Los Angeles County Municipal Code Part 4 Long-Term Disability Plan

There is hereby established the County of Los Angeles Long-Term Disability Plan, hereinafter called the "LTD Plan." The LTD Plan is established for the purpose of providing a Benefit for the Plan.

(Ord. 94-0079 § 8 (part), 1994.)

A.

Nonelective Coverage. Each Retirement Plan E Member who has completed five or more years of continuous service as of the commencement of the current Plan Year, shall be entitled to nonelective LTD coverage equal to his Basic Monthly

Compensation multiplied by 40 percent.

B.

Elective Coverage.

Each Retirement Plan A, B, C, D, or G Member may elect LTD coverage equal to his Basic Monthly Compensation multiplied by 40 percent, or 60 percent.

Each Retirement Plan E Member who has less than five years of continuous service as of the commencement of the Plan Year for which he is eligible to make an election, may elect LTD coverage equal to his Basic Monthly Compensation multiplied by 40 percent, or 60 percent.

Each retirement Plan E Member who has five or more years of continuous service as of the commencement of the Plan Year for which he is eligible to make an election, may elect LTD coverage equal to his Basic Monthly Compensation multiplied by 60 percent.

LTD Health Insurance Benefit.

a.

Benefits for Eligible Employees.

(1)

For disabilities incurred prior to January 1, 2007, if the Covered Employee timely elects and pays for the 75 percent LTD Health Insurance Benefit in accordance with the terms of the Plan, the Covered Employee is covered by an LTD Health Insurance Benefit that pays for 75 percent of the cost of Applicable Health Insurance Coverage for the employee and his Medical Dependents during the period described in section 5.28.450B.4.c. The Covered Employee must make monthly contributions to purchase the 75 percent LTD Health Insurance Benefit, in amounts determined by the County, in accordance with the terms of the Plan. The remaining 25 percent of the cost of Applicable Health Insurance Coverage elected by the employee shall be paid for by monthly employee payments in the time and manner determined by the County when the medical insurance coverage is received. Applicable Health Insurance Coverage will not be provided unless the employee timely remits his or her share of the cost for such coverage.

(2)

For disabilities incurred on or after January 1, 2007, unless a Covered Employee makes the election provided in section 5.28.450B.4.a.(3), he is automatically covered, at no cost, by an LTD Health Insurance Benefit that pays for 75 percent of the cost of Applicable Health Insurance Coverage for the employee and his Medical Dependents during the period described in section 5.28.450B.4.c. The remaining 25 percent of the cost of any Applicable Health Insurance Coverage elected by the employee shall be paid for by monthly employee payments in the time and manner determined by the County when the medical insurance coverage is received. Applicable Health Insurance Coverage will not be provided unless the employee timely remits his or her share of the cost for such coverage.

(3)

Beginning January 1, 2007, for disabilities incurred after that date, if the Covered Employee timely elects and pays for the 100 percent LTD Health Insurance Benefit in accordance with the terms of the Plan, the Covered Employee is covered by an LTD Health Insurance Benefit that will pay for 100 percent of the cost of Applicable Health Insurance Coverage for the employee

and his Medical Dependents during the period described in section 5.28.450B.4.c. The Covered Employee must make monthly contributions to purchase the 100 percent LTD Health Insurance Benefit, in amounts determined by the County, in accordance with the terms of the Plan.

b.

Benefits for LTD Health Survivors.

(1)

Each LTD Health Survivor with respect to a Covered Employee described in section 5.28.450.B.4.a.(1) or (2) shall receive an LTD Health Insurance Benefit that pays for 75 percent of the cost of Applicable Health Insurance Coverage for that LTD Health Survivor during the period described in section 5.28.450B.4.c. The remaining 25 percent of the cost of any Applicable Health Insurance Coverage provided to the LTD Health Survivor shall be paid for by monthly payments by that individual in the time and manner determined by the County when the medical insurance coverage is received. Applicable Health Insurance Coverage will not be provided unless the covered individual timely remits his or her share of the cost for such coverage.

(2)

Each LTD Health Survivor with respect to an Eligible Employee or Participant who elects and purchases the 100 percent LTD Health Insurance Benefit as described in section 5.28.450.B.4.a.(3) shall receive an LTD Health Insurance Benefit that pays for 100 percent of the cost of Applicable Health Insurance Coverage for that LTD Health Survivor during the period described in section 5.28.450B.4.c.

c.

