(A) For the purpose of sections 5505.18
and 5505.181 of the Revised Code and agency 5505 of the Administrative
Code:
(1) "Member"
shall have the meaning described in division (I) of section 5505.01 of the
Revised Code except "member" does not include state highway patrol
cadets attending training schools pursuant to section 5503.05 of the Revised
Code.
(2) A terminated
employee, whether the termination from the state highway patrol is voluntary or
involuntary, ceases to be a member of the state highway patrol retirement
system (HPRS). Except as provided in rule 5505-3-07 of the Administrative Code,
a member shall not be considered terminated while receiving benefits pursuant
to section 124.385 of the Revised Code.
(3) "Totally and
permanently incapacitated" means a disabling condition that physically or
mentally totally incapacitates a member from the performance of regular duty
for a period of at least twelve months from the date of HPRS's receipt of
the completed application packet.
(4) "In the line of
duty" means an illness or injury that occurred during or resulted from
the performance of official duties under the direct supervision of the state
highway patrol.
(5) "Not in the
line of duty" means an illness or injury that did not occur during or
result from the performance of official duties under the direct supervision of
the state highway patrol. Unless the illness or injury meets the presumption
criteria outlined in division (A) of section 5505.18 of the Revised Code or
competent and credible evidence is submitted to HPRS, a disability condition is
presumed to be not in the line of duty.
To be eligible for retirement on account of a
disability incurred not in the line of duty, the member must have accrued five
years of service credit since becoming a "member" as defined by this
rule and section 5505.18 of the Revised Code.
(6) "Disability
committee," as referred to in this rule, shall mean the "health,
wellness, and disability" standing committee established pursuant to
paragraph (A)(1) of 5505-9-08 of the Administrative Code.
(7) "Medical
advisor," as referred to in this rule, shall mean the expert physician
appointed by HPRS' board who advises the disability committee and board
during its deliberations relating to disability applications.
(8) "Examining
physician" means a physician recommended by the medical advisor and
approved by the HPRS board.
(9) Unless otherwise
stated in this rule, all notifications or correspondence shall be sent by
regular U.S. mail to the member's address included in disability benefits
application unless HPRS receives notice in writing of an alternative
address.
(B) A disability benefits application
packet, hereafter referred to as application packet, provided by HPRS may be
filed by a member, a person acting on behalf of a member, or the superintendent
of the state highway patrol. In order for the application packet submission to
be considered complete, the applicant will submit the following:
(1) A completed
application for disability benefits, on a form approved by the board, listing
the disabling condition(s),
(2) Attending physician
medical evaluation form and statement, on a form approved by the board,
supporting the disabling condition(s) listed in the application,
(3) Employer
determination and completed form of applicant's inability to perform
his/her job duties and responsibilities, and
(4) All medical reports
and documentation that relate to the disabling conditions listed in the
application. All medical reports must be received within one week of initial
submission of application.
(5) An incomplete
application packet will not be accepted and will not be considered
filed.
(6) Once an application
packet has been accepted by HPRS and submitted to the medical advisor,
additional medical reports or documentation will not be accepted unless
requested by the board, disability committee or the medical advisor. Any
documentation that is received by HPRS after submission of the application
packet to the medical advisor shall be held and included as part of any
reconsideration hearing as described within this rule. Should the right to
reconsideration not be exercised, the additional medical evidence will be
returned to the applicant.
(7) An application packet
that does not include an attending physician medical evaluation statement that
indicates the applicant is totally and permanently incapacitated will not be
accepted.
(C) Upon receipt of a completed
application packet, HPRS shall schedule the applicant for an examination by at
least one examining physician with expertise in the disabling condition(s)
listed in the application as recommended by the medical advisor, unless the
medical advisor recommends it is inadvisable to do so.
(1) Payment of any fees
connected to the acquisition of records or the preparation of reports of the
attending physicians shall be the responsibility of the member.
(2) Payment of any fees
connected with the preparation of reports of the examining physician(s) shall
be the responsibility of HPRS.
(D) After examining the applicant and
reviewing the application packet, any medical reports submitted by the
applicant, and the results of any additional medical testing, the examining
physician will file a written report with HPRS with the following
information:
(1) Whether the member is
totally incapacitated for duty in the employ of the patrol,
(2) Whether the
incapacity is expected to be permanent, and
(3) The cause of the
member's incapacity.
(E) After the examining
physician(s)' report(s) is submitted, the medical advisor shall review
the entire record and file a written report with HPRS with the following
information:
(1) A recommendation of
whether the applicant should be granted disability retirement benefits based on
the medical advisor's independent review or the record,
(2) Whether the injury or
illness was in the line of duty or not in the line of duty,
(3) Recommended medical
treatment and medical reports.
The medical advisor's report shall be
considered an independent medical opinion.
(F) When all necessary medical reports and records have been
received by HPRS, including the completed application packet, examining
physician's report described in paragraph (D) of this rule, and the
medical advisor's report / recommendation described in paragraph (E) of
this rule, HPRS shall schedule a hearing to be held at the next disability
committee meeting. If HPRS does not receive the required information described
in this paragraph of this rule at least fourteen days before the next
disability committee meeting, the application will be heard at the following
scheduled meeting of the disability committee.
(G) No less than fourteen days prior to the hearing, the
applicant will be sent notification of:
(1) The hearing date and
time, and
(2) The right to appear
at the hearing, with or without counsel, to present testimony.
(3) If circumstances
warrant it, the notice requirement may be waived upon mutual consent of the
applicant and HPRS.
