Subchapter III — Long-Term Disability Insurance
ETF 50.40   Purpose.
ETF 50.42   Definitions.
ETF 50.44   Scope and application.
ETF 50.46   Optional election of coverage.
ETF 50.48   Claim for benefits.
ETF 50.50   Eligibility for LTDI benefits.
ETF 50.52   LTDI benefits.
ETF 50.54   Administration.
ETF 50.56   Termination of benefits.
ETF 50.58   Special provisions applicable to certain categories of employment.
ETF 50.60   Plan accounting.
ETF 50.62   Proration of adjustment percentages and monthly benefits.
subch. I of ch. ETF 50 Subchapter I — Income Continuation Insurance
ETF 50.10 ETF 50.10Public employer income continuation insurance.
ETF 50.10(1)(1) An employee of an employer, other than the state, shall be eligible for income continuation insurance under s. 40.61 (3), Stats., if the requirements of ss. 40.02 (46) and 40.22, Stats., are satisfied.
ETF 50.10(3) (3) The employer shall pay an employer contribution toward the income continuation insurance premium which is not less than the corresponding gross premium for the 180-day waiting period plan.
ETF 50.10 History History: Cr. Register, December, 1987, No. 384, eff. 1-1-88; CR. 16-034: am. (1) (intro.), r. (1) (a), (b), (c), (2) Register April 2017 No. 736, eff. 5-1-17.
subch. II of ch. ETF 50 Subchapter II — Disability Annuity
ETF 50.30 ETF 50.30Eligibility for a disability annuity.
ETF 50.30(1) (1) A person may be eligible for a disability annuity under s. 40.63, Stats., provided the person is not receiving benefits under subch. III.
ETF 50.30(1g) (1g) For purposes of eligibility under s. 40.63 (1), Stats., and notwithstanding s. ETF 50.46 (2) (b), an election of coverage filed under s. ETF 50.46 (1) to receive benefits under subch. III will not cause a person to be ineligible for a disability annuity if a claim is filed on or after January 1, 2018.
ETF 50.30(1m) (1m) For purposes of eligibility under s. 40.63 (2), Stats., employment which is substantial gainful activity has intervened if, during any 12 consecutive calendar months beginning with the first of the month following the date service for the participating employer terminated, the participant received aggregate earnings, wages, salary and other earned income exceeding the annual dollar amount determined under s. 40.63 (11), Stats., that is in effect at the end of the 12 consecutive calendar month period.
ETF 50.30(2) (2) If the department determines that an applicant does not meet the requirements of s. 40.63 (1) (a), Stats., or this subchapter, the department shall deny the application. The applicant may file a written request for an appeal to the appropriate board under ch. ETF 11 no later than 90 days after the date the department's determination was mailed to the applicant.
ETF 50.30(3) (3) In measuring creditable service earned in a calendar year for purposes of s. 40.63 (1) (a), Stats., and in totaling accumulated creditable service for purposes of s. 40.63 (4), Stats., the creditable service shall be determined based upon the service that would have been credited if the participant's account had not been divided by a qualified domestic relations order to which s. 40.08 (1m) (b) 1., Stats., applied.
ETF 50.30(3m) (3m) For purposes of s. 40.63 (1) (a), Stats., only, if a participant was previously receiving a long-term disability insurance benefit under subch. III, which was terminated for reasons other than fraud, misrepresentation, error, mistake or failure to provide required information, the participant is deemed to have received full creditable service for any month for which the previous long-term disability insurance benefit was paid.
ETF 50.30(4) (4) For purposes of benefits administered under ch. 40, Stats., the participant shall be treated as terminated for all ch. 40, Stats., purposes effective on the date before the s. 40.63, Stats., annuity is effective or on the termination date reported to the department by the employer, whichever is earlier. The benefits include, but are not limited to, health insurance coverage, sick leave credit usage, life insurance coverage, income continuation insurance coverage, Wisconsin retirement system coverage and death benefits under s. 40.73 (1) (am) and (c), Stats., and deferred compensation contributions and benefits under s. 40.80, Stats. This rule does not preclude a participating employer from placing the participant on an administrative leave of absence for purposes of benefits not administered under ch. 40, Stats.
