2765) and Article 7 (commencing with Section 2775) of Chapter 2 of Part 2 do not apply to this chapter. (c) Sections 2609, 2610, 2611, 2625, 2712 and do not apply to this chapter. Hawaii Financing of Nonindustrial Disability Benefits -- (a) Nonindustrial disability benefits are payable by the Controller upon authorization by the Employment Development Department to individuals who are eligible to receive such benefit payments under this chapter. (b) In lieu of the contributions required of employees, the State of California shall pay into the Disability Fund in the State Treasury at the times and in the manner provided in subdivision (c), an amount equal to the additional cost to the Disability Fund for added administrative work arising out of nonindustrial disability insurance for state employees. (c) In making the payments prescribed by subdivision (b), there shall be paid or credited to the Disability Fund, either in advance or by way of reimbursement, as may be determined by the director, such sums as he estimates the Disability Fund will be entitled to receive from the State of California under this section for each fiscal year, reduced or increased by any sum by which he finds that his estimates for any prior fiscal year were greater or less than the amounts which should have been paid to the fund. Such estimates may be made upon the basis of statistical sampling, or other method as may be determined by the director. Upon making such determination, the director shall certify to the Controller the amount determined with respect to the State of California. The Controller shall pay to the Disability Fund the contributions due from the State of California. (d) The director may require from each state agency such employment, wage, financial, statistical, or other information and reports, properly verified, as may be deemed necessary by the director to carry out his duties under this chapter, which shall be filed with the director at the time and in the manner prescribed by him. (e) The director may tabulate and publish information obtained pursuant to this chapter in statistical form and may divulge the name of the employing unit. (f) Each state agency shall keep such work records as may be prescribed by the director for the proper administration of this chapter FINDINGS AND PURPOSE -- A large portion of the labor force of this State annually is disabled from pursuing gainful employment by reason of non-occupational sickness or accident and as

15 a result suffers serious loss of income. In approximately ten percent of the cases such sickness or accident can be expected to cause disability of more than one week's duration. More than two-fifths of the employees in private employment have either no fixed legal protection against wage loss from disabling non-occupational sickness or accident, or only protection for a period of one work week or less; more than one-third of the workers covered by formal sick leave plans are not protected against disability extending beyond two work weeks. Since the hardship for workers and their families mounts with the extension of the duration of the disability from whatever cause, there is a need to fill the existing gaps in protection and to provide benefits to individuals in current employment that will afford them reasonable compensation for wage loss caused by disabling non-occupational sickness or accident where the disability is temporary in nature and exceeds the period of one work week. This legislation is designed not to impede the growth of voluntary plans which afford additional protection. This chapter shall be liberally construed in the light of the stated reasons for its enactment and its declared purpose ESTABLISHMENT OF TEMPORARY DISABILITY BENEFITS -- (a) Any individual in current employment who suffers disability resulting from accident, sickness, pregnancy, or termination of pregnancy, except accident or disease connected with or resulting from employment as defined in section or any other applicable workmen's compensation law, shall be entitled to receive temporary disability benefits in the amount and manner provided in this chapter. (b) It is the policy of this chapter that the computation and distribution of benefit payments shall correspond to the greatest extent feasible, to the employee's wage loss due to his disability; that an employee shall not be entitled to temporary disability benefits for periods of disability during which he would not have earned wages from employment according to the schedule of operations of his employer, and that an employee is entitled to benefits only for periods of disability during which, but for the disability, he would have earned wages from employment. This policy, however, shall not be applied to terminate the benefits of an employee who is receiving benefits under this chapter for a disability that commenced while the employee was in current employment, nor shall it be applied to deny benefits under this chapter if a disability that commenced while the employee was in current employment continues into a period during which the employee would earn wages but for the disability PROCEEDINGS TO DETERMINE EMPLOYMENT AND COVERAGE -- The director of labor and industrial relations shall have original jurisdiction over all controversies and disputes over employment and coverage under this chapter. Except in cases where services are specifically and expressly excluded from "employment" under section 392-5, it shall be presumed that coverage applies unless the party seeking exclusion is able to establish under both the control test and the relative nature of the work test that coverage is not appropriate under this chapter. There shall be a right of appeal from decisions of the director to the circuit court and thence to the supreme court WEEKLY BENEFIT AMOUNT -- Benefits shall be computed as weekly amounts in the manner provided in this section. (1) If the average weekly wage of the employee is less than $26, the weekly benefit amount shall be equal to the average wage but not more than $14; (2) If the average weekly wage of the employee is $26 or more, the weekly benefit amount shall be fifty-eight percent of the average weekly wage rounded off, if not a multiple of $1, to the next higher multiple of $1; (3) If the average weekly earnings of the employee exceed an amount equal to one fifty-second of the product obtained by multiplying the amount of the average annual wage in Hawaii, as determined pursuant to section (b) by the factor 1.21, such excess shall not be included in the computation of the weekly benefit amount; and (4) In no case shall the weekly benefit amount exceed the maximum weekly benefit specified in section of the Workers' Compensation Law DURATION OF BENEFIT PAYMENTS -- Temporary disability benefits shall be payable for any period of disability following the expiration of the waiting period required in section The duration of benefit payments shall not exceed twenty-six weeks for any period of disability or during any benefit year WAITING PERIOD -- No temporary disability benefits shall be payable during the first seven consecutive days of any period of disability. Consecutive periods of disability due to the same

16 or related cause and not separated by an interval of more than two weeks shall be considered as a single period of disability ELIGIBILITY FOR BENEFITS -- An individual is eligible to receive temporary disability benefits if the individual has been in employment for at least fourteen weeks during each of which the individual has received remuneration in any form for twenty or more hours and earned wages of at least $400, during the fifty-two weeks immediately preceding the first day of disability CARE BY PHYSICIAN OR EQUIVALENT REQUIRED -- (a) An individual shall be ineligible to receive temporary disability benefits with respect to any period during which he is not under the care of a person duly licensed to practice medicine, surgery, dentistry, chiropractic, osteopathy, or naturopathy, who shall certify, in the form and manner specified by regulation of the director, the disability of the claimant, the probable duration thereof, and such other medical facts within his knowledge as required by regulation. (b) This section shall not apply to an individual who, pursuant to the teachings, faith, or belief of any group, depends for healing upon prayer or other spiritual means. In that case the disability, the probable duration thereof, and any other pertinent facts required to be certified by regulation of the director shall be certified, in the form and manner specified by the regulation, by a duly authorized or accredited practitioner of such group. (c) The proof of disability duly certified by a person licensed to practice medicine, surgery, dentistry, chiropractic, or osteopathy, or an authorized or accredited practitioner of any group which depends for healing upon prayer or other spiritual means shall be submitted by such certifying person to the disabled employee within seven working days after the date on which the employee was examined and found disabled. If the certifying person fails to submit the required proof within seven working days, the director, upon notification by the insurer, may levy a penalty of $25 for each delinquent certification where the certifying person fails to show good cause for his failure to file on time INELIGIBILITY IN CERTAIN CASES -- An individual shall not be eligible to receive temporary disability benefits: (1) For any period of disability during which the individual would be disqualified from receiving benefits under the Hawaii Employment Security Law by reason of unemployment due to a stoppage of work existing because of a labor dispute for the duration of such disqualification. (2) If the director finds that the individual has knowingly made a false statement or representation of a fact or knowingly failed to disclose a material fact in order to obtain benefits under this chapter to which the individual is not otherwise entitled. The ineligibility shall be for a period determined by the director, but shall not exceed the period of disability with respect to which the false statement or representation was made or the nondisclosure occurred. (3) For any period of disability due to willfully and intentionally self-inflicted injury or to injury sustained in the commission of a criminal offense specified in title 38. (4) For any day of disability during which the employee performed work for remuneration or profit, except that, if an employee returning to work suffers a relapse after performing work for less than a full-day, the employee shall be paid benefits or be given waiting period credit, provided the employee's wages for the partial day's work did not equal or exceed the prorated disability benefits to which the employee is entitled. The amount of the benefit payable is derived by subtracting the gross wages received for performing less than a full day's work, from the prorated disability benefits to which the employee is entitled. (5) Unless the claim for disability benefits is filed within ninety days after the commencement of the period of disability or as soon thereafter as is reasonably possible DUPLICATION OF BENEFITS NOT PERMITTED -- No temporary disability benefits shall be payable for any period of disability for which the employee is entitled to receive. (1) Weekly benefits under the Employment Security Law or similar laws of this State or of any other state or of the United States, or under any temporary disability benefits law of any other state or of the United States except as provided in section (2) Weekly disability insurance benefits under 42 U.S.C.A. sec (3) Weekly benefits for total disability under the Workers' Compensation Law of this State or any other state or of the United States, except benefits for permanent partial or permanent total disability previously incurred. If the claimant does not receive benefits under such workmen's compensation law and his entitlement to such benefits is seriously disputed, the employee, if otherwise eligible, shall receive temporary disability benefits under this chapter, but any insurer or employer or

17 the special fund for disability benefits providing such benefits shall be subrogated, as hereinafter provided, to the employee's right to benefits under the workmen's compensation law for the period of disability for which he received benefits under this chapter to the extent of the benefits so received. (4) Indemnity payments for wage loss under any applicable employers' liability law of this State, or of any other state or of the United States. If an employee has received benefits under this chapter for a period of disability for which he is entitled to such indemnity payments, any insurer or employer or the special fund for disability benefits providing such benefits shall be subrogated to the employee's right to such indemnity payments in the amount of the benefits paid under this chapter as hereinafter provided NO ASSIGNMENT OF BENEFITS; EXEMPTIONS FROM ATTACHMENT, ETC. -- No assignment, pledge, or encumbrance of any right to benefits which are or may become due or payable under this chapter shall be valid; and such rights to benefits shall be exempt from levy, execution, attachment, garnishment, or any other remedy whatsoever provided for the collection of debt. No waiver of any exemption provided for in this section shall be valid PROVISION FOR PAYMENT OF BENEFITS -- (a) An employer or an association of employers shall secure temporary disability benefits for their employees in one or more of the following ways: (1) By insuring and keeping insured the payment of temporary disability benefits with any stock, mutual, reciprocal or other insurer authorized to transact the business of disability insurance in the State; or (2) By depositing and maintaining with the state director of finance, securities, or the bond of a surety company authorized to transact business in the State, as are satisfactory to the director securing the payment by the employer of temporary disability benefits according to the terms of this chapter; or (3) Upon furnishing satisfactory proof to the director of his or its solvency and financial ability to pay the temporary disability benefits herein provided, no insurance or security or surety bond shall be required, and the employer shall make payments directly to his employees, as they may become entitled to receive the same under the terms and conditions of this chapter; or (4) By a plan, entitling employees to cash benefits or wages during a period of disability, in existence on the effective date of this chapter. (A) If the employees of an employer or any class or classes of such employees are entitled to receive disability benefits under a plan or agreement which remains in effect on January 1, 1970, the employer, subject to the requirements of this section, shall be relieved of responsibility for making provision for benefit payments required under this chapter until the earliest date, determined by the director for the purposes of this chapter, upon which the employer has the right to discontinue the plan or agreement or to discontinue his contributions toward the cost of the temporary disability benefits. Any such plan or agreement may be extended, with or without modification, by agreement or collective bargaining between an employer or employers or an association of employers and an association of employees; provided the benefits under the plan or agreement, as extended or modified, are found by the Director to be at least as favorable as the disability benefits required by this chapter. (B) Any other plan or agreement in existence on January 1, 1970 which the employer may, by his sole act, terminate at any time, or with respect to which he is not obligated to continue for any period to make contributions, may be accepted by the director as satisfying the obligation to provide for the payment of benefits under this chapter if the plan or agreement provides benefits at least as favorable as the disability benefits required by this chapter and does not require contributions of any employee or of any class or classes of employees in excess of the amount authorized in section , except by agreement and provided the contribution is reasonably related to the value of the benefits as determined by the director. The director may require the employer to enter into an agreement in writing with the director that until the employer shall have filed written notice with the director of his election to terminate such plan or agreement or to discontinue making necessary contributions toward the cost of providing benefits under the plan or agreement, he will continue to provide for the payment of the disability benefits under the plan or agreement. Any plan or agreement referred to in this paragraph may be extended, with or without modification; provided the benefits under the plan or agreement, as extended or modified, are found by the director to be at least as favorable as the disability benefits required by this chapter; or (5) By a new plan or agreement. On or after January 1, 1970 a new plan or agreement with an insurer may be accepted by the director as satisfying the obligation to provide for the payment of benefits under this chapter if the plan or agreement provides benefits at least as favorable as the disability benefits required by this

18 chapter and does not require contributions of any employee or of any class or classes of employees in excess of the amount authorized in section , except by agreement and provided the contribution is reasonably related to the value of the benefits as determined by the director. Any such plan or agreement shall continue until written notice is filed with the director of intention to terminate the plan or agreement, and any modification of the plan or agreement shall be subject to the written approval of the director. (b) During any period in which any plan or agreement or extension or modification thereof authorized under subsection (a)(4) or (5) provides for payments of benefits under this chapter, the responsibility of the employer and the obligations and benefits of the employees shall be as provided in the plan or agreement or its extension or modification rather than as required under this chapter; provided the employer or insurer has agreed in writing with the director to pay the assessments imposed by section (c) If any plan or agreement authorized under subsection (a)(4) or (5) covers less than all of the employees of a covered employer, the requirements of this chapter shall apply with respect to his remaining employees not covered under the plan or agreement. (d) As used in subsection (a)(4) and (5), "benefits at least as favorable as the disability benefits required by this chapter" means the temporary disability benefits under any plan or agreement whose component parts (waiting period for illness, waiting period for accident, duration of benefits, and percentage of wage loss replaced) add in total to cash benefits or wages which are determined by the director to be at least as favorable as the disability benefits required by this chapter. The insurance commissioner shall establish a set of tables showing the relative value of different types of cash benefits and wages to assist the director in determining whether the cash benefits and wages under a plan are at least as favorable as the temporary disability benefits required by this chapter. (e) Any decision of the director rendered pursuant to this section with respect to the amount of security required, refusing to permit security to be given or refusing to accept a plan or agreement as satisfying the obligation to provide for the payment of benefits under this chapter shall be subject to review on appeal in conformity with the provisions of this chapter. (f) In order to provide the coverage required by this chapter for employers otherwise unable to obtain or provide such coverage, the insurance commissioner may, after consultation with the insurers licensed to transact the business of disability insurance in this State, approve a reasonable plan or plans for the equitable apportionment among such insurers of employer applicants for such insurance who are in good faith entitled to but are unable to procure such insurance through ordinary methods and, when such a plan has been approved, all such insurers shall subscribe thereto and participate therein; provided, however, that the commissioner shall not, for insurance issued or in connection with any such plan or plans, require or allow the use of premium rates which are either inadequate or excessive in relation to the benefits to be provided. Any employer applying for such insurance or any insured under such plan and any insurer affected may appeal to the commissioner from any ruling or decision of the manager or committee designated to operate such plan. All orders of the commissioner in connection with any such plan shall be subject to judicial review as provided in chapter 91. (g) All insurers shall in form prescribed by the director notify employer applicants who are unable to procure the required insurance through ordinary methods, the availability of the plan described in (f) above NOTICE OF INSURANCE -- If payment of disability benefits is provided for in whole or in part by insurance pursuant to section , (a)(1), (4), or (5), the employer or insurer shall forthwith file with the director in form prescribed by the director a notice of his insurance together with a statement of benefits provided by the policy. If an employer or insurer fails to file the notice of insurance within 30 days after purchase of insurance, the director may levy a penalty of not more than $10 for each delinquent notice, unless good cause for failure to file can be shown by the employer or insurer INSURER'S REQUIREMENTS; FAILURE TO MAINTAIN A CLAIMS SERVICE OFFICE; PENALTY; INJUNCTION -- (a) Each insurer shall maintain a complete claims service office or engage an independent claims adjusting service as its claims agent in this State with draft authority for the processing of temporary disability insurance payments. (b) If an insurer fails to comply with subsection (a), the insurer shall be subject to a civil penalty of not less than $2,500 or $100 for every day during which such failure continues, whichever sum is greater, to be recovered in an action brought by the director in the name of the State, and the amount so collected shall be paid into the special fund created by section The director, in the director's discretion, for good

