Wis. Admin. Code Department of Employee Trust Funds ETF 50.56 - Termination or suspension of benefits
(1) DURATION OF
BENEFITS. Except as otherwise provided in this section:
(a) For a recipient whose LTDI benefit
effective date is prior to the date the recipient attains age 61, all LTDI
benefits terminate at the end of the month in which the recipient attains age
65.
(b) For a recipient whose LTDI
benefit effective date is on or after the date the recipient attains age 61 and
prior to the date the recipient attains age 63, all LTDI benefits terminate at
the end of the month in which the recipient attains age 66.
(c) For a recipient whose LTDI benefit
effective date is on or after the date the recipient attains age 63 and prior
to the date the recipient attains age 65, all LTDI benefits terminate at the
end of the month in which the recipient attains age 67.
(d) For a recipient whose LTDI benefit
effective date is on or after the date the recipient attains age 65 and prior
to the date the recipient attains age 67, all LTDI benefits terminate at the
end of the month in which the recipient attains age 68.
(e) For a recipient whose LTDI benefit
effective date is on or after the date the recipient attains age 67 and prior
to the date the recipient attains age 68, all LTDI benefits terminate at the
end of the month in which the recipient attains age 69.
(f) For a recipient whose LTDI benefit
effective date is on or after the date the recipient attains age 68 and prior
to the date the recipient attains age 69, all LTDI benefits terminate at the
end of the month in which the recipient attains age 70.
(g) For a recipient whose LTDI benefit
effective date is on or after the date the recipient attains age 69, all LTDI
benefits terminate 12 months after the LTDI benefit effective date.
(h) Notwithstanding pars. (a) to (g), no LTDI
benefits shall be payable for any date after the recipient's death.
(i) The effective date used to determine the
duration of LTDI benefits is the effective date of the benefits being paid, not
the effective date of terminated LTDI benefits paid under a previous
application.
(j) The duration of
LTDI benefits for recipients whose LTDI benefit effective date is on or after
the date the recipient attains age 61 shall be periodically reviewed and may be
revised based on the actuary's determinations, as approved by the employee
trust funds board, so as to provide LTDI benefits meeting equal cost standards
under federal age discrimination law. As part of the regular 3-year general
investigation under s.
40.03(5) (b), Stats., beginning with the investigation
based on data through 1996, the actuary shall determine the appropriate
duration for LTDI benefits beginning at and after age 61. The employee trust
funds board shall be responsible for approving any change to the duration of
LTDI benefits. If the duration of LTDI benefits is changed, the duration of
LTDI benefits being paid as the result of an application received by the
department prior to the effective date of the change shall not be affected. Any
such revision shall be effective upon promulgation as an amendment to this rule
by the employee trust funds board.
(2) TERMINATION FOR FRAUD, MISREPRESENTATION,
ERROR OR MISTAKE.
(a) Payment of LTDI
benefits may be terminated immediately and overpayment recovered upon a
department determination of either of the following:
1. LTDI benefits were granted as the result
of fraud or misrepresentation in the application or in required evidence of
eligibility.
2. LTDI benefits were
granted due to an error or mistake by the department or due to an error or
mistake in the information supplied by the employer used for determining
eligibility, effective date or amount of LTDI benefits.
(c) The amount of monthly LTDI benefits may
be altered upon a determination that the amount of LTDI benefits was computed
in error.
(d) LTDI benefits may be
terminated effective upon a determination by the department that the recipient
has made misrepresentations or submitted false or fraudulent information
regarding continued disability, earnings, wages, salary or other earned
income.
(e) If the department
alters the amount of monthly LTDI benefits under par. (c) or terminates payment
of LTDI benefits under par. (d), the department shall send notice of the action
to the recipient. The notice shall be in the form of a written determination
stating the reasons for the termination. The recipient may file a timely appeal
of the alteration or termination with the employee trust funds board as
provided in ch. ETF 11. If no timely appeal is filed, the alteration or
termination of LTDI benefits is final.
(3) TERMINATION UPON RECOVERY OR FOR FAILURE
TO FURNISH INFORMATION.
(a) The payment of
LTDI benefits shall be terminated based on a determination by the department of
any of the following:
1. The written
physician's report required in s.
ETF 50.54(3) indicates that the recipient
has recovered from the medically determinable impairment so that the recipient
is no longer totally and permanently disabled, or, for a recipient who
qualified under s.
ETF 50.58, recovered to the extent that the recipient can
efficiently and safely perform the duties required by the recipient's former
position as a protective occupation participant or that the recipient's
impaired condition is not likely to be permanent. LTDI benefits are payable up
to the date of recovery.
2. The
recipient refuses to submit to an examination under s.
ETF 50.54(3) or refuses to submit information regarding
earnings, wages, salary or other earned income as requested by the department.
LTDI benefits shall not be payable for any month following the deadline for the
recipient's compliance set by the department.
(b) If the department terminates payment of
LTDI benefits under this subsection, the department shall send notice of the
termination to the recipient. The notice shall be in the form of a written
determination stating the reasons for the termination. The recipient may file a
timely appeal of the termination with the employee trust funds board, as
provided in ch. ETF 11. If no timely appeal is filed, the termination of LTDI
benefits is final.
(4)
TERMINATION OR SUSPENSION BASED ON EARNINGS.
(a) Except as provided in par. (b) and s.
ETF 50.58(2), the payment of LTDI
benefits shall be terminated and no LTDI benefits shall be payable after the
first of the month in which a determination is made by the department that the
recipient has received during the calendar year earnings or other earned income
exceeding the earnings limit.
(b)
On the first occasion that the department determines that the recipient has
exceeded the earnings limitation as described in par. (a), the payment of LTDI
benefits shall be suspended rather than terminated. Payment of LTDI benefits
suspended under this paragraph shall resume on the earlier of the first day of
the next calendar year or the first day of the second month following the
termination of personal services due to recurrence of the medically
determinable impairment which was the basis for payment of LTDI benefits. A
recipient's LTDI benefits may only be suspended once and must be terminated if
par. (a) subsequently applies.
(5) TERMINATION UPON CERTAIN REEMPLOYMENT.
LTDI benefits for a recipient under s.
ETF 50.58(1) shall be terminated upon
reemployment as provided in s.
ETF 50.58(3).
Notes
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