Except as otherwise indicated, this rule shall apply only to
disability claims initiated under Iowa Code section
97B.50A.
Except as otherwise indicated, disability claims under Iowa Code section
97B.50(2) shall be administered under rule
495-13.1 (97B).
(1)
Initiation of disability
claim. The disability claim process shall originate as an application
to the
system by the member. The application shall be forwarded to the
system's
designated retirement benefits officer. An application shall be sent upon
request to members who qualify pursuant to Iowa Code section
97B.50A(13).
The application consists of the following sections which must be completed and
returned to the
system's designated retirement benefits officer:
1. General applicant information.
2. Applicant's statement.
3. Employer's statement.
4. Member's assigned duties.
5. Disability/injury reports.
6. Medical information release.
(2)
Preliminary
processing. Completed forms shall be returned to the disability
retirement benefits officer. If the forms are not complete, they will be
returned for completion. The application package shall contain copies of all
relevant medical records and the names, addresses, and telephone numbers of all
relevant physicians. If medical records are not included, the designated
retirement benefits officer shall have the authority to contact the listed
physicians for copies of the files on the individual and shall request that any
applicable files be sent to the medical board. In addition, IPERS may request
workers' compensation records, social security records and such other official
records as are deemed necessary. The application, including copies of the
medical information, shall be forwarded to the medical board for review. All
medical records that will be part of a member's permanent file shall be kept in
locked locations separate from the member's other retirement records.
(3)
Scheduling of
appointments. Upon receipt and forwarding of the application and
sufficient medical records to the medical board, the disability retirement
benefits officer shall establish an appointment for the applicant to be seen by
the medical board in Iowa City. The member shall be notified in writing of the
appointment and shall be given general instructions about where to go for the
examinations. The appointment for the examinations shall be no later than 60
days after the completed application, including sufficient medical records, is
provided. The member shall also be notified about the procedures to follow for
reimbursement of travel expenses and lodging. Fees for physical examinations
and medical records costs shall be paid directly by IPERS pursuant to its
contractual arrangements with the medical providers required to implement Iowa
Code section
97B.50A.
(4)
Medical board
examinations. The medical
board, consisting of three physicians from
the University of Iowa occupational medicine clinic and other departments as
required, shall examine the member and perform the relevant tests and
examinations.
The medical board shall submit a letter of recommendation to
the system, based on its findings and the job duties supplied in the member's
application, whether or not the member is mentally or physically incapacitated
from the further performance of the member's duties and whether or not the
incapacity is likely to be permanent. "Permanent" means that the mental or
physical incapacity is reasonably expected to last more than one year. The
medical board's letter of recommendation shall include a recommended schedule
for reexaminations to determine the continued existence of the disability in
question.
IPERS shall not be liable for any diagnostic testing procedures
performed in accordance with Iowa Code section
97B.50A
and this rule which are alleged to have resulted in injury to the members being
examined.
The medical board shall furnish its determination, test
results, and supporting notes to the system no later than ten working days
after the date of the examination. The medical board may use electronic
signatures in fulfilling its reporting obligations under this rule.
The medical board shall not be required to have regular
meetings, but shall be required to meet with IPERS' representatives at
reasonable intervals to discuss the implementation of the program and
performance review.
(5)
Member and employer comments. Upon receipt by the system, the
medical board's determination regarding the existence or nonexistence of a
permanent disability shall be distributed to the member and to the employer for
review. The member and the employer may forward to the system written
statements pertaining to the medical board's findings within ten days of
transmittal. If relevant medical information not considered in materials
previously forwarded to the medical board is contained within such written
statements, the system shall submit such information to the medical board for
review and comment.
(6)
Fast-track review. IPERS' disability retirement benefits
officer may refer any case to IPERS' chief benefits officer (CBO) for
fast-track review. The CBO or the CBO's designee may, based upon a review of
the member's application and medical records, determine that the medical board
be permitted to make its recommendations based solely upon a review of the
application and medical records, without requiring the member to submit to
additional medical examinations by, or coordinated through, the medical
board.
(7)
Initial
administrative determination. The medical board's letter of
recommendation, test results, and supporting notes, and the member's file shall
be forwarded to IPERS. Except as otherwise requested by IPERS, the medical
board shall forward hospital discharge summary reports rather than the entire
set of hospital records. The complete file shall be reviewed by the system's
disability retirement benefits officer, who shall, in consultation with the
system's legal counsel, make the initial disability determination. Written
notification of the initial disability determination shall be sent to the
member and the member's employer within 14 business days after a complete file
has been returned to IPERS for the initial disability determination.
(8)
General benefits
provisions. Effective July 1, 2000, if an initial disability
determination is favorable, benefits shall begin as of the date of the initial
disability determination or, if earlier, the member's last day on the payroll,
but no more than six months of retroactive benefits are payable, subject to
Iowa Code section
97B.50A(13).
"Last day on the payroll" shall include any form of authorized leave time,
whether paid or unpaid. If a member receives short-term disability benefits
from the employer while awaiting a disability determination hereunder,
disability benefits will accrue from the date the member's short-term
disability payments are discontinued. If an initial favorable determination is
appealed, the member shall continue to receive payments pending the outcome of
the appeal.
Any member who is awarded disability benefits under Iowa Code
section
97B.50A
and this rule shall be eligible to elect any of the benefit options available
under Iowa Code section
97B.51.
All such options shall be the actuarial equivalent of the lifetime monthly
benefit provided in Iowa Code section
97B.50A(2)
and (3).
The disability benefits established under this subrule shall be
eligible for the favorable experience dividends payable under Iowa Code section
97B.49F(2).
