HomeMy WebLinkAboutRESOLUTIONS - 01011981 - 1981-907 In the Board of Supervisors
of
Contra Costa County, State of California
RESOLUTION NO. 81/907
In the Motter of
Long Term Disability
Benefits for Management
Employees
The Contra Costa County Board of Supervisors in its capacity as
governing board of the County of Contra Costa and all districts of which
it is the ex officio governing board resolves that:
1 . Effective August 1 , 1980 the long term disability benefits
formerly provided unrepresented management employees by
insurance under an insurance policy with Standard Insurance
Company shall be provided by the County under a self-insured
program.
2. Those benefits will be as follows:
Section 1 . GENERAL DISABILITY BENEFITS
A. AMOUNT OF MONTHLY INCOME 60% of the first $3,333 of the
Member's basic monthly earnings,
reduced by all Deductible Benefits.
B. MAXIMUM BENEFIT PERIOD:
1 ) For Safety Members of the County Retirement System - To age
60 or 12 months, whichever is longer.
2) For all other Members:
AGE* AT BEGINNING MAXIMUM BENEFIT
OF TOTAL DISABILITY PERIOD
61 or younger. . . . . . . . . . . . . . . . . . . . . .To age 65
62 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 years 6 months
63 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 years
64 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 years 6 months
65 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 ,years
66 . . . • . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 year 9 months
67 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 year 6 months
68 . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . .1 year 3 months
69 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 year
70 or older. . . . . . . . . . . . . . . . . . . . . . . .0
*Age means age at the Member's last birthday.
RESOLUTION NO. 81/907
C. WAITING PERIOD - Benefits will not be paid for either (1 )
the first 120 days of each period of total
disability or (2) the period of Sick Leave
and Vacation Pay to which the Member is
entitled under the Employer's Sick Leave and
Vacation Programs, whichever is longer.
Section 2. DEFINITIONS
A. General Definitions
1 . "Member" means a regular permanent classified or exempt employee
whose job classification has been formally identified as a manage-
ment classification eligible for these benefits by Resolution of
the Contra Costa County Board of Supervisors or formal designation
of the County Employee Relations Officer, an Elected Official , or
a member of the Board of Supervisors of the County of Contra Costa
and who is regularly working at least 20 hours per week throughout
the entire duration of the Employer's work week.
2. "Employer" means Contra Costa County and such affiliated Districts
as shall be approved by the Contra Costa County Board of Supervisors.
3. "Basic Monthly Earnings" means basic monthly wage or salary (not
including overtime, bonuses, commissions and other extra compen-
sation) earned by the member while working for the employer. For
purpose of receiving benefits under this program, basic monthly
earnings shall be determined as of the first day of the calendar
month in which the disability commences or other loss occurs.
Any change in basic wage or salary approved after total disability
begins or after any other loss occurs shall not be considered in
determining the amount of basic monthly earnings. Basin monthly
earnings during an approved rehabilitation program under Long
Term Disability Coverage are reduced by earnings from the program
(see "Rehabilitation". )
4. "Actively at work" means the member is currently employed and
actually performing the duties of that employment in a full-time
permanent capacity at the Employer's usual place of business and
has completed at least one full day of such employment.
5. "Termination of employment", when necessary to determine termination
of status as a Member, means cessation of active work as an employee,
except that if a Member is absent from active work because of sickness
or injury, his employment shall be deemed to continue until terminated
by the employer.
B. LONG TERM DISABILITY BENEFITS DEFINITIONS
1 . "Monthly Income" means the monthly amount of Long Term Disability
benefit payable to a disabled Member pursuant to all the terms and
conditions of this program.
2. "Deductible Benefits" is income which, if received by a member, will
result in a like reduction in long term benefits hereunder subject
to the EXCEPTIONS and DEDUCTIBLE BENEFITS RULES shown below;
Deductible benefits are:
a. The amount of any salary or other compensation paid by the
employer.
b. The amount to which the Member, the Member's dependents and
any other persons are entitled by reason of the Member's
disability or retirement under:
(1 ) a worker's compensation act or similar law (including
benefits for partial or total disability, whether
permanent or temporary) ;
(2) any federal , state or other governmental disability
or retirement plan (including but not limited to the
Federal Social Security Act) ;
RES . NO. 81/907
(3) Any retirement plan (pension, profit-sharing and others)
toward which any employer contributed or made payroll
deductions;
(4) any group insurance coverage;
(5) any arrangement of coverage for individuals in a common
group (association coverage, franchise insurance, whole-
sale insurance, individual disability policies toward
which any employer made a contribution, and others).