ETF 50.30 History History: Cr. Register, September, 1983, No. 333, eff. 10-1-83; emerg. renum. to be (2) and am., cr. (1), eff. 10-15-92; renum. to be (2) and am., cr. (1) and (1m), Register, May, 1993, No. 449, eff. 6-1-93; cr. (3), Register, July, 1999, No. 523, eff. 8-1-99; am. (1m), Register, September, 2000, No. 537, eff. 10-1-00; CR 08-026: cr. (4) Register September 2009 No. 645, eff. 10-1-09; CR 17-031: renum. (1) (intro.) to (1) and am., r. (1) (a) to (c), cr. (1g), (3m) Register December 2017 No. 744, eff. 1-1-18.
ETF 50.31 ETF 50.31Cancellation of a disability annuity application. An application for a disability annuity under s. 40.63, Stats., shall be canceled upon request of the applicant if the applicant's written request for cancellation is received by the department no later than the close of the department's regular office hours on the day before the participant's account in the employee accumulation reserve is debited for funding the benefit as provided by s. ETF 10.633 (1) (b). If the day before the debiting date falls on a Saturday, Sunday or holiday under s. 230.35 (4) (a), Stats., the request to cancel shall be considered timely only if received in the department by the close of regular office hours on the last working day preceding the Saturday, Sunday or holiday. Repayment in full of any sum paid under the application for which cancellation is sought shall be required. The employer may not make this payment on behalf of the recipient of the benefit.
ETF 50.31 History History: Cr. Register, September, 1983, No. 333, eff. 10-1-83; am. Register, January, 1996, No. 481, eff. 2-1-96.
ETF 50.32 ETF 50.32Definitions. In this subchapter and s. 40.63, Stats.:
ETF 50.32(1) (1) “Last day paid" means the most recent date for which the employee was paid earnings, including accumulated sick leave, other paid leave, vacation, compensatory time or worker's compensation temporary disability benefits which may result in the last day paid being subsequent to the date the employee last rendered services.
ETF 50.32(2) (2) “Last rendered services" means most recently performed actual work for which entitled to earnings, excluding any subsequent period on sick leave, other paid leave, vacation, compensatory time and worker's compensation temporary disability benefits.
ETF 50.32(3) (3) “Substantial gainful activity" means any work of a nature generally performed for remuneration or profit, involving the performance of significant physical or mental duties, or a combination of both, for which annual compensation exceeds an amount equal to $6,573 for determinations made in the calendar year commencing on January 1, 1992. For determinations made in subsequent calendar years, this dollar amount shall be increased by the salary index for each subsequent year, ignoring fractions of the dollar. Work is considered substantial even if performed part-time and even if it is less demanding or less responsible than the individual's previous employment. Work is considered gainful even if it pays less than the individual's previous employment.
ETF 50.32(4) (4) The date on which service for the participating employer terminated, for purposes of s. 40.63 (2), Stats., is the date on which the person last rendered services as defined under sub. (2).
ETF 50.32 History History: Emerg. cr. eff. 10-15-92; cr. Register, May, 1993, No. 449, eff. 6-1-93; cr. (4), Register, September, 2000, No. 537, eff. 10-1-00.
subch. III of ch. ETF 50 Subchapter III — Long-Term Disability Insurance
ETF 50.40 ETF 50.40Purpose. The purpose of this subchapter is to provide long-term disability insurance coverage to participating employees as of October 15, 1992, who elect its benefits as provided in s. ETF 50.46 and to all persons who become participating employees on or after October 16, 1992, who are receiving benefits under this subchapter or who have filed a claim for benefits with the department before January 1, 2018.
ETF 50.40 History History: Emerg. cr. eff. 10-15-92; cr. Register, May, 1993, No. 449, eff. 6-1-93; CR 17-031: renum. (1) to ETF 50.40 and am., r. (2) Register December 2017 No. 744, eff. 1-1-18.
ETF 50.42 ETF 50.42Definitions. Words, phrases and terms used in this subchapter have the same meaning as set forth in s. 40.02, Stats., and s. ETF 10.01, except as defined in this subchapter or where the context clearly indicates a different meaning. In this subchapter:
ETF 50.42(1) (1) “Claimant" means a person making a claim for long-term disability benefits under this subchapter.
ETF 50.42(2) (2) “Earnings limit" means an amount equal to $6,573 for determinations made in the calendar year commencing on January 1, 1992, and for determinations made in subsequent calendar years, this amount shall be increased by the salary index for each subsequent year, ignoring fractions of the dollar.
