RTW 101 SERIES

Disability Retirement Services Process Overview May 15, 2013

Presented by Debbie Semnanian & Tamara CaldwellDisability Retirement Services

California Employee Retirement Law (CERL) &LACERA Board of Retirement

• LACERA’s Board of Retirement is separate, legal entity• Board decisions based on Retirement Law (CERL)• LACERA grants only on permanent incapacity• Not bound by Workers’ Compensation system• Not a party to Workers’ Compensation decisions

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Key Terms

• Service-Connected Disability• Eligible from 1st day of employment• Must be permanently disabled• Must have a direct causational link to the workplace

• Nonservice-Connected Disability• Must have at least 5 years of service (60 months)• Must be permanently disabled• No direct link to the workplace

• Service Retirement • Concurrent with Disability Application• Waive reinstatement rights

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• Government Code Section 31721• Allows any County Department to file an application on behalf of

an employee

• Employee’s Options• Act in accordance with with Employer Application by submitting

required documents• File there own Application • Take No Action and file will be CLOSEDCLOSED

• LACERA’s Process once Application is Received• Send Notice of Employer Application with required documents• 30 days to respond or Application is CLOSEDCLOSED• Required Documents

• Physician Statement• Authorization to Obtain and Release Information (DIS 104)• Claims Against Third Parties (DIS 117)• Missed Medical Appointment form (pg. 8)

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Employer Applications

IMPORTANT!!

• Employer Application Not Considered Valid Until:• We Receive All Required Documents and• Physician Statement certifies that the employee

has a permanently incapacitating condition(s)

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EMPLOYER APPLICATION

• Application • Completed by employee

• Authorization to Obtain and Release Information Form

• Claims Against 3rd Party Form• Physician Statement

• Completed by treating physician

• Application • Completed by employer

• Authorization to Obtain and Release Information Form

• Missed Medical Appointment Form• Claims Against 3rd Party Form• Physician Statement

• Completed by treating physician

EMPLOYEE APPLICATION

Employee vs. Employer ApplicationIs there a difference?

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EMPLOYEEAPPLICATION

EMPLOYER APPLICATION

Application Intake Process

• Review all applications received on daily basis• Identify and evaluate applications with complex eligibility and/or legal issues• Assign applications to specialists for processing• Collaborate with Return to Work Units to obtain additional information

Our Intake Review Process

Intake

Complex cases Complex cases Further Further

InvestigationInvestigation

• Retrieve all Workers’ Compensation records from Third Party Administrator (AIMS, TriStar, Intercare)

• Retrieve additional records from outside sources• Kaiser/personal physicians/chiropractors/therapists

• Retrieve Personnel, Health & Safety, and/or Occupational Health records

• Ask for additional documentation/information, when necessary

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Fact Gathering/Investigation

Interview Process• Establish Timelines

• Occupational History•Prior job assignments•Current job assignment and duties

• Focus on specific job duties and physical requirements within last assignment • Were there any work restrictions?

• If so, were they permanent or temporary?

• Were there any accommodations offered to the employee?

• If offered, when and were they temporary or permanent?

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Interview Process•History of Injury/Illness

• Mechanics of the injury•How, When & Where did it happen?•What body parts were injured?•Were there any witnesses?

• Reporting & Initial Treatment and Diagnosis• Follow-up treatment, diagnostic tests,

surgical procedures, etc., if any• Current symptoms and reason they

cannot perform their job duties

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Interview Process• Current symptoms/level of activity• Witness statements

•Contact supervisor• Confirm job duties/physical requirements• Obtain information regarding injury/illness• Applicant’s current condition/ability to perform duties

•Contact RTW Coordinator• Confirm medical leave status• Confirm temporary and/or permanent work restrictions• Verify temporary or permanent accommodations, if applicable

•Contact other witnesses, when necessary

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Panel Medical Examination• Independent objective medical finding based on:• Physical Examination• Record Review• Objective Evidence (diagnostic tests)

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Follow-up with RTW Unit• If the panel physician issues permanent work

restrictions• Contact RTW Coordinator • Address department’s ability to accommodate

work restrictions• If so, how would the department accommodate?• If not, provide explanation why unable to accommodate?

• Require written Response• Email, letter or fax

• Important that person giving response is authorized to make statement

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Reasonable Accommodation•Within employee’s job class (Modified Work)• Employer may provide modification to

applicant’s assignment or offer another assignment in job class• If employee accepts the offer and the

accommodation is successful, a disability retirement application can be avoided

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Reasonable Accommodation (cont.)

