D. Long-Term / Short Term / Disability and Life Insurance

Life / Disability Insurance

No one likes to be sick or hurt in an accident. But you may face that at some time in your life. When either happens it could mean absence from work for a little while, or a long time. For many people that could spell financial disaster. Due to this, after your 30-day probation period, Northeast Data offers each full-time employee the company paid Life, STD, LTD, and Accidental Death / Dismemberment Policy.

The Life, STD, LTD, and Accidental Death and Dismemberment Insurance Package and Short Term / Long Term disability is a valued part of your employee package. With enrollment in this life insurance you will receive three booklets explaining detailed coverage of both programs. This program coverage is not for compensation of work related injuries. (Please refer to the Workers Compensation Policy for more information on work related injuries.)

Workers Comp

Employees on short term disability will be covered for up to 12-weeks (90 days) premium on the life insurance / short -long term insurance and dismemberment policy. After the 12-weeks are completed a waiver will be filed with the insurance company for the premium to be waived for payment by Northeast Data. An employee enrolling into the long term disability will be given the option to roll their plan into a conversion plan. Once short-long term disability is discontinued and the employee has returned to work, the employee will be offered to re-enroll into the company provided benefit.

Disabilities Excluded from Coverage

1. War
• You are not covered for a Disability caused or contributed to by War or any act of War. War means declared or undeclared war, whether civil or international, and any substantial armed conflict between organized forces of a military nature
2. Intentionally Self – Inflicted Injury
• You are not covered for a Disability caused or contributed to by any intentionally self-inflicted Injury, while sane or insane.
3. Work Related
• You are not covered for a Disability arising out of or in the course of any employment for wage or profit.
4. Violent or Criminal Conduct
• You are not covered for a Disability caused or contributed to by your committing or attempting to commit an assault or felony, or actively participating in a violent disorder or riot. Actively participating does not include being at the scene of a violent disorder or riot while performing your official duties.
5. Loss of License or Certification
• You are not covered for a Disability caused or contributed to by the loss of your professional license, occupational license or certification.

How do you file a claim?

Claims need to be completed on a “Principal Insurance” claim form. You must contact the Northeast Data office as soon as possible to have the form complete by the employer. If you do not receive the completed form within 15 days after you ask for them, you may submit your claim in a letter to the “Principal Insurance”. The letter should include the date Disability began, and the cause and nature of the Disability.

When calling into the office with your claim information you must notify the Operations Department of the following information:

1. Employee Name
2. Social Security Number
3. Home Phone Number
4. Date of Birth
5. Sex
6. Home address
7. What is your Disability
8. Last date of active work and how many hours worked on your last day of active work
9. Date you became disabled
10. Date you expect to return

If submitting disability for pregnancy

1. Expected Date of Delivery
2. Actual Date of Delivery
3. Type of Delivery: Vaginal or C-section

Time Limits on Filing Proof of Loss

You must give “The Principal Insurance” Proof of Loss within 90 days after the end of the Benefit Waiting Period. IF you cannot do so, you must give it to them as soon as reasonably possible, but no later than one year after that 90-day period. If Proof of Loss is filed outside these time limits, your claim will be denied. These limits will not apply while you lack legal capacity. Employees must complete the employee portion of the form and submit to Principal Financial. Your physician must also complete the physician statement.

Proof of Loss

Proof of Loss means written proof that you are Disabled and entitled to benefits. Proof of Loss must be provided at your expense.

For claims of Disability due to conditions other than Mental Disorders, “The Principal Insurance” may require proof of physical impairment that results from anatomical or physiological abnormalities, which are demonstrable by medically acceptable clinical and laboratory diagnostic techniques.

Documentation

Completed claims statements, a signed authorization for “The Principal Insurance” to obtain information, and any other items are required in support of a claim and must be submitted at your expense. If the required documentation is not provided within 45 days after they mail they mail the request, your claim may be denied.

Investigation of Claim

“The Principal Insurance” may investigate your claim at any time.

At their expense, they may have you examined at reasonable intervals by specialists of their choice. They may deny or suspend Benefits if you fail to attend an examination or cooperate with the examiner.

Time of Payment

“The Principal Insurance” will pay Benefits within 60 days after you satisfy Proof of Loss.

