Qualifying to Receive Benefits
The plan pays benefits if you become disabled and qualify to receive benefits. The benefit payable is based on the Schedule of Benefits in effect on the date you became disabled.
To be considered qualified to receive benefits, you must:
- Be covered on the date you become disabled and the condition causing your disability is not excluded from coverage,
- Be covered on the date the benefit waiting period begins,
- Provide notice of a claim in writing to Duke HR Benefits and file such claim within 180 calendar days of you becoming disabled or while receiving wage replacement from the Duke Workers' Compensation program in order to satisfy claim submission requirements. If you are unable to send written notice that you are disabled, someone must notify the plan on your behalf, and
- Be receiving regular and appropriate care and treatment intended to aid your recovery and your return to work. Regular and appropriate care and treatment means supervised care or treatment by a doctor for the sickness or accidental injury causing your disability.
Benefit Waiting Period
The benefit waiting period is the length of time you must be continuously partially or totally disabled before you qualify to receive any benefits.
Your benefit waiting Period is:
Duke Health System - 90 calendar days
Duke Raleigh Hospital - 90 calendar days
Durham Regional Hospital - 90 calendar days
All Other Employees - 120 calendar days
The benefit waiting period begins on the first day your doctor states in writing that you are disabled because of sickness or accidental injury; no benefits are payable during the benefit waiting period. You must be under the continuous care of a doctor during your benefit waiting period for benefits to be payable after the benefit waiting period. During the waiting period, you can receive pay and benefits through your vacation, sick, Paid Time Off (PTO) benefit, Faculty Temporary Medical Leave, or donated hours through the Kiel Memorial Vacation/PTO Donation Program.
Exception: You may return to work or continue to work in the case of partial disability, for up to 30 calendar days during the benefit waiting period without having to begin a new benefit waiting period. The days you work do not count toward meeting the benefit waiting period, and any part of a day worked will count as a full day for the benefit waiting period. Any full days you work do not count toward meeting the benefit waiting period. If you return to work, or continue to work, for more than 30 full calendar days before satisfying your benefit waiting period, you will have to begin a new benefit waiting period.
When Benefits are Paid
After completion of the benefit waiting period, you will be paid a monthly benefit around the 15th of each month in which you qualify for benefits. Direct deposit is required for all benefit payments. If you are disabled for part of a month, the benefit payable is based on 1/30th of your monthly income benefit for each day you are disabled.
Filing a Claim
If your treating physician indicates you will be out of work more than your benefit waiting period due to disability, you may file for benefits under the Duke Disability plan. To obtain the necessary forms, request a disability claim kit.
Return the claim paperwork to Human Resources within 180 calendar days of becoming disabled and/or your last day worked due to disability. Your claim will be sent to the disability vendor, who will acknowledge receipt and notify you if additional medical information is needed. Approval or denial of a disability claim, which generally takes four to six weeks, will be determined after all the necessary documentation is obtained for claim review. Applying for Disability does not guarantee that you will be approved.
In order to satisfy claim submission requirements, Duke Disability claim forms must be completed and filed within 180 calendar days of your becoming disabled and/or your last day worked due to disability or while on Duke Workers’ Compensation leave and receiving wage replacement.