a)
Nonoccupational Disability and Temporary Disability
1) Any member of the State Employees'
Retirement System (SERS) claiming benefits for nonoccupational disability or
temporary disability shall file at the Springfield Office of SERS a written
application on forms prescribed by the Board.
2) If a member makes a payment of
contributions to SERS in order to establish sufficient credit to qualify for a
nonoccupational disability benefit, payment of the benefit shall accrue as of
the latter of the 31
st day of absence from work
(including any periods of the absence for which sick pay was received), the day
after the member is last entitled to receive compensation (including any sick
pay), or the date of payment to SERS. The date of payment of the required
contributions shall be determined in accordance with the provisions of Section
1540.220(a)
(Period for Payment). If a member is receiving a nonoccupational disability
benefit, and incurs a concurrent sickness or condition that is severe enough to
disable the member past the period in which the member is disabled from the
original sickness or condition, the nonoccupational benefit would continue
uninterrupted and the member would not be required to obtain a new leave of
absence or incur a new 30 day waiting period. A benefit will continue
uninterrupted in the manner described only if the member is otherwise eligible
for the benefit and a licensed healthcare professional's report is provided and
supports the disabling sickness or condition.
3) If a member makes a payment of
contributions to SERS in order to establish sufficient credit to qualify for a
temporary disability benefit, payment of the benefit shall accrue as of the
latter of the 31
st day after the member is last
entitled to receive compensation or the date of payment to SERS. The date of
payment of the required contributions shall be determined in accordance with
the provisions of Section
1540.220(a)
(Period for Payment).
4) If a
member who is receiving a nonoccupational or temporary disability benefit
wishes to make a payment of contributions to extend the period of eligibility
for receipt of the benefit, the request to make the payment must be received at
the Springfield Office of SERS before the period of eligibility terminates and
the date of payment of the required contributions shall be determined in
accordance with the provisions of Section
1540.220(a)
(Period for Payment).
5) If a
member requests to have service credits under the State Universities Retirement
System (SURS) or the Teachers' Retirement System of the State of Illinois (TRS)
considered for the purposes of determining nonoccupational or temporary
disability benefit eligibility under Section 14-124 or 14-123.1 of the Illinois
Pension Code, or for purposes of calculating the total period of time for which
benefit will be paid, SERS shall not include in its calculations any credits
accrued under Article 15 or 16 of the Code that have been forfeited by
acceptance of a refund or applied toward a retirement annuity and that have not
been restored or otherwise reestablished in accordance with the requirements of
those Articles of the Code. Credits accrued under Article 15 or 16 of the Code
that have been forfeited by acceptance of a refund or applied toward a
retirement annuity, and that have not been restored or otherwise reestablished
in accordance with the requirements of those Articles of the Code, shall not be
considered for purposes of determining eligibility for a nonoccupational or
temporary disability benefit under Section 14-124 or 14-123.1 of the Illinois
Pension Code (Code) [40 ILCS 5 ] or in determining the total period of time for
which such a benefit is payable.
6)
The System may deem the requirement of Section 14-124(4) of the Code to be
satisfied with respect to a member if the member who is applying for a
nonoccupational disability benefit is eligible to be granted a leave of absence
for disability but, before the leave could be granted, upon medical
examination, the member is found to be permanently and totally incapacitated to
perform the duties of the member's position.
b) Occupational Disability
Any member of SERS claiming benefits for occupational
disability shall file at the Springfield Office of SERS a written application
on forms prescribed by the Board.
c) Licensed Healthcare Professionals
Before an occupational, nonoccupational or temporary disability
benefit can be approved, one statement must be received from a licensed
healthcare professional attesting to the disability. An additional statement
from a second licensed healthcare professional may be required by the
disability examiner assigned to the case, depending on the nature of the
disabling condition.
d)
Report of Licensed Healthcare Professionals
1)
All reports provided to the System by a licensed healthcare professional shall
contain, among other things, the date and place of the first examination by the
licensed healthcare professional, the cause and nature of the member's
disability, information regarding surgical work or laboratory tests performed
for the member, the date of last examination by the licensed healthcare
professional, prognosis regarding the member's disability, an estimate of the
probable length of the member's disability, and the licensed healthcare
professional's license number.
2)
All licensed healthcare professional's reports shall be signed by a licensed
healthcare professional or by medical records personnel employed by or acting
pursuant to the direction of the licensed healthcare professional.
e) Suspension and Termination for
Gainful Employment
The occupational, non-occupational, and temporary disability
benefits that are payable to members under Article 14 of the Illinois Pension
Code are subject to suspension and termination for gainful employment in
accordance with Section
1540.85.
f) Investigation of Claims
1) The SERS Board of Trustees recognizes its
obligation to provide a systematic program for the continued investigation,
control and supervision of disability claims.
