FAQ’s Related to Coronavirus

Written By Darin Ryburn

Written By Darin Ryburn

Published April 10, 2020

CALIFORNIA LAW ENFORCEMENT ASSOCIATION
FREQUENTLY ASKED QUESTIONS

The Trustees (the “Trustees”) of the California Law Enforcement Association (“CLEA”) Safety & Non-Safety Personnel Trust (the “Trust”) have prepared the following responses to some frequently asked questions regarding the California Law Enforcement Association Long Term Disability Plans (the “Plans”) and the COVID-19 (“Coronavirus”) outbreak in California and throughout the world (“FAQ’s”).

These FAQ’s are intended for the members of the Plans and their families. Additional information regarding the Plans is available from the Plan Administrator, California Public Safety Administrators, Inc. by telephone at 1 (800) 832-7333 or by email at mail@clea.org. Information is also available for Members of the National Peace Officers and Firefighters Benefits Trust (“LTC Trust”) Long Term Care Plan (“LTC Plan”) from the office of the Plan Administrator. Please contact the Plan Administrator if you have any questions regarding the maters summarized below.

CLEA is committed to providing ongoing and timely assistance for each of the Plan Members and their families and has provided these FAQ’s to help understand the Plan. Many unknowns remain, but CLEA and the Plan Administrator are taking many actions to continue to provide a high level of service for the Members and their families.

Is a Member eligible to receive Plan benefits if the Member contracts the Coronavirus?

If the infection results in a long term disability as defined in the Plan or in death the Member (or the Member’s beneficiary) will be eligible for Plan Benefits. If a Plan Member contracts the Coronavirus and the disease causes the Member to be totally disabled under the Plan, the Member generally will be eligible to receive benefits. (A total disability is defined in the Plans as the inability to perform the material duties of the Member’s own occupation, including, any available alternative, modified or light duty employment for his or her Employer.) However, the Member must first satisfy the elimination period (a minimum of 30 days) before receiving benefits, during which the Member typically will use available personal leave time.

If the Member dies as a result of the Coronavirus, the Member’s designated beneficiary will be eligible for the Plan death benefit and his or her eligible dependent survivors may be entitled to a survivor benefit of six months continuing disability income payments. Each Member should verify that his or her beneficiary designation is current and updated to ensure that any death benefits are paid to the correct person. This can be done by contacting the Plan Administrator or by submitting a modification or as provided at the CLEA web site (clea.org).

CLEA will review every claim based on the Plan language and the unique facts of the Member’s situation, including factors such as the diagnosis and medical certification and the progress of the virus/condition.

Will the current governmental orders and directives delay the ability of CLEA or the Plan Administrator to pay or process a Member’s claim to CLEA?

CLEA is prepared to continue its operations throughout this and any pandemic. The Plan Administrator has in place a continuity plan and has established processes to safeguard its continued operations. It has a call and claim center in the Central California area that remains fully operational. The system is capable of managing a high number of calls and emails per day and this system has been employed with minimum disruption for previous natural disasters such as wildfires, earthquakes, major power outages and other disasters.

What happens if staff members of the Plan Administrator are required to work from home or are unavailable?

The Plan Administrator has systems capability and flexibility, with options to further expand these capabilities as warranted, to allow its staff to work from home. Depending on the situation, the Plan Administrator and Trustees will evaluate other actions to allow uninterrupted service.

If a Member is advised not to work due to being at high risk of infection, will the Member be considered disabled?

No, a restriction on a Member’s performance of material work duties due to preventative or precautionary measures, such as medical advice not to go to work because of a heightened risk of becoming infected with Coronavirus, does not establish a disability for which Plan Benefits are payable.  

Is a Member considered disabled if he/she is placed under quarantine related to the Coronavirus?

It depends on the nature of the Member’s condition. In order to be eligible to receive Plan benefits, the Member must be totally disabled from performing his/her own law enforcement occupation as a result of the infection. Simply being quarantined does not establish that a Member has a total disability or that he or she is eligible for Plan benefits.

If a Member is placed on forced quarantine and not disabled, will the Member remain covered under the Plan?

