If a participant is sick or injured and unable to work, he or she may receive benefits through STD.
- Disability Sick Leave (DSL)
- Voluntary Short-Term Disability Insurance (VSDI)
- Leidos California Voluntary Disability Plan (Leidos CA VDP)
- Other State-Mandated Short-Term Disability Plans including: California State Disability Insurance (CA DSI)*, Hawaii Short-Term Disability, New Jersey Temporary Disability Insurance, Washington DC Universal Paid Leave, New York Voluntary Disability Plan, Puerto Rico Temporary Disability Insurance, Washington Paid Family Leave, and Rhode Island State Temporary Disability Insurance.
* All Leidos employees living in California, excluding those working at Varec & BD Systems are automatically covered by the Leidos California Voluntary Disability Plan (Leidos CA VDP). Leidos employees working for certain subsidiaries in California locations are covered by the State of California SDI program. If you are unsure which plan you participate in, contact HR Employee Services as 855-553-4367, option 3 or email [email protected]
STD benefits may be paid for up to 180 days of continuous disability. The benefit that is paid is determined by the length of the disability, the participant's elected disability coverage and any state disability benefits.
Below are some important terms used in describing how a participant is eligible to receive benefits through the disability plans:
- Active Pay Status — Employee receives pay for a normal scheduled day of work, including regular pay, comprehensive leave, bereavement, or jury duty benefits. Active pay status does not include employees who are on leave of absence, on whole-week voluntary or involuntary LWOP, or receiving disability benefits (DSL, CA VDP, VSDI, or LTD).
- Claims Administrator — The organization that is accountable for receiving the participant's application, determining which benefits are payable and ensuring that payments are made:
- For DSL, VSDI and Leidos' CA VDP, Sedgwick CMS administers the plans.
- For the Hawaii state disability plan, Life Insurance Company of North America administers the plan.
- For the New Jersey, New York, Rhode Island, and Puerto Rico state disability plans, the respective states administer the plans.
- Hospital Confinement — Any 24 hour period of time, or any part thereof, for which a claimant is properly charged a full day's rate for room and board as a registered bed patient in a hospital, or in a nursing home. Emergency Room visit and Outpatient Surgery are excluded.
- Physician – Includes physicians and surgeons holding an M.D. or D.O. degree, physician's assistant (P.A.), nurse practitioners (N.P.'s), psychologists, optometrists, dentists, podiatrists, and chiropractic practitioners licensed by state law and acting within the scope of their practice as defined by state law. For disability related to normal pregnancy or childbirth, medical certification may be provided by a midwife or nurse practitioner.
- Psychologist – A licensed psychologist with a doctoral degree in psychology, or a doctoral degree deemed equivalent for licensure by the Board of Psychology pursuant to Section 2914 of the Business and Professions Code, and who either has at least two (2) years of clinical experience in a recognized health setting or has met the standards of the National Register of the Health Service Providers in Psychology.
- Qualified Disability — A disability that has been certified by a physician or other health care provider, based on objective medical evidence, and subsequently reviewed and approved by the claims administrator. Each plan may have different definitions as to what types of conditions are disabling (for example, some state plans differ from the private insurance plans). Keep in mind that not all disabilities will be approved.
In general, under most short-term disability plans, a participant is considered disabled when he or she:
- Is physically or mentally ill, or is injured and the condition prevents him or her from performing his or her regular work;
- Is under the regular and continuous care of a physician or other health care provider; and
- Is not performing work for any other employer, including self-employment.
Regardless of the plan, the participant may be required to provide objective medical evidence to qualify for benefits. The claims administrator will determine the types of medical documentation needed and how frequently the documentation must be updated.
- Recurring Disability — Recurring Disability shall mean two or more intervals of disability, due to the same cause or condition, separated by less than 31 days of continuous active work with the Company, shall be considered the same Disability. A new waiting period will not be required. The period of time worked will count against the total leave duration approved in the initial claim. For purposes of calculating the claimant's amount of benefits under the Plan, regular wages as of the date of the original onset of disability shall be used.