Duration of the LTD Health Insurance Benefit. The LTD Health Insurance Benefit shall be provided: (1) in the case of benefits provided under Section 5.28.450B.4.a., during the period that total disability benefits are paid under Section 5.28.460; and (2) in the case of benefits provided under Section 5.28.450B.4.b., until the LTD Health Survivor's death or until the individual no longer qualifies as an LTD Health Survivor. Notwithstanding the foregoing, in the event an individual receiving LTD Health Insurance Benefits becomes eligible to receive any retiree health insurance coverage from the Los Angeles County Employees Retirement Association ("LACERA"), (whether or not he or she elects to receive that insurance coverage), that individual's LTD Health Insurance Benefits will cease. However, in the case of the LTD Health Survivor of an Eligible Participant or Covered Employee with at least five years but less than ten years of service credited with LACERA and whose disability and/or death as a direct consequence and result of injury or disease did not arise out of and in the course of the performance of his or her assigned duties, the cessation of benefits will be postponed unless and until the LTD Health Survivor has received LTD Health Insurance Benefits for a period of two years.

d.

Limitations. Notwithstanding any other provision governing the LTD Health Insurance Benefit:

(1)

To be eligible to receive an LTD Health Insurance Benefit, a Covered Employee, Medical Dependent or LTD Health Survivor must be covered under a County-sponsored medical plan offered through the Cafeteria Plan at the time the LTD Health Insurance Benefit commences; provided, however, that an employee receiving an LTD Health Insurance Benefit may elect to cover a Medical Dependent during open enrollment in accordance with Plan rules or to the extent otherwise required by applicable law.

(2)

Any eligible employee receiving disability benefits under this Chapter 5.28 or completing the Waiting Period: (1) shall not be entitled to become covered by (if not already covered), or elect to increase the level of, the LTD Health Insurance Benefit unless and until the employee returns to work as a Covered Employee, and (2) will not be entitled to become covered by (if

not already covered), or elect to increase the level of, the LTD Health Insurance Benefit with regard to that same disability unless and until the employee returns to active employment as a Covered Employee for at least 6 months. Additionally, any Covered Employee who does not elect the optional 100 percent LTD Health Insurance Benefit shall be ineligible to make such election for the following Plan Year. The Covered Employee must wait two Plan Years before again being eligible to elect this option.

e.

Additional benefit eligibility rules may be determined as necessary by the Chief Executive Officer for the prudent administration of the LTD Health Insurance Benefit program and set forth in the applicable Cafeteria Plan documents and materials.

C.

Cost. Nonelective LTD coverage shall be provided at no cost to the affected Participants. Elective LTD coverage, including elective LTD Health Insurance, shall require contributions from the affected Participants as provided for in the Election Information.

(Ord. 2014-0033 § 12, 2014; Ord. 2008-0014 § 8, 2008: Ord. 2006-0074 § 8, 2006; Ord. 2004-0001 § 17, 2004; Ord. 94-0079 § 8 (part), 1994.)

A.

Payment of Benefits. An Eligible Participant shall begin accruing the benefit determined under Section 5.28.450 on the first day following the expiration of the Waiting Period. Except as otherwise herein provided, such benefit shall be paid until the Eligible Participant's Total Disability ceases.

B.

Basic Monthly Benefit. The basic monthly benefit payable to the Eligible Participant shall be the Participant's Basic Monthly Compensation multiplied by the percent determined under Section 5.28.450, subtracting therefrom other income benefits as specified in subsection C of this section.

C.

Other Income Benefits. Other income benefits are those benefits identified below to which the Eligible Participant is entitled. These other income benefits, payable either periodically or in a lump sum, are:

The amount of any salary or other compensation, including sick leave, vacation, annual leave, or other pay the eligible Participant receives from the County which shall be coordinated with the LTD benefit as specified in the Election Information. For purposes of this paragraph, "compensation" shall not include cash or other compensation resulting from any County contribution to a County-sponsored cafeteria benefit plan. Nor shall compensation include any payment for accrued sick leave, vacation, annual leave, or other accrued time when such payment is made on account of an employee's termination from County service or an employee's death. Employees who have not terminated County service may use sick leave, vacation, annual leave, or other accrued time in lieu of LTD benefits as otherwise provided by this Code; provided, however, that, in such case, the substitution shall be made on a day for day basis (not dollar for dollar basis) resulting in one day's loss of LTD benefits for each day of substituted time;

50 percent of any other salary, compensation or income the Eligible Participant receives from any other employer, or otherwise earns;

The amount of any benefits with respect to the same disability or disabilities and with respect to the same period for which the basic monthly benefit is payable under the LTD Plan when such benefits are provided or payable:

a.

