Your long-term disability benefits are designed to provide continuing income if you become ill or injured, and are unable to work.  You are eligible to participate in this plan as described in the “About Your Benefits” section.  You are not eligible to participate in this plan if you are on leave without pay, including educational leave, personal leave, family medical leave or military leave.

You become entitled to benefits after you have been totally disabled, as defined in the Glossary, for 180 calendar days. Long-term disability benefits pick up where short-term disability benefits leave off, after you have been disabled for 180 calendar days.

NOTE:  Six months or 26 weeks of disability are administered as 180 days.

Benefit Amount

Your monthly long-term disability plan benefit equals 60% of your regular monthly Pay as of your last day of short-term disability, up to a maximum monthly benefit of $5,000, reduced by income you are eligible to receive from other sources, as described under “Reduction of Benefits.”

“Pay” is defined in the Glossary.

 

Duration of Benefits

Benefits under the long-term disability plan are payable to you once you have been totally disabled, as defined in the Glossary, for 180 calendar days, subject to approval by the claims administrator for the Company. 

Phase One
Under the long-term disability plan, you are considered totally disabled during your first 24 months of long-term disability if you are unable to perform the duties of your regular job with the Company due to illness or injury, and are under the appropriate care and treatment of a licensed practicing physician. 

“Appropriate Care and Treatment” is defined in the Glossary.

Should you recover from your illness/injury during the first 24 months of long-term disability leave, you must contact the Company Disability Administration Office to request a return to work medical evaluation.

The decision on whether you return to work will be based on the results of this medical evaluation and the availability of a position for which you qualify.  The Disability Administration Office will verify that a position is available for you.  If a position is available, a return to work medical evaluation will be completed. 

Phase Two
After you have received long-term disability benefits for 24 months, you are considered totally disabled if you remain under the appropriate care and treatment of a licensed practicing physician and you are unable to work at any job for which you might be qualified, based on your education, training and experience. 

You may be eligible for severance pay after receiving long-term disability benefits for 24 months.  Severance pay benefits are calculated based on your last day worked.  See the “Severance Plan” section for details.

While you are receiving long-term disability benefits under either Phase One or Two, you must furnish periodic medical evidence of your illness or injury if requested by the Company, and you may be required to undergo periodic evaluations in order for the Company to determine whether you are able to return to work.  Failure to do so can result in your benefits being discontinued.

Normally, if you qualify for benefits under the provisions of the plan as stated above, long-term disability benefits are payable until you recover or until you reach age 65, if earlier (unless one of the events under “When Long-Term Disability Benefits End” occurs).  However, special provisions apply if you are age 60 or older when you become totally disabled.  If you become totally disabled:

• at age 60 but before age 69, benefits are payable for up to five years (starting with the date you begin long-term disability) or until age 70, whichever comes first
• at or after age 69, benefits are payable for up to 12 months (starting with the date you begin long-term disability). 

For example, for a 59-year old employee who begins short-term disability in November 2005, turns 60 in December 2005 and then begins long-term disability benefits in May 2006 – this employee’s long-term disability would end in May 2011.

 

Reduction of Benefits

Your long-term disability benefits are reduced by other sources of income that are payable to you because of your disability.  Income that will reduce your long-term disability benefits includes but is not limited to:

• workers' compensation benefits or benefits provided under a similar law, state disability benefits and other statutory benefits for disability, retirement, or unemployment
• benefits provided through Company benefit plans, including the pension and business travel accident insurance plans
• income you receive for working on a reduced-hour basis or for rehabilitative employment

or

• any Social Security disability benefits for which you are eligible (refer to the Social Security and long-term disability benefits chart that follows). 

If any of this income is paid as a lump sum and results in an overpayment of disability benefits to you, you must reimburse the Company for the amount of the overpayment.  If you do not repay the Company, your long-term disability benefit will be calculated as if this income is paid monthly.  The Company has the right to recover any overpayments you receive, and your monthly benefit payment will be reduced by the maximum amount possible, as determined by the claims administrator, to recover any overpayment you receive. 

The claims administrator which pays the long-term disability benefits will instruct you on how to apply for Social Security benefits.  If you do not exhaust the steps to obtain Social Security benefits, your long-term disability benefits will be reduced by your estimated Social Security benefits, as calculated by the claims administrator.  See the following “Social Security and Long-Term Disability Benefits” chart for more information.

