Extended Sick Leave and Short-Term Disability
Table of Contents
- Benefit Exclusions
- Employment Termination
- Short-Term Disability Period/Recurrent Disability
- Return-to-Work Program
- Other Benefits
- Coordination with Family and Medical Leave (FMLA)
- Coordination with Long-Term Disability (LTD) Benefits
- Recovery of Overpayments
Washington and Lee University (the "University") Extended Sick Leave Benefit Program (the "Program") provides salary continuation to eligible nonexempt employees during periods of short-term disability. Benefits under the Program are provided at no expense to eligible employees. However, benefits when received will be subject to all applicable taxes.
The following are the definitions of terms as used in the Program description.
"Short-Term Disabled" or "Short-Term Disability" for purposes of this Program means:(1) an employee is unable to perform the material and substantial duties of his/her regular occupation due to a sickness or injury; (2) resulting in a loss of 20% or more of his/her weekly earnings due to the sickness or injury; and (3) the employee is under the regular care of a Provider. The definition of "short-term disabled" or "short-term disability" under this Program does not necessarily indicate a corresponding disability for purposes of the Americans with Disabilities Act (ADA). Whether an employee is a qualified person with a disability for purposes of the ADA will be assessed on a case-by-case basis in accordance with University policy and applicable law.
"Elimination Period" means, unless precluded by law, the ten-day period of time that an employee must be disabled before benefits under the Program will be paid.
"Provider" means a person who is performing tasks that are within the limits of his or her medical license or other qualifications described in this definition; and
- is licensed to practice medicine and prescribe and administer drugs or to perform surgery; or
- has a doctoral degree in Psychology (Ph.D. or Psy.D) and whose primary practice is treating patients; or
- is a legally qualified medical practitioner according to the laws and regulations of the jurisdiction in which s/he practices.
The Program will not accept medical evidence from an employee's relative including, but not limited to, the employee, a spouse, a child, a sibling, or parent.
"Weekly Earnings" means an employee's gross weekly earnings in effect before the short-term disability began and does not include bonuses, overtime, or other extra compensation paid by the University.
Employees who meet all of the following criteria of either category may be eligible for benefits under the Program.
1.Category 1: Full- time nonexempt employees who
- have been employed by the University for at least 12 continuous months prior to the start of the short-term disability period;
- are regularly scheduled to work 35 hours or more each week for at least nine months of the year; and
- work at least 1,365 hours per year.
2.Category 2: Part-time nonexempt employees with partial benefits who
- have been employed by the University for at least 12 continuous months prior to the start of the short-term disability period;
- work in established positions that have been approved for less than full-time but at least 1,000 hours per year; and
- work at least 1000 hours per year.
New employees in either Category 1 or Category 2 above who had been covered for at least twelve consecutive months by a short-term disability policy/program with their immediate prior employer are eligible for this Program when they start work at W&L.
Otherwise eligible employees who do not submit a completed claim form, including medical evidence of the disability submitted by a licensed provider, will not be eligible for benefits.
When Benefits Begin
Benefits will begin to be paid as of the eleventh day of a short-term disability resulting from a sickness or injury and may continue for up to six months subject to the provisions noted below under "When Benefits Terminate" and "Periods of Disability." During the ten-day elimination period, an employee must use any available days from the employee's Sick Leave Reserve (SLR)/Combined Time Off (CTO) to receive continued salary. If/once the employee has exhausted available paid time, the remainder of the elimination period will be unpaid.
The benefit amount received is as follows.
- After the elimination period, employees will be paid 100% of their weekly earnings for the remainder of the eligible short-term disability period under the Program less all applicable taxes and any elected employee benefit contribution amounts.
- Employees who return to work on a reduced work schedule will receive 100% of their weekly earnings for any time worked less all applicable taxes and any elected employee benefit contribution amounts.
The amount paid under this Program will be reduced by certain other income benefits that an employee receives for the short-term disability period, as listed below. Note: this reduction does not apply if state law or regulation does not allow salary continuation benefits for short-term disability to be reduced by any of the following types of income:
- All disability benefits that the employee is entitled to receive from any applicable temporary disability benefits required by state law.
- All disability benefits that an employee is entitled to receive from any other group plan. Note: This does not include individual short-term disability plans such as AFLAC .
- All disability benefits an employee is entitled to under any; (a) no-fault motor vehicle coverage; (b) motor vehicle financial responsibility act; or (c) similar law. All disability benefits to which an employee is entitled from any third party when the short-term disability is the result of the negligence or intentional tort of that third party.
- All workers' compensation wage benefits that the employee is entitled to receive for the period of short-term disability.
Each employee receiving benefits under this Program shall immediately report to the Office of Human Resources any income such employee receives for his or her short-term disability. Failure to report such income may result in an employee's ineligibility for benefits under the Program.
When Benefits Terminate
Benefits under the Program with terminate at the earliest of the following dates.
- The date indicated by the employee's Provider as the employee's return-to-work date;
- The date that the employee exhausts the available benefit period provided by the Program;
- The date the employee fails to provide requested documentation or to comply with other terms of the Program;
- The date the employee informs the University that s/he will not be returning to work; or
- The date that is six months from the date of short-term disability.
