HB468: Sickness and Disability Program; clarifies emp. receiving benefits must apply for soc. security.
Be it enacted by the General Assembly of Virginia:
1. That §§ 51.1-1112, 51.1-1114, 51.1-1123 and 51.1-1125 of the Code of Virginia are amended and reenacted as follows:
§ 51.1-1112. Long-term disability benefit.
A. Long-term disability benefits for participating employees shall commence upon the expiration of a 125-work-day waiting period. The waiting period shall commence the first day of the disability. If an employee returns to work for 14 or fewer consecutive calendar days during such 125-work-day waiting period and cannot continue to work, the periods worked shall not be deemed to have interrupted the 125-work-day waiting period. However, if the cause of the participating employee's disability is a major chronic condition, as defined by the Board or its designee, the 125-work-day waiting period is cumulative from the first day of the disability and can be interrupted by periods of active employment.
B. Except as provided in subsection D and § 51.1-1131, long-term disability benefits shall provide income replacement in an amount equal to 60 percent of a participating employee's creditable compensation.
C. Creditable compensation during periods an employee receives long-term disability benefits shall (i) not include salary increases awarded during the period covered by long-term disability benefits and (ii) be increased annually by an amount recommended by the actuary of the Virginia Sickness and Disability Program and approved by the Board.
D. An employee's disability credits shall be used, on a day for day basis, to extend the period an employee receives long-term disability benefits paid at 100 percent of replacement of creditable compensation.
E. Long-term disability benefits shall be payable only during periods of (i) total disability or (ii) partial disability.
F. Unless otherwise directed, to be eligible for benefits under this section, the employee must apply for Social Security disability benefits, including such reapplications and appeals of the denial of the claim as may be requested by the administrator of the plan.
§ 51.1-1114. Adjustments to disability benefits.
A. Disability benefit payments shall be offset by an amount equal to any sums payable to a participating employee from the following sources:
1. During the first 12 months the employee receives disability benefits, an amount equal to the employee's wages and salary from any employment times the creditable compensation replacement percentage;
2. After the first 12 months the employee receives disability benefits, an amount equal to 70 percent of the employee's wages and salary from any employment;
3. Except as provided in subsection F, disability payments from the Social Security Administration, military disability benefits, local government disability benefits, federal civil service disability benefits or other similar governmental disability program benefits received by the employee or his family as a result of the qualifying disability;
4. Benefits received from any other group insurance contract provided by the Commonwealth for the purpose of providing income replacement; and
5. Benefits paid under any compulsory benefits law.
B. Disability benefit payments shall be offset by
amounts from any of the sources listed in subdivisions A 3, A 4, and A 5 for
which a participating employee is eligible as if the employee received such
amounts. However, if the employee has applied for such benefits, and has reapplied
and appealed denials of the claim as requested by the administrator of the
plan, and the claim is not approved, the employee's disability payments shall
not be reduced thereby.
CB. If a
participating employee's disability benefit payments are reduced as the result
of payments from sources listed in subdivisions A 3, A 4, and A 5 or pursuant
to subsection B, the employee's disability benefits shall not thereafter be
further reduced on account of cost-of-living increases in payments from such
sources.
DC.
Participating employees shall be required to repay, with interest to the Board
or their employer, any overpayments of disability benefits on account of the
failure of the employee to provide the Board or its designee with information
necessary to make any of the reductions required to be made under this article.
ED. Any
payment to a participating employee that is later determined by the Board or by
the employer to have been procured on the basis of any false statement or
falsification of any record knowingly made by or on behalf of the member, or
the employee's failure to make any required report of change in disability
status, may be recovered from the employee by the Board, with interest, either
by way of a credit against future payments due the employee, his survivor and
beneficiaries or by an action at law against the employee.
FE.
Supplemental disability payments will not be offset for a participating
employee if the employee is receiving a primary retirement benefit for service
in the United States armed services, even if a percentage of that primary
retirement benefit has been declared a disability payment. Any disability
payment that is not a part of the primary retirement benefit will be offset.
§ 51.1-1123. Supplemental long-term disability benefit.
