Short-Term Disability Program

Transcription

1 Short-Term Disability Program April 1, 2015

2 THE CBS SHORT-TERM DISABILITY (STD) PROGRAM The CBS Short -Term Disability (STD) Program is a salary continuance program designed to provide eligible employees with a percentage of their salary in the event of disability due to a covered illness or injury. Unum provides administrative services for CBS Corporation (CBS) with respect to this program. Active, full-time staff employees are eligible for the program as of their first day of work. The terms and conditions of a union s bargaining agreement with CBS govern eligibility for union employees. Short-term disability illnesses are those of 8 or more consecutive calendar days in duration, provided that you are under the care of a licensed physician. Sick days are used for illnesses less than 8 consecutive calendar days in duration, as provided for separately under Company policy. Provided that your disability period is approved by Unum and all requirements for the Family and Medical Leave Act of 1993 (FMLA) and/or the California Family Rights Act (CFRA) are met, your leave will be designated as FMLA and/or CFRA leave time. STEPS YOU ARE REQUIRED TO TAKE Notify your manager or supervisor to report your absence. Visit your physician or medical provider for evaluation and treatment of your condition. If your absence is expected to last 8 or more consecutive days in duration, you must report your claim* to Unum either by calling , Unum s Intake Unit operates Monday Friday, 8:00 AM 8:00 PM, EST (except holidays), or you may file your claim online at Your Authorization must be on file in order for UNUM to review your claim. If you are reporting your call via telephone your authorization may be completed through voice signature at that time. You may also sign and submit your authorization electronically online, fax or mail your authorization form to UNUM. If you are faxing or mailing the form, the Unum Authorization Form is included as part of Unum s disability brochure. The Authorization allows your doctor to share medical information with Unum and is essential to the processing of your claim. You will need to provide a signed and dated copy to your physician as well. If your absence is work-related, you still must report your claim to Unum. It is vital that you inform Unum if your disability is work-related when you first call in your claim. If you have a planned disability absence (such as for childbirth or a scheduled surgery), you may notify Unum up to 2 weeks in advance of your expected last day of work. Explain to your physician that your company has a managed disability program and that it is very important to you that he/she respond to Unum s requests for information in a timely manner so that you may receive your salary continuation benefit without delay. Stay involved with your claim. Follow up with Unum and your physician to make sure all required medical information has been provided to Unum. Otherwise, the processing of your claim may be delayed. You may contact Unum by calling to follow up on your claim or online at 2

3 Keep your supervisor or department head and Unum informed about your ability to return to work. If, for some reason, you are not able to return to work on your expected return to work date, it is your responsibility to contact Unum and your supervisor. You must follow up with your physician to provide additional medical information to Unum. If needed, Unum will assist you in contacting your doctor for additional information that will allow Unum to determine if there is objective medical information to extend your period of disability. When you are able to return to work, you must obtain a written release from your physician listing any restrictions preventing you from performing your full duties and provide that release to Unum and to your supervisor. You may not return to work until your physician releases you from your disability and Unum and your supervisor have a copy of your release on file. *In order to be eligible for CBS short-term disability (STD) benefits, you must notify Unum of your claim as soon as possible but no later than 60 days following your last day of active work. If you fail to report your claim to Unum at all, or if you do not provide written notice of your claim to Unum until after the 60- day claim-filing deadline has passed, you will not be eligible to receive CBS STD benefits for your absence even if your absence is due to a true medical disability. UNAUTHORIZED ABSENCES PLEASE NOTE: If you do not report your illness or injury to Unum, or if you delay in doing so, your absence may be considered unauthorized, which will result in the suspension of your pay and could result in disciplinary action. If it is determined that you are no longer disabled, and you do not return to work at the time you are deemed eligible to do so by Unum, your continued absence will be considered unauthorized. Salary continuance is not payable for an unauthorized absence, and the Company will seek to recoup any overpayment made to you for a period during which your absence was not authorized. IF YOUR CLAIM IS APPROVED You will receive a letter from Unum indicating that your claim has been approved for payment and for how long (number of weeks). The letter will also state when you are expected to return to work and will identify what information is needed to consider an extension of your claim. Unum will notify CBS Human Resources of the approval and your expected return to work date. If you need to stay out of work past the date for which your claim was approved by Unum, you must contact Unum and follow up with your physician to provide additional medical information to Unum. You must also notify your supervisor that you are applying for an extension of your disability period and, therefore, you will not be returning to work as expected. PAYMENT OF STD BENEFITS WHEN BENEFITS BEGIN - DETERMINING YOUR DISABILITY DATE Benefits begin after you have been disabled for 8 or more consecutive calendar days, provided that you are under the regular care of a licensed physician. This 8-day period is referred to as the program s Elimination Period. If your disability is approved by Unum, your STD benefit will begin on your Disability Date. Your Disability Date is the first day you were expected at work but could not work due to your illness or injury provided that your physician certifies you were disabled on that date. For example, assume an employee s regular work week is Monday through Friday. The employee works Monday and Tuesday and then is absent for the next 10 days due to illness or injury. If the employee sought medical care on Wednesday following the last day at work, then Wednesday is the employee s Disability Date (i.e., the first day the employee was expected at work but could not work due to illness). However, if the 3

