19 Del. Admin. Code § 2007-6.0

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

Section 2007-6.0 - STD Coverage

6.1 For a disability caused by a covered sickness or accident, STD benefits begin after completion of the calendar day elimination period for up to a maximum benefit period of 182 calendar days starting with the employee's date of disability per 29 Del.C. § 5253(b). The 182 calendar day STD benefit period includes the calendar day elimination period. Each day an employee receives a total disability benefit or a residual (partial) disability benefit or the minimum disability benefit, counts toward exhaustion of the maximum 182 calendar day STD benefit period.

6.2 The employing organization is responsible for providing the DIP insurance carrier or third-party administrator with information needed to process an employee's STD claim that is not shared on the electronic enrollment file to the DIP insurance carrier or third-party administrator because it is not stored in the State of Delaware's Human Resource Benefits & Payroll systems, such as last day worked, partial days worked and whether the employee was awarded the three month or twelve month Salary Supplement. Organizations with employees injured performing hazardous duty assignments entitled to the twelve month salary supplement must notify the DIP insurance carrier or third-party administrator of the employees entitlement to the 12 month (versus 3 month) salary supplement. This information must be provided by the employing organization to the DIP insurance carrier or third-party administrator within 48 hours of the date when the employee files the STD claim or from the date the employing organization receives formal notification of an employee's STD claim filing from the DIP insurance carrier or third-party administrator.

6.3 "Total Disability" or "Totally Disabled" means the employee is prevented by accidental bodily injury, sickness, mental condition, substance abuse, pregnancy, or loss of license due to medical condition from performing the essential duties of the employee's occupation, and as a result, the employee is earning 20% or less of the base rate of compensation received on the last day of employment before becoming disabled. IMPORTANT NOTE: Weekly earnings means the employee's usual base rate of pay including hazardous duty pay if applicable. Weekly earnings do not include commissions, bonuses, shift differential pay, overtime pay or another fringe benefit or extra compensation. If disabled, weekly earnings will be the rate on the last day as an active full-time employee before becoming totally disabled.

6.4 The STD program does not cover:

6.4.1 Injury, sickness, mental condition, substance abuse, or pregnancy not being treated by a health care provider.

6.4.2 Disability caused by or contributed to by war or act of war, declared or not;

6.4.3 Disability caused by commission of or attempt to commit a felony, or to which a contributing cause was the employee being engaged in an illegal occupation or activity;

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

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

6.5 Bus drivers who are contractually required to remain symptom free from disabling illness or injury for one year starting with the date of disability will be approved for STD benefits for up to the maximum 182 calendar day benefit period.

6.6 There is no pre-existing conditions limitation in the STD program.

19 Del. Admin. Code § 2007-6.0

19 DE Reg. 78 (7/1/2015)
20 DE Reg. 70 (7/1/2016)
28 DE Reg. 57 (7/1/2024) (Final)