- Regular Wages
- With respect to Regular, Full-time Employees, regular wages shall mean the scheduled base salary amount of compensation prior to any voluntary salary reduction, excluding overtime, Health & Welfare benefit payments, shift differential pay, bonuses, commissions, stock transactions, expense reimbursements and moving expenses in effect during the last completed payroll period immediately prior to the date of commencement of the employee's disability.
- With respect to all Part-time Employees, regular wages shall mean the average weekly compensation paid by the Company excluding overtime, Health & Welfare benefit payments, shift differential pay, bonuses, commissions, and stock transactions during the previously completed twelve (12) week period immediately prior to the date of commencement of the employee's disability.
This document provides only a summary of general plan provisions. Separate documents are available from the plan administrators, which serve as the legal documents that govern these plans.
Our STD Program is made up of four components:
- Disability Sick Leave (DSL) hours, which are provided by Leidos at no cost to eligible employees;
- Voluntary Short-Term Disability Insurance (VSDI), which is elected and paid for by the participant;
- Leidos California Voluntary Disability Plan (Leidos CA VDI), which is paid for by the participant; and
- Other state-mandated disability insurance in California, Hawaii, New Jersey, New York, Puerto Rico and Rhode Island, which is paid for by the participant.
If a participant becomes disabled, these STD benefits are designed to work together to replace a percentage of a participant's regular wages prior to the disability. After a participant is certified as having a qualified disability, STD benefits are generally payable for up to 180 days, based on the length of disability and the program components available.
Under some circumstances, separate absences might be defined as the same disability if there were two consecutive periods of qualified disability due to the same or a related cause or condition that are separated by 31 consecutive days or less.
The STD Program components are outlined below:
PLAN WHO IS COVERED? WHO PAYS FOR COVERAGE? WHEN DOES IT BEGIN? HOW LONG DOES IT LAST? DSL Those in benefit-eligible fringe packages Leidos On the 8th calendar day, except when hospitalized For a maximum of 180 days or upon exhaustion of benefits in accordance with plan limits VSDI Only those who enroll The participant On the 8th calendar day, except when hospitalized Until the end of the qualified disability, to a maximum of 180 days Leidos CASDI California employees who are eligible and automatically enrolled in this plan The participant On the 8th calendar day of disability Until the end of the 52nd week of a qualified disability; or after the participant has exhausted his or her 52-week benefit amount, if part-time Other State Laws Employees in California (including ex-patriates) who are not eligible for the Leidos CASDI program; all employees in Hawaii, New Jersey, New York, Puerto Rico and Rhode Island Varies by state; usually both the participant and the employer Varies by state Varies by state
Disability Sick Leave (DSL), which is company provided and administered by Sedgwick CMS, provides participants with paid time off for short-term illness or injury (less than 180 days). If a participant becomes sick or is injured, DSL can be used to replace income or augment other short-term disability payments to the maximum level of DSL benefits available, based on the length of disability leave.
A participant receives DSL hours on the first day of hire or transfer date into a benefit-eligible status. Thereafter, a participant receives DSL hours on his or her employment anniversary date. A participant receives 80 hours of DSL each year. Participants can accumulate up to 1,560 hours of DSL. Unused DSL hours are not payable upon termination. Employees scheduled to work less than 40 hours per week will receive a prorated number of DSL hours equivalent to two times their scheduled workweek on their DSL employment anniversary date.
The commencement of DSL benefits depends on the circumstances of the participant's disability. DSL is payable:
- On the first day of a qualified disability if the participant is hospitalized as defined;
- On the eighth calendar day of a qualified disability.
Should it be medically necessary for the participant to reduce his or her work hours by 25% or more, but not cease work entirely, the waiting period may be served in hour increments consecutively for seven calendar days.
DSL benefits are payable for up to 180 days for any one period of disability. DSL may not be used to supplement Long-Term Disability (LTD) benefits, even if the participant has DSL available.