Benefits will be paid to you at the end of each week you qualify for them. Benefits remaining unpaid at your death will be paid to your estate.

Notice of Decisions On Claims

“The Principal Insurance” will evaluate your claim promptly after you file it. Within 45 days after they receive you claim they will send you:

1. A written decision on your claim
2. A notice that they are extending the period to decide you claims, for an additional 90 days. If an extension is due to your failure to provide information necessary to decide the claim, the extended time period for deciding your claim will not begin until you provide the information or otherwise respond.

If they extend the period to decide your claim, they will notify you of the following:

1. The reasons for the extension
2. When they expect to decide your claim
3. An explanation of the standards on which entitlement to benefits is based
4. The unresolved issues preventing a decision
5. Any additional information they need to resolve those issues

If they request additional information, you will have 45 days to provide the information. If you do not provide the requested information within 45 days, they may decide your claim based on the information they have received.

If they deny any part of your claim, you will receive a written notice of denial containing:

1. The reasons for their decision
2. Reference to the Parts of the Group Policy on which their decision is based
3. Reference to any internal rule or guideline relied upon in making their decision
4. A description of any additional information needed to support your claim
5. Information concerning your right to review their decision
6. Information concerning your right to bring a civil action for benefits under section 502(a) of ERISA if your claim is denied on review.

Review procedure

If all or part of a claim is denied, you may request a review. You must request a review in writing within 180 days after receiving a notice of the denial.

You may send us written comments or other items to support your claim. You may review and receive copies of any non-privileged information that is relevant to your request for review. There will be no charge for such copies. You may request the names of medical or vocational experts who provided advice to us about your claim.

The person conducting the review will be someone other than the person who denied the claim and will not be subordinate to that person. The person conducting the review will not give deference to the initial denial decision. If the denial was based on a medical judgment, the person conducting the review will consult with a qualified health care professional. This health care professional will be someone other than the person who made the original medical judgment and will not be subordinate to that person. Their review will include any written comments or other items you submit to support your claim.

“The Principal Insurance” will review your claim promptly after they receive your request. Within 45 days after they receive your request for review they will send you:

1. A written decision of the review
2. A notice that they are extending the review period for 45 days. If the extension is due to your failure to provide necessary information to decide the claim on review, the extended time period for review of your claim will not begin until you provide the information or otherwise respond.

If “The Principal Insurance” extend the review period, they will notify you of the following:

1. The reasons for the extension
2. When they expect to decide your claim on review
3. Any additional information they need to decide your claim.

If “The Principal Insurance” request additional information, you will have 45 days to provide the information. IF you do not provide the requested information within 45 days, they may conclude their review of your claim based on the information they have received.

If “The Principal Insurance” deny any part of your claim o review, you will receive a written notice of denial containing:

1. The reasons for their decision
2. Reference to the parts of the Group Policy on which their decision is based
3. Reference to any internal rule or guideline relied upon in making their decision
4. Information concerning your right to receive, free of charge, copies of non-privileged documents and records relevant to your claim.
5. Information concerning your right to bring a civil action for benefits under section 502(a) of ERISA.

The Group Policy does not provide voluntary alternative dispute resolution options. However, you may contact your local US Department of Labor Office and your State insurance regulatory agency for assistance.

Assignment

The rights and benefits under the Group Policy are not assignable.

If you should leave employment at Northeast Data, your Life and Accidental Death and Dismemberment Insurance Package will be terminated effective your last date of hire.

Returning To Work

An employee who is out on Short Term or Long Term Disability is required to communicate to your immediate manager your expected date of return to work. Upon returning to work, the employee must complete a return to work form on the below link.

The Office will process any additional forms required for your return. The operations department will notify you of additional forms and customer checks (background check and drug testing) that will be needed prior to returning to work. Please complete the return to work form at least 1-week prior to returning to work. If you have submitted your return to work information and have not heard from a representative regarding your next step, please contact our HR department at 1-800-435-3816.

Termination

If you should be separated or terminate employment with Northeast Data, this benefit will be discontinued effective your last day of employment. Any and all questions after separation/termination may be discussed at the following office:

Principal Insurance

1-860-547-5000