• In new job class (Alternative Work)• Employer provides permanent accommodation in

new job class• Worker either returns to work or may file a

disability application and request a Salary Supplemental Allowance

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Reasonable Accommodation

• If BOR determines reasonable accommodation is available within applicant’s pre-injury job class:•Disability Retirement will be Denied

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Processing Timeframes• Typical amount of time to process a disability application is 12 to 18 months (may be longer)• Depends on how many injuries/illness are

being claimed• Extra time may be needed for extensive

investigation or delays in obtaining medical evidence; or• Additional medical specialties evaluations

may be necessary

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Communication between Disability Retirement Services & Return to Work

Disability Retirement CANNOT provide information on the following:

1.What medical conditions did the employee apply for?2.Proposed date of service retirement?3.What is staff’s recommendation to the Board? 4.What do we think the Board action will be? 5.How much will employee make if they get the disability

retirement?

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Disability Retirement CAN provide information on the following:

1.About Disability Process and Procedures2.Time frame to process3.Status of case4.Name of Investigator5.Service retirement date, once confirmed by Board

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Communication between Disability Retirement Services & Return to Work

SUPPLEMENTAL DISABILITY ALLOWANCE

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Engaging the Process

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The Disability Retirement Services Division want to work closely with County Human Resource managers and Return to Work Coordinators to facilitate a better awareness of the Salary Supplement options.

Supplemental Retirement Allowance

• How do we retain disabled members in County Service?• Salary Supplement is the process of retaining

experienced employees; re-employment initiative

• Government Codes §31725.5, 31725.6 and 31725.65• Applications are to be treated like any other

application; the criteria is that the applicant must be found disabled from the ORIGINAL position and medically cleared to perform NEW position

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What Can the Department Do?

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• Department may file an application on behalf of the employee and apply for salary supplement allowance

• Department may keep employee in current job classification while performing new job duties during the application process

• Department may place an employee on “Y-Rate” with CEO approval pending the Board of Retirement’s approval

• Submit supporting documentation with the application including the lower item job classification, essential job functions and salary

Conditions of Supplemental Allowance

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• The offer of a permanent position with a lower salary schedule which accommodates the employee’s permanent work restrictions

• The acceptance of this position by the employee

• Panel Physician MUST find applicant permanently disabled from performing duties of ORIGINAL position and find capable of performing duties of NEW position

Contingent on:

Member’s Future Earnings

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• The calculation is based upon the member’s actual earnings at the time the benefit is granted. The calculation does not allow for future item raises and cost-of-living increases.

• The member can be promoted in the new position career chain. When the member receives a pay raise, it is reviewed against the original item number salary and the salary supplement allowance is lowered accordingly.

• If the new item number salary exceeds the original position’s salary, the Salary Supplement allowance stops.

Show Me the Money!

Salary Supplemental AllowanceHow does it work?

Not only does the member get to return to work and continue earning service credit; the salary supplemental allowance creates a savings for the system

**Supplemental Allowance cannot **Supplemental Allowance cannot exceed maximum disability exceed maximum disability retirement benefit allowedretirement benefit allowed

Plan Transfers

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What’s the Issue?

• Employees who have transferred from Plan E to Plan D and have become disabled

• Employee may be disabled, but ineligible to apply for disability retirement due to failure to meet 2/5 requirement.

How it Works?Frequently Asked Questions

QUESTION:

What is the 2/5 requirement?

As a Prospective Plan Transfer there is a time requirement; to apply for disability retirement:

• Completion of two continuous years of active service after his or her most recent transfer date, or

• Earned five years of retirement service credit under Retirement Plan D after his or her most recent transfer date. (Sec. 31494.5(e).)

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Effective January 1, 2011 (Post-AB 1902)

Disabled Plan D PPT transferee who fails to meet 2 /5 requirement has options:

•May transfer back to Plan E and continue under the County LTD program•Or may file for a service retirement under Plan D

Resources• General Information Hotline - (626) 564-2419General Information Hotline - (626) 564-2419• Log on to www.lacera.com

• Click “Benefits” tab (upper right hand side)• Click “Active Member” tab (left side)• Click “Disability Retirement” (lower left side)

• Contact the individual investigator• (Contact List Available Upon Request)

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