11-28-2018 Council Packet - Laserfiche WebLink

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Appeal Process for a Denied Claim If the City determines that an employee is not eligible for full or partial benefits, the City Administrator will provide a written determination including the specific reason(s) for a denial and additional information or material needed for the employee to refile a claim. If the employee believes they are entitled to greater or different benefits, an appeal can be filed in writing for review by the City Council. The appeal must be filed within 14 calendar days of the initial denial notice from the City Administrator. The appeal shall state the employee’s reasons for requesting greater or different benefits and include any claim pertinent information. The City Administrator shall notify the employee, on behalf of the City Council, of the appeal decision in writing within 14 calendar days of receipt of said appeal. The City Council’s decision is final. Return to Work Employees must coordinate their return to work with their supervisor prior to the end of the STD period. An employee returning to work is expected to provide a doctor’s note releasing them to work. This note must also provide any activity restrictions and duration of these restrictions. The City reserves the right to not allow the employee to return to work if the City cannot accommodate the restrictions. Disability Extension Requests If an employee finds they are unable to return to work by the date certified by the doctor in the original claim paperwork and needs to continue receiving STD benefits (if less than allowable maximum), an employee must submit medical documentation substantiating the extension of the disability and rehabilitation for the changed timeframe. The physician must recertify that the absence from work continues to be due to the same injury or illness and provide an updated recovery and prognosis report and timeline. This information must be submitted to the City Plan Administrator prior to the original scheduled return date. The employee must also notify their supervisor of their inability to return to work prior to the scheduled return date. In order to continue to receive STD benefits, all required forms must remain in effect and unexpired for the duration of the disability. If the request is to be absent more than the 89 calendar day maximum coverage for STD, the employee should request the paperwork to file a claim for Long Term Disability (LTD) benefits.