Any DSL benefits participants receive are taxable, and payroll deductions for elected benefits will continue to be made while a participant receives DSL benefits.
Based on the length of disability and the DSL hours available:
- A participant who is unable to work due to a qualified disability may receive a weekly benefit of up to 100% of his or her regular wages after satisfying the waiting period. These benefits are available for weeks two through ten of disability.
- If eligibility continued, after 10 weeks of disability, a participant may receive up to a maximum of 80% of his or her regular wages. These benefits are available through the 19th week of disability.
- If the participant remains eligible after the 19th week of disability, he or she may receive up to 66 2/3% of his or her regular wages. These benefits are available through the 26th week of disability not to exceed 180 days.
Eligible employees can purchase additional STD coverage through Voluntary Short-Term Disability Insurance (VSDI). This plan is intended to integrate with other Leidos plans such as DSL, Leidos CA VDP and state-mandated programs. Contributions are made on a pre-tax basis. VSDI is administered by Sedgwick CMS.
VSDI benefits begin:
- On the first day of a qualified disability if the participant is hospitalized as defined; or
- On the eighth calendar day of a qualified disability.
Should it be medically necessary for the participant to reduce his or her hours by 25% (minimum two hours for an eight hour workday) or more, but not cease work entirely, the waiting period may be served in hour increments consecutively for seven calendar days.
A participant who elects VSDI will be eligible to receive up to 80% of his or her total disability benefit (not to exceed plan maximums) from the VSDI plan.
These benefits are available through the 26th week of disability not to exceed 180 days.
The VSDI schedule illustrates the integration of VSDI with other disability plans such as DSL and other state plans for periods of up to 26 weeks, not to exceed 180 days.
PERIOD OF DISABILITY TOTAL PAY
(from all sources)
(integrated with state plan,
DSL PORTION Week 1 0
(7 day waiting period)
(7 day waiting period)
(7 day waiting period)
Weeks 2- 10 100% of regular weekly wages 80%
(to a maximum weekly benefit of $4808)
20%, as available Weeks 11 - 19 80% of regular weekly wages 80%
(to a maximum weekly benefit of $3846)
20%, as available Weeks 20 - 26 * 66 2/3% of regular weekly wages 80%
(to a maximum weekly benefit of $3202)
20%, as available
* Not to exceed 180 days
Example: For a participant who does not live in a state with a mandated plan, has enrolled in VSDI and is making $1,000 per week, he or she would be eligible for the following disability benefits:
LENGTH OF DISABILITY TOTAL BENEFIT
(from all sources)
(integrated with state plan,
DSL BENEFIT Week 1 0 0 0 Weeks 2- 10 $1,000 $800 $200** Weeks 11 - 19 $800 $640 $160** Weeks 20 - 26 * $667 $534 $133**
* Not to exceed 180 days
** Based on DSL balance
If hospitalized as defined, the participant will receive:
- Weeks 1 - 9: Up to 100% of weekly wages to a maximum plan benefit
- Weeks 10 - 18: Up to 80% of weekly wages to a maximum plan benefit
- Weeks 19 - 26: Up to 66 2/3 of weekly wages to a maximum plan benefit
For the same participant who has elected not to enroll in VSDI, all benefits would be paid from the DSL plan and state plan where applicable.
Any VSDI benefits participants receive are taxable, and payroll deductions for elected benefits will continue to be made while a participant receives VSDI benefits.
Leidos California Voluntary Disability Plan (Leidos CA VDP)
Employees who work for a covered California Leidos organization are automatically enrolled in a special short-term disability insurance plan, the Leidos California Voluntary Disability Plan (Leidos CA VDP). This excludes employees working for subsidiaries who are covered by the State of California Short-Term Disability Insurance (CA SDI) program.
The Leidos CA VDP is administered by Sedgwick CMS and meets or exceeds the requirements of the state of California.
Participants pay for coverage through contributions that are no higher than the contribution rate for the California State Disability Insurance Plan. These rates are established each year by the California Employment Development Department.