2) Each disability benefit recipient is
required to provide a current medical examination report each 6 months to
substantiate continued disability. In order to substantiate the member's
continued eligibility for disability benefits, the Disability Claims Examiner
may require that the member submit to independent medical examinations and may
request additional medical statements; hospital records; activity inspection
reports; Department of Employment Security Earning Statements; Social Security
benefit payment information; income tax records; or other pertinent
information, all as deemed reasonable and necessary by the Examiner. SERS may
waive the medical examination report requirement for cases in which the
evidence supports that a member is permanently disabled and that the member
will never be able to return to their former position.
3) Failure of a disability benefit recipient
to submit to an independent medical examination, to cooperate with an activity
inspection, or to provide the information required shall result in suspension
of benefit payments.
4) Any benefit
suspended as a result of a medical examination will be suspended on the last
day of the month in which the claim is reviewed by the Executive
Committee.
5) The System may direct
a covered employee who is receiving a nonoccupational or temporary disability
benefit from the System and who is eligible under the federal Social Security
Act (42 U.S.C.
7) for a disability benefit before attaining the Social Security
full retirement age to file a claim for benefits under the federal Social
Security Act so that the amount of the Social Security offset to the
System-provided disability benefit can be calculated as provided in Sections
14-123.1 and 14-125 of the Code. If an employee does not file a claim for
Social Security benefits within 30 days after receiving written direction from
the System to do so, then the payment of the System-provided disability benefit
shall be suspended until the member files such a claim.
6) Any person who applies for or who is
receiving disability benefits and knowingly makes to SERS any false statement,
falsifies or permits to be falsified any record submitted to SERS, or omits
pertinent information in an attempt to defraud SERS, shall have the benefit
suspended until the correct information has been provided to SERS.
A) If the correct information that is
provided does not substantiate eligibility for the disability benefit payments,
then the benefit shall be terminated.
B) If it is determined that the person
omitted pertinent information and the correct information that is provided
supports that the individual is gainfully employed, then the process prescribed
in subsection (e) shall determine if the benefit payments shall
resume.
C) If it is determined that
the person knowingly made to SERS a false statement, or falsified or permitted
to be falsified any record submitted to SERS, in an attempt to defraud SERS and
the correct information that is provided supports that the individual is
gainfully employed, then the benefit shall be terminated.
g) A disability benefit claim will
be processed after the date that the final payroll payment received by the
member has been posted to SERS' accounting database.
h) When calculating the amount of a
nonoccupational, occupational, or temporary disability benefit under Section
14-123, 14-123.1, or 14-125 of the Code, the "date of disability" or "time
disability occurred" is the date the member is removed from payroll by virtue
of being placed on disability leave.
i) When calculating the final average
compensation of a disability benefit claim, the calculation shall include the
actual compensation received during the month in which the member left the
regular payroll.
j) Any individual
receiving an occupational disability benefit under Section 14-123 of the Code
who remains disabled at the end of the month in which that benefit ceases under
paragraph (3) or (4) of Section 14-123 shall become entitled to a retirement
annuity and have the minimum period of service prescribed for the receipt of
such annuity waived as described in that Section. The disability benefit
described in this subsection (j) applies regardless of whether the member first
became a member on or after January 1, 2011.
k) Definitions
As used in this Section:
"Code" means the Illinois Pension Code [40 ILCS 5 ].
"Full retirement age" means the age at which an individual is
eligible to receive full Social Security retirement benefits.
"The duties of the member's position" means the duties of the
member's position as of the date the member's name is removed from the payroll
without regard to subsequent changes in the duties of the position,
availability of the position, or the member's right to return to the
position.
"Licensed healthcare professional" means any individual who is
licensed by the Department of Financial and Professional Regulation as a
physician under the Medical Practice Act of 1987 [225 ILCS 60 ], as a physician
assistant under the Physician Assistant Practice Act of 1987 [225 ILCS 95 ], as
a psychologist under the Clinical Psychologist Licensing Act [225 ILCS 15 ], or
as an advanced practice registered nurse under the Nurse Practice Act [225 ILCS
65 ] or who is licensed or otherwise credentialed by the licensing body of
another state as a physician, physician assistant, clinical psychologist, or
advanced practice registered nurse under the laws of that state.
"Licensed healthcare professional's license number" means the
unique license number, registration number, or other identifier issued by the
federal Centers for Medicare and Medicaid Services, the Department of Financial
and Professional Regulation, or the licensing body of another state to an
individual who is licensed or otherwise credentialed by the Department of
Financial and Professional Regulation or the licensing body of another state,
as a licensed healthcare professional.
"Member", for purposes of Sections 14-123, 14-123.1, and 14-124
of theCode, means an employee in active service at the time of incurring a
disabling condition.