DC 37 Health and Security Plan Benefits: Disability Benefits

The weekly disability income benefit for full-time per annum employees is 66 2/3% of their weekly salary but no more than $200 per week (7 day week). The benefit is paid for up to a maximum of 26 weeks but not longer than the member remains totally disabled. The weekly disability benefit for part-time or hourly employees is 66 2/3% of their weekly salary but no more than $98 per week. The benefit is paid for up to a maximum of 13 weeks but not longer than the member remains totally disabled.

Disability Payments begin when the member has used up all sick days, Section 3.5, and/or Donated/Dedicated Sick Grant, but not before the end of 8 days of total disability at home. If the member is hospitalized, however, the benefit begins as soon as he/she has exhausted his/her sick days. In order to assist us in expediting the processing of the disability claim form, the following suggestions should be followed:

Be sure that the member completes the claim in its entirety and have his/her physician answer all relevant questions (i.e cause of disability, dates of treatment, and or hospitalization, anticipated return to work date, etc.). Remember, claims must be signed by both member and physician.
Indicate on the claim form the telephone number of the timekeeper, personnel officer, payroll secretary (depending on the agency).
If there is a lawsuit pending because of an accident, supply the name, address and telephone number of the Attorney. For any accident, whether or not a lawsuit has commenced, an assignment must be signed and notarized before payment begins. The assignment is part of the claim and when the member's case is settled, repayment will be made to the Plan.
If the accident occurred on the job, the member must file for Workers' Compensation with his/her employer and also notify the Workers' Compensation Board.
If the disability was due to a car accident, the member must file for No-Fault Insurance with his/her own auto insurance carrier. If the member is injured by an uninsured vehicle, then he/she must file with the Motor Vehicle Accident Indemnification Corp. (M.V.A.I.C. (212) 791-1290).
In these situations, the member will not receive disability benefits. However, he/she is eligible for other Health & Security Plan benefits for a maximum of 26 weeks (or 13 weeks if he/she is a part-time or hourly employee) measured from the last day on active payroll status. If the member remains on active payroll status, receiving either sick leave, vacation pay, Section 3.5 or Section 7.2 leave pay, the eligibility period for Health and Security Benefits is measured from the last day on active payroll status. In order to maintain eligibility for these Health and Security Benefits during the period of disability, a disability claim form must be filed with the Plan. Further documentation will be necessary to extend benefits to the maximum allowable period.

The Disability Unit of the Health and Security Plan utilizes a list of Reasonable and Customary convalescent periods associated with each illness. If a member is out on disability for more than the Reasonable and Customary period of convalescence, the Plan will require an evaluation be performed by a doctor selected by the Health and Security Plan at no cost to the member. Failure to keep the evaluation appointment will cause the denial of any further disability payments, until another evaluation appointment is made and kept.

The Disability Unit periodically forwards requests for medical statements to the member, to be completed by the treating physician. Claims processing could be delayed if the medical statement is not furnished quickly.

The disability claim form must be filed within 15 days from the onset of the disability, regardless of the amount of sick time, vacation time or annual time available. If the claim is filed beyond the 15 days filing limitation, a letter of explanation must be attached to the claim. Complying with the above-mentioned instructions, will permit us to process the claim within 10 working days. However, other problems may cause processing delays (information not received from the payroll department, etc.).

Disability Benefits As They Relate To Workers' Compensation

According to the rules and regulations governing the administration of the Disability Benefit, no benefits are payable if a member is receiving or eligible to receive Workers' Compensation. However, there are instances where a member can turn to the Plan for assistance when his/her case is being controverted and payments for Workers' Compensation benefits will be delayed until after a hearing. Therefore, if the following criteria are satisfied, the Plan will extend Disability Benefits to a member who is in dire need of financial assistance:

The member applied for Workers' Compensation and received a letter from the Law Department indicating that the case is being controverted.
The member has exhausted all accrued sick and annual leave.
The member has made application, if eligible, for but does not qualify for a Section 3.5 or Section 7.2 paid sick leave grant or similar provisions provided by other Agencies.

Once the above criteria are met and Disability Benefits are released, the Disability Unit will send a Compensation Lien Form directly to the Compensation Board. The lien becomes part of the Workers' Compensation Case so that if or when the member is awarded Compensation benefit the Workers' Compensation Board will pay the Plan directly.

Disability Benefits As They Relate To Substance Abuse

We are now able to pay benefits for alcoholism and drug dependency for both in-hospital and out-patient care. For out-patient care coverage, the individual must be in a rehabilitative program that is recognized by the Plan and verification of the care must be supplied to the Plan upon request. This benefit has a maximum coverage of 26 weeks for full-time employees and 13 weeks for part-time employees.

DISABILITY AND THE CULTURAL TRUST

In addition to the aforementioned procedures regarding disability benefits, the following information applies specifically to the Cultural Trust.

Effective March 1, 2000 the weekly disability benefit for full-time per annum employees covered by the DC 37 Cultural Institutions Health & Security Plan is 66 2/3% of their weekly salary but no more that $275 per week (7 day week). The benefit is paid for up to a maximum of 26 weeks but not longer than the member remains totally disabled.

Eligibility

The members of the Cultural Trust are covered for the disability benefit from day 1 of employment (if contributions are received from the Institution) and are covered up to four weeks after the termination date. Please note that this does not apply to the other benefits. The ninety day waiting period remains and eligibility ends at termination for the other Health & Security benefits.

Please be reminded that employees are required to use their sick time before becoming eligible for disability benefits. If there is no sick time on the books, the member is covered from the 8th day of disability if there is no hospitalization. If there is hospitalization, and no sick time, the member is covered from the first day.

The existence and/or concurrent use of annual leave, vacation time, personal time or any other form of leave time not expressly designated for purposes of sick leave shall be disregarded by the Cultural Trust in determining a Covered Employee's eligibility for state mandated disability benefits.

No Fault Insurance (Motor Vehicle Accident) Cases

Disability benefits paid by the Cultural Trust will be considered primary by the No-Fault insurance carrier. The carrier will apply the amount paid by the Trust toward the No-Fault wage loss benefit and pay any difference due.

DISABILITY AND THE NEW YORK PUBLIC LIBRARY TRUST

The members of the New York Public Library Trust receive their short-term disability payment from the State while getting their ancillary benefits from the New York Public Library Trust. If the member is still disabled, he/she will be eligible for a second six months of short-term disability payments. The member, however, will not be eligible for an additional six months of ancillary benefits.