The Kimberly School District will not encumber any additional compensation costs above the amount paid by the State Insurance Fund during the period of disability, unless the employee has been employed on a continuous full-time basis for a minimum of one year and the disability necessitates six or more day’s absence from work. For use in this policy, they are referred to as eligible. Employees employed with the District less that one year, or less than 20 hours per week. Option A is the only choice.
An eligible employee who is absent from work for a period of five (5) days or less as a result of a work-related injury/illness shall have the absence charged to his/her accumulated sick, personal or vacation leave. Absences not covered by sick, personal or vacation days will be considered non-work, non-paid days.
An eligible employee placed on worker’s compensation who is absent from work for a period of six (6) days or more will be able to enact Option A or Option B (election form to initiate Option A or B may be found at the end of the worker’s compensation policy).
Option A – Worker’s Compensation Benefits only
Employee may elect to receive worker’s compensation benefits only and retain his/her accrued sick, personal and vacation leave, if any, for future use. Employee understands that he/she will not receive retirement credit during his/her period of disability. Employee also understands that in order to continue his/her life, health and dental benefits, employee must pay the premiums to the district (if applicable).
Option B – Worker’s Compensation Benefits Supplemented by Accrued Leave
Employee understands that the Kimberly School District will allow him/her to use their accrued leave (sick, personal, and vacation) to maintain his/her income at the approximate current working level. Employee understands that during the monthly pay period, a percentage of his/her available approved leave will be used by the district to compensate him/her while disabled. The percentage of leave used will be 100% less the worker’s compensation percentage allowed. The district will pay his/her health and dental benefits as if employee were still working and will deduct from his/her pay the same amounts of the self-paid premiums as would be payable if working. Employee understands he/she will receive one month of service credit with the Public Employee Retirement System of Idaho for each month he/she is receiving pay. The district shall make normal payroll deductions for the retirement system, state and federal income taxes and social security out of the portion paid to employee. Employee understands the choice of this option will have no effect on his/her present or future claim for worker’s compensation benefits.
Employee understands that district payment of health and dental insurance premiums will continue under the guidelines outlined in the Family Medical Leave Act (maximum of twelve weeks). Employee understands that income maintenance and retirement service credit will last as long as employee has approved leave available, unless employee has been laid off or resigns. If employee has depleted all available approved leave (sick, personal, vacation) Option B is not available.
PLEASE NOTE: If the employee has been employed on a continuous full-time basis (20 or more hours per week) in the Kimberly School District for a period of one or more years, the employee may select from Option A or Option B using the Worker’s Compensation Benefit Election form. Depending on the length of employment and accrued leave, the employee is eligible for Option A or Option B with a maximum of twelve (12) weeks according to the Family Medical Leave Act.
An employee unable to return to work under the conditions of the Family Medical Leave Act shall be considered terminated and all district benefits shall cease. At the time of termination, employee will have a thirty (30) day grace period to convert his/her group insurance coverage to another plan. The employee may be considered for re-employment when he/she has sufficiently recovered as per a doctor’s release.
If employees do not have a sufficient amount of accumulated sick leave to cover the initial five (5) days of absence, then the employee may use personal or vacation days. Absences not covered by sick, personal or vacation days will be considered as non-work, non-paid days.
During the period of disability, the district’s share of disability payments cannot extend beyond the scheduled or contractual working days. The employee is not to receive more than 100% of his/her regular salary.
During the period of disability, when an employee is receiving disability payments, it shall be the responsibility of the employee to report disability benefits received to the district’s payroll department prior to payroll calculation dates. If not reported in a timely manner, the district payroll clerk will estimate worker’s compensation time loss benefits at a maximum of 67% of regular salary.
WORKER’S COMPENSATION BENEFITS ELECTION FORM
Please read the options listed below carefully and enter your choice of
Option A or Option B in the space provided at the bottom of the form.
As an employee of the Kimberly School District, I understand I am eligible for worker’s compensation benefits provided by the State Insurance Fund in the event I am injured by an accident on the job. I also understand my employer has provided me with an additional benefit in that I may elect to use my available leave (sick, personal, and vacation) to make up the difference between what I would receive from my worker’s compensation check and what I received while working.
OPTION A – WORKER’S COMPENSATION BENEFITS ONLY
I wish to receive my worker’s compensation benefits only and retain my accrued sick, personal and vacation for future use. I understand that I will not receive retirement credit during my period of disability. I understand also that in order to continue my life, health, and dental benefits I must pay the premiums.
OPTION B – WORKER’S COMPENSATION BENEFITS
SUPPLEMENTED BY A ACCRUED LEAVE
I understand that the Kimberly School District will allow me to use my available leave (sick, personal, and vacation) to maintain my income at my approximate current working level. I understand that during a monthly pay period, a percentage of my available approved leave will be used by the district to compensate me while I am disabled and receiving worker’s compensation. The district will pay my health and dental benefits as if I were still working and will deduct from my pay the same amounts of self-paid premiums as would be payable if working. I understand I will receive one month of service credit with the Public Employee Retirement System of Idaho for each month I am receiving pay. Normal payroll deductions for the retirement system, state and federal income taxes and social security shall be made out of the amount paid to me by the district. I understand the choice of this option will have no effect on my claim for worker’s compensation benefits in any manner. I understand further that the benefit of the payment of health and dental insurance premiums will last for a maximum of twelve (12) weeks or the period of your disability, whichever is less. I also understand the income maintenance and receipt of retirement credit within the aforementioned limits will continue as long as I have approved leave available, unless I’ve been laid off due to my inability to return to the position and perform assignments as required by my job description.
I have read Option A and Option B in their entirety and have elected Option ________.
_____________________________________ _______________________
Employee’s Signature Date