Short-Term Disability

Policy

Category: Human Resources
Subject: Short-Term Disability
Division: Administrative Services
Policy Number: CA.52.01.115
Effective Date: December 14, 2017

POLICY STATEMENT

Wellington-Dufferin-Guelph Public Health (WDGPH) provides a short-term disability (STD) plan that provides eligible employees with continued income during periods of absence from work due to an approved disability. If employees are deemed unable to work because of a disability, the STD plan will provide an employee with 75% of salary earnings based on the rate of pay of the employee on the last day of active employment for a maximum of 17 weeks or 119 calendar days.

Salary earnings are defined as an employee’s regular earnings and do not include sporadic overtime, or other special payments.

As part of WDGPH’s service to employees, a disability management service has been retained to specifically administer and adjudicate employee STD claims.  Long-term disability (LTD) claims will continue to be administered through WDGPH’s LTD insurance carrier.

WDGPH has obtained an external disability management service provider to adjudicate STD claims to ensure equality of service in dealing with employee STD claims. A disability management service provider specializes in working with and supporting employees to administer and adjudicate STD claims and to assist in establishing a safe return to work process.

Eligibility Requirements:

Permanent full-time and part-time employees regularly working at least 28 hours per week are eligible for STD coverage and must meet the following criteria at time of application. The employee must:

  • Meet the definition of disability and have been absent for three or more consecutive days;
  • Be actively at work immediately prior to the start of the absence or on an approved paid absence;
  • Be under the care of a qualified health care provider and receiving treatment that is deemed appropriate by the Disability Management service provider;
  • Act in good faith, participate and provide appropriate medically required documentation in the claims management and return to work process;
  • Be under the age of 65 as outlined in CA.52.01.134 Benefits;
  • Not be on an unpaid leave of absence, or unpaid vacation;
  • Not be actively working elsewhere during the period of disability; and
  • Not volunteer or attend school unless it is part of an approved medical treatment.

DEFINITIONS:

Disability – To qualify for STD benefits an employee must be “disabled”.  This means that the employee must be unable to perform all of the usual and customary duties of their pre-disability occupation or suitable modified work due to a non-occupational injury or illness. A disability must be supported with objective medical evidence. (Refer to Eligibility Requirements above.) 

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES:

Corresponding Procedure: CA.52.02.115 Short Term Disability

CA.52.01.134 Benefits

Contact for inquiries:  

Manager, Human Resources

 APPROVED BY

Director, Administrative Services


Procedure

Category: Human Resources
Subject: Short-Term Disability
Division:  Administrative Services
Procedure Number: CA.52.02.115
Effective Date: December 14, 2017

PROCEDURE

General short-term disability (STD) process:

  1. Employees will contact their manager each day they are absent as a result of an illness or injury. If the employee provides documentation that substantiates their absence for multiple days the employee is not required to report their absence each day.
  2. On the fourth day of absence the immediate supervisor will confirm the employee is eligible for STD.
  3. If the employee is eligible, the immediate supervisor will complete the disability management service provider’s claim form (ANF) (posted on WDGPH’s website).
  4. The immediate supervisor will email a copy to the disability management service provider with a copy to Human Resources.
  5. Human Resources will forward a letter to the employee about the STD process, including the policy and procedure; as well as an Employee Assistant Program (EAP) pamphlet. Human Resources will advise Payroll accordingly.
  6. The disability management service provider will:
  • Contact the employee who is absent within one business day of receiving the completed disability form;
  • Obtain all relevant medical information from the employee and confirm the next steps in the return to work process;
  • Interface with the employee’s health care provider when required to obtain medical information;
  • Determine if the employee’s claim meets the definition of STD;
  • Contact management and/or Human Resources as necessary with any relevant information while maintaining confidentiality of the employee’s medical information;
  • Identify any barriers to the employee’s return to work to Human Resources and immediate supervisor;
  • Develop, coordinate and implement plans for removing any barriers to the employee’s return to work;
  • Work with employee, identify accommodations if required to enable employee to return to work safely;
  • Formalize modified or full return to work plans, monitor employee’s progress; and
  • Close the employee’s file once the employee has successfully returned to work.
  1. The employee will cooperate and work with the disability management service provider, their immediate supervisor, Human Resources and health care provider, as required, to assist in adjudication of their claim.
  2. The employee will provide medical information as needed and work with the disability management service provider to establish a gradual and/or modified return to work plan if needed.
  3. The employee will return to work following the return to work plan, in order to ensure a safe and healthy return to work.
  4. If a gradual or modified return to work plan is not required, the employee will return to their regular work and work schedule, once the disability management service provider has received clearance from the employee’s health care provider.

