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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsJuly 2015

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19 DE Admin. Code 2007
"Section 25. Notwithstanding the provisions of the Administrative Procedures Act, 29 Del.C. c. 101 or any other laws to the contrary, the State Employee Benefits Committee is authorized to amend the rules for Employees Eligible to Participate in the State Group Health Insurance Program and the State Disability Insurance Program by approving such amendments and causing the amendments to be published in the Register of Regulations with such amendments to be effective as of the date of such publication unless otherwise specified by the State Employee Benefits Committee."
Appeal” is the action you can take pursuant to 29 Del.C. §5258 if you disagree with a coverage decision made by the DIP insurance carrier and/or third party administrator (Administrator) selected to administer and/or insure the program by the Committee SEBC pursuant to 29 Del.C. §5254 and/or the Appeals Administrator from the Statewide Benefits Office and/or the Hearing Officer from the Office of Management and Budget and/or the Committee SEBC.
Base Rate of Compensation” means the employee’s usual rate of pay, including hazardous duty pay if applicable. Base Rate of Compensation does not include commissions, bonuses, shift differential pay, overtime pay or any other fringe benefit or extra compensation.
Claimant” means a person enrolled in the DIP who applies for STD and/or LTD benefits and/or an extension of STD and/or LTD benefits or who is receiving or has received STD and/or LTD benefits.
Committee” means the State Employee Benefits Committee (SEBC)
Creditable Compensations” as defined in 29 Del.C. §5251(c), shall mean the base rate of compensation that the employee received on the last day of employment before the employee developed a disability.
"DIP" means the Disability Insurance Program as defined in 29 Del.C. §5256 of the Delaware Code.
"DIP Insurance Carrier and/or Administrator" means the State's selected vendor for this service.
Employee” shall mean an eligible “employee” as defined in 29 Del.C. §5501(ef), (http://delcode.delaware.gov/title29/c055/sc01/index.shtml) who elects to participate in the DIP as specified in 29 Del.C. §5519. (http://delcode.delaware.gov/title29/c055/sc02/index.shtml). This shall include any employee who is collecting benefits pursuant to 11 Del.C. §8352(4) (http://delcode.delaware.gov/title11/c083/sc03/index.shtml).
Under 29 Del.C. §5501(f), "Employee" shall mean an individual who:
Employing Organizationshall mean the agency, school district, charter school, institution of higher education or court system employing claimants in a position covered by the Delaware State Employees Pension Plan pursuant to 29 Del.C. Chapter 55 who are U.S. citizens or U.S. residents actively at work for one full day on or after January 1, 2006.
Essential Duty” means a duty that is substantial, not incidental; is fundamental or inherent to the occupation; and cannot be reasonably omitted or changed. To be at work for the number of hours in the employee’s regularly scheduled workweek is also an essential duty. Any occupation means an occupation for which the employee is qualified by education, training or experience.
"Family and Medical Leave Act (FMLA)" is a labor law that entitles eligible employees to take up to twelve workweeks of unpaid, job-protected leave during a twelve month period for specified family and medical reasons with continuation of group health insurance coverage under the same terms and conditions as if the employee had not taken leave. Qualified medical and family reasons include personal or family illness, family military leave, pregnancy, adoption, or the foster care placement of a child. FMLA also provides qualifying exigency and military caregiver leave for employees with family members who are covered military members.
"Interactive Process" (ADA) - When medical restrictions prohibit an employee with a disability from doing his or her job, the Americans with Disabilities Act (ADA) requires an employer to communicate with the employee concerning an accommodation. This exchange has been described variously as the "core" or "proactive" process, "cooperative problem solving," "open and individualized exchange," a "search", and a "flexible give-and-take." Most frequently, it is called the "interactive process" or by the redundant term, "interactive dialogue." The purpose of this dialogue is to "identify the precise limitations resulting from the disability and potential reasonable accommodations that could overcome those limitations." 29 C.F.R. § 1630.2(o)(3).
Less Than Twelve Month Educational Employees” are those employed by School Districts, Charter Schools, the Department of Education, University of Delaware, Delaware State University and Delaware Technical & Community College whose normal working period is a school year or semester which is less than 12 months in duration per calendar year. “Less Than Twelve Month Educational Employees” are not defined or categorized by their length of employment.
