PEP, March 2009: A helping hand for sick or injured workers

Question: Am I eligible for a disability benefit?
Answer: Working members can file a claim for benefits from the DC 37 Health and Security Plan if they are unable to work owing to illness or injury. The benefit for full-time employees is up to $200 per week for up to 26 weeks. For part-time employees, it is up to $98 per week for up to 13 weeks.

Q: When should I file my claim?
A: File your claim as soon as you stop working so the Disability Unit can begin the claim process and make a payment to you when you have exhausted your sick leave, similar coverage, sick leave grants, donated or dedicated sick time or employer disability benefits. It begins when you have used up all your sick leave, but not before the end of the eighth day of disability. If you are hospitalized, the benefit begins as soon as you have exhausted all your sick leave.

Q: Must I be under a doctor’s care?
A: Disability benefits are paid only while the patient has been seen by, and is under the care of, a licensed physician. You must be on an approved medical leave of absence to qualify for benefits, except if you are a provisional employee who is ineligible for a medical leave of absence.
No disability benefits will be paid if the employee has retired or resigned, or was terminated or suspended.

Q: I was hurt on the job. Can I get disability benefits?
A: If you were hurt on the job, you must file for Workers’ Compensation benefits. Workers’ Comp will pay toward your lost wages, but you must also file a disability claim form so your union benefits can be extended while you are on Workers’ Comp. File your disability claim as soon as you stop working so your benefits will not be interrupted. You must also send updated notices showing the period that Worker’s Comp covered to extend your H&S benefits.

Q: I filed for Workers’ Comp. If my case is rejected or controverted, can I get a disability benefit?
A: If you receive a letter from the City Law Department or your employer’s Workers’ Comp carrier that your case is being rejected or controverted you must send a copy of that notice to the Disability Unit. If your case was rejected, a benefit will be processed. If your case was controverted, you must show that you have exhausted your sick time and applied and were rejected for paid sick leave under city time and leave rules or similar provisions at other agencies. Health andSecurity will send a lien notice to Workers’ Compensation, allowing the plan to recoup from Workers’ Comp any disability payments it made to you.

Q: Now that I filed my claim, what do I have to do to continue receiving disability?
A: Your initial claim will be reviewed and a benefit paid based on the doctor’s statement and the reasonable and customary period for your illness. Depending upon how long you are out, the disability unit may request more recent dates of treatment from your doctor to confirm your ongoing disability. No disability payments or extensions of H&S benefits can be made without current medical documentation. We recommend that you submit updated medical information to the Disability Unit monthly to ensure the least interruption in payments and other benefits.