City of San Diego
Employees’
Long-Term
Disability
Income Plan
This information is available in alternative formats upon request.
City of San Diego
Employees’
Long-Term
Disability
Income Plan
Summary Plan Description
This handbook contains an explanation of important featu
of the Long-Term Disability Income Plan. The Summary Pl
Description is not intended to modify or replace the Plan
ofcial document.
If any questions arise with respect to your rights under t
Plan, the ofcial Plan Document, not this handbook, will go
and determine your rights. A copy of the Plan Document is o
in the City Clerk’s Office.
Contents
Introduction ............................................................................................. 1
Long-Term Disability Income Plan Summary ........................................ 1
Amendments to the Long-Term Disability Income Plan .......................1
Special Terms–What They Mean............................................................. 2
Eligibility Requirements .......................................................................... 4
Application for Benets .......................................................................... 4
Filing Requirements................................................................................. 4
60-Day Filing Deadline ........................................................................... 5
30-Day Elimination Period ...................................................................... 5
Medical Disablement Certication.......................................................... 5
Federal and State Withholding ............................................................... 6
Flexible Benets ..................................................................................... 6
Payment of Benets ................................................................................ 6
Special Dismemberment Benets........................................................... 7
Duration of Benets................................................................................ 7
Pregnancy Claims .................................................................................... 8
Family and Medical Leave under FMLA and CFRA. ............................. 8
Pregnancy Disability Act ....................................................................... 9
Catastrophic Leave................................................................................ 10
Unpaid Leave of Absence ..................................................................... 10
Other Income Benets.......................................................................... 10
Return To Work Incentives ................................................................... 11
Pre-Existing Conditions........................................................................ .12
Limitations.............................................................................................. 12
Benet Exclusions ................................................................................. 13
Accumulated Leave................................................................................ 14
Industrial Leave ..................................................................................... 14
Workers’ Compensation–Temporary Total Disability .......................... 15
Workers’ Compensation–Vocational Rehabilitation ............................. 15
Placement Assistance–Non-Work Related Disabilities ......................... 16
Light Duty .............................................................................................. 16
Request for Review .............................................................................. 17
Survivor Benets ................................................................................... 17
Retirement Contributions Buy Back .................................................... 17
Representation....................................................................................... 17
Medical Care .......................................................................................... 18
Independent Medical Examinations ..................................................... 18
Right of Recovery and Reimbursement ............................................... 18
Employer-Paid Plan ............................................................................... 18
Administration of the Plan .................................................................... 19
1
General Information
Introduction
The Long-Term Disability Income Plan was established on September 4,
1981 for the purpose of providing income to eligible employees while
disabled as a result of injury, illness, or pregnancy.
Long-Term Disability Income Plan Summary
Long-Term Disability (LTD) is an income replacement plan which
provides you with an income of 70% of your biweekly earnings. In
order to qualify for LTD benets, you must be medically certied as
disabled from performing the duties of your regular occupation and
unable to perform light duty. After the rst 12 months, LTD benets
are continued if you are medically certied as totally disabled from any
gainful employment.
Following the date of your disability, you must serve an elimination
period of 30 calendar days. Benets will begin on the 31st day following
your date of disability and are paid biweekly. Your exible benets will
also be covered as outlined on page 6.
Amendments to the Long-Term Disability Income Plan
The following benet revisions apply to disabilities beginning on or
after July 1, 1994:
1. The LTD Plan does not provide coverage if:
a. your disability is caused by employment with the City of San Di-
ego unless 12 months (2,080 hours) of Industrial Leave coverage
has been exhausted. LTD coverage will then be approved for a
maximum period of 12 months while you are medically certied
as unable to engage in any gainful employment; or
b. your disability is for a mental or nervous/stress disorder including
any physical symptoms resulting from a mental or nervous/stress
disorder.
2. After two years of LTD coverage, your City health insurance will no
longer be paid by the LTD fund. You will be referred to COBRA for
health insurance coverage.
2
Special Terms What They Mean
Administrator shall mean the City Manager or Designee.
Basic Biweekly Earnings shall mean the basic biweekly salary in
effect on the date the employee is removed from work due to his/her
disability or due to any recurrence of his/her disability. This includes
deferred compensation, extra compensation for night or unusual
schedule work shifts, motorcycle pay, bilingual pay, and educational
incentive pay. It excludes overtime, bonuses, and all other extraordinary
compensation.
