Supplemental Works' Compensation Plan: Equity-League Fund

SUPPLEMENTAL WORKERS’ COMPENSATION PLAN

Job Connected Injuries and Sicknesses

If you are under an Actors' Equity Association contract that requires contributions for Supplemental Workers Compensation, you are eligible for this coverage. To qualify, you must apply for and be eligible for Workers' Compensation. If you qualify, the Fund provides compensation in addition to Workers' Compensation. Members who are injured while performing in extraordinary risk capacity shall be designated as Class II Category members. All others shall be designated as Class I Category members.

"Extraordinary Risk" means: (a) performance of acrobatic feats; (b) suspension from a trapeze or wires or like devices; (c) use of or exposure to weapons or to fire or pyrotechnic devices; (d) taking dangerous leaps, falls, throws, catches, knee drops or slides; or (e) any other activity, feat or device which, in accord with your contract, is classified as Extraordinary Risk.

WEEKLY LOSS OF TIME BENEFITS

Benefits during the first one hundred and four weeks are based on total disability in the performer's primary occupation, i.e., acting, singing, or dancing. A performer will be eligible for benefits beyond one hundred and four weeks only if the disability prevents him or her from working in any occupation for which the claimant is reasonably qualified.

APPLICABLE WEEKLY BENEFIT PAYMENTS

Class I Category: The benefit is the lesser of seventy five percent of your weekly salary or seventy five percent of seventy five percent of the current Production Contract minimum weekly salary for each full week less any amount payable under the applicable Workers' Compensation or Occupational Disease Laws.

Class II Category: (Extraordinary Risk Capacity):

A. Until the date the Season or Show Closes - The benefit is the lesser of one hundred percent of the performer's weekly salary or seventy five percent of the current Production Contract minimum less any amount payable under the applicable Workers' Compensation or Occupational Disease Laws.

B. After the date the Season or Show Closes – The benefit is the lesser of seventy five percent of the performer's weekly salary or seventy five percent of seventy five percent of the current Production Contract minimum weekly salary less any amount payable under the applicable Workers' Compensation or Occupational Disease Laws.

HOW TO APPLY

The claims process is explained separately and in detail in the Actors' Equity Association "Work-Related Injury Checklist" (the "Checklist") available from any Actors' Equity office, the Fund Office, or our website, www.equityleague.org. In summary, you must take the following steps to apply for benefits:

· Immediately report the work related injury or illness to the Stage Manager,

· Obtain claim forms for Supplemental Workers' Compensation Plan benefits from any Actors' Equity office or the Fund Office,

· Obtain from your employer the name and address of the Workers' Compensation Insurance carrier,

· Provide your physician with the name of your employer's Workers' Compensation carrier,

· DO NOT USE YOUR PERSONAL HEALTH INSURANCE COVERAGE FOR THE TREATMENT OF WORK-RELATED INJURIES OR ILLNESSES,

· Submit to Actors' Equity your claim forms after you and your attending physician complete them, and

· Provide to Actors' Equity copies of any and all benefit checks and accompanying explanation of benefits paid to you by the Workers' Compensation carrier.

EXCEPTIONS

Not covered is loss of time: (1) caused by an attempt at suicide, while sane or insane, (2) resulting from an act of declared or undeclared war or (3) resulting from air travel unless the performer is traveling as a passenger (and not as a pilot or crew member) during necessary travel time.

IMPORTANT

Be sure that YOUR EMPLOYER completes an Accident or Workers' Compensation report form, if you are injured while working (i.e., rehearsing, performing, etc.) and that you obtain the name and address of the insurance company carrying the Employer's Workers' Compensation policy, or the name and address of their insurance broker. Time and salary loss may not occur, but a record of the injury or sickness should be on file in your employer's place of business since you must know where bills and reports are to be sent should you need medical attention at a later date.

If you lose time and salary as a result of the accident, a Workers' Compensation claim is entered by your employer reporting the injury and your doctor who submits medical evidence of disability to the Employer's insurance company to be matched up with the report.

Claims for supplemental benefit under the Supplemental Workers' Compensation Plan must be filed by you through Actors' Equity Association. Necessary claim forms may be obtained from any Actors' Equity office. Also, be sure to keep your own record of the place, time and date of the accident or injury.

TAX INFORMATION

Since the Supplemental Workers' Compensation Plan benefit is taxable wages and subject to voluntary federal income tax withholding, you will be given a Form W-4S, Request for Federal Income Tax Withholding From Federal Sick Pay. You may select or decline voluntary federal tax withholding on benefits paid. If the Form W-4S is not returned to Actors' Equity, no federal taxes will be withheld. State tax withholding is generally mandatory (except for Illinois and California, where it is voluntary). The benefit is subject to Social Security and Medicare (FICA) taxes for the first six months of the benefit. The employee's share of FICA will be deducted from your payment. For tax reporting purposes, at year-end all recipients of Supplemental Workers' Compensation Plan benefits will receive a Form W-2 from the Fund Office.

