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Administrative Manual - 205 Benefits

205.05 Disability and Workers' Compensation Programs

  1. WORKERS' COMPENSATION INSURANCE
    1. Policy

      JSA/JLab provides Workers' Compensation Insurance coverage at no cost to all employees regardless of employment status and in accordance with the provisions of the Virginia Workers' Compensation Act. This coverage provides payment of medical treatment and/or income replacement benefits to employees who are injured on the job or who experience an occupational illness and who have reported such on a timely basis.

    2. Definitions

      A work related injury is defined as a physical injury or occupational illness incurred by an employee that arises out of and in the course of his/her employment, as specifically defined within the statutes of the Commonwealth of Virginia.

      The waiting period is the initial seven (7) calendar days of absence. For full-time employees, that usually equates to absence of five (5) work days.

    3. Eligibility

      All staff on JSA/JLab payroll are eligible as of the first day of employment. Laboratory contractors and users are not covered under this plan.

    4. Responsibilities

      The employee must report the injury or illness to the supervisor in a timely manner. The supervisor must pass information on to division ES&H staff, and direct the employee to Occupational Health & Safety. The nurses provide first-aid treatment as needed. A Workers' Compensation third party insurance carrier administers the benefits. Occupational Health & Safety maintains contact with the employee during the time that treatment or therapy is in progress, coordinates return to work actions with the employee's supervisor and, when appropriate, with the division ES&H staff. The JLab Risk Manager is responsible for the overall claims handling process.

    5. Policy Components
      1. Regardless of the nature or severity of an incident, all work related injuries must be reported immediately to the employee's supervisor or person in charge at the time. Detailed procedures are available in the Environmental Health and Safety Manual, Chapter 6830. Failure to report an injury can jeopardize a claim.
      2. Injuries are to be initially assessed by the nurse or physician from Occupational Health & Safety. If care beyond first aid is required, the nurse refers the employee to a choice among a panel of off-site medical providers. Employees who are injured at work or on the job outside of normal working hours may seek care at any nearby emergency care facility, informing the facility that they work at Jefferson Lab and they have a work-related injury. They must contact Occupational Health & Safety the next business day. Employees should not seek care for work-related injuries through their personal physician or use their own health insurance resources. These costs may be denied by the Workers' Compensation insurance carrier.
      3. For absences of less than six months, when the employee is medically cleared to return to work he/she shall report first to Occupational Health & Safety with the physician's written instructions concerning activity limitations. The nurse will consult with the employee's supervisor about normal job activities and any prescribed limitations.
      4. After six months of absence while receiving Workers' Compensation benefits the employee will be eligible for Inactive Disability status. See section D below.
      5. Workers' Compensation benefits may be supplemented as specified in section D.2.e below.
  2. SHORT-TERM DISABILITY PLAN
    1. Policy

      JSA/Jlab's provides a short-term disability insurance program for eligible employees. Participation is optional.

    2. Eligibility
      1. All regular and term employees who are normally scheduled to work at least 20 hours a week are eligible to participate upon hire or date of transition to an eligible status. When elected, the plan is effective the first of the month following eligibility date.
      2. Enrollment must occur within 30 days of eligibility, or the eligible employee must wait until the next open enrollment period to apply for coverage. Coverage is then contingent upon the carrier accepting medical evidence of good health.
    3. Premiums

      The cost of coverage, based on base weekly salary, is paid entirely by the employee through after-tax payroll deductions.

    4. Plan Provisions

      The Short-Term Disability Insurance Program provides a partial (66 2/3%) disability weekly benefit when a covered employee becomes totally disabled due to a non-work related accidental injury or illness. Benefits begin after a seven (7) day waiting period has been satisfied and are payable for up to a maximum of 13 weeks. Benefit payments are limited to a maximum of $1,000 per week and are not considered taxable income.