- For the 2020 plan year, the contribution rate is set at 1.0% of taxable wages. The maximum salary subject to this contribution for 2020 is $122,909 and the maximum annual contribution is $1,229.09. For more information, refer to the 2020 CA VDP Employee Notice.
If a participant is enrolled in Leidos CA VDP and is unable to work due to a qualified disability, the plan pays benefits equal to between 60% and 70% of a participant's regular base wages (actual percentage is determined by the state's average quarterly wage). The weekly maximum benefit is $1,300 for 2020. The weekly benefit maximum is set each year by the State of California. This is a calendar-day plan, so each day's benefit during a qualified disability is one-seventh of a participant's weekly benefit.
The Leidos CA VDP will pay benefits after a mandatory seven-calendar-day waiting period, but for no more than 52 weeks (or 52 times the weekly amount). If a participant does not cease work entirely, but there is a medical necessity to reduce his or her hours by 25 percent or more because of a disabling condition, the waiting period may be satisfied with seven consecutive days of partial disability.
Participants who also work for employers other than Leidos are entitled to receive a prorated benefit from those employers' disability plans in addition to any Leidos CA VDP benefit payments. Payments from each plan depend on the number of plans involved. The total amount a participant can receive from each disability plan will equal the portion payable under the California State Disability Insurance Plan. If the participant's employer has a private disability plan (as Leidos does) additional benefits may be payable.
Leidos CA VDP benefit payments are non-taxable, and certain payroll deductions will continue to be made while a participant is receiving Leidos CA VDP benefits.
If you have any questions about this Voluntary Plan or wish to withdraw from the Leidos Private CA VDP plan contact HR Employee Services at 855-553-4367 (select #3) or email [email protected]
To report a claim, contact Sedgwick, Leidos' disability claims administrator, at 1-877-399-6443.
Leidos CA VDP Benefit Limitations
Leidos CA VDP benefits may be limited or not available at all, if:
- The participant is not an employee as defined in the plan;
- The participant did not meet the seven-day consecutive waiting period;
- The participant does not work for a Leidos organization that participates in this program;
- The disability is not supported by a certificate from a physician or health care provider stating a diagnosis, the medical facts within his or her knowledge, a conclusion with respect to the disability and an opinion with respect to the probable duration of the disability:
- Physicians or other health care providers are required to submit an ICD diagnostic code or a detailed description of symptoms. The physician's or other health care provider's certificate must be based on a physical examination;
- If the participant has been referred or recommended by a competent medical authority to participate as a resident in an alcoholism recovery program or drug residential program, the participant need not show actual disability;
- Certification of disability may also be accepted from any duly authorized medical officer of any medical facility of the United States government; the registrar of a county hospital in this state; the duly authorized or accredited practitioner of any bona fide church sect, denomination, or organization, which depends for healing entirely upon prayer and spiritual means;
- Certification is not required if the participant submits evidence of receipts of temporary or permanent benefits under a workers' compensation law for any day for which he or she is entitled to receive disability benefits reduced by such temporary or permanent worker's compensation benefits;
- The participant is receiving unemployment benefits;
- The participant is receiving wages or regular wages from any employer, except that benefits will be paid for any week or partial week not to exceed the maximum weekly benefit amount which, when added to the wages or regular wages, does not exceed the participant's weekly regular wages prior to the beginning of the disability;
- The participant is confined by court order or certification as a dipsomaniac, drug addict or sexual psychopath;
- The participant has knowingly made a false statement or representation in order to receive any benefits under this plan;
- The participant is incarcerated because of a criminal conviction or he or she commits a crime and becomes disabled due to an illness or injury in any way caused by, or arising out of the commission of, arrest, investigation, or prosecution of any crime that results in a felony conviction; or
- The participant is receiving or is entitled to receive benefits or cash payments for temporary disability, vocational rehabilitation maintenance allowance or permanent disability benefits under workers' compensation law. However, if these benefits are less than the amount the participant would otherwise receive as benefits under this plan, he or she will be entitled to receive disability benefits reduced by the amount of these workers' compensation payments. Benefits will be limited to the state plan rate for disabilities occurring during the extended coverage period following the beginning of a layoff without pay or a leave of absence without pay.