SUPPLEMENTAL WORKERS’ COMPENSATION BENEFITS - - CLAIMS AND APPEALS PROCEDURES

Effective for claims filed on or after January 1, 2002, the Fund’s Board of Trustees has adopted the following changes to the Fund’s procedures regarding claims for Supplemental Workers’ Compensation Benefits (see page 33 of the Summary) and appeals of “adverse benefit determinations.” These procedures apply to all “adverse benefit determinations,” which include claim denials, reductions or terminations of benefits, and failures to make payment (in whole or in part) for a benefit, including determinations that are based on decisions relating to a participant’s or beneficiary’s eligibility to participate in the Fund.

Initial Claim Determinations

If your claim for Supplemental Workers’ Compensation Benefits (referred to as “Weekly Loss of Time Benefits”) is wholly or partially denied by the Fund, you will be notified of the Fund’s benefit determination within 45 days after your claim was received by the Fund. If the Fund Manager determines that an extension of time is necessary for processing your claim (due to circumstances beyond the control of the Fund), the 45-day period may be extended for up to an additional 30 days and, if additional time is still needed after that period ends, there may be one more extension of an additional 30 days. If an extension is needed, you will be notified (within the initial 45-day period) of the circumstances requiring the extension and the date by which a decision is expected to be made. The notice will inform you of the standards for entitlement to Weekly Loss of Time Benefits and the issues that are delaying a decision on your claim, as well as the additional information needed to resolve those issues. You will have 45 days to provide the Fund with the requested information.

If the Fund makes an “adverse benefit determination” with regard to your claim for Weekly Loss of Time Benefits, you will be provided with written notification including:

• the specific reasons for the Fund’s determination and references to the specific Summary provisions on which the determination is based,

• a description of any additional material or information needed to complete your claim (including an explanation of why the information is needed),

• a description of the Fund’s appeal procedure and applicable time limits, as well as a statement of your right to bring suit under federal law (Section 502(a) of ERISA) following an adverse determination on appeal,

• a statement that you have the right to submit written comments, documents, records and other information relating to the claim, and that, upon your request, the Fund will make available to you (or provide you with copies of) all documents, records and other information relevant to your claim,

• a description of any internal rule, guideline or similar standard that the Fund relied on in making the decision, or a statement that the rule, guideline or standard was relied on and that a copy will be provided to you (without charge) upon your request,

• a description of any scientific or clinical judgment that the Fund relied on in making a decision based on medical necessity, experimental treatment or a similar limitation, or a statement that such explanation will be provided (without charge) upon your request, and

• the name of any medical or vocational expert whose advice was obtained by the Fund in connection with your claim.

Appeals of Adverse Benefit Determinations

You (or your authorized representative) may appeal the Fund’s adverse benefit determination in writing to the Fund’s Board of Trustees within 180 days after you receive notice of the determination. (Prior to January 1, 2002, you had only 60 days to appeal such a decision.)

You (or your authorized representative) may submit written comments, documents, records and other information relating to the claim in support of your appeal. In considering your appeal, the Board of Trustees will review all information that you submit, even if it was not submitted or considered in the initial benefit determination made by the Fund. In addition, upon your written request, the Fund will provide you (or your authorized representative) with access to, or copies of, all documents, records and other information relevant to your claim.

If the initial decision on your claim for Weekly Loss of Time Benefits was based (in whole or in part) on a medical judgment, in deciding your appeal, the Board of Trustees will consult with a health care professional who has training and experience in the relevant field of medicine and who is not the same person as the individual consulted by the Fund in making the initial decision on your claim (or subordinate to that person).

The Board of Trustees will review your appeal during its next regularly scheduled meeting, provided that your appeal is received by the Fund Office at least 30 days before the meeting date. If your appeal is received by the Fund Office less than 30 days before the next regularly scheduled meeting of the Board of Trustees, your appeal will be reviewed at the second regularly scheduled meeting following the Fund’s receipt of your appeal. If special circumstances require an extension of time for processing your appeal, then the Trustees will make a decision on your appeal during the third regularly scheduled meeting following receipt of your appeal. If this extension is needed, you will be notified in writing (before the extension begins) of the circumstances requiring the extension and the date as of which the appeal determination will be made.

You will be notified in writing of the Board’s decision on your appeal within 5 days after the decision is made. If your appeal is denied, the written notice will include all of the information described above (in the section regarding notice of initial claim determinations), as well as a statement regarding the availability of other voluntary alternative dispute resolution options.

All decisions of the Board of Trustees are final and binding on all parties.

If you have any questions about these new procedures, please contact the Fund Office.