19 Del. Admin. Code § 2007-5.0

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

Section 2007-5.0 - STD Claim Filing Requirements for Employees and DIP/RTW Representatives

5.1 Employees

5.1.1 Employees enrolled in the DIP are required to file a STD claim with the DIP insurance carrier or third-party administrator if the employee expects to be out of work for at least 30 calendar days even if the employee applied for or is receiving lost wage benefits (i.e., Workers' Compensation) or parental leave at the birth of a child. Once an employee exhausts the elimination period, the employee will be deemed to have applied for benefits under this subsection and will not be eligible to utilize paid sick leave or annual leave in lieu of application for STD. Employees not meeting the requirements noted in Section 9.0 of this regulation, will be deemed to have applied for benefits under this subsection and will not be eligible to utilize paid sick leave or annual leave in lieu of application for an extension of STD benefits.

5.1.2 Employees enrolled in DIP who expect to be out of work for the length of the calendar day elimination period are required to file a STD claim in a complete and timely manner, even if the employee applied for or is receiving WC benefits, parental leave, or Other Income Benefits defined in subsections 8.6 and 8.7 of this regulation. Employees injured while performing a hazardous duty assignment, who qualify under 29 Del.C. § 5916(e), 29 Del.C. § 5933 (c) and (d), and 83 Del Laws c 325 section 30 are required to file a STD claim in a complete and timely manner if the employee expects to be out of work for the length of the calendar day elimination period. Employing organizations are required to provide the DIP insurance carrier or third-party administrator with the names of employees injured while performing a hazardous duty assignment entitled to be paid the twelve month salary supplement.

5.1.3 Employees are required to immediately report absences from work to the employee's supervisor and are required to stay in contact with the employee's supervisor and Human Resource Benefits Office during absences from work. For specific reporting time frames, Merit employees should refer to the Merit Rules. Non-Merit employees should refer to the employing organization's leave policy. Required documentation must be provided when requested by the DIP insurance carrier or third-party administrator, the employee's Human Resource Benefits Office, the SBO RTWC, and other representatives from the SBO. It is the employee's responsibility to promptly acknowledge receipt of the STD Form Letter communication from the employee's Human Resource Benefits Office by signing and returning an "Employee Acknowledgement" to the Human Resource Benefits Office office within 5 business days of receiving the letter from the Human Resource Benefits Office.

5.1.4 Employees must contact t health care providers to authorize the release of medical information required by the SBO RTWC or the DIP insurance carrier or third-party administrator. It is the employee's responsibility to be sure that the medical documentation is submitted to the DIP insurance carrier or third-party administrator and the SBO RTWC in a complete and timely manner throughout the duration of the disability as requested. Employees are required to take the action necessary in a timely manner to maintain the claim in an approved status throughout the period of disability.

5.1.5 Employees are responsible for the payment of fees requested by health care providers for the release of preliminary medical information or subsequent attending physician statements APS.

5.1.6 Medical documentation by the employee's health care providers in the form and manner determined by the DIP insurance carrier or third-party administrator must be submitted to determine benefit payment. A health care provider's out of work note will not be sufficient. Medical documentation consists of, but is not limited to a conversation with the employee's health care providers, nurse or other healthcare providers identifying restrictions or limitations or the lack of, test results, lab records, etc.

5.2 DIP/RTW Representatives

5.2.1 Supervisors are required to immediately report an employee's absence from work to the Human Resource Benefits Office. The Human Resource Benefits Office must send the STD Form Letter to the employee no later than the fifth calendar day of absence from work to remind the employee of the STD claim filing requirement in the event the employee expects to be out of work for at least the length of the elimination period.

5.2.2 The Human Resource Benefits Office is responsible for following up with the employee to confirm the STD Claim has been filed in a timely manner. The Human Resource Benefits Office is also responsible for following up with the employee to be sure the employee is requesting an extension of benefits, if applicable and in a timely manner.

5.2.3 It is the responsibility of the Human Resource Benefits Office to follow up with the employee on all requests that have not been responded to.

19 Del. Admin. Code § 2007-5.0

16 DE Reg. 1004 (03/01/13)
18 DE Reg. 79 (7/1/2014)
19 DE Reg. 78 (7/1/2015)
20 DE Reg. 70 (7/1/2016)
22 DE Reg. 861 (4/1/2019)
28 DE Reg. 57 (7/1/2024) (Final)