Temporary Disability Benefits Leave

Purpose

This Temporary Disability Benefits Leave Policy (“the Policy”) is intended to provide guidance to employees who are eligible for benefits from the University’s temporary disability benefits carrier (“the Carrier”) and need a leave of absence because of a non-work related illness or injury. The Policy provides benefits mandated by the New Jersey Temporary Disability Leave Law, as well as certain additional benefits provided by the University as set forth below. It does not apply to Workers Compensation benefits or to Family Temporary Disability Leave benefits.

Scope

University Policy

Definitions

The Policy applies to all administrative employees, as well as union and non-union staff employees. Faculty are not covered by the Policy.

Policy

Eligibility Requirements and Benefit Prerequisites

The Carrier reviews all disability claims and is solely responsible for approval or denial of a claim based on information provided by the employee’s attending physician or healthcare provider and other relevant information.

To be eligible for disability benefits, the employee must follow the Procedures set forth below and:

(a) have had at least twenty (20) calendar weeks of covered New Jersey employment in which s/he passed the wage earnings threshold established for that period by the State of New Jersey, Department of Labor and Workforce Development; and

(b) have a disability due to a non-work related illness or injury (including pregnancy) that has continued for at least eight (8) consecutive days.

Procedures

Initial absences that occur during the eight (8) day eligibility period must be reported by the employee to his/her supervisor, following departmental notification procedures.
After three (3) consecutive days of absence, the employee is required to have his/her healthcare provider fax a note documenting the employee’s continued absence from work and provide an expected date of return. This note is to be faxed to the Department of Human Resources (“HR”) at 973-761-9007.
HR will monitor the appropriate use of accrued sick leave or vacation hours (if sick leave hours have been exhausted) during the (8) day eligibility period and communicate with the employee, if necessary.
The employee is responsible for contacting the Carrier to file a disability claim and for making sure his/her legally licensed healthcare provider (see N.J.S.A. § 43:21-39(d)) submits required and timely documentation to support the claim, including a certification from the healthcare provider as to the employee’s total inability to perform his or her duties of employment. The appropriate forms may be obtained from HR.
Following the initial approval of a claim, the employee’s healthcare provider must provide timely medical updates as requested by the Carrier if disability benefits are to continue. To avoid the claim being terminated by the Carrier, it is imperative that the employee take responsibility for making sure his/her healthcare provider submits required medical documentation to the Carrier on time.
The employee may be required to submit to an independent medical examination (IME) by a doctor designated by the University or the Carrier. The employee must cooperate with the IME, including providing all requested medical information.
Throughout the disability leave period the employee is responsible for maintaining regular communication with HR concerning the need to continue on leave. Similarly, the employee is responsible to immediately inform HR if a return-to-work date is provided by his/her healthcare provider. HR will then inform the employee’s supervisor of the return to work date.
Based on the medical information provided by the employee’s healthcare provider the Carrier will determine the length of the disability coverage and when a claim will be terminated.

Pregnancy

Eligibility for temporary disability benefits and the claim filing procedure are the same for pregnancy as for any other disabling condition. For a normal pregnancy, benefits are usually payable for up to four (4) weeks before the expected delivery date and up to six (6) weeks after the actual delivery date (provided that the employee has not worked during that time). A doctor may certify that the employee is disabled for a longer period if she:

experiences specific complications related to pregnancy;
undergoes a Cesarean section;
has another simultaneous disability; or
is physically unable to do her regular job.

A claim for temporary disability benefits because of pregnancy should not be filed before the employee’s doctor advises that the employee is disabled and unable to work.

The claim should not be filed until the employee has actually stopped working.

Duration of Benefits/Long Term Disability

Benefits under this Policy are payable from the eighth (8th) consecutive day of disability and for each day thereafter that the disability continues up to a maximum of twenty-six (26) weeks. The seven (7)-day waiting period becomes compensable when disability benefits have been paid for all or some part of the three (3) weeks following the waiting period.

If it is anticipated that the disability will continue for more than twenty-six (26) weeks, the employee should contact HR to determine whether s/he may be eligible for benefits under the University’s Long Term Disability Plan.

