Disability Benefits

Guide to Disability Benefits

  • The plan provides benefit payments for a maximum of 52 weeks to disabled members.  
  • Pregnancy-related disability is covered.
  • Benefits are paid based on current income and are paid at the rate of either $475.00 or $375.00 per week.

Who is covered?

All eligible in-service members are covered for benefits under the UFT Welfare Fund Disability Plan.

What are the benefits?

The benefits are $475 per week to maximum of 52 weeks, except for Paraprofessionals and other groups within the same salary range, whose benefits are $375 per week to a maximum of 52 weeks. All disability payments will be issued at the end of each month.

Is there a waiting period?

Yes.

Regular Pedagogical Employees:

There is a consecutive 28-day unpaid waiting period after you have exhausted your Sick Bank (Cumulative Absence Reserve-CAR) and have been removed from the Department of Education payroll. The Department’s grace period (applicable only to regularly appointed pedagogues) runs concurrently with the 28-day unpaid waiting period.

However, if you have borrowed sick days, these borrowed days are not considered part of the 28-day unpaid waiting period. Therefore, the 28-day unpaid waiting period begins after the borrowed days are exhausted.

Paraprofessionals and Non-Pedagogical Employees:

There is a consecutive 14-day unpaid waiting period which begins after all leave balances are exhausted. However, if you have borrowed sick days, these borrowed days are not considered part of the 14-day unpaid waiting period. Therefore, the 14-day unpaid waiting period begins after the borrowed days are exhausted. Grace period is not applicable to Paraprofessionals.

Summer vacation period days are excluded in either case.

Reimbursement Schedule

If an eligible member becomes disabled, the UFT Welfare Fund, following the 28-day unpaid waiting period for pedagogues or the 14-day unpaid waiting period for non-pedagogues and paraprofessionals, will pay benefits in the amount and for the period specified below.

Disability Defined

Disability shall mean only that period during which an eligible member is prevented from performing the duties of his or her employment in any occupation or employment as a result of injury or mental or physical illness as determined by the Fund.

The Welfare Fund has found that not all members who apply for disability benefits are actually disabled. Therefore, a physician has been retained as the Fund's Medical Advisor to review all disability claims. The Medical Advisor initially determines whether the member is disabled and, if so, for how long the member is considered by the Fund to be disabled.

After reviewing each claim, the Medical Advisor may take one or more of the following actions:

  1. authorize payment for all or part of the period of the disability claim;
  2. request additional medical documentation;
  3. determine that an examination(s) by a physician designated by the Medical Advisor is required (at no charge to the member);
  4. reject the claim.

All claimants shall be subject to examination(s) by a designated physician and shall furnish such proof of illness or injury, as the Fund Office shall, in its discretion, direct.

Pregnancy Related Disability

In the case of pregnancy related disability, experience has shown that disability as defined above usually occurs during the 9th month of pregnancy and in the 6 weeks immediately following the delivery (8 weeks for Caesarean section). Therefore, examination by a designated physician will not be required during those periods. If pregnancy related disability is claimed for any other period, the usual rules described above regarding examination will be followed.

Amount Payable Defined

The amount payable, subject to the exclusions and limitations set forth below, is as follows:

  1. Members, other than those included in (2) below, are eligible for a disability benefit of $475 per week (Monday through Friday).
  2. Paraprofessionals and other groups within the same salary range are eligible for a disability benefit of $375 per week (Monday through Friday).
  3. Fractional weeks are payable at a daily rate equal to 1/5 of the weekly benefit.
  4. By law, FICA (Social Security tax) must be deducted from disability payments unless the member is exempt from Social Security taxes, or if the disability payment is paid six (6) months or more after the last month in which the member worked. If exempt, the member should submit a copy of a recent pay stub to the Fund Office with the initial claim.
  5. Any member receiving government benefits relating to this disability (i.e. Social Security Disability, Worker’s Compensation etc.) cannot exceed 100% of his/her pre-disability income when combined with the UFT Welfare Fund Disability benefit.

What is the maximum number of weeks I can collect disability?

There is a 52-week maximum period of continuous disability. In addition, the following rules apply:

  1. Benefits shall be payable commencing with the first day of disability following the expiration of the unpaid waiting period as defined above but only if the member is on an authorized sick leave without pay. This leave must commence immediately following the member’s removal from the Department of Education Payroll. The Department of Education must have granted the member either:
    1. an authorized Leave of Absence Without Pay for Restoration of Health; or
    2. an authorized FMLA Leave for Personal Illness.
    Regularly Assigned Substitutes not eligible for FMLA Leave will require a letter from their Principal stating that they would have been regularly assigned for the term had it not been for injury or illness.
  2. Benefits will end when you are no longer disabled, as determined by the Fund, or have been paid for 52 weeks, whichever occurs first.
  3. All periods of disability due to the same or related sickness or injury followed by a recovery and a return to work for periods of less than forty (40) successive work days, will be considered one continuous period of disability. No benefits will be payable for more than 52 weeks for all such periods combined. *
  4. A member who has returned to work for at least forty (40) successive work days after a period of disability shall be entitled to begin a new period of disability of not more than 52 weeks.*
  5. Benefits for all periods of disability due to the same or related sickness or injury shall not exceed one hundred (100) weeks.
  6. Disability benefits for maternity related illness have a maximum of six (6) weeks for normal deliveries, and eight (8) weeks for Caesarean sections. These are considered routine pregnancies.
  7. Complicated pregnancies have a maximum of 52 weeks, as determined by the Fund’s Medical Advisor. The member should apply for an authorized Leave of Absence without Pay for Restoration of Health.