19 cause shown, may remit all or any part of the penalty in excess of $2,500, if the insurer in default forthwith complies with subsection (a). With respect to such actions, the attorney general shall enforce this subsection if so requested by the director. (c) If any insurer violates subsection (a) for a period of thirty days, the insurer may be enjoined by the circuit court from carrying on the insurer's business any place in the State so long as the violation continues. The action for injunction shall be commenced by the attorney general if so requested by the director AUTHORITY TO WITHHOLD CONTRIBUTIONS, RATE OF CONTRIBUTION, MAXIMUM WEEKLY WAGE BASE -- (a) Subject to the limitation set forth in subsection (b) an employer may deduct and withhold contributions, from each employee of one-half the cost but not more than.5 percent of the weekly wages earned by the employee in employment and the employer shall provide for the balance of the cost of providing temporary disability benefits under this chapter over the amount of contributions of his employees. Unless a different rule is prescribed by regulation of the director, the withholding period shall be equal to the pay period of the respective employee. (b) Weekly wages for the purposes of this section shall not include (1) Wages earned by an employee in employment during any payroll period unless, during the fifty-two weeks immediately preceding such payroll period, the employee has earned wages of at least $400 and has been in employment for at least fourteen weeks during each of which the employee has received remuneration in any form for twenty or more hours; and (2) Remuneration in excess of one fifty-second of the average annual wage in the State as determined for the preceding year pursuant to section (b) multiplied by the factor 1.21, which amount the director shall cause to be published annually prior to the first day of January following the determination. (c) The contributions of the employees deducted and withheld from their wages by their employer shall be held in a separate fund or be paid to insurance carriers as premiums, for the purpose of providing benefits required by this chapter. (d) The director shall have authority to prescribe by regulation the reports and information necessary to determine the cost of providing temporary disability benefits under this chapter, especially in the case of employers or employer associations providing such benefits by means of self-insurance, and to determine the procedures for the determination of such cost. (e) An employee from whose wages amounts greater than those authorized by this chapter have been withheld by his employer shall be entitled to a refund or credit of the excess as prescribed by regulation of the director. (f) The contributions of employees deducted and withheld in amounts greater than those authorized by this chapter, shall be deposited in the special fund for disability benefits if such employees are no longer with the employer and cannot be located. A refund of the excess shall be paid from the special fund for disability benefits to the employees when they are located or if such employees remain unlocated for a period of two years from the date of deposit, such monies shall become a part of the special fund. (g) If an employer fails to provide coverage for his employees after deducting and withholding contributions from his employees as prescribed by this chapter, he shall deposit such contributions in the special disability fund PAYMENTS OF PREMIUM FOR INELIGIBLE EMPLOYEES NOT PERMITTED -- An insurer providing benefits for the employees of an employer or an association of employers, shall not require the payment of premiums from such employer or association of employers for employees who do not meet the eligibility requirements of section However, in the case of employees who concurrently work for more than one employer and are deemed eligible to receive benefits by combining the wages earned and hours worked of the two or more employments, the insurer shall require the payment of premiums in accordance with section The employers or association of employers shall ensure that eligible employees with concurrent employments are provided the required coverage. \ PAYMENT OF DISABILITY BENEFITS -- Benefits provided under this chapter shall be paid periodically and promptly and, except as to a contested period of disability, without any decision by the director. The first payment of benefits shall be paid within ten days, exclusive of Saturdays, Sundays and holidays, after the filing of required proof of claim. Thereafter, benefits shall be due and payable every two weeks. The director may determine that benefits may be paid monthly or semimonthly if wages were so paid, and may authorize deviation from the foregoing requirements to facilitate prompt payment of benefits. If an employer or insurer fails to make the first payment of benefits within ten days, exclusive of Saturdays, Sundays and holidays, after the filing of required

20 proof of claim, the director shall, unless good cause can be shown, require the employer or insurer to pay such benefits plus an additional ten percent of the benefits due and payable to the employee NOTICE OF DENIAL -- No employer or insurer shall deny disability benefits to an employee without first submitting a copy of the notice of denial to the department. The department shall review the denial within ten days of the receipt of the notice. If the department finds the denial erroneous, without proper legal basis, or without sufficient evidence to support it, the department shall request the employer or insurer to reconsider its action in denying disability benefits. If upon reconsideration the employer or insurer again decides to deny disability benefits, the employee and the department shall be so notified. The employee shall have the right to appeal the denial of disability benefits SUBROGATION RIGHTS IF EMPLOYEE ENTITLED TO WORKERS' COMPENSATION BENEFITS OR INDEMNITY UNDER EMPLOYER'S LIABILITY ACTS - - (a) If an individual has received temporary disability benefits under this chapter during a period of disability for which benefits for any disability under the Workers' Compensation Law of this State or of any other state or the United States are subsequently awarded or accepted in any agreement or compromise, the employer, the association of employers, the insurer, or the special fund for disability benefits, as the case may be, providing such temporary disability benefits shall be subrogated to the individual's right to such benefits in the amount of the benefits paid under this chapter. In the event more than one employer or insurer have subrogation rights to the employee's workmen's compensation benefits, such benefits shall be divided proportionately among the employers or insurers according to the amount of benefits each employer or insurer paid under this chapter. Should the subrogated amount of either one or both employers or insurers total less than the amount of benefits that such employers or insurers paid under this chapter, neither the employee nor the special fund for disability benefits nor any other source shall be required to make up the difference. To protect its subrogation rights to benefits payable under the Workers' Compensation Law of this State, the employer, the association of employers, the insurer, or the special fund for disability benefits, providing temporary disability benefits shall file a claim with the division of workmen's compensation in the department and notify the insurer for workmen's compensation or the employer, if self-insured, of its claim and thereupon the employer, the association of employers, the insurer, or the special fund for disability benefits, providing temporary disability benefits shall have a lien against the amounts payable as benefits for disability under the Workers' Compensation Law in the amount of the benefits paid under this chapter during the period for which benefits for disability under the Workers' Compensation Law have been accepted or awarded as payable. The agreement or award shall include a provision setting forth the existence and amount of such lien. (b) If an individual has received benefits under this chapter during a period of disability for which he is entitled to receive indemnity payments for wage loss under any applicable employers' liability law of this State or of any other state or of the United States, the employer, the association of employers, the insurer, or the special fund for disability benefits, providing temporary disability benefits shall be subrogated to the individual's right to such indemnity in the amount of the benefits paid under this chapter and may assert its subrogation rights in any manner appropriate under such acts or any rule of law SUBROGATION RIGHTS AGAINST THIRD PARTIES -- If an individual who has received benefits under this chapter is entitled to recover damages from a third person who is responsible for the sickness or accident causing the disability, the employer, the association of employers, the insurer, or the special fund for disability benefits, providing disability benefits shall be subrogated to, and have a lien upon, the rights of the individual against the third party to the extent that the damages include wage loss during the period of disability for which temporary disability benefits were received in the amount of such benefits. If the individual commences an action against such third party, the individual shall notify his employer, or the director if the individual is unemployed, of the action and the court in which it is pending. The employer, the association of employers, the insurer, or the special fund for disability benefits, providing disability benefits may join as party plaintiff or claim a lien on the amount of any judgment recovered by the individual in such action to the extent of its subrogation rights. If the individual does not commence the action within nine months after the commencement of the sickness or the date of the accident causing the disability, the employer, the association of employers, the insurer, or the special fund for disability benefits,

21 providing temporary disability benefits may commence such action, but the individual shall be entitled to join the action and be entitled to any surplus over the amount to which the employers, the association of employers, the insurer, or the special fund for disability benefits is subrogated REQUEST FOR WAGE AND EMPLOYMENT INFORMATION -- An employer to whom the department has sent a request for wage and employment information for an employee claiming benefits against the special fund for disability benefits, shall complete and file such information within seven days from date the request was sent. If an employer fails to file such information in seven days, the director shall levy a penalty of not more than $10 for each delinquent request, unless the failure to file such information is excused by the director after a showing by such employer that such filing could not be made on the prescribed date therefore owing to conditions over which he had no control APPEAL TRIBUNAL -- Appeals shall be heard by an impartial referee for temporary disability benefits appeals who shall be appointed by the director and who shall serve as the appeal tribunal. New Jersey APPEALS, FILING AND HEARING -- (a) If a person disputes the amount of benefits, paid under part III or part IV, or the denial of benefits, the claimant may file an appeal, in the form and manner prescribed by regulation of the director, at the office of the department in the county in which the claimant resides or in the county in which the claimant was employed prior to his disability, within twenty days after the date of payment of such disputed benefits or the denial thereof. Notice of the appeal shall be served upon the employer or insurer or the special fund for disability benefits in the form and manner prescribed by regulation of the director. (b) The appeal shall be heard in the county in which the appeal is filed; provided that the director may by regulation provide for good cause for the holding of a hearing in another county and may provide for the taking of depositions. Unless the appeal is withdrawn with the permission of the referee, the referee after affording the parties reasonable opportunity for a fair hearing shall make findings and conclusions and on the basis thereof affirm, modify, or deny the disputed benefits. All parties shall be promptly notified of the decision of the referee and shall be furnished with a copy of the decision and the findings and conclusions in support thereof and the decision shall be final and shall be binding unless a proceeding for judicial review is initiated pursuant to section ; provided that, within the time provided for taking an appeal and prior to the filing of a notice of appeal, the referee may reopen the matter, upon application of the director or any party, or upon his own motion, and thereupon may take further evidence or may modify his decision, findings, or conclusions. In the event the matter is reopened, the referee shall render a further decision in the matter, either reaffirming or modifying his original decision, and notice shall be given thereof in the manner hereinbefore provided. The time to initiate judicial review shall run from the notice of such further decision if the matter has been reopened. 43: PURPOSE -- This act shall be liberally construed as remedial legislation enacted upon the following declarations of public policy and legislative findings of fact: The public policy of this State, already established, is to protect employees against the suffering and hardship generally caused by involuntary unemployment. But the unemployment compensation law provides benefit payments to replace wage loss caused by involuntary unemployment only so long as an individual is "able to work, and is available for work," and fails to provide any protection against wage loss suffered because of inability to perform the duties of a job interrupted by illness. Nor is there any other comprehensive and systematic provision for the protection of working people against loss of earnings due to nonoccupational sickness or accident. The prevalence and incidence of nonoccupational sickness and accident among employed people is greatest among the lower income groups, who either cannot or will not voluntarily provide out of their own resources against the hazard of earnings loss caused by nonoccupational sickness or accident. Disabling sickness or accident occurs throughout the working population at one time or another, and approximately fifteen per centum (15%) of the number of people at work may be expected to suffer disabling illness of more than one week each year. It has been found that existing voluntary plans for the payment of cash sickness benefits cover less than onehalf of the number of working people of this State who are now covered by the unemployment compensation law, and that even this degree of voluntary protection affords uneven, unequal and sometimes uncertain protection among the various voluntary benefit programs. It is therefore desirable

22 and necessary to fill the gap in existing provisions for protection against the loss of earnings caused by involuntary unemployment, by extending such protection to meet the hazard of earnings loss due to inability to work caused by nonoccupational sickness or accident. The foregoing facts and considerations require that there be a uniform minimum program providing in a systematic manner for the payment of reasonable benefits to replace partially such earnings loss and to meet the continuing need for benefits where an individual becomes disabled during unemployment. In order to maintain consumer purchasing power, relieve the serious menace to health, morals and welfare of the people caused by insecurity and the loss of earnings, to reduce the necessity for public relief of needy persons, and in the interest of the health, welfare and security of the people of this State, such a system, enacted under the police power, is hereby established, requiring the payment of reasonable cash benefits to eligible individuals suffering accident or illness which is not compensable under the workmen's compensation law. 43: PERSONS ENTITLED TO BENEFITS -- Any covered individual who on the date of the commencement of a period of disability is not entitled to disability benefits under an approved private plan shall be entitled to disability benefits as provided in this article, referred to in this act as the State plan. 43: DURATION OF BENEFITS -- With respect to periods of disability commencing on or after January 1, 1953, disability benefits, not in excess of an individual's maximum benefits, shall be payable with respect to disability which commences while a person is a covered individual under the Temporary Disability Law, and shall be payable with respect to the eighth consecutive day of such disability and each day thereafter that such period of disability continues; and if benefits shall be payable for 3 consecutive weeks with respect to any period of disability commencing on or after January 1, 1968, then benefits shall also be payable with respect to the first 7 days thereof. The maximum total benefits payable to any eligible individual for any period of disability commencing on or after January 1, 1968, shall be either 26 times his weekly benefit amount or 1/3 of his total wages in his base year, whichever is the lesser; provided, that such maximum amount shall be computed in the next lower multiple of $1,000 if not already a multiple thereof. 43: LIMITATION OF BENEFITS -- Notwithstanding any other provision of the Temporary Disability Benefits Law, P.L. 1948, c. 110 (C et seq.), no benefits shall be payable under the State Plan to any person: (a) for the first 7 consecutive days of each period of disability except that if benefits shall be payable for 3 consecutive weeks with respect to any period of disability commencing on or after January 1, 1968, then benefits shall also be payable with respect to the first 7 days thereof; (b) for more than 26 weeks with respect to any one period of disability; (c) for any period of disability which did not commence while the claimant was a covered individual; (d) for any period during which the claimant is not under the care of a legally licensed physician, dentist, optometrist, podiatrist, practicing psychologist, or chiropractor, who, when requested by the division, shall certify within the scope of the practitioner's practice, the disability of the claimant, the probable duration thereof, and, where applicable, the medical facts within the practitioner's knowledge; (e) [Repealed.] (f) for any period of disability due to willfully and intentionally self-inflicted injury, or to injury sustained in the perpetration by the claimant of a crime of the first, second, or third degree; (g) for any period during which the claimant performs any work for remuneration or profit; (h) in a weekly amount which together with any remuneration the claimant continues to receive from the employer would exceed the regular weekly wages immediately prior to disability; (i) for any period during which a covered individual would be disqualified for unemployment compensation benefits under subsection (d) of R.S. 43:21-5 unless the disability commenced prior to such disqualification; and there shall be no other cause of disqualification or ineligibility to receive disability benefits hereunder except as may be specifically provided in this act. 43: WEEKLY AND DAILY BENEFIT AMOUNTS -- With respect to periods of disability commencing on or after July 1, 1961, an individual's weekly benefit amount shall be determined and computed by the division on the same basis as the weekly benefit rate is determined and computed pursuant subsection (c) of R.S. 43:21-3 except that for periods of disability commencing on or after October 1, 1984, an individual's weekly benefit rate shall be two-thirds of his average weekly wage,

