Common Provisions
Disability Overpayments
The plan administrator has the right to recover any STD or LTD overpayments due to:
- fraud,
- any error the plan administrator makes in processing a claim, and
- any deductible sources of income that you receive.
You must reimburse the plan administrator in full for any overpayments, but no more than the amount you were paid. The plan administrator will determine the method by which the repayment is made.
The provisions described in this section apply to both the STD and LTD Plans.
What’s Not Covered
The STD and the LTD Plans do not cover certain disabilities. These include disabilities that are caused by, contributed to by, or resulting from your:
- illness or injury related to your job (not covered under the STD Plans, but covered under the LTD Plans),
- intentionally self-inflicted injuries,
- active participation in a riot,
- the loss of a professional license or occupational license or certification, or
- commission of a crime for which you have been convicted under state, federal, or tribal law.
In addition, you will not receive any benefits for any period of disability during which you are imprisoned or for any disability due to war, declared or undeclared, or any act of war.
How Your Benefits Are Reduced
If you are eligible for income that is subtracted from your STD and/or LTD benefits, the amount of the income you will receive will be estimated. Your STD and/or LTD payment can be reduced by the estimated amount if:
- the income from the other source has been awarded and has not been denied, or
- the income has been denied and the denial is being appealed.
Your benefit will not be reduced by the estimated amount if you meet both the following conditions:
- You apply for the disability benefits from another source of income and appeal your denial to all administrative levels the plan administrator feels necessary, and
- You sign the plan administrator’s payment option form, which states that you promise to pay the plan administrator any overpayment caused by an award.
Income that Doesn’t Reduce Your Benefits
Income from the following sources will not be subtracted from your gross disability benefit:
- 401(k) Plans
- Profit-sharing Plans
- Thrift Plans
- Tax-sheltered annuities
- Stock ownership plans
- Non-qualified plans of deferred compensation
- Pension plans for partners
- Military pension and disability income plans
- Credit disability insurance
- Franchise disability income plans
- A retirement plan from another employer
- Individual retirement accounts (IRAs)
- Individual disability income plans
If your payment has been reduced by an estimated amount, your payment will be adjusted when the plan administrator receives proof of the amount awarded.
If you provide proof that benefits from another income source have been denied and all appeals the plan administrator feels are necessary have been completed, you will receive a lump-sum refund of the estimated amount.
A lump-sum payment you receive from another income source will be prorated on a weekly basis for STD benefits and a monthly basis for LTD benefits, over the time period for which the lump sum was given. If there was no time period assigned to the lump sum, the plan administrator will prorate the sum over a reasonable period of time, depending on all the facts and circumstances of your situation.
Rehabilitation Service
While you are receiving disability benefits, the plan administrator has a vocational rehabilitation program available to assist you to return to work. This program is offered as a service and is voluntary on your part and on the plan administrator’s part. The program includes services such as:
- Coordination with MPTN to assist you to return to work
- Evaluation of adaptive equipment to allow you to return to work
- Vocational evaluation to determine how your disability may impact your employment options
- Job placement services
- Job-seeking skills training
- Retraining for a new occupation
If the plan administrator feels the program would be appropriate for you, you will be contacted about participating. If you have not been contacted, you may ask that the plan administrator have one of its rehabilitation professionals review your file. As your file is reviewed, medical and vocational information will be analyzed to determine whether rehabilitation service might help you return to gainful employment. If the plan administrator concludes that the program is appropriate for you, you will be invited to participate.