[HISTORY: Adopted by the Mayor and Council of the Borough of Netcong
as indicated in article histories. Amendments noted where applicable.]
[The currently effective Salary Ordinance of the Borough
of Netcong is on file in the office of the Borough Clerk and is available
for examination during office hours.]
[Adopted 10-14-1986]
Temporary disability benefits are provided for all eligible employees
during periods of nonoccupational disability in accordance with the provisions
of this article.
As used in this article, the following terms shall have the meanings
indicated:
The amount derived by dividing a covered individual's total wages
earned during the base weeks in the eight calendar weeks immediately preceding
the calendar week in which disability commenced by the number of such base
weeks.
Any calendar week during which an insured employee earned not less
than 15% of the state-wide average weekly wage.
That period during which the employee, because of nonoccupational
bodily injury, mental or physical illness, is prevented from engaging in his
regular occupation.
February 24, 1986.
A person who is employed by the Borough of Netcong.
A person who is an employee.
Includes all periods of disability due to the same or related cause
or causes except periods of disability separated by more than three consecutive
months during which the individual was not disabled.
Includes a currently licensed dentist, optometrist, podiatrist or
chiropractor.
All earnings payable by the borough to covered employees for services.
It includes commissions, bonuses and the cash value of all earnings payable
in any form other than cash.
A.Â
Individuals eligible for benefits hereunder are all of
the employees who work for the Borough of Netcong at least 20 hours a week
on a regular basis.
B.Â
Each such employee employed by the borough on the effective
date will become eligible for benefits on the effective date if he is then
actively at work as an employee; otherwise he will become eligible for benefits
on the earliest day after the effective date on which he is actively at work
as an employee.
C.Â
Each person who becomes an eligible individual after
the effective date will become eligible for benefits on the earliest date
on which such person has completed at least one month's continuous service
as an employee and is actively at work as an employee.
A.Â
The weekly amount of the disability income benefit with
respect to each covered individual will be 100% of the average weekly wage.
Sixty-six and two-thirds percent of this amount to a maximum of $200 per week
shall be payable by an insurer according to the terms of an insurance policy
between the borough and an authorized insurance company. The remainder shall
be payable directly by the Borough of Netcong.
B.Â
A change in the amount of an individual's disability
income benefit due to a change in his salary will take effect on the first
day of the pay period next following the date of the change, unless the result
is an increase in the amount of his disability income benefit and he is not
then actively at work as an employee, in which case the change will be deferred
until he returns to active work as an employee. The change will take effect
automatically.
C.Â
No change will be made in the amount of an individual's
disability income benefit during any one continuous period of disability.
If an individual becomes disabled while covered hereunder, the borough
will, subject to the other terms of this article, pay to the individual bimonthly
(in arrears), during the period commencing on the later of the date on which
the individual has been continuously disabled for eight days, and the date
on which initial proof of the individual's disability, satisfactory to the
borough, is deposited with the borough and continuing while such disability
continues, but not in excess of 26 weeks, the amount of the disability income
benefit applicable under the amount of disability income benefit provision
to the individual at the commencement of such disability. If the period during
which an individual is disabled is not an integral number of weeks, the amount
of disability income benefit payable with respect to the individual for each
day that he is disabled in excess of an integral number of weeks shall be
at the rate of 1/5 of the weekly amount of disability income benefit
which is applicable to him as aforesaid. If benefits shall be payable for
three or more consecutive weeks, then benefits shall be payable from the first
day.
Notwithstanding anything to the contrary in this article, an individual
who has become disabled in accordance with the terms of this article who engages
in any gainful occupation during the period of disability shall be deemed
to cease to be disabled for the purposes of this article as a result of engaging
in such occupation.
A.Â
No amount of disability income benefit will be payable
under this plan for a period of disability during which the individual is
not under the care of a physician legally licensed to practice medicine.
B.Â
No amount of disability income benefit will be payable
under this plan for disability directly or indirectly due to or resulting
from any one or more of:
C.Â
If an individual becomes disabled in accordance with
the terms of this article, the amount of disability income benefit payments
payable under this plan with respect to such disability will be reduced by
the amount of any periodic payments the individual is entitled to receive
with respect to the disability under:
(1)Â
The Social Security Act or railroad retirement, including
dependents benefits by reason of such disability or retirement;
(2)Â
Any labor-management trustee, union or employee benefit
plans;
(3)Â
Worker's compensation insurance plan; or
(4)Â
Any program or coverage required or provided by law or
any government agency.
D.Â
Notwithstanding the foregoing terms of this provision,
the amount of disability income benefit with respect to an individual will
not be reduced below the lesser of 1/10 of his weekly salary or $25.
E.Â
It shall be the employee's obligation to apply for and
pursue whatever benefits such employee shall be entitled to. Failure to apply
for and diligently pursue such benefits may result in a reduction or termination
of benefits, or in a substantial overpayment to the employee which will necessitate
reimbursement of the borough. Such integration of benefits shall be based
on what an employee is entitled to receive, and shall in no way be affected
by an employee's failure or refusal to pursue such benefits.
This plan is not in lieu of, and does not affect any requirement for
coverage by, workmen's compensation insurance.
A.Â
B.Â
Employment shall be deemed to continue during the whole
period that an individual is absent from work if his absence is due to disease
or injury. Employment shall be deemed to continue until the end of the week
next following the week in which the individual's absence began if his absence
is due to a temporary layoff or leave of absence other than service in any
naval, military or air force. However, in no case shall the individual's employment
be deemed to continue beyond the date on which the borough files a written
notice that the individual's employment has terminated.
After two years from the effective date of the coverage with respect
to which any claim is made no misstatement of any individual eligible for
coverage under this article in an application under this article shall be
used to deny a claim for loss incurred or disability (as defined in this article)
commencing after expiration of such two years.
Written notice of claim must be given to the borough within 20 days
of the first day on which the borough is liable, or as soon thereafter as
is reasonably possible. Notice given by or on behalf of the claimant to the
borough or to any authorized agent of the borough with information sufficient
to identify the covered individual, shall be deemed notice to the borough.
The borough, upon receipt of a written notice of claim, will furnish
to the claimant such forms as are usually furnished by it for filing proofs
of loss. If such forms are not furnished within 15 days after the giving of
such notice, the claimant shall be deemed to have complied with the requirements
of this article as to proof of loss upon submitting, within the time fixed
in this article for filing proofs of loss, written proof covering the occurrence,
the character and the extent of the loss for which claim is made.
Subject to due written proof of loss all accrued disability will be
paid bimonthly and any balance remaining unpaid upon the termination of the
period of liability will be paid immediately upon receipt of due written proof.
All indemnities will be payable to the covered individual.
The borough or the insurance carrier at its own expense, shall have
the right and opportunity to examine the person of any individual whose injury
or sickness is the basis of claim when and as often as it may reasonably require
during the pendency of claim hereunder and to make an autopsy in case of death,
where it is not forbidden by law.
No action at law or in equity shall be brought to recover on this article
prior to the expiration of 60 days after written proof of loss has been furnished.
No such action shall be brought after the expiration of three years after
the time written proof of loss is required to be furnished.
Any provision of this article which, on its effective date, is in conflict
with the statutes of the State of New Jersey is hereby amended to conform
to the minimum requirements of such statute.
