Weekly Accident and Sickness Benefit
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FAST FACTS

  • During the first 13 weeks of your disability, you are eligible to receive a benefit of 50% of your gross weekly income, to a maximum of $350.

  • If your disability continues beyond 13 weeks, you are eligible to receive a benefit of 40% of your gross weekly income, to a maximum of $210 for the next 13 weeks, if approved by the Board of Trustees.

  • In order to obtain benefits for more than the 13 initial weeks you must write a letter to the Board of Trustees requesting an extension of benefits for up to 13 additional weeks with supporting information including a current medical doctor’s report.

  • A “period of disability” normally begins at the time you become disabled, and ends when you are no longer disabled.

Note: This benefit provided for Standard Plan (full) coverage only; no provision for “H” Plan (limited) coverage. 

If you are an eligible Active Electrical Worker or Active Non-Bargaining Unit Employee and become disabled due to a non-occupational illness or accidental injury, the Plan pays you a Weekly Accident and Sickness Benefit to help protect your financial security while you’re disabled. Retired Participants, Participants on COBRA, Surviving Spouses and Dependents are not eligible for Weekly Accident and Sickness Benefits.

Eligibility

To be eligible to receive the Weekly Accident and Sickness Benefit, you must be under the regular care of a doctor and following the prescribed course of treatment. You are required to provide written certification by your doctor that you continue to be disabled. You also may be asked to submit to an examination by a doctor appointed by the Trustees to certify your disability.

The Board of Trustees reserves the right to have you examined, at its own expense and by a physician of its own choosing, as it sees fit when deciding on a disability application.

Note: Payment of this benefit beyond 13 weeks requires specific advance approval by the Board of Trustees following your request for extended benefits and review of updated medical information.

What You Need to Do

You must obtain a written certification of your disability from your doctor. Next, contact the Fund Office by calling 301-731-1050 or at 1-800-929-3983. You are required to provide written proof to the Fund Office before your benefits can begin.

How the Weekly Accident and Sickness Benefit Works

The amount of your benefit is based on a percentage of the gross pay you ordinarily would receive for a normal workweek of 40 hours (or less). For periods of less than a full week, the weekly benefit is divided by seven to determine the benefit for each day of disability.

The amount of the Weekly Accident and Sickness Benefit payable is reduced by the amount of any compensation paid, or payable, by your employer or other third party during the period. Payment of the Weekly Accident and Sickness Benefit begins on the first day of a disability that is due to an accident, and on the eighth day of a disability that is due to an illness (including pregnancy).

Benefit based on a percentage of regular gross compensation and a normally scheduled work week of 40 hours (maximum) or less:
Benefit
First 13 weeks 50% up to a maximum of $350 per week
Next 13 weeks-Subject to Trustee Approval 40% up to a maximum of $210 per week

Maintaining Eligibility While On Disability

In order to obtain benefits for more than the initial 13 weeks, you must request an extension of benefits for up to an additional 13 weeks with supporting documentation such as a current medical doctor’s report.

If you are disabled due to a non-occupational cause, you are credited up to 135 hours per month for the first three months of disability as needed to maintain your and your covered dependents’ coverage under the Plan. If you are granted the additional 13 weeks of Accident and Sickness Benefit, you may maintain your and your covered dependents’ eligibility under the Plan by payment of $20 per month for Subsidized Coverage (“S” Coverage). S Coverage provides for only medical, mental health, prescription coverage, and death benefits; no coverage is provided for dental or vision. This option for a $20 payment is available for six (6) months, after which you may qualify to continue your and your covered dependents’ coverage (while disabled) by paying monthly at the current rate of contribution to the Plan times 135 hours, provided you have at least one hour in your hours bank or you worked at least one hour of covered employment in the previous month. If you do not qualify to continue your and your covered dependents’ coverage (while disabled) by paying monthly at the current rate of contribution to the Plan times 135 hours, you may qualify for COBRA continuing coverage. 

If you are disabled due to an occupational cause, you are credited up to 135 hours per month for the first three months of disability as needed to maintain your and your covered dependents’ coverage under the Plan, except that this coverage will not apply for any claims related to your occupational injury. If you are granted additional Workers’ Compensation benefits after the first three months of your disability, you may maintain your and your covered dependents’ eligibility under the Plan, except with regard to claims relating to your occupational injury, by payment of $20 per month for S Coverage. S Coverage provides for only medical, mental health, prescription coverage, and death benefits; no coverage is provided for dental or vision. This option for a $20 payment is available for six (6) months, after which you may continue your and your covered dependents’ coverage (while disabled) by paying monthly at the current rate of contribution to the Plan times 135 hours, provided you have at least one hour in your hours bank or you worked at least one hour of covered employment in the previous month. If you do not qualify to continue your and your covered dependents’ coverage (while disabled) by paying monthly at the current rate of contribution to the Plan times 135 hours, you may qualify for COBRA continuing coverage.

Multiple Periods of Disability

If you become disabled again from the same disability or from a different cause, your successive period(s) of disability are considered one period of disability unless:

  • They are separated by at least one (1) calendar (or payroll) month of work during which you complete 135 hours of work in covered employment;
  • The subsequent disability is due to an illness or injury entirely unrelated to the cause of the previous disability; or The later illness or injury begins after you have been released by the attending physician and have returned to work on a full-time basis.

What’s Not Covered

No Weekly Accident and Sickness Benefit is payable: 

  • When the disability is due to alcohol or substance use disorder unless you are an inpatient receiving benefits under the substance use disorder treatment provisions of the Plan; or 
  • If you are not under the regular care of a physician or not following the course of treatment prescribed including scheduled doctor visits.

Please see Specific Plan / Benefits Exclusions and General Plan Exclusions for an in-depth listing of your Plan’s exclusions.