In certain states, other short-term disability plans will pay benefits. These state-mandated plans include:
- California State Disability Insurance*;
- Hawaii Short-Term Disability;
- New Jersey Temporary Disability Insurance;
- New York Voluntary Disability Plan;
- Puerto Rico Temporary Disability Insurance; and
- Rhode Island State Temporary Disability Insurance.
* Leidos employees working for certain subsidiaries in California locations are covered by the State of California SDI program. All other Leidos employees living in California are covered by Leidos Voluntary Disability Plan. If you are unsure of which plan you participate in, contact HR Employee Services at 855-553-4367, option 3 or via email at [email protected]
The California, New Jersey, Puerto Rico and Rhode Island plans are administered by the participant's respective states. The Hawaii Plan is administered through Life Insurance Company of North America (a Cigna company). The New York plan is administered through The State Fund insurance company. Both the Hawaii and New York plans were purchased by Leidos as required by state law.
DSL and VSDI are supplements to these plans, which means that the State plans pay first and DSL/VSDI will make up the difference, up to the benefit level that the plans would normally pay. The state disability plans that integrate with DSL and VSDI are outlined above.
Contact Information for State-Mandated Plans
For more detailed information about these state-mandated plans, refer to the following plan contacts below.
State Mandated Short-Term Disability Contact Information California State Disability Insurance
Employment Development Department
800 Capitol Mall
Sacramento, California 95814
If you are covered under the Leidos CA VDP, contact Sedgwick at 1-877-399-6443
Hawaii Short-Term Disability
P.O. Box 1639
Honolulu, HI 96806
State Plan General Contact Information
Disability Compensation Division
830 Punchbowl Street, Room 209 Honolulu, HI 96813
New Jersey Temporary Disability Insurance Division of Disability Insurance Service
Department of Labor
P.O. Box 387
Trenton, New Jersey 08625
New York Voluntary Disability Insurance
New York State Insurance Fund Disability Benefits
P.O. Box 66698
Albany, NY 12206
State Plan General Contact:
Disability Benefits Burea Workers Compensation Board
P.O. Box 9029
Endicott, NY 13761-9029
Puerto Rico Temporary Disability Insurance Bureau of Employment Security
Disability Insurance Program
505 Ave. Munoz Rivera
San Juan, PR 00918 – 3514
797-625-7900 or 787-754-5824
Rhode Island State Temporary Disability Insurance Dept. of Labor and Training
Temporary Disability Insurance
1511 Pontiac Avenue
Cranston, RI 02920-4407
If a participant becomes disabled, as defined by the Disability Program, the participant must take the following steps to apply for benefits:
- Notify supervisor of the need for time off.
- If the participant is enrolled in the DSL, VSDI or Leidos CA VDP plan, he or she should call Sedgwick CMS, Leidos' disability claims administrator, at 1-877-399-6443. Participants can contact Sedgwick CMS to file a claim 7 days a week/24 hours a day. The participant will need to provide Sedgwick CMS with the following information:
- The participant's personal information (including name, address, phone number, employee number, and supervisor's name and phone number);
- The participant's health care provider's name, mailing address, phone number and fax number; and
- The participant's anticipated length of time away from work due to the qualified disability.
- If the participant lives in Hawaii, New Jersey, New York, Rhode Island or Puerto Rico, or if the participant lives in California and is not eligible to enroll in the Leidos-CA VDP plan, he or she will also need to file for state disability benefits. See the Other State-Mandated Short-Term Disability Plans section for more information.
The payment of a disability claim is not automatic - the participant must take the appropriate steps or disability benefits may be delayed or denied. Under most circumstances, if the participant is not able to contact the claims administrator(s), a family member or other designee can initiate the appropriate steps on the participant's behalf. The claims administrator will begin evaluating the participant's condition after receiving notification of the disability.