23 subject to a maximum of 53% of the Statewide average weekly remuneration paid to workers by employers as determined under subsection (c) of R.S. 43:21-3; provided, however that such individual's benefit rate shall be computed to the next lower multiple of $1.00 if not already a multiple thereof. The amount of benefits for each day of disability for which benefits are payable shall be oneseventh of the corresponding weekly benefit amount; provided, that the total benefits for a fractional part of a week shall be computed to the next lower multiple of $1.00 if not already a multiple thereof. 43: REQUIREMENTS FOR ENTITLEMENT -- (a) Deleted by amendment, P.L. 1975, c (b) Deleted by amendment, P.L. 2001, c. 17. (c) Deleted by amendment, P.L. 2001, c. 17. (d) With respect to periods of disability commencing on or after October 1, 1984 and before January 1, 2001, no individual shall be entitled to benefits under this act unless the individual has established at least 20 base weeks within the 52 calendar weeks preceding the week in which the individual's period of disability commenced or, in the alternative the individual has earned twelve times the Statewide average weekly remuneration paid to workers, as determined under subsection (c) of R.S. 43:21-3, raised to the next higher multiple of $ if not already a multiple thereof, or more within the 52 calendar weeks preceding the week in which the period of disability commenced, nor shall the individual be entitled to benefits unless he shall duly file notice and proof of claim, and submit to such reasonable examinations as are required by this act and the rules and regulations of the division. (2) With respect to periods of disability commencing on or after January 1, 2001, no individual shall be entitled to benefits under this act unless the individual has, within the 52 calendar weeks preceding the week in which the individual's period of disability commenced, established at least 20 base weeks or earned not less than 1,000 times the minimum wage in effect pursuant to section 5 of P.L.1996, c.113 (C.34:11-56a4) on October 1 of the calendar year preceding the calendar year in which the disability commences, which amount shall be adjusted to the next higher multiple of $100.00, if not already a multiple thereof. 43: PAYMENT OF BENEFITS FROM FUND -- (a) Disability benefits payable pursuant to this article shall be paid out of the State disability benefits fund established by law, and to the extent that such laws, regulations and practices are not inconsistent herewith, shall be administered subject to the same laws, regulations and practices as are applicable under the chapter of the Revised Statutes to which this act is a supplement. 43: PAYMENT OF DISABILITY BENEFITS DUE DECEASED CLAIMANT -- (b) If a claim for disability benefits is not filed by an otherwise eligible individual prior to his death, the first claim for such benefits may be filed, by the surviving spouse, or such other person or persons who may be legally entitled thereto. Payments of benefits shall be made upon receipt of a completed first claim for accompanied by an affidavit executed by such person or persons. The payment by the division of such benefits upon receipt of such affidavit, or affidavits, shall discharge the obligations of the division to the extent of such payment. The division shall prescribe the form of affidavit to be executed. 43: PAYMENT OF DISABILITY BENEFITS DUE MINORS -- (c) In case an infant or minor under the age of twenty-one years shall be entitled to receive any sum in payment for disability benefits under this chapter, the father, mother or natural guardian of the infant or minor shall be authorized and empowered to receive and receipt for such moneys to the same extent as a guardian of the person and property of such infant or minor duly appointed by the surrogate or the court of the county in which such infant or minor resides, and the release or discharge of such father, mother or natural guardian shall be a full and complete discharge of all claims or demands of the infant or minor thereunder. The division shall prescribe the form of affidavit and release to the executed by the parties concerned. 43: REPRESENTATIVE APPOINTED FOR DISABILITY BENEFIT BENEFICIARY -- (d) The director of the division is hereby authorized and empowered when in his judgment it shall be advisable, to appoint a representative with power to act for a person who may be entitled to disability benefits by legally receiving and disbursing said payments under the direction of the director when it shall appear that such person is mentally, legally or physically unable to properly receive or disburse

24 said payments, or when said person, after due diligence cannot be located. Whenever the person entitled to payments is a minor child, and the director determines that there is no proper person available to receive and disburse said payments for such child, then the Child Welfare Board, as constituted by the provisions of chapter five, of Title Institutions and Agencies (Section 30:5-1 et seq.), may be appointed as the representative of such minor child. Application behalf of any such person shall be made in such form as the director shall prescribe. New York 43: PART D. DISABILITY DURING UNEMPLOYMENT -- Section 43:21-3 of the Revised Statutes is amended to read as follows: Benefits from other states An individual is disqualified from disability benefits for any week with respect to which or a part of which the individual has received or is seeking unemployment benefits under an unemployment compensation law of this or any other state or of the United States; provided, that if the appropriate agency of the other state or if the United States finally determines that the individual is not entitled to unemployment benefits, this disqualification shall not apply Employees Eligible for Benefits Under Section Two Hundred Four -- Employees in employment of a covered employer for four or more consecutive weeks and employees in employment during the work period usual to and available during such four or more consecutive weeks in any trade or business in which they are regularly employed and in which hiring from day to day of such employees is the usual employment practice shall be eligible for disability benefits as provided in section two hundred four. Every such employee shall continue to be eligible during such employment and for a period of four weeks after such employment terminates regardless of whether the employee performs any work for remuneration or profit in noncovered employment. If during such four week period the employee performs work for remuneration or profit for another covered employer the employee shall become eligible for benefits immediately with respect to that employment. In addition, every such employee who returns to work with the same employer after an agreed and specified unpaid leave of absence or vacation without pay shall become eligible for benefits immediately with respect to such employment. An employee who during a period in which he or she is eligible to receive benefits under subdivision two of section two hundred seven returns to employment with a covered employer and an employee who is currently receiving unemployment insurance benefits or benefits under section two hundred seven and who returns to employment with a covered employer shall become eligible for benefits immediately with respect to such employment. An employee regularly in the employment of a single employer on a work schedule less than the employer's normal work week shall become eligible for benefits on the twenty-fifth day of such regular employment. An employee who becomes disabled while eligible for benefits in the employment of a covered employer shall not be deemed, for the purposes of this article, to have such employment terminated during any period he or she is eligible to receive benefits under section two hundred four with respect to such employment Disability During Employment Disability benefits shall be payable to an eligible employee for disabilities commencing after June thirtieth, nineteen hundred fifty, beginning with the eighth consecutive day of disability and thereafter during the continuance of disability, subject to the limitations as to maximum and minimum amounts and duration and other conditions and limitations in this section and in sections two hundred five and two hundred six. Successive periods of disability caused by the same or related injury or sickness shall be deemed a single period of disability only if separated by less than three months. 2. The weekly benefit which the disabled employee is entitled to receive for disability commencing on or after May first, nineteen hundred eighty-nine shall be one-half of the employee's weekly wage, but in no case shall such benefit exceed one hundred seventy dollars; except that if the employee's average weekly wage is less than twenty dollars, the benefit shall be such average weekly wage. The weekly benefit which the disabled employee is entitled to receive for disability commencing on or after July first, nineteen hundred eighty-four shall be one-half of the employee's weekly wage, but in no case shall such benefit exceed one hundred forty-five dollars; except that if the employee's average weekly wage is less than twenty dollars, the benefit shall be such average weekly wage. The weekly benefit which the disabled employee is entitled to receive for disability commencing on or after July first, nineteen hundred eighty-three and prior to July first, nineteen hundred eighty-four shall be one-half of the employee's average weekly wage, but in no case shall such benefit exceed one hundred thirty-five dollars nor be less than twenty dollars; except that if the employee's average weekly wage is less than twenty dollars the benefit shall be such average

25 weekly wage. The weekly benefit which the disabled employee is entitled to receive for disability commencing on or after July first, nineteen hundred seventy-four, and prior to July first, nineteen hundred eighty-three, shall be one-half of the employee's average weekly wage, but in no case shall such benefit exceed ninety-five dollars nor be less than twenty dollars; except that if the employee's average weekly wage is less than twenty dollars, the benefit shall be such average weekly wage. The weekly benefit which the disabled employee is entitled to receive for disability commencing on or after July first, nineteen hundred seventy and prior to July first, nineteen hundred seventy-four shall be one-half of the employee's average weekly wage, but in no case shall such benefit exceed seventy-five dollars nor be less than twenty dollars; except that if the employee's average weekly wage is less than twenty dollars the benefit shall be such average weekly wage. For any period of disability less than a full week, the benefits payable shall be calculated by dividing the weekly benefit by the number of the employee's normal work days per week and multiplying the quotient by the number of normal work days in such period of disability. The weekly benefit for a disabled employee who is concurrently eligible for benefits in the employment of more than one covered employer shall, within the maximum and minimum herein provided, be one-half of the total of the employee's average weekly wages received from all such covered employers, and shall be allocated in the proportion of their respective average weekly wage payments Disabilities and Disability Periods for Which Benefits Are Not Payable -- No employee shall be entitled to benefits under this article: 1. For more than twenty-six weeks during a period of fiftytwo consecutive calendar weeks or during any one period of disability; 2. for any period of disability during which an employee is not under the care of a duly licensed physician or with respect to disability resulting from a condition of the foot which may lawfully be treated by a duly registered and licensed podiatrist of the state of New York or with respect to a disability resulting from a condition which may lawfully be treated by a duly registered and licensed chiropractor of the state of New York or with respect to a disability resulting from a condition which may lawfully be treated by a duly licensed dentist of the state of New York or with respect to a disability resulting from a condition which may lawfully be treated by a duly registered and licensed psychologist of the State of New York or with respect to a disability resulting from a condition which may lawfully be treated by a duly certified nurse midwife; for any period of such disability during which an employee is neither under the care of a physician nor a podiatrist, nor a chiropractor, nor a dentist nor a psychologist, nor a certified nurse midwife; and for any period of disability during which an employee who adheres to the faith or teachings of any church or denomination and who in accordance with its creed, tenets or principles depends for healing upon prayer through spiritual means alone in the practice of religion, is not under the care of a practitioner duly accredited by the church or denomination, and provided such employee shall submit to all physical examinations as required by this chapter. 3. for any disability occasioned by the willful intention of the employee to bring about injury to or the sickness of himself or another, or resulting from any injury or sickness sustained in the perpetration by the employee of an illegal act; 4. for any day of disability during which the employee performed work for remuneration or profit; 5. for any day of disability for which the employee is entitled to receive from his employer, or from a fund to which the employer has contributed, remuneration or maintenance in an amount equal to or greater than that to which he would be entitled under this article; but any voluntary contribution or aid which an employer may make to an employee or any supplementary benefit paid to an employee pursuant to the provisions of a collective bargaining agreement or from a trust fund to which contributions are made pursuant to the provisions of a collective bargaining agreement shall not be considered as continued remuneration or maintenance for this purpose; 6. for any period in respect to which such employee is subject to suspension or disqualification of the accumulation of unemployment insurance benefit rights, or would be subject if he were eligible for such benefit rights, except for ineligibility resulting from the employee's disability; 7. for any disability due to any act of war, declared or undeclared, if such act shall occur after June thirtieth, nineteen hundred fifty; 8. for any disability commencing before the employee becomes eligible to benefits hereunder or commencing prior to July first, nineteen hundred fifty, but this shall not preclude benefits for recurrence after July first, nineteen hundred fifty, of a disability commencing prior thereto Non-Duplication of Benefits No benefits shall be payable under section two hundred four or two hundred seven: (a) in a weekly benefit amount, which, together with any amount that the

26 employee receives or is entitled to receive for the same period or any part thereof as a permanent disability benefit or annuity under any governmental system or program, except under a veteran's disability program, or under any permanent disability policy or program of an employer for whom he has performed services, would, if apportioned to weekly periods, exceed his weekly benefit amount hereunder, provided however, that there shall be no offset against the benefits set forth in this article if the claim for disability benefits is based on a disability other than the permanent disability for which the aforesaid permanent disability benefit or annuity was granted; (b) with respect to any week for which payments are received under the unemployment insurance law or similar law of this state or of any other state or of the United States; (c) subject to the provisions of subdivision two of this section, for any period with respect to which benefits, compensation or other allowances (other than workmen's compensation benefits for a permanent partial disability occurring prior to the disability for which benefits are claimed hereunder) are paid or payable under this chapter, the volunteer firemen's benefit law, or any other workmen's compensation act, occupational disease act or similar law, or under any employers' liability act or similar law; under any other temporary disability or cash sickness benefits act or similar law; under section six hundred eighty-eight, title forty-six, United States code; under the federal employers' liability act; or under the maritime doctrine of maintenance, wages and cure. 2. If an employee who is eligible for benefits under section two hundred three or two hundred seven is disabled and has claimed or subsequently claims workmen's compensation benefits under this chapter or benefits under the volunteer firemen's benefit law, and such claim is controverted on the ground that the employee's disability was not caused by an accident that arose out of and in the course of his employment or by an occupational disease, or by an injury in line of duty as a volunteer fireman, the employee shall be entitled in the first instance to receive benefits under this article for his disability. If benefits have been paid under this article in respect to a disability alleged to have arisen out of and in the course of the employment or by reason of an occupational disease, or in line of duty as a volunteer fireman, the employer or carrier or the chairman making such payment may, at any time before award of workmen's compensation benefits, or volunteer firemen's benefits, is made, file with the board a claim for reimbursement out of the proceeds of such award to the employee for the period for which disability benefits were paid to the employee under this article, and shall have a lien against the award for reimbursement, notwithstanding the provisions of section thirty-three of this chapter or section twenty-three of the volunteer firemen's benefit law provided the insurance carrier liable for payment of the award receives, before such award is made, a copy of the claim for reimbursement from the employer, carrier or chairman who paid disability benefits, or provided the board's decision and award directs such reimbursement therefrom Disability While Unemployed An employee whose employment with a covered employer is terminated and who during a period of unemployment within twenty-six weeks immediately following such termination of employment shall become ineligible for benefits currently being claimed under the unemployment insurance law solely because of disability commencing after June thirtieth, nineteen hundred fifty, and who on the day such disability commences is not employed or working for remuneration or profit and is not then otherwise eligible for benefits under this article, shall be entitled to receive disability benefits as herein provided for each week of such disability for which week he would have received unemployment insurance benefits if he were not so disabled. The weekly benefit of such disabled employee shall be computed in the same manner as provided in subdivision two of section two hundred four, and the benefits he is entitled to receive shall be subject to the limitations as to maximum and minimum amounts and duration and other conditions and limitations prescribed in sections two hundred four, two hundred five and two hundred six. 2. An employee whose employment with a covered employer is terminated and who was in employment of one or more covered employers and was paid wages of at least thirteen dollars in such employment in each of twenty calendar weeks during the thirty calendar weeks immediately preceding the date he last worked for such covered employer, and who during a period of unemployment within twenty-six weeks immediately following such termination of employment is not eligible to benefits under the unemployment insurance law because of lack of qualifying wages but who during unemployment has evidenced his continued attachment to the labor market, shall be eligible for benefits under the provisions of this subdivision for disability commencing after June thirtieth, nineteen hundred fifty. If such employee becomes disabled and continues to be disabled for at least eight consecutive days during such twenty-six week period and on the day such disability commences he is not employed or

