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THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Adopted this Order on Julv 10, 199.0 by the following vote:
AYES: Supervisors Powers , Schroder, McPeak, Torlakson, Fanden
NOES: None
ABSENT: None
ABSTAIN: None
SUBJECT: Long Term Disability )
Benefits for ) Resolution No. 90/ 1,33
Management Employees )
Upon the recommendation of the County Administrator, Resolution
81/1239 governing long term disability benefits for management employees is
amended as follows:
I . Section 4 . , Long Term Benefit Disability Provisions, B. ,
Rehabilitation, part 1 . , Approved Rehabilitation Programs, is amended to
read:
B. REHABILITATION
1 . Approved Rehabilitation Programs
(a) If any Member who is receiving Monthly Income under this
program begins a regimen of vocational rehabilitation, or if any such
Member shall engage in part time work for purposes of rehabilitation, the
County may, at its discretion, certify such activity as an Approved
Rehabilitation Program, effective when approved in writing by the County.
(b) An Approved Rehabilitation Program must meet the
following criteria:
i. The program or work must provide education or
training by which the Member can reasonably become fitted for employment.
ii. The program or work must be approved in writing by
either:
a certified vocational rehabilitation counselor
a vocational rehabilitation counselor employed by the
State Department of Vocational Rehabilitation
a vocational rehabilitation counselor employed by the
County under the County Vocational Rehabilitation Program.
(c) Certification of an Approved Rehabilitation 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 the last address of record.
II . Section 4, Long Term Disability Benefit Provisions, C. , Exceptions and
Limitations, part 2 c, is amended to read:.
C. Exceptions and Limitations
2 . No Long Term Disability benefits are payable for any period
during which:
I hereby certify that this is s true and correct copy of
Orig. Dept: Personnel department Benefits Divi�n, ion taken and entered on the minutes of the
ccs Auditor-!:Controller's Office �o'aYp�of Superviso on the date shown.
County Administrator's Office A'tYssrE°'.
PHIL BA HELOR, 'Ierk of the Board
of Supervisors and County Administrator
oeputy
. (1)
+L� 4
(c) The Member is not regularly seen and treated personally
by a physician to the extent necessary under existing standards of medical
practice for the condition causing the total disability.
III . Section 4 . , Long Term Disability Benefit Provisions, C. , Exceptions
and Limitations, part 6, is amended to read:
C. Exceptions and Limitations
6 . Long Term Disability Income is not in lieu of and does not
affect any requirement for coverage by workers' compensation, however,
workers' compensation benefits may reduce long-term benefits as provided in
Section 2, Definitions, B, Long Term Disability Benefits Definitions, part
2 .b. (1) .
IV. Section 5, Payment of Claims, B, Proof of Loss, is amended to read:
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 invalidate
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 otherwise 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;
3 . Of the amount of such benefits payable; and
4 . Of the existence or non-existence of all facts necessary to
determine the application of Section 4, Long Term Disability Benefits
Provisions, C. , Exceptions and Limitations .
V. Section 6 . , Appeals, is added, to read:
Section 6 . .Appeals
Actions by the County denying benefits, reducing benefits, or
terminating benefits, are subject to appeal as follows :
1 . Within 90 days after notice of the action is mailed or
otherwise delivered, the Member may appeal by delivering to the Contra
Costa County Director of Personnel a written statement identifying the
action appealed and the grounds for appeal .
. 2. Within six weeks from the time it is received, the appeal
shall be reviewed by the Employee Benefits Manager, who may direct that the
Member submit available medical information or direct that the Member
undergo at County expense a physical, medical, and/or psychiatric
examination by a licensed physician and receive a report on the findings of
such examination. The Employee Benefits Manager shall make and deliver to
the appellant a written determination granting or denying the appeal . A
determination denying an appeal shall state the facts and conclusions upon
which the denial is based. The time for this determination may be extended
for cause by the Director of Personnel.
(2)
3 . Within 30 days after the determination is mailed or otherwise
delivered, the Member may request a hearing on the appeal . A hearing
officer from the State Office of Administration Hearings shall conduct a
hearing and make a report in accordance with the procedures expressed in
the Personnel Management Regulations, sections 1117 to 1128, with the
Director of Personnel exercising the powers of the Merit Board.
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