Duke Disability: Frequently Asked Questions
What are the Disability benefits?
Duke Disability benefits are 60% of your base salary and are reduced by Workers' Compensation, and/or Social Security Disability, or any income from employment while you are receiving benefits. Disability benefits are subject to both federal and state taxes.
What is the Application Process?
If your physician indicates you will be out of work 3-4 months,
the following forms must be obtained from HR Benefits, completed and returned
within 180 days of your becoming disabled and/or your last day worked due to
disability.
- Employee Statement
- Authorization to Release Information to Disability Administrator
- Attending Physician's Statement of Disability
- Occupational Demands Form
- Social Security/Workers' Compensation Reimbursement Agreement
- Medicare Acknowledgement
- Consent for Release of Social Security Information
When all completed forms and supporting medical documentation are received in Benefits, your claim will be sent to the disability administrator. They will acknowledge receipt of your claim and notify you if additional medical information is needed. Approval or denial of a disability claim, which generally takes three to four weeks, will be determined after all the necessary documentation is obtained for claim review.
Please note that applying for Duke Disability does not guarantee that you will be approved.
Should I request a leave of absence also?
You should apply for a leave of absence as soon as you know you will be out
of work for any length of time. Please discuss with your immediate supervisor
your need to apply for a leave of absence, complete the appropriate leave form
and obtain your supervisor's signature. You may also contact the Human Resources
Information Center at 684-5600 about leave of absence questions.
How do I submit a claim for the Hartford's Voluntary Short Term Disability
benefits?
If you have purchased coverage, you should contact Hartford directly at
800-445-9057 to initiate a separate short-term disability claim.
Is there help available since I have exhausted all of my accrued sick and/or vacation time and I am without pay?
You may inquire about the Kiel Voluntary Vacation/PTO Donation Program which allows employees, who have experienced a catastrophic illness or injury and who have exhausted all accrued time, to receive donations of accrued vacation or PTO Short Term Bank (STB)
hours from fellow employees. Please refer to the Kiel
Program web site to review eligibility, procedures and forms.
How do I pay for my Health Insurance and other benefits during the waiting period or while awaiting a decision on my claim?
If you continue receiving payroll checks for accrued sick time or donated vacation time during the waiting period, all your deductions will continue as usual. Once you receive your last paycheck, you must make arrangements with Duke Accounting Services (919) 684-3123 for direct premium payments. If you are on an unpaid Family Medical Leave (FMLA) for the first 12 weeks of the waiting period, you will be responsible for paying only the employee portion of your health insurance premium as well as the premiums for other benefits that are normally payroll deducted. After the 12 weeks of FMLA, you will be responsible for paying the total premium for health insurance, unless you have accrued sick leave.
What health insurance premium amount will I be responsible for if I am approved?
You will pay only the employee cost if your disability claim is approved.
What happens to my Health Insurance if my claim is denied or my benefits
under Duke Disability end?
Should your Duke Disability claim be denied, health insurance can be
continued for 18 months under COBRA (Consolidated Omnibus Budget Reduction Act)
with your paying the full premium plus a 2% administration fee. It is important
to note that entitlement to 18 months of coverage begins after the end of your
leave under the Family Medical Leave Act, or on the first day of an unpaid
personal, medical, or maternity leave. (The above does not apply if you are on
approved Workers' Compensation.) A COBRA notification will be sent after
placement on an unpaid personal leave of absence or an approved Duke disability.
What are my employment reinstatement rights at Duke University or Duke
Health System?
You have no employment reinstatement rights at Duke University and Health
System after your approved 12-week Family Medical Leave ends. If your disability
claim is denied (you have 60 days to appeal), contact Recruitment to reapply for
employment at Duke. While you are on approved disability, vocational assistance
is available from the disability rehabilitation case managers. However, if your
disability benefit is terminated because you no longer meet the definition of
disabled under the Plan, there is no guarantee of re-employment with the
University or the Health System. You may contact Recruitment at 684-5600 so that
your qualifications and skills can be compared to the requirements of current
positions available at Duke.
What about Partial Disability?
Partial disability is an option for people who are experiencing a loss of
income greater than 20% of their total earnings. If you are not totally
disabled, but are unable to work your full work schedule due to a documented
medical condition, you may qualify for partial disability benefits.
Documentation of time worked from the onset of your partial work schedule must
be submitted with your claim. Partial disability benefits are based on the
percentage of income lost due to part time work.
When will I receive my first benefit?
After the completion of the waiting period and following the
approval of your claim, you should receive your initial benefit soon. Continuing
monthly income benefits are paid at the end of the month for the current month;
therefore, your first check should arrive after the end of the first month
following the waiting period if
approved. PLEASE NOTE: Your first benefit check may be offset by any Duke salary
or accrued time that is paid out in excess of 40% of your salary beyond the
benefit waiting period. Kiel donations used after the waiting period will offset
any disability claim benefit, including retroactively approved claims.
Can I supplement my disability benefit with my accrued sick/
vacation time or PTO?
You may supplement your disability benefit with your accrued time. The amount
should not exceed 40% of your gross salary (pre-disability). Duke University
employees can take
this action while on approved long-term disability until your time is
exhausted or decide to stop using the accrued time. Duke University Health
System employees can take this action for weeks 13-25 only. PLEASE NOTE: Kiel Voluntary
PTO/Vacation Donation Hours are not to be used to supplement disability
benefits. Kiel donations can be used during the disability waiting period and
donations used after the waiting period will offset any disability claim
benefit, including retroactively approved claims.
Must I apply for Social Security Disability?
The disability administrator will review your claim and, if appropriate, direct you to apply for Social Security Disability (SSDI). If Social Security Disability is awarded, it is subtracted from the benefit paid by the administrator. Therefore, a signed Social Security reimbursement agreement must be submitted with your disability claim.
How long will I be able to receive disability benefits?
Benefits may continue for up to 24 months if you are disabled from your own
occupation. After 24 months, you must be unable to work at any occupation you
could reasonably be expected to do because of education, training or experience.
Medical documentation will be required each year to verify disability. If you
become disabled at age 61 or older, you will need to review the Maximum Benefit
Period outlined on page 3 of the Plan Booklet. When disability is due in whole,
or in part, to Subjective Conditions (see Plan Booklet), the Plan limits monthly
benefits to a maximum of 24 months. Disability benefits are payable to age 65 if
you are totally disabled from gainful employment.
What rights do I have if I am denied?
If your claim is denied, you have the right to appeal the decision. You have
60 days from the date you receive the denial to request a review of your claim.
A letter of appeal, with any additional medical documentation supporting your
request, must be sent directly to the disability administrator. A committee at
the disability administrator will review your request and provide you with a
written decision regarding your claim. If you are still not satisfied with the
response, you may request a second review by writing the Plan Administrator,
Lois Ann Green, Director, Benefits.
Who Do I Call For Questions?
Your primary contact in HR - Benefits is Sonya Stewart at 681-4436. If you
are unable to reach Ms. Stewart, call the Human Resource Information Center at
684-5600. At Durham Regional Hospital, call Sharon Edwards at 470-7288, and at
Duke Raleigh Hospital, call Denise Privette at 954-3618. After your claim is
submitted, you will be assigned a Disability Case Manager who will be your
primary contact for claim questions.
The benefits that you receive are based upon the plan's official plan documents, not this guide or any other written or oral statement. If there is a conflict between this guide and the official plan documents, the
official plan documents will govern in all cases. Duke reserves the right at any time to change or terminate these plans.
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