DISABILITY
INCOME BENEFIT
Benefits
DC 37 Health & Security Plan
Benefits
Disability 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, Section
3.5, and/or Donated/Dedicated Sick Grant, 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 form, 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, supply the name, address and telephone number of
the Attorney. For any accident, whether or not a lawsuit has commenced, an
assignment must be signed and notarized before payment begins. The
assignment is part of the claim and when the member's case is settled,
repayment will be made to the Plan.
- 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 the last
day on active payroll status. If the member remains on active payroll
status, receiving either sick leave, vacation pay, Section 3.5 or Section
7.2 leave pay, 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 July, 1 2009 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 $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.
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.
No Fault Insurance
(Motor Vehicle Accident) Cases
Disability
benefits paid by the Cultural 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.
DISABILITY AND THE NEW YORK PUBLIC LIBRARY TRUST
The members of the New York Public Library Trust
receive their short-term disability payment from the State while getting their
ancillary benefits from the New York Public Library Trust. If the member is
still disabled, he/she will be eligible for a second six months of short-term
disability payments. The member, however, will not be eligible for an
additional six months of ancillary benefits.
No
Fault Insurance (Motor Vehicle Accident) Cases
Disability benefits paid by the NYPL Trust will be considered primary by the
No-Fault insurance carrier. The carrier will apply the amount paid by the NYPL
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.