Medical Care” is received when a physician is consulted or medical advice is given or treatment is recommended, prescribed by, or received from a physician. Treatment includes, but is not limited to, medical examinations, tests, attendance or observations and use of drugs, medicines, medical services or equipment.
Member” means a person enrolled in or was previously enrolled in the DIP.
Normal Working Periods” are the scheduled working days for the employee.
Pre-Disability Base Pay” shall mean the compensation paid to the employee on the last day of employment before the employee developed a disability.
Pre-Existing Conditions” means any accidental bodily injury, sickness, mental illness, pregnancy, or episode of substance abuse or any manifestations, symptoms, findings, or aggravations related to or resulting from such accidental bodily injury, sickness, mental condition, pregnancy or substance abuse for which the employee received medical care during the 3 month period that ends the day before:
"Qualified Individual with a Disability" (ADA) is an individual who has:
a) a physical or mental impairment that substantially limits one or more of the major life activities of such individual;
Return To Work (RTW) Coordinator” means the person selected by the Office of Management and Budget to assist individuals enrolled or previously enrolled in the DIP who expect to be out of work due to a disability in with their transition back to work. Return To Work assistance may be requested by an employee, previously employed individual and/or by an employing organization. The RTW Coordinator may also consult with the individual’s health care provider(s) to acquire and/or clarify a claimant’s restrictions and/or limitations if applicable, to facilitate a safe return to the workplace.
"SEBC" means the State Employee Benefits Committee. (As the "Committee" is the SEBC, we have incorporated the acronym "SEBC" in lieu of the term "Committee" in the definitions section of the rules. The definition of "Committee" in Section 2 will be deleted.)
"Temporary" means not permanent; provisional and/or lasting only a short time.
3.1 Pursuant to the authority vested in the State Employee Benefits Committee (SEBC) by 29 Del.C. §5210(4), §9602(b) (4) and §5255, the SEBC adopts these eligibility and coverage rules for the State of Delaware’s Disability Insurance Program (DIP). In the event of conflict between these rules and the Delaware Code, the Delaware Code takes precedence over these rules. DIP is comprised of a Short Term Disability (STD) program and a Long Term Disability (LTD) program. The Rules and Regulations contained herein are to be used in conjunction with the Short Term Disability (STD) and Long Term Disability (LTD) benefit booklets displayed on the Statewide Benefits Office website at http://www.ben.omb.delaware.gov/disability/index.shtml.
3.2.4 Pursuant to 29 Del.C. §5251(e), a retired Delaware State Police Trooper employed in a pension covered position in the Delaware State Employees’ Pension Plan on or after July 1, 2008.
3.6 In accordance with 29 Del.C. §5252, the State shall pay all premium or subscription charges for the full cost of providing coverage for the DIP.
4.1 Pursuant to 29 Del.C. §5253(a), Participating employees shall be eligible to utilize earned sick leave for absences due to accident, illness, or injury for periods before disability benefits commence under this chapter, such that the participating employee receives 100% of creditable compensation for such periods, not to exceed the employee’s sick leave balance.
4.2 Pursuant to 29 Del.C. §5253(b)(1), STD benefits for participating employees shall commence upon the exhaustion of the calendar day elimination period. The elimination period shall begin on the first day following the onset of the participating employee’s physical or mental incapacity. Consistent with the provisions of 29 Del.C. §5255 that allow the DIP insurance carrier and/or Administrator to determine eligibility of a participating employee to receive STD benefits, the elimination period shall begin on the date of disability and STD benefits shall commence on the 31st calendar day of disability. The calendar day elimination period does not have to be satisfied consecutively however, if an employee returns to work for one day or less during the calendar day elimination period, but cannot continue to work thereafter, the period worked shall not be considered to have interrupted the calendar day elimination period.
4.3 Pursuant to 29 Del.C. §5253(b)(1), the calendar day elimination period must commence and conclude within normal working periods for employees who work less than 12 months per calendar year. “Normal working periods” are the scheduled working days of the participating employee.
4.4 Pursuant to 29 Del.C. §5253(b)(5), if a participating employee returns to the employee’s position on a full time basis for 15 consecutive calendar days or longer, any succeeding period of disability for which the participating employee shall become eligible shall constitute a new period of STD with a corresponding calendar day elimination period. A new period of STD shall not be constituted if a participating employee returns to work on a part-time basis.
