Eligibility & Coverage
How can an employee determine if he is eligible for disability coverage?
There are two disability programs available to permanent full-time employees
only, the Duke Disability and the Voluntary Disability. The Duke Disability is
provided at no cost to full-time employees who have at least three years of
full-time continuous service or are under the waiver due to proof of prior group
long-term disability coverage. Duke Disability provides disability coverage for
eligible University/Medical Center employees after 16 weeks (LTD) and disability
coverage for eligible Health System employees after 12 weeks (STD/LTD).
The Voluntary Disability program is an opportunity for eligible employees to
purchase short-term disability coverage to supplement the Duke Disability. It is
also an opportunity for those not eligible (less than 3 years of full-time
continuous service without proof of prior group long term disability coverage)
for the Duke Disability to purchase short-term and/or long-term disability
coverage. If covered, the employee should have a deduction on his paycheck
reflecting the voluntary program(s). The Voluntary Disability vendor is Hartford
Life.
Can employees be covered under both the Voluntary Long-Term Disability and
Duke Disability programs at the same time?
No, if an employee is covered under the Duke Disability, he is ineligible for
coverage under the Voluntary Long-Term Disability. This would be a duplication
of coverage.
Can Health System employees be covered under the Voluntary Short-Term
Disability and Duke Disability programs at the same time?
Yes, because approved Voluntary Short-Term Disability benefits would be payable
in advance of approved Duke Disability (STD) benefits after a four week waiting
period. Does Duke provide Short-Term Disability coverage to its
University/Medical Center employees?
No, as University/Medical Center employees, Duke does not provide this coverage.
Such employees should consider purchasing the Voluntary Short-Term Disability
Plan.
Definitions & Benefits Payable
What is total disability?
Due to sickness or accidental injury, an employee's inability to do essential
duties of his occupation. The disability will have to be documented by a
treating physician.
What is the benefit payable under long-term disability?
For either the Voluntary Long-Term or Duke Disability, approved benefits are 60%
of your monthly base salary for total disability.
Is there short-term disability available?
There is voluntary short-term disability coverage available for purchase for
eligible employees. Please refer to the Voluntary
Disability web site for eligibility details. Full-time Health System
employees are eligible for Duke Disability (STD/LTD) at no cost as long as they
have at least three years of full-time continuous service.
What is the benefit payable under short-term disability?
For the Voluntary Short-Term Disability, the approved benefits are 60% of your
monthly base salary for total disability paid on a weekly basis. As for the Duke
Disability, the approved benefits are 60% of your monthly base salary for total
disability paid monthly.
Is the disability benefit payable retroactive to the date of disability?
Approved disability benefits are payable after the benefit-waiting period, not
the onset of the disability.
What is a benefit-waiting period?
The benefit-waiting period is the length of time the employee must be
continuously partially or totally disabled before he qualifies to receive any
benefits. For the Voluntary Disability, the benefit-waiting period is 4 weeks
for short-term disability; 4 months (University/Medical Center); or 6 months
(Health System) for the long-term disability.
As for the Duke Disability, there is a 3-month benefit-waiting period for Health
System employees and a 4-month benefit-waiting period for University/Medical
Center employees.
What is partial disability?
Partial disability is an option for employees who are experiencing a loss of
income greater than 20% of their total earnings. If the employee is not totally
disabled, but is unable to work his full work schedule due to a documented
medical condition, he may qualify for partial disability benefits. Documentation
of time worked from the onset of the partial work schedule must be submitted
with the claim. Partial disability benefits are based on the percentage of
income lost due to part time work.
Claim Procedure
When should an employee submit a claim for total or partial disability?
If the employee has the Voluntary Disability program and knows s/he will be out
of work for more than 4 weeks, s/he can initiate a claim directly with Hartford
Insurance by calling 800-445-9057.
As for the Duke Disability, it is suggested that claim paperwork begin no later
than the second month of disability during the three-month benefit-waiting
period for Health System employees and no later than the third month of
disability during the four-month benefit-waiting period for University/Medical
Center employees. Claim paperwork for the Duke Disability must be obtained from
Human Resources. Completed claim paperwork should also be returned to Human
Resources, not the disability vendor, within 180 days from the onset of the
disability or the last day worked due to disability.
If the employee's physician has documented that he is totally disabled, won't
the claim be automatically approved?
The disability vendor will have to review the medical information submitted by
the employee's physician and determine if the claim meets the plan's definition
of disabled. Applying for disability does not guarantee approval.
Leave Management
Should the employee exhaust all sick/vacation/PTO before applying for
disability? It is recommended that an employee apply for disability before
exhausting all accrued time. The major reason is while awaiting a decision about
the disability claim, the employee can hopefully maintain income by utilizing
accrued sick/vacation/PTO.
Is there help available for the employee who has exhausted all accrued
sick/vacation/PTO time? Please inquire about the Kiel Memorial
Vacation/PTO Donation Program which allows employees, who have experienced a
catastrophic illness or injury and who have exhausted all accrued time, to
receive donations of accrued vacation or PTO Short Term Bank (STB) hours from
fellow employees. Please refer to the Kiel Program web
site to review eligibility, procedures, and forms.
Should the employee be on an approved leave of absence when he submits a
disability claim? Ideally, yes. The leave of absence can run concurrently
with the benefit-waiting period for disability. The benefit-waiting period is
the length of time the employee must be continuously partially or totally
disabled before he qualifies to receive any benefits.
An employee is on Workers' Compensation. Can he also submit a Duke Disability
claim? Yes, an employee can be on an approved Workers' Compensation claim
and Duke Disability claim simultaneously. However, any amount received from
Workers' Compensation will be offset from any approved Duke Disability benefit
amount. It is to the employee's advantage to pursue disability while on an
active Workers' Compensation claim because in the event that the Workers'
Compensation benefits cease, the employee who is also on an approved Duke
Disability claim will be able to maintain eligibility for Duke benefits. There
is no time limit for applying for Duke Disability if the employee is on an
active Workers' Compensation claim.
