Current through September 18, 2024
A. Introduction
1. These Administrative Rules pertaining to
the application to receive an Ordinary or Accidental Disability Pension are
promulgated pursuant to R.I.Gen. Laws §
36-8-3. The Rules shall be
applicable to the adjudication of all Ordinary Disability Pension applications
received pursuant to R.I. Gen. Laws §§
36-10-12,
36-10-13,
16-16-14,
16-16-15,
45-21-19,
45-21-20, 4521.2-7 and
45-21.2-8, and all Accidental
Disability Pension applications received pursuant to R.I. Gen. Laws §§
36-10-14,
36-10-15,
16-16-16, 1616-17,
45-21-21,
45-21-22,
45-21.2-9 and
45-21.2-10.
2. This Regulation does not apply to members
of the Judicial Retirement Plan or the State Police Retirement
Plan.
B. Definitions
"Active member" shall mean any employee of the State of
Rhode Island for whom the Retirement System is currently receiving regular
contributions pursuant to R.I. Gen. Laws §§
36-10-1 and
36-10-1.1; or any employee of a
participating municipality for whom the Retirement System is currently
receiving regular contributions pursuant to R.I. Gen. Laws §§
45-21-41 and
45-21-41.1; or any police or fire
fighter for whom the Retirement System is currently receiving regular
contributions pursuant to R.I. Gen. Laws §
45-21.2-14; or any teacher for
whom the Retirement System is currently receiving regular contributions
pursuant to R.I. Gen. Laws §§
16-16-22 and
16-16-22.1.
C. Requirements for Application and
Disability Determination
1. Only active
members or members on leave of absence for illness from the Employees'
Retirement System of the State of Rhode Island ("ERSRI") or the Municipal
Employees' Retirement System of the State of Rhode Island ("MERS") with a
minimum of five (5) years of contributing service, three (3) of which must be
consecutive, are eligible to receive an Ordinary Disability Pension. The Board
may consider members that are on workers compensation to be on a leave of
absence for illness within the meaning of this Regulation.
2. Only active members of ERSRI or MERS are
eligible to receive an Accidental Disability pension. The application must be
made within five (5) years of the accident for State employees, municipal
employees and Teachers and within eighteen (18) months of the accident for
municipal police and fire fighters. An application must be filed within three
(3) years of a reinjury or aggravation of a prior injury for State employees
and teachers. For municipal police and fire fighters, an application must be
filed within eighteen (18) months of a reinjury or aggravation of a prior
injury. Applications received after the applicable timeframe will be deemed
untimely and shall result in a denial of the application.
3. Requests to amend an application may only
be made once prior to assignment of Independent Medical Examination(s). A
request to amend an application shall only be granted in instances where the
applicant can show that new facts or conditions exist that were not known to
the applicant at the time the application was submitted and that such facts may
have an effect on the outcome of the Disability Committee's or Board's
decision.
4. Any member eligible to
receive a regular service retirement allowance is prohibited from receiving an
Ordinary Disability Pension. Any member who has attained the age of sixty-five
(65) is prohibited from receiving an Accidental Disability Pension.
5. An applicant for a disability pension
shall complete, sign and submit an application for disability in the form and
manner prescribed by ERSRI. An incomplete application will not be accepted.
Applicants who apply for accidental disability pensions will be considered for
an ordinary disability pension in the event that the Board finds that the
applicant has not met the standards of an accidental disability pension.
Applicants who apply for ordinary disability pensions will only be considered
for an ordinary disability pension.
6. An applicant for an Ordinary or Accidental
Disability Pension must be examined by three (3) independent physicians engaged
by the Retirement Board. Payment for these examinations and any test required
as a result of the examinations shall be borne by the Retirement Systems. It is
the responsibility of the applicant to contact these independent physicians to
make an appointment for examination upon receipt of the physicians' contact
information from the Retirement System. If all required independent medical
examinations are not completed within sixty (60) days of receipt of the contact
information, the Disability Committee and/or the Retirement Board shall either
require that a new application be submitted, or deny the application unless the
applicant can show that any delay in examination is not the result of the
applicant's actions. The filing date of the new application must be within the
applicable timeframe as provided in §§
1.9(C)(1) or
(2) of this Part or will be deemed
untimely.