5.1 Pursuant to 29 Del.C. §5253(b)(7), once an employee exhausts their elimination period, the employee will be deemed to have applied for benefits under this section and shall not be eligible to utilize paid leave in lieu of application for STD.
5.2 All employees enrolled in DIP who expect to be out of work for the length of the calendar day elimination period are required to file a STD claim in a complete and timely manner, even if the employee applied for and/or is receiving Workers’ Compensation (WC) benefits or Other Income Benefits defined in the STD benefits booklet per Delaware Code. Hazardous duty employees injured in the line of duty, who are employed by the Department of Corrections (or its successor agency), the Delaware Psychiatric Center (or its successor agency) who are assigned to programs for the criminally insane, the Department of Services for Children, Youth and Their Families who are assigned to work in the Division of Youth Rehabilitative Services facilities, state law-enforcement officers in the performance of their duties including state employees serving in response to imminent danger of hazardous waste material, including but not limited to the SERT Team are required to file an STD claim in a complete and timely manner if they expect to be out of work for the length of the calendar day elimination period. The employing organization must provide the appropriate monthly hazardous duty amount (i.e., Level A, Level B or Level A1) to the DIP insurance carrier and/or administrator within 24 hours of receiving notice of the employee’s STD claim by the DIP insurance carrier and/or administrator.
5.4 Employees must contact their physician(s) to authorize the release of medical information required by the Return to Work (RTW) Coordinator and/or the DIP insurance carrier and/or third party administrator (Administrator) selected to administer and/or insure the program by the SEBC pursuant to 29 Del.C. §5254. It is the employee’s responsibility to be sure that his or her medical documentation is submitted to the DIP insurance carrier and/or Administrator and the RTW Coordinator in a complete and timely manner throughout the duration of the disability as requested. Employees are required to take any and all action necessary in a timely manner to maintain their claim in an approved status throughout the period of disability.
6.2 The employing organization is responsible for providing the DIP insurance carrier and/or Administrator, with the last day worked and any partial day(s) worked information, if applicable, for each claimant. Organizations that employ Less Than Twelve Month Educational Employees who have filed an STD claim with the DIP insurance carrier and/or Administrator, must also provide the DIP insurance carrier and/or Administrator with confirmation of whether the employee is a "Less Than Twelve Month Educational Employee", the number of contractual days in the employee's school year and a list of all non-contractual days for the twenty-six week period starting with the claimants date of disability.
6.3 “Total Disability” or “Totally Disabled” means the employee is prevented by accidental bodily injury, sickness, mental condition, substance abuse, or pregnancy, or loss of license due to medical condition from performing the essential duties of their occupation, and as a result, the employee is earning less than 80% 20% or less of his or her base rate of compensation received on the last day of employment before becoming disabled.
6.3.1 IMPORTANT NOTE: Weekly earnings means the employee’s usual base rate of pay including hazardous duty pay if applicable. Weekly earnings do, not including include commissions, bonuses, shift differential pay, overtime pay or any other fringe benefit or extra compensation. If disabled, weekly earnings will be the rate in effect on the last day as an active full-time employee before becoming totally disabled.
8.3 STD benefits shall be payable at a rate of up to 75% of the participating employee’s creditable compensation not to exceed the plan maximum during the period the employee has a disability.
8.4 Pursuant to 29 Del.C. §5253(b)(3), creditable compensation during periods an employee receives STD benefits shall include general salary increases awarded or reductions in salary instituted during the period of Short Term disability coverage.
IMPORTANT NOTE: Other Income Benefits also mean any payments that are made to the employee, the employee’s family, or to a third party on behalf of the employee, pursuant to any:
8.7.1 Disability benefit under the Employer's Retirement Plan;
8.7.2 Permanent disability or impairment benefits under a Workers' Compensation Law, the Jones Act, occupational disease law, similar law or substitutes or exchanges of such benefits;
8.7.3 Portion of a settlement or judgment, minus associated costs, of a lawsuit that represents or compensates for the claimant’s loss of earnings; retirement benefit from a Retirement Plan that is wholly or partially funded by employer contributions, unless:
8.7.3.1 the claimant was receiving it prior to becoming Disabled; or
8.7.3.2 the claimant immediately transfers the payment to another plan qualified by the United States Internal Revenue Service for the funding of a future retirement.
