Los Angeles County Municipal Code Ch. 5.38 Long-Term Disability and Survivor Benefit Plan

A.

"Applicable Health Insurance Coverage" means coverage under a County-sponsored medical plan offered through the Cafeteria Plan for which an employee, Medical Dependent or LTD Health Survivor would be eligible if the employee were not disabled or deceased.

B.

"Basic monthly compensation" means the average monthly base rate, as established in Title 6 of this Code, as amended, on salaries, hereinafter referred to as "Title 6," for the position or positions the employee held during the 12 consecutive months immediately preceding the qualifying period; provided, however, that in no event shall the basic monthly compensation include the following:

Overtime compensation; or

Any lump-sum payoff or reimbursement for unused accumulated overtime, vacation, holiday time, or sick leave benefits; or

Compensation from two or more positions held on a concurrent basis. In any case in which the base rate is established in Title 6 on other than a monthly basis, the equivalent monthly base rate provided for in Chapter 6.15 of Title 6 shall be deemed to be the monthly base rate for purposes of this section.

C.

"Cafeteria Plan" means either the pensionable or nonpensionable Flexible Benefit Plan set forth in subdivision 1 of Chapter 5.27 or 5.28 of this Code, The Choices Plan set forth in Chapter 5.33 of this Code, or The Local 660 Cafeteria Plan set forth in Chapter 5.37 of this Code, as applicable.

D.

"CEO" means the Chief Executive Officer of the County appointed by the Board pursuant to the Los Angeles County Code.

E.

"Claims Administrator" means the County department, contracted insurance company, or contracted service company designated by the CEO to be responsible for the adjudication and processing of claims filed under the Long-Term Disability and Survivor Benefit Plan.

F.

"Covered Employee" means an employee who is (1) an "Eligible Employee" or a "Participant" under the terms of an applicable Cafeteria Plan, and (2) enrolled in a County-sponsored medical plan.

G.

"Disability beneficiary" means a former employee who has not retired from service under Retirement Plan E, and who either is receiving disability benefits or is eligible to receive disability benefits.

H.

"Eligible employee" means an employee who becomes totally disabled:

As a direct consequence and result of injury or disease arising out of and in the course of the performance of his or her assigned duties; or

As 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; or

After five years of continuous service with the county.

I.

"Employee" means an employee of the county of Los Angeles who is a general member of the Los Angeles County Employees Retirement Association. General member does not include a safety member.

J.

"LTD Health Insurance Benefit" means a benefit that pays for 75 percent or 100 percent of the cost of Applicable Health Insurance Coverage at the time such coverage is provided pursuant to the rules in section 5.38.020H.

K.

"LTD Health Survivor" means a spouse, domestic partner as defined in Section 298.5 of the California Family Code, or child as defined in Internal Revenue Code Section 152(f) (1) (including a stepchild or adopted child) who is under age 26, of (1) an eligible employee who dies while receiving or entitled to receive disability benefits under section 5.38.020; or (2) a Covered Employee who dies after five years of continuous service with the County or as a direct consequence and result of injury or disease arising out of and in the course of the performance of his or her assigned duties; provided, however, that to be an LTD Health Survivor, an individual must be a spouse, domestic partner or child who is covered by a County-sponsored medical plan offered under a Cafeteria Plan at the time of: (i) the onset of a total disability as determined by the Claims Administrator, or (ii) if the Covered Employee dies before he makes a claim for disability under the LTD Plan, the date of death.

L.

"Medical Dependent" means a Covered Employee's spouse, domestic partner or dependent child who is eligible to be covered under the terms of a County-sponsored medical plan.

M.

"Plan Information" means the information and rules related to the general administration of the Plan. The CEO shall develop and issue such information and rules, except as otherwise provided by the Board.

N.

