Although each case is different, union members and officials need to know that:
1. A member who has worked for at least 4 weeks and who suffers an “off-the-job” illness or injury is entitled to collect disability benefits to replace part of the wage he would have earned if he were not disabled.
Building Trades Note Suppose a member was hurt in an “off-the-job” accident that occurred just after he returned to work for Contractor A in the spring. The member’s claim may be denied because he was not employed by Contractor A for at least 4 weeks. We have won claims by arguing that prior service with Contractor A (for example, during the prior summer or fall) must count toward the 4 week period.
2. Costs of medical care are not included. The benefit is a lost wage benefit only.
3. The member is entitled to collect $170 per week or 50% of his average weekly wage, whichever is smaller.
4. The member is entitled to collect disability benefits for up to 26 weeks in a 52 consecutive week period. The member is not entitled to collect benefits for the first week of disability but can collect for the next 26 weeks.
5. A member who suffers an “off-the-job” illness or injury during the first four weeks after his last employment ends is entitled to collect disability benefits under the insurance policy of his former employer.
Building Trades Note: Suppose a member was hurt in an “off-the-job” accident that occurred on the day he started working for Contractor B but within 4 weeks after he stopped working for Contractor A. If the claim is submitted to Contractor B’s insurance company, it will be denied because he was not employed by Contractor B for at least 4 weeks. If the claim is submitted to Contractor A’s insurance company, however, it will be paid.
6. A member who suffers an “off-the-job” illness or injury more than four weeks after his last employment ends and who is collecting unemployment insurance benefits is entitled to collect disability benefits to replace the unemployment insurance benefits that he would have collected if he were not disabled.
Building Trades Note: Suppose a member was hurt in an “off-the-job” accident that occurred more than 4 weeks after his last job ended and while he was collecting unemployment insurance benefits. The member is entitled to collect disability benefits for each week that he otherwise would have collected unemployment insurance benefits if he were physically able to work. Although the disability benefit is lower than the unemployment insurance benefit, it provides at least some income to the member.
7. Under the law, if the claim is properly completed and the health care provider’s statement has been received, the member can expect to receive his first payment at the end of the third week of disability or 4 business days after the claim is received, whichever is later.
8. Claims must be filed within 30 days after the member becomes disabled. Claims filed later may result in the member not being paid for any period of disability more than two weeks before the claim was filed unless the member can show that it was not reasonably possible to file earlier. An employee may not be entitled to any benefits if he files the claim more than 26 weeks after the disability began.
9. A member whose claim for disability benefits is denied may appeal the adverse decision to the Workers’ Compensation Board by filing a request for review.
10. A member who suffers an “off-the-job” illness or injury and who is unable to work for at least 12 months may be eligible for Social Security Disability benefits. This will allow the member to draw his ultimate Social Security retirement benefit early and without penalty.