Long Term Disability

Basic Disability Benefits:

Monthly Benefits: 2/3 of covered monthly salary
Minimum Benefit: $ 100 per month
Waiting Period: 120 days for accident/120 days for sickness
Cost of Living Adjustment: CPI up to 3%
Tax Withholding: As required by law
Probationary Period: None

How to File a Claim


Submit a disability claim form and proof of disability to the Insurer within 12 months of the date of disability.
Provide notice and evidence of disability to the Insurer within 90 days of filing the claim.

Definitions:


Disability or disabled for the first two years after you become disabled means you are incapable of performing the regular occupation or similar duties you performed for your employer before becoming disabled due to illness or a physical or psychological condition.
After two years, disability or disabled means any physical condition resulting from illness or injury, except a psychological illness or condition, that permanently makes you incapable of engaging in any occupation or employment for wage or profit.
Preexisting Condition means an illness, injury or related medical condition that developed within the 12 months before enrollment in this plan. A condition that exhibited itself or existed before the beginning date of coverage is also considered preexisting. Preexisting condition means a disability which is the result of a complication of a preexisting condition.
Probationary Period means the period you must wait after enrolling in the plan before you can submit long-term disability claim.
Regular Occupation means the duties, responsibilities or assignments you ordinarily perform for your employer.
Waiting period means the length of time following the date you become disabled before disability benefits begin.

Conditions for Receiving Benefits:

  • You will be expected to engage in a vocational rehabilitation program if it is determined through consultation with your physician, rehabilitation specialists, and other providers possessing expertise in the cause of the disability, that you will benefit from vocational rehabilitation.
  • You must apply for all benefits for which you are or may be eligible, including Social Security Disability Income for you and your dependents, Worker’s Compensation, retirement, salary indemnity, sick or vacation leave, or other insurance benefits. (Payments due under this policy will be reduced by income from other sources. See employer for details.)
  • You must agree to provide, or allow others to provide, any information relevant to your disability.
  • The Insurer has the right to recover overpayments or reduce benefits allowable under this plan by the amount you receive or are eligible to receive from any other plan, on an estimated or actual basis. However, your benefits under this plan will not be affected if you purchase supplemental long-term disability (LTD) insurance not paid for or sponsored by your employer.
  • You must be under the continuous care of a physician and must agree to undergo periodic medical examinations as required by the Insurer.
  • You must provide the Insurer with an income statement necessary to verify your income within 30 days after receiving written request from the Insurer.
  • Upon Request, the Insurer may require a copy of your federal and state income tax return from previous years to verify your income.
  • You may be able to receive or continue to receive benefits under this plan even if this plan is terminated or your coverage under this plan is terminated provided the date of your disability is prior to the termination of this policy.

Exclusions:


No benefits will be paid for disability caused by or resulting from:

  • War or any act of war, whether declared or undeclared, or active, full-time military duty.
  • Attempted suicide or self-inflicted injury, while sane or insane.
  • Any act of aggression committed by the insured, or commission or attempted commission of a felony or involvement in an illegal occupation.
  • Any preexisting condition until the member has been enrolled in the program for at least 12 months.

Maximum Length of Benefit Payments


Disabled from Occupation

If you are disabled from performing the duties of the occupation you performed before disability, benefits will be paid while you are totally disabled up to 24 months, unless disability occurred after you reached age 66, in which case ADEA rules apply. (see ADEA schedule below).

Disabled from ALL Occupations

If you are disabled from performing any and all occupations, benefits will be paid while you are totally and permanently disabled up to age 65, or according to ADEA rules. (See ADEA schedule below).

Psychological Disability

Benefits for psychological disability, regardless of cause or origin, will be paid while you are totally disabled up to 24 months.

When Disability Payments End


Payments for disability end on the earliest of the following:

  • The date you are no longer totally disabled.
  • The date of your death.
  • The date you fail to furnish the Insurer satisfactory proof that you continue to be totally disabled.
  • The date you are eligible to retire without reduction of retirement benefits.
  • The date you request benefits be terminated.
  • The date you decline a medical examination by doctors selected and approved by the Insurer.
  • The date you reach age 65, if disability occurred prior to age 60, or according to the ADEA schedule listed below:
Age on the date disability commenced Maximum period payable
Less than 60: Up to 65th birthday
60 but less than: 65 4 1/2 years
65 but less than: 68 1/2 to age 70
68 1/2 or over: 1 year

Termination of Disability Insurance


Your long-term disability insurance coverage will automatically terminate on the earliest of the following:

  • The date any situation described in “When Disability Payments End” occurs.
  • The date you are no longer actively employed.
  • The date you are eligible to retire without reduction of retirement benefits.
  • The date you enter the military force of any country for active, full-time duty.
  • The last day of the month you requested your benefits be terminated, if the premium has been paid.