COMPANY POLICY APPVION, INC. ACCIDENT & SICKNESS FOR BARGAINING UNIT HOURLY EMPLOYEES

Transcription

1 COMPANY POLICY Number: Effective Date: 01/01/1993 Revision: 03/01/2014 Approved: Kerry Arent Subject: APPVION, INC. ACCIDENT & SICKNESS FOR BARGAINING UNIT HOURLY EMPLOYEES I. PURPOSE: Appvion provides income replacement payments to disabled employees and refers to this practice as Accident and Sickness (A&S) for hourly bargaining unit employees. This document summarizes the administration and payments provided under the Appvion A&S for Bargaining Unit Hourly Employees (herein referred to as the Policy ). This document, along with the applicable location Addendums, constitutes the policy. This policy applies to all hourly employees of Appvion, Inc. who are covered under a collective bargaining agreement and who meet the eligibility requirements specified herein. The provided Addendums specify the eligibility differences between locations while your applicable Labor Agreement highlights the weekly payment rate for your location. With the exception of the negotiated Labor Agreements, this document supersedes any prior benefit plans, policies, descriptions, communications, etc., with respect to A&S provided at any location of the Company. Words that are capitalized have specific meanings. Please refer to the Defined Terms section for definitions of these words. II. III. RESPONSIBILITIES/GENERAL: This policy is not governed by the Employee Retirement Income Security Act of 1974 (ERISA). Further, Human Resources is responsible for interpretation of this policy. If you should have a dispute regarding your eligibility to receive A&S benefits, please contact your local HR representative. RELATED POLICIES/PROCEDURES: Labor Agreements 1

2 IV. POLICY: A. Summary 1. Eligible Employees All active Full-Time bargaining unit hourly Employees. An Employee s eligibility begins on the Employee s first day after having been employed Full-Time for the period specified in the applicable Addendum. 2. Waiting Period Please see the applicable Addendum. 3. Maximum Payment Period 26 weeks per period of disability Any week in which the weekly income replacement is calculated as zero (for example, if there are extenuating circumstances involving deductions from pay which result in zero A&S payment to the Employee), the week is still considered a week of income replacement under the policy for the purposes of determining the maximum payment period. A new period of disability begins once the Employee has returned to Full-Time employment for 14 consecutive days or more. 4. When Income Replacement Payments End If an Employee ceases to be an eligible Employee due to a temporary or permanent layoff while receiving payments under the Policy, payments will continue for the remainder of the Disability, up to the maximum payment period, provided the Employee meets the provisions of the Policy. B. Payments Provided Under the Policy 1. Total Disability Payments If the Employee is unable, due to Sickness or Injury, to perform each of the Main Duties of his or her Own Occupation, the Employee may be eligible for A&S. The Company will provide income replacement to the eligible Employee for each week in which the total disability continues, if the Employee: becomes Totally Disabled while employed by Appvion; at the Employee s own expense, submits at Company s request proof of continued Total Disability and Physician s care; and is under the Regular Care of a Physician. Note: The loss by an employee of a professional license, an occupational license or certification, or a driver s license for any reason, does not, by itself, constitute total disability. Duration Benefits end on the earliest of: the date the Employee ceases to be Totally Disabled or dies; or the date the maximum payment period is reached. 2

