19 Del. Admin. Code § 2007-2.0
The following words and terms, when used in this regulation, have the following meaning:
"Appeal" means the action you can take in accordance with 29 Del.C. § 5258 if you disagree with a coverage decision.
"Base Rate of Compensation" means the employee's usual rate of pay, including hazardous duty pay if applicable. Base Rate of Compensation does not include commissions, bonuses, shift differential pay, overtime pay or fringe benefit or extra compensation.
"Claimant" means a person enrolled in the DIP who applies for STD or LTD benefits or an extension of STD or LTD benefits or who is receiving or has received STD or LTD benefits.
"Creditable Compensation" means as defined in 29 Del.C. § 5251(c), the base rate of compensation that the employee received on the last day of employment before the employee developed a disability.
"DIP" means the Disability Insurance Program as defined in 29 Del.C. § 5256.
"DIP Insurance Carrier or Third-Party Administrator" means the State's selected company for this service.
"DIP/RTW Representatives" means employing organizations' Human Resource, Benefits, or Payroll Representatives with DIP or Return to Work "RTW" administrative or paying responsibilities.
"DOE" means Department of Education.
"Elimination Period" means the period of time you must be disabled before disability benefits begin. The elimination period in the Short Term Disability "STD" program is 30 calendar days. The elimination period in the Long Term Disability "LTD" program is the last to be satisfied of the following:
| * | The first 182 consecutive calendar days of a period of disability; or |
| * | The exhaustion of the STD benefit period. |
"Employee" means an eligible "employee" as defined in 29 Del.C. § 5501(f), who chooses to participate in the DIP as specified in 29 Del.C. § 5519.
This shall include an employee who is collecting benefits in accordance with 11 Del.C. § 8352(4).
"Employing Organization" means the agency, school district, charter school, institution of higher education, court system or Delaware Solid Waste Authority (DSWA) employing claimants in a position covered by the Delaware State Employees Pension Plan in accordance with 29 Del.C. Ch. 55 who are U.S. citizens or U.S. residents actively at work for one full day on or after January 1, 2006.
"Essential Duty" means a duty that is substantial, not incidental; is fundamental or inherent to the occupation; and cannot be reasonably omitted or changed. To be at work for the number of hours in the employee's regularly scheduled workweek is also an essential duty.
"Family and Medical Leave Act" or "FMLA" means a labor law that entitles eligible employees to take up to twelve workweeks of unpaid, job-protected leave during a twelve month period for specified family and medical reasons with continuation of group health insurance plan coverage under the same terms and conditions as if the employee had not taken leave as defined in 19 Del.C. § 3702(a).
"Hazardous Duty Pay" means a payment to employees who are determined by the State of Delaware to be working in circumstances that involve an unusual risk of serious physical injury, impairment to health or death resulting from accidental, negligent, or intentional causes. Employees entitled to hazardous duty pay qualify under 29 Del.C. § 5916(e), 29 Del.C. § 5933(c) and (d), and 83 Del Laws c 325 section 30.
"Health Care Provider" means an individual licensed, certified or otherwise authorized or permitted by law to provide health care in the ordinary course of business or practice of a profession.
"Insurance Coverage Office" or "ICO" means the State office responsible for providing quality support for the state government's insurance needs. The office is responsible for managing the insurance program for state owned transportation, buildings and property and workers' compensation, as well as reviewing state facilities for safety issues and providing safety programs to state employees.
"Interactive Process" means when medical restrictions forbid an employee with a disability from doing the job, the Americans with Disabilities Act "ADA" requires an employer to communicate with the employee concerning an accommodation. This exchange has been described variously as the "core" or "proactive" process, "cooperative problem solving," "open and individualized exchange," a "search", and a "flexible give-and-take." Most frequently, it is called the "interactive process" or by the redundant term, "interactive dialogue." The purpose of this dialogue is to "identify the precise limitations resulting from the disability and potential reasonable accommodations that could overcome those limitations."29 C.F.R. § 1630.2(o)(3).
"Less Than Twelve Month Educational Employees" means those employed by School Districts, Charter Schools, the DOE, University of Delaware, Delaware State University and Delaware Technical Community College whose normal working period is a school year or semester which is less than 12 months in duration per calendar year. "Less Than Twelve Month Educational Employees" are not defined or categorized by the employee's length of employment.
"LTD" means long term disability.
"Medical Care" means when a health care provider is consulted or medical advice is given or treatment is recommended, prescribed by, or received from a health care provider.
"Member" means a person enrolled in or was previously enrolled in the DIP.
"Merit Employee" means positions that are subject to the rights, rules, and regulations in accordance with the Merit Rules.
"Non-Merit Employee" means positions that are not subject to the rights, rules, and regulations governed by the Merit Rules.
