My claim has been denied by Standard. How can I appeal?

You can use the appeal/grievance process outlined by Standard in its determination letter or the disability evidence of coverage booklet. There is no appeal through the Employee Benefits Division (EBD) or any other City of Los Angeles entity.

I exhausted FMLA (or was not eligible for FMLA), what happens to my benefits while I wait for Standard to make a disability claim determination?

You should utilize the direct bill option. This option allows you to pay the full cost of your LAwell benefits while you wait for a determination. You can remain on direct bill for a maximum of 60 days while Standard makes its determination. If Standard has not made a decision by the end of that period; your insurance will be canceled and you will be offered COBRA.

What is the Benefit Protection Plan (BPP)?

The Benefit Protection Plan allows you to continue any LAwell medical, dental, vision, basic life insurance, and EFAP coverage you had as an active employee for up to two years while on an approved disability claim with the Standard. You can also continue coverage for any dependents who are enrolled when you become disabled; however, the City subsidy will only continue for the employee, unless there has been no break in your coverage. While on BPP, you will be required to continue paying the coverage costs you paid as an active employee, if any, plus any costs for your dependent coverage. BPP is generally not for work-related injuries while receiving IOD. BPP is also not or for individuals who have terminated or retired from City service for any reason.

• Note: If your disability is work-related, you may still apply for a LTD disability claim with The Standard. If approved, you will be eligible for BPP for up to two years or until your disability claim with The Standard has ended, whichever occurs first. To learn more, visit the Benefit Protection Plan FAQ's

I am on BPP and failed to pay the required payroll deduction premiums. What happens?

If you fail to pay any required premiums in conjunction with your BPP coverage, all of your coverage levels will be canceled and you and your dependents will be offered COBRA.

I have a large amount of sick leave. Once that is exhausted and Standard begins paying me, how long can I be covered under BPP?

A maximum of two years, in conjunction with an active disability claim through The Standard. Visit the FAQ guide for City of Los Angeles Disability Benefits by The Standard for additional information

I have filed a claim with Standard Insurance and it has been denied, but my doctor believes that I am unable to work and my department has placed me on Family Medical Leave. Can I be covered under the Benefit Protection Plan?

While you are eligible to continue receiving the City’s subsidies toward your benefit costs, as outlined by the Family Medical Leave Act (FMLA) provision of your Memorandum of Understanding (MOU), denial of your claim by Standard makes you ineligible for the BPP once your FMLA status has been exhausted (maximum of 9 pay periods). The Benefit Protection Plan is offered in conjunction with an approved disability claim.

If I terminate from City service while on Benefit Protection Plan (BPP), will my benefits continue?

Your participation in this program will end if you retire (service or disability) or leave City service for any reason. However, you will be offered coverage continuation under the Consolidated Omnibus Budget Reconciliation Act (COBRA), which is your opportunity to continue your coverage through direct payment to each insurance company. This law requires that most employers who sponsor group health and dental plans offer employees and their family members the opportunity to temporarily extend health and dental coverage at group rates in certain cases where group coverage would otherwise end. This coverage is identical to the coverage being offered to active employees. Visit COBRA or Please call the LAwell COBRA Coordinator at (213) 978-1655.

I have an approved claim with Standard, which is later denied. Will my BPP coverage continue?

No, BPP will end on the date that the claim is closed by Standard.

If I am approved for disability retirement while under BPP, will my benefits continue?

No, your benefits through the EBD will be terminated. Employees in any type of retirement status must contact the Los Angeles City Employees Retirement System (LACERS) for benefit information. If benefits are not available through LACERS; you have the option of continuing through COBRA or an individual plan.

• Please note: The City requires that disability retirement applications be filed within twelve months from the last day on City payroll. If not, the employee may lose the opportunity to file. Whether you file for disability retirement or not, your benefits from Standard Insurance will be reduced by that amount under the deductible income provision.

What happens if I went from Injured on Duty (IOD) to Workers’ Compensation State Rate, but did not know to file a disability claim for the period of disability after the 6-month waiting period? Am I eligible for the Benefit Protection Plan (BPP)?

Employees who have a work-related injury are not eligible for the BPP while on IOD status during the first 180 days of their work-related injury. After the 180 days, employees with work-related injuries may be eligible for the BPP by filing a LTD claim with the Standard. If approved, BPP would apply to the approved LTD dates determined by The Standard. After being on IOD Status, if a LTD claim is not approved, these individuals are offered continuation of benefits under the Consolidated Omnibus Budget Reconciliation Act (COBRA), which is your opportunity to continue your coverage through direct payment to each insurance company. Visit COBRA for further details.

Standard approved my disability claim retroactively and paid a lump sum for the period of time that has already transpired. How long can I remain under BPP?

From the date of Standard’s approval through the termination date or two years, whichever is less. It is a period of time that corresponds with the benefit payment window determined by Standard. For additional information refer to City of Los Angeles FAQ's about Disability Benefits from The Standard