ETF 50.42(3) (3) “Final average salary" or “FAS" means:
ETF 50.42(3)(a) (a) Except as provided in par. (b), a monthly rate of earnings, ignoring any fractions of a dollar, obtained by dividing 36 into the participant's total earnings received and for which contributions are made under s. 40.05 (1) and (2), Stats., during the 3 annual earnings periods (excluding any period more than 3 years prior to the effective date for any participating employer) in which the earnings were the highest.
ETF 50.42(3)(b) (b) If the claimant does not meet the minimum service requirements of s. ETF 50.50 (2) (b) and the claimant's medically determinable impairment is a result of employment as a participating employee for an employer, then the FAS is calculated as follows:
ETF 50.42(3)(b)1. 1. Divide the total earnings received by the employee in the portion of the annual earnings period in which the last day paid occurs and the 2 immediately preceding annual earnings periods by,
ETF 50.42(3)(b)2. 2. The number of months, with all fractions of a month rounded to the next higher whole number, between the last day paid and the commencement date of the earliest annual earnings period in subd. 1. or, if later, the date the claimant commenced participating employment.
ETF 50.42(3m) (3m) “Last day paid," with respect to a claimant under this subchapter, has the same meaning as in s. ETF 50.32 (1).
ETF 50.42(4) (4) “Last rendered services" means most recently performed actual work for which entitled to earnings, excluding any subsequent period on sick leave, other paid leave, vacation, compensatory time or worker's compensation temporary disability benefits.
ETF 50.42(5) (5) “Long-term disability insurance" or “LTDI" means long-term disability insurance as provided under this subchapter.
ETF 50.42(6) (6) “Medically determinable impairment" means an impairment which has medically demonstrable anatomical, physiological or psychological abnormalities. The described abnormalities are medically determinable if they manifest themselves as signs or laboratory findings apart from symptoms which are not medically determinable.
ETF 50.42(7) (7) “Recipient" means a person receiving LTDI benefits under this subchapter.
ETF 50.42(8) (8) “Substantial gainful activity" has the same meaning as stated in s. ETF 50.32 (3).
ETF 50.42(9) (9) “Totally and permanently disabled" means the inability to engage in any substantial gainful activity by reason of a medically determinable impairment, whether physical or mental, which can reasonably be expected to result in death or to be permanent, or of indefinite and long-continued duration.
ETF 50.42 History History: Emerg. cr. eff. 10-15-92; cr. Register, May, 1993, No. 449, eff. 6-1-93.
ETF 50.44 ETF 50.44Scope and application.
ETF 50.44(1) (1)Participating employees on or after October 16, 1992. Except as provided in sub. (2), this subchapter applies to any person becoming a participating employee on or after October 16, 1992, regardless of any prior employment by a participating employer, who is receiving benefits under this subchapter or has filed a claim for benefits with the department before January 1, 2018.
ETF 50.44(2) (2)Participating employees prior to October 16, 1992.
ETF 50.44(2)(a)(a) This subchapter does not apply to a person who is a participating employee on October 15, 1992, and continuously employed by one or more successive participating employers from that date until terminating employment or taking a final leave of absence due to a medically determinable impairment, unless the person elects to be covered by this subchapter as provided in s. ETF 50.46, and the person files a claim for benefits with the department before January 1, 2018.
ETF 50.44(2)(b) (b) “Continuously employed" as used in this subsection means employed by successive employers without intervening periods of either unemployment or employment by anyone other than a participating employer.
ETF 50.44 History History: Emerg. cr. eff. 10-15-92; cr. Register, May, 1993, No. 449, eff. 6-1-93; CR 17-031: am. (1), (2) (a) Register December 2017 No. 744, eff. 1-1-18.
ETF 50.46 ETF 50.46Optional election of coverage.
ETF 50.46(1) (1)Right to elect coverage. Notwithstanding s. ETF 50.44 (2) (a), any participating employee not otherwise automatically covered under this subchapter may elect to be covered under the LTDI plan in lieu of coverage under s. 40.63, Stats.
ETF 50.46(2) (2)Manner, effects and deadline.
ETF 50.46(2)(a)(a) An election must be in writing, signed by the employee and in a form approved by the department.
ETF 50.46(2)(b) (b) The election to be covered under this subchapter is an irrevocable and absolute waiver of all rights to benefits of any kind under s. 40.63, Stats., by the participating employee and on behalf of his or her dependents, beneficiaries and estate.