A. Supplemental long-term disability benefits for participating employees shall commence upon the expiration of a 125-work-day waiting period. The waiting period shall commence the first day of the disability. If an employee returns to work for 14 or fewer consecutive days during such 125-work-day period and cannot continue to work, the periods worked shall not be deemed to interrupt the 125-work-day waiting period. However, if the cause of the participating employee's disability is a major chronic condition, as defined by the Board or its designee, the 125-work-day waiting period is cumulative from the first day of the disability and can be interrupted by periods of active employment.
B. Except as provided in subsection D and § 51.1-1131, supplemental long-term disability benefits shall provide income replacement in an amount equal to 60 percent of a participating employee's creditable compensation.
C. Creditable compensation during periods an employee receives supplemental long-term disability benefits shall (i) not include salary increases awarded during the period covered by long-term disability benefits and (ii) be increased annually by an amount recommended by the program actuary and approved by the Board.
D. An employee's disability credits shall be used, on a day-for-day basis, to extend the period an employee receives supplemental long-term disability benefits paid at 100 percent of replacement of creditable compensation.
E. Payments of supplemental long-term disability benefits payable under this article shall be reduced by an amount equal to any benefits paid to the employee under the Act, for which the employee is entitled to receive under the Act, excluding any benefit for medical, legal or rehabilitation expenses.
F. Supplemental long-term disability benefits shall be payable only during periods of total and partial disability.
G. To Unless otherwise
directed, to be eligible for benefits under this section, the
employee must apply for Social Security disability benefits, including such
reapplications and appeals of the denial of the
claim as may be requested by
the administrator of the plan.
§ 51.1-1125. Adjustments in supplemental disability benefits.
A. In addition to offsets equal to the amount of any benefits paid to a participating employee under the Act, supplemental disability benefit payments shall be offset by an amount equal to any sums payable to a participating employee from the following sources:
1. During the first 12 months the employee receives disability benefits, an amount equal to the employee's wages and salary from any employment times the income replacement percentage payable;
2. After the first 12 months the employee receives disability benefits, an amount equal to 70 percent of the employee's wages and salary from any employment;
3. Except as provided in subsection G, disability payments from the Social Security Administration, military disability benefits, local government disability benefits, federal civil service disability benefits or other similar governmental disability program benefits received by the employee or his family as a result of the qualifying disability;
4. Benefits received from any other group insurance contract provided by the Commonwealth for the purpose of income replacement;
5. Benefits paid under any compulsory benefits law; and
6. If the participating employee receives a settlement in lieu of periodic payments for a disability compensable under the Act, an amount determined by dividing the workers' compensation benefit which such employee would have received had the lump-sum settlement not been consummated into the settlement actually accepted by the employee.
B. Supplemental disability benefit payments shall
be reduced by amounts from any of the sources listed in subdivisions A 3, A 4,
and A 5 for which a participating employee is eligible as if the employee
received such amounts. However, if the employee has applied for such benefits,
and has reapplied and appealed denials of the claim as requested by the
administrator of the plan, and the claim is not approved, the employee's
supplemental disability payments shall not be reduced thereby.
CB. If a
participating employee's disability benefit payments are reduced as the result
of payments from sources listed in subdivisions A 3, A 4, and A 5 or pursuant
to subsection B, the employee's disability benefits shall not thereafter be
further reduced on account of cost-of-living increases in payments from such
sources.
DC.
Participating employees shall be required to repay, with interest, to the Board
or the employer any overpayments of supplemental disability benefits on account
of the failure of the employee to provide the Board or its designee with
information necessary to make any of the reductions required to be made under
this article.
ED. Any
payment to a participating employee that is later determined by the Board or by
the employer to have been procured on the basis of any false statement or
falsification of any record knowingly made by or on behalf of the employee, or
the employee's failure to make any required report of change in disability
status, may be recovered from the employee by the Board, with interest, either
by way of a credit against future payments due the employee or by an action at
law against the employee.
FE. If a
participating employee's payments under the Act are adjusted or terminated for
refusal to work or to comply with the requirements of § 65.2-603, his
disability benefits shall be computed as if he were receiving the compensation
to which he would otherwise be entitled under the Act.
GF.
Supplemental disability payments will not be offset for a participating
employee if the employee is receiving a primary retirement benefit for service
in the United States armed services, even if a percentage of that primary
retirement benefit has been declared a disability payment. Any disability
payment that is not a part of the primary retirement benefit will be offset.