City means the City of San Diego.
COBRA means the Consolidated Omnibus Budget Reconciliation Act of
1985, as amended. This Federal law requires the City of San Diego to
offer employees and their dependents the opportunity for a temporary
extension of health coverage at group rates in instances where coverage
under the Plan would otherwise end upon termination.
Coverage is when you are eligible to participate in the LTD Plan.
Disability Benets Formula is 70% of your basic biweekly salary, less
taxes and all other applicable income benets while totally disabled.
Disability Date is the rst day you become totally disabled subject to
medical disablement certication.
Elected Ofcers are the Mayor of the City, the Councilmembers and
the City Attorney.
Elimination Period is the 30 calendar days following your disability
date until the date benet payments commence.
If a participant attempts to return to work during the waiting period, the
participant may work ve days for each waiting period without having
to renew the waiting period.
Filing Deadline means that a written application for benets must
be received no later than 60 calendar days from the date of dis-
ability. The Attending Physician’s Statement can be submitted beyond
the 60-day ling deadline.
EXCEPTION: The 60-day ling deadline may be waived providing
a Workers’ Compensation claim is led within 60 days of your
date of disability.
Participant means an eligible City employee who is covered by the Plan.
Participation shall continue as long as a participant remains an eligible
employee. Participation will cease upon termination of employment
or absence of more than 30 days unless such termination or leave of
absence is due to total disability.
Plan means City of San Diego Employees’ Long-Term Disability In-
come Plan.
Physician for the purposes of certifying a disability, physician means a
person who is licensed to practice medicine and surgery as a doctor of
medicine (M.D.), or as a doctor of osteopathy (D.O.). For the purpose of
treating a disability, physician shall include a person licensed to practice
as a dentist, podiatrist, chiropractor, clinical psychologist or optometrist.
Total Disability means an employee who is medically certied by a
licensed physician as unable to perform any and/or all of the duties
of his/her present occupation during the 12 months following the date
of disability. After 12 months of disability, the employee must be un-
able to engage in any gainful employment for which he/she becomes
reasonably tted by education, training or experience.
3
4
Eligibility Requirements
You are eligible to participate in the LTD Plan providing you meet the
following requirements:
1. You are a City of San Diego employee in a permanent or limited posi-
tion. You have a standard number of employment hours each biweekly
period, i.e., 80.0, 60.0, 40.0, 20.0 hours.
2. If you were hired on or before September 3, 1981, actively at work
performing full duties, and service has been continuous in that em-
ployment status, you are automatically eligible to participate. Hourly
and provisional employees are excluded.
3. If you were hired on or after September 4, 1981, you can participate in
the Plan following 12 consecutive months of eligible employment from
your date of hire. Hourly and provisional employees are excluded.
NOTE: The employment eligibility period of 12 months is waived
for job-related disabilities occurring prior to July 1, 1994.
4. You are medically certied as disabled during the 30-day elimina-
tion period.
5. You are either a General or Safety employee of the San Diego City
Employees’ Retirement System (SDCERS), an Elected Ofcer or an
Unclassied employee.
Application for Benets
You can obtain the required application forms from the LTD Program
by calling 236-6100 or 236-5968. You should apply for benets as soon
as you become aware your doctor has disabled you for over 30 days.
You do not automatically receive LTD benets. Your claim must rst be
reviewed and approved by the LTD Administrator. You will be advised
of the status of your claim by the LTD Administrator. If your LTD ap-
plication is incomplete, you will have an opportunity to provide the
requested information.
Filing Requirements
The LTD application consists of four parts:
1. Authorization For Release Of Information (D-1)
2. Employee Statement (D-2)
3. Other Income Benet Questionnaire (D-3)
These three sections should be led with the LTD Administrator, Risk
Management Department, 1200 Third Avenue, Suite 1000, San Diego,
CA 92101, M.S. 51B.
4. Attending Physician’s Statement
The Attending Physician’s Statement should be completed by your treating
physician and forwarded to the LTD Administrator at the address above.
60-Day Filing Deadline
To qualify for LTD coverage, your application should be submitted to
the LTD Administrator within 60 calendar days of your disability date.
If you are uncertain of your eligibility, you should contact the LTD Pro-
gram at 236-6100 or 236-5968.