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

b.

Pursuant to the Federal Railroad Retirement Act; or

c.

As temporary disability benefits under California workers' compensation laws,

d.

Under any other workers' compensation law,

e.

Under any employer's liability law, or

f.

Under the Federal Social Security Act on the basis of the Eligible Participant's record of wages and self-employment income, and not including any amount not paid pursuant to that Act by operation of 42 U.S.C. Section 424(A)(2), and payable to the employee without regard to any deductions from such benefits which might be made:

i.

On account of work, or

ii.

Because of the employee's refusal to accept rehabilitation; provided, however, that other benefits, for purposes of this LTD Plan, shall not include any cost-of-living adjustments applicable to benefits payable under the Federal Social Security Act subsequent to the commencement date of such benefits. If the Eligible Participant is eligible for both retirement benefits and disability benefits under the Federal Social Security Act and receives retirement benefits in lieu of disability benefits, other income shall include the amount of such retirement benefits;

The Amount of retirement benefits that the Eligible Participant receives under Retirement Plans A, B, C, D, or G. For the purposes of this paragraph, such retirement benefits shall not include any cost-of-living adjustments granted subsequent to the date any benefits become payable under this LTD Plan. In the event an Eligible Participant was eligible for retirement benefits under Retirement Plans A, B, C, D, or G but was not receiving such benefits, any such benefits that he would have received shall be estimated by the CEO for purposes of calculating any benefit due under this LTD Plan;

In the event of other income benefits received in the form of a lump-sum payment or payments, the basic monthly benefit shall not commence or continue until the total of all such basic monthly benefits otherwise payable under this Plan equals the aggregate amount of such lump-sum payments.

D.

Cost-of-Living Adjustment. A cost-of-living adjustment shall be applied to the basic monthly disability benefit on the first day following the completion of 24 months of eligibility for such benefit, and annually thereafter for as long as the Participant is entitled to benefits under the LTD Plan. Such adjustment shall equal the annual percentage increase, calculated to the nearest one-tenth of one percent, in the cost of living as measured by the Bureau of Labor Statistics Consumer Price Index for All Urban Consumers for the Los Angeles/Riverside/Orange Counties Metropolitan Area for the preceding January 1st; provided, however, no increase resulting from such calculation shall exceed two percent.

E.

Denial or Cessation of Benefits. No benefit shall be payable under this LTD Plan if any of the following events occur:

The Eligible Participant attains age 65, unless his waiting period commenced on or after the date he attained age 62, in which case the basic monthly benefit shall cease in accordance with the following schedule:

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

The Eligible Participant ceases to be Totally Disabled. Such cessation of Total Disability shall be deemed to have occurred if disability benefits under the Federal Social Security Act are denied or terminated at any time after 24 consecutive months of eligibility for benefit payments;

The Eligible Participant retires as a Retirement Plan E Member;

The Eligible Participant is a Retirement Plan A, B, C, D, or G Member, and fails to apply for any and all retirement benefits after 24 months of eligibility for disability payments;

The Eligible Participant fails or refuses to:

a.

Timely apply for other benefits for which he may be eligible, including but not limited to worker's compensation and Federal Social Security Act benefits,

b.

Furnish Evidence of Disability or any other notice required under this LTD Plan,

c.

Be examined at the request of the County, or

d.

Otherwise cooperate with the County in determination of benefits under this LTD Plan;

Absence from work for six months or more prior to commencement of total disability, unless the absence is for approved, non-medical leave.

F.

Recurrent Disability. If an eligible Participant returns to County employment and is totally disabled again for the same cause within six months from the date of his return to work, or within such other time period as may be specified in the Election Information, disability benefit payments may be resumed without the Eligible Participant serving a new Waiting Period; provided, however, that nothing in this provision shall extend the payment of disability benefits for the original and any subsequent period(s) of disability arising from the same cause beyond a total of 24 months of eligibility for benefit payments unless the Eligible Participant is otherwise eligible for such payments.

G.

Return to Part-Time Work. Any Eligible Participant may return to County employment on a part-time basis pursuant to a program approved by the CAO and may receive disability benefit payments during the period of such employment; provided, however, that 70 percent of any salary, compensation, or income earned under such arrangement shall be subtracted from the basic monthly benefit.

(Ord. 2014-0033 § 13, 2014; Ord. 2006-0084 § 10, 2006; Ord. 94-0079 § 8 (part), 1994.)

A.

