Section 11 – TIME LOSS BENEFIT PROVIDED BY THE TRUST FOR ELIGIBLE EMPLOYEES
The Time Loss Benefit is only available to Eligible Employees. Retired Participants and Dependents are not eligible for the Time Loss Benefit.
Time Loss Benefits provide coverage to help protect an Eligible Employee against loss of income if the Employee is Totally Disabled because of an Illness or Injury. Time Loss Benefits are payable up to $100 per week for each week of Total Disability; up to a maximum of 26 weeks. For partial weeks, the benefit amount for each day is determined by dividing the weekly benefit by seven.
“Total Disability” or “Totally Disabled” means that as a result of an Injury or Illness, an Eligible Employee is absent from work and unable to engage in the duties of his/her customary occupation, and is performing no work of any kind for wage or profit.
Time Loss Benefits begin:
- with the first day of a Total Disability resulting from an Injury; or
- with the eighth day of Total Disability resulting from an Illness.
To qualify for Time Loss Benefits, an Active Participant must be regularly seen, treated, and certified Totally Disabled by a Physician. Time Loss Benefits are subject to federal taxation, including FICA.
Successive Periods of Total Disability
Time Loss Benefits will continue for up to a maximum of 26 weeks as long as an Eligible Employee remains Totally Disabled. A new period of disability will begin if:
- an Eligible Employee returns to full-time work for at least 30 calendar days, then becomes Totally Disabled again from the same cause; or
- an Eligible Employee returns to full-time work for at least one day, then becomes Totally Disabled again from a different cause.
Termination of Eligibility
If eligibility terminates after Total Disability is established and benefits are determined payable, benefits will continue until: (1) the Participant is no longer Totally Disabled, or (2) the maximum benefit has been paid.
EXCLUSIONS No Time Loss Benefit will be extended for any disabilities that are:
- related to any condition for which coverage is available, if proper claim were made, by Workers’ Compensation, occupational disease or injury law or similar legislation. The Plan covers no expenses for any condition arising out of or received or aggravated in the course of engaging in any activity for wage or profit;
- caused by war or any act of war (declared or undeclared); as a result of participation in a riot; or
- resulting from the commission of a crime; or
- as a result of attempted suicide or intentionally self-inflicted Injury, while sane or insane.