(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.
(1) After the 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 board's denial or termination of the disability benefit.
(b) The member's right to file a written request to appeal . Such written request to appeal must be received by the board no later than thirty days from the date of the notice of denial or termination.
(c) Failure of a member to submit a written request to appeal shall make the board's action final as to such application or benefit.
(d) In addition to the written request to appeal, 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 board. Such additional medical evidence shall be presented on a form provided by the retirement system .
(e) Failure to provide the additional medical evidence within forty-five days of the member's appeal request shall make the 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 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 an appeal process that follows a termination of benefits automatically voids the member's appeal and the board's termination of disability benefits is final.
(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 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.
(D) The following apply to disability appeals or applications after the board's decision on an appeal is final:
(1) Any subsequent applications for a disability benefit filed within the two years following the board's final decision on a denial of an appeal shall be submitted with medical evidence supporting progression of the disabling condition.
(2) The board shall not consider an application under this paragraph if the medical consultant or examining physician concludes there is no evidence of progression or a new disabling condition and the application shall be voided.
(3) Notwithstanding paragraphs (D)(1) and (D)(2) of this rule, a member may file a new disability application without showing progression or a new condition if the member has changed his or her position of public employment since the board's decision on the appeal became final.
(4) If two years have elapsed since the date the member's contributing service terminated, no subsequent application shall be accepted.
(E) If an appeal is pending, the retirement system shall void the appeal of a member who returns to public employment covered by Chapter 145. of the Revised Code or files a new disability application and the board's denial or termination of disability benefits is final.
R.C. 119.032 review dates: 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, 1/1/12, 12/10/12, 1/7/13 (Emer)