Frequently Asked Questions
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.
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.
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).
- 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.
According to your 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.
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.
Yes, according to your LTD plan, claim payment may be limited if your disability is caused or contributed to by:
- Musculoskeletal and connective tissue disorders.
- Mental Disorders.
- Alcohol and drug use.
- Other limitations may apply
- 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.
- 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.
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 and 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 #5 above.
Not when first making a claim to the I&B Trust of PORAC. It is the responsibility of the claimant/ member to request and forward all medical documentation requested to the claims analyst. The I&B Trust of PORAC is not responsible for any fees that your physicians may charge for copying these records or completing forms on your behalf.
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.
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.
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).
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.
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.
- 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.
- Refer to the Deductible Income section below.
Yes, the awarded period may overlap with your STD and LTD benefit periods creating an overpayment which you will be required to reimburse the I&B Trust of PORAC and Standard.
Subject to Exceptions To Deductible Income, Deductible Income means:
- If all eligible Members of your Participating Unit are covered under the Plan and your Employer pays you 50% or more of sick leave pay and annual leave pay: sick leave pay and annual leave pay, including donated amounts, (but not vacation pay compensatory time off or a lump sum buyback upon retirement of your sick leave and annual leave pay) paid to you by your Employer, as determined below:
- Determine the amount of your LTD Benefit as if there were no Deductible Income, and add your sick leave pay and annual leave pay to that amount.
- Determine 100% of your Indexed Predisability Earnings.
- If a. is greater than b., the difference will be Deductible Income.
Note: 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.
- If all eligible Members of your Participating Unit are covered under the Plan and you are entitled to receive less than 50% of sick leave pay and annual leave pay from your Employer: all sick leave pay and annual leave pay, including donated amounts, (but not vacation pay compensatory time off, or a lump sum buy-back upon retirement of your sick leave and annual leave pay) that you receive or are entitled to receive from your Employer.
- If not all eligible Members of your Participating Unit are covered under the Plan: all sick leave pay and annual leave pay, including donated amounts, (but not vacation pay compensatory time off or a lump sum buy-back upon retirement of your sick leave and annual leave pay) that you receive or are entitled to receive from your Employer.
- Salary continuation (other than sick leave pay or annual leave pay) that you receive or are entitled to receive from your Employer.
- Your Work Earnings, as described in the Return To Work Provisions.
- Any amount you receive or are entitled to receive because of your disability, including amounts for partial or total disability, whether permanent, temporary, or vocational (but not California permanent Workers' Compensation benefits), under any of the following:
- A workers' compensation law;
- The Jones Act;
- Maritime Doctrine of Maintenance, Wages, or Cure;
- Longshormen's and Harbor Workers Act; or
- Any similar act or law
- Any amount you, your Spouse, or your child under age 18 receive or are entitled to receive because of your Disability or retirement under:
- The Federal Social Security Act;
- The Canada Pension Plan;
- The Quebec Pension Plan;
- The Railroad Retirement Act; or
- Any similar plan or act.
- Amounts that are entitled to be received will be deducted in accordance with the Estimating and Deducting section of Rules For Deductible Income.
- Full offset: Both the primary benefit (the benefit awarded to you) and dependents benefit are Deductible Income.