Mitch Goldberg, Director of the Welfare Fund

By Mitch Goldberg
Director of the Welfare Fund

If you become disabled and cannot work because of an injury or illness that is not job-related or is not covered by no-fault auto insurance, you are eligible to receive short term disability benefits. There is a 14-day waiting period for benefits to begin. A physician must examine you within 3 days of your disability for these days to be included in the waiting period; otherwise the 14-day waiting period begins only when you are examined.

You will lose your right to this benefit if the Fund requests that you have an examination by a physician and the examination does not take place within two weeks of the Fund’s request. If you are being treated for substance abuse, your treatment at a particular center or institute is required, in writing, by the physician who certifies that you are disabled. In addition, if the treatment continues for more than two weeks, the treatment center or institute must have a licensed physician on duty who can provide certification of your continued disability.

The amount of the benefit is 50% of your weekly salary up to a maximum benefit of $300 a week. Benefits begin on the 15th day of your disability, unless you are hospitalized; in that case, benefits are paid from the first day you are confined to the hospital. In any event, you must miss a day of work due to your covered disability for disability benefits to start.

You will be entitled to receive no more than 52 weeks of disability benefit payments during any 104-week period regardless of how many separate disabilities or recurrences you experience during that period. If you return to work before you use up your 52 weeks of disability benefit payments and you are again disabled, you will be entitled to receive benefit payments only for the remainder of the 52 weeks of eligibility you have left during the 104-week period.

In order to receive these disability benefits, you must obtain a claim form from the Fund Office. There are three sections to this form; you should complete the employee section, your doctor should complete the “Attending Physician’s Section,” and your supervisor should complete the employer section.

Return the completed claim form to the Fund Office within 30 days from the first day of your disability. If you cannot submit a claim form within that time period, you must send a letter explaining the reason for the delay and the details of your disability. If the Fund Director determines that the delay in submitting the form was not for good cause, your claim for benefits may be completely or partially disallowed.

In general, the Fund’s short-term disability benefits are not payable for the following injuries or illnesses:

Automobile Accidents. If you are injured as a result of an automobile accident that is covered by no-fault insurance, you are not entitled to receive the Fund’s short-term disability benefits. Automobile accidents that are covered by no-fault insurance include accidents involving cars, vans, SUVs, taxicabs, private car service vehicles and buses. If you are injured in such an accident, you should contact the insurance carrier covering the vehicle involved in the accident and apply for no-fault insurance benefits, as the Fund will not provide benefits in such cases.

Job-Related Injuries or Illnesses. If your injury or illness is job-related, the Fund’s short-term disability benefit would not be payable and you would need to file a workers’ compensation claim for benefits. If the Fund receives a notice (Workers’ Compensation Form C-7) that the claim is controverted by your employer, then the Fund will pay its benefit, pending the resolution of your workers’ compensation claim. In such case, the Fund will have a lien on the workers’ compensation benefits awarded to you (if any). This means that, if you are paid by the Fund and you are later awarded workers’ compensation benefits for the same illness or injury and time period, the Fund is entitled to recover the amount it paid to you, out of your worker’s compensation benefits, so that you are not paid twice for the same illness or injury.