"Qualifying Period" means that a qualifying period shall be required with respect to any one period of disability and shall be a continuous period equal to the six months, commencing with the first day on which an eligible employee is absent from work due to a total disability, and during which he or she remains totally disabled except as provided below; however, this period shall not include any time prior to the operative date of the ordinance codified in this chapter. If the eligible employee ceases to be totally disabled and returns to work for less than an aggregate of 30 days during a qualifying waiting period, any such cessation of total disability shall not interrupt continuity or extend the duration of the qualifying waiting period used to determine the first day on which benefits commence, provided that the successive absences during the qualifying waiting period are due to the same cause. In addition, the continuity of the qualifying waiting period shall not be interrupted, nor shall the qualifying waiting period be extended, merely because an eligible employee incurs a disability during such waiting period that arises from a different and unrelated cause than that which initially caused the eligible employee to be absent from work as long as the eligible employee does not return to active employment at any time during the six months commencing with the first day on which the eligible employee was first absent from work due to a total disability. Notwithstanding the foregoing, the duration of a qualifying waiting period may be extended to a waiting period of more than six months pursuant to Section 5.38.030B.

O.

"Retirement plan A, B, C, D, or G" means any of the contributory retirement plans established by the county of Los Angeles pursuant to the County Employees Retirement Law of 1937.

P.

"Retirement Plan E" means the optional noncontributory retirement plan made operative for general members of the Los Angeles County Employees Retirement Association on or after July 1, 1981, by resolution of the board of supervisors of Los Angeles County pursuant to the Memorandum of Understanding entered into in 1981, by and between the county of Los Angeles and the County Coalition of Unions.

Q.

"Total Disability." During the qualifying period, and during the subsequent 24-month period for which an employee might be eligible to receive benefits under this Plan, "total disability" means the complete and continuous inability and incapacity of the employee to perform the duties of his or her position with the county. After the expiration of 24 consecutive months of eligibility for benefit payments, total disability means that the employee is disabled within the meaning of the Federal Social Security Act and is eligible to receive or is receiving disability benefits under the Federal Social Security Act; provided,

however, that for an employee who makes timely application for disability benefits under the Federal Social Security Act and who has not received a final determination regarding disability under that Act, total disability (for the period prior to the date on which a final determination is made regarding disability) shall mean the complete and continuous inability and incapacity of the employee to perform the duties of his or her position with the county. An employee who is not insured for disability benefits (such as lacking sufficient quarters of covered employment) under the Federal Social Security Act shall be considered totally disabled at the end of the 24-month period of eligibility for benefit payments and during the continuance thereafter of the disability if he or she is disabled within the meaning of Section 223(d) of the Federal Social Security Act.

(Ord. 2014-0033 § 17, 2014; Ord. 2012-0043 § 10, 2012; Ord. 2008-0014 §§ 16, 17, 2008.)

A.

Payment of Benefit. An eligible employee shall begin accruing a basic monthly benefit on the first day following the expiration of the qualifying period. Except as otherwise herein provided, such benefit shall be paid as long as the eligible employee's total disability continues.

B.

Basic Monthly Benefit. The basic monthly benefit payable to the eligible employee shall be the employee's basic monthly compensation multiplied by 60 percent, and then subtracting therefrom other income benefits specified in subsection C of this section.

C.

Other Income Benefits. Other income benefits are those benefits identified below to which the eligible employee is entitled. These other income benefits, payable either monthly or in lump sum, are:

The amount of any salary or other compensation, including sick leave, vacation, or other pay the eligible employee receives from the county, and 50 percent of any other salary, compensation or income the eligible employee receives from any other employer, or otherwise earns. 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.

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 this Plan when such benefits are provided or payable:

a.

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

b.

Pursuant to the Federal Railroad Retirement Act; or

c.

As temporary disability benefits under California worker's compensation law;

d.

Under any other worker's compensation law; or

e.

Under any employer's liability law; or

f.

Under the Federal Social Security Act on the basis of the employee'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. 424a(a)(2), and payable to the employee without regard to any deductions from such benefits which may be made:

i.

On account of work, or

ii.

Because of the employee's refusal to accept rehabilitation; provided, however, that other income benefits, for purposes of this 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 employee 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 benefits shall include the amount of such retirement benefits.

The Amount of Retirement Benefit that the Employee Receives under Retirement Plan A, B, C, D, or G. For 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 Plan. In the event a disability beneficiary or deceased employee was eligible for retirement benefits under Retirement Plan A, B, C, D, or G but was not receiving such benefits, any such benefits that he or she would have received shall be estimated by the Chief Executive Officer for purposes of calculating any benefit due under this Plan.