4 employee does not seek medical treatment until Friday, then Friday is the employee s Disability Date under the STD Program unless the employee s physician certifies the disability began on Wednesday. Without the physician s certification of disability back to Wednesday, STD benefits would not be payable for the interim days between the last day worked and the date the employee finally sought medical treatment. CALCULATING YOUR ELIGIBILITY FOR 100% SALARY CONTINUANCE The number of weeks of salary continuance for which you are eligible depends on your length of Company service and the severity or type of your disability, as documented by the medical evidence. Your doctor must provide the medical evidence to Unum before any benefits may be paid. The following table shows the maximum number of weeks of salary continuance you may receive at 100% of salary based on your years of Company service as determined by your Company Seniority Date. Your Years of Service is defined as the number of full years of service you have completed on the date your disability begins (i.e., your last day at work). Weeks Payable Per Calendar Year The maximum number of weeks at 100% Years of Service * At 100% salary continuance any employee may receive per calendar year is 13 weeks.* Less than to 5 years 8 Once you have exhausted your allotted 5 to 10 years 10 weeks of 100% salary continuance, any 10 or more 13 approved period of STD will be paid at 60%. *Your calendar year maximum may be exceeded in a year if you have a short-term disability from a previous year extend into the next year, followed by a second disability in that year. Please read the Questions and Answers for clarification. *STD benefits end on the earliest of: 1) the employee returns to work, 2) the claim is closed or 3) the date the employee s job reinstatement rights period ends. Please refer to your HR policy guide for job reinstatement rights information; job reinstatement rights for union employees are governed by the terms of their collective bargaining agreement with the Company. Should your disability extend beyond the 26 weeks of short-term disability (and you are eligible and approved for CBS Corporation long term disability benefits), your claim will be transitioned to long term disability. No additional claim filing will be required for long term disability. However, you may be required to provide further documentation to support your continued disability. You will be taken off-payroll at the end of your 26- week STD period and placed on long term disability status pending Unum s decision on your LTD claim. LTD claims are subject to Unum s review and approval. If you are approved for LTD, your LTD benefit will be paid to you on a monthly basis by Unum. All correspondence regarding transition to LTD will come directly from Unum with a copy to CBS Human Resources. IF YOU HAVE A WORK-RELATED ILLNESS OR INJURY If your disability is due to a work-related accident or sickness, your supervisor is required by law to report your accident or sickness to Workers Compensation. Separately, you must still contact Unum if your disability is 8 consecutive calendar days or more in duration. As long as you are receiving salary continuance, Workers Compensation will not pay a benefit for lost wages*. However, you must remain in contact with the Workers Compensation carrier who is handling your claim to keep them informed on the status of your disability. *Note: Under the policies of Showtime Networks, Simon & Schuster, and CBS Television Studios, employees who are disabled due to a work-related injury or sickness will be paid Workers Compensation payments for lost wages and not CBS short-term disability/salary continuance benefits. 4

