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 This Page Describes

• General Information
• The Disability Fund Provides Off-the-Job Disability Benefits
• Eligibility for Disability Benefits
• Temporary Disability
• Permanent Total Disability
• Extended Temporary Disability
• Coverage While on Leave of Absence
• Disability Claim Procedure
• Medical Certification
• First and Second Sick Days Off
• Relapse
• The Amount of Your Benefit Payments
• Percentage of Salary Paid as Temporary Disability
• How Long Benefits Continue
• Limitation of Rights to Disability Benefits
• How Workers' Compensation Affects Your Benefits
• Contingency Disability Benefits
• Federal and California State Income Taxes

General Information

   Good health and the ability to work are assets we usually take for granted. Earnings from work are the major source of financial support for ourselves and our families.

   The disability portion of your Plan protects you against financial emergencies that can occur if you are unable to work due to an off-the-job illness or injury.  It can also supplement Workers' Compensation payments if you are disabled due to an on-the-job illness or injury. The Plan covers short-term and temporary disability as well as long-term illnesses.

   Benefits associated with the first two weeks of disability are administered by your business unit, according to the provisions of the Plan and the Memorandum of Understanding (MOU) which covers you. If you are absent for more than two weeks, disability claims are processed in the Retirement Plan Office and the Board of Administration of the Retirement Plan must approve the payment.

The Disability Fund Provides Off-the-Job Disability Benefits

   Your contributions, the Department’s contributions and the earnings on investments fund your Disability benefits.  Department
contributions are determined so that there is always enough money in these funds to pay for benefits.

   The Department's contributions pay the entire cost of the first two weeks at 100 %.  In addition, the Department pays the entire cost of benefits supplemental to Workers' Compensation.  In total, the Department is paying about 80 % of the cost of all disability benefits provided by the Plan.

Eligibility for Disability Benefits

   If you are a new employee, you will be eligible to receive disability benefits after you have been a Full Member of the Plan for at least one day. (See "Membership in the Plan") However, if you are absent from work on the day you become a Full Member, you will not be eligible for disability benefits until you return to duty for at least one day.

Temporary Disability (Up to 52 Weeks)

   When you cannot perform the duties of your job, because of illness or injury that did not occur as a result of your employment, you may be eligible for Temporary Disability benefits.

Permanent Total Disability

   When you cannot perform any gainful employment, and your disabling condition has continued longer than 52 weeks and is reasonably certain to continue for life, you may be eligible for Permanent Total Disability benefits.

Extended Temporary Disability (Up to 52 Weeks)

   When your condition does not qualify you for Permanent Total Disability benefits but you are still disabled after one year, you may be eligible for Extended Temporary Disability Benefits for up to one additional year.

Coverage While on Leave of Absence

   Your disability coverage will continue automatically during pay periods you are on a paid disability or a paid Worker's Compensation leave, even though you did not make contributions. However, if you are on a leave without pay, including a maternity or family leave, your disability and death benefit coverage will not continue automatically unless you pay for coverage in advance. You may get disability protection for up to 13 payroll periods (approximately six months) while on leave without pay if you pay the required premium in advance. (This is not available to employees who transfer to another City department.) The premiums to be paid consist of your disability contributions plus the amount that is normally paid by the Department toward these benefits. You can arrange to make these advance payments by going to the Disability Section or by calling the Disability telephone number. (Also see "Coverage While on Leave of Absence" in the Death Benefit section)

Disability Claim Procedure

   If you should become disabled due to an off-the-job illness or injury, notify your supervisor immediately of the reason for your absence.  If your absence extends beyond two weeks, your timekeeper will notify the Disability Section.  This office will mail to you a "Disability Notice/Benefit Claim" form which you must complete and return.  Also enclosed will be a "Doctor's Certificate" for you to have your attending physician complete and return. (See "Medical Certification") It is your responsibility to see that the doctor returns the form to the Disability Section.

   If, prior to the 15th calendar day of your disability, it appears that your illness may last for more than two weeks, you can contact the Disability Section and request that the forms be sent to you early.