Discontinuance/Denial of Benefits

An employee otherwise eligible for benefits based on a certification from his/her healthcare provider that the employee is unable to perform his/her duties of employment for a given period of time may, nevertheless, have his/her benefits reduced, terminated or denied because of one or more of the following circumstances:

The Carrier and the healthcare provider have reached a mutual agreement as to a change in the employee’s period of disability.
As the result of an IME, it has been determined that the employee is no longer disabled, in which case benefits shall not be paid beyond the date of the IME.
The employee refuses to submit to or attend an IME or otherwise fails to cooperate with the IME (such as failing to supply requested medical information), in which case the employee is disqualified from all benefits except those previously paid.
The University or the Carrier has obtained credible factual evidence showing that the covered employee is performing activities that demonstrate that s/he is able to perform the regular duties of her/his employment, in which case benefits shall not be paid beyond the date that such factual evidence is obtained.
Benefits may be denied if:
(1) the employee’s injury was intentionally self-inflicted;
(2) the employee was injured during his/her perpetration of a crime;
(3) the employee becomes disabled after having been suspended or discharged for misconduct; or
(4) the employee becomes disabled during a work stoppage due to a labor dispute.

Return to Work After TDB Leave

Employees returning to work from leave must have authorization from their healthcare provider to do so. This authorization is to be sent to HR via fax at 973-761-9007.

When a claim is terminated by the Carrier, the employee is expected to return to work on the next regularly scheduled work day. If the employee cannot return to work on the next regularly scheduled work day, s/he must follow normal call out procedures and supply medical documentation by fax to HR supporting his/her continued absence within two (2) days of the return-to-work date. Failure to return to work, follow normal call out procedures or to provide medical documentation within two (2) days following the return-to-work date will lead to termination of employment, unless the employee is prevented from doing so by reason of extreme emergency.

Prohibition Against Working Elsewhere During TDB Leave

Once a TDB claim has been approved, the employee is not permitted to perform any work for remuneration or profit during the period of disability. If the employee is found in violation of this restriction, his/her employment will be terminated, and the employee will not be entitled to benefits for any period during which such work was performed, and all future benefits will be cancelled.

Appeals

If the employee disagrees with a determination denying benefits, s/he has the right to appeal to the Division of Temporary Disability Insurance. The appeal must be filed within one (1) year of the date the disability began.

A written appeal should be sent to:

Division of Temporary Disability Insurance
Private Plan Operations
Claims Review Unit
PO Box 957
Trenton, NJ 08625-0957

Return to Work With Reasonable Accommodations or in a Modified Duty Temporary Position*

An employee with a non-work related illness or injury may request to return to work in lieu of the benefits otherwise then available under this Policy under the following circumstances:

(1) The employee can perform the essential functions of his/her job with reasonable accommodations. The employee shall advise HR of the accommodations the employee desires and provide supporting medical documentation. Thereafter, the University and the employee will attempt to reach an agreement regarding reasonable accommodations.

(2) An employee (a) who cannot perform the essential functions of his/her job with or without reasonable accommodations and (b) whose disabilities are temporary may request a modified duty temporary position. The University will determine the duration of any temporary position offered on a case-by-case basis. The University may require that a request for a modified duty temporary position be supported by a certification from the employee’s healthcare provider that the employee is able to perform all of the duties of the temporary position. The University retains complete discretion over whether to offer the employee a modified duty temporary position and when to terminate the position.

*Bargaining unit employees should consult their collective bargaining agreement as it relates to this provision.

Enforcement of Return to Work

An employee who is released to return to work either with or without restrictions, must contact HR as soon as the information is known by the employee. HR will inform the employee’s supervisor. If an employee is offered a modified duty temporary position, the employee must be available to begin work on the date the position is established. If the employee does not return to work when required, s/he must follow normal call out procedures and supply medical documentation by fax to HR supporting his/her continued absence within two (2) days of the return-to-work date. Failure to return to work, follow normal call out procedures or to provide medical documentation within two (2) days following the return-to-work date will lead to termination of employment, unless the employee is prevented from doing so by reason of extreme emergency.

Compensation During Disability Leave

For All Employees Covered by this Policy:
The employee will receive the temporary disability benefit check directly from the Carrier. For a period of disability covered by the Carrier, the amount payable is 66.67% of regular weekly wages up to a maximum as declared annually by the State of New Jersey, Department of Labor and Workforce Development.