7. Beyond the
communication necessary to schedule and complete the required medical
examinations, neither applicants nor their attorneys shall make any further
inquiries of, nor have any further communications or contact with the
independent physicians engaged by the Retirement Board. Once the examination is
concluded, neither the applicant nor their counsel shall have any further
communication with any of the independent physicians regarding the physician's
findings, conclusions, recommendations or any other aspect of the examination.
If an applicant or their attorney has any such communication or contact with
the independent physician(s), the Retirement Board and/or its Disability
Committee may deny the application or may choose to disregard any materials
generated by said physician(s) following such communication or
contact.
D. Statutory
Standard for Ordinary and Accidental Disability
1. Upon review of the reports of the medical
examinations of the physicians engaged by the Retirement Board, the Disability
Committee may recommend that the Retirement Board grant the member an Ordinary
or Accidental Disability Pension.
2. For a member to receive an Ordinary
Disability Pension, the Disability Committee must determine that a member is
physically or mentally incapacitated from the performance of duty and ought to
be retired.
3. For a State
employee, teacher, municipal employee, municipal police officer or fire fighter
to receive an Accidental Disability Pension, the Disability Committee must make
a determination that the applicant is physically or mentally incapacitated for
the performance of service as a natural and proximate result of an accident
sustained while in the performance of duty, that the disability is not the
result of willful negligence or misconduct of the member, and is not the result
of age or length of service, and that the member has not yet attained the age
of sixty-five (65). The applicant must the definite time, place, and conditions
of the duty performed by the member and the incident resulting in the alleged
disability for the member to be eligible for an Accidental Disability
Pension.
4. Although the language
in the ordinary disability statutes (R.I. Gen. Laws §§
36-10-12,
16-16-14,
45-21-19, and
45-21.2-7) and the accidental
disability statutes (R.I. Gen. Laws §§
36-10-14,
16-16-16,
45-21-21 and
45-21.2-9) differ slightly, the
Retirement Board endeavors to interpret the language of all the accidental
disability statutes consistently with one another, and the language of all of
the ordinary disability statutes consistently with one another wherever
possible.
E.
Consideration by the Disability Committee
1.
Upon determination by the administration of the Retirement Systems that the
applicant has complied with §
1.9(C)(4) of
this Part, the application will be forwarded to the Disability Committee which
shall review the submitted material.
2. The Disability Committee will vote to
recommend approval or denial, or may postpone the application for the
submission of additional material, and will thereafter recommend a final
determination to the Retirement Board.
3. Applications may be postponed pending the
submission of additional information requested by the Committee or desired to
be presented by the applicant. If a matter is postponed, every effort will be
made to reschedule the matter for the next regularly scheduled meeting. The
matter may be postponed as many times as is necessary to ensure that all
pertinent information has been received from the applicant for review by the
Disability Committee. Failure to respond to a request for information by the
Disability Committee within thirty (30) days of the date of the request may
result in a recommendation of denial of the application by the Disability
Committee.
4. The Disability
Committee may require the applicant to appear before the Disability Committee
to answer questions regarding their application for disability
benefits.
F. Request for
Reconsideration
1. Any member aggrieved by a
decision of the Retirement Board to accept a recommendation of the Disability
Committee to deny their application for Ordinary or Accidental Disability
Benefits, may request that the application be reconsidered by the Disability
Committee.
2. Such request shall be
in writing and shall be sent to the Executive Director of ERSRI within thirty
(30) days of the date of mailing of the notification that the Retirement Board
has accepted the Disability Committee's recommendation of denial.
3. A request for reconsideration shall be
signed by the member or the member's attorney and shall contain the following:
a. Name of member;
b. Date and nature of decision being
contested; and
c. A clear statement
of the objection to the decision.
4. Requests for reconsideration should be
sent to the Executive Director, Employees' Retirement System of Rhode Island,
50 Service Avenue, 2nd Floor, Warwick, RI 02886-1021.
5. Failure to strictly comply with the
procedures outlined in this Section shall be grounds to deny any request for
reconsideration.
G.
Reconsideration Notice
1. Upon receipt of a
request for reconsideration, the matter shall be assigned to the Disability
Committee for a reconsideration hearing date within sixty (60) days of receipt
of the request for reconsideration.
