Current through Register Vol. 24-18, September 15, 2024
(1) If the
department determines you are disabled and you became disabled in the line of
duty, you qualify for a catastrophic duty disability if:
(a) The disability or disabilities that
qualified you for a PSERS disability benefit are so severe that considering
your age, education, work experience, and transferable skills, you cannot
engage in any other kind of substantial gainful activity in the labor market;
and
(b) Your disability or
disabilities have lasted or are expected to last at least 12 months, or are
expected to result in your death.
(2) A person with multiple
injuries/conditions, some duty-related and some not, could qualify for a
catastrophic duty disability but only if the duty injury or injuries, standing
on their own, are catastrophically disabling.
Example 1:
Totally disabled, but not from a duty injury - Not eligible
for a catastrophic duty disability benefit.
A PSERS member suffers a knee injury on duty, leaving them
disabled from PSERS employment. The knee injury, by itself, is not totally
disabling. The member also suffers from amyotrophic lateral sclerosis (ALS) or
Lou Gehrig's disease, a progressive neurodegenerative disease that ultimately
leaves the member totally disabled. Pursuant to the ALS diagnosis the member is
granted a full disability from the Social Security Administration. In this case
the member would qualify for a disability, but not for a catastrophic duty
disability because the fully disabling condition, ALS, is not duty
related.
Example 2:
Totally disabled, duty injury totally disabling - Eligible
for catastrophic duty disability benefits.
A PSERS member suffers a knee injury while fishing. The knee
injury, by itself, is neither duty related nor catastrophically disabling. The
member also suffers severe injuries on the job while responding to an emergency
event at a correctional facility, leaving the member fully disabled. The Social
Security Administration grants the member a full disability based on the
member's total condition. The member qualifies for a PSERS catastrophic duty
disability benefit because the severe injuries, by themselves, render the
member totally disabled.
(3) If you receive catastrophic duty
disability benefits, the department will periodically review your income and
medical status for continued eligibility. This review is not a reassessment of
your initial determination, but an assessment of whether there has been any
change in your condition. If it is determined that there has been a change in
your condition and you are no longer eligible under subsection (1) of this
section, or if you fail to provide required documentation or cooperate with the
review, your catastrophic duty disability benefit may be discontinued or
converted to a different retirement type. DRS will notify you of your review at
least 30 days before it starts.
(a) Income
review: At least annually, you must submit documentation to verify that your
income from earnings is below the defined income threshold as defined in
subsection (4)(c) of this section. You must also notify the department within
30 calendar days of any changes in your income that could impact your
eligibility including, but not limited to, wages and earnings from
self-employment (see subsection (4)(c), (d) and (f) of this section). If DRS is
not notified on time, you may be responsible for any resulting overpayment.
Documentation you may need to provide includes a federal or
state income tax return from the most recent year, employment security records
for the last four quarters, self-employment documents or 1099-R, or other
documentation as requested by the department.
(b) Medical review: The department will
conduct a continuing disability review (CDR) at least once every three years if
at the time of your last determination your condition is expected to improve,
or every six years if your condition is not expected to improve, until you
reach age 65. The department may increase the frequency of your CDRs and
reserves the right to require a CDR at any time if notified of a change in your
condition, but not more than once every 12 months. The department may also
waive the CDR if your disability is determined to be permanent or terminal.
(i) DRS will first review any updated medical
information available from any labor and industries claims related to your line
of duty injury to determine if additional medical information is needed from
you and your primary care provider.
(ii) If needed, the department will provide
you with a Disability Review form, which asks for information about whether
your medical condition has improved since your last eligibility determination.
You will have at least 30 days to complete and return this form to the
department or notify the department that you need additional time. Once
received, the department will have 90 days to review this information and
either notify you of your continued eligibility or the need for additional
information. Before making a change to your disability retirement status, the
department may consult with a contracted vendor for the purpose of providing an
independent medical review.
(4) Definitions. As used in this section:
(a)
Catastrophically disabled
means the same as "totally disabled" as defined under RCW
41.37.230(3).
(b)
Continuing
disability review (CDR) means an assessment of your current medical
condition to determine if it continues to be catastrophically disabling. The
department will review recent documentation, with supplemental assessment by
external medical experts at the department's discretion.
(c)
Defined income threshold
means any substantial gainful activity that produces average earnings, as
defined in (d) of this subsection, in excess of the federal Social Security
disability standards, adjusted annually for inflation. Wages count toward
earnings when they are earned, not when you receive them. Self-employment
income counts when you receive it, not when you earn it.
(d)
Earnings are any income or
wages received, which are reportable as wages or self-employment income to the
IRS.
(e)
Labor market
is the geographic area within reasonable commuting distance of where you were
last gainfully employed or where you currently live, whichever provides the
greatest opportunity for gainful employment.
(f)
Substantial gainful activity
describes a level of work activity and earnings. Substantial gainful activity
is work activity that is both substantial and gainful, and it may be, but is
not required to be, from work or self-employment. Earnings as defined in this
section include compensated work activity that meets or exceeds the defined
income threshold:
(i) Work activity is
substantial if it involves doing significant physical or mental activities.
Your work activity may be substantial even if it is done on a part-time basis
or if you do less, or get paid less, or have less responsibility than when you
worked in your PSERS position.
(ii)
Work activity is gainful if it is work activity that you do for pay or profit.
Work activity is gainful if it is the kind of work usually done for pay or
profit, whether or not a profit is realized.
(iii) Generally, activities like taking care
of yourself, household tasks, profits from rental income, hobbies, therapy,
school attendance, club activities, or social programs are not substantial
gainful activity.
(g)
Transferable skills are any combination of learned or demonstrated
behavior, education, training, work traits, and skills that you can readily
apply. They are skills that are interchangeable among different jobs and
workplaces.