For Administrative Employees
In accordance with NJ Temporary Disability Law, the University may pay all or part of the difference between the employee’s regular weekly wage and the weekly temporary disability benefit amount with no impact on the claim. The total income received cannot exceed the regular weekly wages.

For qualified Administrators, the University may provide a Salary Continuation benefit that pays up to 100% of the difference between the temporary disability benefit amount and the employee’s base monthly pay, provided the employee has a sick leave balance of at least 70 hours to use during the first 10 days of the disability period. The following chart outlines Seton Hall University’s Salary Continuation Program for qualified Administrators:

Approved Disability Amounts
Length of Approved Disability	Less than One Year of Employment	One Year of Employment and Date of Hire after 10/15/84	Date of Hire prior to 10/15/84
First Month	100%	100%	100%
Second Month	60%	100%	100%
Third Month	60%	60%	100%
Fourth Month	0%	60%	100%
Fifth Month	0%	60%	100%
Sixth Month	0%	60%	100%

The employee will receive Salary Continuation only for the duration of approved disability leave provided by the Carrier.

If the employee does not qualify for Salary Continuation benefits, the employee will only receive temporary disability benefits paid by the Carrier.

For Staff Employees

If the Carrier does not cover the first seven (7) days of disability, the employee may use sick hours, or vacation hours if sick time is exhausted, for a full working day (7 or 8 hours).
During remaining periods of disability, the employee may use sick hours and vacation hours to supplement disability benefit payments. The use of sick hours and vacation hours will be limited to approximately 1/3 of weekly pay. The combined income from sick hours, vacation hours and disability payments cannot exceed regular weekly earnings.
An employee without accrued sick or vacation hours at the start of disability, will receive the disability benefit payment issued by the Carrier only.

Employment Status (Including FMLA & Personal Leave Designation) and Benefits During an Approved TDB Leave

To the extent an employee on temporary disability leave has leave available under the Family and Medical Leave Act (FMLA), the employee is required to exhaust his/her leave under this temporary disability leave Policy as part of FMLA leave and cannot add FMLA leave time to his/her temporary disability leave (see the University’s FMLA Policy). An employee with available FMLA leave will be required to provide documentation required for purposes of FMLA leave in addition to any documentation required for temporary disability leave. The FMLA does not require the University to hold the position of an employee who continues to be disabled after the expiration of FMLA leave.* An employee whose period of temporary disability will exceed his/her FMLA leave must, before FMLA leave is exhausted, or as soon thereafter as is practicable, request from HR a Personal Leave of Absence in order to maintain his/her status as an employee. The University will grant or deny the request based on the individual circumstances of each case. Regardless of whether the request for a Personal Leave of Absence is granted, the employee will continue to receive temporary disability benefits as described in this Policy. The University may require the employee to provide additional medical documentation to support the request for a Personal Leave of Absence, which documentation must include an anticipated return-to-work date. Failure to timely request a Personal Leave of Absence, present requested medical documentation for a Personal Leave of Absence request, or to return to work when the Personal Leave of Absence has expired will result in termination of employment, unless the employee was prevented from doing so by reason of extreme emergency.

*Employees covered by collective bargaining agreements should consult their respective contracts for information regarding employment status during an approved disability leave.

Medical benefits for employees on temporary disability leave will continue during any FMLA leave period and thereafter during any Personal Leave of Absence granted by the University up to a maximum of 26 weeks. Any required employee contribution for medical health coverage or other University benefits will automatically continue during Salary Continuation. Employees not eligible for Salary Continuation will be required to make payment of the employee contribution for medical health coverage and other University benefits no later than the 15th of each coverage month. Contact the Benefits Specialist at 973-275-2755 to make necessary arrangements for payment to prevent any lapse and/or termination of coverage.
Vacation and sick time does not accrue when an employee is not actively at work.

Disclaimer

This Policy does not create a contract of employment or alter the at-will employment relationship between the University and its employees. Nothing contained in this Policy shall limit the right of either the University or the employee to terminate the employment relationship at any time, with or without cause.

A work-related illness or injury is not covered by this Policy, but is covered under the provisions of the Employer's Liability Law of New Jersey as Workers' Compensation.

Related Policies

Responsible Offices

Department of Human Resources

Approval

Approved

By A. Gabriel Esteban, President, on the recommendation of the Executive Cabinet on April 22, 2016.

Effective Date

April 22nd, 2016