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Policy 604 - Long Term Disability

604. Long Term Disability

Statement

Santa Clara University employees are covered by a voluntary long term disability insurance plan provided by the University.

Procedure

Definition

Long term disability (within the first 24 months) is defined as the employee’s inability to perform the material duties of his or her own occupation with reasonable continuity, or the inability, because of decreased hours or reassignment, to earn more than 80% of pre-disability earnings. After the first 24 months, long term disability continues if the employee continues to be unable to perform with or without reasonable accommodation, the primary functions of any gainful occupation which is consistent with the skill, experience, and education of the employee or if the employee is unable to earn more than 80% of pre-disability earnings while working in the prior position or in any other position.

Eligibility

All Santa Clara University regular employees working at least 20 hours a week are covered under this policy. In order to receive benefits, the disability must be continuous for at least 360 days.

Amount of Benefits

Employees will receive 66 2/3% of prior monthly earning to a maximum of $6000 per month. Pre-disability earnings are determined by the last full day of active work prior to disability. Benefits will be reduced by any dollar amount received as worker’s compensation, social security, disability benefits from another insurance company, retirement plan, settlement agreements, and any wages earned. The benefits will be reduced so that the combined income does not exceed 100% of pre-disability earnings.

Monthly benefits for Total Disability caused by or contributed to by mental or nervous disorders will not be payable beyond an aggregate lifetime maximum duration of twenty-four (24) months unless the insured is in a hospital or institution at the end of the twenty-four (24) month period. The monthly benefit will be payable while so confined, but not beyond the Maximum Duration of Benefits.

Duration

See the chart below to determine maximum benefit periods.

Age When Disability Occurs Maximum Benefit Period
59 or younger To age 65
60 5 years
61 4 years
62 3 years, 6 months
63 3 years
64 2 years, 6 months
65 2 years
66 1 year, 9 months
67 1 year, 6 months
68 1 year, 3 months
69 or older 1 year

Certification

A claim form must be filed no later than 90 days after the 360 day waiting period of the occurrence of the disability. A completed Attending Physician Statement signed by the doctor and documentation from other benefits sources applied for must accompany the claim form.

Definition

Long term disability (within the first 24 months) is defined as the employee’s inability to perform the material duties of his or her own occupation with reasonable continuity, or the inability, because of decreased hours or reassignment, to earn more than 80% of pre-disability earnings. After the first 24 months, long term disability continues if the employee continues to be unable to perform with or without reasonable accommodation, the primary functions of any gainful occupation which is consistent with the skill, experience, and education of the employee or if the employee is unable to earn more than 80% of pre-disability earnings while working in the prior position or in any other position.

Responsibility

It is the responsibility of the employee to contact the supervisor and Human Resources to notify them of the disability. In order to receive long term disability benefits, the employee must ensure that the proper certification has been filed with the plan administrator.

Resources

Refer to the Long Term Disability Plan Document found in the Comprehensive Benefits Guide (on the HR web site). Refer to the Family and Medical (614), Pregnancy Disability (622), and Industrial Disability (615) leave policies for procedures related to specific leave applications. Contact Human Resources for more information regarding this benefit.


Policy Approved: October 23, 1998
Last Updated: October 28, 1998

Maintainer: Human Resources

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