145-2-23 Disability appeals.

(A) This rule applies when the public employees retirement board either denies an application for a disability benefit filed pursuant to section 145.35 of the Revised Code or terminates a disability benefit pursuant to section 145.362 of the Revised Code.

(B)

(1) After the retirement board has either denied an application for, or terminated, a disability benefit, the member shall be notified in writing of such action.

(2) The notice shall be sent by regular mail.

(3) The notice shall include the following information:

(a) The retirement board’s denial or termination of the disability benefit.

(b) The member’s right to file a written disability benefit appeal request. Such appeal request must be received by the retirement board no later than thirty days from the date of the notice of denial or termination.

(c) Failure of a member to submit an appeal request shall make the retirement board’s action final as to such application or benefit.

(d) The member must also submit additional objective medical evidence. Such additional evidence shall be current medical evidence documented by a licensed physician specially trained in the field of medicine covering the illness or injury for which the disability is claimed and such evidence has not been considered previously by the retirement board. Such additional medical evidence shall be presented on a form provided by the retirement system and shall constitute an appeal of the denial or termination.

(e) Failure to provide the additional medical evidence within forty-five days of the member’s appeal request shall make the retirement board’s action final to such application or benefit unless an extension for submission of such evidence has been requested and granted within the forty-five days. Only one extension, not to exceed forty-five days, may be granted by the retirement board’s staff.

(f) All medical costs of physicians selected by the member and incident to the appeal shall be at the expense of the member.

(g) Returning to public employment covered by Chapter 145. of the Revised Code during the appeal process automatically voids the member’s appeal and the board’s termination or denial of disability benefits is final.

(C)

(1) After submission of any additional medical evidence as described in paragraph (B)(3)(d) of this rule, all evidence shall be reviewed by the retirement board’s medical consultant(s) who shall recommend action for concurrence by the board.

(2) If the board concurs with a recommendation for approval of the appeal, disability benefits shall be paid from the date that was established when the original application for a disability benefit was filed. If a recommendation for termination of a disability benefit was appealed and the appeal is approved by the board, the payments shall be resumed from the date of termination. The member shall be notified by regular mail of the board’s decision.

(3) If the board concurs with a recommendation for denial of the appeal, the member shall be notified by regular mail of the board’s decision and such decision shall be final.

(4) Any subsequent applications for a disability benefit filed after a denial of an appeal shall be submitted with medical evidence supporting progression of the disabling condition or evidence of a new disabling condition. If two years have elapsed since the date the member’s contributing service terminated, no subsequent application shall be accepted.

(D) The retirement system shall void the appeal of a member who returns to public employment covered by Chapter 145. of the Revised Code and the board’s denial or termination of disability benefits is final.

Effective: 01/01/2012

R.C. 119.032 review dates: 09/29/2011 and 09/29/2016

Promulgated Under: 111.15

Statutory Authority: 145.09.

Rule Amplifies: 145.35, 145.36, 145.361, 145.362, 145.37.

Prior Effective Dates: 9/18/63; 2/1/93; 10/7/99; 1/1/03; 2/1/11 (Emer.); 4/18/11