What are Accident and Sickness Benefits?

Accident and Sickness benefits can replace a portion of your pay for up to 52 weeks of illness, injury or pregnancy-related disability.

Eligibility for benefits

You're eligible for Accident and Sickness benefits if you:

Become wholly and continuously disabled by an accidental bodily injury, sickness or pregnancy while covered for Accident and Sickness benefits

Cannot perform all duties of your job

Furnish the claims processor with written notice and satisfactory proof of your disability on a timely basis

Are under a physician's care

Treatment in an alcohol or drug abuse facility qualifies as being under a physician's care, as long as:

The facility is an inpatient residential, day treatment or outpatient substance abuse treatment facility approved for benefits under the Health Care Plan

The physician-director of the facility, or a physician-consultant selected by the facility, certifies your disability based on information and recommendation furnished by the therapist supervising your therapy. A certifying physician must be a licensed Doctor of Medicine (M.D.) or Doctor of Osteopathy (D.O.)

Claims processor

UNICARE Life and Health Insurance Company is presently the claims processor under an administrative services agreement with the Company.

Benefit amount

Your weekly Accident and Sickness benefits are determined according to your base hourly rate. Refer to pages 220-222 of the CBA, Volume II or on page 122 of "Your Employee Benefits" Handbook for weekly benefit rates.

If you are absent from work for part of a week, your Accident and Sickness benefits are based on one-fifth of the weekly benefit for each regular workday of disability (where state laws permit).

Special provisions apply to employees at operations utilizing three crew or alternate production schedules. In those instances, the benefit for each regular workday of disability will be an amount calculated in accordance with the agreement with the union for operation of an alternative work schedule at the plant at which the employee works.

If you have less than one year seniority, your Accident and Sickness benefits will be 75% of the weekly benefit amount for periods of disability occurring prior to the date one year seniority is attained, subject to reduction for other benefits (as described in the "Other sources of benefits" section).

When benefits begin

If you have an accident, your Accident and Sickness benefits begin the first day of disability. If you are absent from work due to sickness, pregnancy or accident which occurred more than one year prior to the present disability, benefits begin on the eighth day you are disabled, or on the first day:

That you are hospitalized at least 18 consecutive hours, or that the hospital charges you for room and board

Of treatment for alcohol or substance abuse in a residential facility approved for such treatment or

After the day you have an outpatient surgical procedure for which you are entitled to at least $25 in benefits under the H-S-M Program

Any day you work less than four hours due to your accident or sickness is considered a day of disability.

When benefits end

For one continuous period of disability, Accident and Sickness benefits end when you are able to return to work or after the lesser of:

52 weeks

A period equal in duration to your service (on the date the disability began) since your most recent date of hire or rehire

Regardless of your length of service, your Accident and Sickness benefits can continue for up to 52 weeks, if:

You still are hospitalized for the same disability at the end of this period

You are receiving lost-time benefits under Workers' Compensation or other laws providing benefits for job-related accidents or sickness because of your employment. (These do not include benefits for dismemberment)

Successive periods of disability

You may be absent due to the same or related disabilities for several periods of time. Successive periods of absence due to the same or related disabilities are considered one continuous disability unless:

You are back to work for 3 or more consecutive working days if your earlier period of disability ended before weekly benefits were payable or

Seven or more consecutive working days if weekly benefits were payable for any part of your previous period of disability

You will be considered to have returned to work if you work 4 or more hours on each working day (where state laws permit).

If a new illness or accident disables you after you have returned to work, you can make a new claim for benefits. You also can make a new claim for benefits if an old accident or illness disables you again after your return to work, as described above.

If you become disabled again for an old accident or illness without having returned to work for seven or more consecutive working days, the benefits shall be the amount you would have received under a continuation of the prior claim.

Other sources of benefits

Your Accident and Sickness benefits may be affected by other benefits you receive:

If Your Are Receiving:	Effect on Your Accident and Sickness Benefits:
Unemployment Compensation	You are not entitled to Accident and Sickness benefits while: § you are eligible for unemployment benefits under any unemployment compensation law or § you are entitled to unemployment benefits, but rejected or waived your right to receive them
Workers' Compensation	Your Accident and Sickness benefits are reduced by the amount of any lost-time Workers' Compensation benefits to which you're entitled. Accident and Sickness benefits are not payable for an occupational disability if you have waived your rights to Workers' Compensation benefits. Your Accident and Sickness benefits will not be reduced if you are receiving Workers' Compensation for: § a dismemberment § the 100% loss of use of a body member or § a work-related, permanent partial disability unrelated to the disability for which you are applying for benefits.
Social Security	Accident and Sickness benefits will be reduced by the weekly equivalent (one monthly benefit equals 4.33 weekly benefits) of any disability benefit or old-age (retirement) benefit (except for Social Security old-age benefits reduced because of age) and payable for the same period of disability. For purposes of determining your Accident and Sickness benefits: § It is presumed at the 40th week of disability that you were eligible for Social Security Disability Benefits as of the 26th week after your disability began. It also is presumed that your Social Security Disability Benefits should have commenced at the 26th week and that your Accident and Sickness benefits should have been reduced effective the 26th week of disability by the amount of your Social Security benefit. § If you provide evidence that you have applied for Social Security Disability Benefits within six months after disability began, your Accident and Sickness benefits will not be reduced until a determination is made by Social Security on your claim. If Social Security Disability Benefits are awarded, your Accident and Sickness benefits will § be reduced by the amount of the primary Social Security benefit which you actually receive. Any benefits paid to you prior to a Social Security determination, which are later determined not to be payable because of a Social Security award, are an overpayment which must be repaid. If not repaid within 30 days, future Accident and Sickness (and Extended Disability Benefits if necessary) will be suspended until the overpayment is recovered § If your first claim for Social Security Disability Benefits is denied and your attorney successfully appeals that denial, you will have to repay the claims processor any overpayment of your benefits less your related attorney's fees within30 days of receiving the Social Security Disability Benefits award. (Your attorney's fees may not, however, exceed 25% of the overpayment due the claims processor). Attorney fees for services before your initial denial of Social Security Disability Benefits will not reduce the amount of overpayment due to the claims processor.
Holiday pay or other pay received from the Company	Accident and Sickness benefits are not payable for any day you are entitled to holiday pay or receive pay for at least 8 hours. If you receive pay for less than 8 hours, the total of the pay you receive and the disability benefits payable cannot exceed 8 times your base hourly rate.

