Short Term Disability Benefits
If you are working at a full-time job while coverage is in force and a covered sickness or covered off-the-job injury causes you to become totally disabled, we will pay you one-thirtieth of the benefit you selected for each day you remain totally disabled. A full-time job is defined as a job at which you work 19 hours or more per week. If you are not working at a full-time job while coverage is in force and you are unable to perform two or more ADLs (activities of daily living) resulting from a covered sickness are accident, as certified by a physician, and you require direct personal assistance to perform such ADLs, we will pay you one-thirtieth of the benefit you selected for each day you remain totally disabled.
Provisions of Coverage
Benefits will be paid for only one disability at a time, even if the disability is caused by more than one sickness, injury, or a sickness and an injury.
AFLAC reserves the reasonable right to meet with you during the pendency of a claim or to use an independent consultant and a physician’s statement to determine whether you are totally disabled, or whether you are unable to perform two or more ADLs and require direct personal assistance.
You must be under the care and attendance of a physician for benefits to be payable. Benefits will cease on the date of your death.
If you have any other disability benefit in force with AFLAC, only one disability benefit is payable under the policy.
Totally disabled is defined as your continuing inability to perform the material and substantial duties of your full-time job. You must also be under the care and attendance of a physician for your condition. If you are unable to perform the material and substantial duties of you full-time job but are able to work at any job, you will continue to be considered totally disabled as long as your earnings are less than 80 percent of your base pay earnings at the time you became totally disabled. If you return to work at any job and are earning 80 percent or more of your pre-disability base pay earnings, you will no longer be considered totally disabled.
Base pay earnings are your gross salary or wages for your full-time job, not including variable pay such as overtime (unless contractual), bonuses, or other incentives. If you are self-employed, base the allowable business deductions from that business. (For tax purposes, base pay earnings is referred to as net earnings.)
Successive periods of disability resulting from the same or a related condition, and not separated by 180 days or more, are considered a continuation of the prior disability. Separate periods of disability resulting from unrelated causes are considered a continuation of the prior disability unless they are separated by your returning to work at a full-time job for 14 working days, during which you are performing the material and substantial duties of this job and are no longer qualified to receive disability benefits.
Activities of Daily Living
- Continence: maintaining control of urination and bowel movements, including your ability to use ostomy supplies or other devices such as catheters
- Transferring: moving between a bed and chair, or bed and a wheelchair
- Dressing: putting on and taking off all necessary items of clothing, and/or medically necessary braces and artificial limbs usually worn
- Toileting: getting to and from a toilet, getting on and off a toilet, and performing associated personal hygiene
- Eating: performing all major tasks of getting food into the body
The effective date of the policy is the date shown in the Policy Schedule, not the date the application is signed.