3. "EXCEPTIONS" means income which, if received by members, will not be
deducted from the long term benefits hereunder. The following
are "exceptions"; they will not be Deductible Benefits:
a. The amount of any increase in benefits under any federal ,
state or other governmental disability or retirement plan
which becomes effective while the Member is totally disabled
and entitled to benefits under such plan and which is
designated under the terms of the plan as a cost of living
increase.
b. Any Social Security benefits received by a dependent child
age 18 or over as a result of the Member's disability or
retirement.
c. Any lump sum payment from a retirement plan provided:
(1 ) such lump sum payment represents the Member's
entire interest under such plan, and
(2) the Member was not eligible to receive an annuity
in lieu of a lump sum payment.
d. Group credit disability insurance benefits.
e. The amount of benefits received, as a result of partial
disability or retirement, which begin prior to the
effective date of the Member's long term disability benefits
under the county program and continue until the commence-
ment of total disability.
f. Any amount received from any source as reimbursement for
hospital , medical or surgical expenses.
g. Any portion of a Deductible Benefit settlement or judgment
which represents attorneys fees incurred in connection with
the recovery of the Deductible Benefit.
h. Payments of deferred compensation.
4. "DEDUCTIBLE BENEFIT RULES" means the following rules which govern
computation of the effects of Deductible Benefits hereunder:
a. If election may be made under any Deductible Benefit which
would increase or decrease the amount of the monthly benefit,
the amount of the Deductible Benefit shall be the amount
applicable in the absence of any such election.
b. If any Deductible Benefit income is paid or payable other
than monthly (including a lump sum payment) the County shall
determine the monthly equivalent which equitably adjusts for
the amount of monthly income hereunder.
c. Deductible Benefits shall be considered to have been paid
notwithstanding that the Member has not effected timely
or proper pursuit of claim therefor or claim therefor is
pending, where it is reasonable to believe that the benefits
would be paid but for the failure of member to elect timely
pursuit of claim or that the benefits for which claim is
pending will be paid, as the case may be.
RES . NO. 81/907
d. If at any time it is determined that the Deductible Benefits
used to compute long term disability benefits are incorrect,
any Monthly Income payments already made shall be retroactively
adjusted and future Monthly Income payments will be adjusted
accordingly.
5. "Hospital" means an institution operated for the care and treat-
ment of sick or injured persons which is legally constituted and
licensed as a hospital and which satisfies all of the following
requirements:
a. Such institution must be under the supervision of a medical
staff of legally qualified physicians and must have 24 hour
nursing service by registered graduate nurses.
b. Such institution:
(1 ) must be a state or federal institution for care and
treatment of mental illness, nervous disorders,
alcoholism or drug addiction, or
(2) must have organized facilities for diagnosis and major
surgery.
c. Such institution must not be specializing as a rest home,
nursing home, convalescent home or home for the aged.
6. "Physician" means a duly licensed physician, osteopath, chiro-
practor, optometrist or chiropodist other than the Member,
treating sickness, injury or pregnancy within the scope and
limitations of his license.
7. "Total Disability" in connection with any one continuous period of
disability is defined as follows.
a. For Safety Employees.
(1 ) During the waiting period and for the first 12 months
thereafter, total disability means complete inability
of the Member to engage in his regular occupation.
(2) Thereafter during the continuance of the same period
of disability, total disability means complete inability
of the Member to engage in any employment or occupation
for which he is or becomes reasonably fitted by reason
of education, training or experience.
b. For all other Members:
(1 ) During the waiting period and for the first 24 months
thereafter, total disability means complete inability
of the Member to engage in his regular occupation.
(2) Thereafter during the continuance of the same period
of disability, total disability means complete inability
of the Member to engage in any employment or occupation
for which he is or becomes reasonably fitted by reason
of education, training or experience.
