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I paid my premium by automatic payroll deduction so it was paid on time every two weeks for the next decade.
Over the years I completely forgot who I had long term disability coverage with, but I knew I had it. When it came time to file, I did not know who to file with. I was initially given the wrong information and filed a claim with a company that provided coverage for general county employees as opposed to safety. I was also told incorrectly I had to exhaust my sick leave and vacation before I would be covered.
When I finally filed my claim, I was on the phone for about 45 minutes with the intake person explaining my situation. Intakes usually take less than 15 minutes. The length of this call becomes an issue later. I tell her about my admin leave and ask if it is a problem because she asked some questions about it. She said no, it was not a problem and it would take about ten days to issue me a check once I returned all the paperwork. She told me I would get the expected 70% of my salary, plus I would receive back pay from the date I went off work. I would receive a certain amount of compensation for the time I was using my sick leave. I did not think I would receive any back pay because of the delay in filing my claim.
I got my forms in the mail within a few days and went to my doctor explaining what he needed to do. I submitted my forms. When did not hear anything after a few weeks I sent an email and was told my Dr did not submit the paperwork. This was a mess of back and forth between me, my doctor and CLEA trying to get the correct paperwork sent in. That is not CLEA's fault but this is definitely not a ten day stream line process from claim until first payment.
As time went by and I was not being paid, I decided to just stop turning in doctors notes to the county forcing them to put me back on the payroll. When they did, payroll deductions were taken and accepted by CLEA for my coverage. This is important because according to CLEA I was ineligible for coverage, but they continued accepting premiums from me without telling anyone.
So finally I get the my answer. My claim is denied, not because of any questions about my medical condition. They appear to concede in their rejection letter that I suffered a work related injury/illness. But since I did not lose any pay until after I was on placed on PAID administrative leave, I was not eligible for coverage.
The reason I was denied coverage was the simple act of being placed on PAID administrative leave. Something that could happen to any police officer at any time. Allegations of misconduct or wrong doing has nothing to do with CLEA covering you. The simple act of being on paid leave will result in your coverage being dropped.
If you read the letter attached at the top of this post, it clearly does not say PAID administrative leave is ineligible for coverage. It does not matter if you return to work or not, once you are ineligible you remain ineligible during your entire admin investigation plus 30 days after you return to work. A lot of other things will cause you to lose eligibility as well, and I will go over the language and exclusions in my next post.