   Disability payments will not be made to you until the Disability Section receives the completed forms. If the required forms are not received within three months from the day your Disability leave ends, the Plan prohibits any payment for the claim.

    The Disability Section will require periodic reports from your attending physician for an extended disability.  In addition, you may be requested to report to the Department Medical Office or to another physician designated by the Department's Medical Director for a status examination during your absence. Failure to submit to such examinations will result in the discontinuation of eligibility for Disability Plan benefits.

Medical Certification

   Disability benefits cannot be paid for any absence that is longer than two weeks without written certification by a licensed physician or chiropractor. Note: A chiropractor may only provide certification within the scope of his or her license.

   The certification must be provided on a form approved by the Board of Administration. Although medical certification always is required for absences of more than two weeks, you may be required to furnish medical certification for any absence.  Medical certification must include a diagnosis, the limitations that justify your absence from work, dates of treatment, and a return to work date.  A licensed physician or chiropractor must sign the certification.

The final determination of whether you are unable to work and for what period of time is made by the Board of Administration based on all available medical evidence, including the recommendation of the Department Medical Director.  Therefore, there is no guarantee that you will receive disability payments even with certification from your treating physician.

First and Second Sick Days Off

   If your disability does not require you to be hospitalized, you are paid for your first and second working days off, up to a maximum of 40 hours in any calendar year. In general, for Half-Time Civil Service Employees, the maximum is 20 hours.  (For more details, refer to the applicable MOU and Operational Rules for Half-Time Civil Service Employees.)  Any partial days sick are also charged against the allowance of 40 hours. After that maximum is reached, you will not receive disability benefits for such first and second days during the remainder of that calendar year, and your Temporary Disability benefits will begin with the third day. If your disability requires admittance to a hospital, the first and second days off are not charged against your 40 hours.

   Any unused portion of your allowed first and second days will be carried over from one calendar year to the next, and added to the maximum to which you are entitled for that year. This will provide you with additional first and second days for a year in which you require more than the usual 40 hours.

   No more than 40 hours may be carried from one year to the next; so you cannot start any calendar year with more than 80 hours of first and second days. However, you will be paid at your existing salary rate for any unused sick time in excess of 80 hours, in accordance with your MOU.

Relapse

When the original disability is two weeks or less:

   If you have a relapse of an illness within seven calendar days and your doctor or the Department's doctor verifies it is the same illness, your benefits may be continued from the first day of the relapse and will not be charged against your bank of sick days.

   If you have a relapse after seven but within 21 calendar days and the Department's doctor verifies it is the same illness, your benefits may be continued from the first day of the relapse and will not be charged against your bank of sick days.

When the original disability is more than two weeks:

   If you have a second disability, for any reason, within 30 calendar days, the total of such disabilities will be considered as a single disability for calculation of benefits. You must provide certification from your treating physician for any absence within 30 days from your last return to work from a prior disability. If the second disability occurs after 30 calendar days, it will be treated as a separate disability claim.

The Amount of Your Benefit Payments

   The percentage of your gross salary you will receive for Temporary Disability depends on the length of your continuous service at the time your disability begins. The percentage is applied to your salary rate as of your first day off work.

   For the first two weeks of a Temporary Disability, the benefits are calculated for the total number of workdays you are disabled, and are included in your regular paycheck. For subsequent periods your benefits are calculated for every workday you are absent and are paid biweekly by special check from the Disability Fund.

   The table below, "Percentage of Salary Paid as Temporary Disability," shows the percentage of salary you will be paid, and the various maximum periods payable. (See "First and Second Sick Days Off" for an exception regarding the first two days)

Percentage of Salary Paid as Temporary Disability

   If you become disabled within six months of returning from a break in service, your Temporary Disability may be less than indicated on the chart above.

How Long Benefits Continue

Temporary Disability and Extended Temporary Disability

   Temporary Disability benefits can continue for as long as 52 weeks. If you are still disabled at the end of that time and are not permanently and totally disabled, you may be eligible for Extended Temporary Disability benefits at 33 1/3% of your salary. These extended benefits can continue for up to 52 additional weeks.