Section 3. ELIGIBILITY FOR PARTICIPATION
A. Members Eligible
1 . For Safety Members of the County Retirement System, a person under age 60
is eligible to participate in the program:
a. If he was a Member on August 1 , 1380; or
b. If he becomes a Member after August 1 , 1380, in which case he
become eligible on the first day of the calendar month next
following the date he becomes a Member.
RES. NO. 81J907
2. For all other Members, a person under age 70:
a. If he was a Member on August 1 , 1980; or
b. If he becomes a Member after August 1 , 1980, in which case he
become eligible on the first day of the calendar month next
following the date he becomes a Member.
B. Members Not Eligible
1 . For Safety members of the County Retirement System, a person who has
attained his 60th birthday on the date on which he would otherwise
become eligible shall not become eligible; no benefits shall be
available to him.
2. For all other members,, a person who has attained his 70th birthday
on the date on which he would otherwise become eligible shall not become
eligible; no benefits shall be available to him.
C. Effective Dates
1 . A Member's eligibility becomes effective when he has been actively at
work for at least one day after the date he became eligible.
2. A Member's eligibility who is not actively at work on the date when
his insurance would otherwise become effective becomes effective on
the next following day on which he is actively at work.
D. Cessation of Eligibility
A Member's eligibility automatically ceases on the earliest of the following
dates:
a. The date of termination of his status as a Member.
b. The date he becomes a full time member of the military (land, sea
or air) forces of any country.
c. The first day of the calendar month next following his 60th birthday
for safety members and 70th birthday for all other members.
d. The date of discontinuance of the program.
Section 4. LONG TERM DISABILITY
BENEFIT PROVISIONS
A. BENEFITS PAYABLE
1 . Monthly Income
Upon receipt by the County of notice and satisfactory proof that any
eligible Member, has become totally disabled as a result of injury or
sickness, and that during the period of such total disability such
Member has been under the regular care and attendance of a physician,
The County will pay periodically the Monthly Income in accordance
with Section 1 . A. during the continuance of such total disability,
subject to all Exceptions and Limitations, and subject to the following
provisions:
a. No Monthly Income shall accrue during the Waiting Period.
b. No Monthly income shall accrue after the end of the Maximum
Benefit Period shown in Section 1 . B. The Maximum Benefit
Period begins at the end of the Waiting Period, and applies
to each continuous period of total disability, whether
from one or more causes.
c. If a Member, under the terms of his employment, is scheduled
to be away from work without pay, any such scheduled period
during which the Member is totally disabled shall not be
treated as a period of total disability for purposes of the
Waiting Period and the Maximum Benefit Period.
RES . NO. 81/907
2. Recurrent Disabilities
a. During Waiting Period
If two or more periods of total disability commence during
the waiting period, all such periods of total disability
shall be added together and considered as one period of
continuous total disability, provided all the following
requirements are met:
(1 ) All periods of total disability must be due to the
same cause or causes and each period must commence
while the Member is eligible for participation in
the long term disability program.
(2) The total number of days of temporary recovery from
total disability must not exceed 5 days for each 30
days of the waiting period,
(3) If the total number of days of temporary recovery
exceeds 5 days for each 30 days of the waiting period,
each period of total disability will be considered as
a separate period of total disability. No long term
disability benefits will accrue until the waiting
period has been properly served (from beginning to
end).
b. After Waiting Period
If Monthly Income is paid to a Member during a period of
total disability, and if the Member recovers from such
total disability and becomes totally disabled again from
the same cause or causes within 6 months, the two periods
of total disability will be added together and considered
as one continuous period of total disability. There will
be no waiting period in connection with the second period
of total disability. However, the following provisions
will apply:
(1 ) No Monthly Income will be paid unless the
member is eligible when the second period of
total disability begins.
(2) No Monthly Income will be paid for the second
period of total disability if the maximum
benefit period ended during the first period
of total disability.
(3) If the maximum benefit period did not end during
the first period of total disability, Monthly
Income payments will be made during the second
period of total disability only for the balance
of the maximum benefit period.