      1. Disability must require ongoing treatment by a licensed practitioner of the healing arts, acting within the scope of license.
      2. A covered employee is deemed totally disabled if he/she cannot do the substantive and material duties of his/her type of work.
      3. Pregnancy or pregnancy-related illness is treated as any other medical disability.
    5. Pay Integration
      1. During an absence due to illness, employees must use sick leave and, if sick leave is exhausted, vacation leave for the waiting period. Also, after the waiting period, employees must use accrued leave hours until the insurance company makes a determination of eligibility and begins payment. Upon payment of the benefit, the Payroll Staff will integrate payments to restore leave hours and dollars as appropriate.
      2. Employees may use leave hours to supplement disability payments in an amount (2.7 hours per day) that equalizes full-time base pay. If the supplement is elected, sick leave must be used first, followed by vacation leave. Required contributions to the disabled employee's TIAA account, and JSA/JLab's matching contribution, will continue as long as the disabled employee is receiving any pay from the Lab.
  3. LONG-TERM DISABILITY INSURANCE
    1. Policy

      JSA/JLab provides an employer paid long-term disability insurance plan that ensures income protection for eligible staff who are, because of disability, unable to work for an extended period of time. All eligible employees are automatically enrolled in the program.

    2. Eligibility

      All regular and term employees who are normally scheduled to work at least 20 hours a week are eligible to participate upon hire or as of date of transition to an eligible employment status.

    3. Premiums

      The cost of this insurance is paid entirely by the Laboratory.

    4. Plan Provisions
      1. The Long-Term Disability insurance plan provides disability payments equal to 60% of the employee's basic monthly salary, up to a maximum benefit of $8,000 per month, after the employee has been totally disabled and absent from work for 90 calendar days. Benefits will continue for as long as the qualifying disability exists. Benefits may be received up to the maximum benefit period which is normally age 65, but adjusted if disability occurs after age 62. Benefit amounts are offset by payments made by retirement plans, Social Security and Workers' Compensation, and are considered taxable.
      2. Benefits under the Lab's LTD program may be supplemented with accrued vacation and sick leave as specified in section D.2.e. below.
      3. Coverage for long-term disability ends on the date of termination of employment unless the employee is receiving benefits under the plan, in which case the benefits continue for as long as the qualifying disability exists.
      4. If the employee may return to his/her own position on a part-time basis or another position on a full-time or part-time basis there are work incentive benefits while the employee is considered residually disabled.
      5. Once the employee is eligible to receive long-term disability benefits, separate periods of disability resulting from the same or related causes are considered a continuous period of disability unless the employee has worked a full six consecutive months.
      6. Monthly benefits will not be paid if the disability falls under a pre-existing condition limitation. The limitation is not applicable after the participant is covered for twelve (12) months.
      7. Survivor benefits are available if the employee participant dies while monthly benefits are being paid.
  4. INACTIVE - DISABILITY STATUS
    1. Policy

      Disabled employees who are receiving disability benefits from the Lab's LTD insurance or Workers' Compensation will be eligible for "Inactive-Disability" status after six months of disability (three months on short-term disability, if available, and three months on long-term disability or six months on Workers' Compensation).

