613.5 APPLICATION AND APPROVAL PROCESS

An employee who is out of work due to a Disability should file a disability claim by entering an application for leave in the University’s Workday on-line system:

• Go to Workday "Time Off and Leave" application,
• Click on "Request Leave of Absence,"
• Enter the "First Day of Leave" and the "Estimated Last Day of Leave,"
• Click on Leave Type "FMLA" and
• The employee will then be directed to download the appropriate forms from the Requesting a Leave of Absence webpage.  
  
  Please note that the employee's leave request is not complete until the employee provides the FMLA Administrator with the required information, including an updated Physician Certification Form.

The employee must have the employee’s physician complete a Physician Certification Form and submit the form to the FMLA Administrator within 20 calendar days of the leave request. A delay in the return of the completed Physician Certification form may cause a delay in the payment of STD benefits. 

On the basis of information received, the FMLA Administrator will determine in a timely manner whether the employee’s health condition constitutes a Disability that may entitle the employee to STD benefits (provided all other requirements in this policy are met).   If such condition exists and all requirements are met, the FMLA Administrator will provide the effective date of the disability (“Disability Date”) and pay any retroactive short-term disability benefits that are due. FML (“Family Medical Leave”) will run concurrently with any STD benefits to which the employee is determined to be entitled but since FML is unpaid, will not result in any additional benefits.

The FMLA Administrator may require that the employee undergo an independent medical examination by a health care provider designated by the FMLA Administrator and/or undergo specified medical testing in order to qualify for commencement or continuation of payments under this policy, and/or to provide additional medical information.

613.6 USAGE

Combined sick and STD benefits paid under this policy are limited to 132 consecutive work days (equivalent to 26 weeks) in a rolling 12 month period, measured from the employee's Disability Date.  Holidays or special winter break periods which may occur during a period of STD are not added to the STD period.

Medical leave resulting from pregnancy shall entitle employees to STD benefits for up to eight (8) weeks, or the length of time determined to be medically necessary as certified by the employee's physician.

Any leave taken on account of Disability will run concurrently with leave periods permitted under Policy 631 (Family and Medical Leave), subject to the terms of such Policy.

STD benefits are only payable when an employee has a Disability as certified by a Physician and the employee is receiving Appropriate Care, as determined by the FMLA Administrator. STD cannot be used for an intermittent leave or to care for a family member.

An employee is not eligible for holidays or special employee-wide vacation periods (such as winter break) which may occur while the employee is receiving short-term disability payments.

Employees approved for STD benefits are prohibited from working at the workplace or at any other location, including the employee's home, either for the University or otherwise. Under no circumstances may an employee receiving STD benefits be working for another employer.  A physician's statement certifying the employee’s fitness to return to work must be provided to the FMLA Administrator before the employee’s return to work.

613.7 JOB SECURITY

Normally employees returning from STD leave will be reinstated to the same or an equivalent position, with equivalent pay, benefits and other terms and conditions of employment. Failure to return to work without qualifying for STD (or another type of permissible leave) may result in termination of employment. At times, departments, schools and/or centers may restructure due to changing business and operational needs and the need to continually enhance programs and services. These restructuring initiatives may result in position discontinuations and employment terminations, even positions held by employees on STD leave.  In such an event, employees on STD leave will be informed of any applicable benefits they may be eligible to receive under the Position Discontinuation and Staff Transition Program (See Policy 628).

An employee who must be absent longer than the maximum number of weeks allowed under the STD policy may apply for an accommodation under the Americans With Disabilities Act or a leave of absence without pay under Policy 616 (Leave of Absence without Pay) or Policy 631 (FMLA).  If a medical leave is expected to last longer than six (6) months, and the employee continues to have a Disability, the employee should also apply for long-term disability benefits under Policy 405.

613.8 DEFINITIONS

Many terms used in this STD Policy have special meaning. A list of these terms and their meanings are as follows:

Appropriate Care – Appropriate care and treatment means medical care and treatment that meet all of the following: it is received from a physician whose expertise, medical training and clinical experience are suitable for treating the employee’s injury or sickness; it is medically necessary; it is consistent in type, frequency and duration of treatment with relevant guidelines based on national medical research or published by health care organizations and government agencies; it is consistent with the diagnosis of the employee’s  condition; and, its purpose is to improve the employee’s  medical condition and thereby aid in the employee’s ability to return to work.

Base Salary - The employee’s base salary immediately prior to the date the employee’s Disability began. It does not include commissions, bonuses, overtime pay, shift differential, stipends or other extra compensation.  For faculty members, base salary only includes salary for the academic year.

Disability – A continuous, serious, incapacitating health condition resulting in the employee's being unable to perform the employee’s job duties caused by an illness, injury, impairment, or physical or mental condition involving:  a) inpatient care in a hospital, hospice or residential medical care facility, b) appropriate and continuing treatment by a physician, or c) pregnancy. In order for an employee to be considered to have a Disability, the employee’s disabling health condition must be certified by a physician and approved by the FMLA Administrator.

Maximum Benefit Period – 132 consecutive days (including the use of available sick time).

Physician - any of the following licensed practitioners: a doctor of medicine (MD), osteopathy (DO), podiatry (DPM) or chiropractic (DC); a licensed doctoral clinical psychologist; or where required by law, any other licensed practitioner who is acting within the scope of their license. A physician does not include the employee, a person who lives with the employee or is a part of the employee’s family (the employee’s spouse, a child, brother, sister or parent of the employee or the employee’s spouse or any persons related to any of them by marriage).

