Calculating your benefit payment Successive disability           Home

UFCW LOCAL 1776 and PARTICIPATING EMPLOYERS                                   HEALTH and WELFARE FUND

 

Disability Benefits

You are eligible for two types of disability benefits. Dependents are not covered under these benefits. First, you may receive Weekly Accident and Sickness Benefits if you cannot work because of an accident that is not related to your job or because of an illness that is not covered under Workers’ Compensation. Second, you are eligible for Workers’ Compensation Supplementary Benefits if you cannot work because of a job-related accident or illness. If you are eligible for disability pay from any other source, check the section titled “Coordination of Benefits” to see how to submit your claims. The Fund also has the right of subrogation or full reimbursement, as set forth in the subsection below titled “Coordinating with Third Parties (Subrogation or Reimbursement).” Weekly Accident & Sickness Benefits You will receive weekly payments if you cannot work because of a sickness or injury that is not related to your job. Benefits begin at different times, depending on whether you are sick or injured. If you are disabled because of: An Accident - Your benefits begin on the first regularly scheduled work day, as long as your disability begins within 48 hours of your accident. If you do not receive medical treatment within 48 hours of your accident, your disability will be considered a sickness. Sickness - Benefits are paid beginning on the fourth regularly scheduled work day that you cannot work. Hospitalization - Payments start on the first regularly scheduled work day that you are in the hospital. Outpatient surgery - You will receive benefits from the day of the outpatient surgery if it is a regularly scheduled work day. You may have these procedures performed in the outpatient department of a hospital, at your doctor’s office or at a surgical center. Your benefits will be paid according to this schedule as long as you begin receiving medical treatment within seven (7) days of the first day you miss work. (Medical treatment means an office, home or hospital visit. A telephone call to your doctor is not accepted as a form of medical treatment.) If you do not receive medical treatment within those seven days, your benefits will not start until the day you first receive medical treatment. In other words, if you are sick on October 1 and cannot work, your benefits would begin on the fourth day if you seek medical treatment within seven days. But if you don’t seek treatment until October 10, for example, then your benefits would not begin until October 10. To receive benefits, you must be under the care of a doctor of medicine or osteopathy, a doctor of dentistry, a chiropractor or a licensed psychologist. Your doctor must submit medical certification to the Fund office. Notes of absence or Short Certificates are not acceptable. You do not have to be in the hospital to receive benefits. The Fund has the right to have its own doctors examine you as often as it determines to be necessary to verify continued eligibility when you are claiming Weekly Accident and Sickness Benefits. If you refuse to allow the examinations, the Fund can refuse to pay your claim. Calculating your benefit payment You are eligible for weekly benefit payments for up to a maximum of 26 weeks provided you remain covered for all benefits under the Fund on account of your disability. The amount of your weekly benefit payment is based on the average number of hours you worked in the eight weeks that preceded your disability.  It does not include overtime pay (time-and-a-half or double-time.) However, any night-shift differential is included in the calculation. There is no maximum on the weekly dollar amount you can receive; however, the maximum number of hours which can be used in calculating your weekly benefit is 35.For each full week you are out of work, you will receive a weekly benefit of 66 and 2/3 percent of your average weekly pay (as calculated above). Your payment for any one day you are out of work is one-seventh of your weekly benefit. Here’s an example of how it works. Let's assume your regular hourly rate is $9 per hour. Let's also assume you worked 192 hours in the eight weeks before you became disabled, or an average of 24 hours per week. Then your average weekly pay is 24 multiplied by $9, or $216.So your weekly accident and sickness benefit would be 66 and 2/3 percent of $216, or $144. Your daily benefit is one-seventh of $144, or $20.57.Your benefit is subject to Social Security and Medicare taxes. In addition, you can elect to have federal income tax withheld from your benefit payments by filing a W-4S Form with the Fund office. Your Weekly Accident and Sickness Benefit is considered income for income tax purposes. Successive disabilities If you have two or more periods of absence that are caused by the same illness or injury, those periods are considered one continuous disability. However, if you have returned to work for at least two consecutive work weeks between the two periods, they are considered separate disabilities. You would be eligible for up to 26 weeks of benefits for each separate disability period. However, if you have two periods of disability caused by unrelated illnesses or injuries, they are considered separate, provided you returned to work for at least one regularly scheduled work day after the first disability