DISABILITY INSURANCE

Sick Leave

You accrue hours in your sick bank that you can use under the City’s sick leave policies.

Disability

Disability insurance may replace part of your income if you are disabled because of sickness, injury, or pregnancy.

Definition of Disability

It’s important to remember that under most disability policies, a covered individual must be unable to work, either at their place of employment or from home, and must experience a loss of income to be eligible for disability benefits in all cases.

For benefits to begin, you must meet one of the following definitions of disability:

• You are required to be totally disabled or partially disabled from your own occupation.

• You are totally disabled from your own occupation if, as a result of physical disease, injury, pregnancy, or mental disorder, you are unable to perform with reasonable continuity the substantial and material acts necessary to pursue your own occupation and you are not working in your own occupation.

• You are partially disabled from your own occupation if you are not totally disabled and you are actually working in your own occupation but, as a result of physical disease, injury, pregnancy, or mental disorder, you are unable to earn 80% or more of your indexed predisability earnings.

• For supplemental disability coverage only: After 24 months for which LTD benefits are paid, you are required to be totally disabled or partially disabled from all occupations.

For more details, see your Certificate of Insurance, available here.

Basic and Supplemental Disability Coverage Overview

The overview table below is not intended to provide a detailed description of an individual’s coverage. Please refer to your Certificate of Insurance for more information, including definitions, exclusions, limitations, and terminating events.

* Benefits are calculated on your pre-disability earnings and may be reduced by income you receive from other sources. See the “How Benefits Are Calculated”
** Definition of disability and terms of the Certificate of Insurance apply.
*** LTD benefits last up to 18 months during your entire lifetime for disabilities related to a mental disorder, alcohol use, alcoholism, or drug use or drug addiction. LTD maximum benefit age may reduce benefit term when a disability benefit begins after age 61.
**** When you have a change in job classification (e.g., due to a promotion), your cost will be adjusted based on your new salary. Generally, cost of living and step increases gained during the year will not adjust your cost until the following plan year.

How Benefits Are Calculated

Pre-Disability Earnings

Disability benefits are calculated on your pre-disability earnings. Pre-disability earnings are your City base pay, including but not limited to any bonuses or shift differential counted toward your retirement benefit under the Los Angeles City Employees’ Retirement System. Any benefits are based on eligible pre-disability earnings on your last full day of active work and will not be adjusted for any later salary increases, including those based on MOU negotiations.

Other Income Sources

Your disability benefits may be reduced by any benefits you receive from other sources, like Workers’ Compensation, Social Security, LACERS disability or another group plan – including the LA City Club plan. If you are receiving other group disability benefits and you have supplemental disability coverage, those other benefits plus your LAwell supplemental disability benefits cannot be more than the highest benefit percentage provided by either plan (offset in excess of 80%).

If your disability is work-related and you have filed a Workers’ Compensation claim, you should also file a claim with Standard Insurance Company. Standard Insurance Company will consider your STD claim while a decision is being made on your Workers’ Compensation claim. However, if your Workers’ Compensation claim is accepted, compromised, or settled, it is your responsibility to immediately repay Standard Insurance Company for all of the STD benefits received. You may receive LTD benefits following the Benefit Waiting Period. Workers’ Compensation benefits would reduce your LTD benefit.

Salary Changes

When you have a change in job classification (e.g., due to a promotion), your supplemental employee disability insurance benefit amount (and your per pay period cost) will be adjusted based on your new salary. Generally, cost of living and step increases gained during the year without a change in job classification will not adjust your supplemental disability insurance benefit amount (or your per pay period cost) until the following plan year.

Active Work Requirement

You must meet the “active at work” definitions of the group policy for your disability insurance to take effect. If you cannot work because of sickness, injury, or pregnancy on the day before your disability coverage (or any coverage increase) becomes effective, your coverage, including any increases, will not become effective until the day after you complete one full day of active work as an eligible employee.

Approval Requirement

Before you can receive disability benefits, Standard Insurance Company reviews your claim to determine if you meet the eligibility requirements and the definition of disability, as well as other requirements to receive benefits under the terms of the group policy. Standard Insurance Company must approve your claim and you must be under the ongoing care of a physician. Please keep in mind that some conditions may not qualify for benefits. Approved STD and LTD benefits may be eligible for waiver of premium.

Medical History Statement (MHS) Requirement

In most situations, enrolling in supplemental disability coverage during Open Enrollment will require you to complete a Medical History Statement (MHS). The MHS, available here, asks a series of questions (about five) regarding your current and past medical conditions. Once received, Standard Insurance Company will review your statement and determine if any additional information or action is required of you before an approval of coverage determination can be made.

Your Personalized Benefit Statement and your Benefits Central Portal online account will show the Disability Coverage options available to you and which of those options will require you to complete an MHS. If you enroll in a plan that requires an MHS, you will receive a confirmation statement that provides you a deadline for submitting the MHS. During Open Enrollment, the deadline is March 1. During a Life Event, the deadline is, typically, 60 days from the date of your confirmation statement. However, you can complete the MHS form online at any time here.

You must complete and return the MHS before your submission deadline and it must be approved by Standard Insurance Company before your coverage can take effect. If your MHS has not been submitted by the deadline, any pending coverage will be removed from your benefits account and the City will send a confirmation statement of this change to you. If the MHS is submitted before your deadline, but Standard Insurance Company requires additional information/ action before an approval determination can be made, your coverage will become effective on the date of approval. The City will not make payroll deductions until the insurance company provides a date of approval. MHS submitted and approved for Open Enrollment elections will not be effective until January 1, if approved prior to January 1.

If you have a disabling condition that may use up your 100% and 75% sick leave, contact The Standard Insurance Company at 844-505-6025 as early as possible to find out what you will need to do to file a claim for disability benefits.

Generally, you will be provided with a claim package with forms to be completed by you, your doctor, and the City – plus an authorization form allowing Standard Insurance Company to contact your doctor for more information. Once Standard Insurance Company receives your completed forms, the review process will begin. Approval may take longer if more information is needed. By starting the process early, you can allow yourself time to complete the paperwork and avoid a lengthy gap in income between the time your sick leave ends and the time disability benefits begin.

Disability Benefits Require Approval

Before you can receive disability benefits, Standard Insurance Company reviews your claim to determine if you meet the eligibility requirements and the definition of disability, as well as other requirements to receive benefits under the terms of the group policy. Standard Insurance Company must approve your claim and you must be under the ongoing care of a physician. Please keep in mind that some conditions may not qualify for benefits. Approved short-term disability (STD) and long-term disability (LTD) benefits may be eligible for waiver of premium.