In the event of other income benefits received in the form of 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.

Denial or Cessation of Benefits. Payment of the basic monthly benefit shall cease or not commence upon the occurrence of the first of the following events:

Attainment of age 65, unless the eligible employee's qualifying period commences on or after the date he attains age 62, in which case the basic monthly benefit shall cease in accordance with the following schedule.

Refusal by an eligible employee or disability beneficiary to accept an offer of county employment which is (a) consistent with his or her work restrictions as determined by the chief executive officer, and (b) appropriate to his or her training, experience, and/or abilities as determined by the chief executive officer.

Cessation of total disability, including denial, or termination of, Federal Social Security disability benefits at any time after 24 consecutive months of eligibility for benefit payments.

Early or normal retirement from the county within the meaning of Retirement Plan E.

For an eligible employee or disability beneficiary who is a general member of Retirement Plan A, B, C, D, or G, and otherwise eligible for continuation of disability benefits under this Plan, failure to apply for any and all retirement benefits after 24 months eligibility for disability payments.

Failure or refusal of the eligible employee or disability beneficiary to:

a.

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

b.

Furnish proof of disability or any other notice required under this Plan;

c.

Be examined at the request of the county; or

d.

Otherwise cooperate with the county in the determination of benefits under this Plan.

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

E.

Recurrent Disability. If an eligible employee or disability beneficiary returns to county employment and is disabled again for the same cause within six months from the date of his or her return to work, disability benefit payments may be resumed without the eligible employee or disability beneficiary serving a new qualifying period. 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 employee or disability beneficiary is otherwise eligible for such payments.

F.

Return to Work Part-Time. An eligible employee or disability beneficiary may return to county employment of a part-time basis pursuant to a program approved by the chief executive officer 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.

G.

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 this 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 County Metropolitan Area for the preceding January 1st; provided, however, no increase resulting from such calculation shall exceed two percent.

The provisions of this subsection G of Section 5.38.020 shall be applicable to disability cases with Qualifying Periods that begin on or after January 1, 2001.

H.

LTD Health Insurance.

Benefits for Covered Employee.

a.

For disabilities incurred prior to (1) January 1, 2007, for Covered Employees eligible to participate in the Flexible Benefit Plan under subdivision 1 of Chapters 5.27 and 5.28 of this Code, or (2) January 1, 2008, for Covered Employees eligible to participate under either the Local 660 Cafeteria Plan or the Choices Plan: if the Covered Employee timely elects and pays for the 75 percent LTD Health Insurance Benefit in accordance with the terms of the applicable Cafeteria 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 5.38.020H.3. 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 applicable Cafeteria 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.

b.

For disabilities incurred on or after (1) January 1, 2007, for Covered Employees eligible to participate in the Flexible Benefit Plan under subdivision 1 of Chapters 5.27 and 5.28 of this Code, or (2) January 1, 2008, for Covered Employees eligible to participate under either the Local 660 Cafeteria Plan or the Choices Plan: unless the Covered Employee makes the election provided in section 5.38.020H.1.c., 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 5.38.020H.3. 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.

c.

For periods beginning on or after (a) January 1, 2007, for Covered Employees eligible to participate in the Flexible Benefit Plan under subdivision 1 of Chapters 5.27 and 5.28 of this Code, or (b) January 1, 2008, for Covered Employees eligible to participate under either the Local 660 Cafeteria Plan or the Choices Plan: if the Covered Employee timely elects and pays for the 100 percent LTD Health Insurance Benefit in accordance with the terms of the applicable Cafeteria 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 5.38.020H.3. 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 applicable Cafeteria Plan.

Benefits for LTD Health Survivors.

a.

Each LTD Health Survivor with respect to a Covered Employee described in section 5.38.020H.1.a. or b. 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 5.38.020H.3. 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.

b.

Each LTD Health Survivor with respect to a Covered Employee who elects and purchases the 100 percent LTD Health Insurance Benefit as described in section 5.38.020H.1.c. 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 5.38.020H.3.