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

Determining Your Long-Term Disability Benefit To calculate the amount you are eligible to receive under the long-term disability plan, follow these steps: Step 1:    Multiply your monthly Pay by 60% to determin your maximum monthly                 benefit the plan up to $5,000.   Step 2:    Subtract other income you are eligible to receive, except for family                 Social Security, to find your adjusted monthly benefit from the plan.                 Continue on to Step 3 only if you are eligible to receive family Social                 Security.   Step 3:    Add your adjusted monthly benefit (from Step 2) to all other income you                 are eligible to receive, including family Social Security.  If the resulting                 total of all income benefits you are eligible to receive is more than 75% of                 your monthly Pay, your monthly long-term disability benefit will be                 reduced to bring your total disability income to 75% of your monthly Pay.

Social Security and Long-Term Disability Benefits
You should apply for Social Security disability benefits within 90 days of the date your long-term disability leave becomes effective.  If you have not received a benefit determination from Social Security after you have been receiving long-term disability benefits for 12 months, or if your original claim is denied and you do not file an appeal within 30 days of your receipt of the denial, then your long-term disability benefits will be reduced by your estimated Social Security benefits, as calculated by the claims administrator.
If...	Then...
You later complete the Social Security appeals process and are denied benefits	Your long-term disability benefits will be retroactively reinstated, and you will receive a "catch-up" payment.
You receive a cost of living increase to your Social Security disability income after your long-term disability benefit has been calculated	Your long-term disability benefits will not change.
Your disability makes you eligible to receive family Social Security benefits	Your total disability income from all sources may not exceed 75% of your monthly Pay.

 

Claiming Long-Term Disability Benefits

Long-term disability benefits cannot begin until the claim forms sent to you by the claims administrator have been satisfactorily completed by you and your physician and received by the claims administrator.  The claims administrator and the Disability Administration Office will assist you in filing your claim. 

You are required to apply for Social Security and any other income you may be eligible to receive as a result of your disability.  If your initial application for Social Security is denied, you are required to pursue the entire Social Security benefits appeals process through the Social Security Office. 

 

Exclusions

Long-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
• 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
• resulting from your attempt to commit or commission of a crime under state or federal law
  or
• directly or indirectly due to war, declared or undeclared

 

Taking a Job While Disabled

If you return to work at the Company in a full-time position on an approved reduced-hour basis, you will be eligible to receive 100% of Pay, and your long-term disability benefits will end.  You may work a reduced-hour schedule for up to five months, subject to Company approval.  If you are not able to resume a full schedule after the period for which your reduced-hour schedule is approved, the reduced-hour work schedule will end.  You will then return to long-term disability status, and your long-term disability benefits will resume.

The claims administrator provides a rehabilitative employment program to assist you in pursuing other employment opportunities if it is determined that you will not be able to return to your job at the Company.  If you participate in the rehabilitative employment program, you will be eligible to continue to receive part of your long-term disability income during your participation.  Your monthly long-term disability benefits will be reduced by 70% of any income you receive from your rehabilitative employment.  Your combined long-term disability benefit and rehabilitative employment income cannot exceed 100% of your regular monthly Pay as of your last day of short-term disability.  Your participation in the rehabilitative employment program and the length of time you participate are subject to the discretion and approval by both the Company and the claims administrator.

Example of Offset for Rehabilitative Income
Assume you begin receiving rehabilitative income of $1,500 a month.
Monthly rehabilitative income...	$1,500
x 70%
Max. rehabilitative income offset …	$1,050
Assume your long-term disability benefit is $2,500 a month.
Monthly long-term disability benefit …		$2,500
– Monthly rehabilitative income offset …		– $1,050
= Adjusted disability benefit...		$ 1,450
+ Rehabilitative income...		+ 1,500
Final monthly income...		$2,950

 

When Long-Term Disability Benefits End

Long-term disability benefits will end on the first of the following days when:

• you refuse 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 long-term disability plan
• you become self-employed or perform services for a third party without the prior written permission of the claims administrator
• you recover from your disability
• you return to work
• you have received the maximum number of benefit payments
• you are confined in a jail, prison, or other penal facility or correctional facility
• you retire
• you die
• you voluntarily decline the benefits
• the collective bargaining agreement expires (for hourly employees only)

or

• the plan terminates.

 

Successive Disabilities

If you receive long-term disability benefits, return to work for less than 520 hours or 90 calendar days (whichever is longer) and again become disabled due to the same illness or injury, long-term disability income will resume without a six-month waiting period.  However, if you have been working for at least 520 hours, or more than 90 calendar days (whichever is longer), you will need to satisfy the waiting period before long-term disability benefits begin. 

Disabilities due to unrelated causes will be treated as separate disabilities requiring satisfaction of separate waiting periods if the disabilities are separated by your return to work for eight consecutive hours. 

 

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.  In addition, the collective bargaining agreement contains information related to the resolution of disputes for hourly employees.

Administrative Information Information about the administration of your disability benefits can be found in the section entitled “Administrative Information.”