*Note: During the school year, any paid holidays or recess periods that occur within this return to work period shall be deemed a “work day” for purposes of counting the forty (40) successive work days.

How are the benefits obtained?

 It is your responsibility to:

  1. When you have been disabled for a period of 28 consecutive days (14 days for Non-Pedagogues and Paraprofessionals) or if you know that you will be disabled for a period of 28 consecutive days (14 days for Non-Pedagogues and Paraprofessionals) or longer, you should request a disability claim form from the Fund Office at (212) 539-0500.
  2. There are two types of claim forms in connection with this benefit. One is white and marked in the upper right hand corner, “DBL-1- Initial Application.” The other is blue and marked in the upper right hand corner, “DBL-2- Supplemental Application.”
    1. complete the Member’s portion Section A;
    2. make sure that your Principal or Payroll Secretary completes Section B     (Section B is not required on the DBL-2 form);
    3. make sure that your Physician completes Section C;
    4. sign and date the Certification at the bottom;
    5. ensure that all the necessary documentation has been attached to the claim form and is forwarded to the Fund Office.
      Photocopies of the DBL-1 and DBL-2 claim form are not acceptable.
  3. Your first claim (DBL-1- Initial Application) must be filed no later than thirty (30) days following your waiting period, or thirty (30) days following the issuance of your Leave, whichever is later. Failure to file within this period may result in the loss of benefits for the period between the 29th day of disability (15th day for non- Pedagogues and Paraprofessionals) and the date the claim is received by the Fund Office. Physical inability, or delays in obtaining the required documentation necessary to file within this period, may be considered an exception and will be given consideration.
  4. Upon receipt of a properly completed and signed form, with necessary documentation (See # 7 below), the Fund will have the claim reviewed by its Medical Advisor, as described in the “Disability Defined” section above.

    If approved, payments will be made at the end of each month.
  5. After having received your initial disability benefit payment from the Fund, and if you are eligible for further disability benefits, the blue “DBL-2 Supplemental Application” form (which will be mailed to you by the Fund) must be completed.

    A DBL-2 will not be sent when:
    1. the maximum benefit has been paid; or
    2. the Medical Advisor has determined that no additional benefits are payable; or
    3. you have returned to work; or
    4. you were paid for a routine pregnancy.
  6. You should submit your DBL-2 Supplemental Application no later than thirty (30) days following the last date of the previous UFT Welfare Fund disability payment.
  7. In addition to completing the claim form (DBL-1 or DBL-2), you should attach the documentation specified as follows:

Regular Pedagogical Appointees:

  • A copy of the approved leave of absence application from SOLAS (Self-Service Online Leave Application System), or
  • Department of Education Leave of Absence approval letter from HR Connect, or
  • Department of Education approved FMLA (Family Medical Leave Act) Leave for Personal Illness or Maternity, as applicable.

Paraprofessionals:

  • A copy of the approved leave of absence application from SOLAS (Self-Service Online Leave Application System), or
  • Department of Education Leave of Absence approval letter from HR Connect, or
  • The Department of Education approved FMLA (Family Medical Leave Act) Leave for Personal Illness or Maternity, as applicable.

Non-Pedagogical Employees:

  • A copy of an approved Department of Education FMLA (Family Medical Leave Act) Leave for Personal Illness or Maternity, as applicable, or
  • Department of Education Leave of Absence approval letter from HR Connect, or
  • A letter from your Supervisor stating that you would have been regularly assigned for the term had it not been for your illness or injury.

Regularly Assigned Substitutes:

  • A copy of an approved Department of Education FMLA (Family Medical Leave Act) Leave for Personal Illness or Maternity, as applicable, or
  • Department of Education Leave of Absence approval letter from HR Connect, or
  • A letter from your Principal stating that you would have been regularly assigned for the term had it not been for your illness or injury.

Other Covered Members:

When your DBL-1 Initial Application is received by the Fund Office, you will be advised of any additional documentation that is required.

It should be noted that:

  1. Whenever applicable, proof of the child's birth must be submitted.
  2. All Department of Education forms specified above are issued by the Department of Education and may be obtained from your Payroll Secretary or the Department of Education website at schools.nyc.gov. These forms are not available from the Fund Office.

Line of Duty Injuries/Medical Arbitration

Members who are injured in the line of duty and/or have had to apply for medical arbitration, should file for disability using the procedures outlined above. However, a copy of the medical arbitration decision must accompany the claim form. Upon receipt of these documents, the Fund will review the disability claim for processing.

What is not covered under the Disability Plan?

No benefits shall be paid:

  1. For any period for which there has not been proper filing.
  2. For any period for which pay is received from the Department of Education.
  3. For any period during which benefits are paid or payable under any unemployment compensation or similar laws.
  4. For any period during which the member is not under the care of a legally licensed physician for the condition causing the disability.
  5. For any period of disability that commences while a member is not covered under the UFT Welfare Fund rules of eligibility.
  6. For any period of disability due to willfully and intentionally self-inflicted injury or sickness or to injury sustained in the commission of a crime.
  7. For any period during which pension is received from any governmental retirement service or upon retirement from the Department of Education.
  8. For any period during which benefits are paid or payable under the New York State or other jurisdiction’s No-Fault Insurance Law. This exclusion is not applicable after no-fault benefits are exhausted. A letter from the no-fault insurance carrier confirming this must accompany your DBL-1.
  9. For any period for which reimbursement may be obtained from any other third party, such as by way of litigation arising out of an accident, or otherwise, unless a written assignment or lien in a form acceptable to the Fund is executed by the claimant to the Fund for the amount claimed.
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