County of Los Angeles Long Term Disability Benefits Program April 20, 2011

Maximized Resources •Simplified ProcessesMaximized Resources •Simplified Processes

County of Los AngelesLong Term Disability Benefits Program

April 20, 2011

Facilitators:

Lance Tomei, Operations Manager

Jason Rubinstein, Account Manager


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Disability Benefit Plans

Two Disability Benefit Plans are managed by Sedgwick CMS1. “Regular” Long-term Disability Benefit Plan

1. Long Term Disability - LTD

2. Survivor Benefit - SB

2. Mega Flex Plans1. Short Term Disability - STD

2. Long Term Disability - LTD


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Eligibility for Regular LTD Plan

5 years of continuous County Service and a general member of the Los Angeles County Retirement Association (LACERA). General member does not include a safety member.

Or as a direct consequence and result of injury or disease arising out of and in the course of the performance of the employee’s assigned duties.

Satisfaction of a 6 month qualifying period . If employee returns to work for less than 30 days during a

qualifying period, any such cessation shall not interrupt continuity of the qualifying period, provided it is the same disability.

If employee returns to work for 30 days or more, the qualifying period must start again.


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The LTD Application

LTD Application (LTD Claim Packet) Sent to Employee by Sedgwick as of the 4th month of absence. 1. LTD & Survivor Benefit Plan Booklet2. Employee Statement Form3. Job History4. LTD & Survivor Warrant Recipient Designation5. W4 Tax From6. Authorization to Release Information (ROI)7. Right of Reimbursement (ROR)8. Attending Physician Statement (APS)


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The LTD Process

The following records/information are obtained and reviewed in order to adjudicate a claim:

1. Medical records

2. Payroll information

3. Late filing explanation – if claim filed over one year after first date of disability

4. Check WC payment history and notes, if work related injury or illness, WC claim system checked every 30 days


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Processing Timeframe for LTD

The average initial LTD claim review timeframe is within 90 days from receipt of the complete claim packet.

However, there may be circumstances where additional time is needed in order to request and obtain sufficient information in order to make a claim determination.


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LTD Disability Plan Basics Six-month qualifying period “Total Disability” has two meanings:

1.During the Qualifying Period (first six months of disability) and the first 24 months of benefit eligibility, Total Disability means the complete inability to perform the duties of your County position. Own Occupation

2.After 24 months of LTD benefit eligibility, Total Disability means that you are disabled within the meaning of the FSSA and you are eligible to receive or are receiving benefits under the FSSA. Any Occupation

LTD Benefit = 60% of monthly earnings (based on prior 12 months of earnings) Cost of Living Increase applicable annually to claimants who have been disabled

for more than 30 months with a disability begin date of January 1, 2001 or later. All LTD applicants are required to provide written proof they have applied for

Social Security Disability (SSD) benefits within 30 days from the date of claim application. Applying for Supplemental Security Income (SSI) benefits will not satisfy the Plan requirements.


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LTD Disability Plan Basics If a County Employee was employed after April 1, 1986, they have been

making mandatory contributions to the Social Security Medicare Fund through payroll deductions. If the employee does not have enough quarters to qualify for SSD benefits, they must still provide written proof from the Social Security Administration that they have applied for Medicare benefits.

PARTIAL RETURN TO WORK : The LTD Plan continues to provide benefits, if the employee is able to return to work on a part-time basis. As soon as the employee becomes aware that he/she is able to return to work, the employee must notify Sedgwick. Failure to timely notify Sedgwick may result in termination of LTD benefits. Any such part-time return to work must be approved by the CEO.

Upon return to a County position on a part-time basis the LTD benefit will be reduced by 70% of any salary, compensation, or income earned.


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LTD Disability BenefitsOffsets:

•Salary or other compensation including sick or vacation pay, applied on a day for day basis.

•LACERA Retirement Benefits (Plans A-D)

•50% of salary or other compensation received from another employer.

•70% of salary, compensation, or income earned from County employment.

•Disability benefits received from any federal, state, County, municipal or other governmental agency.

•Worker’s Compensation Benefits: Temporary Total Disability (TTD) or Vocational Rehabilitation Maintenance Allowance (VRMA); any other employer’s liability law. Permanent Disability (PD) is not offsetable.

• Railroad retirement

• Social Security disability benefits will not include cost of living increases


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LTD Duration:•24 months for Own Occupation

•To Age 65 or Death, if Social Security criteria met

•Age 62: 3 1/2 years maximum benefit duration

•Age 63: 3 years maximum benefit duration


•Age 65: 2 years maximum benefit duration




•Age 69 and over: 1 year maximum benefit duration

• Employee retires under Plan E will result in claim termination.