8.12 If a participating employee returns to the employee’s position on a full-time basis, as defined by the Committee SEBC, for 15 consecutive calendar days or longer, any succeeding period of disability for which the employee shall be approved for STD benefits shall constitute a new period of short-term disability with a new corresponding calendar day elimination period. A new period of short term disability shall not be constituted if a participating employee returns to work on a part-time basis. If recurrent periods of disability are due to the same or a related cause; and separated by less than 15 consecutive day(s) of work as an active full-time employee, they will be considered to be the same period of disability.
8.13 If while receiving STD benefits an employee should experience a disability due to a new disability, the 182nd calendar day associated with the first disability will not be extended and the plan’s exclusions will apply to the new disability. The employee is immediately required to report the new disability to their supervisor, Human Resource office and to the DIP insurance carrier and/or Administrator.
8.15 It is the employing organization’s responsibility to promptly pay STD benefits to their employees. Overpayment and/or underpayment amounts must be immediately reported to the DIP insurance carrier and/or Administrator and to the current or former employee by the employing organization. In the event of an overpayment or underpayment, the DIP insurance carrier and/or Administrator shall provide each employing organization with a report listing each claimant who receives or has received Other Income Benefits awarded as defined in the STD benefits booklet during the approved STD benefit period or who has been underpaid STD benefits as a result of a change in the member's claim. The report will also illustrate the additional following information:
All overpayments must be immediately collected by the employing organization and returned to the Pension Office via the State’s payroll system (PHRST) or other accepted payroll process for tax reporting purposes. For Human Resources and Payroll Representatives, detailed instructions on how to interpret data and information in the overpayment or underpayment report can be found on the Statewide Benefits Office secure benefits representative website under "Procedures". The document is titled "Interpretation of STD Initial Account Balance Reports/Sample Reports" and is numbered as DIP-003.
8.16 It is the current or former employing organizations responsibility to promptly notify the DIP insurance carrier and/or Administrator of any and all retroactive awards from other programs awarded to STD claimants.
8.17 It is the current or former employee’s responsibility to promptly notify and repay the DIP insurance carrier and/or Administrator and repay the State of Delaware and/or the DIP insurance carrier and/or Administrator for all overpayments including income paid as an offset during the STD and/or LTD benefit period.
9.1.1 Provided the employee files their STD claim no later than the 15th calendar day from the date of disability and abides by the employing organization’s policy and procedures regarding attendance and calling out absent, the employee may continue to use available sick and/or annual leave to be paid until the STD claim is approved, if not approved by the exhaustion of the STD calendar day elimination period.
9.1.1.2 At the discretion of the employing organization, employees who are appealing an STD determination and have not returned to work or whose STD claim is still under review by the DIP insurance carrier and/or Administrator and/or the Appeals Administrator from the Statewide Benefits Office and/or the Hearing Officer appointed by the State Employee Benefits Committee SEBC, may be paid accrued annual and/or sick leave until the STD claim is approved or extended. If the STD claim is approved or extended, the employing organization must reconcile the employee’s leave record.
9.1.2 Pursuant to 29 Del.C. §5253(b)(4), an employee may utilize annual, sick, compensatory, or donated leave to supplement STD benefits to equal 100% of pre-disability base pay for a maximum benefit period of 182 calendar days.
9.1.4 Donated leave may be used to pay employees during the calendar day STD elimination period. However, regardless of whether a claim was filed with the DIP insurance carrier and/or Administrator, donated leave is not to continue following the calendar day elimination period until the employee’s STD claim is in an has been approved status and the employee continues to be in an STD approved status. Upon approval of the employee’s STD claim and while the employee remains in an approved STD status, the employing organization may apply donated leave retroactively to supplement the STD benefit payment.
9.1.6 If an employee is otherwise eligible for holiday pay or a paid leave other than identified in 29 Del.C. §5253(b)(4), the employee will be granted 100% pay on the day in question without a residual. All leave supplements will be calculated on a per pay basis.
