- Eligibility & Coverage
- Definitions & Benefits Payable
- Claim Procedure
- Leave Management
- Administrative Process
- Benefits Continuation
- Return to Work
How can an employee determine if he is eligible for disability coverage?
There are two disability programs available to permanent full-time employees only, the Duke Disability and the Voluntary Disability. The Duke Disability is provided at no cost to full-time employees who have at least three years of full-time continuous service or are under the waiver due to proof of prior group long-term disability coverage. Duke Disability provides disability coverage for eligible University/Medical Center employees after 120 days and disability coverage for eligible Health System employees after 90 days.
The Voluntary Disability program is an opportunity for eligible employees to purchase short-term disability coverage to supplement the Duke Disability. It is also an opportunity for those not eligible (less than 3 years of full-time continuous service without proof of prior group long term disability coverage) for the Duke Disability to purchase short-term and/or long-term disability coverage. If covered, the employee should have a deduction on his paycheck reflecting the voluntary program(s). The Voluntary Disability vendor is the Hartford.
Can employees be covered under both the Voluntary Long-Term Disability and Duke Disability programs at the same time?
No, if an employee is covered under the Duke Disability, he is ineligible for coverage under the Voluntary Long-Term Disability. This would be a duplication of coverage.
Can Health System employees be covered under the Voluntary Short-Term Disability and Duke Disability programs at the same time?
No, because approved Voluntary Short-Term Disability benefits would be payable in advance of approved Duke Disability benefits after a four week waiting period.
Does Duke provide Short-Term Disability coverage to its University/Medical Center employees?
No, as University/Medical Center employees, Duke does not provide this coverage. Such employees should consider purchasing the Voluntary Short-Term Disability Plan.
What is total disability?
Due to sickness or accidental injury, an employee's inability to do essential duties of his occupation. The disability will have to be documented by a treating physician.
What is the benefit payable under long-term disability?
For either the Voluntary Long-Term or Duke Disability, approved benefits are 60% of your monthly base salary for total disability.
Is there short-term disability available?
There is voluntary short-term disability coverage available for purchase for eligible employees. Please refer to the Voluntary Disability web site for eligibility details.
What is the benefit payable under short-term disability?
For the Voluntary Short-Term Disability, the approved benefits are 60% of your monthly base salary for total disability paid on a weekly basis.
Is the disability benefit payable retroactive to the date of disability?
Approved disability benefits are payable after the benefit-waiting period, not the onset of the disability.
What is a benefit-waiting period?
The benefit-waiting period is the length of time the employee must be continuously partially or totally disabled before he qualifies to receive any benefits. For the Voluntary Disability, the benefit-waiting period is 4 weeks for short-term disability; 4 months (University/Medical Center); or 6 months (Health System) for the long-term disability.
As for the Duke Disability, there is a 90-day benefit-waiting period for Health System employees and a 120-day benefit-waiting period for University/Medical Center employees.
What is partial disability?
Partial disability is an option for employees who are experiencing a loss of income greater than 20% of their total earnings. If the employee is not totally disabled, but is unable to work his full work schedule due to a documented medical condition, he may qualify for partial disability benefits. Documentation of time worked from the onset of the partial work schedule must be submitted with the claim. Partial disability benefits are based on the percentage of income lost due to part time work.
When should an employee submit a claim for total or partial disability?
If the employee has the Voluntary Disability program and knows s/he will be out of work for more than 4 weeks, s/he can initiate a claim directly with Hartford Insurance by calling 866-945-4558.
As for the Duke Disability, it is suggested that claim paperwork begin no later than the second month of disability during the 90-day benefit-waiting period for Health System employees and no later than the third month of disability during the 120-day benefit-waiting period for University/Medical Center employees. Claim paperwork for the Duke Disability must be obtained from Human Resources. Completed claim paperwork should also be returned to Human Resources, not the disability vendor, within 180 days from the onset of the disability or the last day worked due to disability.
If the employee's physician has documented that he is totally disabled, won't the claim be automatically approved?
The disability vendor will have to review the medical information submitted by the employee's physician and determine if the claim meets the plan's definition of disabled. Applying for disability does not guarantee approval.
Should the employee exhaust all sick/vacation/PTO before applying for disability?
It is recommended that an employee apply for disability before exhausting all accrued time. The major reason is while awaiting a decision about the disability claim, the employee can hopefully maintain income by utilizing accrued sick/vacation/PTO.
Is there help available for the employee who has exhausted all accrued sick/vacation/PTO time?
Please inquire about the Kiel Memorial 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.
Should the employee be on an approved leave of absence when he submits a disability claim?
Ideally, yes. The leave of absence can run concurrently with the benefit-waiting period for disability. The benefit-waiting period is the length of time the employee must be continuously partially or totally disabled before he qualifies to receive any benefits.
An employee is on Workers' Compensation. Can he also submit a Duke Disability claim?
Yes, an employee can be on an approved Workers' Compensation claim and Duke Disability claim simultaneously. However, any amount received from Workers' Compensation will be offset from any approved Duke Disability benefit amount. It is to the employee's advantage to pursue disability while on an active Workers' Compensation claim because in the event that the Workers' Compensation benefits cease, the employee who is also on an approved Duke Disability claim will be able to maintain eligibility for Duke benefits. There is no time limit for applying for Duke Disability if the employee is on an active Workers' Compensation claim.
An employee submitted a physician's note stating that he should no longer work due to total disability. Does the department process a payroll form to place the employee on the disability leave?