(H) The disability committee hearing will be held in executive
session. An audio recording of testimony on behalf of the applicant will be
made to provide the disability committee and board with a record for further
review, notwithstanding rule 5505-9-07 of the Administrative Code. The
disability committee will consider the application packet, the examining
physician's report, the recommendation of the medical advisor, and other
relevant information.
(1) Consideration of a
member's application by the disability committee and board shall be
limited to the disabling condition(s) listed in the application and listed in
the attending physician's report as described in paragraph (B)(2) of this
rule that are supported by medical documentation provided to HPRS.
(2) Acts occurring after
the application packet is completed and accepted that create new disabling
condition(s) or progress the disabling condition(s) described in paragraph
(H)(1) of this rule will not be considered by the disability committee or the
board. Nothing in this division shall preclude a member from filing a new
application for disability benefits.
(I) The disability committee may recommend one or more of the
following to the board:
(1) Approval or denial of
the application,
(2) A finding on whether
or not the disability occurred in the line of duty,
(3) A finding that
disability retirement be contingent on compliance with a treatment
plan,
(4) Postpone
determination, pending an additional examination, or the submission of
additional fact, or
(5) No decision, if the
disability committee cannot agree on a recommendation or acquire a majority
vote.
(J) No more than five days after the hearing, the applicant will
be sent notification of:
(1) The disability
committee's recommendations,
(2) The right to request
reconsideration of the disability committee's decision.
(K) No more than twenty days after the initial hearing, the
applicant may file a written request for reconsideration. The written request
shall be accompanied by a statement from the applicant, his or her counsel
and/or attending physician that the request for reconsideration will be based
on evidence contrary to the findings of the examining physician or the
committee.
(1) The request for
reconsideration will be considered at the next regularly scheduled meeting of
the disability committee unless rescheduled for the reasons outlined in
paragraph (K)(2) of this rule.
(2) No more than ten days
after requesting reconsideration, the member must file new medical evidence
relative to the disabling condition(s) considered by the disability committee.
The member may request one extension of twenty days to submit new medical
information. One additional extension, of no greater than twenty days, will be
granted if the member can show, and the medical advisor concurs, that
additional time is needed to obtain relevant new medical evidence that is
already in progress. If additional extensions are granted, the request for
reconsideration will be rescheduled to the next available disability committee
meeting. HPRS shall void the request for reconsideration if new medical
evidence is not received by HPRS in the time described in this
paragraph.
(3) Copies of the reports
of the examining physician will be sent to the member and the member's
agent upon written authorization of the member, unless the release of such
reports is otherwise prohibited by law. The medical advisor's
recommendation will not, however, be released until the committee has made a
recommendation regarding the member's disability application.
(4) The disability
committee will consider only new medical evidence and new relevant information
submitted in support of the request for reconsideration.
(5) The applicant has the
right to appear at the hearing, with or without counsel, to present new
relevant evidence and testimony, and
(6) Evidence,
information, or other documentation not already submitted in accordance with
this rule will not be permitted.
(L) At the conclusion of the reconsideration hearing, the
disability committee may recommend one or more of the following to the board:
(1) Approval or denial of
the application,
(2) A finding on whether
or not the disability occurred in the line of duty,
(3) A finding that
disability retirement be contingent on compliance with a treatment
plan,
(4) Postpone
determination, pending an additional examination, or the submission of
additional fact, or
(5) No decision, if the
disability committee cannot agree on a recommendation or acquire a majority
vote.
(M)
(1) Except as provided in
paragraph (M)(2) of this rule, the committee's recommendation will be
considered at the next regularly scheduled meeting of the board. The board may
adopt or reject the recommendation, in whole or in part, or remand the
recommendation to the disability committee for further consideration. Unless
requested by the board, an applicant may not appear before the board. The
decision of the board is final.
(2) If the disability
committee postpones determination pursuant to paragraph (L)(4) of this rule, no
more than five days after the hearing, the applicant will be sent notification
of the reason for the postponement and the date the committee will make a final
recommendation to the board.
(N) The member will be notified of the
board's action no more than ten days after the board meets. If benefits
are granted, the member shall be advised of the member's right
to:
(1) Accept the benefit
granted; or
(2) Waive the benefit and
continue working
(a) No later than thirty days after the board's final
action, the member shall elect, on a form provided by the board, either to
accept or waive the board's grant of disability benefits.
(b) If no such election is made within the thirty-day period
provided in paragraph (N)(2)(a) of this rule, the award shall be rescinded. If
benefits are accepted but the member fails to terminate employment with the
state highway patrol within the thirty-day period provided in paragraph
(N)(2)(a) of this rule, the award shall be rescinded.
(O) As a condition to granting an
application for disability benefits, the member shall agree in writing, on a
form provided by the board, to obtain any medical treatment recommended by the
examining physician or medical advisor and submit the required medical reports
as required by the board.
(1) Such additional
medical treatment shall be of common medical acceptance and readily available,
and may include, but is not limited to, medicine, alcohol and/or drug
rehabilitation, or mechanical devices.
(2) The member shall also agree in
writing to provide, upon HPRS' request, any existing medical report
relevant to the member's disability.
(3) If the member fails to submit a
required medical report or does not continue treatment, the member's
disability benefit shall be suspended until such report is received by HPRS,
the member resumes treatment or the physician providing treatment certifies,
and the medical advisor concurs, that treatment is no longer helpful or
advisable. If such failure continues for one year, the disability benefit shall
be terminated.
(P) Any subsequent application for a
disability benefit filed after a denial of a disability application or
termination of previously granted disability benefits shall be submitted with
medical evidence, to the satisfaction of the medical advisor, supporting
progression of the disabling condition or evidence of a new disabling
condition.
(Q) A member may withdraw an application
packet prior to the disability committee's initial recommendation
described in paragraph (H) of this rule.