Current through all regulations passed and filed through September 16, 2024
(A)
The department of
administrative services ("the department") provides disability leave benefits
to eligible state of Ohio employees.
(B)
An employee who
is eligible to receive disability leave benefits may receive disability leave
benefits due to a disabling illness, injury, or condition.
(C)
Procedures to be
followed for determining an application for disability leave benefits.
(1)
Employees will
submit an application for disability leave benefits to the director of the
department or the director's designee within twenty calendar days from the last
day worked due to the disabling illness, injury, or condition.
(2)
Employees will
submit a request to extend disability leave benefits within twenty calendar
days of the ending date of granted disability leave benefits or within twenty
calendar days of the date of a written request for additional
information.
(3)
Employees will submit to the director or the director's
designee, within twenty calendar days of a request to do so, medical
documentation from a state licensed medical practitioner establishing that the
employee's illness, injury, or condition prevents the employee from performing
the duties of the employee's position, a similar position, or other duties
within a transitional work program.
(4)
The director or
the director's designee is responsible for determining whether an employee is
eligible and meets the specifications for receiving disability leave benefits
due to a disabling illness, injury, or condition.
(5)
Eligible
employees who fail to file an application, a request for an extension, or the
requested medical documentation relating to the claim within the deadline may
have their disability leave benefits delayed to the date of the
filing.
(D)
Payment of disability leave benefits.
(1)
Disability leave
benefits will commence following a waiting period of fourteen consecutive
calendar days from the last date worked due to the disabling illness, injury,
or condition.
(2)
Disability leave benefits will be paid at sixty-seven
per cent of the employee's base rate as of the date the employee became
disabled, up to a lifetime maximum of twelve months based on the employee's
scheduled hours of work at the time of the filing of their claim. All
disability leave benefits that were granted for claims filed on or after
October 29, 2006, will be counted toward the twelve-month lifetime maximum
limitation.
(3)
An employee receiving disability leave benefits, and an
employee during the waiting period, may indicate a desire to utilize
accumulated sick leave, personal leave, and vacation leave balances, as well as
compensatory time, to receive up to one hundred per cent of pay for time on
disability leave or during the waiting period. Such supplementation will have
an effective date as of the date the employee requests the supplementation. The
sick leave, personal leave, and vacation leave balances, and compensatory time,
will be paid at a rate equal to the employee's base rate of pay in effect at
the time the employee became disabled.
(4)
An employee who
does not have sufficient accumulated sick leave, personal leave, vacation
leave, or compensatory time to be paid during the waiting period will be
considered to be on an approved unpaid leave of absence.
(E)
Service credit. An employee receiving disability leave
benefits will continue to accrue service credit for purposes of determining
vacation benefits, annual step increases, longevity supplement, and retirement
benefits. Vacation leave benefits will not accrue while an employee is
receiving disability leave benefits. The period during which an employee is
receiving disability leave benefits will not count toward an employee's
probationary period.
(F)
Insurance and premiums.
(1)
For those
benefits paid in whole or in part by the state, the employer's and employee's
share of the health, life, and other insurance benefits will be paid by the
employer during the time an employee is in a no pay status while the claim for
disability leave benefits is being processed and during the period that the
employee is receiving disability leave benefits. If an employee is in paid
status while the claim for disability leave benefits is being processed, the
employee is responsible for their share of health, life, and other insurance
benefits.
(2)
If an employee has exhausted disability benefits, the
employee is not entitled to have health, life, or any other insurance benefit
paid by the employer.
(3)
If an employee's claim for disability leave benefits is
subsequently denied and the employee had been in a no-pay status while the
employee's claim was being processed, it is the employee's responsibility to
reimburse the employer the insurance premiums paid on the employee's
behalf.
(4)
An employee receiving disability leave benefits may
participate in an open enrollment period. Any change in the employee's health
insurance benefits will be effective at the beginning of the benefit
year.
(G)
Termination of disability leave benefits. An employee's
benefits will be terminated if the employee:
(1)
Is removed from
state service except as provided under rule
123:1-41-21 of the
Administrative Code;
(2)
Engages in any occupation for wage or profit that is
the same or similar to their current state of Ohio position or has the same or
similar physical or mental qualifications, except where the employee is
engaging in transitional work, partial return to work, or light
duty.
(3)
Engages in any act of fraud or misrepresentation
involving the disability claim including the alteration of attending physician
statements;
(4)
Fails to comply with the provisions of section
124.385 of the Revised Code or
this rule;
(5)
Is convicted of the commission of a felony;
or
(6)
Does not notify the appointing authority of a change of
address.
(7)
Fails to participate in a transitional work program
that is agreed upon by both the employee's medical practitioner and the
employee's appointing authority.
(H)
Necessity of
applying for retirement benefits.