3 2. Partial Day Disability Please see the Payment Commencement Date located in your location s applicable Addendum for determining how payments are distributed. 3. Recurrent Disability Recurrent disability means a Disability caused by a Sickness or Injury which is the same as, or related to, the cause of a prior Disability for which the Employee received payments. A recurrent disability will be treated as a new period of Disability, if the Employee: has returned to his or her Own Occupation or similar position; and has worked on a Full-Time basis for 14 consecutive days or more. In this case, a new Maximum Payment Period will apply. A recurrent disability will be treated as part of the prior Disability, if the Employee: has returned to his or her Own Occupation or similar position; and has worked on a Full-Time basis for less than 14 consecutive days. In this case, since the disability is recurrent, the waiting period will not be reinstated. 4. Holiday and Vacation Pay During Disability When an Employee is receiving A&S payments and a holiday occurs, the Company will pay the holiday per the terms of the labor agreement in addition to the weekly A&S payments. Vacation may also be used to supplement A&S. Since A&S is a reduced amount of pay, Employees may use vacation time in addition to receiving A&S. Holidays and vacation days do not extend the period of Disability. See applicable labor agreement for additional details. 5. Reduction for Other Benefits For any period in which A&S payments are available for the same Disability from another source, A&S payments under this policy will be reduced by the amount of such benefit. This includes, without limitation, payments received or receivable from the following sources: a. Social Security retirement or disability received by the Employee on the basis of his/her earnings record (no reduction shall be made for family Social Security benefits based on the Employee s earnings records); such reduction shall apply as of the time the Employee first becomes eligible to receive Social Security retirement or disability benefits, irrespective of whether the employee applies for such benefits; b. payments to which the Employee is entitled for lost wages under any state Workers Compensation program or any government, federal, state or local disability program not already mentioned. In the case of government disability programs such as Social Security, state or local disability programs, or state no fault auto insurance disability programs, if the Employee is eligible for benefits, he or she is required to timely request such benefits. This means that if the Employee is eligible, he or she must promptly apply for such 3

4 benefits and if denied, must file an appeal. If the Employee fails to promptly pursue such benefits, the Company has the option to deny or suspend A&S payments under this Policy or to reduce payments by an estimated amount. If Workers Compensation or similar benefit may be payable for the same Disability, the Employee and the Company will cooperate in filing for those benefits. The Company will use proof of denial or duration of those benefits to confirm eligibility under this policy. Rarely, an Employee may have two disabilities, one work related and payable under Workers Compensation and another non-work related and eligible for payment under this A&S policy. In this circumstance, the A&S payment will be reduced by the amount of the Workers Compensation payment. The intent is that in no case will the Employee on Disability receive combined A&S payments more than the Employee would receive in wages while working Full-Time. There are no reductions for disability payments received from private disability policies in which the Employee has paid premium. 6. Reimbursement to Appvion of Payments Made The Employee will promptly repay the Company for any overpayment of A&S in the event the Employee receives payments from or on behalf of a responsible person (includes auto policies and other liability litigation), Social Security retirement or disability, Workers Compensation payments, severance payments, or any other federal, state or local disability program for the same time period (in whole or in part). The repayment will be limited to the payment amount(s) received for the losses. The Employee may withhold a reasonable amount in order to pay for any fees associated with collection. This requirement for repayment applies even if the responsible person does not admit liability or itemize the payment(s) to the Employee. If requested, the Employee must furnish to the Company copies of documents relating to the Employee s request(s) against any person(s) considered responsible for the Sickness or Injury. Amounts promised to be reimbursed to the Company may be deducted from an Employee s future payments from Appvion. C. Exclusions Payments will not be made for any period of Disability: 1. which is the result of the Employee s commission of, or attempt to commit, a crime; 2. during which the Employee was incarcerated for the commission of a crime; 3. during which the Employee is not under the Regular Care of a Physician; 4. during which the Employee is working for compensation (except as otherwise provided in the policy); 5. which is the result of war (declared or undeclared), any act incident to war, and any Sickness or Injury occurring, or arising from, service in the armed or military forces of any country; 6. which is the result of participation in a riot; or 7. which arises out of (or in the course of) any employment for wage or profit, when the Disability would be covered by Workers Compensation, any government program, or similar coverage. 4