    2. Benefits Provisions
      1. For as long as the Inactive-Disability employee remains disabled and receiving disability benefits from LTD or Workers' Compensation, JSA/JLab will continue paying its portion of medical and dental premiums for the enrolled employee and enrolled eligible dependents until the employee reaches age 65 and eligibility for Medicare and/or JSA/JLab retiree benefits. The employee must remain in the same medical insurance plan in which he/she was enrolled at the time the Inactive-Disability status was initiated. The disabled employee must apply for any Social Security and Medicare coverage for which he/she may be eligible.
      2. If a disabled employee is not enrolled in a JSA/JLab medical or dental plan at the time Inactive-Disability status begins, he/she will not be able to enroll.
      3. If the disabled employee is receiving Medicare benefits, he/she may retain JLab medical plan coverage as well.
      4. If the disabled employee receives benefits from Social Security, the Lab's LTD or Workers' Compensation plans will pay the difference between the Social Security benefit and the plan benefit.
      5. For the first twelve months on disability (three months short-term disability, if available, and nine months long-term disability or twelve months Workers' Compensation) benefits under the Lab's Workers' Compensation or Long-Term Disability Plan may be supplemented with accrued sick or vacation leave. Required contributions to the disabled employee's TIAA-CREF account and JSA/JLab's matching contribution will continue as long as the disabled employee is receiving any pay from the Lab. After twelve months on disability leave, the employee may no longer supplement Workers' Compensation or LTD benefits with sick leave.
        1. For employees on Workers' Compensation, after paid leave is exhausted JSA/JLab shall make supplemental disability payments in an amount equal to the difference between the Workers' Compensation temporary total payments and two-thirds the amount of the employee's base salary. The supplement is available for a maximum of 13 weeks and the total benefit may not exceed $1,000 per week.
      6. Basic life insurance will be continued for a period of up to 13 months for employees on Inactive-Disability status until a decision is finalized on waiver of premiums by the insurance carrier.
      7. An Inactive-Disability employee may continue short-term disability coverage by continuing to pay the full premium. Short-term disability coverage is not available to terminated employees or retirees.
      8. After twelve months from the date of disability, employees who are not enrolled in a JLab medical insurance plan will be terminated, any accrued vacation will be paid out, and he/she will be offered COBRA. (Note: If an employee who is not enrolled in a JLab medical insurance plan has not received a final decision from the life insurance carrier on a waiver of premium by the end of the twelfth month of disability, termination may be delayed until the end of the thirteenth month when the waiver decision is due.) Employees who are enrolled in a JLab medical insurance plan will remain on Inactive-Disability status and may continue to supplement Workers' Compensation or LTD benefits with any remaining accrued vacation.
      9. If at any time after twelve months from the date of disability, while on Workers' Compensation or LTD, the employee decides to discontinue health benefits coverage under the Lab's plan, he/she will be terminated, any accrued vacation will be paid out, and he/she will be eligible for COBRA.
      10. In the event of the death of an Inactive-Disability employee, any insurance coverage provided by JSA/JLab for his/her dependents will cease. Said dependents will be eligible for coverage under COBRA.
      11. Additional service credits will continue to accrue to a maximum accumulation of five years for the Inactive-Disability employee.
    3. Position Status of Inactive Disability Employees
      1. During the first six months of disability, the disabled employee's position shall be either kept open or filled on a temporary basis.
      2. When the disabled employee is placed on Inactive-Disability status (after six months of disability), his/her supervisor, appropriate line management, Human Resources and Occupational Health & Safety will conduct a Disability Case Review to determine whether keeping the inactive employee's position open will create a hardship for the Laboratory. This evaluation is based on Lab needs and includes such considerations as the difficulty of not having a regular employee in the position, the difficulty of filling the position, and the projected return to work by the disabled employee. The results of the review must be approved by the Director of Human Resources and Occupational Health & Safety and Legal Counsel. If the Lab's decision is that keeping the position open will cause a hardship, the position may be filled. If the Lab's decision is to allow the position to remain open, this decision shall be reviewed at a future date.
    4. Return to Work
      1. If the treating physician authorizes a return to work for the employee on Inactive-Disability status and there is an open position at the Lab for which he/she is qualified and able to perform (with accommodation, if necessary), the employee will be activated and placed in that position. Accommodation could include returning to work in a modified capacity or alternate work assignment. Refusal of a reasonable assignment could be the basis for lost-time benefits to be suspended.
      2. The employee shall report first to Occupational Health & Safety with the physician's written instructions concerning activity limitations. The nurse will consult with the employee's supervisor about normal job activities and any prescribed limitations.
      3. If at the time the employee is released to return to work, there is no position available for which the employee on Inactive-Disability status is qualified and able to perform, even with accommodation, he/she will be terminated, any accrued vacation will be paid out and he/she will be eligible for COBRA.


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