[The currently effective Salary Ordinance of the Borough
of Netcong is on file in the office of the Borough Clerk and is available
for examination during office hours.]
Temporary disability benefits are provided for all eligible employees
during periods of nonoccupational disability in accordance with the provisions
of this article.
As used in this article, the following terms shall have the meanings
indicated:
AVERAGE WEEKLY
The amount derived by dividing a covered individual's total wages
earned during the base weeks in the eight calendar weeks immediately preceding
the calendar week in which disability commenced by the number of such base
weeks.
BASE WEEK
Any calendar week during which an insured employee earned not less
than 15% of the state-wide average weekly wage.
DISABILITY
That period during which the employee, because of nonoccupational
bodily injury, mental or physical illness, is prevented from engaging in his
regular occupation.
EMPLOYEE
A person who is employed by the Borough of Netcong.
ONE CONTINUOUS PERIOD OF DISABILITY
Includes all periods of disability due to the same or related cause
or causes except periods of disability separated by more than three consecutive
months during which the individual was not disabled.
PHYSICIAN
Includes a currently licensed dentist, optometrist, podiatrist or
chiropractor.
WAGES
All earnings payable by the borough to covered employees for services.
It includes commissions, bonuses and the cash value of all earnings payable
in any form other than cash.
If an individual becomes disabled while covered hereunder, the borough
will, subject to the other terms of this article, pay to the individual bimonthly
(in arrears), during the period commencing on the later of the date on which
the individual has been continuously disabled for eight days, and the date
on which initial proof of the individual's disability, satisfactory to the
borough, is deposited with the borough and continuing while such disability
continues, but not in excess of 26 weeks, the amount of the disability income
benefit applicable under the amount of disability income benefit provision
to the individual at the commencement of such disability. If the period during
which an individual is disabled is not an integral number of weeks, the amount
of disability income benefit payable with respect to the individual for each
day that he is disabled in excess of an integral number of weeks shall be
at the rate of 1/5 of the weekly amount of disability income benefit
which is applicable to him as aforesaid. If benefits shall be payable for
three or more consecutive weeks, then benefits shall be payable from the first
day.
Notwithstanding anything to the contrary in this article, an individual
who has become disabled in accordance with the terms of this article who engages
in any gainful occupation during the period of disability shall be deemed
to cease to be disabled for the purposes of this article as a result of engaging
in such occupation.
This plan is not in lieu of, and does not affect any requirement for
coverage by, workmen's compensation insurance.
After two years from the effective date of the coverage with respect
to which any claim is made no misstatement of any individual eligible for
coverage under this article in an application under this article shall be
used to deny a claim for loss incurred or disability (as defined in this article)
commencing after expiration of such two years.
Written notice of claim must be given to the borough within 20 days
of the first day on which the borough is liable, or as soon thereafter as
is reasonably possible. Notice given by or on behalf of the claimant to the
borough or to any authorized agent of the borough with information sufficient
to identify the covered individual, shall be deemed notice to the borough.
The borough, upon receipt of a written notice of claim, will furnish
to the claimant such forms as are usually furnished by it for filing proofs
of loss. If such forms are not furnished within 15 days after the giving of
such notice, the claimant shall be deemed to have complied with the requirements
of this article as to proof of loss upon submitting, within the time fixed
in this article for filing proofs of loss, written proof covering the occurrence,
the character and the extent of the loss for which claim is made.
Subject to due written proof of loss all accrued disability will be
paid bimonthly and any balance remaining unpaid upon the termination of the
period of liability will be paid immediately upon receipt of due written proof.
All indemnities will be payable to the covered individual.
The borough or the insurance carrier at its own expense, shall have
the right and opportunity to examine the person of any individual whose injury
or sickness is the basis of claim when and as often as it may reasonably require
during the pendency of claim hereunder and to make an autopsy in case of death,
where it is not forbidden by law.
No action at law or in equity shall be brought to recover on this article
prior to the expiration of 60 days after written proof of loss has been furnished.
No such action shall be brought after the expiration of three years after
the time written proof of loss is required to be furnished.
Any provision of this article which, on its effective date, is in conflict
with the statutes of the State of New Jersey is hereby amended to conform
to the minimum requirements of such statute.