To CAPF Participants:
On behalf of the CAPF executive board, I am pleased to provide you with an update on the state of our LTD plan and to tell you that our plan continues to be financially strong and the overwhelming choice among professional firefighters in California for long-term disability coverage.
Recently, our competitors have made major changes to the structure of their LTD plans. CPF announced last month that its plan is limiting its self-funded coverage of disability benefits to two years, after which claims will be underwritten and managed by a stockholder owned, for-profit insurance company. The CSFA LTD plan, meanwhile, is now fully operated and administered by an insurance company from day one and they recently announced a 10% rate increase and some reductions of benefits.
CAPF, unlike our competitors, remains a fully self-funded, member-owned plan with a sustainable reserve that now exceeds $6.1 million. Three out of four firefighters with LTD coverage in California are CAPF plan members; our list of participants includes 153 union and association groups and a growing number of Cal Fire members. In total, our plan serves over 18,000 professional firefighters throughout California.
The reason for our continued success is simple: For nearly 30 years, we have provided significantly better benefits than our competitors for a lower monthly cost. Our competitors' plans do not provide lifetime coverage or 80% of wages of disability benefits, as we do, and they (CSFA) includes limitations such as 24 months for musculoskeletal and connective tissue disorders, which comprise almost two-thirds of all claims. From the start, our primary goal has been to provide unparalleled value to firefighters in California and it is clear we are continuing to successfully fulfill that mission.
Our financial strength is bolstered by our success recovering claim dollars from employers who have initially denied Workers' Compensation benefits to our members. In 2013, we recovered an average of almost $45,000 per month and we are aggressively pursuing an additional $2.6 million in outstanding recoverable claims. Through this process, we ensure our members' financial needs are covered even when employers initially reject their claims. In over 80% of cases, however, we are successful in helping to prove the employer's responsibility for coverage and receive reimbursement for benefit payments provided to our members. To the best of our knowledge, neither of our competing plans has ever achieved this level of success in recoveries.
Since our inception in 1985, CAPF has paid over $53 million in claims to its members and their families. We are proud that our claims decisions are made by a committee of firefighters, not insurance company employees who may not put your best interests first. A growing number of our members are celebrating relationships of 15, 20, or 25 years (or more) with CAPF, and we are committed to providing continued value as a self-insured plan managed by firefighters for firefighters.
Thank you for your continued support of CAPF and I invite you to contact me with any questions you may have.
Gene Dangel, President
Applications for Children's Scholarship Program Due April 1, 2014
Workers' Compensation Medical Treatment -- Pre-designation of the Treating Physician
Firefighters who have sustained a work injury, such as while pulling hose or lifting gear, are faced with a complex system that can be a maze. After an injury, a primary concern is receiving prompt medical treatment so that the firefighter can return back to work. All too often, however, medical treatment benefits are stymied for firefighters, prolonging the off duty status and creating further uncertainty in their future. This article will provide a guide for the medical treatment benefits in the workers' compensation process.
When a firefighter sustains a work injury, the agency must provide medical treatment that will cure and relieve the effects of the injury. Labor Code §4600 outlines the employer's obligations to provide prompt medical treatment.
The plain language of the §4600 is clear--the employer must timely provide and authorize medical treatment. Unfortunately, in 2004 the medical treatment benefits experienced significant changes under the Workers' Compensation reform bills by then--Governor Schwarzenegger.
Now, the injured firefighter must select physicians within the employer Medical Provider Network (MPN). The MPN will identify a number of treating physicians by specialty in the surrounding geographic area of where the firefighter resides. It is important to determine who the good treating physicians are on the MPN list. If the firefighter has no pre-designated treating physician, the injured firefighter will be forced into locating a treating physician within the network.
On the other hand, if the firefighter pre-designates a primary treating physician (PTP), the firefighter can avoid the MPN. A firefighter may be treated for an industrial injury by a personal physician that was pre-designated prior to the industrial injury if the following three conditions are met: (1) Notice of the pre-designation of a personal physician is in writing, and (2) is provided to the agency prior to the industrial injury for which treatment by the personal physician is sought. Lastly, the notice shall include the personal physician's name and business address. Click to Read More
About the Author-John A. Ferrone is a partner in the law firm of Adams, Ferrone & Ferrone. The law firm specializes in the representation of public safety regarding contract negotiation, grievances, internal affairs, firefighter involved shootings, workers' compensation, retirement, and personal injury. The law firm has offices in Westlake Village, Newport Beach, Bakersfield, and San Diego. If you have further inquires, please e-mail them to email@example.com.
Click to download Pre-designation Form
Top 10 Reasons to Buy NPFBA Long Term Care Coverage
- Rates are 50% to 70% lower than other long term care (LTC) plans.
- Lifetime Benefits -- Waiver of Payment while receiving benefits.
- Fixed payment terms -- No lifetime payments.
- 5% Compounded Inflation Protection means your benefit grows for the first 15 years you're in the plan.
- Skilled/Nursing Care benefits start at $150 per day and grow to $297 per day.*
- Residential/Assisted Living benefits start at $105 per day and grow to $208 per day.*
- In-Home Care benefits start at $75 per day and grow to $148 per day.*
- Death Benefit.
- Available only to fire department employees and their spouse. Managed by your CAPF Executive Board Members (NPFBA Trustees).
- Plan actuarially sound through 2085 as of the last actuary.
Download NPFBA Information
Download NPFBA Cost Schedules
*Other Plan options available. For illustration only. Refer to Plan documents for specific details. CA Insurance Lic. #O544968
Alameda County Firefighters Annual Pancake Breakfast
Date: March 15, 2014
Time: 7 to 10 AM
Location: Fire Station #16, 7494 Donahue Drive, Dublin
Tickets: $5 per person. Available at door.
Children's Scholarship Program Application Deadline
Date: April 1, 2014
More Information: www.CAPF.org/scholarship.html
CAPF Board of Directors Meeting
Date: April 4, 2014
Location: San Diego
If you have an event you'd like us to include, please send an email to Rebecca@caladmin.com. Events published at CAPF's discretion.
COMMON TERMS & DEFINITIONS IN LTD & LTC
Activities of Daily Living (ADLs)
Long Term Disability & Long Term Care
The Activities of Daily Living (ADLs) are bathing, dressing, toileting, transferring, ambulating, continence and eating. A person's ability to perform these activities generally determines the degree of his/her disability and eligibility for benefits. For example, the NPFBA Long Term Care Plan requires a person to be unable to perform a minimum of 2 ADLs including transferring to be eligible for
Do you have questions
Your CAPF Vice Presidents invite you to contact them with your questions or concerns.
Vice President North
Vice President South
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Cardiovascular Diagnostic Center.
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