Claiming Short-Term Disability Benefits

If you are unable to come to work because of a short-term disability absence, you must contact the claims administrator for the Company in order to receive benefits.

• If you are a salaried employee, you must call on the fourth calendar day of your absence.
• If you are an hourly employee, you must call on the fourth work day of your absence or earlier if you are admitted to a hospital as an inpatient or receive treatment as a day surgery patient during the waiting period.
• You must also contact the claims administrator for anticipated absences related to pregnancy or a scheduled surgery or other procedure or treatment. 

The claims administrator will give you further instructions, send you an information packet via U.S. mail for your claim for benefits, and answer any questions you may have.

Also, you must furnish periodic medical evidence of your pregnancy, illness or injury if requested by the Company or claims administrator; you must provide the requested information within the timeframe stated in the request, or your benefits may be suspended or denied.  The Company and claims administrator reserve the right to confirm your disability with a physician and/or require a written statement from your attending physician at any time during your absence.  Upon return to work, a physician's statement may be required indicating your fitness to resume work duties. 

“Physician” is defined in the Glossary.

In addition, during your disability, you may be required to undergo periodic evaluations in order for the Company to determine if you are able to return to light duty or a reduced work schedule.  You may work a reduced schedule for up to five months subject to the approval of the Company.

The claims administrator has the authority to interpret and administer the plan for the Company.

The claims administrator will notify you of their decision regarding approval of your claim or if additional information is needed to make a decision on your claim.

If you take an unpaid leave of absence, you must return to active work for at least one full regularly scheduled work day (normally eight consecutive hours) to resume eligibility for short-term disability benefits.

Benefit Payments
Plan benefits will be reduced by income benefits you are eligible to receive from other sources because of your disability, such as workers' compensation or any state or federal disability or occupational disease laws or benefits.

If your absence extends beyond 180 calendar days, benefits may become payable according to the Company's long-term disability plan. Any short-term disability benefit overpayments you receive may be recovered by the Company from amounts owed to you when you go on long-term disability or from benefit payments you receive under the long-term disability plan.

Your plan benefits will not be reduced by any private disability coverage that you have purchased.

Exclusions

Short-term disability benefits are not payable for disabilities:

• if you are not under the appropriate care and treatment of a licensed practicing physician
• that result from working for yourself (in an income-producing capacity except for Company-approved arrangements) or an employer other than UT-Battelle
• due to willful misconduct, violation of Company rules, or refusal to use safety appliances
• due to any intentionally self-inflicted injury

or

• resulting from your attempt to commit or the commission of a crime under state or federal law.

In addition to the above exclusions, if you are an hourly employee, short-term disability benefits are not payable for disabilities:

• occurring during the first 12 months that your plan coverage is in effect if caused by any condition for which you received treatment during the three-month period immediately before your plan coverage became effective

or

• directly or indirectly due to war, declared or undeclared.

When Short-Term Disability Benefits End

Benefits for any absence will end on the first of the following days when:

• you refuse to contact your supervisor and the claims administrator to report your disability or to provide updates about your continuing disability
• you do not provide requested satisfactory evidence of or provide incorrect information about your disability
• you refuse to be examined by a physician, ignore a physician’s appointment or stop following a physician’s prescribed course of treatment
• you refuse to follow any step related to the administration of the short-term disability plan
• you become self-employed or perform services for a third party without the prior written permission of the Company or claims administrator
• you are no longer considered eligible because of a change in your employment status
• you recover from your disability
• you return to work
• you do not return to work for light duty or a reduced work schedule if you are able
• you have received the maximum number of benefit payments
• your employment with the Company is terminated for any reason
• you are confined in a jail, prison, or other penal facility or correctional facility
• you are no longer an active employee
• you voluntarily decline the benefits
• the collective bargaining agreement expires (for hourly employees only)

or

• the plan terminates. 

Appeal Procedures
You may file claims for plan benefits and appeal adverse claim decisions.  For appeal procedures, see “Claims Review & Appeals” in the “Administrative Information” section.