ETF 50.46(2)(c) (c) The election is effective upon receipt by the department.
ETF 50.46(2)(d) (d) An election to be covered under this subchapter will not be accepted unless a claim for benefits has been filed with the department before January 1, 2018.
ETF 50.46 Note Note: Form ET-5321, “LTDI Election," may be obtained at no charge by writing to: department of employee trust funds, P.O. Box 7931, Madison, Wisconsin 53707-7931, or by calling (608) 266-3285 or toll free at (877) 533-5020.
ETF 50.46 History History: Emerg. cr. eff. 10-15-92; cr. Register, May, 1993, No. 449, eff. 6-1-93; CR 17-031: r. and recr. (2) (d) Register December 2017 No. 744, eff. 1-1-18.
ETF 50.48 ETF 50.48Claim for benefits.
ETF 50.48(1) (1)Claimant's application. A claimant shall establish that he or she meets all the requirements to receive benefits under this subchapter. A claimant shall apply for benefits by making an application on the form approved by the department or by contacting the third-party administrator.
ETF 50.48 Note Note: Form ET-5313, “Long-Term Disability Benefit Claim Form" may be obtained at no charge by writing to: department of employee trust funds, P.O. Box 7931, Madison, Wisconsin 53707-7931, or by calling (608) 266-3285 or toll free at (877) 533-5020.
ETF 50.48(2) (2)Medical reports. Except as the department shall otherwise direct in writing, the claimant, at his or her own cost, shall be responsible for obtaining and delivering to the department medical reports from physicians approved or appointed by the department supporting the application, as provided in s. ETF 50.50 (6).
ETF 50.48 Note Note: Form ET-5338, “LTDI Medical Report" is sent to the applicant with the LTDI claim form ET-5313. Form ET- 5353, “LTDI Special Disability Medical Report" will be sent with the LTDI claim form upon request of a protective occupation participant.
ETF 50.48(3) (3)Employer statement.
ETF 50.48(3)(a)(a) The department shall provide the employer with a form for the employer to state the information necessary under s. ETF 50.50 (5).
ETF 50.48(3)(b) (b) Each participating employer shall provide and state the following information to the department in response to an application for LTDI benefits:
ETF 50.48(3)(b)1. 1. The employer shall state the date on which the employee last rendered services.
ETF 50.48(3)(b)2. 2. The employer shall state the employee's last day paid and provide an explanation if this date is different from the date the employee last rendered services. The employer's explanation shall expressly identify payments including accumulated sick leave, other paid leave, vacation, compensatory time or worker's compensation temporary disability benefits which caused the last day paid to follow the date the employee last rendered services.
ETF 50.48(3)(b)3. 3. The employer shall state whether the employer has paid to the employee all earnings to which the employee is entitled and provide an explanation of earnings to which the employee remains entitled.
ETF 50.48(3)(b)4. 4. The employer shall describe the employee's present employment status, expressly including, if applicable, a statement that the claimant's employment is terminated or that the claimant is on a leave of absence and is not expected to resume active service. The statement shall include the date of the termination or of commencement of leave of absence, as applicable.
ETF 50.48(3)(b)5. 5. The employer shall state in writing on the employer statement form the reason for the employee's termination or leave of absence.
ETF 50.48(3)(b)6. 6. For a claimant who is an elected official only, the employer shall state the date of the end of the elected official's term of office.
ETF 50.48(3)(c) (c) If an employer fails to provide the required report within 90 days of the department's request for an employer statement, the department may charge the employer $20 for each calendar day following until the report is received by the department, plus interest at 0.04% per day on the unpaid balance of any charges under this paragraph as provided in s. 40.06 (3), Stats. This paragraph shall not in any way limit the employer's liability to a claimant whose application is void under sub. (5) as a result of the employer's failure to provide information required under this subsection.
ETF 50.48 Note Note: Form ET-5315, “Employer Statement (LTDI)," is sent to the employer by the department after a claim form is received.
ETF 50.48(4) (4)Department determination.
ETF 50.48(4)(a)(a) The department shall report its determination to grant or deny each application for LTDI benefits to the employer and the claimant. A claimant or employer who wishes to contest the department's findings shall make a timely appeal to the employee trust funds board. If no timely appeal is filed, the department's determination to grant or deny the application for LTDI benefits shall be final.
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Published under s. 35.93, Stats. Updated on the first day of each month. Entire code is always current. The Register date on each page is the date the chapter was last published.