27 working for remuneration or profit and is not then otherwise eligible for benefits under this article, he shall be entitled to receive disability benefits, as herein provided, beginning with the eighth consecutive day of such disability, for each week of such disability thereafter. The weekly benefit of such disabled employee shall be computed in the same manner as provided in subdivision two of section two hundred four, and the benefits he is entitled to receive shall be subject to the limitations as to maximum and minimum amounts and duration and other conditions and limitations prescribed in sections two hundred four, two hundred five and two hundred six. 3. The benefits payable under this section shall be subject to the provisions and limitations generally applicable to disability benefits payable under this article, and shall be paid by the chairman out of any assets in the fund created by section two hundred fourteen. The chairman may require an employee claiming benefits under this section to file proofs of disability and of his employment and wages, and other proofs reasonably necessary for the chairman to make in the first instance the determination of eligibility and benefit rights under this section; and may require his employer or his former employer or employers to file reports of employment and wages and other information reasonably necessary for such determination. The chairman may make administrative regulations for such determinations. The chairman may also by regulation establish reasonable procedures for determining pro rata benefits payable with respect to disability periods of less than one week. Any employee claiming benefits under this section whose claim is rejected in whole or in part by the chairman, shall be entitled to request a review by the board and shall have all the rights with respect to contested claims provided in this article. 4. An employment of not more than four weeks with a non-covered employer or employers occurring within such twenty-six weeks period shall not disqualify an employee from benefits provided such employee was otherwise eligible to receive benefits under this section at the time such employment for a noncovered employer commenced Payment of Disability Benefits Benefits provided under this article shall be paid periodically and promptly and, except as to a contested period of disability, without any decision by the board. The first payment of benefits shall be due on the fourteenth day of disability and benefits for that period shall be paid directly to the employee within four business days thereafter or within four business days after the filing of required proof of claim, whichever is the later. Thereafter benefits shall be due and payable bi-weekly in like manner. The chairman may determine that benefits may be paid monthly or semi-monthly if wages were so paid, and may authorize deviation from the foregoing requirements to facilitate prompt payment of benefits. 2. The chairman may, whenever such information is deemed necessary, require any carrier to file in form prescribed by the chairman a report or reports as to any claim or claims, including (but without limitation) dates of commencement and termination of benefit payments and amount of benefits paid under this article. The chairman may also require annually information in respect to the aggregate of benefits paid, the number of claims allowed and disallowed, the average benefits and duration of benefit periods, the amount of payrolls covered and such other information as the chairman may deem necessary for the purposes of administering this article. If the carrier is providing benefits in respect to more than one employer, the chairman may require that such information be shown separately as to those employers who are providing only benefits that are substantially the same as the benefits required in this article Contribution of Employees for Disability Benefits Every employee in the employment of a covered employer shall, on and after January first, nineteen hundred fifty, contribute to the cost of providing disability benefits under this article, to the extent and in the manner herein provided. 2. The special contribution of each such employee to the accumulation of funds to provide benefits for disabled unemployed shall be as provided in subdivision one of section two hundred fourteen. 3. The contribution of each such employee to the cost of disability benefits provided by this article shall be one-half of one per centum of the employee's wages paid to him on and after July first, nineteen hundred fifty, but not in excess of sixty cents per week. 4. Notwithstanding any other provision of law, the employer is authorized to collect from his employees, except as otherwise provided in any plan or agreement under the provisions of subdivisions four or five of section two hundred eleven, the contribution provided under subdivisions two and three, through payroll deductions. If the employer shall not make deduction for any payroll period he may thereafter, but not later than one month after payment of wages, collect such contribution through payroll deduction. 5. In collecting employee contributions through payroll deductions, the employer shall act as the agent of his employees and

28 shall use the contributions only to provide disability benefits as required by this article. After June thirtieth, nineteen hundred fifty, if the employer is not providing, or to the extent that he is not then providing, for the payment of disability benefits to his employees by insuring with the state fund or with another insurance carrier, he shall keep the contributions of his employees as trust funds separate and apart from all other funds of the employer. The payment of such contributions by the employer to a carrier providing for the payment of such benefits shall discharge the employer from responsibility with respect to such contributions Employer Contributions Every covered employer shall, on and after January first, nineteen hundred fifty, contribute the cost of providing disability benefits in excess of the contributions collected from his employees, to the extent and in the manner provided in this article. 2. The special contribution of each covered employer to the accumulation of funds to provide benefits for disabled unemployed shall be as provided in subdivision one of section two hundred fourteen. 3. The contribution of every covered employer to the cost of providing disability benefits after June thirtieth, nineteen hundred fifty, shall be the excess of such cost over the amount of the contributions of his employees. 4. No profit shall be derived by any employer or association of employers or of employees from providing payment of disability benefits under this article. All funds representing contributions of employers and employees, and increments thereon, held by employers or associations of employers or of employees authorized or permitted to pay benefits under the provisions of this article, and by trustees paying benefits under plans or agreements meeting the requirements of section two hundred eleven, shall be trust funds and shall be expended only to provide for the payment of benefits to employees and for the costs of administering this article and for the support of the fund established under section two hundred fourteen Provision for Payment of Benefits -- A covered employer shall, with his own contributions and the contributions of his employees, provide disability benefits to his employees in one or more of the following ways: 1. by insuring and keeping insured the payment of such benefits in the state fund, or 2. by insuring and keeping insured the payment of such benefits with any stock or mutual corporation or reciprocal insurer authorized to transact the business of accident and health insurance in this state, or 3. by furnishing satisfactory proof to the chair of the employer's financial ability to pay such benefits, in which case the chair shall require the deposit of such securities as the chair may deem necessary of the kind prescribed in subdivisions one, two, three, four and five and paragraph a of subdivision seven of section two hundred thirty-five of the banking law or the deposit of cash or the filing of irrevocable letters of credit issued by a qualified banking institution as defined by rules promulgated by the chair or the filing of the bond of a surety company authorized to do business in this state, conditioned on the payment by the employer of its obligations under this article and in form approved by the chair or the posting and filing of a combination of such securities, cash, irrevocable letter of credit and surety bonds in an amount to be determined by the chair, to secure his or her liability to pay the compensation provided in this chapter. The amount of deposit or of the penal sum of the bond shall be determined by the chair and shall not be less than one-half the estimated contributions of the employees of the employer for the ensuing year or one-half of the contributions of the employees which would have been paid by the employees during the preceding year, whichever is the greater, or if such amount is more than fifty thousand dollars an amount not less than fifty thousand dollars. The chair shall have authority to deny an application to provide benefits pursuant to this subdivision or to revoke approval at any time for good cause shown. In the case of an employer who maintains a deposit of securities, irrevocable letters of credit or cash in accordance with subdivision three of section fifty of this chapter, the chair may reduce the amount of the deposit or of the penal sum of the bond, provided the securities, irrevocable letters of credit or cash deposited by or for such employer under subdivision three of section fifty of this chapter are, by agreement satisfactory to the chair, made available for the payment of unpaid benefits under this article with respect to obligations incurred for disabilities commencing prior to the effective date of such revocation. An association of employers or employees authorized to pay benefits under this article or the trustee or trustees paying benefits under a plan or agreement authorized under subdivisions four and five of this section, may with the approval of the chair furnish such proof and otherwise comply with the provisions of this section to provide disability benefits to employees under such plan or agreement. 4. by a plan in existence on the effective date of this article. If on the effective date of this

29 Puerto Rico article the employees of a covered employer or any class or classes of such employees are entitled to receive disability benefits under a plan or agreement which remains in effect on July first, nineteen hundred fifty, the employer, subject to the requirements of this section, shall be relieved of responsibility for making provision for benefit payments required under this article until the earliest date, determined by the chairman for the purposes of this article, upon which the employer shall have the right to discontinue the provisions thereof or to discontinue his contributions towards the cost. Any such plan or agreement may be extended, with or without modification, by agreement or collective bargaining between an employer or employers or association of employers and an association of employees, in which event the period for which the employer is relieved of such responsibility shall include such period of extension. Any other plan or agreement in existence on the effective date of this article which the employer may, by his sole act, terminate at any time, or with respect to which he is not obligated to continue for any period to make contributions, may be accepted by the chairman as satisfying the obligation to provide for the payment of benefits under this article if such plan or agreement provides benefits at least as favorable as the disability benefits provided by this article and does not require contributions of any employee or of any class or classes of employees in excess of the statutory amount provided in section two hundred nine, subdivision three, except by agreement and provided the contribution is reasonably related to the value of the benefits as determined by the chairman. The chairman may require that the employer shall enter into an agreement in writing with the chairman that he will pay the assessments set forth in sections two hundred fourteen and two hundred twenty-eight and that until he shall have filed written notice with the chairman of his election to terminate such plan or agreement or to discontinue making necessary contributions to its cost, he will continue to provide for the payment of the disability benefits under such plan or agreement. During any period in which any plan or agreement or extension thereof authorized under this subdivision provides for payment of benefits under this article, the responsibility of the employer and the obligations and benefits of the employees shall be as provided in said plan or agreement rather than as provided under this article, other than the benefits provided in section two hundred seven, and provided the employer or carrier has agreed to pay the assessments described in sections two hundred fourteen and two hundred twenty-eight. Any such plan or agreement may be extended with or without modification, provided the benefits under such plan or agreement, as extended or modified, shall be found by the chairman to be at least as favorable as the benefits provided by this article. 5. by a new plan or agreement. After the effective date of this article, a new plan or agreement with a carrier may be accepted by the chairman as satisfying the obligation to provide for the payment of benefits under this article if such plan or agreement shall provide benefits at least as favorable as the disability benefits provided by this article and does not require contributions of any employee or of any class or classes of employees in excess of the statutory amount provided in section two hundred nine, subdivision three, except by agreement and provided the contribution is reasonably related to the value of the benefits as determined by the chairman. Any such plan or agreement shall continue until written notice [is] filed with the chairman of intention to terminate such plan or agreement, and any modification of such plan or agreement shall be subject to the written approval of the chairman. During any period in which any plan or agreement or extension thereof authorized under this subdivision provides for payment of benefits under this article, the responsibility of the employer and the obligations and benefits of the employees shall be as provided in said plan or agreement rather than as provided under this article, other than the benefits provided in section two hundred seven, and provided the employer or carrier has agreed to pay the assessments described in sections two hundred fourteen and two hundred twenty-eight. 6. if any plan or agreement authorized under subdivisions four and five of this section covers less than all of the employees of a covered employer, the provisions of this article shall apply with respect to his remaining employees not covered under such plan or agreement. The chairman may make reasonable regulations for the filing under subdivisions four and five of this section of plans and agreements to provide for the payment of benefits under this article. 3. PAYMENT OF BENEFITS -- (a) Disability benefits shall be paid, in the amounts indicated in Section 3(d), to an insured worker who suffers loss of wages as a consequence of disability, due to a non-occupational illness or accident not connected with his employment, subject to all the conditions, limitations and provisions of this Section. Provided, that under this Section, no benefits shall be paid for disability caused by an automobile accident covered by Act No. 138 of June 26, 1968, as amended, known as the Automobile Accident Social Protection Act. INSURED STATUS -- (b)(1) A person

30 shall be considered as an insured worker if he or she has received wages of at least $150 in covered employment during his or her base year. Such base year shall be the first four of the last five consecutive calendar quarters immediately preceding the date of filing a claim for benefits. (2) "Disability period" shall be the period during which a person has been continuously disabled. Subsequent disability periods caused by the same illness or accident, or related thereto, shall be considered as one sole disability period if the subsequent periods occur in lapses of less than 90 days. WAITING PERIOD AND DURATION OF BENEFITS -- (c)(1) Disability benefits shall be paid commencing with the eighth day of disability and therefrom during the existence of the disability, but not for more than 26 weeks in any disability period nor in any period of 52 consecutive calendar weeks. Provided that, for purposes of this section, the days paid or payable as vacation or sick leave provided by mandatory decree, collective bargaining or provision of law shall not be deducted from the maximum benefit period. (2) If the claimant has been admitted into a duly authorized hospital, on orders by a physician, health officer, or court of justice, within the first seven (7) days of the disability period, benefits shall be paid commencing on the first day of the hospitalization. (3) An individual who is disabled during a continued period of unemployment within a benefit year in which he served a waiting period as required by Act No. 74 of 1956, amended, the Puerto Rico Employment Security Act, and who but for the disability would be entitled to receive unemployment insurance, benefits shall be paid commencing with the first day of disability. Provided that, the waiting period shall not be required in cases of agricultural workers who become disabled during a continued period of unemployment within a benefit year. (4) Upon the arising of subsequent disability periods caused by the same illness or accident, or connected thereto, they shall be deemed as recurrent states thereof if the subsequent periods occur in a time span of 90 days or less. Provided that in these cases the waiting period elapsed in the first stage of the claim will not be required. AMOUNT OF BENEFITS -- (d)(1) Benefits for illness or injury (a) Non-agricultural workers. The amount of weekly benefits shall be the highest amount specified in Column C of the following table under which the worker qualifies owing to the fact that his insured wages in his base year and the insured wages in the quarter of highest income during his base year comply with the corresponding requirements indicated in Columns A and B. The requirements of Columns A and B correspond to the amount of benefits as it appears in the same line. "Insured wages in the quarter of highest income during the base year" means the wages payable to the worker for insured work in that calendar quarter of his base year in which the total of said wages was the highest. Column A Column B Column C Insured wages in the quarter of highest income of Insured Wages in the base year, Amount of weekly the base year of at least: of at least: Benefits $37.50 $ $

