Los Angeles County Municipal Code Part 3 Short-Term Disability Plan

There is hereby established the County of Los Angeles Short-Term Disability Plan, hereinafter called the "STD Plan." The STD Plan is established for the purpose of providing Eligible Participants with income replacement benefits in the event the Participant incurs a Disability. With respect to Eligible Participants whose Disability qualifies them for workers' compensation benefits, the STD Plan is declared to be of the same general character as workers' compensation benefits.

(Ord. 2005-0072 § 1 (part), 2005: Ord. 90-0164 § 1 (part), 1990.)

A.

Core Coverage. The STD Plan, shall pay, after a 14-calendar day Waiting Period, an Eligible Participant an income replacement benefit equal to the Eligible Participant's Compensation multiplied by 70 percent.

B.

Optional Benefit. Each Eligible Employee and each Participant may elect to increase the core coverage, payable after a 7- calendar day Waiting Period, in the event of and for the period that a Disability is Nonindustrial as follows:

To an amount equal to the Participant's Compensation multiplied by 100 percent for the first three weeks of the period during which STD Benefits are payable under this STD Plan; and

To an amount equal to the Participant's Compensation multiplied by 80 percent for the balance of the period during which STD Benefits are payable under this STD Plan.

C.

Cost. Core STD coverage shall be provided at no cost to Participants. The optional STD benefit shall require contributions from the affected Participants as provided for in the Election Information.

D.

Hourly Rate Determination. Effective beginning on and after April 1, 2010, or such later date as may be determined by the Chief Administrative Officer when the human resources management system reflecting this provision is implemented, the income replacement benefit will be paid at the workday hourly rate for the Eligible Participant's Compensation, with such hourly rate calculated by dividing one-half of Compensation by the number of scheduled workday hours in the applicable semi-monthly pay period; provided, however, that for Eligible Participants whose Disability qualifies them for workers' compensation benefits, the income replacement benefit will be paid at the calendar day hourly rate for the Eligible Participant's Compensation, with such hourly rate calculated by dividing the monthly benefit by the number of calendar day hours in the month.

(Ord. 2010-0014, § 22, 2010; Ord. 2005-0072 § 1 (part), 2005; Ord. 99-0084 § 2, 1999: Ord. 90-0164 § 1 (part), 1990.)

A.

Payment of Benefits. An Eligible Participant shall begin accruing the benefit determined under Section 5.27.390 on the first day following the expiration of the waiting period. Except as otherwise herein provided, such benefit shall be paid as long as the Eligible Participant's Disability continues, but in no event longer than 26 weeks from the first day of Disability.

B.

Other Income Benefits.

The STD Plan Benefit payable to the Eligible Participant shall be reduced by other income benefits. "Other income benefits" are those benefits identified below to which the Eligible Participant is entitled. Such benefits, which may be payable either periodically or in a lump sum, are:

a.

The amount of any benefit with respect to the same Disability and the same period for which the monthly benefit is payable under this STD Plan when such benefits are provided or payable:

(1)

By any federal, state, county, municipal or other government agency;

(2)

As temporary disability benefits under California workers' compensation laws;

(3)

Under any other workers' compensation law; or

(4)

Under any employer's liability law.

b.

The amount of any salary or other compensation, including sick leave, vacation, annual leave, or other pay the Eligible Participant receives from the County shall be coordinated with the STD benefit as specified in the Election Information.

Where other income benefits are received in the form of a lump-sum payment or payments, such benefits shall be coordinated with the benefits otherwise payable under this STD Plan in the manner set forth in the Election Information.

C.

Termination of Benefits. No benefit shall be payable under this STD Plan if any of the following events occur:

The 26-week period, calculated from the first day of Disability, concludes;

The Eligible Participant ceases to be Disabled;

The Eligible Participant dies, retires, or terminates employment with the County;

The Eligible Participant engages in gainful self-employment or receives earned compensation from an employer other than the County, unless the earnings do not invalidate the legitimacy of the injury or illness as the basis of a claim under the Plan, as determined by the CEO or his designee;

The Eligible Participant fails to provide satisfactory Evidence of Disability, ceases to be under the care of a Physician, and/or is not receiving appropriate treatment for the Disability as defined by a recognized professional association established for the license type of the Physician;

The Eligible Participant refuses to accept an offer of County employment which is consistent with work restrictions imposed by the Claims Administrator or the CEO, and appropriate to his experience, training, and/or abilities;

D.