Administrative Process
An employee submitted a physician's note stating that he should no longer
work due to total disability. Does the department process a payroll form to
place the employee on the disability leave?
No, the department should speak with the employee about requesting a FMLA or
medical leave of absence. The department should also suggest or advise the
employee to inquire about submitting a disability claim. Only Human Resources is
authorized to place an employee on an approved disability leave. If the
employee's claim for Duke Disability is approved, HR will process the necessary
payroll form.
How will the department know if the employee has been approved for Duke
disability?
Human Resources will send a copy to the department of the payroll form processed
to place the employee on an approved disability leave.
An employee is receiving a voluntary disability check from Hartford.
Shouldn't the employee be on a disability leave?
No, the disability leave code is only for employees approved for Duke's
Disability, not the voluntary plan. However, it is important that the employee
be placed on either a FMLA or medical leave of absence.
An employee was approved for partial disability benefits under the Duke plan.
Will the Disability Representative in Human Resources be responsible for payroll
reporting?
No, the employee will remain under his current organizational key and cost
distribution center since he continues to work a reduced schedule for the
department.
I have a monthly employee working a reduced schedule due to partial
disability. How do I ensure that the employee is not paid a full salary?
Payroll advises that the department complete a staff change form to reflect the
reduced salary, but do not change the work schedule. If you were to
change the work schedule, you may affect the benefits eligibility of the
employee. Include in the "Remarks" section of the staff change form that the
salary reduction is due to partial disability benefits.
An employee was working a reduced schedule under approved partial Duke
Disability, but the employee's physician has now requested the employee cease
work totally. What should the department do?
The employee must offer a written request from his physician stating the request
to stop work. The written request should be faxed to Sonya Stewart in Human
Resources at 681-8774 immediately. The disability vendor will adjust the
approved Duke Disability benefit amount accordingly. Also, Human Resources will
process a payroll form changing the disability from partial to total disability;
a copy will be sent to the department for record.
Will the employee approved for Duke's total disability remain in my cost
center?
With the exception of an employee on an active Workers' Compensation claim,
an employee approved for Duke's total disability will be transferred to
the disability organizational key by Human Resources. However, the cost center
will remain under the employing department. When Human Resources processes the
"disability leave without pay" request form, it will disable any further payroll
expenses for the employee from the department's cost center. Anyone approved for
total disability solely should not be receiving pay through the payroll
system. The department should not terminate the employee approved on Duke
disability benefits as they are to remain in the payroll system.
An employee has been approved for Duke Disability benefits. Can the employee
supplement the disability benefit with accrued sick/vacation/PTO time?
For a University/Medical Center employee, one can supplement Duke's Long-Term
disability benefits with 40% of accrued sick or vacation time. For Health System
employees, accrued PTO can be used to supplement Duke's Short-Term disability
pay at 40% of base salary for weeks 13 - 25 of an approved Duke Disability
only. When supplementing eligible Duke disability benefits with accrued
vacation/sick/PTO time, the salary should not exceed 100%. Kiel hours
cannot be used to supplement disability benefits.
In contrast, Voluntary Disability benefits cannot be supplemented with
accrued sick/vacation/PTO/Kiel time.
Benefits Continuation
An employee was approved for Voluntary Disability benefits from Hartford.
Will benefit deductions be taken from that check?
No, the employee will need to make arrangements with the vendors directly for
premiums other than health, dental, Basic Life insurance, or Personal Accident
insurance. During an unpaid leave of absence, Duke Accounting Services
(684-3123) should be contacted for arrangements about the Basic Life insurance,
or Personal Accident insurance premiums. As for health and dental insurance, the
employee will be COBRA notified.
Will the health premium remain the same for an employee receiving Voluntary
Disability benefits?
In order for the employee to continue to qualify for the employer contribution
towards the health premium, the employee must be on an approved FMLA. Otherwise,
the total premium under COBRA will be due.
Will benefit deductions be taken from an approved Duke Disability benefit
payment?
If an employee is approved for Duke Disability, a letter will be sent
instructing the employee on how to maintain benefit coverage. Only health and
dental deductions can be taken from the Duke Disability benefit and for any
other benefit premiums, arrangements should be made with the vendors.
Return to Work
What rehabilitative services are available to those on long-term
disability?
Rehabilitation is a process of providing services to a disabled person with the
goal of aiding recovery and return to work. The employer and the disability
vendor determine who receives rehabilitation services through the disability
program.
An employee currently on Duke's total disability has a return to work
clearance (with or without restrictions) from his physician. Can I process a
return from leave payroll form?
No, Human Resources (attn: Sonya Stewart, fax 681-8774) should be sent
immediately any return to work request submitted for an employee on an approved
Duke disability. Human Resources will process the necessary payroll form after
coordination with the disability vendor. The department will receive a
copy of any processed payroll form for an employee on Duke Disability. This is
important because the employee runs the risk of receiving an overpayment from
the disability vendor when in fact he has already returned to work. Only HR
should be removing an employee from a disability leave status.
Payroll contacted the department about the inability to pay an employee who
recently returned to work from total disability. What happened?
The organizational key is probably still under the "disability leave without
pay" code. That's why it is important to notify Human Resources as soon as a
return to work authorization has been received for an employee returning from
total disability. Human Resources is responsible for removing the disability
leave status and transferring the employee from the disability organizational
key back to the employing department.
A review of the Disability web site for additional
detailed information is encouraged. You may also contact the Human Resources
Information Center at 684-5600 or Sonya Stewart at 681-4436 for questions.
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