Yes, as long as the dues payments to the Plan continue on behalf of the Member and the Member remains employed by his or her qualifying employer, the Member will remain covered under the terms of the Plan for a disability or death occurring during the forced quarantine period. The normal terms and conditions of coverage under the Plan will apply. Once the forced quarantine period ends, the Member must return to active service in his or her qualifying law enforcement job to continue coverage under the Plan.

What if a Member can medically return to work and does not wish to return?

Under the Plans, benefits are paid only when a member is totally disabled from his/her occupation. If an employee is medically able to work the Member will not remain eligible to receive Plan benefits.

If a Member’s salary is adjusted because of the Coronavirus situation, does this impact benefit levels?

It may. Disability benefit levels are generally based on the Member’s base monthly earnings (as defined in the Plan). This amount is determined by the rate of pay in effect as of the last day of the applicable waiting period, or for Members with an industrial disability, the rate of pay in effect as of the last day for which the Member receives compensation under California Labor Code section 4800 or 4850. However, for Members who retire and receive pension benefits under the California Public Employees’ Retirement System or another city or county retirement system for public employees, base monthly earnings is the unmodified pension allowance used for the Member’s wage calculation as applied by the applicable public retirement system. Base monthly earnings includes the Member’s base pay plus any holiday pay, educational incentive pay, or other specialty assignment pay, shift differential pay, clothing allowance pay, longevity pay and hazardous duty compensation, but does not include any bonuses, overtime pay, or other extra compensation not listed.

What is required to submit a disability claim based on an incidence of Coronavirus?

A Member, beneficiary, survivor or representative may initiate a disability claim by contacting the Plan Administrator, by telephone or in writing, and submitting a completed claim form together with proof of disability to the Plan Administrator. The claimant must also complete all other documents required under the Plan in connection with the claimant’s claim, including an acknowledgement form, all necessary Workers’ Compensation lien forms, and third party lien forms, and provide to the Plan Administrator other documents requested by the Plan Administrator in connection with such claim. The claimant must submit the completed claim form and proof of disability to the Plan Administrator within 12 months after the disability occurs.

Should the Member apply for benefits under any applicable Workers’ Compensation provisions, SDI, FMLA, and other state disability and paid family medical leave plans?

The Member must apply for any applicable Workers’ Compensation benefits, medical leave benefits, disability benefits and other offsetting benefits described in the Plan document. On March 18, 2020 President Trump signed the Families First Coronavirus Response Act into law, expanding leave and paid leave benefits for Americans. Several states have proposed, and some have begun to pass, additional legislation to support workers within those specific states. Members are required to seek other offsetting benefits if eligible.

What if the Member is not certain if he or she should file a disability claim with CLEA?

The Plans require that a Member be disabled from his/her occupation as a law enforcement employee. It is important that the Member check the applicable Plan to determine if he or she is eligible for disability benefits. If the Member believes that the he or she meets the requirements for benefit payments, the Member should contact the Plan Administrator to discuss eligibility and to submit a disability claim if appropriate.

If the Plan Administrator determines that a Member is not eligible for disability benefits, can the Member file an appeal?

If the Plan Administrator determines that a Member is not eligible for Plan benefit payments in accordance with the applicable Plan provisions, the Member, his or her beneficiary or representative may appeal the denial by filing a written request to the Trustees within one hundred and eighty (180) days following the denial. The appeal will be determined by the Trustees, all of whom are current or former law enforcement personnel.

THE ABOVE INFORMATION SUMMARIZES PLAN INFORMATION AS IN EFFECT AS OF THE DATE SET FORTH ABOVE AND IS SUBJECT IN ALL RESPECTS TO THE TERMS OF THE APPLICABLE PLAN DOCUMENT. CERTAIN EXCEPTIONS AND LIMITATIONS SET FORTH IN THE PLAN DOCUMENT MAY APPLY. WE BELIEVE THE INFORMATION IS ACCURATE AS OF THE DATE SHOWN ABOVE, BUT IT IS NOT INTENDED AS AN ADDITION OR MODIFICATION TO ANY PLAN LANGUAGE, AND IS NOT INTENDED AS LEGAL ADVICE. FOR A COMPLETE DESCRIPTION OF THE TERMS AND CONDITIONS OF THE APPLICABLE PLAN, YOU SHOULD REVIEW THE PLAN DOCUMENT, WHICH IS AVAILABLE ON REQUEST FROM THE ADMINISTRATOR.

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