Or. Admin. Code § 459-076-0050 - Periodic Reviews

(1) Members receiving a disability benefit are subject to periodic reviews of their disabled status until the member reaches normal retirement age or staff determines that periodic reviews are no longer warranted.

(2) Periodic reviews will be used to determine that continued disability benefits are warranted. In recommending the continuance or discontinuance of a disability benefit, PERS will follow the criteria established under OAR 459-076-0005 for the original approved disabling condition or a new medical condition. If a member receiving a disability benefit becomes employed, the member's disability benefit will be terminated as provided in OAR 459-076-0005.

(3) For a duty disability, the periodic review will not revisit the original determination that the injury or disease was duty caused, unless there is evidence of misrepresentation or fraud.

(4) PERS will establish review dates for each member subject to a periodic review depending on type of disability, extent of disability, and medical reports unique to each individual case:

(a) The reviews may be medical or vocational in nature, or both;

(b) Upon review, PERS may accept or require:

(A) New treating or consulting physician or specialist reports;

(B) Updated physician or specialist reports;

(C) Independent medical or vocational examinations; or

(D) Employment and wage information, including but not limited to, tax returns or information from the State Employment Department.

(c) PERS may immediately discontinue the disability benefit of any person who fails to provide current medical evidence; submit requested employment, wage, income, or tax information; or refuses to submit to a medical or vocational examination.

(A) If the disability claim is discontinued, the staff shall issue an Intent to Discontinue letter by regular and certified mail, return receipt requested. The Intent to Discontinue letter shall advise the applicant that additional information to substantiate the claim, or a request for an extension of 30 days to present additional information, may be submitted to the staff in writing within 30 days of the date of the Intent to Discontinue letter;

(B) Following the issuance of an Intent to Discontinue letter, staff will review any additional information which is submitted within 30 days:

(i) If the additional information results in a recommendation to continue the disability benefit, staff shall resubmit the disability claim to the Director, or the Director's designee, with the recommendation;

(ii) If the additional information does not result in a recommendation to continue the disability benefit, PERS will issue a final discontinuation letter by regular and certified mail, return receipt requested.

(C) If no additional information is received within 30 days, PERS will issue a final discontinuation letter by regular and certified mail, return receipt requested;

(D) The final discontinuation letter will provide the applicant with notification of the right to request a contested case hearing as provided for in OAR 459-015-0030 and 459-001-0035.

(5) The member has the burden to prove continuing eligibility for a disability benefit.

(6) The Director, or Director's designee, may approve or deny the continuance of a disability benefit.

Notes

Or. Admin. Code § 459-076-0050

PERS 16-2005, f. & cert. ef. 10-3-05; PERS 7-2007, f. & cert. ef. 4-4-07; PERS 8-2011, f. & cert. ef. 10-5-11; PERS 8-2021, amend filed 12/03/2021, effective 12/3/2021

Statutory/Other Authority: ORS 238A.450

Statutes/Other Implemented: ORS 23 A8.235