Disability plans FAQs
We have answers for using your Disability plan.
How do I file for benefits?
If you have both short term disability (STD) and long term disability (LTD) coverage through the WEA Trust, you only need to file a claim for STD benefits. If your disability exceeds the maximum days payable under your STD plan, we will take care of the transition from STD benefits to LTD benefits for you.
You may obtain an STD claim form by clicking here to print one, by contacting your employer for the appropriate form, or by calling us at 800.279.4000 to request a claim form. The form requires statements from you, your employer, and your treating physician along with the appropriate medical records. You should file your claim as soon as possible after you stop working, but you must file it within 90 days of becoming disabled.
You may obtain an LTD claim form by clicking here to print one, by contacting your employer for the appropriate form, or by calling us at (800) 279-4000 to request a claim form. The form requires statements from you, your employer, and your treating physician along with the appropriate medical records. You should file your claim as soon as possible after you stop working, but you must file it within 90 days of becoming disabled.
If you have specific questions about completing the claim form or about your STD and/or LTD policy, please contact us during normal business hours at (800) 279-4000.
Why do you need medical records?
Your disability policy requires that you provide objective medical and/or psychiatric information documenting that you are unable to perform the duties of your occupation. A physician's declaration that you are disabled, without accompanying objective medical and/or psychiatric evidence, is not sufficient to prove that you are disabled. We need your medical records so that we can make a determination regarding your claim.
Why do you need authorization forms?
Authorization forms allow us to obtain documentation and clarification regarding your medical condition. This type of information is essential to evaluating your eligibility for disability benefits. By law, to protect you, your providers cannot release this information to us without your written authorization. Therefore, we ask you to sign an authorization form that allows us to obtain information from your providers that is needed for your claim.
Why do I have to pay for medical records?
Under the terms of your short term and long term disability policies, it is your responsibility to provide medical documentation to us and to pay any fees associated with the release of this information. The cost of medical records is not covered under your plan.
Why does WEA Trust need a copy of the school calendar?
Long term disability (LTD) benefits are paid based on the "contract day" method. We replace the insured salary for each contracted day that is missed due to disability. This means we use the school calendar to determine which days are contracted days and which are not.
Why does WEA Trust need a copy of the settled teachers' salary schedule?
Some long term disability plans include the WEA Cost of Living Adjustment (COLA), which is based on the settled teachers' salary schedule for the particular school district. Thus, every year, we need the settled teachers' salary schedule so that we can calculate the appropriate salary adjustment due under this COLA provision.
Please note that we need the teachers' settled salary schedule in addition to the salary census that you may have to complete for our Eligibility Services Department.
How does sick leave affect my benefits?
Your sick leave, vacation pay, and other forms of compensation do not affect your short term disability (STD) benefits.
Sick leave benefits are integrated under the terms of your long term disability (LTD) policy. This simply means, once you satisfy your elimination period, we reduce your LTD benefit by the amount of any sick leave benefits paid to you for the same period in which you are eligible for LTD benefits.
For other types of compensation, such as vacation pay, retirement benefits, cash payments in lieu of health insurance, bonuses, etc., please contact us immediately to determine how these other sources of income affect your LTD benefits.
How are benefits calculated?
Under the terms of your short term disability (STD) policy, you must satisfy a three-day elimination period before any STD benefits are payable, if you are disabled due to an illness. An elimination period is a certain number of calendar days during which you must remain disabled, and for which no benefits will be paid, beginning on the date that we find you to be disabled. If you are claiming disability due to an injury, there generally is no elimination period, assuming you seek treatment immediately.
STD benefits are calculated based on a weekly rate and are payable for every day of the week, for the length of your disability, up to the plan maximum. Please note that your weekly benefit cannot exceed 66-2/3% of your weekly salary. Benefits are issued on a monthly basis at the end of the month.
Under the terms of your long term disability (LTD) policy, you must satisfy an elimination period before any LTD benefits are payable. An elimination period is a certain number of calendar days during which you must remain disabled, and for which no benefits will be paid, beginning on the date that we find you to be disabled. You may use sick leave, vacation pay, or unpaid leave during the elimination period, depending upon your employer's policy. Benefits are never payable for the elimination period. The length of the elimination period varies depending on your specific coverage.
