742-3-04 Disability benefit recipient's annual earnings statement.

(A) Unless the board’s physician certifies that a disability benefit recipient’s disability is ongoing according to the terms of the governing board policy and the board waives the requirement that a recipient file an annual statement of earnings, a disability benefit recipient shall file an annual statement of earnings by September first of each year with the Ohio police and fire pension fund (“OP&F”). The statement must be on the form provided by OP&F. The section of the statement relating to employment, education, and earnings must be notarized. In addition, the disability benefit recipient must also provide any supporting documentation requested by OP&F.

(B) The first annual statement shall be filed September 1, 1996.

(C) OP&F shall send written notice to those recipients who have been granted waivers by the board within ninety days of the board’s approval.

(D) Once a disability benefit recipient has been granted a waiver from the requirement to file annual earnings statement by the board, the disability benefit recipient shall thereafter be relieved from filing an annual earnings statement, unless otherwise notified in writing by OP&F.

(E) For those earning statements due on September 1, 1998, and every September first thereafter, the refusal of the benefit recipient to comply with paragraph (A) of this rule shall result in the suspension of disability benefits and any health care and prescription drug benefits selected by the disability benefit recipient upon ninety days prior written notice to the disability benefit recipient.

(1) If the disability benefit recipient fails to file the past due annual earning statement(s) in proper form with OP&F within the aforementioned ninety day notice period, OP&F shall suspend the recipient’s health care and prescription drug benefits selected by the disability benefit recipient, if any, effective on the first day of the month immediately following the expiration of such notice period.

(2) In the event the disability benefit recipient files all of the past due earning statement(s) in proper form with OP&F after the aforementioned ninety day notice period, OP&F will reinstate the recipient’s disability and health care benefits on the first day of the month immediately following OP&F’s receipt of all past due annual earnings statements in proper form, subject to the terms of health care and prescription drug benefits selected by the disability benefit recipient, if any, and the recipient shall be entitled to retroactive coverage of disability and health care benefits during that time in which the benefits were suspended. In such event, the disability benefit recipient shall fully cooperate with OP&F on the coordination of claims filed for medical expenses incurred during such suspension period. Notwithstanding the reinstatement of disability and health care benefits, OP&F shall not be obligated to restore the identical benefits previously provided to the disability benefit recipient, if such benefits are not available at the time of such disability benefit recipient’s reinstatement of medical expense benefits, and OP&F shall not be obligated to pay for certain medical expenses that were incurred after the effective date of the disability benefit recipient’s suspension, and in such event, OP&F shall not be responsible for any additional out-of-pocket expenses and deductibles incurred by the disability benefit recipient arising out of such replacement benefits.

(3) Notwithstanding the terms of paragraph (E) of this rule, OP&F shall not suspend dental and vision benefits of such non-complying disability benefit recipient provided and for so long as the disability benefit recipient pays the monthly costs of such benefits in advance to OP&F within thirty days after OP&F sends an invoice to the disability benefit recipient.

(F) If the disability benefit recipient files the required annual earnings statement in proper form with OP&F on or before December first of the following year in which it was due (i.e. fifteen months after the original due date), OP&F will reinstate the recipient’s disability benefits and the health care and prescription drug benefits selected by the disability benefit recipient, if any, subject to the terms of the health care plan sponsored by OP&F. In such event, the disability and health care and prescription drug benefits selected by the disability benefit recipient, if any, shall be paid retroactively and, in such event, the disability benefit recipient shall fully cooperate with OP&F on the coordination of claims filed for medical expenses incurred during such suspension period. Notwithstanding the reinstatement of disability and health care and prescription drug benefits selected by the disability benefit recipient, if any, OP&F shall not be obligated to restore the identical benefits previously provided to the disability benefit recipient, if such benefits are not available at the time of such disability benefit recipient’s reinstatement of health care and prescription drug benefits selected by the disability benefit recipient, if any, OP&F shall not be obligated to pay for certain medical expenses that were incurred after the effective date of the disability benefit recipient’s suspension. In such event, OP&F shall not be responsible for any additional out-of-pocket expenses and deductibles incurred by the disability benefit recipient arising out of such replacement benefits.

(G) If the disability benefit recipient has not filed the required annual earnings statement in proper form with OP&F on or before December first of the following year in which it was due, then the disability benefits shall be forfeited in accordance with the terms of division (D) of section 742.40 of the Revised Code and the health care and prescription drug benefits selected by the disability benefit recipient, if any, shall be forfeited in accordance with section 742.45 of the Revised Code, with such forfeiture being effective as of the date of the original suspension, as referenced in a writing provided to the recipient from OP&F.

(H) For purposes of determining whether the recipient has refused to comply with the provisions of division (D) of section 742.40 of the Revised Code and this rule, OP&F may conclusively rely upon OP&F’s books and records.

(I) All notices to the disability benefit recipient provided for under this rule shall be either delivered personally, sent by express delivery service, certified mail or first class U.S. mail, postage prepaid and addressed to the disability benefit recipient at the most recent address set forth in such recipient’s file with OP&F, or to such other address as the disability benefit recipient shall thereafter designate by proper notice in accordance with this paragraph. All notices to OP&F shall be addressed at its principal place of business.

(J) For purposes of this rule, “Disability Benefit Recipient” shall mean the member of OP&F who is receiving a disability benefit pursuant to division (C)(2), (C)(3), (C)(4), or (C)(5) of former section 742.37 of the Revised Code or section 742.38 of the Revised Code.

Eff. 11-30-95 (Emer.); 2-10-96; 9-8-97; 9-16-98 (Emer.); 12-10-98; 7-17-04

Rule promulgated under: RC 111.15

Rule authorized by: RC 742.10

Rule amplifies: RC 742.40

R.C. 119.032 review dates: 09/24/2009 and 07/27/2014