5 IF YOU HAVE A BEHAVIORAL HEALTH CLAIM If your disability is due to a behavioral health condition, you are required to be under the care of a behavioral health specialist within 14 days of your notice of claim to UNUM. If necessary the Employee Assistance Program (EAP) Live and Work Well at , can assist you with finding an appropriate provider in your area and will help you secure an appointment. If you do not seek care from a behavioral health specialist within the 14 days of notice, your claim will be closed and benefits will not be paid beyond the 14 days. IF YOU BECOME ILL OR INJURED OVER A WEEKEND OR ON A SCHEDULED DAY OFF You begin to count 8 consecutive days starting with the first day you were expected at work but could not come back due to your sickness or injury. IF YOU BECOME ILL OR INJURED ON A VACATION Your 8-day elimination period for STD benefits starts with the first day you are under the care of a physician. This information must be documented. IF YOUR CLAIM FOR STD BENEFITS IS DENIED A letter from Unum will be sent to you stating the specific reason(s) for denial of your claim and will provide instructions regarding your rights to appeal the claim decision. A separate notice, which does not contain specific medical information, will be sent to CBS Human Resources stating that your claim for benefits has been denied. See page 8 for information on filing an appeal. CLAIM-FILING DEADLINE You must provide written notice of your short-term disability claim to Unum no later than 60 days following your last day of active work. Failure to do so will result in your ineligibility to receive CBS STD benefits for your absence regardless of your actual disability status during your absence period. SPECIAL INSTRUCTIONS FOR CALIFORNIA EMPLOYEES You must file for California State Disability Insurance (SDI) benefits online at or by requesting a special OCR RED form from the EDD office. This is a separate process that must be initiated by you. You are cautioned not to delay in filing your SDI claim. Failure to file your claim with the state within 49 days may result in loss of benefits for the number of days the claim is late unless good cause for the delay is established. You may obtain more information by: Contacting your local EDD office Call the State at: ( TTY) (statewide) Visit the State s website at: (select Disability Insurance) California State Disability benefits per week depends on an employee s quarterly wages. Your paycheck will automatically be offset by this amount for the duration of your approved short-term disability (up to 26 weeks). Once you begin to receive your state disability benefit, you must provide proof of your payment to Human Resources so that the reduction in your STD benefit may be verified as accurate. Please send a copy of your state disability check stub to your local Human Resources representative. The Company will seek to recoup any overpayment resulting from an inadequate offset of your STD benefit. 5

6 Any pay you receive from your employer is immediately offset by the benefit amount you are expected to receive from California SDI. Therefore, it is very important that you promptly file with the state to minimize any gap in your pay. If the illness or injury is work-related, California State Disability will not pay a benefit. As a result, you will not receive a paycheck adjustment for this type of disability. Also, as long as you have salary continuance payable, Workers Compensation will not pay a benefit for lost wages. However, you must remain in contact with your Workers Compensation carrier to keep them informed as to the status of your disability. QUESTIONS AND ANSWERS How do sick days differ from short-term disability? Sick days are intended for absences due to illness or injury that are less than 8 consecutive days in duration. The sick days provided for under your employer s sick day policy are to be used for absences of a short duration (e.g., the flu or an injury with a short recovery period). You are not required to exhaust your sick days to be eligible for short-term disability leave. Conversely, you may not add sick days to extend your short-term disability leave. How does Short-Term Disability affect what I am entitled to receive under the Family and Medical Leave Act of 1993 (FMLA)? Under the Family and Medical Leave Act of 1993, unpaid leaves of absence are available to employees with at least one year of service. However, this unpaid leave is offset by paid leave such as STD/Salary Continuance. Please understand that although STD and FMLA leave run concurrently, there are situations where this would not apply because STD is based on a calendar year and FMLA leave entitlement is 12 weeks* during a single twelve-month period, measured forward from the date the employee's FMLA leave begins. For example, if you have nine years of service and become disabled September 1, 2015 for 12 weeks, you will not be eligible again for 100% STD/Salary Continuance until January 1, You will not be eligible again for FMLA leave until September 1, *Connecticut and Washington D.C. require 16 weeks in any two-year period; Rhode Island requires 13 weeks in any two-year period. My disability is due to pregnancy. How does the STD Program cover pregnancy disabilities? The STD Program covers disability due to pregnancy the same as any other illness. Under the Program, you may stop working up to a maximum of two weeks prior to your expected due date and qualify for STD benefits even without any pregnancy complications. If your physician recommends that you stop working for medical reasons at any time during your pregnancy, you should contact Unum to open your disability claim at that time and not wait until your baby is born. Your physician will need to provide Unum with information as to when and why you are being told to stop working. Please note that in either case, if you stop working in advance of your delivery date, your FMLA leave period begins on the day following your last day of active work. What happens if I have more than one period of illness in a calendar year? Let s assume you were paid salary continuance for some period of time (less than 26 weeks) and returned to work, but again had to stop work for the same disability. If you had been back at work for less than 30 days, this second period of disability is considered a recurrence of the same disability. Therefore, you will be immediately eligible for benefits without having to satisfy a new elimination period. 6

