California Code of Regulations › Title 22 - Social Security › Division 1 - Employment Development Department › Subdivision 1 - Director of Employment Development › Division 1 - Unemployment and Disability Compensation › Part 2 - Disability Compensation › Chapter 6 - VOLUNTARY PLANS › Section 3253-1 - Payment of Disability Benefits Because of Simultaneous Coverage

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Simultaneous coverage is deemed to exist when an
						  individual is covered by and entitled to benefits from more than one plan
						  (including one or more voluntary plans and the Disability Fund.) Benefits shall
						  be paid from the Disability Fund to individuals who are simultaneously covered
						  by one or more voluntary plans and the Disability Fund, if they are otherwise
						  eligible, in an amount equal to the quotient obtained by dividing the daily
						  benefit amount of unemployment compensation disability or Family Temporary
						  Disability Insurance benefits to which the individual would be entitled if no
						  part of his or her base period wages had been exempt from contributions under
						  Section 3252 of the code and if he or she
						  were covered only by the Disability Fund, by the number of plans (including
						  voluntary plans and the Disability Fund) under which he or she is
						  simultaneously entitled to benefits.
(a) When an individual is entitled to
						benefits from the Disability Fund during the same disability benefit period for
						which he or she received benefits from a voluntary plan, or plans, the amount
						of all benefits, at a daily rate not exceeding his or her daily benefit rate
						pursuant to Sections
						2627 and
						2655 of the code paid or to be
						paid to him or her under all approved voluntary plans during that disability
						benefit period, shall be deducted from the benefits payable from the Disability
						Fund during that benefit period. The remaining balance shall be paid to the
						claimant, if otherwise eligible.
(b) Simultaneous coverage shall be deemed to
						exist if an individual is covered by and eligible from one or more voluntary
						plans and the Disability Fund at the time he or she establishes a care
						recipient period. "Care recipient period," as the term is defined in section
						3254-4, means all periods of
						family care leave that an individual takes within a 12-month period, as defined
						in section
						3301(d) -
						1, to care for the same care
						recipient. The plan or plans under which the care recipient period is
						established remain liable for all claims associated with the same care
						recipient through the end of the 12-month period, as defined in section
						3301(d) -
						1, regardless of any change in
						employment. Liability for Family Temporary Disability Insurance benefits
						remains with the plan or plans that covered the individual when the care
						recipient period was established in accordance with the provisions of section
						3254-4.
The amount of all benefits paid by the voluntary plans
						  at a daily rate not exceeding the individual's daily benefit rate pursuant to
						  sections 3301 and
						  3303 of the code during that
						  12-month period, as defined in section
						  3301(d) -
						  1, shall be deducted from the
						  benefits payable from the Disability Fund during that 12-month period, as
						  defined in section
						  3301(d) -
						  1. The remaining balance shall be
						  paid to the individual, if otherwise eligible.
EXAMPLE 1. Claimant A is employed and covered by both a
						  state plan employer and a voluntary plan employer. She is unable to work for
						  both employers due to the need to provide care for her seriously ill parent.
						  Claimant A establishes valid claims under both the state plan and the voluntary
						  plan. The state plan daily benefit amount is $104.00.
Claimant A may receive $52.00 a day from the Disability
						  Fund and $52.00 a day from the voluntary plan for up to six weeks, if otherwise
						  eligible.
EXAMPLE 2. Claimant B is employed and covered by a
						  voluntary plan employer and is unable to work due to the need to provide care
						  for his seriously ill mother. Claimant B establishes a valid claim and receives
						  benefits from the voluntary plan. Claimant B returns to work for the voluntary
						  plan employer and begins concurrent employment for a second employer with state
						  plan coverage. Claimant B later is unable to work for both employers due to the
						  need to again provide care for his seriously ill mother and files a claim with
						  the voluntary plan.
Liability for Claimant B's Family Temporary Disability
						  Insurance claim rests solely with the voluntary plan because the plan or plans
						  under which the individual was covered at the commencement of a care recipient
						  period remains liable for all periods of family care leave claimed for the same
						  care recipient through the end of the 12-month period, as defined in section
						  3301(d) -
						  1, regardless of whether the need
						  for family care leave is consecutive or intermittent.
EXAMPLE 3. Claimant C, employed by and covered by a
						  voluntary plan employer, is unable to work due to the need to provide care for
						  his seriously ill mother. Claimant C establishes a valid claim and receives
						  benefits from the voluntary plan. Claimant C returns to work for the voluntary
						  plan employer and begins concurrent employment for a second employer with state
						  plan coverage. Later, Claimant C is unable to work for both employers due to
						  the need to provide care for his seriously ill father and establishes a claim
						  with both the voluntary plan and the state plan.
With respect to the claim for Claimant C's father,
						  simultaneous coverage exists because Claimant C was concurrently employed when
						  he established the care recipient period for his father. Both plans will
						  therefore remain liable for all subsequent claims associated with the father
						  for the remainder of Claimant C's 12-month period, as defined in section
						  3301(d) -
						  1. The voluntary plan and the
						  Disability Fund are each liable for benefits at one half of the state plan
						  rate. The voluntary plan is liable for the amount, if any, above the state plan
						  rate for which the individual is eligible, as specified by the voluntary
						  plan.
1.
						  Amendment filed 4-1-82; effective thirtieth day thereafter (Register 82, No.
						  14).
2. Amendment of first paragraph, designation of second
						  paragraph as subsection (a), new subsection (b) and amendment of NOTE filed
						  7-1-2004 as an emergency; operative 7-1-2004 (Register 2004, No. 27). A
						  Certificate of Compliance must be transmitted to OAL by 10-29-2004 or emergency
						  language will be repealed by operation of law on the following
						  day.
3. Certificate of Compliance as to 7-1-2004 order transmitted
						  to OAL 10-25-2004 and filed 12-2-2004 (Register 2004, No.
						  49).
Note: Authority cited: Sections
							 305,
							 306
							 and
							 2602,
							 Unemployment Insurance Code. Reference: Sections
							 3253,
							 3301,
							 3302.1
							 and
							 3303,
							 Unemployment Insurance Code.