Life Insurance FAQ

FAQ

 


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What is the minimum and maximum compensation rates?

6) As of 7/1/13, the weekly state minimum compensation rate: $346.00 per week
The weekly state maximum compensation rate: $691.00 per week

When is the right to compensation barred?

5) SDCL 62-7-35.3: the right to compensation is barred if no medical treatment has been obtained within seven years after the employee first files the first report of injury.

How long does the TPA have to investigate each claim?

4) SDCL 62-6-3: The TPA has a minimum of 20 days and a maximum of 50 days to investigate each claim and must notify the employee and the Department of Labor and Regulation in writing if denying liability for the reported injury.
A company or employer which fails to comply with this statute will be fined $100 by the Department of Labor & Regulation for each act of non-compliance.

How long does an employer have to complete First Report of Injury?

3) SDCL 62-6-1 states an employer must complete the First Report of Injury “within 7 calendar days, not counting Sundays and legal holidays, after any employer has knowledge of the occurrence of an injury.
The employer shall preserve the record for a period of at least 4 years from the date of injury. The records shall be signed by the employer and a copy given to the injured employee. Any employer who fails to complete or maintain the injury records required by this section is guilty of a Class 2 misdemeanor.”.

How long does an Employee have to report and Injury?

2) According to SDCL 62-7-10, an employee must report an injury to the employer as soon as practicable. Written notice of the injury should be provided to the employer within 3 business days after the injury occurred.
The 3 day period does not start until the employee should have realized he was injured.
If notice is not given timely, a claim may be denied unless: (a) the employer had actual knowledge of the injury (the standard is whether a “reasonably conscientious manager should have known of the possibility of a compensable claim”
(b) the employee had “good cause” for not providing written notice within 3 days (for example: an employee is incapacitated).

Q1. What is the Maximum Benefit amount of coverage I can take out for Optional Life Insurance?

Answer:

  • The individual employee may choose up to $300,000 Maximum Optional Life and it needs to be in $10,000 Increments.
  • The Dependent Spouse Optional Maximum Benefit is $25,000; this can be in $5,000 increments.
  • The Dependent Child Optional Maximum Benefit is $10,000; this can be in $5,000 increments.

Q2. Are there any age factor limitations with this Life Insurance?

Answer:

An Employee or Dependent Spouse has the face value of the amount of coverage chosen, however it will reduce to 65% when one attains the age of 70 years and then to 50% when one attains age 75 years.
Example: a $10,000 policy at the age of 70 would be $6,500 and then at the age of 70 it would be $5,000.
A Dependent Child may be covered to the age of 25 years if the Employee’s child is an enrolled full-time student and depends on the Employee for 50% or more of his /her support.

Q3. If I do not decide to take the Optional Life Insurance with in the 31 days of my starting employment and then decide I would like to do so, can I take out Optional Life Insurance?

Answer:

One could apply for coverage’s but would be require to fill out and submit and Evidence of Insurability, it would then be reviewed and a decision would be made as to if you can or cannot have the Optional Life Insurance. If once approved your Optional Life coverage would start the first of the month after being approved.

Q4. Do I earn any annuity with this policy and can it be cashed out?

Answer:

No. This is Term Life Insurance with Accidental Death and Dismemberment Insurance. If you or your covered Dependent Spouse should die you would be paid the face value of your Basic and Optional Life Coverage’s. In the event that death was caused by and accident, proven to be an accident, then the coverage will double.
Example: If one is covered for $10,000 and there was an accidental death of a covered individual the amount would be twice the face value, $20,000. (this is just an example and remember there is an age factor of 70 years and 75 years where there is a reduction of the benefit of 65% and 50% respectfully)

Q6. What is meant by Dependent to an Employee?

Answer:

Dependent means:

  • Spouse
  • Unmarried child from live birth to under age 21
  • Unmarried child under age 25 who is enrolled as a full-time student and depends on the Employee for 50% or more of his support
  • Unmarried step-child, foster child or adopted child is included as a Dependent if he depends on the Employee for 50% or more of his support and is living with the Employee in a regular parent-child relationship.
  • A Dependent does not include:
  • Any person who is insured as an Employee; or
  • Any person residing outside of the United Stated, Canada or Mexico.

Q7. Are there any circumstances that I can lose my life insurance coverage?

Answer:

The amounts may cease or be reduced due to the following:

  • Termination of his employment; or
  • Termination of his membership in an Eligible Class; or
  • The Employee retirement; or
  • The Employee reaching a specified age; or
  • The Employee changing to a different Eligible Class; or termination of the Employee’s Waiver of Premium continuation; or
  • The Employee’s continuation period ending during layoff or an approved leave of absence;

Then the Employee may apply for an individual policy on his own life up to the amount that ceased. If the amount of Life Insurance that ceased is $10,000 or more, the minimum amount of the individual policy must be $10,000.

Q8. Are there any other added Benefits to this policy that I should be aware of?

Answer:

There are situations in which Additional Benefits may be payable with satisfactory written proof. (Please refer to Section IV – Benefit Provisions in the Policy Booklet)

  • Seat Belt Benefit
  • Air Bag Benefit
  • Disappearance Benefit
  • Repatriation Benefit
  • Dependent Education Benefit
  • Child Care Benefit

Q9. Are there any circumstances that Exclude Benefits for the AD&D?

Answer:

No Accidental Death or Accidental Dismemberment payment will be made for a loss which is due to the results from:

  • Suicide while sane or insane.
  • Intentionally self-inflicted injuries.
  • Bodily or mental infirmity or disease of any kind or infection unless due to an accidental cut or wound.
  • Committing or attempting to commit an assault, felony or other criminal act.
  • Active participation in a war (declared or undeclared) or active duty in any armed service during the time of war.
  • Active participation in a riot, rebellion or insurrection.
  • The Insured Person’s voluntary use of any controlled substance that would be considered a felony. (refer to Section IV – Benefits Provisions in the Policy Booklet)

The Insured Person’s operation of any motorized vehicle while intoxicated.

Q10. What does it take to qualify for Basic and/or Optional Life Insurance with AD&D? And is there a waiting Period for individuals?

Answer:

All full-time Employees scheduled to work 20 hours per week. There is not a waiting period for basic life coverage that is provided through your employer. Optional Life coverage starts the first of the month after the enrollment form is signed and it is with in the 31 day period from start of employment.

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306 E. Capitol Ave
Pierre, SD 57501
Phone: 1-800-543-7808
605.773.2500
Fax: 605.773.2501
Email: info@asbsd.org