   If you are laid off for lack of work or funds while you are on disability, your benefits will continue until you have exhausted them or until you have recovered, whichever occurs first. However, if you resign from Department service or are discharged for cause while on disability, you may be eligible for limited disability benefits only.

Permanent Total Disability

   After 52 weeks of Temporary Disability or during or after 52 weeks of Extended Temporary Disability, you may qualify for Permanent Total Disability benefits if you are unable to perform any gainful employment.

   Benefits for Permanent Total Disability are 40% of your salary at the time you first became disabled. You will receive monthly payments as long as you are permanently and totally disabled, or

• until you reach age 65, if your benefits begin before you reach age 60,
  or

• up to five years if your benefits begin after you reach age 60,
  or

• until you retire.

   Your Permanent Total Disability benefits may increase or decrease up to 3% annually. Any such adjustments will be made each July 1 in accordance with the percentage change in the Consumer Price Index for the Los Angeles-Riverside-Orange County Metropolitan Area--All Items for All Urban Consumers.

   The Plan also provides for a special review not less than every third calendar year. If the Board of Administration determines that the annual adjustments of up to 3% have not been adequate, it may grant a special increase to partially offset the effects of inflation.

Limitation of Rights to Disability Benefits

   You will not be paid disability benefits for any period if you refuse to submit to a physical examination. Furthermore, you will not be paid disability benefits for any period after the first two weeks if you are not under the care of a physician. If you conceal or fail to disclose material information or submit false or incorrect data pertaining to your disability, the Board may terminate or cancel your disability benefits.

   Also, the Plan specifically prohibits you from working in any other type of employment, either full-time or part-time, while you are being paid disability benefits, unless such employment is approved in advance by the Board of Administration for rehabilitative purposes.

How Workers' Compensation Affects Your Benefits

   If you become ill or are injured in connection with your Department employment, the Department (not the Retirement Plan) will provide the benefits required to be paid under any Workers' Compensation law. These include cash disability benefits and necessary hospital and medical care, nursing care, and medicine. If you have questions regarding Workers' Compensation, please call the Department's Workers' Compensation Office at
213-367-1942.

   You may be paid supplemental benefits from the Disability Fund in addition to your Worker's Compensation benefits. These supplemental benefits are calculated so that when they are added to the amount you receive under Workers' Compensation, the total is equal to what you would be entitled to receive for an off-the-job illness or injury.

Contingent Disability Benefits

   Contingent disability benefits are paid when a member of the Plan is definitely disabled but is not certain whether the disability is due to off-the-job or on-the-job causes. These payments are considered advances of necessary living expenses, and are made in the amount which would equal Disability Plan payments. The payments are made only after the disabled member agrees in writing to reimburse the Disability Plan for any benefits or advances paid which are over and above the benefits which supplement Workers' Compensation, if it is ultimately determined that the disability had on-the job causes.

   It is important to note that no disability benefits will be paid under the Plan for any disability resulting from an illness or injury arising out of employment with any employer other than the Department.

Federal and California State Income Taxes

   The Retirement Office reports paid Temporary, Extended Temporary Disability, and Industrial Supplemental Disability benefits to the IRS and the California State Franchise Tax Board. The taxable portion of the benefits is based on a ratio of your contributions and the Department’s contributions over a three-year period. Since the Department funds a majority of your benefits, they are mostly taxable. The taxable amount is included on the W-2 form you receive at the end of the year from the Department Payroll Office.

   The Retirement Office also reports Permanent Total Disability benefits you have received to the IRS and the California State Franchise Tax Board. The taxable portion of the benefits is based on a ratio of your contributions and the Department’s contributions over a three-year period. You may qualify for certain special tax credits. You should discuss this matter with your personal tax preparer or the IRS. The amount we report to the IRS and the Franchise Tax Board is printed on the 1099 form you receive at the end of the year from the Retirement Office.

   State and Federal taxes are automatically withheld from your Temporary, Extended Temporary, and Industrial Supplemental Disability payments. If you are receiving Permanent Total Disability benefits, you may arrange to have taxes withheld by contacting the Disability Section.

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