The Upper New York Conference provides short-term disability insurance through Guardian Insurance for all employees (both clergy and lay) of local churches, conference offices and operations, camps and affiliated organizations in accordance with New York State law. Benefits are payable for disability due to non-work-related accidents, injuries, or illnesses. Payments may be made for up to 26 weeks after a one week waiting period. Maximum reimbursement to the church/employer is 50% of wages up to $170 in benefit per week.

Any clergy person or employee who needs to file a claim for disability benefits should complete a claim form (below). The church treasurer should complete Part C – Employer Information. It is recommended the plan number and division number be handwritten on the top right of each page of the claim form. The plan number is 00926076. The division number is unique to each church and is available on the Certificate of Disability Insurance mailed to the church in January each year. 

• For active clergy claims, the questions pertaining to continuation of salary and reimbursement to employer should be answered “YES.” Refer to Part A, Question #13. (Churches should have their own policies in relation to continuation of salary for lay employees.)

• For retired clergy serving a church in retirement, the church is not responsible for continuing salary if a pastor is on short-term disability. The carrier, if the claim is approved, would send a check directly to the clergy person (50% of pay up to a max of $170/wk).

The claimant will then provide the DB450 form to their physician to complete Part B – Health Care Provider’s Statement. The physician’s office can submit the claim directly to Guardian via any of the methods listed below.

Claims need to be filed within 30 days following the start date of disability.

It is expected that when a person who is covered by the Church’s disability policy is not working for more than one week due to a medical condition, and salary is being continued, that said person will file a claim for benefits to be reimbursed to the church. Should the clergy person/employee desire not to file a claim, their salary may be reduced by the expected amount of the insurance reimbursement upon action by the SPRC and notification to the District Superintendent.

Short-Term Disability Resources:

Disability Notice of Rights (DB271-S) – To be provided to all employees at time of hire

New York State Disability Benefits Information

Forms need to be completed and submitted to Guardian within 30 days of following the start date of disability.

Guardian Insurance

State Disability Claims

P.O. Box 14332

Lexington KY 40512

Customer Service: 1-800-268-2525 

Email: State_Disability_Claims@glic.com

Fax # 610-807-2953

Certificate of Disability Insurance (DB 120.1) Requests 

Please contact Chelsea Connor, Administrative Services Assistant or Suzannah Emerson

Phone: (315) 898-2022

Email: chelseaconnor@unyumc.org

Email: SEmerson@WalshDuffield.com

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Certificates of insurance for disability insurance coverage (DB 102.1) are issued by the disability insurance carrier, Guardian. The following information will be needed from you to request the certificate of insurance. You can email either Chelsea Connor, Administrative Services Assistant, at chelseaconnor@unyumc.org or Suzannah Emerson at SEmerson@WalshDuffield.com with the following information. Please allow at least five (5) business days for your request to be processed.    

Name Of Insured Church:  

Mailing Address Of Insured Church:  

Email Address To Where Db 120.1 Certificate Should Be Sent:  

Name Of Entity Requesting Proof Of Insurance (Typically The Dept Of Health):  

Address Of Entity Requesting Proof Of Insurance:   

Need help? Contact Tracy Rickett at tracyrickett@unyumc.org or (315) 898-2017.