5 D. Procedures 1. Notification As soon as an Employee becomes aware of a Disability which is expected to cause the Employee to be absent three (3) or more days, the Employee should notify the Company. In the event of an emergency, notice must be provided to the Company no later than two (2) business days after the Disability begins. Calling in sick is not considered notification for Disability. The failure of an Employee to timely notify the Company of the need for Disability may result in the denial of A&S benefits. 2. How to File a Request Once notice is received by the Company, the Company will provide the Employee with the appropriate forms to complete and return. An Employee who wishes to request A&S benefits must provide the Company with a Health Care Provider Certification completed by the treating Physician or Health Care Provider. The Health Care Provider Certification must be provided at the Employee's own expense. The Health Care Provider Certification must show the date the Disability began, and its cause and degree. Documentation must include the following: a completed statement by the treating Physician or Health Care Provider which must describe any restrictions on the performance of the duties of the Employee's job or position; a signed authorization to allow the Company to obtain more information; and any other items the Company may reasonably require in support of the request. This document must be provided to the Company s Leave Administrator no more than 15 calendar days after the Company requests the information. Failure to provide this documentation on a timely basis may result in the delay or denial of A&S benefits. Due date extensions may be available if necessary and requested in advance. In the event the certification is incomplete or contains insufficient information with which to make a request determination, the Company may request a clarification of the certification from the Employee s Health Care Provider. Any requested clarification must be completed and returned to the Company within seven (7) calendar days after the request, unless the Company agrees to an extended response date. 3. Recertification While an Employee is receiving A&S benefits, the Company may require the Employee to submit additional certifications periodically during the Disability. Recertifications of the Health Care Provider Certification may be requested, where permitted by law, every 30 calendar days (or if longer, the stated duration of the leave) unless the facts and circumstances do not appear to support the original Certification or the Company has information which casts doubt on the Employee's Disability. In such a case, a recertification of the Disability may be requested at an earlier point in time. The Company will provide notice to the Employee of any recertifications which may be required. 4. Examination After receiving the Health Care Provider Certification or recertification, the Company may require that an Employee see a Health Care Provider of the Company s choice in order to verify the information provided. The Company will pay the cost of this 5

6 examination. If the results of the second examination differ from the original certification, the Company may require a third examination, again at its expense, by a mutually agreed upon Health Care Provider. Both the Company and the Employee are obligated to cooperate in selecting a suitable Health Care Provider. The results of this third examination will be final and binding on the Employee and the Company. If the Company determines that (in its opinion) the Employee has failed to cooperate with an examiner, failed to take an exam scheduled by the Company, or postponed such an exam more than twice, then A&S benefits may be denied or suspended, until the required exam is completed. 5. Material Misrepresentation A material misrepresentation is an incomplete or untrue statement that caused the Company to provide payments to an Employee. An Employee who fraudulently submits a request under the policy is subject to discipline up to and including termination of employment. 6. Timing of Payments Income replacement will be paid after the Company receives a complete written request and all required information. Payments will be made bi-weekly as per the Company s regular payroll process and are subject to payroll taxes, deductions and garnishments. 7. Notice of Company s Decision The Company will send the Employee a written notice of its decision. If the Company denies any part of the Employee s request, a written notice will explain: a. the reason for the denial, under the terms of the policy and any internal guidelines; b. how the Employee may request a review of the Company's decision; and c. whether more information is needed to support the request. This notice will be sent within five (5) days after the Company makes a determination. If an Employee has a dispute regarding eligibility to receive payments under the policy, the Employee should contact their local human resources representative. 8. Right of Recovery If for any reason, the employee is overpaid, full reimbursement via lump sum to the Company is required within 30 days. If reimbursement is not made, the Company has the right to reduce or suspend future payments until full reimbursement is made. Such reimbursement is required whether the overpayment is due to fraud, the Company's error, or any other reason. 9. Legal Actions No legal action may be brought until the review procedure has been completed and the Company has issued a final determination. No such legal action may be brought more than three (3) years after a final determination is issued by the Company. 10. Company s Discretionary Authority The Company has the authority to manage this Policy, interpret its provisions, administer requests and resolve questions arising under it. The Company's authority includes (but is not limited to) the right to: a. establish administrative procedures, determine eligibility and resolve request questions; b. determine what information the Company reasonably requires to make such decisions; and 6

