Benefit Report
April 2007
DISABILITY INFORMATION & ELIGIBILITY GUIDELINES
Sick and accident benefits are payable for disability due to illness or injury not caused by an accident after a waiting period of seven calendar days, unless you are admitted as an in-patient to a legally licensed hospital - then there shall be no waiting period.
If injury was caused as result of an accident, (a sudden, unexpected and unforeseen event), then there shall be no waiting period. Benefits are payable beginning with the day following an outpatient surgical procedure, for which $25 or more was paid under the employee’s medical/surgical coverage.
· If your condition is work-related and you are off less than 15 days, the first 7 days’ benefits are based on sick and accident guidelines, with any additional days covered by workers’ comp.
· If you are off 15 calendar days or more, then workers comp will pay retroactive to day one of disability.
· Examination and Certification of Disability must be performed by a physician within 7 days of the onset of your illness or injury, and must be reported within 20 days to the GM Disability Unit.
· Nurse Practitioner and Physician Assistant examination and certification will not be accepted and will result in denial of your claim. Some of our employee’s who live in rural areas and are enrolled with Priority Health HMO, have elected a Physician Assistant as a Primary Care Provider. You can not go to them and qualify for disability benefits. You would need to get a referral by a physician.
Another pothole to avoid is if you return to work from a certified disability, even if for only an hour and find you are not able to perform your job, you must be re-examined and re-certified by your physician to be eligible for continuing disability benefits. You must also again notify the GM Disability Unit at 1(800) 489-4646.
If you remember just one thing from this article, the most important would be to call your benefit rep when you are faced with a lost time situation. We have an informational sheet to give you, which will guide you through the process and keep you from harms way.
Submitted by Lauri Veneman.
Local 730 Benefit Reps
Grant Holst, Jolan Jackson, Lauri Veneman, Denise Deboer, and Carrie Jackson