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SINOT

What is the Temporary Non Occupational Disability Insurance (SINOT, in Spanish)?


The Temporary Non Occupational Disability Insurance is a plan provided by the Law 139 of June 26, 1968 providing benefits to workers who have lost their income due to an illness or accident that is not related to their work or automobile accident.


Who can obtain coverage under this plan?


This plan protects any worker, except drivers, employees of the Commonwealth of Puerto Rico, the United States of America Government, and of non profit organizations, unless the employer included them voluntarily.


ELIGIBILITY


What are the eligibility requirements for the employee?


The worker must:


1- Have received a salary of at least $150.00 in a covered employment during his or her base year.

2- Be unable to work due to a disability caused by an illness or accident that is not related to work or an automobile accident.

3- Be receiving medical treatment from an authorized physician or chiropractor.


What benefits does the insured worker receive?


The insured worker will receive weekly benefits for loss of income. It also provides benefits for death and dismemberment resulting from an accident not work related or caused by an automobile accident.


How much does the plan cost?


The contribution is 60% of the salary paid to the employee up to a $9,000 maximum in the regular year.


How is this contribution paid?


Generally, the employer and the employee contribute the same amount. The employer may opt to pay the total premium amount, or a larger portion than the one the insured employee pays.


What is the meaning of base year?


It refers to the insureds’ salaries during the first four (4) of the last five (5) quarters preceding application for benefits filing date.


What is the amount of weekly benefits?


The weekly benefit for the basic plan is between $12.00 and $113.00 depending on the insured salary for the base year. Upon the employer’s request alternate plans may be offered.

There is a Federal Social Security deduction because the employer’s contribution is considered income.


What are the accidental death and dismemberment benefits?


The basic benefits vary, depending on the loss, between $2,000 and $4,000. The coverage losses are: loss of life or limb, hand, finger, or vision. Upon the employer’s request alternate plans may be offered with additional benefits.


When do insured workers receive disability benefits?


Disability benefits are paid from the first day in which the worker is admitted to the hospital or on the eighth day after the disability ensued, if the worker was not hospitalized.


What is the duration of disability benefits for employees?


The insured workers receive benefits for the duration of the disability, up to a maximum of 26 weeks in any period of disability and in any period of 52 regular consecutive weeks.


Can a pregnant employee claim benefits outside of the maternity leave period?


Yes. A pregnant worker may receive benefits if she is unable to work and complies with the other provisions of the law.


Can a worker receive disability benefits during the rest period of maternity leave?


No. The provisions of the Working Mothers Protection Law, Law Number 3 of March 13, 1942, as amended, mandate that the employer must pay the employee’s salary. The worker may be eligible for benefits when the employer does not have the responsibility to provide payment during a leave of absence for maternity purposes.


Claims and Limitations


What is the process to file a claim under this plan, and when can a claim be submitted?


To receive benefits for which they are eligible, the insured employee must submit a claim in writing or in person with the Company’s Central Office. If the claim is for loss of income due to a disability, the employee must submit a claim within three (3) months following the disability. If the claim is for accidental death or dismemberment, the employee must submit a claim within six (6) months following the loss.


What are the restrictions or exclusions of this plan?


The individual will not be eligible to receive benefits under this plan:


1- If he or she is not receiving treatment from a duly licensed physician or chiropractor.

2- If he or she worked with or without receiving compensation.

3- If the disability is caused by intentional injuries, self-inflicted or sustained during the commission of an act.




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