7 c. resolve all matters when review is requested. The Company assumes no obligation to continue this Policy in effect, and reserves the right at any time to terminate this Policy in whole or in part with respect to all employees, whether active or inactive. Any decision the Company makes in the exercise of its authority shall be conclusive and binding. However, this Policy remains subject to any applicable labor agreements. E. Defined Terms As used throughout the Policy, the following terms shall have the meanings indicated below. 1. ACCIDENT or INJURY means bodily Injury which results directly from an accident, independently of all other causes. In determining benefits, a Disability will be considered caused by a sickness if: a. The Disability begins more than 60 days after the Accident or Injury; or b. The Accident or Injury occurred before the Employee s effective date of coverage under this policy. The term Accident or Injury shall not include any: 1. condition to which a Sickness, its natural progression or its treatment is a substantial contributing cause (based upon the preponderance of medical evidence); 2. condition caused by emotional stress or trauma; infection (except pyogenic bacterial infection of an Injury); or medical or surgical treatment (except when needed solely for an Injury); 3. repetitive trauma condition which results from repetitious, physically traumatic activities that occur over time; or 4. pregnancy; except for complications that result from an Injury. 2. ACTIVE WORK or ACTIVELY AT WORK means an Employee s performance of all Main duties of his or her Own Occupation, for the regularly scheduled number of hours. Unless disabled on the prior workday or on the day of absence, an Employee will be considered Actively at Work on the following days: a. a Saturday, Sunday or holiday that is not a scheduled workday; b. a paid vacation day or other scheduled or unscheduled non-workday; or an approved non-medical leave of absence of 12 weeks or less, whether taken with the Company s prior approval or on an emergency basis. This includes a Military Leave or an approved Family or Medical Leave that is not due to the Employee s own health condition. 3. ADDENDUM means supplemental documents which may include waiting periods, benefit amounts or other information which is specific to a location and are attached to and made part of this Policy. 4. COMPANY means Appvion, Inc. 5. DISABILITY or DISABLED means Total Disability. (See definition of Total Disability). 7

8 6. EMPLOYEE or FULL-TIME EMPLOYEE means a person: a. who is a bargaining unit hourly Employee eligible for coverage under this Policy; b. who is regularly working the normal Full-Time schedule for his or her job classification; and c. who is not considered temporary or an independent contractor. 7. FAMILY OR MEDICAL LEAVE means an approved leave of absence that: a. is subject to the federal FMLA law (the Family and Medical Leave Act of 1993 and any amendments to it) or a similar state law; b. is taken in accordance with the Company s leave policy and the law; and c. does not exceed the period approved by the Company and required by law. Under the Federal FMLA law, such leaves are permitted for up to 12 weeks in a 12- month period. The 12 weeks may consist of consecutive or intermittent work days or may be granted on a part-time equivalency basis. If an Employee is on an FMLA leave due to his or her own health condition on the date Disability income replacement takes effect under this Policy, he or she is not considered Actively at Work. 8. HEALTH CARE PROVIDER as it applies to the Heath Care Provider Certification means the following: a. a doctor of medicine or osteopathy who is authorized to practice medicine or surgery (as appropriate) by the State in which the doctor practices; b. others capable of providing health care services to include the following: 1. podiatrists, dentists, clinical psychologists, optometrists, chiropractors (limited to treatment consisting of manual manipulation of the spine to correct a subluxation as demonstrated by x-ray to exist) authorized to practice in the state and performing within the scope of their practice as defined under state law; 2. nurse practitioners, nurse midwives and clinical social workers who are authorized to practice in the state and performing within the scope of their practice as defined under state law; and 3. Christian Science practitioners listed with the First Church of Christ, Scientist in Boston. 9. HEALTH CARE PROVIDER CERTIFICATION or CERTIFICATION means the form accepted under the Family and Medical Leave Act (FMLA) which is used to gather specific information relating to an Employee s serious health condition. This form is also used as the A&S claim form. 10. LEAVE ADMINISTRATOR means staff member within the location s human resources department who administers all leaves of absence for the location. 11. MAIN DUTIES or MATERIAL AND SUBSTANTIAL DUTIES means those job tasks that: a. are normally required to perform the Employee s Own Occupation; and b. Could not reasonably be modified or omitted. To determine whether a job task could reasonably be modified or omitted, the Company will apply the Americans with Disabilities Act s standards concerning reasonable accommodation. It will apply the Act s standards, whether or not: a. the Company is subject to the Act; or b. the Employee has requested such a job accommodation. 8