9.1.10 Upon the exhaustion of the maximum STD benefit period, any employee, except those entitled to hazardous duty pay as defined in 29 Del.C. §5933(c), and those working on a temporary reduced, alternate, light duty and/or part-time basis, shall no longer be an employee of the State or any of its political subdivisions provided the employee has exhausted their FMLA entitlement and/or is not FMLA eligible. Employees entitled to hazardous duty pay as defined in 29 Del.C. §5933(c) who exhaust the maximum short term disability benefit period shall no longer be an employee of the State or any of its political subdivisions at the end of their entitlement to hazardous duty pay provided the employee has exhausted their FMLA entitlement and/or is not FMLA eligible and is not working on a temporary reduced, alternate, light duty and/or part-time basis. The employee has two options with respect to remaining accrued leave.
9.2 Non Merit Employees
9.2.1 Provided the employee files their STD claim no later than the 15th calendar day from the date of disability and abides by the employing organization’s policy and procedures regarding attendance and calling out absent, the employee may continue to use available sick and/or annual leave to be paid until the STD claim is approved, if not approved by the exhaustion of the STD calendar day elimination period.
9.2.2 Pursuant to 29 Del.C. §5253(b)(4), an employee may utilize annual, sick, compensatory, or donated leave (if applicable) to supplement STD benefits to equal 100% of pre-disability base pay for a maximum benefit period of 182 calendar days.
9.2.4 Upon the exhaustion of the maximum STD benefit period, any employee, except those entitled to hazardous duty pay as defined in 29 Del.C. §5933(c), and those working on a temporary reduced, alternate, light duty and/or part-time basis, shall no longer be an employee of the State or any of its political subdivisions provided the employee has exhausted their FMLA entitlement and/or is not FMLA eligible. Employees entitled to hazardous duty pay as defined in 29 Del.C. §5933(c) who exhaust the maximum short term disability benefit period shall no longer be an employee of the State or any of its political subdivisions at the end of their entitlement to hazardous duty pay provided the employee has exhausted their FMLA entitlement and/or is not FMLA eligible and is not working on a temporary reduced, alternate, light duty and/or part-time basis. The employee has two options with respect to outstanding accrued leave.
9.2.4.1 Escrowed Leave. Prior to the commencement of LTD benefits, the employee may make a written request to the employing organization to escrow accrued annual and sick leave for a maximum period of six months. If the member returns to full-time State employment in a benefit eligible position for 30 calendar days within the 6 month escrow period, the member’s leave balances will be restored. If the member does not return to State employment in a benefit eligible position, the escrowed leave will be paid to the member based on the rules of the member’s former employing organization.
10.1.5 Upon the exhaustion of the maximum STD benefit period, any employee, except those entitled to hazardous duty pay as defined in 29 Del.C. §5933(c), shall no longer be an employee of the State or any of its political subdivisions provided the employee has exhausted their FMLA entitlement and/or is not FMLA eligible. Employees entitled to hazardous duty pay as defined in 29 Del.C. §5933(c) who exhaust the maximum short term disability benefit period shall no longer be an employee of the State or any of its political subdivisions at the end of their entitlement to hazardous duty pay provided the employee has exhausted their FMLA entitlement and/or is not FMLA eligible.
11.0 Appeals - STD Claim Determinations
11.2 Pursuant to 29 Del.C. §5258, within 90 days of the postmark date of the carrier’s written notice of its determination regarding STD benefits, a claimant may appeal any determination of disability benefits by filing a written petition setting forth with particularity the grounds for appeal with the DIP insurance carrier and/or Administrator. The DIP insurance carrier and/or Administrator has the authority to reverse all or any part of its initial STD benefit determination and shall notify the claimant, the employing organization and the Statewide Benefits Office in writing by certified mail, return receipt requested within 10 days of the determination.