"Normal Working Periods" means the scheduled working days for the employee.
"Parental Leave" means a law that entitles full-time employees in the employment of the State, a reorganized school district, charter school or vocational school district for at least one year, to twelve weeks of paid leave as of the birth or adoption of a child who is 6 years of age or younger to care for or bond with the child in accordance with 29 Del.C. § 5253 and 14 Del.C. § 1333.
"Personal Injury Protection " or "PIP" means insurance coverage that is statutorily mandated for Delaware registered state owned transportation. 21 Del.C. § 2118 requires minimum PIP limits of $15,000 per person; $30,000 per accident for reasonable and necessary medical expenses, net amount of loss earnings, funeral expenses, and substitute services incurred within 2 years of an automobile accident.
"Pre-Disability Base Pay" or "Creditable Compensation" means the employee's usual rate of pay paid to the employee on the last day of employment before the employee developed a disability including hazardous duty pay, if applicable.
"Pre-Existing Condition" means an accidental bodily injury, sickness, mental illness, pregnancy, or episode of substance abuse or the manifestations, symptoms, findings, or aggravations related to or resulting from the accidental bodily injury, sickness, mental condition, pregnancy or substance abuse for which the employee received medical care during the 3 month period that ends the day before:
| * | The employee's effective date of coverage in DIP; or |
| * | The effective date of a change in DIP coverage. |
"Qualified Individual with a Disability" means an individual who has satisfied the requisite skill, experience, education, and other job-related requirements of the employment position that the individual holds, and who, with or without reasonable accommodation, can perform the essential functions of the position. A person with a disability according to the ADA is defined as someone who:
| * | Has a physical or mental impairment that substantially limits one or more of the major life activities of the individual; |
| * | Has a record of the impairment; or |
| * | Is being regarded as having the impairment. |
"Reasonable Accommodation" means a change in the work environment or in the way things are customarily done that would enable an individual with a disability to have equal employment opportunities, and includes the following:
| * | Modifications or adjustments necessary to enable a qualified individual with a disability to perform the essential functions of the job; |
| * | Modifications or adjustments that enable employees with disabilities to have equal benefits and privileges of employment. |
"Return to Work Coordinator" or "RTWC" means the person in the Department of Human Resources, Statewide Benefits Office "SBO" who provides RTW and stay at work assistance to employees or former employees who are currently on an approved STD or LTD claim.
"RTW" means return to work.
"Salary Supplement" means in accordance with 29 Del.C. § 5933 that whenever an officer as defined in 29 Del.C. § 5812(n)(1), or employee of the State including those exempt from the classified service, qualifies for workers' compensation disability benefits, the officer or employee, for a period not to exceed three months from the date the compensation begins, is not charged sick leave and shall receive from the State the difference, if any, between the total of: The amount of the compensation, disability benefits received under the Federal Social Security Act, and ( another employer supported disability program, and the amount of wages to which the officer or employee is entitled on the date the compensation begins, provided the injury or disease for which the compensation is paid is not the direct result of the officer or employee's misconduct and occurs during a period of employment for which the employee is entitled to receive wages. No more than 1 period of supplemental pay shall be made under this subsection for a work injury, including a recurrence or aggravation of that work injury. The 3 month limitation will not apply to any employee injured while performing a hazardous duty assignment and whose injury or injuries arose out of and in the course of performing hazardous duty; providing, however, the employee will be entitled to the benefits of this section for not more than 12 months. Those positions are outlined in 29 Del.C. § 5933 (c) and (d) and 29 Del.C. § 5916(e).
"SBO" means Statewide Benefits Office. SBO is the "administrative arm" of the State Employee Benefits Committee "SEBC", meaning SBO is responsible for the administration of all health and related benefit programs, including the DIP and RTW.
"SEBC" means the State Employee Benefits Committee. (As the "Committee" is the SEBC, we have incorporated the acronym "SEBC" in lieu of the term "Committee" in the definitions section of this regulation.)
"Stay at Work Assistance" means consultation, advisement, or other assistance provided to an employee in order to allow the employee to remain in the current job position and perform essential functions of that position.
"STD" means short term disability.
"Temporary" means not permanent; provisional or lasting only a short time.
"Workers' Compensation" or "WC" means a system, established under 19 Del.C. Ch. 23, which provides compensation to workers who are injured or who contract an occupational disease while working.
19 Del. Admin. Code § 2007-2.0
19 DE Reg. 78 (7/1/2015)
20 DE Reg. 70 (7/1/2016)
21 DE Reg. 234 (9/1/2017)
22 DE Reg. 861 (4/1/2019)
28 DE Reg. 57 (7/1/2024) (Final)