31 , , , , , , , , , , , , , , , , , , , , , , , , , , , , Column A Column B Column C Insured wages in the quarter of highest income of Insured Wages in the base year, the base year of at least: of at least: not applicable 5, not applicable 5, not applicable 5, not applicable 5, not applicable 5, not applicable 5, not applicable 5, not applicable 5, not applicable 6, not applicable 6, not applicable 6, not applicable 6, not applicable 6, not applicable 6, not applicable 6, not applicable 6, not applicable 6, not applicable 6, not applicable 7, not applicable 7, not applicable 7, not applicable 7, not applicable 7, not applicable 7, not applicable 7, not applicable 7, not applicable 7, not applicable 7, not applicable 8, Amount of weekly Benefits

32 not applicable 8, not applicable 8, not applicable 8, not applicable 8, not applicable 8, not applicable 8, not applicable 8, not applicable 8, not applicable 8, not applicable 9, (b) Agricultural workers (i) The weekly benefit amount of an agricultural worker more than 50 percent of whose insured wages in his base year were paid for agricultural services as specified in section 202(j)(1)(C) of this title shall be the highest amount allocated in Column B of the following table in that line of the Column under which the total wages paid to an individual for insured work in his base year appear: Annual Wages (Column A) Weekly Benefit (Column B) $ $ , , , , , , , , , , , , , , , , , , , ,

33 2, , , , , , , and over (ii) When a worker qualifies to receive benefits for work specified under paragraphs (A) and (B) as well as under paragraph (C) of subsection (j)(1) of Section 2, he may, at his discretion, elect whether he claims benefits under the table appearing under subsection (d)(1) of this section or the table appearing under subsection (d)(2) of this section, or he may leave to the discretion of the Secretary to pay him that amount of benefit which is greater, provided that, once the worker has made the election, such election will be final with respect to said disability period. (2) Pregnancy benefits. When a female worker becomes disabled due to pregnancy, she shall receive the benefits provided in subparagraph (1) of paragraph (d) of this Section. Provided, however, that the benefits for temporary disability payable for any period during which the pregnant disabled employee receives benefits under Act 3 of March 13, 1942, as amended [ of Title 29], shall be the difference between the benefits payable under said Act and seventy-five (75) percent of her weekly wages. The amount between the benefit paid by the employer under the provisions of the Act to Protect Working Mothers and the benefit payable under this subparagraph shall not be less than the weekly benefit that would correspond to the working woman under the provisions of subparagraph (1) of this paragraph. APPORTIONMENT -- (e) A week shall be any period of seven (7) consecutive days beginning Sunday at 12:01 A.M. and ending Saturday at 12:00 M., and one "day" shall be the period of 24 hours, beginning and ending at midnight. In the case of any disability period of less than a week, the benefits payable shall be computed in one seventh ( 1/7) part of the amount of weekly benefits, for each day of disability. The total of benefits for one fraction of a week shall be computed to the highest whole dollar ($1.00). OTHER BENEFITS -- (f)(1) Death Benefit. Upon the sudden death of an insured worker as a result of an injury or accident otherwise compensable under this Act, or if as a result of an injury or illness compensable under this chapter the death of a worker occurs within the period of 52 calendar weeks immediately following the date in which the disability began, there shall be paid, in addition to the benefits owed, the amount of four thousand ($4,000) dollars, as the Secretary may prescribe by regulation, to the person or persons that the Secretary may declare depended directly on the beneficiary worker. Said regulations do not necessarily have to be in harmony with the provisions of law on descendants and distributions applicable to estates. Provided, that benefits under this section will not be paid for death from an automobile accident as covered by Act #138, 26 June 1968 [ 2051, et seq. of Title 9]. The following persons shall be deemed as beneficiaries of the insured worker, with the rights and limitations established herein below: (A) The surviving spouse and all the children, including adopted and foster children. Provided, that when the persons that depended on the insured at the time of his death were minors or mentally disabled, the benefits corresponding to these beneficiaries shall be delivered to the person who was or who will be in charge of said minors or disabled persons, if after conducting the corresponding investigation, it is advisable to deliver the same to such persons, thus causing the Secretary of Labor and Human Resources, his agents or employees to be hereby released from all future liability upon making the payment in the manner indicated. It is further provided that, in the case of parents that are separated or divorced, the mother and the children shall not be affected if the father has neglected his obligations towards them, thus being forced to depend on social welfare or relatives for their support. Children 18 years of age or less shall be deemed to be dependents, unless they are permanently physically disabled, or up to 25 years of age if they are students. (B) The man or woman who had been living, honestly and publicly, as man and wife, with the worker during the last three years, prior to the death of the latter, and the parents of the insured worker, including foster parents, if they depended on the insured worker for their support. (C) Grandparents, and in their absence, siblings, nephews, nieces, grandchildren and cousins, up to the fourth degree of consanguinity and the second of affinity, and to all the remaining relatives that depended on the insurance worker for their support because they are unable to look after themselves and have no other means for subsistence. (D) Any person who is under 18 years of age, or over 18 years who has physical or mental defects and who depended on the insured worker and is

34 unable to support himself without the help of the worker. A receipt from the persons or persons to whom the payment is made will totally release the Fund, the Director, the Administrator of a private plan and the Secretary from any liability with respect to said benefits. The dependents of the deceased worker must file their claim under this subsection, with the period of six (6) months following the death of the worker, in the manner the Secretary may prescribe by regulations. However, the Director may extent the period of the claim for just cause. However, no claim filed after the lapse of a year from the date of the worker's death shall be deemed entitled to benefits by the Director or the Secretary. (2) Benefits for Dismemberment. (A) If the injuries suffered by the worker in an accident compensable under this chapter, except injuries caused by or in relation with an automobile accident covered under Act #138 of 26 June 1968, result in any of the disabilities set forth in paragraph (C) of this subsection within 90 days from the date of the accident, the amount provided for such disability shall be paid. The period of 90 days may be extended by the Director for a period of not more than one year from the date of the accident, if at the beginning of each period of 30 days subsequent to the date of expiration of said period of 90 days, a medical certificate is produced stating that the victim is being treated for injuries that may eventually result in one of the disabilities set forth in paragraph (C) of this subsection. (B) If the worker dies within 30 days immediately following the date of the occurrence of any disability compensable under clause (A) of this subsection, any amount paid by virtue of clause (C) of this subsection shall be deducted from the death benefit established under subsection (f)(1) of this section. (C) In case of the occurrence of the disabilities indicated, the following dismemberment benefits shall be paid: Total and permanent loss of the sight of both eyes $4,000 Loss of both feet from or above the ankle 4,000 Loss of both arms from or above the wrist 4,000 Loss of an arm and a leg 4,000 Loss of an arm from or above the wrist 3,000 Loss of a leg from or above the ankle 3,000 Loss of a hand or foot 2,500 Total and permanent loss of sight of one eye 2,500 Loss of at least three fingers or toes 2,000 In the case of an individual who suffers more than one of the disabilities indicated above in an accident, the maximum amount for all his disabilities shall be $4,000. (D) The worker shall file his claim under this subsection within the six (6) months following the date on which the dismemberment occurred, in the form prescribed by the Secretary through regulation. However, the Director may, for good cause, extend the claim period. Nevertheless, no claim filed after the lapse of a year from the date of the dismemberment shall be considered as entitled to benefits by the Director or the Secretary. LIMITATIONS -- (g) No person shall be eligible for disability benefits: (1) In any period during which he or she is not under treatment by a duly authorized physician or by a chiropractor authorized under Act Number 943, approved May 15, 1952; "Act Regulating the Practice of the Chiropractic Profession in Puerto Rico". A claimant who is outside of Puerto Rico at the time of the disability shall be under the care of a physician or chiropractor duly authorized to practice in the jurisdiction where the claimant is residing. (2) during any disability period caused by or in relation to abortion, except in cases of abortions provoked for medical reasons or if complications arise as a result thereof; (3) in any day of disability during which the worker rendered service (in a work whether covered or not) whether or not for compensation; (4) for any disability caused by premeditated or intentionally self-inflicted injuries or illness, or by injuries received by the claimant in the commission of an unlawful act; (5) in such amount as the disability benefits during any period, in addition to any compensation he or she

35 continues to receive from the employer or from a fund to which the employer has contributed, exceed the regular full time weekly wages he or she is receiving immediately prior to his or her disability; (6) in any period during which the claimant is receiving retirement or pension payment, public or private, except when, after beginning to receive such retirement or pension, said worker has performed services in an insured employment for at least fifteen (15) weeks; (7) during any disability period in which he is in prison, confined or secluded in an institution as a dipsomaniac, drug addict or sexual psychopath by order of a competent court; (8) in any period during which claimant is receiving benefits under sections 681 et seq. of Title 29 [Chauffeurs Social Security Act, Act No. 428, approved May 15, 1950], unless said claimant has been covered by the approval of the employer's elective coverage pursuant to Section 7(e), in which case the worker shall receive the weekly benefit he is eligible for in the Program, provided, that said payment, added to the benefits received under section 681 et seq., of Title 29 does not exceed the regular weekly wages he earned before the disability. (9) during any disability period caused by or in connection with an automobile accident covered under the Automobile Accident Social Protection Act, Act No. 138 of June 26, 1968, sections of Title 9. REFUND TO EMPLOYERS PAYING WAGES DURING PERIODS OF DISABILITY -- (h)(1) If a worker, otherwise eligible for disability benefits, was ineligible for said benefits during one or more days, because he received full payment from his employer for those days, the disability benefits payable for those days shall be paid to the employer provided that the following requirements are complied with: (A) the employer requests in writing the corresponding refund within two (2) months after the payment of the last day of the period for which said refund is claimed; (B) the worker files with the Director a claim for disability benefits and a verification of wages paid by the employer during the disability period in the form prescribed by the Secretary; (C) evidence of the worker's disability is submitted to the Director in accordance with subsection (k) of this section; and (D) the employer has certified to the Director in the blank form prescribed by the Secretary, the payment of the wages involved in the claim. In no account shall said payment exceed the total of the wages paid to the workers, nor shall it correspond to a disability period for which there are paid or are payable leave of absence or sick leave as provided by mandatory decree, collective agreement or by provision of law. Upon prescribing regulations to enforce this subsection the Secretary may require the employers to file in advance with the Director their plans or practices for the voluntary payment of wages during disability periods and to provide the necessary requirements to avoid refunds under this subsection if the employing unit unduly restricts the payment of wages to its employees during disability periods. For purposes of this subsection it shall be understood by voluntary payment, that complete payment of wages voluntarily made by the employer and not due to obligation or duty. (2) If the Fund or the Administrator of a Private Plan makes benefits payments to a worker for a period during which no corresponding payment need have been made because neither was the insurer of the worker, the Fund or the Administrator of the Private Plan may request the insurer to whom payment of the claim corresponded, to reimburse it for the amount corresponding to the benefits paid erroneously. DUPLICATION OF BENEFITS -- (i)(1) No disability benefits shall be paid with regard to any week during which benefits are received under the Employment Security Act, or the Unemployment Compensation Act of any State or of the United States. (2) No disability benefits shall be paid for any period regarding which workmen's compensation benefits are paid, except as hereinafter provided: (A) If a claimant eligible for disability benefits claims benefits under the workmen's compensation act and said claim is disputed under the provisions of said act, on the grounds that the disability did not arise from, or during, the course of employment, or from an occupational illness, he shall be eligible, in the first place, to receive benefits under this act for his disability. (i) The benefits payable under this clause shall be computed according to subsection (d) of this section; Provided, that in no case, more than sixty five dollars ($65.00) or less than twelve dollars ($12.00) per week shall be paid. If, subsequently, the worker becomes eligible to receive compensation benefits under the Workmen's Accident Compensation Act, sections 1-42 of this title [Title XI] the Director, in behalf of the Fund, or the Administrator of a private plan which is paying disability benefits under such circumstances shall have a lien on the adjudication for the refund of the disability benefits payable under this subsection, notwithstanding any other provision of law to the contrary. However, if the decision of the State Insurance Fund would be that the worker's injury or sickness is of a non-occupational character, the Director or the Administrator of a Private Plan, who has paid disability compensation under this subsection, shall reconsider the initial determination, assigning to the worker the weekly benefit amount that would correspond according to the tables appearing under subsection (d) of this section,

36 or on the basis of the benefit formula of a Private Plan approved under the provisions of Section 5 of this act, as the case may be. In the cases in which the State Insurance Fund should decide that the worker's injury or illness is non-occupational and the worker had received benefit payments for temporary disability from said Fund, said payments shall be deducted from the disability benefits he is entitled to hereunder. This deduction shall never be for an amount exceeding the disability benefits to which he is eligible. The amount thus deducted shall be reimbursed to the State Insurance Fund by the Disability Benefit Fund upon the filing by the State Insurance Fund Manager of a certified invoice containing the liquidation of payments made to the worker. Notwithstanding the provisions of Section 3(k), for the purpose of paying the disability benefit provided herein to a worker who had received benefit payments for temporary disability from the State Insurance Fund on account of an injury or illness which has been finally found to be non-occupational, the filing date of the claim shall be understood to be the filing date of the case in the State Insurance Fund. (B) No disqualification shall be applicable on the basis of workmen's compensation payments if the payments are made on account of partial permanent disability occurring prior to the disability for which benefits are claimed. (3) No disability benefits shall be paid for any period with respect to which benefits, compensation or other payments are paid or have been awarded, regardless of whether the latter have begun to be paid, under any employers liability act, under any act of temporary disability benefits, of benefits for illness, any similar act or disability benefits under the United States Social Security Act; Provided, that this provision shall not be applicable if the payments are received on account of a different permanent partial disability incurred prior to the disability for which benefits are being claimed or when benefits are received under the Act to Protect Working Mothers as provided under paragraph (d), subparagraph (2) of this Section. (4) The Fund shall not pay disability benefits for any day of disability with respect to which benefits are payable under a private plan approved under Section 5 of this Act, unless said payment is a payment prorated due to concurrent employment on the last day of employment preceding the disability. The Secretary shall prescribe by regulations the prorating of benefits if a worker is eligible for benefits in more than one plan due to concurrent employment on the last day of employment preceding the disability. (5) The Secretary shall prescribe by regulation the apportionment of benefits if the worker is eligible for benefits under more than one plan, due to concurrent employment on his last day of employment preceding the disability. (6) [Repealed.] PAYMENT IN THE CASE OF INJURIES CAUSED BY A THIRD PARTY -- (j) If a worker eligible for disability benefits is disabled as a consequence of an injury caused by the negligence or fault of a third person, said worker shall be eliglble for said disability benefits, but the Fund, or the Administrator of a Private Plan paying disability benefits, shall have a lien on the total amount recovered from the third person, whether by execution of a sentence, contract, or other method, after deducting the reasonable and necessary expenses, including attorneys' fees due on said recovery, up to the limit of the total amount of the disability benefits paid. The rights, limitations, and proceedings previously indicated shall also apply to actions and recoveries under the employer liability act and Section 688, Title 46 of the United States Code, and under the "Maritime Doctrine of Maintenance, Wages and Cure". CLAIMS AND EVIDENCE -- (k) The disability benefits claims shall be made in accordance with the regulations approved by the Secretary. In order to be eligible for the benefits: (1) The claimant shall file his initial claim for disability benefits and any subsequent claim on the form prescribed by the Secretary. The claim shall be filed no later than three months from the date the disability began, except that the Director may, for good cause, extend the period for filing the claim. However, no claim filed after one year has elapsed from the date the disability began shall be deemed by the Director or by the Secretary as entitled to benefits. (2) The claimant shall submit, in support of his claim, a certificate by a duly authorized physician or a certificate from the custodian of medical records of a hospital or medical center, in the absence of the corresponding doctor, in the form prescribed by the Secretary, containing a declaration of the medical facts he has knowledge of, his conclusion regarding the disability of the claimant, and his opinion on the probable duration of the disability. A corresponding certificate by a chiropractor shall be sufficient if his practice so authorizes. (3) The claimant shall submit himself to those reasonable examinations that may be required therefrom by the Director, and shall furnish any information reasonably related with the determination of his right to benefits that may be requested by the Director. PAYMENTS TO MINORS, INCOMPETENT PERSONS AND DECEDENTS -- (l)(1) The benefits owed and payable to a decedent or to a person who has been judicially adjudged incompetent shall be paid, as prescribed by the Secretary by regulation, to the person or persons who the Secretary declares depended directly on