11.3 Pursuant to 29 Del.C. §5258, within 20 days of the postmark date of the DIP insurance carrier and/or Administrator’s determination of benefits being appealed, a claimant may file a second level appeal by filing a written petition setting forth with particularity the grounds for second appeal to the Appeals Administrator at the Statewide Benefits Office, who shall conduct an informal review, and who shall have the authority to reverse all or any part of the decision of the DIP insurance carrier and/or Administrator to deny benefits. The claimant’s written appeal should be addressed and mailed to:
11.4 Pursuant to 29 Del.C. §5258, if the Appeals Administrator affirms the DIP insurance carrier and/or Administrator’s decision to deny disability benefits or any part thereof, a claimant may file an appeal to the SEBC within 20 days of the postmark date of the notice of the determination from the Appeals Administrator by filing a written petition with the SEBC setting forth with particularity the grounds for the appeal. The claimant’s written appeal should be addressed and mailed to:
The SEBC may designate an appropriate representative from the Office of Management and Budget as a hearing officer to hear evidence presented by the employee or, in its sole discretion, it may decide to hear the appeal directly. The Committee SEBC or the hearing officer, as the case may be, shall determine whether the determination to deny benefits complies with the applicable disability plan adopted by the Committee SEBC. The Hearing officer and/or Committee SEBC shall have all of the following powers in respect to the conduct at the hearing:
11.4.2 To examine persons as witnesses, take evidence, require the production of documents, and do all other things pursuant to law which are necessary to determine the appeal. In proceedings before the Committee SEBC or its hearing officer, if any person neglects to produce any pertinent document, neglects or refuses to appear after having been subpoenaed, refuses to testify or be examined, disobeys or resists any lawful order or process, or intentionally obstructs the hearing, the Committee SEBC shall certify facts under the signature of its chairperson or the hearing officer to any judge of the Superior Court, which judge shall there upon hear evidence as to the acts complained of. The judge shall, if the judge deems the evidence so warrants, issue an order requiring such persons to testify or produce documents or otherwise comply with the requirements of the Committee SEBC, as the case may require. Refusal to comply with the order of the Court shall constitute contempt of Court;
11.4.4 If the Committee SEBC elects to hear the matter directly and not to assign it to the hearing officer, it shall issue its final decision containing findings of fact and conclusions of law, within 60 days of the hearing, and shall notify the parties of its action by certified mail, return receipt requested.
11.5 Pursuant to 29 Del.C. §5258, within 30 days of the postmark date of the Committee’s SEBC’s determination to deny benefits on appeal, a claimant may file a final action to Superior Court. The appeal shall be on the record.
12.0 Employment Employee Termination
12.4 Pursuant to 29 Del.C., §5933(c), hazardous duty employees injured while performing a hazardous duty assignment and whose injuries arose out of and in the course of performing hazardous duty are entitled to a 12 month salary supplement. Employees entitled to hazardous duty pay as defined in 29 Del.C., §5933(c) who exhaust the maximum short term disability benefit period shall no longer be an employee of the State or any of its political subdivisions at the end of their entitlement to hazardous duty pay provided the employee has exhausted their FMLA entitlement and/or is not FMLA eligible and the employee is not working on a temporary reduced, alternate, light duty and/or part-time basis. See subsection 9.1.10 and 9.2.4 for a complete description.
14.2 The elimination period shall commence on the first day following the onset of a disability date of disability and LTD benefits will commence on the 183rd calendar day.
15.6 Pursuant to 29 Del.C. §5524(d), DIP participants vested in the Delaware State Employees’ Pension Plan as of December 31, 2005 may be enrolled in the disability pension plan upon the exhaustion of LTD benefits due to mental condition and/or substance abuse. Members will be mailed an authorization form to complete and return to the DIP insurance carrier and/or Administrator. Upon receipt, the DIP insurance carrier and/or Administrator will send a copy of the member’s disability file to the Pension Office for processing.
16.3 As defined in 29 Del.C. §5253(c)(3), LTD benefits shall not include general salary increases during the period of long term disability. LTD benefits may be increased annually by an amount approved by the State Employee Benefits Committee (SEBC).
16.5.2 governmental law or programs that provides disability or unemployment benefits as a result of the employees job with the State;
IMPORTANT NOTE: Other Income Benefits also means any payments that are made to the claimant, the claimant’s family, or to a third party on behalf of the claimant, pursuant to any:
16.5.7.1 disability benefit under the Employer's Retirement Plan;
16.5.7.2 permanent disability or impairment benefits under a Workers' Compensation Law, the Jones Act, occupational disease law, similar law or substitutes or exchanges of such benefits;
16.5.7.3 portion of a settlement or judgment, minus associated costs, of a lawsuit that represents or compensates for the claimant’s loss of earnings;
16.5.7.4 retirement benefit from a Retirement Plan that is wholly or partially funded by employer contributions, unless:
16.5.7.4.1 the claimant was receiving it prior to becoming Disabled; or
16.5.7.4.2 the claimant immediately transfers the payment to another plan qualified by the United States Internal Revenue Service for the funding of a future retirement.
