Current through Register Vol. 48, No. 14, April 8, 2022
A. General (Able and Available 375.05).
Current receipt of group health insurance benefits for a concurrent period of
recuperation creates a presumption that the claimant is unable to work. This
presumption can be overcome if the claimant can establish that he is qualified
and able to do work of a specific kind and his statement is supported by
corroborating evidence. However, information on local labor market conditions
available to the local office may create a presumption that the physical
requirements for all work of the type for which he is qualified are too
difficult to be met by the claimant. The terms of the group or health insurance
policy or plan must be investigated in order to ascertain whether the
claimant's allegations in his claim for benefits are contradictory to the
statements made to the group or health insurance plan for the purpose of
securing benefits. If the claimant's contentions or statements are
contradictory, the truthfulness of the claimant's statements must be weighed in
the light of all the facts.
Disability compensation (Able and Available 375.1)
1. Receipt of compensation for disability
raises a presumption that the claimant is not able to work, but it is not in
itself conclusive evidence of inability.
If the disability prevents work in his
former occupation and there is no evidence that he is qualified for other work,
he may be considered unable to work.
Evidence of the claimant's physical capacities must be
obtained as a determination cannot be properly made solely on the basis of the
receipt of workmen's disability compensation.
Pension (Able and Available 375.3)
1. A claimant's retirement or receipt of a
pension creates a presumption that either the claimant has withdrawn from the
labor market or his retirement is involuntary because of his inability to
continue work. Positive evidence that he has re-entered the labor market will
be required to overcome the presumption of ineligibility after
2. The terms and
conditions in the plan or policy under which the claimant has or was retired
must be ascertained. If a condition for receipt of a pension requires
withdrawal from all work, the claimant would be required to show what he has
done to rescind or forego his rights to the pension.
If the terms of the retirement agreement
or plan merely preclude the continuation of employment with a given employer
but makes no restriction on employment in other localities and with other
employers, the presumption that the claimant has withdrawn from the labor
market may be refuted by:
a. Employment after
b. Registration for
work and certification of availability,
c. Efforts to find work.