Everbrite LLC – Union Short-Term Disability (STD) Plan Cheat Sheet

Carrier: Reliance Standard Life Insurance Company
Policy Number: STD 1320000347
Effective Date: March 1, 2024
Anniversary Date: March 1 each year
Plan Type: Non-contributory, employer-paid
Jurisdiction: Governed by Wisconsin law and ERISA
Premiums: 100% employer-paid (0% employee contribution)

Eligibility & Enrollment

• Full-time employees only (30+ hours/week)
• Not eligible: Temporary or seasonal employees
• Reinstatement: Within 6 months if returning from approved leave or layoff

STD is commonly used for:

• Surgeries (e.g., knee, back, hernia)
• Pregnancy and childbirth recovery
• Serious illnesses (e.g., pneumonia, COVID complications)
• Injuries outside of work (e.g., car accident, broken bone)

Weekly Income Benefit

Definitions

• Disability: Inability to perform job duties, not working, under physician care
• Earnings: Base weekly salary (excludes OT, bonuses, commissions)
• Physician: Licensed provider not related to the insured
• Full-time: 30+ hours/week
• Partial Disability: Eligible if working part-time under a rehab plan approved by a physician and insurer

Exclusions

No benefits paid for disabilities:

• Self-inflicted injuries
• War or military service-related injuries
• While incarcerated
• Resulting from committing a felony
• Covered by Workers’ Comp or similar laws
• Arising from elective procedures (e.g., cosmetic surgery, IVF, sterilization reversal)

Coordination with Other Benefits

Benefits are reduced by income from:

• Other group or individual disability plans
• Government disability or retirement systems
• Social Security (including dependent benefits)
• Workers’ Comp or similar laws
• Salary continuation or wages from employer
• Settlements under Jones Act or Longshore & Harbor Workers’ Comp Act

Claims Process

Here’s a step-by-step guide for how an employee covered under the Everbrite LLC Union Short-Term Disability (STD) Plan can file a claim with Reliance Standard Life Insurance Company:

How to File a Short-Term Disability (STD) Claim

Plan: Everbrite LLC – Union STD
Carrier: Reliance Standard Life Insurance Company
Policy Number: STD 1320000347

Step-by-Step Claim Process

1. Notify Employer

• Inform your supervisor or HR department as soon as you become disabled.
• Ensure your absence is documented and that HR is aware you intend to file an STD claim.

2. Obtain Claim Forms

• Request the STD claim packet from HR or download it from Reliance Standard’s website:
• www.reliancestandard.com  go to “Forms” then go to “Disability Claim Packet”

3. Complete the Claim Packet

The packet typically includes three sections:

• Employee Statement:

  • Personal information
  • Details of your disability (date of onset, symptoms, treatment)
  • Signature and date

• Employer Statement:

  • Completed by HR or payroll
  • Includes job duties, salary, last day worked, and other employment details

• Attending Physician Statement:

  • Completed by your treating provider
  • Must include diagnosis, treatment plan, and estimated return-to-work date

4. Submit the Completed Packet

Send all completed forms to Reliance Standard via one of the following:

Email: claims@rsli.com
Fax: 267-256-3519
Mail:
Reliance Standard Life Insurance Company
Attn: Disability Claims Department
P.O. Box 8330
Philadelphia, PA 19101-8330

Need Help?

• Reliance Standard Claims Department: 800-351-7500
• Everbrite HR Contact: Sara Peterson speterson@everbrite.com 

Everbrite LLC Union STD.pdf