Recurrent Disability. If an Eligible Participant returns to active County employment and is disabled again for the same cause within 30 calendar days from the date of his return to active employment, or within such other time period as may be specified in the Election Information, STD benefit payments may be resumed without a new Waiting Period; provided, however, that nothing in this provision shall extend the payment of income replacement benefits for the original and any subsequent period(s) of Disability arising from the same cause beyond a total of 26 weeks from the first day of Disability. For purposes of this section, an Eligible Participant will be treated as having returned to active County employment, only if the Eligible Participant has resumed a normal working schedule at the County facility at which he is employed for the regularly scheduled working days during the 30 calendar days after his return to active employment.

(Ord. 2014-0033 § 3, 2014; Ord. 2005-0072 § 1 (part), 2005; Ord. 90-0164 § 1 (part), 1990.)

A.

Application for Benefits. The Eligible Participant shall give notice of the Disability to the Claims Administrator in accordance with the procedures established for such purpose in the Election Information.

B.

Evidence of Disability. Written medical certification of Disability must be submitted by a Physician, practicing within the scope of his license, to the Claims Administrator within the time frame established for such purpose in the Election Information. Failure to furnish Evidence of Disability within the time required will not invalidate or reduce any claim if it was not reasonably possible to give such evidence within such time, provided that the Evidence of Disability is furnished as soon as reasonably possible.

C.

Medical Records and Medical Examination. The Claims Administrator may require such additional evidence, as is deemed necessary, including copies of medical records, and/or a medical examination at County expense to determine the existence, cause and extent of any injury or illness which may be the basis of a claim under the STD Plan.

D.

Determination.

If the Evidence of Disability shows to the satisfaction of the Claims Administrator that an Eligible Participant is Disabled, the STD Plan benefit as specified under this section shall become payable effective as of the expiration of the Waiting Period.

If the Claims Administrator determines after review of the Evidence of Disability and all other evidence, including, but not limited to, medical records and medical examination, that an Eligible Participant is not Disabled, no benefits under this STD Plan shall be payable.

E.

Appeal. A Participant may appeal any denial, cessation, or cancellation of benefits under the STD Plan by filing a written notice of appeal with the Claims Administrator, together with any pertinent supporting medical documentation. The Claims Administrator shall conduct a full and fair evaluation of the appeal and render a decision, which shall be final. The appeal from the Participant, and the final decision from the Claims Administrator shall be completed within the time frames established for such purposes in the Election Information. If the employee's disability precludes submission of medical documentation within the established time frames, the deadline for the appeal may be extended by the CEO or his designee. Consideration of such extension by the CEO is contingent upon the provision of the medical documents as soon as reasonably possible.

(Ord. 2014-0033 § 4, 2014; Ord. 90-0164 § 1 (part), 1990.)

Benefits provided for under this STD Plan shall not be paid for any Disability not supported by prevailing medical evidence and treatment. In addition, benefits shall not be paid for any Disability resulting from or as a consequence of one or more of the following:

A.

Intentionally self-inflicted injuries;

B.

Participation in the commission of a felony;

C.

War or an act of war, declared or undeclared, unless said Disability is a direct consequence and result of injury or disease arising out of and in the course of active military service during a military leave of absence, in which case, the provisions of this subparagraph C shall not apply;

D.

Mental or nervous disorders, alcoholism, or chemical dependency, except while the Eligible Participant is under regular care in a planned program of observation and treatment by a Physician as required by applicable medical standards; or

E.

Any other cause or circumstance set forth in the Election Information.

(Ord. 2012-0043 § 2, 2012; Ord. 90-0164 § 1 (part), 1990.)

The provisions of this Part 3 shall be operative on January 1, 1991. Participant contributions for elective STD coverage shall first be reflected on County pay warrants issued on or about February 15, 1991.

(Ord. 90-0164 § 1 (part), 1990.)