Frequently Asked Questions (FAQ’s) About Your Disability Plan
What is Disability coverage? Top
Disability coverage, both Short Term and Long Term, is a benefit program designed to provide income replacement in the event you become disabled due to an injury or illness and cannot perform the duties of your normal occupation.
What is the difference between Short Term and Long Term disability coverage? Top
In general, Short Term disability coverage provides benefits to an individual who is disabled and unable to work due to an injury or illness expected to last weeks or months but not longer than one year. However, if an individual continues to be disabled and unable to work beyond the initial one year period they may be eligible for benefits under the Long Term Disability plan, which dependent upon the nature of the disability can provide benefits up until age 65.
How much of a benefit can I receive if I’m disabled and can’t work? Top
Dependent upon the Group Disability plan elected by your local association you may receive a monthly benefit of up to $9,000 (70% of the first $12,857 monthly Pre-Disability Earnings, reduced by Deductible Income).
What date is considered the date of Disability? Top
- Your date of Disability is the date that you are first deemed unable to perform the Substantial and Material Duties of your Own Occupation and you are unable to earn 80% or more of your Indexed Predisability Earnings.
- If your Disability is work-related, your date of Disability is NOT the date your workers compensation benefits are exhausted.
Are there any specific requirements regarding what type of physician I received treatment from? Top
According to the Disability Plan, you must seek treatment from a physician who specializes in a field appropriate to your condition. This includes complications related to Pregnancy. For example, for musculoskeletal conditions, the appropriate physician may be an orthopedist or a neurologist.
Do Disability benefits end when retirement plan benefits become payable? Top
Not necessarily. Because most retirement plan benefits are considered Deductible Income, they will be coordinated with your Disability Plan benefits. If your retirement plan benefits are greater than the Gross Monthly Disability benefit payable to you, your Disability Plan benefits will probably cease. If your unmodified retirement benefit is less than the Gross Monthly Disability benefit you may be eligible to receive a net benefit check for the difference.
Are there any duration limits as to how long I may be eligible for benefits? Top
Yes, according to your LTD plan, claim payment may be limited if your disability is caused or contributed to by:
a. Musculoskeletal and connective tissue disorders.
b. Mental Disorders.
c. Alcohol and drug use.
d. Other limitations may apply.
Are there any Waiting Periods or other time periods I should be aware of that may impact when my Disability Plan benefits begin? Top
- Short Term Disability: For non-occupational disabilities there is a 0 day Benefit Eligibility Waiting Period if you have been unable to work for 15 days
- (During the first 60 days of continuous disability, we will deduct all sick leave pay and annual leave pay, including donated amounts that you receive or are entitled to receive from your employer.)
- For occupational injuries there is NO Benefit Waiting Period.
- Long Term Disability: For all conditions there is a 365 day Waiting Period.
Is there a minimum guaranteed benefit? Top
Short Term Disability: Yes, while you are receiving sick leave pay or annual leave pay, including donated pay for a non-occupational disability you are eligible to receive a Minimum Benefit of $200 a month on approved claims.
(During the first 60 days that you are on claim, any sick leave pay or annual leave pay, including donated pay for non-occupational injuries is considered Deductible Income if you are entitled to receive it and will be subtracted from your STD Gross Monthly Benefit).
Long Term Disability: For a non-occupational Disability there is a $200 per month Minimum Benefit while receiving sick leave pay or annual leave pay, including donated pay on approved claims. There is a $50 per month Minimum Benefit in all other circumstances
Are there specific guidelines related to pregnancy claims? Top
Eligibility for Disability Plan benefits for pregnancy claims will be administered in a manner consistent with the disability recommendations set forth by the state of California. Pregnancy claims may begin as early as four (4) weeks prior to the expected delivery date. Benefits can extend through six (6) weeks post-partum for a vaginal delivery and eight (8) weeks post-partum for a cesarean section delivery.
For complications refer to question 5 above.
I signed an Authorization to Obtain Information; will the Disability claims analyst request my medical records during the claim review? Top
Not when first making a claim to the IBT. It is the responsibility of the claimant/member to request and forward all medical documentation requested to the Claims Analyst. The IBT is not responsible for any fees that your physicians may charge for copying these records or completing forms on your behalf.
Will my Disability Plan benefits begin when my Workers’ Compensation benefits end? Top
No. Your STD benefit eligibility period will begin once you are no longer receiving full pay from your employer due to an approved Disability. This may run concurrently with the period that you receive Workers Compensation, 4850 or Total Temporary benefit payments. As a consequence, you may wish to apply for STD Plan benefits and Workers’ Compensation benefits at the same time.
What is a Workers’ Compensation lien? Top
If your Workers’ Compensation is denied and you are appealing the denial through the Workers’ Compensation Appeals Board, I&B Trust of PORAC may file a lien through the appeals board to help ensure recovery on possible retro 4850 pay and Temporary Disability pay (Deductible Income). The lien is strictly against possible Workers’ Compensation settlement.
What should I do if there is a Workers’ Compensation Lien? Top
Make sure your Attorney is aware of the lien. Keep your Claims Analyst updated on the events of your Workers’ Compensation case (i.e. MSC, PQME appointments, and Trials).
Are Permanent Disability benefits considered Deductible Income under my PORAC plan? Top
No, only 4850 pay, Temporary Disability and Rehabilitation benefits are considered Deductible Income. To ensure proper management of your Disability Plan claim notify your Claims Analyst of any changes in benefits.
Must I apply for Workers’ Compensation benefits? Top
Short Term Disability: Yes, if it appears your disability is work-related or falls under the “presumptive law” then you must apply for Workers’ Compensation benefits. If you do not, the STD Plan will estimate your Workers’ Compensation benefit and reduce you STD Plan benefit accordingly.
Must I apply for other benefits? Top
Your STD plan states that you must pursue Deductible Income you may be entitled to receive. Notify your Claims Analyst immediately of all benefits. If you fail to pursue Deductible Income for which you are entitled, we may reduce your STD benefit by the estimated amount you could have received.
For more information regarding Deductible Income click here.
If my Disability claim is closed and I am awarded Workers’ Compensation and/or Retirement Plan Benefits must I still notify IBT of PORAC? Top
Yes, the awarded period may overlap with your STD and LTD benefit periods. This creates an overpayment, which you will be required to reimburse the IBT of PORAC and Standard.