Subrogation

If your disability is the result of an event that creates a legal liability in another person or entity and you seek to recover economic or compensatory damages through legal or other action against that person or entity, the Company may initiate or join the action to recover the cost of the benefits paid to you by the plan. If you recover monies, economic or compensatory through personal injury action, the payments can be offset from the disability benefit. You must notify the Company or UNICARE in the event you initiate legal action to enforce your right to recovery from another party.

How to file your claim

To expedite processing of your claim, immediately call UNICARE at this toll-free number: 1-800-572-1581 and report your claim by phone. You must submit a "Notice of Application for Hourly Disability Benefits", which can be obtained at plant medical, or can be downloaded from the forms page of this website. This form must be completed and signed. The white copy should be given to your treating physician and the yellow copy mailed to Unicare. (You must call Unicare before you mail the yellow copy) It is imperative that these forms are completed and sent to the appropriate places. Once your physician provides your medical information to Unicare you should receive your first check within 5 days. (Providing you have called and mailed the yellow copy to Unicare.) All other insurance disability information, including physician's reports, will be obtained by dialogue between your doctor and UNICARE.

Notice and proof of claim

You must provide written notice of claim to UNICARE within 20 days after you become disabled, or as soon as is reasonably possible. Proof of your injury or sickness also must be provided to UNICARE within 90 days after the end of your covered disability.

If you fail to furnish this proof within the time required, your claim will not be honored unless:

It was not reasonably possible for you to give such proof within the time required

You provide the proof as soon as reasonably possible and, in no event, except in the absence of legal capacity, later than one year from the time proof is otherwise required

Physical examination

UNICARE has the right to have you examined, at its expense, while your Accident and Sickness claim is pending or being paid. Failure to report for an examination may result in denial or termination of Accident and Sickness benefits.

Waiver of benefits

If you have one or more years of seniority, you may waive irrevocably any right to Accident and Sickness benefits for any period of disability by completing a waiver form furnished by the claims processor. Accident and Sickness benefits shall not be payable for any period of disability covered by such a waiver.

Reinstatement of Accident and Sickness benefits during layoff

Your Accident and Sickness benefits will be reinstated if you:

become wholly and continuously disabled while on a qualifying layoff as defined in the 1996 Ford-UAW Supplemental Unemployment Benefit Plan (SUB Plan) or are found to be medically disabled by the plant physician upon recall from a qualifying layoff or are certified by your physician to be unable to return to work because of disability and

are insured for Life Insurance and

are eligible for a Regular Benefit under the SUB Plan or have been employed by another employer immediately before becoming disabled.

If you wish to receive benefits, you must submit notice and proof of your claim to UNICARE within the time limits described above.

With respect to each week for which a benefit is claimed, you also must:

be unable to perform all duties of your job

be under the care of a physician (as defined in the Accident and Sickness benefits section) and

be otherwise eligible to receive a benefit under the SUB Plan or, if the 1987 SUB Plan is reinstated, have to your credit at least a Credit Unit under the 1987 SUB Plan.

If you were receiving Regular Benefits under the SUB Plan immediately before you became disabled, Accident and Sickness benefits will begin on the first day following the last day a Regular Benefit was payable to you. If you were not receiving Regular Benefits, Accident and Sickness benefits will begin on the first day of qualifying disability.

Benefits will not continue after you cease to satisfy the disability requirements. If, however, you remain on qualifying layoff under the SUB Plan, benefits are payable for remaining days in the same week (as defined in the SUB Plan) for which you do not receive a Regular Benefit.

Reinstated Accident and Sickness benefits will not be paid for any week in which:

you receive an Accident and Sickness benefit (see the "What are Accident and Sickness benefits?" section for more details) or an Extended Disability Benefit or

if the 1987 SUB Plan is reinstated, the Credit Unit Cancellation Base under the SUB Plan is below the applicable dollar amount at which a SUB benefit is payable according to your seniority.

Your Reinstated Accident and Sickness benefits will be reduced by the amount of any disability benefit you receive for the same week under a plan paid in whole or in part by another employer.

Reinstated Accident and Sickness benefits are governed by the applicable Accident and Sickness benefits provisions described earlier.

For more information concerning you Accident and Sickness benefits, consult "Your Employee Benefits" Handbook.

Local Medical Leave Procedure

Successive periods of disability

Other sources of benefits

Reinstatement of Accident and Sickness benefits during layoff

Send mail to webmaster@uawbenefits.org with questions or comments about this web site. Last modified: 06/07/2011

Send mail to webmaster@uawbenefits.org with questions or comments about this web site.
Last modified: 06/07/2011