18.0 Appeals - LTD Claim Determinations
19.1.2 Employees receiving STD benefits under 29 Del.C. §5253(b) will be treated as “regular officers and employees” under these regulations and are eligible for enrollment in the Group Health Insurance Program with State Share contributions, as applicable. STD beneficiaries are subject to the Group Health Insurance Program Eligibility and Enrollment Rules.
19.2.3 LTD claimants receiving benefits under 29 Del.C. §5253(c) will be treated as “eligible pensioners” and are eligible for enrollment in the Group Health Insurance Program with State Share contributions, as applicable. LTD beneficiaries are subject to the Group Health Insurance Plan Eligibility and Enrollment Rules.
20.1 Pursuant to 29 Del.C., §5256(5), a contract exists between the Committee SEBC and the Statewide Benefits Office for the purpose of the administration of the DIP, including but not limited to determination of an individual’s ability to return to work by the RTW Coordinator pursuant to 29 Del.C. §5257(ba).
20.1.1.1 Pursuant to 29 Del.C. §5257(a), once an employee has been determined to have the ability to return to employment by the Committee SEBC, the employee will receive the following assistance:
20.1.1.4 There is a Return to Work process that shall be followed to assess and plan for keeping or returning an employee with a disability to work. The return to work process for all employing organizations shall be as follows:
20.1.1.56 The employee is eligible to receive assistance from the RTW Coordinator and the employing organization if temporary restrictions and limitations prevent an employee from performing his/her job at full capacity or should an assistive device be necessary. The employee will return to modified, transitional, or full duty work as soon as approved to do so by a medical provider as well as with the approval of the employing organization and within the merit rule time frames.
20.1.1.67 If the employing organization is not able unable to accommodate the employee with temporary restrictions or limitations, the employing organization must notify the RTW Coordinator stating the reason the accommodation cannot be granted. Once an employee has been released to modified duty or regular work, the employee is required to return to work at such time that the employing organization is able to accommodate the restrictions or limitations. Employees should work closely with the RTW Coordinator and the employing organization if modified duty is being requested.
20.1.1.78 When looking for options beyond the employee’s own job, the RTW Coordinator and employing organization shall consider the employee’s abilities, anticipated absence duration, training and experience. If placement cannot be accommodated, the employing organization must provide a written explanation to the RTW Coordinator.
20.1.1.89 If the employing organization is not able unable to accommodate the employee’s restrictions so that he/she may return to work, the employee may be eligible for a continuation of STD benefits provided the employee is still unable to perform the essential duties of their own occupation.
20.1.1.910 If the employing organization agrees to accommodate the temporary restrictions or limitations recommended by the employee’s medical provider while recovering from disability and the employee refuses to return to work, benefits may be discontinued.
20.1.1.1011 When appropriate, the RTW Coordinator may refer employees to the Division of Vocational Rehabilitation when it has been determined by a medical professional that an employee will no longer have the ability to perform the essential functions of the position on a permanent basis.
20.1.1.1112 When assigned to a rehabilitation program, the employee is required to maintain a treatment schedule corresponding to medical restrictions and/or normal working hours as designed by the location.
21.1 Pursuant to 29 Del.C. §5257(b), once an individual has been determined to have the ability to return to employment by the committee SEBC, the individual will receive the following assistance:
21.2 Individuals previously employed in a Merit position, must should contact the RTW Coordinator at the Statewide Benefits Office within 15 days of their release to return to work and/or the termination of their LTD benefit prior to the beginning of LTD to discuss the RTW processes.
21.6 Individuals formerly employed by a school district, charter school, institution of higher education or other nonmerit employing organization, should contact their former Human Resource department for assistance in placement may utilize the services of the RTW Coordinator and/or former employing organization for placement assistance.
21.9 Individuals are not required to have been approved or be approved for LTD to receive RTW services from the Statewide Benefits Office.
Last Updated: December 31 1969 19:00:00.
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