No, the department should speak with the employee about requesting a FMLA or medical leave of absence. The department should also suggest or advise the employee to inquire about submitting a disability claim. Only Human Resources is authorized to place an employee on an approved disability leave. If the employee's claim for Duke Disability is approved, HR will process the necessary payroll form.
How will the department know if the employee has been approved for Duke disability?
Human Resources will send to the department the payroll form to complete to place the employee on an approved disability leave. The completed form is returned to the Disability Analyst in Human Resources.
Managers should also review and complete the Duke Disability Checklist located on the Payroll website.
An employee is receiving a voluntary disability check from Hartford. Shouldn't the employee be on a disability leave?
No, the disability leave code is only for employees approved for Duke's Disability, not the voluntary plan. However, it is important that the employee be placed on either a FMLA or medical leave of absence.
An employee was approved for partial disability benefits under the Duke plan. Will the Disability Representative in Human Resources be responsible for payroll reporting?
No, the employee will remain under his current organizational key and cost distribution center since he continues to work a reduced schedule for the department.
I have a monthly employee working a reduced schedule due to partial disability. How do I ensure that the employee is not paid a full salary?
Payroll advises that the department complete a staff change form to reflect the reduced salary, but do not change the work schedule. If you were to change the work schedule, you may affect the benefits eligibility of the employee. Include in the "Remarks" section of the staff change form that the salary reduction is due to partial disability benefits.
An employee was working a reduced schedule under approved partial Duke Disability, but the employee's physician has now requested the employee cease work totally. What should the department do?
The employee must offer a written request from his physician stating the request to stop work. The written request should be faxed to the Disability Analyst in Human Resources at 681-8774 immediately. The disability vendor will adjust the approved Duke Disability benefit amount accordingly. Also, Human Resources will process a payroll form changing the disability from partial to total disability; a copy will be sent to the department for record.
Will the employee approved for Duke's total disability remain in my cost center?
With the exception of an employee on an active Workers' Compensation claim, an employee approved for Duke's total disability will be transferred to the disability organizational key by Human Resources. However, the cost center will remain under the employing department. When Human Resources processes the "disability leave without pay" request form, it will disable any further payroll expenses for the employee from the department's cost center. Anyone approved for total disability solely should not be receiving pay through the payroll system. The department should not terminate the employee approved on Duke disability benefits as they are to remain in the payroll system.
Will the Duke Disability payments affect my department’s budget?
No, Duke has a third party administrator who disburses approved Duke Disability payments. It doesn’t come from your departmental budget.
An employee has been approved for Duke Disability benefits. Can the employee supplement the disability benefit with accrued sick/vacation/PTO time?
For a University/Medical Center employee, one can supplement Duke's disability benefits with 40% of accrued sick or vacation time. For Health System employees, accrued PTO can be used to supplement Duke's disability pay at 40% of base salary for weeks 13 - 25 of an approved Duke Disability only. When supplementing eligible Duke disability benefits with accrued vacation/sick/PTO time, the salary should not exceed 100%. Kiel hours cannot be used to supplement disability benefits.
In contrast, Voluntary Disability benefits cannot be supplemented with accrued sick/vacation/PTO/Kiel time.
An employee was approved for Voluntary Disability benefits from Hartford. Will benefit deductions be taken from that check?
No, the employee will need to make arrangements with the vendors directly for premiums other than health, dental, Basic Life insurance, or Personal Accident insurance. During an unpaid leave of absence, the Human Resource Information Center (919-684-5600) should be contacted for arrangements about the Basic Life insurance, or Personal Accident insurance premiums. As for health and dental insurance, the employee will be COBRA notified.
Will the health premium remain the same for an employee receiving Voluntary Disability benefits?
In order for the employee to continue to qualify for the employer contribution towards the health premium, the employee must be on an approved FMLA. Otherwise, the total premium under COBRA will be due.
Will benefit deductions be taken from an approved Duke Disability benefit payment?
If an employee is approved for Duke Disability, a letter will be sent instructing the employee on how to maintain benefit coverage. Only health and dental deductions can be taken from the Duke Disability benefit and for any other benefit premiums, arrangements should be made with the vendors.
What rehabilitative services are available to those on long-term disability?
Rehabilitation is a process of providing services to a disabled person with the goal of aiding recovery and return to work. The employer and the disability vendor determine who receives rehabilitation services through the disability program.
An employee currently on Duke's total disability has a return to work clearance (with or without restrictions) from his physician. Can I process a return from leave payroll form?
No, Human Resources (attn: Disability Analyst, fax 681-8774) should be sent immediately any return to work request submitted for an employee on an approved Duke disability. Human Resources will process the necessary payroll form after coordination with the disability vendor. The department will receive a copy of any processed payroll form for an employee on Duke Disability. This is important because the employee runs the risk of receiving an overpayment from the disability vendor when in fact he has already returned to work. Only HR should be removing an employee from a disability leave status.
Payroll contacted the department about the inability to pay an employee who recently returned to work from total disability. What happened?
The organizational key is probably still under the "disability leave without pay" code. That's why it is important to notify Human Resources as soon as a return to work authorization has been received for an employee returning from total disability. Human Resources is responsible for removing the disability leave status and transferring the employee from the disability organizational key back to the employing department.
A review of the Disability web site for additional detailed information is encouraged. You may also contact the Human Resources Information Center at 684-5600 or the Disability Analyst at 681-4436 for questions.