9 Should the Company choose not to modify or omit other job tasks, this does not render the Employee unable to perform the Main Duties of the job. Main Duties include those job tasks: a. as described in the U.S. Department of Labor Dictionary of Occupation Titles; and b. as performed in the general labor market and national economy. Main Duties are not limited to those specific job tasks as described in the position profile or job description. 12. MEDICALLY APPROPRIATE TREATMENT means diagnostic services, consultation, care or services that are consistent with the symptoms or diagnosis causing the Employee s Disability. Such treatment must be rendered: a. by a Physician whose license and any specialty are consistent with the disabling condition; and b. according to generally accepted, professionally recognized standards of medical practice. 13. MILITARY LEAVE means a leave of absence that: a. is subject to the federal USERRA law (the Uniformed Services Employment and Reemployment Rights Act of 1994 and any amendments to it); b. is taken in accordance with the Company s leave policy and the federal USERRA law; and c. does not exceed the period required by that law. 14. OWN OCCUPATION or REGULAR OCCUPATION means the occupation, trade or profession in which the Employee was employed with the Company prior to Disability. 15. PHYSICIAN means: a. a legally qualified medical doctor who is licensed to practice medicine, to prescribe and administer drugs, or to perform surgery; or b. any other duly licensed medical practitioner who is deemed by state law to be the same as a legally qualified medical doctor. The medical doctor or other medical practitioner must be acting within the scope of his or her license. He or she must be qualified to provide Medically Appropriate Treatment for the Employee s disabling condition. Physician does not include a relative of the Employee receiving treatment. Relatives include: a. the Employee s spouse, siblings, parents, children and grandparents; and b. his or her spouse s relatives of like degree 16. REGULAR CARE OF A PHYSICIAN means the Employee: a. personally visits a Physician, as often as medically required according to standard medical practice to effectively manage and treat his or her disabling condition; and b. receives Medically Appropriate Treatment, by a Physician whose license and any specialty are consistent with the disabling condition. 17. REGULAR OCCUPATION--See Own Occupation definition. 18. SICKNESS means illness, disease or pregnancy (childbirth, abortion, or miscarriage). 9

10 19. TOTAL DISABILITY or TOTALLY DISABLED means the Employee s inability, due to Sickness or non-work related Injury to perform each of the Main Duties of his or her Own Occupation. The loss of a professional license, an occupational license or certification, or a driver s license for any reason does not, not itself, constitute Total Disability. 20. WAITING PERIOD means the period of time an Employee must be employed in an eligible class before he or she becomes eligible to enroll for income replacement under this Policy. Employees should refer to the applicable Addendum. 21. WORKERS COMPENSATION OR SIMILAR COVERAGE means coverage under any Workers Compensation or occupational disease law. 10

11 Addendum to A&S Policy For Bargaining Unit Employees Appleton, WI Eligibility Income replacement payments begin after an Employee has been employed Full-Time for 80 consecutive calendar days (extended by periods of absence). Payment Commencement Date Payments will begin on the fourth consecutive day of Total Disability. However, if an Employee will be Disabled for ten (10) or more consecutive days, the commencement date will be the first day of Total Disability. In determining the payment commencement date for a Sickness, a day on which preadmission testing is made will be considered a day of Total Disability. The testing must be made within ten (10) days prior to a later hospital stay for which room and board charges are made and in connection with the Sickness requiring the later hospital stay. 11