Duration of LTD Health Insurance Benefit. The LTD Health Insurance Benefit shall be provided: (a) in the case of benefits provided under Section 5.38.020H.1., during the waiting period that total disability benefits are paid under Section 5.38.020; and (b) in the case of benefits provided under Section 5.38.020H.2., 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.

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

a.

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 Cafeteria Plan rules or to the extent otherwise required by applicable law.

b.

Any eligible employee receiving disability benefits under this Chapter 5.38 or completing the qualifying 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.

Subject to the County's obligation to meet and confer with employee organizations, other benefit eligibility rules or procedures may be determined 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.

(Ord. 2014-0033 § 18, 2014; Ord. 2008-0014 § 18, 2008; Ord. 2006-0084 § 15, 2006; Ord. 2004-0001 § 27, 2004; Ord. 2000- 0074 § 10, 2000: Ord. 89-0158 § 4, 1989; Ord. 88-0086 § 1(e)—(h), 1988; Ord. 87-0222 § 4(a), 1987; Ord. 86-0097 § 1, 1986; Ord. 85-0172 § 4(b), 1985; Ord. 85-0149 § 3, 1985; Ord. 84-0003 § 3(a) and (b), 1984; Ord. 12406 § 1(part), 1981: Ord. 4099 Art. 119 § 24051, 1942.)

A.

Claim Forms. The County shall furnish the claimant with the appropriate forms for applying for benefits and for filing proof of disability. If such forms are requested by the employee and not furnished in a timely manner by the county, the employee shall be deemed to have complied with the requirements for filing application for benefits under this Plan provided a written notice is submitted covering the occurrence and the character and the extent of the disability for which a claim is made within the period of time provided in this Plan for applying for benefits.

B.

Application for Benefits. Application for disability benefits must be filed with the county within five months after the first day of absence due to total disability or as soon thereafter as is reasonably possible. However, in the event application is not made within one year from the first day of absence due to the claimed disability, the qualifying 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 30 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. In addition, the employee shall be required to apply for disability benefits under the Federal Social Security Act and to provide the county with verification of such application within 30 days after applying for disability benefits under this Plan.

C.

Proof of Disability. Written proof covering the occurrence, the character, and the extent of disability must be furnished to the county within 90 days after an application for benefits has been filed. Failure to furnish proof within the time required will not invalidate or reduce any claim if it was not reasonably possible to give proof within such time; provided, that proof 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 Plan in the event the required Evidence of Disability is not furnished within:

One year from the first day of absence, however, the qualifying period otherwise provided for in this Plan shall be extended by one day for each day the proof of disability 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 two years 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 Examination. The county may require such additional proof, as is deemed necessary, including a medical examination at county expense to determine the existence, cause and extent of any injury or sickness which is the basis for a claim for plan benefits.

E.

Determination.

If the proof received shows to the satisfaction of the chief executive officer, that an employee is totally disabled, the basic monthly disability benefit shall become payable to be effective as of the expiration of the qualifying period.

Total disability shall in all cases be determined by the chief executive officer, except that any final decision of the Social Security Administration concerning a claim for disability benefits under the Federal Social Security Act shall be conclusive and binding upon all parties.

If the chief executive officer determines after medical examination that an eligible employee or a disability beneficiary is not totally disabled, no disability benefit shall be payable.

F.

Appeal. A claimant may appeal, within the established time frames, the denial, cessation, or cancellation of a benefit under this 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. In accordance with the procedures established for such purpose in the Plan 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 is contingent upon the provision of the medical documentation as soon as reasonably possible.

(Ord. 2015-0063 § 16, 2015; Ord. 2014-0033 § 19, 2014; Ord. 2012-0043 § 11, 2012; Ord. 88-0086 § 1(k), (l), (m), 1988; Ord. 85-0172 § 4(d), 1985; Ord. 12406 § 1 (part), 1981: Ord. 4099 Art. 119 § 24053, 1942.)

A.

1. Upon the death of:

a.

An employee either:

i.

As a direct consequence and result of injury or disease arising out of and in the course of the performance of his or her assigned duties, or

ii.