If the award of disability benefits is overturned upon appeal,
the member may be required to repay the amount already received or, upon
retirement, have payments suspended or reduced until the appropriate amount is
recovered.
(9)
In-service disability determinations. Subject to the
presumptions contained in Iowa Code section
97B.50A
in determining whether a member's mental or physical incapacity arises in the
actual performance of duty, "duty" shall mean:
a. For special service members other than
firefighters, any action that the member, in the member's capacity as a law
enforcement officer:
(1) Is obligated or
authorized by rule, regulation, condition of employment or service, or law to
perform; or
(2) Performs in the
course of controlling or reducing crime or enforcing the criminal law;
or
b. For firefighters,
any action that the member, in the member's capacity as a firefighter:
(1) Is obligated or authorized by rule,
regulation, condition of employment or service, or law to perform; or
(2) Performs while on the scene of an
emergency run (including false alarms) or on the way to or from the
scene.
c. A presumption
shall exist that a special service member contracted a disease while on active
duty only if the disease is defined by Iowa Code section
97B.50A(2)
"c" as amended by 2010 Iowa Acts, House File 2518, section 31.
If a presumption exists, IPERS may, in making its determination as to whether a
disability was incurred while the member was on active duty, go forward with
evidence to rebut the presumption. IPERS can rebut the presumption when
credible evidence exists to the contrary or when the requirements are met in
Iowa Code section
97B.50A(2)
"c" as amended by 2010 Iowa Acts, House File 2518, section 31.
Under no circumstances shall the burden of proof shift from the special service
member to IPERS.
(10)
Appeal rights. The member or the employer, or both, may appeal
IPERS' initial disability determination. Within 30 days after the notification
of
IPERS' initial disability determination was mailed, the member shall submit
to
IPERS' CEO or CEO's designee a notice of appeal in writing setting forth:
a. The name, address, and social security
number of the member or employee number of the employer;
b. A reference to the decision from which the
appeal is being made;
c. The fact
that an appeal from the decision is being made;
d. The grounds upon which the appeal is
based;
e. Additional medical or
other evidence to support the appeal; and
f. The request that a different decision be
made by
IPERS.
The system shall conduct an internal review of the initial
disability determination, and the CEO or CEO's designee shall notify in writing
the party who filed the appeal of IPERS' final disability determination with
respect to the appeal. The CEO or CEO's designee may appoint a review committee
to make nonbinding recommendations on such appeals. The disability retirement
benefits officer, if named to the review committee, shall not vote on any such
recommendations, nor shall any members of IPERS' legal staff participate in any
capacity other than a nonvoting capacity. Further appeals shall follow the
procedures set forth in 495-Chapter 26.
(11)
Notice of abuse of disability
benefits. The
system has the obligation and full authority to
investigate allegations of abuse of disability benefits. The
system, in its
sole discretion, may initiate investigations in the absence of a complaint. The
scope of the investigation to be conducted shall be determined by the
system
and may include the ordering of a sub rosa investigation of a disability
recipient to verify the facts relating to an alleged abuse. A sub rosa
investigation shall only be considered upon receipt and evaluation of an
acceptable notice of abuse. The notification must be in writing and include:
a. The informant's name, address, telephone
number, and relationship to the disability recipient; and
b. A statement pertaining to the
circumstances that prompted the notification, such as activities which the
informant believes are inconsistent with the alleged disability.
c. Anonymous calls shall not constitute
acceptable notification.
IPERS may employ such investigators and other personnel, in
IPERS' sole discretion, as may be deemed necessary. IPERS may also, in its sole
discretion, decline to carry out such investigations if more than five years
have elapsed since the date of the disability determination.
(12)
Qualification for
social security or railroad retirement disability benefits. Upon
qualifying for social security or railroad retirement disability benefits, a
special service member may contact the system to have the member's disability
benefits calculated under Iowa Code section
97B.50(2).
The member and spouse must complete the designated application to stop having
benefits calculated under Iowa Code section
97B.50A
and to start having benefits calculated under Iowa Code section
97B.50(2).
The decision is irrevocable, and must be made within 60 days after the member
receives written notification of eligibility for disability benefits from
social security or railroad retirement and has commenced receiving such
payments.
(13)
Reemployment/income monitoring. A member who retires under
Iowa Code section
97B.50A
and this rule shall be required to supply a copy of a complete set of the
member's state and federal income tax returns, including all supporting
schedules, by June 30 of each calendar year, in order to continue qualification
for
IPERS special service disability benefits.
IPERS may suspend the benefits
of any such member if such records are not timely provided. This subrule does
not apply to a member who is at least 55 years of age and would have completed
22 years of service if the member had remained in active special service
employment.
Only wages and self-employment income shall be counted in
determining a member's reemployment comparison amount, as adjusted for health
care coverage for the member and member's dependents.
(14)
Offset to allowance. A
member who retires under Iowa Code section
97B.50A
shall have benefits reduced by other disability-related payments the member
receives for the same disability, including, but not limited to, benefits from:
a. Social security.
b. Long-term disability insurance.
c. Workers' compensation, subject to the
limitations set forth in Iowa Code section
97B.50A(5)
"b" and "c."
d. Unemployment insurance.
e. Employer-paid disability plans, programs,
or policies.
f. Other laws.
For purposes of calculating the income offsets required under
Iowa Code section
97B.50A,
IPERS shall convert any lump sum workers' compensation award, disability
insurance payments, or similar lump sum awards for the same illnesses or
injuries to an actuarial equivalent, as determined by IPERS. IPERS shall
convert any monthly, weekly, or other stated period workers' compensation
award, disability insurance payments, or other awards for the same illnesses or
injuries, dollar-for-dollar, to the same monthly, weekly, or other stated
period, as determined by IPERS.