EXCEPTION: The 60-day ling deadline will be waived providing
a Workers’ Compensation claim is led within 60 days of your
date of disability.
30-Day Elimination Period
You must serve an elimination period of 30 calendar days following the
date you rst become totally disabled (during which time you do not
work). Benet coverage begins on the 31st day following your date of
disability. LTD benets are not payable during the elimination period.
During the elimination period, you may be eligible for:
1. Annual Leave;
2. Family and Medical Leave (page 8);
3. Pregnancy Disability Leave (page 9); or
4. Catastrophic Leave (page 10).
Medical Disablement Certication
You are responsible for obtaining the Attending Physician’s Statement(s)
for medical certication of your disability, at no cost to the City. The
standardized LTD Attending Physician’s Statement, included in the ap-
plication package, should be utilized.
5
Federal and State Withholding
LTD benets provide you with an income of 70% of your biweekly
earnings. Federal and state income tax will be withheld based on your
W-4 Withholding Allowance Certicate on le with the City Auditor. A
Medicare tax of 1.45% will be withheld for those employees hired after
April l, 1986. Other income you receive may reduce your LTD benet.
Other income benets are listed on page 10.
Flexible Benets
1. Flexible benets will be paid up to a maximum of one year. (Your
exible benets will be paid up to a maximum of one year of com-
bined industrial leave and/or LTD benets, if applicable.) After the
rst year of coverage, only your health and life insurance premiums
will be paid for the duration of your disability in accordance with
Plan provisions.
2. If your date of disability begins on or after July 1, 1994, your ex-
ible benets will be paid up to a maximum of one year. After your
rst year of coverage, only your health and life insurance premiums
will be paid for a maximum of one additional year. You will then be
referred to COBRA which provides you and your dependents the
temporary extension of health coverage at group rates.
3. Dependent health, dental/medical/vision, dependent care, and vol-
untary life insurance premiums are automatically deducted from your
LTD payment if there are sufcient funds.
NOTE: No deductions are withheld for Supplemental Pension Sav-
ings Plan (including loan payments), City Employees’ Retirement,
401(k) (including loan payments), Deferred Compensation, credit
union loans and union dues.
Payment of Benets
You can expect to receive your LTD payment on, or about, normal City-
scheduled paydays. Your LTD payment can be electronically deposited
into your account at any bank or nancial institution. If you do not
elect direct deposit, the payment will be mailed to you. Any change of
address should be promptly reported in writing to the LTD ofce.
6
7
Special Dismemberment Benets
LTD benets may be payable up to a maximum period of 30 months if
an eligible employee suffers the severance of both entire hands, feet,
sight of both eyes, or one entire hand and foot.
LTD benets may be payable up to a maximum period of six months if
an eligible employee suffers the loss of one hand, one foot, or one eye.
Duration of Benets
LTD benets are payable beyond the 12 month period providing you
are medically certied as totally disabled from all gainful employment
for the length of time specied below. (The duration of benets table
outlined below does not apply to job-related claims with disabilities
beginning after July 1, 1994 or dismemberment.)
Age at General Safety Elected
Disability Employees Employees Ofcers
54 or younger To age 65 To age 55 To age 60
55 through 59 To age 65 (1) To age 60
60 or younger To age 65 (1) (2)
61 through 65 5 years 5 years 5 years
66 4 years 4 years 4 years
67 3.5 years 3.5 years 3.5 years
68 3 years 3 years 3 years
69 2.5 years 2.5 years 2.5 years
70 2 years 2 years 2 years
71 1.75 years 1.75 years 1.75 years
72 1.5 years 1.5 years 1.5 years
73 1.25 years l.25 years 1.25 years
74 or older l year 1 year 1 year
(1) Participant under San Diego City Employees’ Retirement System (SDCERS)
– benets under SDCERS Plan will become payable and no benets will
be payable under the LTD Plan.
(2) Participant in Elected Ofcers’ Retirement Plan (EORP) – benet equal to
the EORP service benet. Non Participant in EORP – benet equals 70% of
basic biweekly earnings, less EORP benets had they been a member.
Pregnancy Claims
Pregnancy claims must meet the same criteria as all other disabilities.
In the majority of cases, the date of delivery is established as the date
of disability.
