STD - Salary Continuation

Clare

We have a self funded STD Plan, which is basically a salary continuation plan for a period of up to 13 weeks for illness or injuries.

The plan states that benefits are paid for "non-occupational" injuries or illness.

One of our employees incurred an injury while he was doing a job "on the side" - he was being paid, but not by a company with workmen's comp insurance. Rather he was being paid by an individual. He will be out of work for at least 6 weeks and has requested STD benefits.

The question is: Is this treated as an occupational injury, making him ineligible for the STD? I also know that we would be horribly criticized by other employees if we denied his benefit. I don't know if this is a battle I want to fight.

Any suggestions?

dchr9203

I'd treat it as an eligible claim.

marc

I may be wrong, but I don't think most STD plans have to be related to work, like WC claims do. If you broke your leg in a car wreck, you still have a short term disability - and therefore a claim.

Am I wrong?

irenesmsaclaims

Disability plans (short term or long term) almost always exclude work-related injury or illness. Additionally, the exclusion typically says "whether or not Workers Comp. is in force, or whether or not the individual is covered" because the person should have been covered. I'm not sure I have ever seen a distinction for work performed for the sponsor of the disability plan that is being claimed against, or another employer. You need to read the plan document carefully, as to the work-related illness or injury. I would be really careful with this one, and the precedent it could set. Disability seems to me to be the "occupation" of the times, unfortunately.

Clare

Thank you for your responses. As I mentioned, our plan is self funded and the document is pretty simple. We excluded benefits for occupational injuries and illnesses to avoid someone collecting double benefits. In this case, the employee was injured while working for someone else without workmens comp coverage.

I've worked here for 15 years, and this is the first time something like this has come up. For now, we will pay the benefits. I believe the ultimate cost will be less... thanks!