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TEMPORARY DISABILITY INSURANCE - page 11 / 11

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TEMPORARY DISABILITY INSURANCE

EFFECT OF OTHER TYPES OF INCOME ON ELIGIBILITY--Other types of income that affect eligibility include wages, employer pensions, old-age and survivors insurance benefits.

In Rhode Island a claimant who is not working because of illness is eligible for benefits even though he is receiving regular wages or a part thereof. New Jersey and Puerto Rico take such wages into account and limit the total of wages and benefits to the claimant's weekly wages immediately prior to the disability. In Puerto Rico a pregnant worker may not be paid during any period in which she is receiving benefits under the Act to Protect Working Mothers, unless such benefits are less than her weekly disability benefit amount, in which case she may receive the difference. California provides that the daily combination of such wages and disability benefits shall not exceed one- seventh of the claimant's weekly wage, excluding overtime pay, immediately prior to the disability. New York deducts from the benefits any payment from the employer or from a fund to which the employer contributes, except supplementary benefits paid pursuant to a collective bargaining agreement. New Jersey applies the UI formula for partial benefits to claimants receiving disability benefits during unemployment. Also, a claimant's disability benefit is reduced by the amount of any pension plan to which his most recent employer has contributed. In Puerto Rico any claimant receiving any pension payments or retirement income is denied benefits unless subsequent to receipt of the pension or retirement payment he has performed services in insured work for at least 15 weeks immediately preceding the disability.

ADMINISTRATION

The systems of disability insurance coordinated with UI use the same wage record procedures for both programs. Claims procedures, however, necessarily differ for UI claimants and for claimants who are not able to work. Disability claims are filed by mail. The first claim or notice of disability is normally filed after the end of the first week of disability. All claims are sent to the central office in New Jersey and Rhode Island. In California the first claim in any period of disability as well as continued claims are sent directly to one of the field offices. In New York employed workers file claims with their employers, and unemployed workers with the worker's compensation board.

Under all the laws, medical certification of disability in connection with claims is required from the claimant's attending doctor, with minor differences in the types of medical personnel permitted to certify. California, Hawaii and New York accept certification from an authorized religious practitioner with respect to the illness of a member of his group. All the State laws give the agency authority to require that claimants, without cost to themselves, submit to examination by a designated licensed physician.

Claimants who are dissatisfied with determinations on their disability claims have the right to appeal under all State laws. In the States with disability and UI coordinated, the appeal is to the UI appeal bodies; in New York, to the worker's compensation board; and in Hawaii to the referee for temporary disability benefits. In the States with private plans, a private-plan claimant may also appeal to the States unemployment appeal tribunal.

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