In some cases, you will have employees who are temporarily disabled but have not recovered to the extent they are able to return to work after the initial 365-day short-term disability period ends. In these cases, the short-term disability period may be extended for as many as 365 days. During periods of extended short-term disability, the payment of benefits will be made directly by the Disability Income Plan provided the Retirement Systems finds that the disability continues to be temporary and is likely to end during the extended period. The member must apply for extended short-term disability benefits within 180 days from the end of the short-term period, the end of any accumulated leave payments, or the conclusion of any Workers’ Compensation payments. An employee is not entitled to extended short-term disability benefits if his or her disability is of a permanent and total nature.

The extended short-term disability benefit continues at half of one month’s portion of the annual base rate of compensation plus half of one month’s portion of the annual longevity, with appropriate reductions. The extended short-term disability benefit is not reduced by Social Security benefits the employee may be receiving.

The first step in applying for extended short-term disability benefits is the completion of Form 704 (Requesting Additional Benefits Through the Disability Income Plan of North Carolina). Form 704 should be completed and signed by the employee or his or her legal representative. You should forward the form to the Retirement Systems Division approximately 90 days prior to the conclusion of the short-term disability period. Please discuss Guides A, B and F on Form 704 regarding extended short-term disability benefits with the employee.

The following forms/information should be submitted with Form 704:

• Form 700 (Requesting Employer Information Required for Member Disability Income Plan Benefits)
• Form 7A (Medical Report for Disability Eligibility Review) completed by a licensed physician
• Form 701 (Requesting Short-Term Benefits Through the Disability Income Plan)
• Form 703 (Reporting Earnings for Short-Term Disability Benefits and Medical Report for Eligibility Review)
• supporting medical documentation
• a copy of the member’s job description

After the above information is received by our office, the application will be referred to the DIPNC Medical Review Board for review. Based on the medical evidence furnished, the Medical Review Board will determine if the employee is eligible for extended short-term disability benefits, and if so, the length of time the benefits may be extended (not to exceed 365 days).

This initial approval for extended short-term disability benefits does not prevent an employee from applying for additional periods of extended short-term disability benefits, if the DIPNC Medical Review Board did not initially extend benefits for the full 365 days, nor does it prevent the employee from applying for long-term disability benefits if it becomes apparent during the extended short-term disability period that the disability is likely to be permanent.

You and the employee will be notified by letter regarding the approval or denial of extended short-term disability benefits, as well as the date through which payment will be extended, if approved.

Extended short-term disability payments are paid on the 25th day of each month.