11. TIME LOSS BENEFIT PROVIDED BY THE TRUST FOR ELIGIBLE
EMPLOYEES
The Time Loss Benefit is only available to Eligible
Employees. Retired Participants and Dependents are not eligible for the Time
Loss Benefit.
Time Loss Benefits provide coverage to
help protect an Eligible Employee against loss of income if the
Employee is
Totally Disabled because of an Illness or Injury. Time Loss Benefits are
payable up to $100 per week for each week of Total Disability; up to a maximum
of 26 weeks. For partial weeks, the benefit amount for each day is
determined by dividing the weekly benefit by seven.
“Total Disability” or “Totally Disabled”
means that as a result of an Injury or Illness, an Eligible
Employee is
absent from work and unable to engage in the duties of his/her customary
occupation, and is performing no work of any kind for wage or
profit.
Time Loss Benefits begin:
- with the first day of a Total Disability resulting from an
Injury; or
- with the eighth day of Total Disability resulting from an
Illness.
To qualify for Time Loss Benefits,
an Active Participant
must be regularly seen, treated, and certified Totally
Disabled by a Physician. Time Loss Benefits are subject to federal taxation,
including FICA.
Successive Periods of Total
Disability
Time Loss Benefits will continue for
up to a maximum of 26 weeks as long as an Eligible Employee remains Totally
Disabled. A new period of disability will begin if:
- an Eligible Employee returns to full-time work for at least
30 calendar days, then becomes Totally Disabled again from the same
cause; or
- an Eligible Employee returns to full-time work for at least
one day, then becomes Totally Disabled again from a different
cause.
Termination of
Eligibility
If eligibility terminates after
Total Disability is established and benefits are determined payable, benefits
will continue until: (1) the Participant is no longer Totally Disabled, or (2)
the maximum benefit has been paid.
EXCLUSIONS
No Time Loss Benefit will be extended for any disabilities that
are:
- related to any condition for which coverage is available, if
proper claim were made, by Workers’ Compensation, occupational disease or
injury law or similar legislation. The Plan covers no expenses for any
condition arising out of or received or aggravated in the course of engaging in
any activity for wage or profit;
- caused by war or any act of war (declared or undeclared); as
a result of participation in a riot; or
- resulting from the commission of a crime; or
- as a result of attempted suicide or intentionally
self-inflicted Injury, while sane or insane.
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