During the 24-month period following your date of disability, your LTD benefits will be calculated and paid on a contract day basis. Under this method, we divide your covered salary by the number of scheduled work days in your contracted work year to yield a daily rate of pay. We then multiply this amount by the percent of the insured salary for which your LTD plan guarantees replacement. Each month, this daily rate of pay is multiplied by the number of days that you would normally have worked that month. This means that no benefits are payable for periods during which you would not normally work (e.g., summer break).
Note: Your ""covered"" salary is determined by your employer. It may or may not include pay for extra duties (e.g., coaching, department chair, etc.) or summer school.
EXAMPLE OF THE CONTRACT DAY METHOD OF BENEFIT CALCULATION:
Date of Disability: February 24, 2009
Elimination Period: 60 days
Date eligible for Benefits: April 24, 2009
Covered Salary: $38,000.00
Percent of Covered Salary Insured: 90%
Days in contracted work year: 190 days
Daily Gross Benefit: $180.00 ($38,000.00 ÷ 190 x 90%)
After the initial 24-month period, we will ""annualize"" your covered salary. This simply means that we will spread your LTD benefits across the entire calendar year rather than your contracted calendar days. To calculate your LTD benefits under this method, we will divide your annual covered salary by 12 and multiply this amount by the percent of the insured salary for which your LTD plan guarantees replacement.
BENEFIT CALCULATION METHOD: ANNUALIZED SALARY
Date of Disability: February 24, 2009
Elimination Period: 60 days
Date eligible for Benefits: April 24, 2009
Covered Salary: $36,000.00
Percent of Covered Salary Insured: 90%
Monthly Gross Benefit: $2,700.00 ($36,000.00 ÷ 12 x 90%)
How long will I receive benefits?
The length of time that you will receive disability benefits from us depends on four things: A finding of disability, your ability to return to work, your maximum benefit period, and compliance with the terms of your policy.
Under the provisions of your short term disability (STD) plan, you will receive benefits for up to the maximum benefit period allowed if we find you to be disabled and all policy provisions are satisfied. Please refer to your specific insurance benefit description for your maximum benefit period.
For a normal pregnancy and delivery, STD benefits are paid for a maximum of six weeks and up to eight weeks following a cesarean delivery.
Under the terms of your long term disability (LTD) policy, during the first 24 months of disability, you will receive benefits if we find you to be disabled and all policy provisions are satisfied. After the initial 24-month period, you must be totally disabled, receiving Social Security Disability Insurance (SSDI) benefits, and must have at least applied for, and be pursuing in good faith, Wisconsin Retirement System (WRS) disability/Long Term Disability Insurance (LTDI) benefits to continue to receive LTD benefits. If all of these criteria are satisfied, and all other policy provisions are met, the chart below will help you determine your maximum benefit period based on your age on the date we establish that you became disabled.
Age at the start of disability:
Less than 62...............benefits are payable to age 65
63................benefits are payable for up to 36 months
64................benefits are payable for up to 30 months
65................benefits are payable for up to 24 months
66................benefits are payable for up to 21 months
67................benefits are payable for up to 18 months
68................benefits are payable for up to 15 months
69 or older....benefits are payable for up to 12 months
Are disability benefits taxable?
Generally, short term disability (STD) benefits are not taxable. You are required to pay the premiums yourself, with post-tax dollars, for your STD plan. This makes your STD benefits nontaxable; however, we are legally required to report to the IRS the amount of STD benefits paid to you.
Normally, long term disability (LTD) benefits are 100% taxable. The WEA Trust will withhold FICA taxes as required by law. You may choose to have federal and/or Wisconsin state income taxes withheld from your LTD benefit. To have federal and/or state income taxes withheld from your LTD benefit, you must complete the appropriate withholding form. You may contact us to have the form mailed to you.
If you have questions about the amount of federal and/or state income taxes that you should withhold from your LTD benefit, please consult your tax advisor. We cannot provide specific advice on the amount of taxes you should have withheld from your LTD benefits because each person's tax situation is different.
We will mail a W-2 form or other tax information for tax reporting purposes by January 31 every year if you received STD and/or LTD benefits in the previous calendar year.
How often are benefits issued?
If you are eligible for a benefit, and your elimination period has been satisfied, disability benefits are generally issued at the end of each month.
What information do I need to submit before a payment is issued?