(1)
The following employees will apply for disability
retirement benefits as set forth in paragraph (H)(2) of this rule in order to
receive continued disability leave benefits:
(a)
Disability
retirement eligible employees who are nearing six months of continuous
disability leave payments;
(b)
Those employees
whose physicians have deemed them permanently disabled; and
(c)
Those employees
whose total disability leave will exceed twelve months.
(2)
To
comply with the provisions of this rule, employees will complete all of the
following:
(a)
Submit an application to the applicable state employees'
retirement system;
(b)
Comply with all retirement system specifications;
and
(c)
Submit all information requested by the retirement
system for disability retirement benefits.
(3)
After the
employee submits documentation establishing compliance with this provision, the
employee may receive disability leave benefits in an amount that will bring the
employee to sixty-seven per cent of the employee's base rate of pay as of the
date the employee became disabled.
(I)
Disability leave
benefits are not payable for any disability caused by or resulting from:
(1)
Any injury or
illness received in the course of and arising out of any employment covered by
any workers' compensation or federal compensation plan, or during any period in
which the employee is receiving, or has been approved for, occupational injury
leave, salary continuation, or lost time wages from the bureau of workers'
compensation except as outlined in paragraphs (I)(1)(a) and (I)(1)(b) of this
rule.
(a)
In the
case of any injury or illness that may be covered by the bureau of workers'
compensation, an employee may file an application for disability leave benefits
within twenty calendar days of the receipt of a denial order from the bureau of
workers' compensation.
(b)
Employees who do not intend to appeal a denial order
will submit an affirmation of such with their application for disability leave
benefits.
(c)
Employees who have or intend to appeal a denial order
from the bureau of workers' compensation on an initial claim may receive an
advancement of disability leave benefits. All disability leave benefits
received by the employee as an advancement will be reimbursed by the employee
to the disability leave benefits program if the employee is awarded weekly wage
payments by the bureau of workers' compensation for the same time period for
which the advancement was made or the employee has been paid a lost time wage
settlement.
(d)
An employee who receives injury pay pursuant to section
124.381 or section
5503.08 of the Revised Code may
be eligible for disability leave benefits when injury pay expires if the
employee has received a final notice denying workers' compensation benefits and
has applied for disability leave benefits within twenty calendar days of such
notice;
(2)
Attempted suicide, or self-inflicted injury with the
intent to do bodily harm, unless there is a medical history of treatment within
five years from the current date of disability for a psychiatric illness, in
which case the director or the director's designee reserves the right to review
the claim for consideration of a benefit award;
(3)
Any act of war,
declared or undeclared, whether or not the employee is in the armed forces. In
the case of an employee who is a veteran of the United States armed forces,
disability benefits will not be denied because the employee contracted the
illness or received the injury in the course of or as a result of military
service and the illness or injury is or may be covered by a compensation plan
administered by the United States department of veterans'
affairs;
(4)
Participating in a riot or
insurrection;
(5)
Drug addiction or alcoholism. However, alcohol or other
drug addiction diagnoses may be covered if the employee is receiving and
complying with ongoing treatment and it is determined that such treatment
program prevents the employee from working as documented by the treatment
provider; or
(6)
Any injury received or illness contracted in the act of
committing a felony.
(J)
Discipline of an
employee receiving disability leave benefits. An employee receiving disability
leave benefits may be disciplined pursuant to the provisions of section
124.34 of the Revised Code, an
applicable collective bargaining agreement, or the appointing authority's
policies. If the appointing authority conducts a pre-disciplinary investigatory
interview, the employee may be granted administrative leave with pay for the
duration of the interview. The employee will not receive payment of disability
leave benefits for those hours spent on administrative leave with pay, nor will
the hours count towards the employee's lifetime maximum benefit. If an employee
is removed from service, disability leave benefits will be discontinued as of
the date the employee is removed from service. The appointing authority is
responsible for notifying the director or the director's designee of any
employee removed from service who is receiving disability
benefits.
(K)
Appeals.
(1)
Upon the denial of an employee's application for
disability leave due to a medical issue, or upon the termination of disability
leave benefits due to a medical issue, an employee may file an appeal to the
director or the director's designee within thirty days of the date of notice of
the denial or termination. If the employee provides new medical documentation
with the appeal, the director or the director's designee will obtain a medical
opinion from a third party to address the medical issue. The selection of a
third party will be made within fifteen days of the appeal request unless an
extension is agreed to by the parties. The third party will render a medical
opinion within thirty days of the selection and the decision of the third party
will be binding.
(2)
Upon the denial of an employee's application for
disability leave or upon the termination of disability leave benefits where no
medical question is at issue, an employee may file an appeal to the director or
the director's designee within thirty days of the date of notice of the denial
or termination.
(L)
The director or
the director's designee will initiate all necessary steps to recover disability
leave benefits or insurance premiums paid in error or paid as a result of
fraud, or to make any needed adjustments to ensure that proper payment of
benefits and insurance premiums has been made. When necessary, the director or
the director's designee will request the attorney general to take appropriate
action to recover improperly paid benefits or insurance
premiums.