Medical restriction information requirements:

Medical restriction information may be required from employees for the following reasons:

  • To enable the disability management service provider, on behalf of WDGPH, to assess whether an absence qualifies for disability;
  • To provide WDGPH with an understanding of employees’ current abilities and limitations so that WDGPH can provide the necessary accommodations to enable employees to safely and productively return to work; and
  • To enable the manager to identify staffing requirements.

An employee does not automatically qualify for STD benefits after prolonged absences of three or more consecutive days. The absence may qualify as sick time. WDGPH may request the employee to provide a medical certificate after an absence of three consecutive days of sickness. However, if the employee wishes to apply for STD benefits, medical information must be submitted to our disability management service provider.

Due to privacy and confidentiality of individual medical information, managers are not to obtain any medical information beyond a medical certificate or information that the employee has a medical condition which prevents them from attending work. In a case where managers receive confidential information from their employee, the manager should send all confidential information back to the employee. The employee then needs to submit this information directly to the disability management service provider. 

If a short-term disability claim is denied:

If the disability claim is not approved by the disability management service provider based on the information provided by the employee’s health care provider, the employee will return to work, use vacation, compensation time or take an unpaid leave of absence if necessary to cover the time away from work.

If the employee wishes to appeal the disability management service provider decision, the following steps must be taken.  The employee must submit the below to the disability management service provider:

  • A written request to appeal the denial decision within 30 calendar days from the date of denial of STD benefits; and
  • New and previously un-reviewed medical information within 30 calendar days from the date of denial, suspension or termination of STD benefits.

When the disability management service provider receives the information, they will confirm receipt with the employee and advise the Human Resources contact.

The quality assurance manager/ability management specialist or director from the disability management service provider will review the appeal documentation, as well as the STD file in its entirety. Based on this objective information, a decision to either approve benefits entitlement or uphold the denial decision will be provided to Human Resources and to the employee within five to ten business days of receiving the appeal documentation.

In cases where the first appeal is denied, the employee may be able to submit a second appeal and will again be provided with 21 calendar days to submit new and previously un-reviewed medical information. 

Absences due to pregnancy:

Absences related to pregnancy will be evaluated like any other health condition and will require objective medical information to qualify for STD benefit payment.

Absences due to substance abuse:

Alcohol and substance abuse are recognized as a disability. Absences due to alcohol or substance abuse will be evaluated in the same manner as any STD claim. The employee must be participating in an appropriate rehabilitation program in order to be eligible for benefit payment.

Exclusion of disabilities:

Employees will not receive disability income for illness or injury resulting from:

  • A work related accident or occupational illness in the performance of their duties (W.S.I.B. may apply);
  • Participating in a riot, insurrection, war or hostilities;
  • The commission of or attempted commission of a criminal act; or
  • During an approved leave of absence.

Additional limitations:

No benefits are payable to an employee who:

  • Does not meet the definition of disability as identified in this policy;
  • Does not have a confirmed health condition or if the health condition is not severe enough to support a disability;
  • Is not receiving appropriate treatment for their health condition;
  • Does not participate or cooperate in the prescribed treatment plan;
  • Performs activities that are inconsistent with their disability;
  • Is receiving benefits under any Worker’s Compensation Act or similar law;
  • Is on a unpaid leave of absence, unpaid vacation;
  • Is actively working in any other paid occupation with any employer during a disability;
  • Is going to school or pursuing education (unless otherwise approved); or
  • Is traveling (vacation) except for emergency reasons due to personal or family related issues.

Disability recurrence:

If, within ten consecutive work days of returning to work following a period of disability for which an employee received STD income, the employee again becomes totally disabled as a result of the same or related causes, this latter period will be considered to be a continuation of the first. Payments for the balance of the benefit period will resume immediately.

