Short Term Disability
If you cannot work due to an illness, non-work-related injury, or pregnancy, you may be eligible for short-term disability benefits through the Health and Welfare Plan. The Short-term disability benefits are self-administered.
- How Short-Term Disability Benefits Work
- Applying for Short-Term Disability Benefits
- Continuing Your Health & Welfare Coverage While You Are Disabled
- Collecting Disability Benefits While You Wait for a Workers’ Compensation Appeal Determination
- When Disability Benefits End
How Short-Term Disability Benefits Work
Short-term disability benefits are paid to you if you suffer an illness or injury that is not work-related. You will receive $170 per week (or $270 per week if you are pregnant) during your disability for up to 26 weeks.
If your application is approved, a check will be mailed to the address you provide on your application.
Employee FICA taxes, in addition to federal and state taxes, will be deducted from your payment. Short-term disability benefits begin after you have used all your sick leave or after a waiting period of 30 days, whichever occurs later.
Benefits are payable only for periods during which you are certified as unable to perform your job duties by your attending physician. Physician certification is required at least monthly. Periods of disability of less than one week will be pro-rated based on a five-day workweek.
Benefits are not payable if your disability is the result of:
- Injuries or diseases resulting from or sustained during service in the armed forces of the United States or any other nation.
- Injuries or diseases resulting from or sustained by you while in the service of another employer during a period of leave of absence or layoff from METRO.
- Illness or injury caused or resulting directly or indirectly from the use of narcotics or your criminal misconduct.
- If you become disabled due to work-related illness or injury, you may be eligible for Workers’ Compensation or Compensation under similar legislation.
Applying for Short-Term Disability Benefits
Contact Health & Welfare Plan and request a Short-Term Disability application.
If you have already received a short-term disability benefit from the Plan, you can submit a new claim for STD benefits only after you have returned to work for at least 28 calendar days. The 28-day rule for a new claim does not apply if you return to work sooner than 26 weeks, stay for no more than 45 calendar days, and cannot continue working due to the same condition that led to your first STD claim.
Continuing Your Health & Welfare Coverage While You Are Disabled
While you’re on short-term disability for any reason, you are required to make your Health & Welfare monthly premium payments. The Health & Welfare Plan does not bill you or send notice that payment is due. If you do not make your payments, you will lose your medical coverage, life insurance, and short-term disability coverage.
Your Health & Welfare monthly premium payments will be deducted from your short-term disability payments. You can have your STD payments deposited directly (via electronic payment) to your bank account. Contact the Health & Welfare Plan for more information about this process.
Collecting Disability Benefits While You Wait for a Workers’ Compensation Appeal Determination
If you agree to re-pay your benefits to the Plan if your injury or illness is compensable under Workers’ Compensation or similar legislation, you can receive your disability benefits pending the appeal determination.
When Disability Benefits End
Your short-term disability benefits will end at the earliest of:
- when you return to work
- when you are deemed able to return to work by your attending physician
- when you retire
- when your maximum benefit of 26 weeks has expired
Employees voluntarily participating in the Employee Assistance Program may be eligible for short-term disability benefits for up to 26 weeks if they comply with the program.
Long Term Disability
If you cannot work due to a disability that lasts longer than 180 days, you may be eligible for long-term disability coverage through the Health & Welfare Plan. Long-term disability coverage protects you against loss of income if you are totally disabled. Unlike short-term disability benefits, workers’ compensation eligibility does not affect your eligibility for long-term disability benefits.
- How Long-Term Disability Benefits Work
- Eligibility
- Definition of Disabled
- Duration of Long-Term Disability Benefits
- How to File a Claim for Long-Term Disability Benefits
- Long-Term Disability Benefit Plan
How Long-Term Disability Benefits Work
Effective September 1, 2020, after you have been disabled for at least 180 days and file a claim, you will be paid 55% of your base monthly earnings, up to $5,000 per month, during your disability. However, the amount you receive will be reduced by any other income you receive, like Social Security, pension benefits, and Workers’ Compensation.
When you begin receiving your Social Security disability benefits, your long-term disability benefits will be reduced by the amount of your Social Security disability benefits. If your Social Security disability benefits are retroactive, you will be responsible for paying back retroactive reductions to the LTD carrier.
Eligibility
To be eligible for long-term disability, you must be an active, full-time, or part-time employee who is a participating member of the Transit Employees’ Health & Welfare Plan and who is represented by the Amalgamated Transit Union Local 689 (this includes employees on leave of absence while holding office in or performing duties for the Union or a State or Local AFL-CIO Central Body, or as a staff member of the Transit Employees Health & Welfare Plan). Re-hired retired employees are excluded.
Definition of Disabled
“Disabled” or “Disability” means that, due to sickness, pregnancy, or accidental injury, you are receiving appropriate care and treatment from a doctor continuingly and:
- During the 180 days of continuous disability before your long-term disability benefit begins and 36 months following that period, you are unable to earn more than 80% of the salary that you earned before your disability occurred in the same job; (“own occupation” rule) and
- After the 36 months, you cannot earn more than 80% of the salary you earned before your disability occurred in any job for which you are reasonably qualified based on your training, education, experience, and former wage.
Duration of Long-Term Disability Benefits
Your long-term disability benefits are paid according to the chart below.
| Your age on the date your Disability Starts | Benefits Are Paid |
|---|---|
| Younger than age 63 | To normal retirement age, or for 42 months if greater |
| 63 | To normal retirement age, or for 36 months if greater |
| 64 | 30 months |
| 65 | 24 months |
| 66 | 21 months |
| 67 | 18 months |
| 68 | 15 months |
| 69 and over | 12 months |
How to File a Claim for Long-Term Disability Benefits
Contact Health & Welfare Plan to get a Long-Term Disability Application.
You should file your application for long-term disability as soon as possible.
You will need to provide your LTD administrator with:
- proof of your continuing disability
- proof that you are under the appropriate care and treatment of a doctor throughout your disability
- information about other income benefits
- any other material information related to your disability that is requested, including the date the disability started, the cause of the disability, and the prognosis of the disability.
Contact your LTD administrator for more information.
Long-Term Disability Benefit Plan
Download the Long-Term Disability Benefit Plan for more info.