3. Special Dismemberment Benefit
a. General
Upon receipt by the County of notice and satisfactory proof that
any eligible Member has sustained any of the losses shown in the
following Table of Losses, as a direct result of accidental bodily
injuries, independently of all other causes and within 90 days of
the date of such accident, the County will consider the Member,
who due to such injury is not actively at work, to be totally
disabled for the period of time listed in the Table of Losses, even
though the Member may not be totally disabled as defined herein,
and benefits, if any, will be payable accordingly.
RES . 'INTO. 81/907
TABLE OF LOSSES
Type of Loss Minimum Disability Period
Any two or more of eyes, hands or feet. . . . . . . . . . . . . . . . . .30 Months
One hand, one foot or one eye. . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Months
Loss shall mean, with regard tohands and feet, actual severance
through or above wrist or ankle joints; with regard to eyes, entire
and irrecoverable loss of sight.
b. Special Dismemberment Provisions
This Special Dismemberment Benefit shall be subject to the following
provisions:
(1 ) During the Minimum Disability Period Deductible Benefits
will not be deducted.
(2) Benefits will begin at the end of the Waiting Period and
continue until the end of the Minimum Disability Period
or the death of the Member, whichever is earlier.
(3) Benefits under this Special Dismemberment provision shall
be in lieu of benefits otherwise provided during the
Minimum Disability Period.
(4) If the Member is totally disabled at the end of the Minimum
Disability Period any further Long Term Disability benefits
payable under the group shall be paid as provided.
(5) Even though a loss- results from accidental bodily injury, no
Special Dismemberment Benefits will be paid if such loss or
accident is caused directly or indirectly by any of the
following:
(a) Any insurrection, war, or act of war. War includes
declared or undeclared war, whether civil or inter-
national , and any substantial armed conflict with
organized forces of a military nature.
(b) Injuries intentionally inflicted by the Member, while
sane or insane.
(c) committing or attempting to commit an assault or
felony, or participating in a violent disorder.
(d) Any self-administered drug, poison or chemical
compound, bodily or mental infirmity, sickness,
disease or infection existing at the time of the
accident, or medical or surgical treatment for any
of the foregoing.
4. Effect Of Death Of Disabled Member
In the event of the death of a "Member during a period for which
Monthly Income is payable, the amount of Monthly Income which was
payable to the Member will be continued without deducting Deductible
Benefits, during the lifetime of the Member's spouse or children,
for a maximum of 3 months. Such benefits shall be payable at the
option of the County to the Member's spouse or any one or more of
the surviving children of the Member or to any person(s) who has
assumed responsibility for the care and support of any one or more
of such persons. All benefits will terminate on the earlier of (a)
3 months after the death of the Member and (b) the death of the last
survivor of the Member, the Member's spouse, and the Member's children.
Child as used in this paragraph means a Member's legitimate unmarried
child under 21 years of age.
RES . NO. 81/907
B. REHABILITATION
1 . Approved Rehabilitation Programs
If any Member who is receiving Monthly Income under this
program begins a regimen of vocational rehabilitation,
whether formal or informal , or if any such Member shall
engage in part time work for purposes of rehabilitation,
the County may, at its discretion, consider such activity
to be an Approved Rehabilitation Program, effective when
approved in writing by the County.
Consideration of any such activity as an Approved Rehab-
ilitation Program will be given by the County only upon
written request of the Member. Approval of any such
program once given may be revoked by written notice
mailed to the Member at his last known address.
2. Effect on Monthly Income
During the continuance of an approved rehabilitation
program, payment of Monthly Income will be continued.
However, Basic Monthly Earnings, for purposes of
determining the amount of Monthly Income payable, will
be reduced by earnings from the approved rehabilitation
program. Accordingly the definition of Basic Monthly
Earnings is modified during an approved rehabilitation
program to mean (a) basic monthly earnings immediately
prior to commencement of total disability, less (b) monthly
earnings from the approved rehabilitation program.
C. EXCEPTIONS AND LIMITATIONS
1 . Long Term Disability Benefits do not include disability
caused contributed to by any of the following:
a. Any insurrection, war or act of war. War includes
declared oundeclared war, whether civil or inter-
national , and any substan armed conflict with
organized forces of a military nature;
b. Injuries intentionally inflicted by the Member, while
sane or insane; and
c. Committing or attempting to commit an assault or felony
or partpating in a violent disorder.