613.9 EXCLUSIONS AND OFFSETS

The STD Policy will not cover any Disability due to cosmetic surgery unless such surgery is in connection with an injury or sickness sustained while the individual is eligible for this policy.  Further, any third-party payments attributable to wage loss during the period of STD eligibility (such as Workers’ Compensation payments received from an insurance company for occupational sickness or injury) shall be offset from any STD payments otherwise due.

613.10 CLAIMS PROCESS

The FMLA Administrator will provide the employee with notice of its STD claim decision no later than 10 business days after the FMLA Administrator receives the Physician Certification.  This time period may be extended by an additional 10 business days if the FMLA Administrator determines that such an extension is necessary. The FMLA Administrator will notify the employee of circumstances requiring the extension of time and the date by which the FMLA Administrator expects to render a decision. If such an extension is necessary due to the employee’s failure to submit the information necessary to decide the claim, the notice of extension will specifically describe the required information the employee needs to provide and the employee will be afforded at least five (5) days from receipt of the notice within which to provide the specified information. If the employee delivers the requested information within the time specified, any extension period will begin after the employee has provided that information. If the employee fails to deliver the requested information within the time specified, the FMLA Administrator may decide the claim without that information.

The employee will have 45 days from the receipt of notice of an adverse benefit determination to file an appeal. The employee may file a written request for appeal of an adverse benefits determination with the FMLA Administrator.

The FMLA Administrator

3451 Walnut Street, 6th Floor

Philadelphia, PA 19104-6205

A decision on any appeal will be made by the FMLA Administrator not later than 30 days following receipt of the written request for appeal. If the FMLA Administrator determines that circumstances require an extension of time for a decision on review, the review period may be extended by an additional 30 days (sixty (60) days in total). The claims administrator will notify the employee in writing if an extension is needed.

If extension is necessary due to the employee’s failure to submit the information necessary to decide the appeal, the notice of extension will specifically describe the required information. If the employee delivers the requested information within the time specified, the extension of the appeal period will begin after the employee has provided that information. If the employee fails to deliver the requested information within the time specified, the FMLA Administrator may decide the appeal without that information.

The employee will have the opportunity to submit written comments, documents or other information in support of the employee’s appeal. The employee will have access to all relevant documents. The review of the adverse benefit determination will take into account all new information, whether or not presented or available at the initial determination. No deference will be afforded to the initial determination.

In the case of an appeal based on medical diagnosis or medical determination, the FMLA Administrator will conduct the appeal review, after consulting with such medical professionals as the FMLA Administrator deems necessary, and will communicate the final appeal decision to the employee.  In the case of an appeal based on any other reason (such as eligibility, calculation of benefit or offset), the FMLA Administrator will conduct the appeal review, after consulting with such legal or Human Resources professionals as the FMLA Administrator deems necessary (which may include professionals employed with the University), and will communicate the final appeal to the employee. The employee also may file a second appeal directly to the University of any denial of appeal based on grounds other than medical diagnosis or medical determination.

This administrative appeal process (including the second appeal to the University for appeals based on non-medically based grounds) must generally be completed and exhausted before the employee can begin any legal action regarding the employee’s claim. Any legal action regarding the employee’s claim must be brought within 60 days of the date this administrative appeal process is completed.  Except as otherwise required by applicable law, if the employee does not bring a legal action during this period, the employee forever waives the right to bring a legal action regarding the employee’s claim.

613.11 LEGAL PROVISIONS

The Short-Term Disability Policy is a payroll practice funded entirely by the assets of the University, not by insurance and is not subject to the terms of the Employee Retirement Security Income Act (“ERISA”).

613.12 STAFF WORKING IN OTHER JURISDICTIONS

The benefits and policies for University of Pennsylvania staff members who work in locations outside of the Commonwealth of Pennsylvania may be different from the benefits and policies set forth in this policy.  Staff members working outside the Commonwealth of Pennsylvania should contact Human Resources for more information.

613.13 EMPLOYEE ASSISTANCE PROGRAM (EAP)

Dealing with issues that qualify for Short-Term Disability can be challenging.  Returning to work following a Disability leave can be stressful. For these and other matters, the University offers the Employee Assistance Program (EAP) for free, confidential, one-to-one support at any time. EAP counselors can be reached 24 hours a day, 7 days a week (1-866-799-2329) to help you manage the issues at hand and prepare for a successful return to the workplace. Additional useful information may also be found on the EAP website.

Policy Number: 613 
Effective Date: 10/24/2016
Last Reviewed Date: 06/13/2019
Revised Date: 07/01/2019
Supersedes Policy Number(s):  613 (06/01/1998, 01/12/1999, 08/18/2004, 04/01/2009, 01/19/2012, 3/5/2013, 05/13/2015, 07/01/2015)
Applicability: Full-time faculty, full-time academic support staff (as defined in the Faculty Handbook, II.B.4) and regular full-time staff members who are granted up-front sick leave.
Cross-reference: Short-Term Disability - Policy 404, Long-Term Disability - Policy 405, Attendance - Policy 603, Paid Time Off - Policy 607, Termination - Policy 629, Family and Medical Leave Act - Policy 631

Policy Manual Disclaimer