Reso 2001-399 - Laserfiche WebLink

Home Browse Search

VOLUNTARY VOCATIONAL REHABILITATION BENEFIT PROVISION BENEFIT, If an Insured Employee is Disabled and is receiving Policy benefIts; then he or she may be eligible for a Vocational Rehabilitation BenefIt. This BenefIt consists of services which may include: 1, vocational evaluation, counseling, training or job placement; 2. job modifIcation or special equipment; and 3. other services which the Company deems reasonably necessary to help the Insured Employee return to work. The Company will determine the Insured Employee's eligibility and the amount of any BenefIt payable. ELIGIBILITY, An Insured Employee may be eligible for this BenefIt, if the Company fmds that he or she: 1. has a Disability that prevents the performance of his or her regular occupation; and, after the Own Occupation Period, also lacks the skills, training or experience needed to perform any other gainful occupation; 2. has the physical and mental abilities needed to complete a Program; and 3, is reasonably expected to return to work after completing the Program; in view of his or her-degree of motivation and the labor force demand for workers in the proposed occupation. The Company must also fmd that the cost of the proposed services is less than its expected claim liability. AMOUNT, The amount of any Vocational Rehabilitation BenefIt will not exceed the Company's expected claims liability. This benefIt will not be payable for services covered under the Insured Employee's health care plan or any other vocational rehabilitation program. Payment may be made to the provider of the services, at the Company's option. CONDITIONS, Either the Company, the Insured Employee, or his or her Physician may ftrst propose vocational rehabilitation. When a Program is approved by the Company, this Policy's defmition of "Disability" will be waived during the rehabilitation period; but it will be reapplied after the Program ends. The Company will determine the amount and duration of any Long Term Disability benefIts payable after the Program ends, LIMITATION. This Policy will not cover any period of Disability for an Insured Employee who has received a Vocational Rehabilitation BenefIt and has failed to complete the Program, without Good Cause. BFINITIONS "Good Cause", as used in this provision, means the Insured Employee's: 1. documented physical or mental impairments, which render the Insured Employee unable to take part in or complete a Program; 2, involvement in a medical program, which prevents or interferes with the Insured Employee's taking part in or completing a Program; or 3, participating in good faith in some other vocational rehabilitation program, which: (a) conflicts with taking part in or completing a Program developed by the Company; and (b) is reasonably expected to return the Insured Employee to work. "Program" means a written vocational rehabilitation program: 1. which the Company develops with input from the Insured Employee; his or her Physician; and any current or prospective employer, when appropriate; and 2. which describes the Program's goals; each party's responsibilities; and the times, dates and costs of the rehabilitation services. GL3001-L TD-17,3 98 Voluntary Rehab. 26