ICC19 RL-STD-CERT-19 14 D12972 (11/25) C. IF YOU’RE DISABLED AND WORKING, AND YOUR DISABILITY EARNINGS ARE MORE THAN 80% OF YOUR WEEKLY EARNINGS If you are working and your Disability Earnings are more than 80% of your Weekly Earnings, no benefit will be payable. We may require you to send proof of your weekly Disability Earnings each week. We will adjust your payment based on your weekly Disability Earnings. As part of your proof of Disability Earnings, we can require that you send us appropriate financial records that we believe are necessary to substantiate your income. IF YOUR DISABILITY EARNINGS FLUCTUATE If your Disability Earnings routinely fluctuate from week to week, we may average your Disability Earnings over the most recent twelve weeks to determine if your claim should continue. If we average your Disability Earnings, we will not terminate your claim unless the average of your Disability Earnings from the last twelve weeks exceeds 80% of your Weekly Earnings. We will not pay you for any week during which your Disability Earnings exceed the amount allowable under the Policy. In no event will benefits be paid beyond the Maximum Period of Payment. TOTAL BENEFIT CAP If you are eligible to receive benefits under the Policy in addition to the Weekly Payment, the total benefit payable to you on a weekly basis (including all benefits provided under the Policy) will not exceed 100% of your Weekly Earnings. However, if you are participating in a Vocational Rehabilitation Plan, the total benefit payable to you on a weekly basis (including all benefits provided under the Policy) will not exceed 110% of your Weekly Earnings. DEDUCTIBLE SOURCES OF INCOME The following are Deductible Sources of Income: The amount that you receive, or are eligible to receive, as disability income payments under any: – Federal, state or local (including the District of Columbia) compulsory benefit act or law. – Individual Disability income plans which are wholly or partially paid for by the Policyholder or your Employer, or for which the Policyholder or your Employer makes payroll deductions, to the extent that cumulative benefits payable would exceed Your Weekly Earnings. – Military Disability benefit plan. – Governmental retirement system as a result of your job with your Employer. – Other group insurance policy to the extent the plan covers the same Weekly Earnings. The amount that you receive, as disability income payments under any "No fault" motor vehicle plan. The amount you receive under The Jones Act, the Maritime Doctrine of Maintenance and Cure or the Doctrine of Unseaworthiness. The amount you receive for lost income from a Third Party (after subtracting attorney's fees) by award, judgment, settlement or otherwise. If the award, judgment or settlement does not specify the lost income amount, we will estimate the amount using a percentage of the total amount received based on your Weekly Earnings, prorated to cover the period for which the award, judgment or settlement was made. The amount you receive under any Salary Continuation or Accumulated Sick Leave plan; sick pay, vacation pay, severance or other similar paid time off plan. The amount that you: – Receive as Disability payments under your Employer's Retirement Plan; – Voluntarily elect to receive as retirement payments under your Employer's Retirement Plan; or – Receive as retirement payments when you reach the later of age 62 or normal Retirement age, as defined in your Employer's Retirement Plan.
Short Term Disability Income Insurance Plan for Noblesville Schools Page 14 Page 16