If secondary, complicating medical conditions arise during your preg-
nancy which disable you from working, medical certication describing
your medical condition must be provided.
Benets are payable based on medical certication and following the
required 30-calendar day elimination period during which time you do
not work. Benet payments begin on the 31st day following your date
of disability.
Benets cease following a six week recovery period for a normal delivery
and an eight week recovery period for a Caesarean section delivery.
NOTE: The above does not imply that LTD benets are payable
for six full weeks or eight full weeks. No benets are payable for
any non-medical certication period or during the 30-calendar
day elimination period.
Family and Medical Leave Under FMLA and CFRA
The following is a brief summary of your rights as an employee under the
federal Family and Medical Leave Act (FMLA) and the California Family
Rights Act (CFRA) as they pertain to the LTD program. For more detailed
information, see the City’s Family and Medical Leave Policy and forms.
Benets: FMLA and CFRA authorize up to 12 workweeks of unpaid, job
protected leave per 12 month period for certain family and medical rea-
sons. The law protects you from losing your employment status while on
a qualied leave due to your own illness or the illness of immediate family
members. Although FMLA and CFRA provide for unpaid leave, the City
allows you to use available annual, sick, and other types of leave during
FMLA/CFRA absences. All FMLA/CFRA eligible absences count as part of
your 12 workweek entitlement, including annual leave, leave without pay,
Industrial Leave, Workers’ Compensation, and LTD. Accordingly, if your
LTD absence meets the qualifying criteria under FMLA/CFRA, your LTD
absence will count toward your 12 workweek allotment and begin the 12
month eligibility period. The City of San Diego is required to provide you
with group health coverage during FMLA/CFRA leave and guarantee your
return to the same or similar job. Additionally, if your absence meets the
qualifying criteria under FMLA, it will count toward your 12 week FMLA
allotment, even if it does not qualify for LTD.
8
Eligibility: To be eligible for FMLA/CFRA leave, you must have been
employed by the City of San Diego for at least 12 months and have
worked at least half-time (1040 hours) during the past year.
Reasons for FMLA/CFRA Leave: Employees may take FMLA/CFRA
leave for any of the following reasons:
• To care for your child after birth, or placement for adoption or
foster care;
• To care for your spouse, child, stepchild or foster child under 18,
adult dependent son or daughter, or parent who has a serious
health condition; or
• For a serious health condition that makes you unable to perform
your job.
Generally, a condition that meets the requirements of the LTD program
will also qualify as a serious health condition under FMLA and CFRA.
FMLA and CFRA run concurrently for a total of 12 workweeks of leave,
except where the leave is due to disability caused by pregnancy, child-
birth, or a related medical condition. Under the Pregnancy Disability Act
(PDA), California law provides up to four months of additional unpaid
leave for pregnancy or childbirth related disability. That leave is not
counted as part of the 12 workweeks of leave provided by CFRA.
Under CFRA, family care leave for the birth of a child may be taken in
addition to a maximum of four months of pregnancy disability leave
under the Pregnancy Disability Act.
Pregnancy Disability Act
The Pregnancy Disability Act authorizes up to four months of unpaid
pregnancy disability leave (if annual leave not available). You are con-
sidered “disabled by pregnancy” (including childbirth) when, in the
opinion of your health care provider, you are unable to perform any one
or more of the essential functions of your job or to perform these func-
tions without undue risk to yourself, the successful completion of your
pregnancy, or to other persons. You are also considered to be disabled
by pregnancy if you are suffering from severe morning sickness or need
to take time off for prenatal care. The law protects your employment
status while on a qualied leave for up to four months. There is no
length of service requirement before an employee disabled by pregnancy
9
is entitled to a pregnancy disability leave. The Pregnancy Disability Act
does not require employers to provide group health insurance coverage.
However, since FMLA runs concurrently with PDA, you will be covered
by the City’s health insurance coverage for 12 of the 16 weeks.
Catastrophic Leave
The City’s Catastrophic Leave Plan allows City employees to assist other
City employees who face extended leaves without pay due to a cata-
strophic occurrence in their lives. A catastrophic occurrence is dened
as any event that would qualify under the Family Medical Leave Act as
determined by the City Manager.
Requests to establish a Catastrophic Leave Bank are processed through
Labor Relations. For further information regarding this Plan, please
contact your Payroll Specialist.