As a direct consequence and result of injury or disease arising out of an in the course of active military service during a military leave of absence, or

iii.

After five years of continuous service with the County, or

b.

A disability beneficiary; there shall be payable a survivor benefit to his or her surviving spouse or domestic partner consisting of a monthly payment equal to 50 percent of that disability benefit, as defined in Section 5.38.020, to which the disability beneficiary was entitled or the employee would have been entitled if the employee had been totally disabled immediately preceding his or her death; provided, however, effective July 1, 2001 said 50 percent survivor benefit shall be adjusted to 55 percent. This benefit shall continue during and throughout the life of the spouse or domestic partner; provided, however, that no benefit shall be paid to a survivor of a deceased disability beneficiary who was not married to or certified pursuant to Section 298.5 of the California Family Code as a domestic partner prior to the qualifying period. If no surviving spouse or domestic partner is entitled to this benefit, or if he or she dies before every child of such deceased employee or deceased disability beneficiary, including a stepchild or adopted child, attains the age of 18 years, then the benefit which the surviving spouse or domestic partner would have received had she or he lived shall be paid to the child or children of the deceased employee or deceased disability beneficiary under the age of 18 years. For the purposes of this section, "stepchild" means a stepchild that was dependent on the employee for support and maintenance at the time of the employee' s death. Notwithstanding anything herein to the contrary, no benefits shall be payable if such benefits are not permitted pursuant to state or federal law.

If the survivor benefit is to be paid to surviving children, then the benefit shall be divided among such children in equal amounts; provided, however, that the right of any such child to share in the benefits shall cease upon his or her death, marriage, or upon attaining the age of 18 years. Notwithstanding any other provision of this subsection, the benefit otherwise payable to the children of the deceased employee or deceased disability beneficiary shall be paid to such children through the age of 21 years if such children remain unmarried and are regularly enrolled as full-time students in an accredited school as determined by the chief executive officer.

B.

In the event the deceased employee or disability beneficiary was not receiving Social Security disability benefits, the amount of such benefits the employee or disability beneficiary would have received, if otherwise eligible, shall be estimated for the purpose of computing the benefit provided by this section. The chief executive officer, upon actuarial advice, shall establish and adjust annually, if required, the table of estimated Social Security disability benefits which shall be utilized in computing the survivor benefits.

C.

Should the surviving spouse or domestic partner fail to cooperate with the County for a period of 90 days, the benefit shall be payable to the surviving children of the deceased employee or deceased disability beneficiary who otherwise meet all eligibility requirements. In the event that the survivor benefit is paid to the surviving children, duplicate payment for the same period shall not subsequently be payable to a surviving spouse or domestic partner.

(Ord. 2014-0033 § 20, 2014; Ord. 2012-0043 § 12, 2012; Ord. 2004-0001 § 28, 2004; Ord. 2000-0074 § 11, 2000: Ord. 89- 0158 § 5, 1989; Ord. 88-0184 § 2, 1988; Ord. 85-0172 § 4(e), 1985; Ord. 84-0003 § 3(c), 1984; Ord. 12406 § 1 (part), 1981: Ord. 4099 Art. 119 § 24054, 1942.)

Types of Exclusions. The benefits provided for under this Plan shall not be payable for any:

A.

Total disability not justified by prevailing medical evidence and treatment.

B.

Disability or death resulting from or contributed to, by any one or more of the following:

Intentionally self-inflicted injuries,

Participation in or consequences of having participated in the commission of a felony,

War or any act of war, declared or undeclared, unless said Disability or death 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

C.

Disability resulting from, or contributed to, by mental or nervous disorder, drug addiction, or alcoholism, except while the employee is under regular care in a planned program of observation and treatment by a licensed physician or surgeon as required by applicable medical standards.

(Ord. 2012-0043 § 13, 2012; Ord. 2004-0001 § 29, 2004; Ord. 88-0086 § 1(j), 1988; Ord. 87-0222 § 4(b), 1987; Ord. 85-0172 § 4(c), 1985: Ord. 12406 § 1 (part), 1981: Ord. 4099 Art. 119 § 24052, 1942.)