2. No Long Term Disability benefits are payable for any period
of during which:
a. The Member is confined in any penal or correctional
instition connection with a criminal or other public
offense, or
b. The Member is engaged in any occupation, work or
employment wage or profit, unless such occupation,
work or employment is part of an Approved Rehabilitation
Program, or
c. The Member is not regularly seen and treated personally
by a physician, or
d. The Member, under the terms of his employment, is
scheduled to be away from work without pay.
3. If total disability is caused directly or indirectly by a
mental or nervous disorder, Monthly Income payments for each
period of total disability due to either or both of such
causes shall not be made for more than 24 months, except
that if the Member is confined in a hospital as a resident
patient at the end of such 24 months this 24 month limitation
shall not apply during the continuance of such confinment.
4. If total disability is caused directly or indirectly by
alcoholism, drug addiction or the use of any hallucinogen,
Monthly Income payments for all periods of total disability
RES . NO. 81/907
due to one or more of such causes shall not be made for more
than 24 months during the entire 1 of the Member.
5.1 If a period of total disability is caused or contributed to
by a pre-existing condition or medical or surgical treatment
for a pre-existing condition, no Monthly Income will be payable
for such period of total disability unless the Member's long
term disability coverage has been in force for at least 12
consecutive months immediately preceding commencement of such
total disability and the Member has been actively working at
his employer's usual place of business for at least 12 con-
secutive months after the effective date of the Member's
eligibility for participation in the long term disability program.
Pre-existing condition is defined as a mental or physical
condition for which the Member has received medical treatment
or services, taken prescribed drugs or medicines or consulted
a physician at any time during the three months period imme-
diately preceding the effective date of the Member's eligi-
bility to participate in the long term disability program.
6. Long Term Disability Income is not in lieu of and does nto
affect any requirement for coverage by workers' compensation
insurance.
Section 5. PAYMENT OF CLAIMS
A. Payment of Benefits
All benefits provided by this program shall be paid as stated in this
section upon receipt of written proof on the County's forms or (if such
forms are not furnished by the County) upon receipt within 15 days after
demand therefor, of written proof covering the occurrence, character and
extent of the event for which claim is made.
Any benefits for loss of life provided by this program will be payable
in accordance with the beneficiary designation and the provisions
respecting such payment which may be prescribed herein and effective
at the time of payment. Any other accrued benefits unpaid at the
insured Member's death may, at the option of the County, be paid either
to the beneficiary or the Member's estate. All other benefits will be
payable to the Member.
B. Proof of Loss
Written proof of loss must be furnished to the County within 90 days after
the date of such loss in all cases of claim for loss for which this
program provides any periodic payment contingent upon continuing loss.
In the event of claim for total disability, subsequent written proofs of
continuance of total disability must be furnished to the County, at the
Member's expense, at such intervals as the County may reasonably require.
Failure to furnish such proof within the time required shall not in-
validate nor reduce any claim if it was not reasonably possible to give
proof within such time, provided such proof is furnished as soon as
reasonably possible and in no event, except in the absence of legal
capacity of the Member, later than one year from the time proof is other-
wise required.
The County shall have the right to require, as part of the proof of loss
with respect to Long Term Disability, satisfactory evidence:
1 . That the Member has made application for all Deductible
Benefits;
2. That he has furnished all required proofs for such
benefits; and
3. The amount of such benefits payable.
RES . NO, 81/907
C. Physical Examination and Autopsy
The County, at its own expense, shall have the right and opportunity to
examine the person of any individual whose injury or sickness is the
basis of claim when and as often as it may reasonably require during the
pendency of a claim hereunder and to make an autopsy in case of death,
where it is not forbidden by law.
D. Assignment
The Member's eligibility and benefits are non-assignable.
Section 6. MISSTATEMENT OF INFORMATION
In the event of the misstatement of the age of any Member, there will be
made an equitable adjustment of the benefits.
CC : County Auditor-Controller
County Treasurer-Tax Collector
Countv Administrator
County Counsel
Director of Personnel
CERTIFIED COPY
that
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'I f',11' true Co'reCt C0J,' Of -11)(7
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was b�y the Board ()f Supc:vl:sors ()f
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ATTEST;J. P1,G.
---'N,Count,,,Clerk& Gerk
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on 1981
RES. NO. 81/907