Current through all regulations passed and filed through September 16, 2024
(A) For the purpose
of sections 5505.18 and
5505.181 of the Revised Code and
agency 5505 of the Administrative Code:
(1)
"Member" shall have the meaning described in division (J) of section
5505.01 of the Revised Code
except "member" does not include state highway patrol cadets attending training
schools pursuant to section
5503.05 of the Revised
Code.
(2) A terminated employee,
whether the termination from the state highway patrol is voluntary or
involuntary, ceases to be a member of the state highway patrol retirement
system (HPRS). Except as provided in rule
5505-3-07 of the Administrative
Code, a member shall not be considered terminated while receiving benefits
pursuant to section 124.385 of the Revised
Code.
(3) "Totally and permanently
incapacitated" means a disabling condition that physically or mentally totally
incapacitates a member from the performance of regular duty for a period of at
least twelve months from the date of HPRS's receipt of the completed
application packet.
(4) "In the
line of duty" means an illness or injury that occurred during or resulted from
the performance of official duties under the direct supervision of the state
highway patrol.
(5) "Not in the
line of duty" means an illness or injury that did not occur during or result
from the performance of official duties under the direct supervision of the
state highway patrol. Unless the illness or injury meets the presumption
criteria outlined in division (A) of section
5505.18 of the Revised Code or
competent and credible evidence is submitted to HPRS, a disability condition is
presumed to be not in the line of duty.
To be eligible for retirement on account of a
disability
incurred not in the line of duty, the
member must have accrued five years of service credit since becoming a "member"
as defined by this rule and section
5505.18 of the Revised
Code.
(6) "Disability
committee," as referred to in this rule, shall mean the "health, wellness, and
disability" standing committee established pursuant to paragraph (A)(1) of
5505-9-08 of the Administrative Code.
(7) "Medical advisor," as referred to in this
rule, shall mean the expert physician appointed by HPRS' board who advises the
disability committee and board during its deliberations relating to disability
applications.
(8) "Examining
physician" means a physician recommended by the medical advisor and approved by
the HPRS board.
(9) Unless
otherwise stated in this rule, all notifications or correspondence shall be
sent by regular U.S. mail to the member's
address included in disability benefits application unless HPRS receives notice
in writing of an alternative address.
(B) A disability benefits application packet,
hereafter referred to as application packet, provided by HPRS may be filed by a
member, a person acting on behalf of a member, or the superintendent of the
state highway patrol. In order for the application packet submission to be
considered complete, the applicant will submit the following:
(1) A completed application for disability
benefits, on a form approved by the board, listing the disabling
condition(s),
(2) Attending
physician medical evaluation form and statement, on a form approved by the
board, supporting the disabling condition(s) listed in the
application,
(3) Employer
determination and completed form of applicant's inability to perform his/her job duties
and responsibilities, and
(4) All
medical reports and documentation that relate to the disabling conditions
listed in the application. All medical reports must be received within one week
of initial submission of application.
(5) An incomplete application packet will not
be accepted and will not be considered filed.
(6) Once an application packet has been
accepted by HPRS and submitted to the medical advisor, additional medical
reports or documentation will not be accepted unless requested by the board,
disability committee or the medical advisor. Any documentation that is received
by HPRS after submission of the application packet to the medical advisor shall
be held and included as part of any reconsideration hearing as described within
this rule. Should the right to reconsideration not be exercised, the additional
medical evidence will be returned to the applicant.
(7) An application packet that does not
include an attending physician medical evaluation statement that indicates the
applicant is totally and permanently incapacitated will not be
accepted.
(C) Upon
receipt of a completed application packet, HPRS shall schedule the applicant
for an examination by at least one examining physician with expertise in the
disabling condition(s) listed in the application as recommended by the medical
advisor, unless the medical advisor recommends it is inadvisable to do so.
(1) Payment of any fees connected to the
acquisition of records or the preparation of reports of the attending
physicians shall be the responsibility of the member.
(2) Payment of any fees connected with the
preparation of reports of the examining
physician(s) shall be the responsibility of HPRS.
(D) After examining the applicant and
reviewing the application packet, any medical reports submitted by the
applicant, and the results of any additional medical testing, the examining
physician will file a written report with HPRS with the following information:
(1) Whether the member is totally
incapacitated for duty in the employ of the patrol,
(2) Whether the incapacity is expected to be
permanent, and
(3) The cause of the
member's incapacity.
(E) After the examining physician(s)'
report(s) is submitted, the medical advisor shall review the entire record and
file a written report with HPRS with the following information:
(1) A recommendation of whether the applicant
should be granted disability retirement benefits based on the medical
advisor's independent review or the record,
(2) Whether the injury or illness was in the
line of duty or not in the line of duty,
(3) Recommended medical treatment and medical
reports.
The medical advisor's report shall be considered an independent
medical opinion.
(F) When all necessary medical reports and
records have been received by HPRS, including the completed application packet,
examining physician's report described in paragraph (D) of this rule, and the
medical advisor's report / recommendation described in
paragraph (E) of this rule, HPRS shall schedule a hearing to be held at the
next disability committee meeting. If HPRS does not receive the required
information described in this paragraph of this rule at least fourteen days
before the next disability committee meeting, the application will be heard at
the following scheduled meeting of the disability committee.
(G) No less than fourteen days prior to the
hearing, the applicant will be sent notification of:
(1) The hearing date and time, and
(2) The right to appear at the hearing, with
or without counsel, to present testimony.
(3) If circumstances warrant it, the notice
requirement may be waived upon mutual consent of the applicant and
HPRS.