We require ongoing documentation of your disability and compliance with all policy provisions in order to issue benefits. Generally, we require monthly supplemental forms to be completed by you and your treating physician before we issue a disability benefit. We will include these supplemental forms with your benefit payment.
Do I need to fill out a supplemental form every month? Does my doctor need to fill out a supplemental form every month?
Supplemental forms provide us with updated information regarding your specific situation. We use this information as part of the process of determining your eligibility for benefits. Normally, unless we have notified you otherwise, we need to receive completed supplemental forms from you and your treating physician every month. These forms will accompany your benefit payment. Please read your benefit statement because we put messages on these regarding how often you need to submit the supplemental forms, along with other important information. You may contact us to discuss how frequently we need your and/or your physician's supplemental forms.
What happens if I return to work?
Please contact us immediately if you are thinking of working.
Under the terms of your short term disability (STD) policy, if you resume performing the majority of your normal duties, your benefits will end. However, if you are unable to continue working because of the same or a related disabling condition, benefits may possibly be resumed without another elimination period.
Under the terms of your long term disability (LTD) policy, you may, during the first two years of disability, and with our preapproval, return to work on a partial basis or in another capacity without a complete loss of benefits. In such cases, we will integrate a portion of your earned income. This arrangement allows you to receive from LTD benefits, earnings, and any other income benefits combined up to a maximum of 100% of your predisability income.
If you are able to return to performing the majority of your normal duties, your LTD benefits will end. However, if you are unable to continue working because of the same or a related disabling condition, and you have not returned to work, satisfactorily performing your job for at least six months, benefits may possibly be resumed without another elimination period.
If you have specific questions about returning to work, please contact us during normal business hours at (800) 279-4000.
Do I have to apply for other income benefits such as worker's compensation benefits, Social Security Disability Insurance (SSDI) benefits, or Wisconsin Retirement System (WRS) disability/Long Term Disability Insurance (LTDI) benefits?
Your long term disability (LTD) policy requires that you file for all other income benefits for which you may be eligible. If you apply for other income benefits, please notify us immediately. We require copies of your applications, award and/or denial notices, and any other correspondence from these other agencies to administer your LTD claim properly.
If you are unable to work because of an injury, accident, or incident that occurred at work or is related to the performance of your job duties, you must file a claim for worker's compensation benefits.
To be eligible for SSDI and WRS disability/LTDI benefits, you must be totally and permanently disabled. The Social Security Administration (SSA) defines total and permanent disability as "the inability to engage in substantial gainful activity by reason of any medically determinable physical or mental impairment that can be expected to result in death or to last for a continuous period of not less than 12 months." For WRS disability/LTDI purposes, total and permanent disability is defined as the inability "to engage in any substantial gainful activity by reason of a medically determinable physical or mental impairment which can be expected to result in death or to be long-continued and of indefinite duration."
For more information or to request an SSDI application, you may contact the SSA by calling (800) 772-1213, or you may go to their web site at www.ssa.gov. In many cases, you can complete the entire application process through the mail and by telephone.
To file an application for WRS disability benefits, please contact the Department of Employee Trust Funds by calling (877) 533-5020.
To file an application for LTDI benefits, please contact the Wisconsin Disability Program at (800) 960-0052.
What happens if I am eligible to receive other income benefits such as worker's compensation benefits, Social Security Disability Insurance (SSDI) benefits, or Wisconsin Retirement System (WRS) disability/Long Term Disability Insurance (LTDI) benefits?
When you are eligible for other income benefits, your WEA Trust long term disability (LTD) benefit is reduced by the gross amount of the other benefits you are eligible to receive. Your LTD plan considers all other sources of income first. In other words, your gross LTD benefit is first reduced by the other income benefits you are eligible to receive. Any net LTD benefit remaining is what you are eligible to receive. We will continue to pay the difference between your other income benefits and the percent of your insured salary that your LTD policy replaces as long as you comply with the requirements of the policy.
Retroactive benefit payments from other programs usually result in an overpayment of LTD benefits. Therefore, it is important to notify us immediately of any payments you are eligible to receive from other programs. We will let you know if an overpayment has occurred and how much you must refund to us. We expect prompt reimbursement of the entire amount owed. Therefore, do not spend any retroactive payments until we have calculated the overpayment amount.