Exclusions and Limitations
The STD Plan will pay no benefits for:
- War, declared or undeclared, or any act of war.
- Active participation in a riot.
- Committing or attempting to commit an indictable offense.
- Cosmetic surgery unless such surgery is in connection with an injury or sickness sustained while you are an employee of the Company.
- Any period of incarceration.
For California employees, additional exclusions include the following:
- If you are confined in an institution or other plans as a dipsomaniac, drug addict, or sexual psychopath.
- For any period of disability for which you are eligible to receive Unemployment Compensation benefits of any state.
- If you file a statement declaring your adherence to the faith or teaching of any bona fide religious organization that disclaims any disability benefit.
No benefits are payable for disabilities that are not supported by a certificate from the treating physician. The certificate must include a diagnosis and diagnostic code (if a diagnosis has not yet been obtained, the certificate must include a detailed statement of symptoms); a statement of medical facts based on the physician's examination and documented medical history; and a statement of the physician's opinion as to the expected duration of your disability. However, a certificate is not required in these specific situations:
- If you show documentation of receiving Workers' Compensation benefits for any day you are entitled to receive Unemployment Compensation Disability (UCD) benefits.
- If you have been ordered not to work by written order from a state or local health officer because you are infected with, or suspected of being infected with, a communicable disease.
- If you have been referred or recommended by competent medical authority to participate as a resident of an approved alcoholism recovery home or drug-free residential facility, and there is no other disabling condition.
- If you adhere to the teachings of any bona fide church, sect, denomination, or organization which depends for healing entirely upon prayer or spiritual means, the certificate of a duly authorized or accredited practitioner of such bona fide church, sect, denomination or organization as to the disability and the estimated duration of such disability, will be accepted.
Benefits will be limited to the California state disability insurance level of benefits (55% of gross pay, as defined by the state, up to the state maximum) for the following situations:
- Disabilities that begin during the first 15 days of an unpaid leave of absence or temporary layoff without pay (provided a definite rehire date has been given).
- If you are not totally disabled and have declined alternative employment offered by the Company that is of comparable status and compensation to your previous occupation.
- The objective medical evidence provided by the attending physician does not support the disability due to the stated diagnosis but the employee meets all other criteria for plan benefits.