(H) The disability
committee hearing will be held in executive session. An audio recording of
testimony on behalf of the applicant will be made to provide the disability
committee and board with a record for further review, notwithstanding rule
5505-9-07 of the Administrative
Code. The disability committee will consider the application packet, the
examining physician's report, the recommendation of the medical
advisor, and other relevant information.
(1)
Consideration of a member's
application by the disability committee and board shall be limited to the
disabling condition(s) listed in the application and listed in the attending
physician's report as described in paragraph (B)(2) of
this rule that are supported by medical documentation provided to
HPRS.
(2) Acts occurring after the
application packet is completed and accepted that create new disabling
condition(s) or progress the disabling condition(s) described in paragraph
(H)(1) of this rule will not be considered by the disability committee or the
board. Nothing in this division shall preclude a member from filing a new
application for disability benefits.
(I) The disability committee may recommend
one or more of the following to the board:
(1)
Approval or denial of the application,
(2) A finding on whether or not the
disability occurred in the line of duty,
(3) A finding that disability retirement be
contingent on compliance with a treatment plan,
(4) Postpone determination, pending an
additional examination, or the submission of additional fact, or
(5) No decision, if the disability committee
cannot agree on a recommendation or acquire a majority vote.
(J) No more than five days after
the hearing, the applicant will be sent notification of:
(1) The disability committee's recommendations,
(2) The right to request reconsideration of
the disability committee's decision.
(K) No more than twenty days after the
initial hearing, the applicant may file a written request for reconsideration.
The written request shall be accompanied by a statement from the applicant, his
or her counsel and/or attending physician that the request for reconsideration
will be based on evidence contrary to the findings of the examining physician
or the committee.
(1) The request for
reconsideration will be considered at the next regularly scheduled meeting of
the disability committee unless rescheduled for the reasons outlined in
paragraph (K)(2) of this rule.
(2)
No more than ten days after requesting reconsideration, the member must file
new medical evidence relative to the disabling condition(s) considered by the
disability committee. The member may request one extension of twenty days to
submit new medical information. One additional extension, of no greater than
twenty days, will be granted if the member can show, and the medical advisor
concurs, that additional time is needed to obtain relevant new medical evidence
that is already in progress. If additional extensions are granted, the request
for reconsideration will be rescheduled to the next available disability
committee meeting. HPRS shall void the request for reconsideration if new
medical evidence is not received by HPRS in the time described in this
paragraph.
(3) Copies of the
reports of the examining physician will be sent to the member and the
member's agent upon written authorization of the
member, unless the release of such reports is otherwise prohibited by law. The
medical advisor's recommendation will not, however, be
released until the committee has made a recommendation regarding the
member's disability application.
(4) The disability committee will consider
only new medical evidence and new relevant information submitted in support of
the request for reconsideration.
(5) The applicant has the right to appear at
the hearing, with or without counsel, to present new relevant evidence and
testimony, and
(6) Evidence,
information, or other documentation not already submitted in accordance with
this rule will not be permitted.
(L) At the conclusion of the reconsideration
hearing, the disability committee may recommend one or more of the following to
the board:
(1) Approval or denial of the
application,
(2) A finding on
whether or not the disability occurred in the line of duty,
(3) A finding that disability retirement be
contingent on compliance with a treatment plan,
(4) Postpone determination, pending an
additional examination, or the submission of additional fact, or
(5) No decision, if the disability committee
cannot agree on a recommendation or acquire a majority vote.
(M)
(1) Except as provided in paragraph (M)(2) of
this rule, the committee's recommendation will be considered at the
next regularly scheduled meeting of the board. The board may adopt or reject
the recommendation, in whole or in part, or remand the recommendation to the
disability committee for further consideration. Unless requested by the board,
an applicant may not appear before the board. The decision of the board is
final.
(2) If the disability
committee postpones determination pursuant to paragraph (L)(4) of this rule, no
more than five days after the hearing, the applicant will be sent notification
of the reason for the postponement and the date the committee will make a final
recommendation to the board.
(N) The member will be notified of the
board's action no more than ten days after the board
meets. If benefits are granted, the member shall be advised of the
member's right to:
(1) Accept the benefit granted; or
(2) Waive the benefit and continue working
(a) No later than thirty days after the
board's final action, the member shall elect, on a form provided by the board,
either to accept or waive the board's grant of disability benefits.
(b) If no such election is made within the
thirty-day period provided in paragraph (N)(2)(a) of
this rule, the award shall be rescinded. If benefits are accepted but the
member fails to terminate employment with the state highway patrol within the
thirty-day period provided in paragraph (N)(2)(a) of
this rule, the award shall be rescinded.
(O) As a condition to granting an application
for disability benefits, the member shall agree in writing, on a form provided
by the board, to obtain any medical treatment recommended by the examining
physician or medical advisor and submit the required medical reports as
required by the board.
(1) Such additional
medical treatment shall be of common medical acceptance and readily available,
and may include, but is not limited to, medicine, alcohol and/or drug
rehabilitation, or mechanical devices.
(2) The member shall
also agree in writing to provide, upon HPRS' request, any existing medical
report relevant to the member's disability.
(3) If the member fails
to submit a required medical report or does not continue treatment, the
member's disability benefit shall be suspended until
such report is received by HPRS, the member resumes treatment or the physician
providing treatment certifies, and the medical advisor concurs, that treatment
is no longer helpful or advisable. If such failure continues for one year, the
disability benefit shall be terminated.
(P) Any subsequent application for a
disability benefit filed after a denial of a disability application or
termination of previously granted disability benefits shall be submitted with
medical evidence, to the satisfaction of the medical advisor, supporting
progression of the disabling condition or evidence of a new disabling
condition.
(Q) A member may
withdraw an application packet prior to the disability
committee's initial recommendation described in
paragraph (H) of this rule.
