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Policy Coverages

Methods of Providing Benefits
Your employer may adopt one or more of the following methods of providing TDI benefits: 1. by purchasing insurance from a licensed insurance carrier, called an "insured" plan, 2. by adopting a sick leave policy which must be approved by the TDI office called a "self-insured" plan, 3. by a collective bargaining agreement which contains sick leave benefits at least as favorable as required by the TDI law.

All plans must be submitted to the TDI office for review and approval before they can be put into effect. The benefits provided by your employer's plan will fall in one of the following categories: 1. Statutory benefits, meaning benefits which follow the minimum standards set by law. 2. Equivalent benefits, meaning benefits "as favorable as" statutory benefits, as determined by the TDI office. 3. Better-than-equivalent benefits, meaning benefits that are superior to statutory benefits.

Who Pays for the Cost Providing Benefits?
The cost of providing TDI benefits may be financed in one of two ways: 1. Your employer may pay for the entire cost. 2. Your employer may require you to share in the cost, in which case your employer may deduct one-half the premium cost but not more than 0.5% of your weekly taxable wages up to the maximum set annually by the Division. If your employer deducts more than what the law prescribes, notify the TDI office immediately.

How Much Benefits Are You Entitled To?
Your employer's plan determines how much benefits you will receive each week, how long you will be paid and whether you have to serve a waiting period. 1. If you employer has a statutory plan; you are entitled to: a. cash benefits up to 58% of your average weekly wages rounded to the next higher dollar, but not more than the maximum weekly benefit amount annually set by the DC Division. The maximum weekly benefit for 2001 is $384.00 b. benefits from the eighth day of disability. c. a maximum of 26 weeks of payments during a benefit year. 2. If your employer has a sick leave plan which differs from statutory benefits but which has been approved by the TDI office as an equivalent or better-than-equivalent plan, your weekly benefit amount, duration of payments, and whether or not a waiting period is required will be determined by the plan.


Coverages
Any worker who meets the eligibility requirements, whether hired on a part-time, intermittent, or full-time basis must be provided TDI coverage by his/her employer. However, if the employee fails to meet the eligibility requirements under the law, the employer is not required to provide coverage. Excluded from coverage are employees of the federal government, certain domestic workers, insurance agents paid solely on a commission basis, individuals under 18 years of age in the delivery or distribution of newspapers, family employees, student nurses, interns and workers in other categories specifically exempted by law.


What are the Eligibility Requirements?
You must have been in employment at least 14 weeks during each of which you were paid for 20 hours or more and earned not less than $400 in the four completed calendar quarters preceding the first day of disability. The 14 weeks need not be consecutive nor with only one employer.

Other Requirements that must be Met

• Your injury or illness is not work related; not caused by your job.
• Your injury or illness prevents you from performing your regular work.
• Your disability is certified by a licensed physician, surgeon, dentist, chiropractor, osteopath, naturopath, or an accredited practitioner of a faith-healing group.
• You were employed immediately before the date you suffered your injury or illness, or if you were separated from your job, your disability occurred within two weeks from your separation date.

• You performed work for pay during your disabled period.
• You were denied unemployment insurance benefits because of a work stoppage due to a labor dispute.
• Your injury was self-inflicted willfully and intentionally or it was received while committing a criminal offense.
• You received or will receive unemployment insurance, workers' compensation or federal disability benefits.