7 Further, let s assume that during the first episode of your disability you received the total number of weeks of salary continuance at 100% for which you were eligible. For the balance of the 26-week short term disability period, you will be eligible to receive salary continuance at 60%. The recurrence of a disability must take place while you are still covered under the Plan. If your disability recurs after you have been back to work for 30 days or more or is due to another cause, you start a new 8 calendar day elimination period and a new 26-week maximum period payable. In this instance, if you received the full number of weeks of salary continuance at 100% for which you were eligible during your first period of disability, you would be entitled to receive salary continuance at 60% for this new 26-week period until you either return to work or qualify for long term disability. The maximum number of weeks of salary continuance at 100% you may receive is based on your eligibility on the date your disability begins. Once you receive the maximum number of weeks at 100% for which you qualify, any subsequent periods of disability in the calendar year will be paid at 60%. What happens if my short-term disability goes into another calendar year? Your entitlement to a short-term disability benefit is always governed by the policy in effect when your disability begins. This includes the number of weeks of 100% salary continuance for which you are eligible, which is based on your completed years of service as of the date your disability begins. Take an example of an employee who is eligible for 11 weeks of salary continuance at 100%. This employee was disabled for 5 weeks from April 22 through May 26, 2015, and received salary continuance at 100%. If this employee became disabled again from December 14, 2015 through February 7, 2016, salary continuance would be paid as follows: 1) December 14, 2015 through January 24, weeks at 100% 2) January 25, 2016 through February 7, weeks at 60% During calendar year 2015, the employee was eligible for 11 weeks at 100% pay. Because the employee had received 5 weeks of salary at 100% during the first episode of disability in 2015, he or she would only be entitled to 6 weeks at 100% during the second episode of disability that began in If this employee returned to work on February 8, 2016 and became disabled again after being back for longer than the recurrent disability period (30 days or more), he or she would have to satisfy a new 8-day elimination period and would then be eligible for a new 26-week period of STD. The employee would have a new allotment of weeks payable at 100% (based on his or her Company Seniority Date) for a new disability because it began in the new year. In this instance, this employee could get up to an additional 11 weeks at 100% for another short term disability in What if my disability is due to a work-related accident or sickness? If your disability is due to a work-related accident or sickness, your supervisor is required by law to report your accident or sickness to Workers Compensation by submitting an accident report to your local Human Resources representative. However, you must also call Unum if you are disabled for more than 8 consecutive calendar days for a work-related cause. This is required because the Company s salary continuance program pays benefits for lost wages before Workers Compensation*. For this reason, CBS requires Unum and the Workers Compensation carrier to communicate and share medical information with each other. This sharing of information also prevents your physician from having to submit the same medical documentation twice. 7

8 There may still be times when Unum will have to ask your physician for additional medical information because different criteria apply to Workers Compensation and STD claims. Workers Compensation must pay claims in accordance with statutory requirements, and its primary focus is on lost time and medical benefits. In addition, the definition of lost time can vary from state to state. Unum has to determine if an employee is disabled in accordance with the definition under the CBS Short- Term Disability Program. This definition of disability is consistent for all employees in all states. *Under the policies of Showtime Networks, Simon & Schuster, and CBS Television Studios, employees who are disabled due to a work-related injury or sickness will be paid Workers Compensation payments for lost wages and not CBS short-term disability/salary continuance benefits. Employees of these divisions who expect to remain disabled beyond 26 weeks must contact Unum to initiate their CBS Corporation LTD claim since Unum will not be administering their short-term disability absence. What if my disability is due to a behavioral health condition? If your disability is due to a behavioral health condition, you are required to be under the care of a behavioral health specialist within 14 days of your notice of claim to UNUM. If necessary the Employee Assistance Program (EAP) Live and Work Well at , can assist you with finding an appropriate provider in your area and will help you secure an appointment. If you do not seek care from a behavioral health specialist within the 14 days of notice, your claim will be closed and benefits will not be paid beyond the 14 days. What if my disability is due to an elective medical procedure? If your disability is due to elective surgery or other voluntary medical procedure, your eligibility for STD benefits is determined by the reason for your disability. As long as your procedure is medically necessary, is covered by the Company s medical plan, and it is not deemed experimental or investigative or cosmetic in nature, you will be eligible for STD benefits. Once I am ready to return to work, what do I need to do? Before you may return to work, your physician must provide a medical release from your disability to Unum and you must also provide a copy of the release to your direct supervisor. Your release should stipulate if you are being fully released from your disability, or if there are any restrictions or limitations imposed on your return to work, and if any, the expected duration of those restrictions or limitations. Unum will notify CBS Human Resources of your ability to return to work. If there are restrictions or limitations imposed on your return, CBS Human Resources in conjunction with your department or supervisor will determine if the restrictions/limitations can be accommodated and will notify Unum if you may return to work. You may not return to work without providing a medical release to Unum and to your direct supervisor. Any accommodated return to work schedules, hours worked, or job responsibilities will need to be approved by CBS in partnership with Unum before you are able to return to work. What happens if I am still disabled beyond 26 weeks? One of the conveniences of the Short-Term Disability Program is a one-time reporting of disability. Should your disability extend beyond the 26-week maximum short-term disability period (and if you are eligible and approved for CBS Corporation long term disability benefits), no additional claim filing will be required for long term disability benefits. The transition will be automatic. You will be taken off-payroll, and Unum will review your LTD claim. If approved for LTD, your LTD benefit will be paid to you on a monthly basis by Unum. 8