Unpaid Leave of Absence
A leave of absence of 30 days or more may be requested by submitting
a Request for Special Leave Without Pay to your division/department
head for approval by the Civil Service Commission. You can obtain this
form fromyour department payroll specialist. For further information,
please contact your department’s assigned personnel liaison.
Other Income Benets
Your Long-Term Disability benets will be reduced by other income
benets you receive or are entitled to receive including:
• 100% of the primary and family insurance amount under the Federal
Social Security Act or Railroad Retirement Act;
• any group policy of accident and health insurance providing benets
for loss of time from employment because of disability which has been
provided by the City or any other employer or with respect to which
the City or any other employer shall have made payroll deductions;
• any plan providing benets for loss of time from employment because
of disability pursuant to any benet act or law;
• any disability benet under a retirement program to which the City
or other employer makes contributions;
10
• government-sponsored plans, such as Veterans Administration, armed
forces, and similar programs providing income replacement or dis-
ability benets relevant to the current disabling condition;
• any service retirement benet under a retirement program to which
the City makes contributions;
• any Workers’ Compensation Temporary Total Disability, Vocational
Rehabilitation, Industrial Leave, short-term disability and sick leave
income; (Workers’ Compensation Permanent Disability income is not
considered as other income benets for offsetting purposes.)
• all other earnings from employment, or self-employment; and
• payoffs such as sick leave, annual leave, compensatory time, and pay-
in-lieu of vacation paid prior to an effective retirement date.
NOTE: Third party disability insurance, such as disability in-
surance policies with the Credit Union, are not considered other
income benets for LTD offsetting purposes.
You may be requested to furnish the LTD Administrator with satisfactory
information and/or documentation as to the amount you are receiving
or are entitled to receive from any other income benet source. In
the event the requested information is not provided, or you provide
erroneous or misleading information, the LTD Administrator has the
authority to withhold, correct, or adjust benet payments based upon
the facts or data available.
Return to Work Incentives
If you return to work on a limited basis as part of a plan of rehabilitation rec-
ommended and supervised by a licensed physician, only 50% of the wages
you receive will be considered in determining other income benets.
Example:
Your gross biweekly salary is $1120.00 based on an 80 hour biweekly
work schedule and you return to work part-time (40 hours biweekly).
Gross LTD biweekly benet rate ($1120.00 x 70%) .. $ 784.00
LESS 50% of part-time earnings ($560.00 x 50%) ....... – 280.00
Gross LTD benet payable ........................................... $ 504.00
Part-time earnings (40 hrs.) .................................................$ 560.00
LTD benet ..........................................................................+ 504.00
Gross biweekly income.............................................................. $1064.00
11
Pre-Existing Conditions
A pre-existing condition is dened as any disability for which you
received medical treatment within six months prior to your effective
date of LTD coverage. This includes any disability which is caused or
contributed to, by a pre-existing condition, or by a medical or surgical
treatment for a pre-existing condition.
If your disability is pre-existing as described above and you were hired
on or after September 4, 1981, you will participate in the LTD Plan after
serving an additional 12 consecutive months from the date you were
rst covered for that condition.
If you were hired on or before September 3, 1981, and there has not
been a break in service, the pre-existing condition limitation does not
apply. You are eligible to receive benets under the LTD Plan imme-
diately and all conditions are covered automatically.
Limitations
1. Benets are payable for a maximum of 12 months following your
date of disability or a maximum of 12 aggregate months for recurrent
conditions if you are disabled from performing the duties of your
regular occupation for that same condition.
a. Recurrent conditions means if you are totally disabled as dened
in the LTD Plan, return to full duty with the City of San Diego, and
again become totally disabled for the same condition.
b. If you become disabled due to a recurrent condition and your
second period of disability occurs within 12 months from the date
you return to work, you do not have to repeat the 30-calendar day
elimination period.
c. If your second period of disability occurs after 12 months from the
date you return to work, you do have to repeat the 30-calendar
day elimination period.
2. Benets may continue to be payable after the rst 12 months if you
are medically certied as totally disabled from engaging in any gainful
employment for which you become reasonably tted by education,
training, or experience. The duration of benets will depend on your
age and nature of your disability. Please refer to page 7.