37 the beneficiary-worker. Said regulation does not necessarily have to be in harmony with the provisions of the laws of inheritance and distribution of property applicable to successions. A receipt signed by the person or persons to whom payment is made shall totally relieve the Fund, the Director and the Secretary from responsibility regarding said benefits. (2) When it is determined that the dependent person entitled to receive any benefit hereunder, is a minor or disabled, the compensation shall be paid through the father or the guardian. However, such payments shall not be made through the father or mother who may have abandoned or neglected his or her obligations to the child, in which case the payments shall be made through the person who has had the minor beneficiary under his care and attention at the moment of the occurrence of the entitlement. The Secretary may, through a special administrative procedure with the assistance of the Legal Division, enter into the handling and resolution of the designation of special guardians in cases of disabled adults, in order to administer their goods or care for them, and in the case of minors, exclusively for the purposes of benefits payments hereunder. In these cases procedural guarantees shall be provided to safeguard the rights of the involved parties. The Director must present to the Secretary of Labor the records of the case with a report that contains the initial investigation, his conclusions, and legal recommendations. (3) Insured workers under age shall be eligible to receive disability or dismemberment benefit payments, subject to those limitations that the Secretary may provide by regulations. NULLITY OF WAIVER OF RIGHTS -- (m) Any agreement whereby a person waives, relieves, or commutes his or her rights to receive benefits or any other rights under this act, except in those cases authorized thereby, shall be null and void. Similarly, any agreement whereby a person rendering services to an employer binds himself to pay in whole or part any contributions which this act requires said employer to pay shall be null and void. No employer shall require or accept the waiver of any right granted by this act to any person employed by him, nor may discriminate regarding the contracting or performance of any work or regarding any working conditions against a person on the basis that said person claims benefits under this act, nor may obstruct or prevent the claim of benefits thereunder. ASSIGNMENT OF BENEFITS -- (n) The assignment, pledge, or encumbrance of any of the benefits due or payable under this act except in the cases authorized thereby, shall be void; and said benefit rights shall be exempt from attachment, execution, confiscation, order regarding the payment of attorneys' fees, or any other remedy provided for the collection of debts, and the benefits received by any person, as long as they are not mingled with other funds of the person who has received payment, shall be exempt from any remedy for the collection of debts, excepting debts incurred for needs of said person or his spouse or any of his dependents during the time said person was disabled. The waiver of any of the exemptions provided in this subsection shall be void. PENALTY FOR PREMEDITATED FALSE REPRESENTATION -- (o) If during a particular week it is discovered that a person within the period of 24 calendar months immediately preceding said week, such person, with the intention of committing fraud to obtain benefits not payable hereunder, makes a false statement or misrepresentation of a material fact knowing it to be false or knowingly conceals a material fact, he shall not be eligible in said week nor shall he be eligible for benefits in any other seven (7) weeks during which, in any other way, he would have been eligible for benefits in a period of 52 calendar consecutive weeks counting from the beginning of the disability. REFUND AND REPARATION -- (p)(1) Any person who makes, or causes to be made by another, a false statement or misrepresentation of a material fact knowing it to be false or knowingly fails, or causes another to fail to disclose a material fact, or as a consequence of such act has received any amount as benefits under this chapter to which he was not etitled shall, in the discretion of the Secretary, be liable within the period of two (2) years following the finding to repay such amount to the Secretary for the Fund or to have such amount deducted from any future benefits payable to him under this chapter. (2) No redetermination or decision shall be construed to authorize the recovery of the amount of any benefits paid to a claimant or the deduction of such amount from future benefits payable to him unless the written notice of such redetermination or decision specifies that he is liable to repay to the Fund the amount of the benefits paid to him by reason of a nondisclosure or misrepresentation of a material fact as specified in section 203(o) of this title; as well as the nature of such nondisclosure or misrepresentation and the days or weeks for which such benefits were paid. (3) In any case in which, under this subsection, a claimant is liable to repay any amount to the Secretary for the Fund, such amount shall be collectible without interest. REINSTATEMENT AFTER DISABILITY -- (q) In cases of disability for work in accordance with the provisions of this law, the employer shall be required to reserve the job filled by the worker at the time the disability begins and to reinstate him in the same, subject to the following

38 conditions: (1) that the worker request the reinstatement from the employer within a period of 15 days from the date he was declared able and provided such request be made no later than one year following the onset of the disability; (2) that the worker be mentally and physically capable of fitting the job at the time he requests such reinstatement; and (3) that said job still exists at the time the worker requests reinstatement. The job shall be understood to exist when it is vacant or being occupied by another worker. It shall be presumed that the job was vacant if it is covered by another worker within 30 days after the date on which the reinstatement request was made. If the employer does not comply with the provisions of this subsection, he shall be obliged to pay the worker or his beneficiaries the wages that said worker would have earned if he had been reinstated, and further, shall respond for all damages and injuries this may have caused. The worker or his beneficiaries may prosecute and transact the corresponding reinstatement claim and/or damages in court through ordinary action or through the procedure for salary claim established in sections of Title 32 [Act # 2, 17 October 1961]. Rhode Island 4. WRITTEN NOTICE OF DETERMINATION AND RECONSIDERATION -- (a) After their request for benefits, all claimants will be sent a written notification of their determination of eligibility or ineligibility. The Director will send every determination by mail, certified mail or personal service, to the last known address of the claimant. If the insured, or his beneficiaries, or any person who claims to have the right to the benefits provided by this law was not satisfied with the determination of the Director, he may request the reconsideration of the same in writing, provided it is filed within twenty (20) days following the date of notification. In the absence of such request for reconsideration, the determination will be considered final BENEFIT YEAR (6) "Benefit year" with respect to any individual who does not already have a benefit year in effect, and who files a valid claim for benefits as of November 16, 1958 or any later date, shall mean fifty-two (52) consecutive calendar weeks, the first of which shall be the week containing the day as of which he or she first files that valid claim in accordance with regulations adopted as hereinafter prescribed; provided, however, that for any benefit year beginning on or after October 7, 1990, the benefit year shall be fifty-three (53) consecutive calendar weeks if the subsequent filing of a new valid claim immediately following the end of a previous benefit year would result in the overlapping of any quarter of the base period of the prior new claim; provided, further, however, that in no event shall a new benefit year begin prior to the Sunday next following the end of the old benefit year; (i) For benefit years that begin on or after July 1, 2012, an individual s benefit year will begin on the Sunday of the calendar week in which an individual first became unemployed due to sickness and for which the individual has filed a valid claim for benefits Temporary caregiver insurance. The purpose of this chapter is to establish, within the state temporary disability insurance program, a temporary caregiver insurance program to provide wage replacement benefits in accordance with the provisions of this chapter, to workers who take time off work to care for a seriously ill child, spouse, domestic partner, parent, parent-in-law, grandparent, or to bond with a new child. Definitions as used in this chapter: (1) "Child" means a biological, adopted, or foster son or daughter, a stepson or stepdaughter, a legal ward, a son or daughter of a domestic partner, or a son or daughter of an employee who stands in loco parentis to that child. (2) "Newborn child" means a child under one year of age. (3) "Adopted child" means a child adopted by, or placed for adoption with, the employee. (4) "Bonding or bond" means to develop a psychological and emotional attachment between a child and his or her parent(s) or persons who stand in loco parentis. This shall involve being in one another's physical presence. (5) "Parent" means a biological, foster, or adoptive parent, a stepparent, a legal guardian, or other person who stands in loco parentis to the employee or the employee's spouse or domestic partner when 1 he/she was a child. (6) "Domestic partner" means a party to a civil union as defined by chapter (7) "Spouse" means a party in a common law marriage, a party in a marriage conducted and recognized by another state or country, or in a marriage as defined by chapter (8) "Grandparent" means a parent of the employee's parent. (9) "Parent-in-law" means the parent of the employee's spouse or domestic partner. (10) "Employee" means any person who is or has been employed by an employer subject to chapters 39 through 41 of this title and in employment subject to those chapters. (11) "Serious health condition" means any illness, injury, impairment, or physical or mental condition that involves inpatient care in a hospital, hospice, residential health care facility, or continued treatment or continuing supervision by a licensed

39 health care provider. (12) "Department" means the department of labor and training. (13) "Persons who stand in loco parentis" means those with day-to-day responsibilities to care for and financially support a child or, in the case of an employee, who had such responsibility for the employee when the employee was a child. A biological or legal relationship shall not be required Benefits. (a) Subject to the conditions set forth in this chapter, an employee shall be eligible for temporary caregiver benefits for any week in which he or she is unable to perform his or her regular and customary work because he or she is: (1) Bonding with a newborn child or a child newly placed for adoption or foster care with the employee or domestic partner in accordance with the provisions of subdivision (c)(1); or (2) Caring for a child, a parent, parent-in-law, grandparent, spouse, or domestic partner, who has a serious health condition, subject to a waiting period in accordance with the provisions of section Employees may use accrued sick time during eligibility waiting period in accordance with the policy of the individual's employer. (b) Temporary caregiver benefits shall be available only to the employee exercising his or her right to leave while covered by the temporary caregiver insurance program. An employee shall file a written intent with their employer, in accordance with rules and regulations promulgated by the department, with a minimum of thirty (30) days notice prior to commencement of the family leave. Failure by the employee to provide the written intent may result in delay or reduction in the claimant's benefits, except in the event the time of the leave is unforeseeable or the time of the leave changes for unforeseeable circumstances. (c) Employees cannot file for both temporary caregiver benefits and temporary disability benefits for the same purpose, concurrently, in accordance with all provisions 1 of this act and chapter (d) Temporary caregiver benefits may be available to any individual exercising his or her right to leave while covered by the temporary caregiver insurance program, commencing on or after January 1, 2014, which shall not exceed the individual's maximum benefits in accordance with chapters The benefits for the temporary caregiver program shall be payable with respect to the first day of leave taken after the waiting period and each subsequent day of leave during that period of family temporary disability leave. Benefits shall be in accordance with the following: (1) Beginning January 1, 2014 temporary caregiver benefits shall be limited to a maximum of four (4) weeks in a benefit year; (e) In addition, no individual shall be paid temporary caregiver benefits and temporary disability benefits which together exceed thirty (30) times his or her weekly benefit rate in any benefit year. (f) Any employee who exercises his or her right to leave covered by temporary caregiver insurance under this chapter shall, upon the expiration of that leave, be entitled to be restored by the employer to the position held by the employee when the leave commenced, or to a position with equivalent seniority, status, employment benefits, pay, and other terms and conditions of employment including fringe benefits and service credits that the employee had been entitled to at the commencement of leave. (g) During any caregiver leave taken pursuant to this chapter, the employer shall maintain any existing health benefits of the employee in force for the duration of the leave as if the employee had continued in employment continuously from the date he or she commenced the leave until the date the caregiver benefits terminate; provided, however, that the employee shall continue to pay any employee shares of the cost of health benefits as required prior to the commencement of the caregiver benefits. (h) No individual shall be entitled to waiting period credit or temporary caregiver benefits under this section for any week beginning prior to January 1, (i) Temporary caregiver benefits shall be in accordance with federal Family and Medical Leave Act (FMLA) P.L and Rhode Island Family Parental and Family Leave Act in accordance with section , et. seq. An employer may require an employee who is entitled to leave under the federal Family and Medical Leave Act, PL and/or the Rhode Island Parental and Family Medical Leave Act, et seq., who exercises his or her right to benefits under the temporary caregiver insurance program under this chapter, to take any temporary caregiver benefits received, concurrently, with any leave taken pursuant to the 1 federal Family and Medical Leave Act and/or the Rhode Island Parental and Family Medical Leave Act Certification of eligibility for leave. (a) An individual who exercises his or her right to leave covered by the temporary caregiver insurance program under this chapter shall file a certificate form with all information required by the department. (b) For leave for reason of caring for a seriously ill family member, an employee shall file a certificate with the department that shall contain: (1) A diagnosis and diagnostic code prescribed in the international classification of diseases, or where no