9 What if my employment terminates while I am on an approved Short-Term Disability absence? If your employment terminates while you are on an approved STD absence, you will not be eligible to receive STD benefits from CBS Corporation beyond your termination date. Even if Unum had approved your STD claim beyond your termination date, STD benefits end on the date your employment terminates. If you remain totally disabled through the 26-week elimination period for CBS Long Term Disability (LTD) benefits, you may still file a claim with Unum for LTD benefits. Your terminated employment status does not affect your eligibility for CBS LTD benefits since you were an active employee at the time your disability began. I am a Supervisor. What steps should I take when one of my employees is out for 8 or more days? You should instruct the employee to immediately report his/her claim to Unum by calling in the event he or she did not already do so. Within reason and depending on the individual circumstances, you should also ask your employee to remain in regular contact with you during his/her absence to keep you informed as to his/her ongoing status and also to notify you if and when a return to work may be expected. Your local Human Resources contact or Business Manager will keep you informed as to your employee s approval status with Unum. Should you have any questions about whether an employee s continued absence is authorized, you should contact your local Human Resources representative or Business Manager. Please note: It is the responsibility of the employee s department to complete any paperwork that may be required for the administration of an employee s disability absence (e.g., reduction in salary continuance to 60% pay when the maximum allotment of 100% weeks has been reached, Off-Payroll authorization at the conclusion of the employee s approved paid STD period, etc.). If I have questions regarding the Company s STD policy that are not answered here, who can I call? Any additional questions you have regarding the CBS Short-Term Disability/Salary Continuance Program should be directed to the CBS Corporate Benefits Department in New York. **************************************************************************************************************************** OTHER INFORMATION IF YOU DISAGREE WITH A DECISION REGARDING YOUR CLAIM If you disagree with a decision regarding your claim, you have the right to file an appeal with Unum. An appeal is your written disagreement with the claim decision and a request for review of that decision by an Appeals Specialist. Filing an Appeal To file an appeal, you must submit a written letter of appeal outlining the basis for your disagreement with the decision and should provide any additional information you would like considered, including written comments, documents, or other information in support of your appeal. You have 90 days from the date of an adverse determination letter to you to submit your written appeal to Unum. Your appeal should be complete (i.e., it must include all supporting documentation you wish to have taken into consideration) when it is filed with Unum. If Unum does not receive your complete written appeal within this 90-day timeframe, your original claim determination will be final. 9

10 The decision on the appeal will be based on the information that is received within 90 days so it is important that you provide to Unum any and all information. Information that is received outside the 90 days will not be reviewed. Your written request for an appeal should be mailed or faxed to Unum as follows: Unum The Benefits Center Appeals Unit P.O. Box 9548 Portland, ME Fax Number: The Appeals Unit will send you a letter acknowledging receipt of your appeal including your Appeals Specialist s contact information. The Appeals Specialist will review your entire claim including any new information you submitted with your appeal and will complete the review as soon as possible. While your appeal is being reviewed, the Appeals Unit will provide you with status updates at least every thirty days until a decision is reached. The Appeal Unit s decision regarding your claim is final. In the event the original decision on your claim is upheld, no additional appeal is available. 10