This protection is designed to partially replace an Employee’s income during periods of temporary disability. The Plan provides for payment up to the maximum shown in the Summary of Benefits beginning on the 1st day of such disease or illness if hospital-confined. The compensation continues for a maximum period of 26 weeks for each disability. This benefit is limited to a lifetime maximum of four (4) separate claim occurrences.
Accident and Sickness (Weekly Benefit)
Benefits begin on the first day for an accident or hospital confinement and on the eighth day in case of a non-hospital illness. The benefit covers non-occupational accidents or illness only.
- 1st thirteen weeks – $100
- 2nd thirteen weeks – $150
The Employee need not be confined to his/her home, but he/she must be wholly and continuously disabled as to be prevented from performing each and every function pertaining to his/her employment and must be under the care of a legally qualified physician or surgeon. Proof that a person continues to be disabled will be required at reasonable intervals by the Trust. If a person fails to furnish proof or refuses to be examined by a physician (designated and paid by the Trust), such a person will no longer be considered disabled.
All disability absences will be considered as having occurred during a single period of disability unless acceptable evidence is furnished that:
- the causes of the latest disability absence cannot be connected with the cause of any of the prior disability absences and the latest disability absence occurs after return to active full-time work for at least one day; or
- a connection with prior disability absences can be established but that, between the last of the previous disability absences which are connected and the latest one, you have returned to active full-time work for at least two (2) consecutive weeks.
If a period of disability is extended by a new cause while short term disability benefits are payable, short term disability benefits will continue while you remain disabled. However, ‘1’ and ‘2’ below will apply.
Short term disability benefits will not continue beyond the end of the original Maximum Benefit Period.
The General Exclusions and Limitations section will apply to the new cause of Disability, as well as the original cause of Disability.
Exclusions & Limitations
Certain disabilities are beyond the scope of this short term disability benefit. Therefore, a person will not receive benefits for a disability arising from any of the following causes:
- Intentionally self-inflicted injury while sane or insane;
- The commission of, or participation in a felony;
- An act of war (whether declared or not), insurrection, rebellion or participation in a riot or civil commotion;
- Arising out of or in the course of any employment for wage or profit; and
- Where such bodily injury or disease is due to such a person’s willful engagement in any illegal activity or occupation or the self-infliction of such, or any other injury resulting from chronic alcoholism or the use of narcotics unless the same were administered pursuant to the orders of a licensed physician.
- Care of a Physician
You must be under the ongoing care of a legally qualified Physician during the Benefit Waiting Period and thereafter. No short term disability benefits will be paid for any period of disability when you are not under the ongoing care of a qualified physician or surgeon.
- Occupational Benefits
No short term disability benefits will be paid for any period you are found eligible to receive benefits under a workers’ compensation law or similar law. If your claim for worker’s compensation benefits is accepted, compromised or settled (whether disputed or undisputed), you must repay the Plan for the full amount of any payments to you while your claim for occupational benefits was pending.
- Paid Sick Leave
No short term disability benefits will be paid for any period when you are receiving paid sick leave from your Employer.
No short term disability benefits will be paid for any period: (a) when you are working for wage or profit for any employer, or (b) when you are self-employed.
Your benefit ends automatically on the earliest of ‘1’ through ‘4’ below:
- The date you are no longer Disabled.
- The date your Maximum Benefit Period ends.
- The date you die.
- The date you begin working for any employer.
The disability absence must commence while Plan coverage is in force and while the Employee was working or signed on the out-of-work list and available for work for a contributing employer.
A terminated employee, who is not signed on the out-of-work list or is making COBRA self-payments is not eligible for this benefit. Dependents are not eligible for this benefit.
Weekly payments for this short-term disability plan are paid directly from Trust Fund assets.
Claims received at the Fund Administrator’s Office more than sixty (60) days after the inception of the Employee’s disability absence will not be paid unless the Employee provides satisfactory evidence that he/she has remained continuously disabled from the inception of the disability absence through the date the application is received.
Your short-term disability benefit payments are subject to Federal income tax and, if applicable, state income tax. The Fund Administrator will mail W-2 forms for short-term disability benefit payments made during the calendar year to Employees by January 31st of the following year.