After certification of a qualified disability, the participant receives STD benefits based on the length of disability, elected coverage (VSDI), DSL balance and any state benefits.
A participant will receive disability benefits based on the following schedule:*
- Week 1: 7 calendar day waiting period unless hospitalized as defined;
- Weeks 2 - 10: Up to 100% of weekly wages to a maximum plan benefit;
- Weeks 11 - 19: Up to 80% of weekly wages to a maximum plan benefit;
- Weeks 20 - 26*: Up to 66 2/3% of weekly wages to a maximum plan benefit.
*If hospitalized as defined, the participant will receive:
- Weeks 1 - 9: Up to 100% of weekly wages to a maximum plan benefit
- Weeks 10 - 18: Up to 80% of weekly wages to a maximum plan benefit
- Weeks 19 - 26: Up to 66 2/3 of weekly wages to a maximum plan benefit
If the participant is receiving benefits from the DSL, VSDI and/or Leidos CA VDP plan plans:
- Disability benefits will be paid through the Leidos payroll system;
- The benefit amount will be reduced proportionately if a benefit is payable for less than a full week;
- Benefits are paid through the participant's paychecks, through direct deposit, if applicable, as long as the check is processed as part of the regular payroll cycle;
- DSL and VSDI payments are taxable income. The Leidos CA VDP benefit payments are not taxable.
- Payroll deductions will continue to be made for all employee benefits.
- Participants on part-time disability will have a one pay period delay in receiving their benefit payment.
If the participant is receiving benefits from a state-mandated STD plan:
- Benefit payment schedules and taxability vary by plan;
- The plan determines eligibility for benefits;
- The employee will receive a separate check directly from the state plan;
- Contact the state agency or review the insurance company's SPD for specific information.
Each STD claims administrator determines eligibility for the plan it administers and makes a determination of benefits eligibility.
Each STD plan may require, at the Plan's expense, an independent medical evaluation. The participant may be required to go to a doctor of the plan's choice to be examined or to have medical records sent to a third party for review.
In each plan, there is a formal appeal process if the participant disagrees with the determination of the claims administrator.
- For the DSL and VSDI plans, refer to "Claims Appeal and Review Procedures Under ERISA" in the Plan Information section for more information on relevant procedures.
- For all other plans, contact the claims administrator for information on the appeal process.
Pregnancy is treated like any other disability. Participants who are considered to be disabled due to pregnancy must follow the same process as for all other disabilities.
A participant on a rotational work schedule (e.g. 90 days on/90 days off) who has a qualifying disability, will be paid disability benefits even if the disability falls on a period the participant is scheduled to be off.
Illnesses or disabilities that involve home confinement and that have been certified by a physician or other health care provider qualify employees for disability benefits as of the 8th calendar day, based on approval from the claims administrator.
All medical information that a participant and his or her physician or health care provider supply to the disability plans is kept confidential and will be protected from unauthorized use. Certain claims may require the use of a special, written authorization form. The participant will need to sign and return the form as soon as possible so there is no delay in processing the claims.
All STD plans require that the participant cooperate in collecting the medical information necessary to review the claims and make a benefit determination. The most common reason that claim payments are delayed is the failure of the participant's health care provider to return calls, return forms or otherwise provide requested medical documentation. A participant can help the claims administrators make more timely decisions by:
- Explaining to the health care provider that the administrator will be contacting them;
- Following up with the health care provider's office after a request for information has been made to ensure that the information is being collected and sent to the administrator; and
- Notifying the claims administrator immediately if the participant's return-to-work plans change, or if the health condition significantly changes (for example, if a surgery is needed). This will allow the plan administrator to help the employee file for an extension of benefits, if appropriate.
Some state plans insist that the documentation be provided only on specific forms. The health care provider should be aware of these requirements. However, a participant who receives a letter from the state indicating that the documentation was not provided in the appropriate format should contact his or her health care provider immediately.
