Long Term Disability Summary Plan Description

SECTION 4 - DISABILITY INCOME BENEFITS (Continued)

LONG TERM DISABILITY COVERAGE (Continued) Workplace Modification Benefit

When is Your Workplace Modification Benefit Payable? If you are Disabled or Partially Disabled and receiving a benefit from Liberty, a benefit may be payable to the Sponsor as part of your benefit for modifications to the workplace to accommodate your return to work or to assist you in remaining at work. Liberty will reimburse the Sponsor for up to 100% of reasonable costs the Sponsor incurs for the modification, up to the greater of:

1. $1,000.00; or 2. the equivalent of 2 months of your Monthly Benefit.

To qualify for this benefit: 1. the Disability or Partial Disability must prevent you from performing some or all of the Material and Substantial Duties of your occupation; and 2. any proposed modifications must be approved in writing and signed by you, the Sponsor and Liberty; and 3. the Sponsor must agree to make the modifications to the workplace to reasonably accommodate your return to work or to assist you in remaining at work. The Sponsor's costs for the approved modifications will be reimbursed after: 1. the proposed modifications have been made; and 2. written proof of the expenses incurred by the Sponsor has been provided to Liberty; and 3. Liberty has received proof that you have returned to and/or remain at work.

Long Term Disability Workplace Modification

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