Benefits will not cover short-term disabilities due to injuries that resulted from active participation in the commission of a crime.
Unless prohibited by law, if at the end of the extended sick leave benefit period an employee is unable to return to work, employment with the University may be terminated. The University will on a case-by-case basis determine if a reasonable accommodation can be made to extend employment for a qualified individual with a disability for purposes of the ADA. See below "Return-to-Work Program."
Employees are eligible to receive salary continuation benefits for up to six consecutive months for any single period of short-term disability.
If an employee returns to his/her normal work schedule for a period of more than one month but less than 12 months and thereafter becomes short-term disabled again due to the same or substantially related condition(s), the reoccurrence will not be subject to a new elimination period. The maximum allowance in any twelve-month period will be six months of salary continuation.
Washington and Lee has a Return-to-Work Program to help employees who cannot work at full capacity return to work in a modified, less demanding assignment on a temporary basis where such modifications do not create an undue hardship for the University. This will afford the employee the opportunity to return to work on either a reduced schedule basis or at an earlier date than s/he would have otherwise. Additional information on the Return-to-Work Program is available in the Employee Handbook and from the University's Human Resources Office.
While on short-term disability under this Program, employees will continue to receive the University benefits to which they are entitled and in which they are enrolled (for example, group health insurance, life insurance, retirement plan contributions) on the same basis as prior to the start of their short-term disability, subject to the terms, conditions, and legal requirements applicable to such benefits. Employees will continue to pay any amounts they had previously designated to be deferred for these benefits (See Coordination with Family and Medical Leave below).
In general, except as provided under the terms and conditions of other plans, programs or policies of the University, any period for which an employee is out on short-term disability and is eligible for benefits under this Program shall be treated as a period of approved leave and continued employment with the University. If an employee exhausts the salary continuation benefit under this Program, any other benefits that are able to be continued after the end of the approved short-term disability/extended sick leave will be offered in accordance with any applicable law or insurance contract, including, but not limited to, COBRA, waiver of premium provisions, conversion provisions, etc., or as otherwise provided in the Employee Handbook regarding any further period of approved unpaid leave.
If an employee's short-term disability leave is also eligible to be covered under the requirements of FMLA, the leave provided under the Program will run on a concurrent basis with FMLA leave. This includes employees retaining the right to continue or suspend their health coverage during their FMLA leave. For any employees who elect to suspend their health coverage during FMLA leave, when the employee returns from FMLA leave, the employee will be able to re-enroll for health coverage on the same basis as before the short-term disability leave began.
However, this Program provides for a paid benefit leave period and a longer leave period than required under FMLA. Therefore, any employee retains the right to only provide the documentation and comply with the obligations as required under FMLA and forego the salary continuation benefit provided by this Program.
The Program does not duplicate the requirements and benefits offered under the University's insured LTD plan; therefore, eligibility to receive salary continuation under the Program does not guarantee that benefits will be paid under the insured LTD plan.
Additional information on LTD benefits is included in the LTD carrier's booklet and/or is available from the Human Resources Office.
After the elimination period, an employee must submit written evidence of his/her short-term disability to Human Resources. This written evidence includes a completed Short-Term Disability Statement (available from Human Resources) and a Provider's statement, which includes diagnosis, prognosis, and expected date of return to work.
The University retains the right to require an employee to submit to an independent medical examination (IME) by a Provider of the University's choice to receive salary continuation benefits. The results of the IME will be binding on both the University and the employee. If an employee refuses to do so, benefits will be terminated under the Program.
Once the short-term disability has been approved, the salary continuation benefit will be paid in accordance with the Program. Checks will either be sent to the address that you have provided or, if you choose, automatically deposited into your bank account
Employees may have their short-term disability approved prior to the actual start of the disability, (for example, pregnancy or childbirth related incapacity, scheduled procedures, etc.) if all the required documentation has been submitted for such approval.
Continued evidence of short-term disability may be required on at least a monthly basis. However, the University reserves the right to require more frequent evidence of short-term disability.
If an error occurs and an employee is overpaid amounts due them under the Program, the University has the right to recover such overpayments.
The University also has the right to recover any salary benefit paid for absences ultimately disapproved under this Program.
If the University determines that an employee has fraudulently or intentionally misrepresented his/her health condition or ability to work in order to obtain benefits under this Program, the University has the right to recover salary already paid under this Program, in addition to any other remedies it may seek, not limited to disciplinary action or prosecution.
The University will be responsible for the day-to-day operation of this Program, including the right to contract with third-party claims administrators for claim reviews.
The University reserves the right to amend or terminate this Program. However, any change or termination will not affect the salary continuation and associated benefits of employees who are receiving benefits under the Program at the time of such change or termination.
Nothing in this Program diminishes or eliminates an employee's rights under the Americans with Disabilities Act, the Family and Medical Leave Act, or any other law which may be applicable to an employee's physical or mental health condition or other circumstances associated with an employee's claim for benefits under this Program, or any other disability benefit sponsored by the University.
DATE adopted: 2/11/2013