40 diagnosis has yet been obtained, a detailed statement of symptoms; (2) The date if known, on which the condition commenced; (3) The probable duration of the condition; (4) An estimate of the amount of time that the licensed qualified health care provider believes the employee is needed to care for the family member; (5) A statement that the serious health condition warrants the participation of the employee to provide care for his or her family member. "Warrants the participation of the employee" includes, but is not limited to, providing psychological comfort, arranging third-party care for the family member as well as directly providing, or participating in the medical and physical care of the patient; and (6) A certificate filed to establish medical eligibility of the serious health condition of the employee's family member shall be made by the family member's treating licensed qualified heath care provider. (7) In the case of a parent, or persons who are in loco parentis caring for the serious health condition of a foster care child, the employee shall submit all required information in accordance with this section, with a written request to the department of children, youth and families for the release of medical information by the child's treating licensed qualified health care provider. The department of children, youth and families shall transmit the requested medical information, pending all properly submitted forms, to the department of labor and training, within ten (10) business days of request. In the absence of the requested transmitted medical information by the department of children, youth and families within ten (10) business days, the employee may request the licensed qualified healthcare provider to directly transmit the medical eligibility of the serious health condition to the department of labor and training. Payment shall not be delayed, in accordance with all provisions of chapter 39-41, as a result of delays by the department of children, youth and families in transmitting medical information. (c) The department shall develop a certificate of eligibility form for leave in the case of bonding as defined herein, for the birth of a newborn child of the employee 1 or the employee's domestic partner, or the placement of a child with the employee in connection with the adoption or foster care of the child by the employee or domestic partner, or persons in loco parentis. Information shall include the following: (1) A birth certificate, certificate of adoption, or other competent evidence showing the employee or the employee's domestic partner, or persons in loco parentis is the parent of the child within twelve (12) months of the child's adoption, birth or placement for adoption or foster care with the employee Determination of a Claim.-- (a) In accordance with section , upon the filing of a claim, the director shall promptly examine the claim and on the basis of facts found by the director and records maintained by the department, the claim shall be determined to be valid or invalid, if the claim is determined to be valid, the director shall promptly notify the claimant as to the week with respect to which benefits shall commence, the weekly benefit amount payable, and the maximum duration of those benefits. If the claim is determined to be invalid, the director shall likewise notify the claimant and any other interested parties of that determination and the reasons for it. if the processing of the claim is delayed for any reason, the director shall notify the claimant, in writing, within three (3) weeks of the date the application for benefits is filed of the reason for the delay. Unless the claimant or any other interested party, within fifteen (15) days, requests a hearing before the board of review, the determination with reference to the claim is final. However, for good cause shown the fifteen (15) day period may be extended after notification by the director has been mailed to his or her last known address, as provided in this section. At any time within one year from the date of a monetary determination, the director, upon request of the claimant or on his or her own motion, may reconsider his or her determination if he or she finds that an error in computation or identity has occurred in connection with it or that additional wages pertinent to the claimant's status have become available, or if that determination has been made as a result of a nondisclosure or misrepresentation of a material fact. (b) If an appeal is duly filed, benefits with respect to the period prior to the final decision, if it is found that those benefits are payable, shall be paid only after the decision. If an appeal tribunal affirms a decision of the director, or the board of review affirms a decision of an appeal tribunal allowing benefits, those benefits shall be paid regardless of any appeal which may subsequently be taken Confidential Health Information.-- Information pursuant to any individual's temporary disability claim or temporary caregiver insurance claim shall be held confidential in accordance with chapters 39-41, section , , and all applicable 1 state and federal regulations.

41 Powers and Duties.-- (a) The director of the department of labor and training shall have the following powers and duties: (1) To promulgate regulations relative to the operation of the temporary caregiver insurance program; (2) To create all necessary applications and certificates to fulfill the purposes of this section; (3) To disseminate information regarding the program to Rhode Island employers and shall carry out a public education program to inform workers and employers about the availability of benefits under the temporary caregiver insurance program. The director may use a proportion of the funds collected for the temporary caregiver insurance program in a given year to pay for the public education program and/or funding received from other sources for the purpose of educating the public about their benefits. Outreach information shall be available in English and other languages; and (4) To inform Rhode Island employees of their disability insurance rights and benefits due to the employee's own sickness, injury, or pregnancy, or the employee's need to provide care for any sick or injured family member or new child. The notice shall be given by every eligible employer to each new employee hired on or after January 1, 2014, and to each employee taking leave from work on or after January 1, 2014 due to pregnancy or the need to provide care for any sick or injured family member or new child. The director shall require each employer to post and maintain information regarding the program in accordance with section Fraud and Misrepresentation of Benefits. -- (a) The temporary caregiver insurance program shall be part of the temporary disability insurance fund. If the director finds that any individual falsely certifies the medical condition of any person in order to obtain family temporary disability insurance benefits, with the intent to defraud, whether for the maker or for any other person, the director shall assess a penalty against the individual in the amount of twenty-five percent (25%) of the benefits paid as a result of the false certification. Unless otherwise specified to the contrary, all of the provisions of chapters 39 through 41 of this title shall apply to the temporary caregiver insurance program. (b) If a physician or other qualified health care provider licensed by a foreign country is under investigation by the department for assisting in the filing of false claims and the department does not have the legal remedies to conduct a criminal investigation or prosecution in that country, the department may suspend the processing of all further certifications until the licensed qualified health care provider fully cooperates and continues to cooperate with 1 the investigation. A qualified health care provider licensed by and practicing in a foreign country who has been convicted of filing false claims with the department shall be barred indefinitely from filing a certificate in support of a temporary disability insurance or temporary caregiver insurance claim in the state of Rhode island Criminal Prosecution. -- All criminal actions for any violation of chapter of this title, or any rule or regulation of the department shall be prosecuted by the attorney general, or by any qualified member of the Rhode Island bar, that shall be designated by the director and approved by the attorney general to institute and prosecute that action Receipt of Federal Funds. -- To the extent that funds are made available by the federal government, under title III of the Social Security Act, (42 U.S.C. 501 et seq.), or otherwise for such purpose, the expenses of administering chapter of this title shall be paid from those funds, provided that this section shall not be considered to permit any expenditure of funds from the employment security administration account contrary to section In the event that the Social Security Act is amended to permit funds granted under Title III to be used to pay expenses of administering a sickness compensation law, such as chapter of this title, then from and after the effective date of that amendment, the expenses of administering those chapters shall be paid out of the employment security administration account or any other account or fund in which funds granted under Title III are deposited AMOUNT OF EMPLOYEE CONTRIBUTIONS WAGES ON WHICH BASED -- (a) The taxable wage base under this chapter for all calendar years shall be equal to the greater of $38,000 or the annual earnings needed by an individual to qualify for the maximum weekly benefit amount and the maximum duration under chapters of this title. That taxable wage base shall be computed as follows: Every September 30, the maximum weekly benefit amount in effect as of that date shall be multiplied by thirty (30) and the resultant product shall be divided by thirty-six hundredths (.36). If the

42 result thus obtained is not an even multiple of one hundred dollars ($100), it shall be rounded upward to the next higher even multiple of one hundred dollars ($100). That taxable wage base shall be effective for the calendar year beginning on the next January 1. (b) Each employee shall contribute with respect to employment after the date upon which the employer becomes subject to chapters of this title, an amount equal to the fund cost rate times the wages paid by the employer to the employee up to the taxable wage base as defined and computed in subsection (a). The employee contribution rate for the following calendar year shall be determined by computing the fund cost rate on or before November 15 of each year as follows: The total amount of disbursements made from the fund for the twelve-month period ending on the immediately preceding September 30 shall be divided by the total taxable wages paid by employers during the twelve-month period ending on the immediately preceding June 30. The ratio thus obtained shall be multiplied by one hundred (100) and the resultant product if not an exact multiple of one-tenth of one percent (0.1%) shall be rounded down to the next lowest multiple of one-tenth of one percent (0.1%); provided, however, that if the fund balance as of the preceding September 30 is less than the total disbursements from the fund for the sixmonth period ending on that September 30, that difference shall be added to the total disbursements for the twelve-month period ending September 30 for the purpose of computing the fund cost rate, and if the resulting fund cost rate is not an exact multiple of one-tenth of one percent (0.1%) it shall be rounded to the nearest multiple of one-tenth of one percent (0.1%) EXEMPTION OF EMPLOYEE DEPENDENT ON SPIRITUAL HEALING -- An employee who adheres to the faith or teachings of any church, sect, or denomination and in accordance with its creed, tenets, or principles, depends for healing upon prayer or spiritual means in the practice of religion, shall be exempt from the provisions of chapters of this title and excluded therefrom upon the filing with the director and with his or her employer, affidavits, in duplicate, stating that adherence and dependence, and disclaiming any and all benefits under those chapters whether or not arising before the passage hereof, and stating therein the name of the employer of that employee, which affidavits shall contain certifications by the president of the church which that employee attends, or certifications of any practitioner in the state who is authorized to practice healing based upon prayer or spiritual means, stating such adherence and dependence of that employee. Thereafter that employee and his or her employer shall be exempt from liability for contributions with respect to that employee provided for under chapters of this title, and the employer shall be entitled to rely upon the affidavit filed with it unless and until it shall receive notice from the director that the provisions hereof shall not have been complied with or that such affidavit is not in proper form. In case the employee, after the filing of the affidavits, shall obtain new employment, he or she must file new affidavits as hereinbefore provided in order to be exempt from chapters of this title LAG DAY BENEFITS (a) An individual who, having been unemployed due to sickness and who is in receipt of benefits under this chapter, returns to work prior to the end of the immediately succeeding week, shall be entitled to one-fifth ( 1 / 5 ) of his or her benefit rate for each day of unemployment due to sickness in which work is ordinarily performed in the occupation in which he or she is employed during the week in which he or she returns to work, figured to the highest dollar, including any holiday when the performance of services is waived by his or her employer, provided, however, that in no case shall any individual be entitled to more than four-fifths ( 4 / 5 ) of his or her benefit rate, figured to the highest dollar, for that week. (b) An individual who, having been unemployed due to sickness at a later date during his or her benefit year, again becomes unemployed due to sickness, and refiles his or her claim for benefits therefor, shall, if his or her first day of unemployment begins on a day subsequent to the first day of any week, be entitled to one-fifth ( 1 / 5 ) of his or her benefit rate for each day in such week in which work is ordinarily performed in the occupation in which he or she was last employed, including any holiday when the performance of services is waived by his or her employer, figured to the highest dollar, if his or her unemployment continues for seven (7) consecutive calendar days, including the first day of unemployment due to sickness for which he or she has refiled his or her claim, provided, however, that in no case shall any individual be entitled to more than four-fifths ( 4 / 5 ) of his or her benefit rate, figured to the highest dollar, for the week in which his or her unemployment begins on a day subsequent to the first day of that week.

43 EXEMPTION OF MINORS FOURTEEN (14) AND FIFTEEN (15) YEARS OF AGE -- Minors fourteen (14) and fifteen (15) years of age shall be exempt from chapters of this title EXEMPTION OF CERTAIN DISABLED PERSONS -- Disabled persons employed through a "supported employment" program as described in the federal rehabilitation act amendments of 1992 and who are ineligible to receive temporary disability benefits because their pay is too low may elect to be exempt from the provisions of chapters of this title WAGES INCLUDED FOR BENEFIT PURPOSES -- Notwithstanding any provisions of chapters of this title to the contrary, the term "wages" as used in the phrase "wages for employment from employers" shall mean, with reference to the benefits provisions of chapters of this title, only those wages which are paid subsequent to the date upon which the employing unit, by whom those wages were paid, has satisfied the conditions of (12) with respect to becoming an employer subject to those chapters. No individual shall be denied benefits under chapters of this title because his or her employer continued to pay to that individual his or her regular wages, or parts thereof, while he or she was sick and unable to perform his or her regular or customary work or services. However, the amount of any payments, whether or not under a plan or system, made to or on behalf of an employee by his or her employer after the expiration of six (6) calendar months following the last calendar month in which the employee performed actual bona fide personal services for that employer, shall not be deemed to be wages for the purpose of being used as a basis for paying benefits under chapter 41 of this title WAGES INCLUDED FOR BENEFIT PURPOSES -- Notwithstanding any provisions of chapters of this title to the contrary, the term "wages" as used in the phrase "wages for employment from employers" shall mean, with reference to the benefits provisions of chapters of this title, only those wages which are paid subsequent to the date upon which the employing unit, by whom those wages were paid, has satisfied the conditions of (12) with respect to becoming an employer subject to those chapters. No individual shall be denied benefits under chapters of this title because his or her employer continued to pay to that individual his or her regular wages, or parts thereof, while he or she was sick and unable to perform his or her regular or customary work or services. However, the amount of any payments, whether or not under a plan or system, made to or on behalf of an employee by his or her employer after the expiration of six (6) calendar months following the last calendar month in which the employee performed actual bona fide personal services for that employer, shall not be deemed to be wages for the purpose of being used as a basis for paying benefits under chapter 41 of this title WEEKLY BENEFIT RATE DEPENDENTS' ALLOWANCES -- (a) Benefit rate. (1) The benefit rate payable under this chapter to any eligible individual with respect to any week of his or her unemployment due to sickness, when that week occurs within a benefit year, shall be eighty-five percent (85%) of the average weekly wage paid to individuals covered by Chapters of this title for the preceding calendar year ending December 31. If the maximum weekly benefit rate is not an exact multiple of one dollar ($1.00) then the rate shall be raised to the next higher multiple of one dollar ($1.00). Those weekly benefit rates shall be effective throughout the benefit years beginning on or after July 1 of the year prior to July of the succeeding calendar year. (2) The benefit rate of any individual, if not an exact multiple of $1.00, shall be raised to the next higher multiple of $1.00. (b) Dependents' allowances. An individual to whom benefits for unemployment due to sickness are payable under this chapter with respect to any week, shall, in addition to such benefits, be paid with respect to each week a dependent's allowance of seven percent (7%), of the individual's benefit rate, payable under subsection (a), whichever is greater for each of such individual's children, including adopted and stepchildren or that individual's court-appointed ward who, at the beginning of the individual's benefit year, is under eighteen (18) years of age and who is at that time in fact dependent on that individual. A dependent's allowance shall also be paid to that individual for any child, including an adopted child or a stepchild or that individual's court-appointed ward, eighteen (18) years of age or over, incapable of earning any wages because of mental or physical incapacity, and who is

