Current through Register Vol. 48, No. 38, September 20, 2024
a)
Pursuant to Code Section 15-150, a participant may be granted a disability
benefit if, while a participating employee, he or she becomes physically or
mentally incapacitated and unable to perform the duties of his or her assigned
position for any period exceeding 60 consecutive calendar days and the employee
had completed 2 years of service at the time of disability, unless the
disability is a result of an accident. An employee shall be considered disabled
only during the period for which the Board determines, based upon the evidence
listed in this Section, that the employee is unable to reasonably perform the
duties of his or her assigned position as a result of a physical or mental
disability. This determination shall be based upon:
1) a written certificate from one or more
licensed and practicing physicians appointed by or acceptable to the Board,
stating that the employee is disabled and unable to reasonably perform the
duties of his or her assigned position;
2) a written certificate from the employer
stating that the employee is unable to perform the duties of his or her
assigned position; and
3) any other
medical examinations, hospital records, laboratory results, or other
information necessary for determining the employment capacity and condition of
the employee.
b)
Application Filing Requirements
1) An
application for disability benefits must include the certifications described
in subsections (a)(1) and (a)(2), and supporting documentation described in
subsection (a)(3), all as explained in more detail in this Section, for each
disabling condition as well as for the entire period of disability.
2) The application must be filed within one
calendar year after the date on which the disability occurred. This limitation
may be waived upon a showing of good cause, including, but not limited to,
circumstances in which the applicant was under some physical, mental or medical
infirmity or legal status that prevented the applicant from filing within the
time period.
c)
Certification By Physicians. For purposes of subsection (a)(1), the following
shall apply:
1) Physicians acceptable to the
Board are attending physicians, physicians designated by the participant and
physicians to whom the participant was referred by the attending or designated
physician. Physicians appointed by SURS staff to examine the participant are
deemed to be physicians appointed by the Board. The physician must be licensed
to practice and be currently practicing in the field of expertise related to
the underlying physical or mental condition for which disability benefits are
sought.
2) The certification must
be signed by a physician described in subsection (c)(1) or an authorized
representative of the physician and must state the following:
A) the medical diagnosis of the physical or
mental condition;
B) the prognosis
of the physical or mental condition;
C) the physical or mental limitations to
which the participant should adhere; and
D) that the participant is disabled and is
unable to reasonably perform the duties of his or her assigned position as a
result of the physical or mental disability.
3) The certification must be accompanied by a
report containing the following:
A) the date
of examination;
B) the medical
history of the participant;
C) the
results of any diagnostic tests used;
D) the diagnosis of the physical or mental
condition;
E) the plan of treatment
for the physical or mental condition and prognosis in response to the treatment
plan;
F) an evaluation of the
physical or mental condition as it bears upon the participant's ability to
reasonably perform the duties of his or her assigned position; and
G) any existing documentation of objective
medically demonstrable anatomical, physiological or psychological abnormalities
manifested as test results or laboratory findings apart from self-reported
symptoms.
d)
Certification by Employers. For purposes of subsection (a)(2), the
certification must be signed by an officer authorized by the employer and must
state the following:
1) the physical or
mental performance requirements for the reasonable performance of the
participant's assigned position;
2)
whether the participant is able to satisfy each physical or mental performance
requirement for the reasonable performance of his or her assigned position to
the best of the employer's knowledge or belief and the reason for that
knowledge or belief; and
3) whether
the participant is able to reasonably perform the duties of his or her assigned
position based on the provisions of subsections (d)(1) and (d)(2).
e) Determination of Disability. If
the participant establishes, by a preponderance of the evidence, that he or she
is physically or mentally disabled and unable to perform the duties of his or
her assigned position as a result of the disability, the participant shall be
determined eligible for disability benefits under Section 15-150 of the Code.
1) SURS staff shall determine whether
certifications made under subsections (a)(1) and (a)(2) and supporting
documentation described in subsection (a)(3) establish eligibility for
disability benefits.
2) At the
discretion of SURS staff, the participant may be required to submit to
additional examinations by staff appointed physicians or specialists to aid in
the determination process.
3)
Physical or mental conditions resulting from self-inflicted injuries, substance
abuse, or any act for which the participant was convicted of a misdemeanor or
felony are not the result of an accident for purposes of Code Section
15-150.
f) Subsequent
Re-examination of Disabled Participants
1)
SURS staff shall secure from one or more physicians, periodically,
re-evaluation reports concerning the continued disability of the participant.
The date of re-evaluation shall be determined by SURS staff on the basis of the
medical reports received previously, the nature of the disability, and other
relevant information.
2) In the
re-evaluation of disability claims, the examining physician shall be the
attending physician or the physician designated by the participant, but, if the
nature of the disability or other circumstances justifies the appointment of
someone other than the participant's attending physician or designated
physician as the examining physician, SURS staff shall make the appointment.
All other procedures that may be applicable in processing the initial claim for
disability benefits shall be followed in re-evaluation of the claim.
g) Release of Medical Information.
The participant may be required to authorize the release of all medical or
other information related to the disability claim, including but not limited to
medical reports, hospital records, Department of Employment Security earnings
statements, income tax records, unemployment records, and any record deemed
necessary to the administration of the disability claim. The failure of the
participant to submit to a re-evaluation examination or a treatment plan, to
produce records, or to approve release of information required may result in
the suspension of disability benefit payments.
h) Vacation Payments and Disability Benefit
Commencement. If an employee receives payment for unused vacation leave accrued
under the employment from which the employee is disabled, the date of the
"termination of payment of salary or sick leave benefits" under Code Section
15-151 shall be delayed by the number of work days attributable to the vacation
payment.