12
Benet Exclusions
Coverage is not provided for:
1. benet accruals, if any, during eligibility, light duty status, elimination
period, or any period when other income exceeds the 70% ceiling
limit;
2. while a disabled employee is outside the continental limits of the
United States, Hawaii, Alaska or Canada, unless the employee returns,
upon request, for physical evaluation and disability certication;
3. any period of disability when an employee is conned in any penal
or correctional institution as a result of a conviction for a criminal
offense;
4. any total disability caused by:
a. war, whether declared, or undeclared, or any act of war;
b. intentionally self-inicted injury of any kind, while sane or insane; or
c. participation in, or in consequence of having participated in the
commission of a felony;
5. any disability beginning on or after July 1, 1994 caused by em-
ployment with the City of San Diego unless a period of 12 months
(2,080 hours) of Industrial Leave coverage has been exhausted for
such disability. LTD coverage will then be approved for a maximum
period of 12 months while you are medically certied as totally dis-
abled from engaging in any gainful employment as reasonably tted
by education, training or experience; or
6. any disability beginning on or after July 1, 1994 caused by mental or
nervous/stress disorders including any physical symptoms resulting
from mental or nervous/stress disorders.
13
14
Accumulated Leave
While you are receiving LTD benets, you are considered to be in a
non-pay status for payroll purposes. Consequently, you do not earn
annual leave credit.
You may elect to use your accumulated leave credits, subject to de-
partmental approval, in lieu of receiving LTD benets. Your election to
retain the use of leave time in lieu of LTD benets shall count toward
your 12 months of LTD eligibility. You will be requested to sign a form
acknowledging that you are eligible to receive LTD benets, but prefer
to use your accumulated leave credits.
If you elect to substitute LTD benets for leave taken, the Plan Adminis-
trator shall take necessary action to have the leave time taken reimbursed
at the rate of 70%. You will be requested to sign a form as to your se-
lection of LTD benets within 10 days of the notication. If no response
is received within the 10 day period, the LTD Administrator will assume
you wish to retain the use of leave in lieu of LTD benets.
The option to elect substitution of LTD benets for leave taken does
not apply unless you have led an application for LTD benets and
your claim has been approved. Under no circumstances can you use
accumulated leave credits and receive LTD benets simultaneously.
Industrial Leave
If your disability is work-related, you may be eligible for Industrial Leave.
The City’s Industrial Leave Program pays 100% of your salary while you
are disabled from working. To apply, you and your physician must com-
plete City Form RM-1634 within 24 hours of your date of disability.
Since Industrial Leave pays 100% of your salary, no LTD benets would
be paid. Industrial Leave runs concurrent with your eligibility for LTD
benets.
A revision to the LTD Plan allows coverage for job-related disabilities
occurring on or after July 1, 1994 only after 12 months (2,080 hours) of
Industrial Leave has been exhausted. LTD coverage may then be ap-
proved for a maximum period of 12 months provided you are medically
certied as totally disabled from engaging in any gainful employment
as reasonably tted by education, training or experience.
Worker’s Compensation–
Temporary Total Disability
If Industrial Leave is not approved, you may be eligible for Workers’
Compensation Temporary Total Disability (TTD) coverage. The City’s
Workers’ Compensation Program provides medical care to treat any oc-
cupational illness or injury and TTD benets for lost wages. If your TTD
allowance is less than the 70% LTD entitlement, you may be eligible to
receive the difference from the LTD Plan.
NOTE: A revision to the LTD Plan allows coverage for job-re-
lated disabilities occurring on or after July 1, 1994, only after a
period of 12 months (2,080 hours) of Industrial Leave has been
exhausted. LTD coverage will then be approved for a maximum
period of 12 months while you are medically certied as totally
disabled from engaging in any gainful employment as reasonably
tted by education, training or experience.
Example:
If your biweekly salary is $1120.00, your LTD benet would be $784.00.
LTD biweekly benet ($1120.00 x 70%) ........ $ 784.00
LESS anticipated biweekly TTD benet .........– 672.00
Gross LTD benet payable ............................. $ 112.00
Biweekly LTD benet ................................................. $ 112.00
PLUS biweekly TTD benet ....................................... + 672.00
Gross biweekly income........................................................$784.00
Workers’ Compensation–Vocational Rehabilitation
If you are permanently disabled from performing the duties of your
usual and customary occupation as a result of a work-related disability,
you may be eligible to participate in the City’s Vocational Rehabilitation
Program. The Rehabilitation Program will attempt to modify the duties
of your current occupation to conform with your work restrictions, or
provide alternate placement assistance if one exists. Vocational rehabili-
tation assistance can be provided for employment outside the City.
