Current through all regulations passed and filed through September 16, 2024
(A)
For the purpose of this rule:
(1)
"Medical advisor"
and "examining physician" have the same meaning as rule
5505-3-02 of the Administrative
Code.
(2)
"Benefit recipient" means any person who is receiving
disability retirement benefits pursuant to section
5505.18 of the Revised
Code.
(B)
Every benefit recipient under the age of sixty annually
shall be subject to a medical examination by HPRS' examining physician, unless
the board's medical advisor certifies that a benefit recipient's disability is
ongoing and the board waives the requirement that the benefit recipient undergo
an annual medical examination.
(C)
Every person
under the age of sixty who is receiving disability benefits pursuant to section
5505.18 of the Revised Code
shall annually submit a statement of earnings, an attending physician's report,
and any other medical or employment information as deemed necessary by the
executive director or medical advisor to determine whether the benefit
recipient is still disabled as defined by section
5505.18 of the Revised Code. The
board may waive the requirement to submit an annual statement of earnings or
attending physician's report if the board's medical advisor certifies that a
disability benefit recipient's disability is ongoing.
(1)
The information
required pursuant to paragraph (C) of this rule shall be submitted at a time
designated by the executive director, and shall be reported on forms provided
by HPRS.
(2)
The information required pursuant to paragraph (C) of
this rule shall be reviewed by the medical advisor. If the medical advisor
determines the benefit recipient may no longer be disabled or if the benefit
recipient has requested termination of benefits, HPRS shall:
(a)
Schedule a
medical examination with an examining physician recommended by the medical
advisor.
(b)
If the examining physician certifies the benefit
recipient no longer meets the disability standards set forth in section
5505.18 of the Revised Code,
HPRS staff and medical advisor shall present the benefit recipient's file to
the board at the next available meeting. No additional information will be
accepted from the benefit recipient accept as described in paragraph (E)(2) of
this rule. Unless requested by the board, the benefit recipient may not appear
before the board.
(3)
The board shall
review the examining physician's report and if it concurs with the examining
physician's certification that the benefit recipient no longer meets the
disability standards set forth in section
5505.18 of the Revised Code, the
disability benefits shall terminate the earlier of:
(a)
Thirty days after
the board concurs with the examining physician's certification,
(b)
Upon employment
with the state highway patrol, or
(c)
Upon employment
in a position as described in rule
5505-3-03.1 of the
Administrative Code.
(d)
Notwithstanding paragraph (C)(3)(a) of this rule,
disability benefits will terminate the earlier of sixty days after the board
concurs with the examining physician's certification or upon employment with
the state highway patrol if HPRS receives confirmation from the state highway
patrol that the benefit recipient will be reinstated.
(D)
The benefit recipient will be sent notification of the
board's action no more than five days after the board meets and such notice
will be sent by regular US mail to the benefit recipient's last known address.
The notice will inform the benefit recipient of the date his or her benefits
will terminate, if applicable, and his or her right to appeal.
(E)
Within twenty
days of the board's decision, the benefit recipient may file a written notice
of appeal. The notice of appeal shall reference the decision being appealed and
shall include the reason(s) why the decision is being appealed. If the benefit
recipient does not file a notice of appeal as described in this rule, the
board's determination made under paragraph (C) of this rule is final.
(1)
The notice of
appeal will be considered at the next regularly scheduled meeting of the board.
Except as provided in this rule, benefits shall not be terminated while an
appeal is pending.
(2)
Within forty days of the board's determination made
under paragraph (C) of this rule, the benefit recipient must file any evidence
he or she would like considered by the board. New disabling conditions and the
related medical evidence will not be considered. Extensions will only be
granted if the benefit recipient can show, and the board chair concurs, that
additional time is needed to obtain relevant new medical evidence and the
process for obtaining that evidence is already in process. HPRS shall void the
notice of appeal if new evidence is not received by HPRS in the time described
in this paragraph.
(3)
Copies of the reports of the examining physician and
medical advisor 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. However, the medical advisor's recommendation will not be
released until the board has made an initial decision regarding the member's
disability benefits.
(4)
The applicant has the right to appear at the hearing,
with or without counsel, to present new testimony.
(5)
Evidence,
information, or other documentation not already submitted in accordance with
this rule will not be permitted.
(6)
The board's
decision is final.
(F)
Nothing in this
rule or any waiver granted by the board shall waive any rights of HPRS to
request the benefit recipient to undergo a medical examination if information
is received at any time which indicates the benefit recipient may no longer be
eligible for disability benefits.
(G)
Any benefit
recipient who desires to be reexamined in conjunction with a request to return
to active duty status shall first be required to submit a medical examination
report from a physician of his or her choice, which certifies that the benefit
recipient is no longer eligible for disability benefits. The benefit recipient
shall then be subject to the process described in paragraph (C) of this
rule.
(H)
Failure to comply with the provisions identified in
this rule may result in the suspension of disability and healthcare
benefits.
(1)
Unless for good cause shown, the disability benefit recipient shall be presumed
to have refused to submit to the medical examination by an examining physician
if HPRS has scheduled such examinations two times and such disability benefit
recipient has canceled, rescheduled, or failed to submit to such scheduled
medical examinations.
(2)
The refusal of a benefit recipient to submit to a
medical examination or submit employment information requested pursuant
paragraphs (B) and (C) of this rule shall result in the suspension of
disability benefits and health care or prescription benefits selected by the
disability benefit recipient, if any, upon thirty days prior written notice to
the benefit recipient and shall continue until compliance.
(a)
The suspension of
disability and health care or prescription drug benefits selected by the
disability benefit recipient, if any, shall be effective on the first day of
the month immediately following the expiration of the aforementioned thirty day
notice period.
(b)
In the event the benefit recipient submits to the
required medical examination or information after the aforementioned thirty day
notice period, HPRS will reinstate the benefit recipient's disability and
health care or prescription drug benefits selected by the benefit recipient, if
any, on the first day of the month immediately following the benefit
recipient's compliance.
Replaces: 5505-3-03
Effective: 5/18/2017
Five Year Review
(FYR) Dates: 05/18/2022
Promulgated Under: 111.15
Statutory Authority: 5505.07,
5505.18
Rule Amplifies: 5505.18
Prior Effective Dates:
2/15/1981, 1/1/1986, 11/2/1989, 10/1/1996, 3/28/2013,
11/17/2016