For the DSL, VSDI and Leidos CA VDP plans, Sedgwick CMS will contact the participant's physician or health care provider to request the appropriate documentation. In addition, Sedgwick CMS will make a determination as to the expected return-to-work date based on objective medical evidence provided by the participant's physician or health care provider. If a participant's qualified disability extends beyond the original estimated return-to-work date, the participant should have his or her physician or health care provider complete the extension form provided by Sedgwick CMS. Failure to provide disability extension documentation could result in delayed or denied benefits.
The STD Program is designed to provide a certain degree of income protection if a participant is unable to work. The individual STD plans coordinate with each other so that participants do not receive duplicate benefits In addition, some offsets or deductions may be made for other plans for which the participant might be eligible. In general, STD benefits will be offset by:
- Social Security benefits (except family Social Security benefits) for any period of time during which disability benefits are paid. Once disability benefits begin, however, they will not be further reduced by any statutory increase in Social Security benefits. If the receipt of Social Security retirement benefits commenced prior to the Participant's Disability such benefits will not be offset
- Any benefits based on wages payable to the participant under any worker's compensation law;
- Disability benefits payable to the participant under any employer-sponsored group policy other than the Leidos disability plans;
- Disability/medical leave benefits for employee's own serious health condition payable under any federal or state law;
- Any salary (excluding vacation pay), income or sick pay from any employer or from self-employment.
- Retirement benefits, paid or due from a Leidos-sponsored Pension Plan or Savings Plan offset net disability dollar for dollar paid during the disability. Any plan, fund or other arrangement, by whatever name called, providing disability benefits pursuant to any Compulsory Benefit Act or law of any government.
- Any government retirement or disability plan that is initiated or increased as a result of a participant's disability.
- Some portion of income or wages earned during rehabilitation employment; (refer to the individual plan's SPD or evidence of coverage for more information;
- Any financial settlement, award, benefit or other monetary recovery the participant receives — through litigation or otherwise — attributable in whole or in part to the negligence, the wrongful act or any other civil or criminal incident that resulted, in whole or in part, in the disease, illness, incapacity or injury that substantiates the disability claim. (This offset can be made for the entire amount of the third party recovery, regardless of whether it is attributable to lost wages, incurred medical expenses or punitive damages.)
Although the coordination of benefits may reduce the amount received from the STD plans, all benefits together will still equal the total amount the participant is eligible for under the STD plan(s) that he or she is enrolled in.
Leidos requires that all participants returning from a disability leave provide a "fitness for duty" or "doctor's release" clearly stating the date he or she is no longer considered to be disabled, as well as the date he or she is able to return to work. This document is usually a note from the health care provider stating that the participant may return to full duty. If the health care provider is requesting modified duty or limited hours, this should be discussed with the claims administrator and the workplace in advance of the participant's return to work. A participant who does not present a release may not be allowed to work until the release is presented.
STD benefits generally end when the participant:
- Returns to work as cleared by the participant's physician
- Is no longer disabled as defined by the particular disability plan;
- Reaches the maximum duration payable under that plan;
- Refuses to submit to an independent medical examination (arranged and paid for by the claims administrator) or fails to comply with any request, by the claims administrator, to help substantiate that the participant is disabled;
- Is no longer under the regular and continuous care and treatment of a qualified Physician; or
If a participant's disability started prior to termination of employment, disability benefits will continue to be paid up to the maximum duration approved under the plan.
For collectively bargained participants, disability benefits will continue to be paid if a strike occurs and the disability started prior to the strike. Benefits will be paid up to the maximum duration approved under the plan.
For more information about when benefits end for all disability plans, refer to the plan's SPD or Certificate of Insurance for each plan.
If a participant recovers from an illness or injury and returns to full active employment with Leidos (other than in rehabilitation employment), the participant may again be eligible for disability benefits if, within 31 days, the participant suffers another period of disability caused by, related to, and based on the same diagnosis as the prior period of disability. If these conditions are met, the participant will not be required to satisfy another waiting period.
