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Long Term Disability

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LETTER OF EXPLANATION and REIMBURSEMENT AGREEMENT The County of San Mateo’s Long Term Disability plan (LTD) is designed to provide you with income while disabled, and more importantly, to provide you with benefits while your applications(s) for other benefits is pending. Examples of other benefits would include, but not be limited to: State Disability Insurance (SDI) or short term disability coverage Social Security income Social Security Disability Income (SSDI) for claimant &/or dependent(s) Retirement-regular service, non-service connected disability, or service connected disability Workers’ Compensation payments – temporary, permanent disability, vocational rehabilitation, and any settlement monies Catastrophic leave monies You should be aware that any other income benefit you receive during your eligibility for LTD will be subtracted from your monthly LTD payment. You must notify Risk Management, the LTD plan administrator, if you begin receiving any other income from any source. LTD benefits may be paid to you at the full rate for which you are eligible while you await payment of other benefits. In order to receive the full benefit rate to which you are eligible, you will need to sign and return the enclosed Reimbursement Agreement otherwise, at the County’s discretion, benefits will be paid at either the $50.00 minimum payment or the estimated amount payable after other income offsets have been taken. Often, a retroactive payment of Social Security or Retirement benefits, or other income received during the same period you are receiving LTD benefits, such as Workers’ compensation settlement, will result in an overpayment to you of Long Term Disability benefits. This overpayment must be reimbursed to the LTD administrator immediately upon receipt of the funds from the other source. Therefore, we recommend that you do not use or disperse any part of such payments until you have contacted the County of San Mateo Risk Management Division, the LTD administrator, at (650) 363-4611 to be sure no monies are due to the County. Risk Management will work with you to keep you informed about your LTD benefits and potential overpayments, so that you will be aware of an estimated amount due in advance of your receiving payments from other income sources. Again, failure to sign the Letter of Explanation and Reimbursement Agreement will result in a reduction of the benefit amount paid. LTD Authorization Form LTD Claim Form LTD Physician's Statement Form LTD Physical Capabilities Form LTD Occupational Demands Form LTD Employee Statement LTD Claim and Physician's Statement