Claim Forms. The County shall furnish the Participant with the appropriate forms for applying for benefits and for filing Evidence of Disability. If such forms are requested by the Participant and not furnished in a timely manner by the County, the Participant shall be deemed to have complied with the requirements for filing an application for benefits under this LTD Plan, provided Evidence of Disability is submitted within the period of time provided in this LTD Plan for applying for benefits.

B.

Application for Benefits. Application for disability benefits must be filed with the Claims Administrator in accordance with the procedures established for such purpose in the Election Information. However, in the event application is not made within one year from the first day of absence due to the claimed disability, the waiting period otherwise provided for in this Plan shall be extended by one day for each day the application is delayed beyond one year from the first day of absence due to total disability unless the employee's disability precludes submission of an application within said one year, in which case, the one year deadline may be extended by the CEO or his designee. Consideration of such extension by the CEO or his designee is contingent upon the provision of an application and all required medical documentation as soon as reasonably possible.

Notwithstanding the foregoing, no benefits shall be paid under this Plan if application is not made within thirty months from the first day of absence due to total disability, provided, however, that the CEO or its designee may, in its sole discretion, extend the 30-month deadline if the CEO or its designee determines that extension of the deadline is warranted due to equitable considerations.

C.

Evidence of Disability. Written medical certification of Total Disability must be submitted by a Physician, practicing within the scope of his license, to the County within 90 days after an application for benefits has been filed. 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. However, a day-for-day penalty period will be extended to the six-month qualifying waiting period for each day the claim is not completed under this LTD Plan in the event the required Evidence of Disability is not furnished within:

One year from the first day of absence, however, in the event evidence of disability is not provided within one year from the first day of absence due to the claimed disability, the waiting period otherwise provided for in this Plan shall be extended by one day for each day the application is delayed beyond one year from the first day of absence due to total disability unless the employee's disability precludes submission of an application within said one year, in which case, the one year deadline may be extended by the CEO or his designee. Consideration of such extension by the CEO or his designee is contingent upon the provision of an application and all required medical documentation as soon as reasonably possible. Notwithstanding the foregoing, no benefits shall be paid under this Plan if application is not made within thirty months from the first day of absence, provided, however, that the CEO or its designee may, in its sole discretion, extend the 30-month deadline if the CEO or its designee determines that extension of the deadline is warranted due to equitable considerations, due to Total Disability; or

In the case of an individual claiming a disability as a consequence of active military service during a military leave of absence, within such longer period as may be authorized by the Chief Executive Officer. For purposes of this subsection C, "active military service" shall mean Active Military Service as defined in Section 6.20.080 of this Code.

D.

Medical Records and Medical Examination. The County may require such additional Evidence of Disability, 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 LTD Plan.

E.

Determination.

If the Evidence of Disability shows to the satisfaction of the CEO that an Eligible Participant is Totally Disabled, the basic monthly benefit shall begin accruing on the first day following the expiration of the waiting period.

Total Disability shall in all cases be determined by the CEO, except that any final decision of the Social Security Administration concerning a claim for disability benefits under the Federal Social Security Act, other than not being insured for disability benefits under that Act, shall be conclusive and binding upon all parties.

If the CEO determines after medical examination that an Eligible Participant is not Totally Disabled, no disability benefits shall be payable.

F.

Appeal. A Participant may appeal, within the established time frames in the Election Information, the denial, cessation, or cancellation of benefits under the LTD Plan by filing 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. In accordance with the procedures established for such purpose in the Election Information, the Claimant may file a written request for a hearing regarding a denial of benefits by the Claims Administrator. The matter shall then be reviewed by a hearing officer designated by the CEO. The hearing officer shall conduct a full and fair hearing and render a decision, which shall be final. 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 or his designee is contingent upon the provision of the medical documentation as soon as reasonably possible.

(Ord. 2014-0033 § 14, 2014: Ord. 2012-0043 § 7, 2012; Ord. 94-0079 § 8 (part), 1994.)

The benefits provided for under this LTD Plan shall not be paid for any:

A.

Total Disability not supported by prevailing medical evidence and treatment;

B.

Total Disability resulting from or as a consequence of any one or more of the following:

Intentionally self-inflicted injuries,

Participation in the commission of a felony,

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 3 shall not apply,

Any exclusion or other condition making an individual ineligible for disability benefits under the Federal Social Security Act, other than not being insured under that Act, or

Any mental or nervous disorder, 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,

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

(Ord. 2012-0043 § 8, 2012; Ord. 94-0079 § 8 (part), 1994.)