However, should the participant go out on an approved disability again related to the initial claim within 31 days, the period of time worked will count against the total leave duration for the initial claim. For example, if a participant is on approved disability for eight weeks, returns to work for two weeks and then takes disability leave again for the same issue within 31 days, the participant is considered to have been disabled for a total of ten weeks. Therefore, disability benefits will reflect the benefits level payable for that week. In this example, benefits payable at week eleven will decrease to 80% of weekly wages. Successive disability benefits will begin on the most recent date the participant was unable to work.
The participant must notify Sedgwick CMS within five days of the successive disability. Participants in a state-mandated plan must also notify the appropriate state claims administrator.
For more information about what happens when a participant becomes disabled again, refer to the plan's SPD or Certificare of Insurance for each plan. State-mandated plans, have different maximum benefit durations.
In general, benefits may be limited or not available at all if:
- The participant is not in an employment status that is eligible for disability benefits
- The disability leave is not supported by objective medical evidence from a treating physician or other health care provider and approved by the claims administrator
- The participant is confined, pursuant to commitment, court order, or certification, in an institution, or other place, as a dipsomaniac, drug addict or sexual psychopath
- The participant has reached the maximum benefits or duration allowed under the plan
- The participant receives benefits or is eligible for benefits payable under any Unemployment Compensation Act of the United States or of any state during any period of disability leave
- The participant receives wages from Leidos (excluding Paid Time Off pay) for any day. However, benefits will be paid for any seven-day week or partial week, in an amount that does not exceed the participant's maximum weekly benefit amount and which, when added to the wages received, does not exceed the participant's weekly wage, exclusive of the wages paid for overtime immediately prior to the commencement of the participant's qualified disability
- The participant, for any day of unemployment or disability, receives or is entitled to receive benefits or cash payments for:
- Temporary or permanent disability under a workers' compensation or employer liability law of this state or any other state, or of the federal government; or
- If the cash payments for temporary or permanent disability or a maintenance allowance, combined with permanent disability benefits, are less than the amount of disability benefit the participant would have received, the participant will be entitled to receive disability benefits, reduced by the amount of such cash payments, if otherwise eligible
- The participant:
- Is incarcerated in any federal, state, or municipal penal institution, jail, medical facility, public or private hospital, or in any other place because of a criminal conviction of a federal, state or municipal law or ordinance; or
- Commits a crime and is disabled due to an illness or injury, caused by, or arising out of the commission of, arrest, investigation, or prosecution of any crime that results in a felony conviction.
- For any period of disability the participant records uncompensated time, overtime, bereavement, jury duty, voting, or holiday on his or her timesheet.
- The employer can provide alternative employment that is within the capabilities of the employee, and that has status and compensation comparable to the employee’s regular occupation as determined solely by the employer.
- The participant has willfully, for the purpose of obtaining benefits, either made a false statement or representation, with actual knowledge of the falsity thereof, or withheld a material fact, in order to obtain any benefits from the Plan.
- The disability is:
- Not disabling (i.e., do not prevent the employee from doing his or her job)
- Incurred during, or as a result of, engaging in a criminal act
- Incurred while on layoff or leave of absence (FMLA and similar protected leaves), severance, military leave, or any other status where the participant was not engaged in active employment with Leidos
- Incurred while on full-time or part-time long-term disability
- Incurred while the employee was on unauthorized absence, or was not an employee
- Incurred as a result of service in any armed forces, except as required by law
- Intentionally self-inflicted
- Incurred because the participant was not receiving care or following the prescribed treatment plan that is:
- From a health care provider whose training and clinical experience are suitable for treating the disease, illness, incapacity or injury
- Consistent in type, frequency and duration of treatment with relevant guidelines of national medical, research, and health coverage organizations and governmental agencies
- Consistent with the diagnosis of the condition
- For the purpose of maximizing medical improvement
- The participant is not under the continuous care and treatment of a duly qualified physician
- The illness or injury is caused by any act of war, declared or undeclared, or insurrection, except while traveling overseas on company business.
- The disability is filed more than 60 days after the qualified disability began.
For more information on limitations and exclusions, refer to the Plan Document or Certificate of Insurance for each plan.