Advocate Health Care
Benefits
Disability Benefits / Leave of Absence

 


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Social Security Disability Benefits
How Social Security disability benefits affect your payments from the plan
Your LTD benefits will be reduced by any Social Security disability benefits you receive for yourself. Your Social Security award is multiplied by 12 and the result is divided by 26 pay periods to arrive at an accurate amount for the Social Security offset.

You must apply for Social Security disability benefits immediately for your long term disability benefits to continue to be paid from Advocate. If your claim for Social Security is denied, Advocate requires you to appeal a denied request for benefits with Social Security, as follows:

Request for reconsideration—Within 60 days of the date you’re denied initial benefits, make a written request to your local Social Security office to review your case.
Administrative law judge hearing—If your request for reconsideration is denied, within 60 days of the date you’re denied reconsideration, make a written request to your local Social Security office to request an administrative law judge hearing. You may choose to seek legal representation at this point in the process.

You must provide the Disability Council with:

Evidence of your application and appeal(s) for Social Security disability benefits, and
Evidence of any denial or award letters.

If you don’t provide satisfactory proof to the Disability Council, your long term disability benefits will end. If you don’t return to work, you’ll be considered to have voluntarily resigned.

The Disability Council will start to take an estimated Social Security offset even if you haven’t begun to receive Social Security disability benefits. This will be effective at the beginning of the 12th month of total disability benefits (including the time you were covered under the Short Term Disability Plan).

If you receive an award for Social Security disability benefits after your long term disability benefits have begun, you must repay the plan the retroactive disability award from Social Security. If you don’t repay Advocate within four weeks after you receive an award, you won’t receive any future disability benefits until you repay the plan. If you participate in the medical or dental plans, you’ll assume the full cost for COBRA coverage.

If you hire an attorney to represent you in your attempts to obtain Social Security disability benefits, the plan will reduce the amount you owe Advocate by the amount of your attorney’s fees (up to $6,000) if you’re eventually granted Social Security disability benefits.

The plan won’t reduce your long term disability benefit for a cost-of-living increase if you receive a cost-of-living increase to your Social Security disability benefit after your long term disability benefit has been calculated.