19 Del. Admin. Code § 2007-15.0

Current through Reigster Vol. 28, No. 6, December 1, 2024

Section 2007-15.0 - LTD Coverage

15.1 LTD benefits are paid by the DIP insurance carrier or third-party administrator on a monthly basis directly to the claimant.

15.2 "Disability" or "disabled" during the first 24 months following the elimination period means the claimant is prevented by accidental bodily injury, sickness, mental condition, substance abuse, or pregnancy from performing one or more of the essential duties of the claimant's occupation and, as a result, the claimant's current monthly earnings are less than 80% of pre-disability earnings. After the exhaustion of the first 24 months of disability, the claimant is prevented from performing one or more of the essential duties of an occupation. The claimant's failure to pass a physical examination required to maintain a license to perform the duties of the claimant's occupation alone, does not mean that the claimant has a disability.

15.3 The LTD program does not cover:

15.3.1 Disabilities not under the regular care of a health care provider;

15.3.2 Disability that is caused or contributed to by war or an act of war (declared or not);

15.3.3 Disability caused by commission of or attempt to commit a felony, or to which a contributing cause was the claimant's being engaged in an illegal occupation;

15.3.4 Disability caused by or contributed to by an intentionally self-inflicted injury, and;

15.3.5 Injury sustained as a result of doing work for pay or profit from another employer.

15.4 The maximum duration of LTD benefits is as follows:

Age When Disabled Benefit Duration in Months

Before age 60 To age 65

60 60

61 48

62 42

63 36

64 30

65 24

66 21

67 18

68 15

69 12

19 Del. Admin. Code § 2007-15.0

20 DE Reg. 70 (7/1/2016)
28 DE Reg. 57 (7/1/2024) (Final)