Unrelated disability:

If employees return to active employment for one full day prior to the onset of a new, unrelated disability, full STD benefits will apply to the new unrelated disability claim.

Claim administration and adjudication:

  • Employees must immediately notify their manager of any illness or injury which prevents them from attending work;
  • Beginning on the fourth day of absence after the employee has been absent for three consecutive days, the manager will confirm that the employee is covered for STD benefits; 
  • Upon confirmation of coverage, the manager must complete a notification form (ANF) and submit the form to the disability management service provider with a copy to Human Resources; and
  • If the employee is aware of an impending absence i.e. surgery, the ANF form can be submitted by the manager as soon as the planned surgery date has been confirmed.

If an employee’s disability claim is denied, the disability management service provider will inform both the employee and WDGPH.  An employee may choose to appeal the disability management service provider’s decision.  See procedure CA.52.02.115 for appeal process.

Top-up payments:

WDGPH, upon notification that an employee’s claim has been accepted, can apply for a top-up of the STD benefits if the employee qualifies and requests a top up payment. This top up will be applied using an employee’s accrued and unused vacation and compensation time. Human Resources will be responsible for coordinating the payment of any top-up pay. Employees interested in applying for a top-up should contact Human Resources.

Reductions to STD benefits:

Short-term disability benefits will be reduced by:

  • Any amount payable from the Canada Pension Plan or the Quebec Pension Plan for loss of time (excluding any payment in respect of an employee’s children) and/or a retirement pension;
  • Any related disability income employees may receive from any no-fault automobile insurance plans which have been approved as an acceptable limitation under the Unemployment Insurance Act, and by the Criminal Injuries Compensation Act; or
  • Notice payments employees receive as a result of termination of employment.

Termination of STD coverage:

Short-term disability coverage terminates upon the earlier date of:

  • The employee’s return to their regular hours of work;
  • The benefit period ends;
  • The employee no longer qualifies to meet the definition of disabled;
  • The employee reaches age 65;
  • The employee’s termination, layoff or unpaid leave;
  • The employee’s retirement;
  • The death of the employee; and
  • The employee is gainfully employed with another organization.

Return to work:

WDGPH will work with employees to provide a safe return to work process that meets:

  • The occupation which an employee performed on a regular and continuing basis before becoming disabled; and
  • The needs of both the employee and WDGPH.

Long-term disability (LTD):

Should the employee not be able to return to work at the end of the STD coverage, the employee is required to apply directly to the external LTD insurance carrier who will adjudicate their claim for LTD benefits.

Refer to the LTD insurance carrier’s booklet for further details regarding LTD.

RESPONSIBILITY:

Management will:

  • Have a clear understanding of the STD policy and administer the policy as required;
  • Ensure employees understand and follow the policy;
  • Promote health and wellness in WDGPH to all employees;
  • Be responsible for attendance management and address absenteeism concerns with employees;
  • Report absences that meet the STD requirements within appropriate timelines; and
  • Work with employees to address accommodation needs for a safe return to work.

Human Resources will:

  • Work with managers, employees and the disability management service provider to support the STD process including all return to work plans.

Employee will:

  • Know and follow the policy guidelines as they relate to STD;
  • Work with their manager, Human Resources and the disability management service provider regarding all STD claims, accommodation and a safe return to work plan; and
  • Work towards maintaining their health and reducing absences.

Disability Management Service Provider will:

  • Work with management, the employee and Human Resources to address disability claims;
  • Contact employees within the required timeline providing appropriate documents;
  • Obtain medical information from both the employee and their health care provider;
  • Adjudicate the claim providing feedback in a timely manner to management and the employee;
  • Maintain legal compliance relating to confidentiality of private medical information;
  • Work with management, the employee and Human Resources to establish an appropriate return to work plan that meets the need of the employee and WDGPH; and
  • Monitor the disability claim until the file is closed including return to work process.

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES:

Corresponding Policy:  CA.52.01.115  Short-Term Disability

CA.52.01.116   Sick Days

CONTACT FOR INQUIRIES:

Manager, Human Resources

APPROVED BY

Director, Administrative Services