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MegaFlex Participants


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MegaFlex STD SummaryEligibility• Waiting Period • 14 days – Basic Plan• 7 days – Buy Up• Must be unable to perform own job• Medical Evidence of DisabilityBenefit• Basic Plan : 70%• Buy Up : 100% first 21 days, 80 % 22nd -

term


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MegaFlex STD Basics

Duration

• End of Disability as determined by Sedgwick or 26 weeks, whichever occurs first

• Initial loss periods based on Occupational Disability Guidelines (ODG), beyond ODG may require additional medical evidence, including but not limited to, medical records, IME, FCE etc.

Late Claims

• Penalty: one day extension to the Waiting Period for each day the claim is late, resulting in a loss of benefits for day the claim application is late.


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MegaFlex STD - LTD Transition Process

1. Seamless transition from STD to LTD.

2. LTD Claim packet sent as of the 4th month of disability.

3. All available medical documentation requested prior to LTD transition.

4. Payroll information requested.

5. WC claim system checked for activity. If active, checked every 30 days for life of the claim


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MegaFlex (only) LTD Plan Provisions

26-weeks qualifying period. No 5-year service requirement. Not eligible for the basic Survivor Benefit

Plan. 40% or 60% LTD Benefit option (MegaFlex

participants of Retirement Plan E, with 5 years of County service receive the 40% benefit at no cost)

All other MegaFlex LTD Plan provisions and requirements are exactly the same as the General LTD Plan.


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BALANCEING LTD AND LACERA BENEFIT PROGRAMS


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LTD Rules that effect Retirement Plans A-D All members must apply for any Retirement benefit they may

be eligible for as of the 24th month of LTD Benefits. Failure to provide proof of Retirement application as of the

24th month will result in the termination of the LTD claim. If proof of the Retirement application has been provided

timely, however the monthly Retirement Benefit amount has not been provided as of the 24th month, Sedgwick will apply an estimated Retirement offset until the actual award amount has been provided by LACERA.

Benefits received under the LACERA Retirement Plans A-D must be offset from LTD benefits.


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LTD Rules that effect Retirement Plan E

LTD Plan does not require Plan E members to apply for Retirement as of the 24th month of LTD benefits.

If the Plan E member chooses to retire at anytime his/her LTD benefits will terminate as of the date of their retirement.


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LTD Overpayments due to Retroactive Retirement Benefits If you receive other income benefits for the same period of time that

you also received LTD benefits, this will result in an LTD overpayment.

It is important that all Plan members contact Sedgwick CMS prior to spending the check from “other” non-LTD benefits they may receive. Sedgwick CMS will calculate any existing overpayment and negotiate an appropriate repayment plan with the member.

Retirement Example: Let’s say you file for disability retirement, requesting that your retirement start on the first day of your disability. Your disability retirement benefit is approved one year later, retroactive to the first day of your disability. LACERA issues you a check covering the entire retroactive period, however, you had also received six months of LTD benefits during this period. Since you received your LTD benefits for the same period, an overpayment has occurred.


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Management Team Lance Tomei

Title - County of Los Angeles Team Leader Telephone – (818) 222-3001 Email – [email protected]

Sue Anselmo Title - County of Los Angeles Supervisor Telephone – (818) 591-5344 Email – [email protected]

Jason Rubinstein Title - County of Los Angeles Account Manger Telephone – (818) 222-3026 Email – [email protected]


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Claims Team NAME PHONE FAX EMAIL

Gail VanselowLTD Case Manager(Plan 13301 B, C, K) (Plan 133004 A-I)

818-222-3075 818-591-7664 [email protected]

Jorge RodriguezLTD Case Manager(D, F, H, O, U-V, X-Z)

818-222-3140 818-591-7664 Jorge [email protected]

Mike BrownLTD Case Manager (G, J, L, R, T)

818-222-3087 818-591-7664 [email protected]

Toiya TuckerLTD Case Manager(Plan 133004 J-K) (Plan 133003 A-Z) (LTD A, I, P-Q, S)

818-222-3004 818-591-7664 [email protected]

Mirna RamosDisability Specialist (STD A-Z)

818-222-3044 818-591-7664 [email protected]

Lissett CruzDisability Specialist (SB Claims)

818-591-5356 818-591-7664 [email protected]

Judy PandoReturn to Work Specialist

818-222-3157 818-591-7664 [email protected]


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Any Questions?

Documents

County of Los Angeles Long Term Disability Benefits Program April 20, 2011