DISABILITY INCOME BENEFIT
(Active employees only)
The weekly disability income benefit for
full-time per annum employees is 66 2/3% of their weekly salary but no more
than $200 per week (7 day week). The benefit is paid for up to a maximum of 26
weeks but not longer than the member remains totally disabled. The weekly
disability benefit for part-time or hourly employees is 66 2/3% of their weekly
salary but no more than $98 per week. The benefit is paid for up to a maximum of
13 weeks but not longer than the member remains totally disabled.
Disability payments begin when the member has used up all sick days but not
before the end of 8 days of total disability at home. If the member is
hospitalized, however, the benefit begins as soon as he/she has exhausted
his/her sick days. In order to assist us in expediting the processing of the
disability claim forms, the following suggestions should be followed:
- Be sure that the member completes
the claim in its entirety and have his/her physician
answer all relevant questions (i.e cause
of disability, dates of treatment, and or hospitalization, anticipated
return to work date, etc.). Remember, claims must be signed by both member
and physician.
- Indicate on the claim form the
telephone number of the timekeeper, personnel officer, payroll secretary
(depending on the agency).
- If there is a lawsuit pending
because of an accident be sure to supply the
name, address and telephone number of the Attorney.
NOTE: for any accident, whether or not a lawsuit has commenced, an assignment must be signed and notarized before payment begins. - If the accident occurred on the
job, the member must file for Workers' Compensation with his/her employer
and also notify the Workers' Compensation Board. If the disability was due
to a car accident, the member must file for No-Fault Insurance with
his/her own auto insurance carrier. If the member is injured by an
uninsured vehicle, then he/she must file with the motor Vehicle Accident
Indemnification Corp. (M.V.A.I.C. (212) 791-1290). In these situations,
the member will not receive disability benefits. However, he/she is
eligible for other Health & Security Plan benefits for a maximum of 26
weeks (or 13 weeks if he/she is a part-time or hourly employee) measured
from his/her date of disability. Unless subsequent to being disabled, the
member remains on active payroll status receiving either sick leave,
vacation pay, Section 3.5 or Section 7.2 leave pay, in which case the
eligibility period for Health and Security Benefits is measured from the
last day on active payroll status. In order to maintain eligibility for
these Health and Security Benefits during the period of disability, a
disability claim form must be filed with the Plan. Further documentation
will be necessary to extend benefits to the maximum allowable period.
The Disability Unit of the Health and
Security Plan utilizes a list of Reasonable and Customary convalescent periods
associated with each illness. If a member is out on disability for more than
the Reasonable and Customary period of convalescence, the Plan will require an
evaluation be performed by a doctor selected by the Health and Security Plan at
no cost to the member. Failure to keep the evaluation appointment will cause
the denial of any further disability payments, until another evaluation
appointment is made and kept.
The Disability Unit periodically forwards requests for medical statements to
the member, to be completed by the treating physician. Claims processing could
be delayed if the medical statement is not furnished quickly.
The disability claim form must be filed within 15 days from the onset of the
disability, regardless of the amount of sick time, vacation time or annual time
available. If the claim is filed beyond the 15 days filing limitation, a letter
of explanation must be attached to the claim. Complying with
the above-mentioned instructions, will permit us to process the claim within 10
working days. However, other problems may cause processing delays
(information not received from the payroll department, etc.).
Disability Benefits As They Relate To Workers' Compensation
According to the rules and regulations governing the
administration of the Disability Benefit, no benefits are payable if a member
is receiving or eligible to receive Workers' Compensation. However, there are
instances where a member can turn to the Plan for assistance when his/her case
is being controverted and payments for Workers'
Compensation benefits will be delayed until after a hearing. Therefore, if the
following criteria are satisfied, the Plan will extend Disability Benefits to a
member who is in dire need of financial assistance:
- The member applied for Workers'
Compensation and received a letter from the Law Department indicating that
the case is being controverted.
- The member has exhausted all
accrued sick and annual leave.
- The member has made application, if
eligible, for but does not qualify for a Section 3.5 or Section 7.2 paid
sick leave grant or similar provisions provided by other Agencies.
Once the above criteria are met and
Disability Benefits are released, the Disability Unit will send a Compensation
Lien Form directly to the Compensation Board. The lien becomes part of the Workers'
Compensation Case so that if or when the member is awarded Compensation benefit
the Workers' Compensation Board will pay the Plan directly.
Disability Benefits As They Relate To
Substance Abuse
We are now able to pay benefits for alcoholism and drug
dependency for both in-hospital and out-patient care. For out-patient care
coverage, the individual must be in a rehabilitative program that is recognized
by the Plan and verification of the care must be supplied to the Plan upon
request. This benefit has a maximum coverage of 26 weeks for full-time
employees and 13 weeks for part-time employees.
DISABILITY AND THE CULTURAL TRUST
In addition to the aforementioned procedures regarding
disability benefits, the following information applies specifically to the
Cultural Trust.
Effective March 1, 2000 the weekly disability benefit for full-time per annum
employees covered by the DC 37 Cultural Institutions Health & Security Plan
is 66 2/3% of their weekly salary but no more that $275 per week (7 day week).
The benefit is paid for up to a maximum of 26 weeks but not longer than the
member remains totally disabled.
Eligibility
The
members of the Cultural Trust are covered for the disability benefit from day 1
of employment (if contributions are received from the Institution) and are
covered up to four weeks after the termination date. Please note that this does
not apply to the other benefits. The ninety day waiting period remains and
eligibility ends at termination for the other Health & Security benefits.
Please be reminded that employees are required to use their sick time before
becoming eligible for disability benefits. If there is no sick time on the
books, the member is covered from the 8th day of disability if there is no
hospitalization. If there is hospitalization, and no sick time, the member is
covered from the first day.
The existence and/or concurrent use of annual leave, vacation time, personal
time or any other form of leave time not expressly designated for purposes of
sick leave shall be disregarded by the Cultural Trust in determining a Covered
Employee's eligibility for state mandated disability benefits.
DISABILITY AND THE
The
members of the
No Fault Insurance (Motor Vehicle
Accident) Cases
Disability benefits paid by the Trust will be considered primary
by the No-Fault insurance carrier. The carrier will apply the amount paid by
the Trust toward the No-Fault wage loss benefit and pay any difference due.
Should you have any general questions relating to the disability benefit,
contact the Inquiry Unit at (212) 815-1234.
