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Following are the answers to Frequently Asked Questions
regarding Disability Benefits coverage. To
report a Disability Benefits claim or inquire about the status of a
claim, refer to the contact information included with the claim packet
you received upon enrollment. Please reference the claimant's Social Security number
on all correspondence.
If you have any questions regarding your carrier's
contact information you can contact April Gidley at 1-800-958-7475,
ext. 245 or agidley@prm.com.
Q.
What is a "day of disability?"
A. A "day of disability" is one on which the
employee was prevented from performing work because of a disability
and because of that he/she did not receive regular wages or
remuneration.
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Q. Are the costs
of medical care included?
A. No. Costs of medical care are not included
under the statutory provisions of the Disability Benefits Law.
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Q. May an employer/insurance carrier have an employee claiming
benefits examined by a health care provider designated by the
employer/carrier?
A. Yes. The employee must comply with a request
for a medical exam at certain intervals but not more than once a week.
Exams are not paid for by the employee and are held at a reasonable
time and place. Refusal to submit to an exam may jeopardize a
claimant's benefits.
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Q. After
a claim is filed, how soon will it be paid?
A. If a claim is properly completed with the
required statements, the first payment should arrive within four
business days after the 14th day of disability or four business days
after the receipt of the claim, whichever is later. Benefits are
payable every two weeks during the period of disability.
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Q. Can a claimant collect Unemployment Insurance and Disability
Benefits for the same period of time?
A. No.
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Q. Can a claimant collect Disability Benefits for disability caused by
pregnancy?
A. Yes. If she is disabled because of pregnancy,
she may be entitled to up to 26 weeks of benefits. Disability can
occur at any time during pregnancy.
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Q. What
determines disability due to pregnancy?
A. Disability can only be determined and
certified by a physician or certified nurse midwife through the
submission of medical reports. If a claimant becomes disabled more
than four to six weeks prior to the anticipated birth date, or is
disabled more than four to six weeks after the actual birth date, more
detailed information regarding the disability may be required.
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Q. Can an employee collect disability benefits if on maternity leave?
A. Yes. If she is on a leave of absence without
pay (i.e. maternity leave), and becomes disabled within four weeks of
the last day she actually worked, she is entitled to benefits from the
employer/carrier (if otherwise eligible). If the disability begins
more than four weeks from the last day actually worked and she is
claiming/receiving Unemployment Benefits, she is entitled to
disability benefits from the Special Fund for Disability Benefits (if
otherwise eligible).
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Q. Is there a limit on the number of weeks a claimant can receive
benefits?
A. Yes. There is a limit of 26 weeks of benefits
during a period of 52 consecutive calendar weeks or during any one
period of disability. The amount of benefits a claimant receives is
dependent upon the length of time he/she is actually disabled as
certified by a physician.
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Q. What if a claimant is still disabled, but benefits have stopped?
A. If he/she received less than 26 weeks of
benefits, is still disabled, and has not received a Notice of
Rejection; he/she must submit further medical evidence to his/her
employer, insurance carrier or the Special Fund for Disability
Benefits. If he/she has received a Notice of Rejection, the claimant
may request a review of the rejection by completing its reverse side
and mailing it to the Disability Benefits Bureau at the Workers'
Compensation Board.
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Q. Is a claimant entitled to Disability Benefits for an injury
incurred in an auto accident?
A. Yes. However, the amount of the disability
benefits may reduce any no-fault insurance benefits the claimant is
eligible to receive.
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Q.
If a claim is rejected or not paid, may it be reviewed?
A. Yes. If a claim is rejected or not paid, the
employee should complete the reverse side of the Notice of Rejection
(sent by the employer/carrier/the Special Fund, within 45 days of its
receipt of the claim) and mail it within 26 weeks to the Disability
Benefits Bureau. The address is located on the back of the rejection
notice. The Workers’ Compensation Board will determine if the
rejection was proper and valid.
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Q. If a claimant is entitled to or receiving Social Security
Retirement Benefits, may he/she still receive Disability Benefits?
A. Yes. If he/she is entitled to Disability
Benefits, the fact that he/she is eligible for or receiving old-age
insurance benefits under the Social Security Act does not affect
his/her right to Disability Benefits.
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