2. The notice of the reconsideration hearing
date shall contain:
a. A statement of the time
and place of the reconsideration hearing;
b. A statement that a party who fails to
attend or participate in the reconsideration hearing may be held to be in
default and may have the original denial of their application affirmed by the
Disability Committee and/or the Retirement Board without further
hearing.
H.
Additional Documentation before the Disability Committee
Any applicant wishing to present additional documentation
during the reconsideration hearing before the Disability Committee must forward
to the Disability Committee ten (10) copies of the additional documentation a
minimum of ten (10) days prior to the date of the reconsideration hearing. The
hearing to reconsider the Disability Committee's original recommendation of
denial with respect to the applicant's application for a disability pension is
the applicant's opportunity to explain to the Disability Committee why the
applicant believes they are entitled to a disability pension and why they
believe the initial decision was erroneous, or to present new evidence or
documentation which was previously unavailable in support of the applicant's
application. Fifteen (15) minutes will be allotted for any applicant wishing to
appear before the Disability Committee at the reconsideration hearing. An
applicant may represent themselves at this hearing or may be represented by an
attorney. Consistent with R.I. Gen. Laws §
11-27-2, any person accompanying
the applicant who is not a lawyer (certified member of the bar of the State of
Rhode Island), cannot represent the applicant before the Disability
Committee.
I. Recommendation
of the Disability Committee after Reconsideration
1. Upon completion of the reconsideration
hearing, and subject to any further postponements the Disability Committee may
deem necessary or advisable, the Disability Committee will recommend to the
Retirement Board either approval or denial of the member's application for an
Ordinary or Accidental Disability Pension.
2. The Retirement Board shall notify the
applicant of its decision to accept or reject the recommendation of the
Disability Committee which, if denied, the notice of final decision will
constitute final administrative action for all purposes pursuant to R.I. Gen.
Laws §
42-35-1, et.
seq.
J. In the event that
an applicant's application for an Ordinary or Accidental Disability Pension is
approved, such approval is conditioned on the applicant completing all
necessary paperwork within thirty (30) days of receipt of the notice of
approval with the exception of the Employers' Certification of Retirement and
Final Wages form which must be signed within ten (10) business days of being
notified by ERSRI/MERS that it has been completed by applicant's employer.
Failure to complete the paperwork within the required timeframes set forth
herein will result in rejection of the application and will require the
submission of a new application. The filing date of the new application must be
within the applicable timeframe as provided in §§
1.9(C)(1) or
(2) of this Part or will be deemed
untimely.
K. Applications by
Terminal Members
1. An application for
accidental or ordinary disability benefits on behalf of a member whose
disability is deemed terminal by the Board's medical advisor may be considered
with only one (1) additional medical report by an independent physician. The
ERSRI medical advisor must supply the Disability Committee with a written
certification of the terminal status of the member.
2. When a member, whose accidental or
ordinary disability application has been accepted by the Disability Committee,
and who has completed three (3) independent medical examinations, dies prior to
the approval of the disability pension, the Retirement Board may award the
disability to the member's beneficiary provided an option selection form
indicating Option One or Option Two had been received by the Retirement Board
prior to the member's death.
L. Committee Composition
1. The composition of the Committee shall be
consistent with §1.1.1(K) of this Part with the following exception:
a. For board members allowed to send a
designee to represent themselves on the Disability Subcommittee, a written
proxy statement must be provided to the full Board one (1) month in advance of
the next regularly scheduled meeting for their consideration.
b. Upon approval by the Board, the designee
shall be required to attend a minimum of two (2) meetings before serving as the
voting designee and will be provided training material by ERSRI on the
operation and adjudication process currently employed by the
committee.
c. In the event the
approved designee is unable to attend a meeting because they have notified the
Executive Director at least ten (10) business days before the scheduled meeting
that they are unable to attend; is involved in an emergency beyond their
control; or contracts an illness the day of the meeting and notifies the
Executive Director before the start of the meeting, the Board member, except
the public representatives, will be allowed to send another designee to
represent themselves for the designated committee meeting.
(1) Such absences shall be limited to two (2)
meetings annually.