15
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A vocational rehabilitation maintenance allowance is payable, if you
qualify. For further information, please contact the Rehabilitation Pro-
gram at 236-6299.
Placement Assistance –
Non-Work Related Disabilities
If you are permanently disabled from performing the duties of your
occupation as a result of a non-work related disability, you will be re-
ferred to the Personnel Department for review of your qualications,
positions available within the City and Vocational Rehabilitation Transfer
list placement. Placement services will not be provided for employment
outside the City.
Light Duty
The Light Duty Program allows you to continue working light duty on
a temporary basis. You will continue to receive your normal compen-
sation and benets. Hourly employees with non-job related disabilities
are not eligible to participate. Light duty assignments end:
l. upon your medical release to return to full duty, or
2. after 10 days written notice from your department if you have been
medically certied as permanently disabled from performing your
usual and customary duties.
Written medical restrictions are required in order to arrange a suitable
light duty assignment within your medical limitations. If your department
is not able to provide you with a light duty assignment, your supervisor
or department liaison should refer you to the City’s Risk Management
Department for placement elsewhere within the City.
Since you receive full salary while working light duty, you will not be
eligible for LTD benets. However, it is in your best interest to le an
application for benets to ensure you meet the 60-calendar day ling
deadline. This may enable you to be eligible for benets should your
medical condition prevent you from continuing to work in a light duty
capacity.
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Request for Review
If your claim is not approved, you will receive written notice. You may
request a review of the LTD Administrator’s decision by ling a written
Request for Review form with the Labor Relations Manager within
10 days after receipt of the Administrator’s decision. Clearly state why
you are appealing the decision and attach any additional information
or supporting documentation.
Survivor Benets
A death benet may be payable upon the death of a participant who
is receiving LTD benets. This benet is payable only to a qualied
spouse and/or dependent children and is equal to 90 calendar days of
LTD benets. No payments are made if there are no surviving spouse
or dependent children.
Retirement Contributions Buy Back
If you wish to make up your retirement contributions during the time
you were covered by LTD, you should contact the Retirement Ofce at
533-4660 upon your return to work.
Representation
You are not required to be represented when applying for LTD benets.
However, if you appoint a representative, a written notication must
be submitted to the LTD Administrator. All future communication will
be between the LTD Administrator and your appointed representative.
There are no provisions in the LTD Plan for payment of attorney fees.
Medical Care
No medical care is provided under the LTD Plan. Your City health in-
surance coverage will continue while you are receiving LTD benets.
NOTE: If your date of disability begins on or after July 1, 1994,
after two years of LTD coverage, your City health insurance will
no longer be paid by the LTD fund. You will be referred to CO-
BRA for health insurance coverage.
You must be under the regular care of a physician, within the scope
and limitations of his/her license to be eligible for benets.
Independent Medical Examinations
The LTD Administrator may schedule appointments when necessary for
independent medical evaluations. Failure to keep a scheduled medical
appointment could result in benets being delayed or suspended.
Right of Recovery and Reimbursement
The City of San Diego has the right to recover from and against Third
Parties or persons, as well as their agents or insurers any payments
made by the Plan.
Employer-Paid Plan
The Long-Term Disability Income Plan is totally paid by the City of San
Diego. The City retains an independent actuarial rm which evaluates
contribution rates, reserve requirements, plan needs, design and expense
factors in an effort to maintain the Plan on a scally sound basis.
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Administration of the Plan
Plan Sponsor
City of San Diego
1200 Third Avenue, Suite 1000
MS #51-B
San Diego, CA 92101
Plan Administrator
LTD Administrator
City of San Diego
1200 Third Avenue, Suite 1000
MS #51-B
San Diego, CA 92101
(619) 236-6100
Employer Identication Number: 95-6000776
Plan Number: 510
Agent for Service of Legal Process
The City Clerk
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Notes
Printed on recycled paper using soy-based inks.
RM-1685 (Rev. 1-03)
Printed on recycled paper using soy-based inks.
RM-1685 (Rev. 1-03)