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EmployeeDisabilityLetter Powered By Docstoc
					To:    UCR Employee

From: Theron Lyon, Benefits Manager

Re:    Short Term Disability (University Paid Temporary Disability-UTD)
       Supplemental Disability (Employee Paid Temporary Disability-ETD)

We have been notified that you may be filing a claim under one or both of the disability
plans listed above. In order to establish a disability claim, you must complete the Liberty
Mutual Disability Claim Form and your physician must complete the Liberty Mutual
Attending Physician’s Statement and return it to Liberty Mutual, Disability Claims, P.O.
Box 37500, Phoenix, AZ 85069-7500.

If you will be on an approved leave of absence without pay, you are eligible to continue
your benefits during this period. Please read the “Disability Factsheet” for complete
benefit details. To continue your benefits, you will need to complete a Benefits
Insurance Continuation Form (BIC) available through the Benefits or Payroll
Office. You may also qualify for the Family Medical Leave (FML), please contact your
Department Personnel Assistant (DPA) for more information. Also, contact Parking
Services at extension 24395 regarding your payroll deduction.

Benefits received under UTD are taxable and must be reported when you file your federal
income tax return. Liberty Mutual will issue a W-2 form covering the amount of taxable
income received from your disability pay. In general, the law permits exclusion of a
limited amount of these benefits payments from taxable income only if the employee is
permanently and totally disabled, as defined by IRS regulations. Please keep a record of
UTD payments you receive for use when preparing your tax return. This information is
intended to serve only as a general guideline. Consult a tax professional for more
information. Retirement plan members who are coordinated with Social Security will
have FICA withheld from their UTD benefits at the current rate. If you have been
employed by the University for less than 18 months, you may qualify for State Disability
Insurance. Please contact the State Disability Office at (800) 480-3287 for more details.

It is your responsibility to keep your department regularly informed of your status during
your disability. If you have any questions or concerns, please contact Tina Rodriguez at
(951) 827-1440.