Weekly Income Benefit

Weekly Income Benefits are available only for eligible employees who are not utility employees. Weekly Income Benefits are not provided for retirees, dependents or persons who are making COBRA self-payments.

Weekly Income Benefits are designed to help replace lost wages when you are totally disabled and unable to work. No Weekly Income Benefits are payable for any period of time during which you are able to work.

Eligibility for Weekly Income Benefits - To be eligible for Weekly Income Benefits, you must meet the following requirements:

  1. You must be totally disabled as a result of a non-occupational accidental bodily injury or sickness and be completely unable to perform each and every duty of your occupation or employment; and
  2. Your disability must begin, and you must see a doctor about the disability, within 15 days after the last day you worked for a contributing employer; and
  3. You must be covered under the Plan due to worked hours when your disability begins. However, if your disability begins prior to the date you become eligible due to worked hours, or during a period in which you are eligible for a reason other than worked hours (for example, if you are making COBRA self-payments), Weekly Disability Benefits will begin when you first become eligible because of worked hours.

Amount of Benefit - The amount of the weekly benefit is shown on page 6 of the Schedule of Benefits. The weekly benefit will be paid on the basis of a regular 5-day work week, Monday through Friday. No benefits are paid for Saturdays and Sundays. If benefits are due you for a partial week, you will receive one-fifth of the weekly benefit for each day of disability. In accordance with federal law, the Plan will withhold your share of the FICA (Social Security) tax from each weekly payment made to you and will send it to the government. In addition, keep in mind that you must include the weekly benefits you receive in your gross income and pay Federal income tax on them. If you have a question about this, or about exclusions in the law, you should check with a competent tax advisor or attorney.

Period of Payment/When Benefits Start - Weekly benefits are payable for up to 26 weeks while you are totally disabled, but not for more than 26 weeks for any one continuous period of disability.

Weekly benefits will begin:

  1. On the first day of disability due to an accidental injury.
  2. For disabilities due to sickness:
    • On the eighth day of disability if not hospitalized as an inpatient, or
    • On the first day of an inpatient hospital stay if the admission was before the eighth day of sickness.

      If a female employee is disabled due to maternity or a pregnancy-related condition, the disability will be treated as a disability due to sickness.

A disability will not be considered to have started until the first day that you are actually examined or treated by a doctor.

Successive Periods of Disability - Two or more periods of disability due to the same or related causes will be considered one period of disability unless you return to full-time work for a continuous period of at least two weeks between the periods of disability. Successive periods of disability separated by less than two weeks of active full-time work will be considered one period of disability unless the second disability is entirely unrelated to the causes of the first disability and begins after you return to full-time work for at least one full day.

If you have successive periods of disability due to one accident, only the first period of disability will be considered as caused by an accident. All other periods of disability due to that accident will be considered as due to a sickness.

Exclusions and Limitations - No weekly benefits are paid for:

  1. Any disability which results from a sickness or injury for which you are not under the direct care of a doctor;
  2. Any disability which results from any injury or sickness for which you are or may be entitled to receive benefits in whole or in part under any Workers' Compensation law, Occupational Diseases law, Employer's Liability law or similar law;
  3. Any disability that results from any injury sustained while performing any act or duty pertaining to any occupation or employment for remuneration or profit; or
  4. Any disability or days of disability caused by substance abuse:
    1. If you are not undergoing covered inpatient treatment in a hospital or an approved treatment facility for substance abuse;
    2. Beyond the date an inpatient course of treatment is completed; or
    3. For which inpatient medical or Mental Health and Substance Abuse Benefits are not payable by the Plan, including an inpatient course of treatment that is terminated before the course of treatment is completed.