44 dependent on that individual in fact at the beginning of the individual's benefit year. However, in no instance shall the number of dependents for which an individual may receive dependents' allowances exceed five (5) in total. The weekly total of dependents' allowances payable to any individual, if not an exact multiple of one dollar ($1.00), shall be rounded to the next lower multiple of one dollar ($1.00). The number of an individual's dependents, and the fact of their dependency, shall be determined as of the beginning of such individual's benefit year; provided, however, that only one individual shall be entitled to a dependent's allowance for the same dependent with respect to any week. Each individual who claims a dependent's allowance shall establish his or her claim thereto to the satisfaction of the director under procedures established by the director. This provision shall be effective for all benefit years beginning on or after July 1, (c) Any individual's benefit rate and/or dependents' allowance in effect for a benefit year shall continue in effect until the end of that benefit year. (d) Partial unemployment due to sickness. For weeks beginning on or after January 1, 2006, an individual partially unemployed due to sickness and otherwise eligible in any week shall be paid sufficient benefits with respect to that week, so that his or her wages, rounded to the next higher multiple of one dollar ($1.00), and his or her benefits combined will equal in amount the weekly benefit rate to which he or she would be entitled if totally unemployed due to sickness in that week; provided that an individual must have been totally unemployed due to sickness for at least seven (7) consecutive days prior to claiming partial benefits under this provision; provided, further, that nothing contained herein shall permit any individual to whom remuneration is payable for any work performed in any week in an amount equal to or greater than his or her weekly benefit rate to receive benefits or waiting period credit for that week EFFECT ON WAITING PERIOD CREDIT AND BENEFITS OF RECEIPT OF WORKERS' COMPENSATION PAYMENTS -- (a) No individual shall be entitled to receive waiting period credit benefits or dependents' allowances with respect to which benefits are paid or payable to that individual under any workers' compensation law of this state, any other state, or the federal government, on account of any disability caused by accident or illness. In the event that workers' compensation benefits are subsequently awarded to an individual, whether on a weekly basis or as a lump sum, for a week or weeks with respect to which that individual has received waiting period credit, benefits, or dependents' allowances, under chapters of this title, the director, for the temporary disability insurance fund, shall be subrogated to that individual's rights in that award to the extent of the amount of benefits and/or dependents' allowances paid to him or her under those chapters. (b)(1) Whenever an employer or his or her insurance carrier has been notified that an individual has filed a claim for unemployment due to sickness for any week or weeks under chapters of this title for which week or weeks that individual is or may be eligible for benefits under chapters of this title, that notice shall constitute a lien upon any pending award, order, or settlement to that individual under chapters of this title. (2) The employer or his or her insurance carrier shall be required to reimburse the director, for the temporary disability insurance fund, the amount of benefits and/or dependents' allowances received by the individual under chapters of this title, for any week or weeks for which that award, order, or settlement is made. (c) Whenever an individual becomes entitled to or is awarded workers' compensation benefits for the same week or weeks with respect to which he or she has received benefits and/or dependents' allowances under chapters of this title, and notice of that receipt has been given to the division of workers' compensation of the department of labor and/or the workers' compensation court, the division or court is hereby required to and shall incorporate in the award, order, or approval of settlement, an order requiring the employer or his or her insurance carrier to reimburse the director, for the temporary disability insurance fund, the amount of any disability benefits and/or dependents' allowances which may have been paid to the employee for unemployment due to sickness for those weeks under chapters of this title. (d) In the event that, through inadvertence, error or mistake, an individual shall have received benefit payments and/or dependents' allowances for any week or weeks under chapters of this title, and has also received payments for the same week or weeks under any workers' compensation law of this state, any other state, or of the federal government, he or she shall, in the discretion of the director of the department of employment and training, be liable to have such sum deducted from any benefits payable to him or her under chapters of this title, or shall be liable to repay to the director, for the temporary disability insurance fund, a sum equal to the amount so received, and that sum shall be collectible in the manner provided in for the

45 collection of past due contributions. (e) Notwithstanding any other provision of this section, no individual who, prior to September 1, 1969, has sustained an injury by reason of which he or she may be eligible for benefits under chapters of this title shall be deprived of any rights which he or she may have under chapters of this title TOTAL AMOUNT OF BENEFITS -- The total amount of benefits payable during a benefit year to any eligible individual shall be an amount equal to thirty-six percent (36%) of the individual's total wages for employment by employers subject to chapters of this title during his or her base period; provided, however, that no individual shall be paid total benefits in any benefit year which exceed thirty (30) times his or her weekly benefit rate; provided, further, however, that dependents' allowances to which he or she might be entitled under shall be in addition to these total benefits. If the total amount of benefits is not an exact multiple of one dollar ($1.00), then it shall be raised to the next higher multiple of one dollar ($1.00). Prior to amendment by Ch. 109, L. 2000, effective July 7, 2000, Sec read as follows: (a) The maximum total amount of benefits payable during a benefit year to any eligible individual whose benefit year begins on or after July 1, 1985 and prior to October 7, 1990 shall be determined in the following manner: (1) The total number of weeks of employment in his or her base period shall be multiplied by three-fifths ( 3/5), and the result thereof, if not a whole number of weeks, shall be adjusted to the next higher whole number of weeks; (2) The number of weeks so obtained shall be multiplied by the individual's weekly benefit rate for unemployment due to sickness; and the result thereof shall be the total amount of benefit credits to which that individual shall be entitled during his or her benefit year; provided, however, that no individual shall be paid total benefits in any benefit year which exceed thirty (30) times his or her weekly benefit rate; provided further, however, that dependents' allowances to which he or she might be entitled under shall be in addition to these total benefits; and (3) Each week of employment within an individual's base period shall be counted as one week for the purpose of this section, regardless of the number of employers for whom an individual performed services in employment during that week. For the purpose of this section, a week of employment shall be any calendar week within which an individual has performed services in employment for one or more employers subject to chapters of this title. "(b) The total amount of benefits payable during a benefit year to any eligible individual whose benefit year begins on or after October 7, 1990, shall be an amount equal to thirty-six percent (36%) of the individual's total wages for employment by employers subject to chapters of this title during his or her base period; provided, however, that no individual shall be paid total benefits in any benefit year which exceed thirty (30) times his or her weekly benefit rate; provided, further, however, that dependents' allowances to which he or she might be entitled under shall be in addition to these total benefits. If the total amount of benefits is not an exact multiple of one dollar ($1.00), then it shall be raised to the next higher multiple of one dollar ($1.00)." PREGNANCY BENEFITS -- An otherwise eligible individual who is unemployed due to sickness resulting from pregnancy, childbirth, miscarriage or abortion shall be entitled to receive those benefits which are regularly provided for unemployment due to sickness in chapters of this title. Prior to amendment by Ch. 109, L. 2000, effective July 7, 2000, Sec read as follows: (a) For weeks beginning on or after July 5, 1981, an otherwise eligible individual who is unemployed due to sickness resulting from pregnancy, childbirth, miscarriage or abortion shall be entitled to receive those benefits which are regularly provided for unemployment due to sickness in chapters of this title, except as provided in subsection (b). (b) An otherwise eligible individual, upon giving birth to a child during the period July 5, 1981 through July 31, 1981, may elect to receive in lieu of any and all benefits provided in subsection (a), a lump sum maternity benefit under the following terms and conditions: (1) If, under chapters of this title, the total amount of benefits to which an individual is entitled for unemployment due to sickness is five hundred dollars ($500) or more at the time the child is born, then the amount of the lump sum maternity benefit to be paid to that individual shall be five hundred dollars ($500). (2) If, under those chapters, the total amount of benefits to which an individual is entitled is less than five hundred dollars ($500) at the time the child is born, then such lesser sum only shall be paid to the individual as the lump sum maternity benefit to which she is entitled; and "(3) The receipt of a maternity benefit shall not be deemed to have satisfied the requirement of a waiting period as specified in for any

46 subsequent period of unemployment due to sickness, if no waiting period has been previously established." LAG DAY BENEFITS -- (a) An individual who, having been unemployed due to sickness, has served a waiting period, or is in receipt of benefits under this chapter, returns to work prior to the end of the immediately succeeding week, shall be entitled to one-fifth ( 1/5) of his or her benefit rate for each day of unemployment due to sickness in which work is ordinarily performed in the occupation in which he or she is employed during the week in which he or she returns to work, figured to the highest dollar, including any holiday when the performance of services is waived by his or her employer, provided, however, that in no case shall any individual be entitled to more than four-fifths ( 4/5) of his or her benefit rate, figured to the highest dollar, for that week. (b) An individual who, having been unemployed due to sickness, served a waiting period and, at a later date during his or her benefit year, again becomes unemployed due to sickness, and refiles his or her claim for benefits therefor, shall, if his or her first day of unemployment begins on a day subsequent to the first day of any week, be entitled to one-fifth ( 1/5) of his or her benefit rate for each day in such week in which work is ordinarily performed in the occupation in which he or she was last employed, including any holiday when the performance of services is waived by his or her employer, figured to the highest dollar, if his or her unemployment continues for seven (7) consecutive calendar days, including the first day of unemployment due to sickness for which he or she has refiled his or her claim, provided, however, that in no case shall any individual be entitled to more than four-fifths ( 4/5) of his or her benefit rate, figured to the highest dollar, for the week in which his or her unemployment begins on a day subsequent to the first day of that week BENEFITS PAYABLE FOR LAST WEEK OF BENEFIT YEAR -- Notwithstanding any provision of chapters of this title to the contrary, if the benefit year of an individual terminates prior to the end of a week throughout which he or she is unemployed due to sickness and eligible and his or her benefit credits for that benefit year have not been exhausted, then that individual shall be entitled to receive for that week the full amount of benefits which he or she would have received if his or her benefit year had not so terminated; provided, however, that this shall in no manner affect the establishment of a new base period and benefit year in accordance with (2) and (6) ELIGIBILITY (a) For benefit years beginning on or after July 1, 1981, and prior to October 7, 1990, an individual shall be deemed eligible for benefits for any given week of his or her unemployment due to sickness only if he or she has, within the base period immediately preceding the benefit year in which that week of unemployment occurs, earned wages amounting to at least twenty (20) times the minimum hourly wage as defined in chapter 12 of this title, in each of at least twenty (20) weeks or, in the alternative, in an amount equal to three (3) times the total minimum amount hereinabove required. (b) In order to be deemed eligible for benefits, an individual whose benefit year begins on or after October 7, 1990, must have been paid wages in: Any one calendar quarter of the base period which are at least two hundred (200) times the minimum hourly wage, as defined in chapter 12 of this title, and must have been paid wages in the base period amounting to at least one and one-half (1 ½) times the wages paid to the individual in that calendar quarter of the base period in which the individual's wages were highest; provided, however, that the minimum amount of total base period wages paid to the individual must be at least four hundred (400) times the minimum hourly wage, as defined in chapter 12 of this title; provided further, however, that the base period wages must have been paid to the individual for performing services in employment for one or more employers subject to chapters of this title; or, in the alternative, (2) The base period for performing services in employment for one or more employers subject to chapters of this title amounting to at least three (3) times the total minimum amount required in subsection (b)(1) (c) In addition to the provisions of subsection (b) of this section, for benefit years that begin on or after July 1, 2012, an individual must have been unemployed due to sickness for at least seven (7) consecutive days in order to be eligible for benefits WAITING PERIOD -- (a) For benefit years beginning on or after July 6, 2008, the waiting period of any individual shall be either seven (7) consecutive days commencing with the Sunday of

47 the week in which the claimant filed a claim for benefits, during which that individual is unemployed due to sickness and during which the individual earned remuneration in an amount less than his or her weekly benefit rate for work performed during that week prior to his or her unemployment due to sickness; or (2) Seven (7) consecutive days, commencing with the Sunday of the week following the week in which the individual filed a claim for benefits, during which the individual is unemployed due to sickness and the individual earned remuneration in an amount greater than or equal to his or her weekly benefit rate for work performed during that week prior to filing a claim for benefits. (b) No waiting period shall be credited to any individual unless he or she has filed a valid claim in accordance with regulations adopted as hereinbefore prescribed. (c) Benefits shall be payable to an eligible individual only for those weeks of his or her unemployment due to sickness within a benefit year which occur subsequent to one waiting period, which shall be served at any time during the benefit year. If the first week of an individual's unemployment due to sickness which occurs within his or her new benefit year is immediately preceded by a week for which he or she is in receipt of benefits (including lag day payments as provided in ) for total or partial unemployment due to sickness under chapters of this title, or under similar federal provisions, he or she shall not be required to serve a waiting period for that new benefit year. (d) Except as provided in subsection (c), no period of unemployment due to sickness shall be counted towards an individual's required waiting period if with respect to any portion of such period of unemployment due to sickness, benefits have been paid under the employment security or temporary disability insurance acts of any other state or of any similar acts of the United States or of any foreign government. (e) If an individual is unemployed due to sickness for the seven (7) consecutive days, as provided for in subsection (a), and his or her sickness continues for at least an additional twenty-one (21) consecutive days, he or she shall be eligible to receive benefits for the waiting period of seven (7) consecutive days DISQUALIFICATION BY RECEIPT OF UNEMPLOYMENT COMPENSATION BENEFITS -- (a)(1) An individual shall be disqualified from receiving benefits during any week with respect to which he or she will receive remuneration in the form of benefits under an unemployment compensation law of any state or of the United States. (2) However, notwithstanding any provisions of chapters of this title to the contrary, an individual receiving unemployment compensation and who is injured while unemployed and who is then denied unemployment compensation as a result of those injuries, shall, if otherwise eligible, be eligible to receive temporary disability insurance benefits without serving a waiting period as required in (b) Notwithstanding any provisions of chapters of this title to the contrary, in the event that an individual has been determined to have been paid unemployment compensation benefits and/or dependents' allowances under chapters of this title, for the same week or weeks with respect to which the individual was entitled to receive temporary disability insurance benefits and/or dependents' allowances under chapters of this title, that individual shall, at the discretion of the director, be liable to have that sum deducted from any benefits payable to him or her under chapters of this title for the same week or weeks, to reimburse the director for the employment security fund. Sec DISQUALIFICATION BY CONVICTION OF FRAUD -- (a) An individual who has been convicted by a court of competent jurisdiction of knowingly or fraudulently making a false statement, or knowingly or fraudulently misrepresenting a material fact, with intent thereby to defraud the temporary disability insurance fund of any benefit or wrongfully to obtain or increase any benefit, either for himself or herself or for any other person, shall thereby be disqualified from receiving benefits for a period of one year following that conviction. (b) This disqualification shall be imposed by the director and shall be in addition to any criminal penalty which may be imposed under any other provision in chapters of this title DETERMINATION OF CLAIM -- (a) Upon the filing of a claim, the director shall promptly examine the claim and on the basis of facts found by the director and records maintained by the department, the claim shall be determined to be valid or invalid. If the claim is determined to be valid, the director shall promptly notify the claimant as to the week with respect to which benefits shall commence, the weekly benefit amount payable, and the maximum duration thereof. If the claim is determined to be invalid, the director shall likewise notify the claimant and any other interested parties of that determination and the reasons therefore. If the processing of the claim is delayed for any

48 reason, the director shall notify the claimant, in writing, within three (3) weeks of the date the application for benefits is filed of the reason therefore. Unless the claimant or any other interested party shall, within fifteen (15) days, except that for good cause shown the ten-day period may be extended after notification by the director has been mailed to his or her last known address, as provided in this section, request a hearing before the board of review, the determination with reference to the claim shall be final; provided, however, that at any time within one year from the date of a monetary determination, the director, upon request of the claimant or on his or her own motion, may reconsider his or her determination if he or she finds that an error in computation or identity has occurred in connection therewith or that additional wages pertinent to the claimant's status have become available, or if that determination was made as a result of a nondisclosure or misrepresentation of a material fact. (b) If an appeal is duly filed, benefits with respect to the period prior to the final decision, if it is found that those benefits are payable, shall be paid only after the decision; provided, that if an appeal tribunal affirms a decision of the director, or the board of review affirms a decision of an appeal tribunal allowing benefits, those benefits shall be paid regardless of any appeal which may thereafter be taken.