(a) Initial non-service-connected disability benefits.
(1) An employee is entitled to receive disability benefits if the administrator determines that the employee has:
(A) incurred an initial non-service-connected disability; and
(B) worked for the County for the 6 months immediately preceding the disability.
(2) The employee is entitled to receive disability benefits subject to this plan for a period of:
(A) 12 consecutive months for a public safety employee; and
(B) 36 consecutive months for a non-public safety employee.
(b) Continued non-service-connected disability benefits. Before the end of the distribution period for initial non-service-connected disability benefits, the administrator must re-evaluate the employee to determine if the employee satisfies the requirements for a continued non-service-connected disability. If the employee does not meet the requirements for a continued non-service connected disability, the payment of disability benefits must stop. If a participant meets the requirements for a continued non-service connected disability, the payment of disability benefits must continue, subject to this plan.
(c) Temporary disability. In extenuating circumstances, the administrator may:
(1) waive the requirement that an employee's disability is likely to be permanent for continued service-connected or non-service-connected disability benefits; and
(2) approve temporary disability benefits for one or more one-year periods until the administrator determines that the disability:
(A) has ended; or
(B) qualifies as a continued disability.
(d) Initial service-connected disability benefits. An employee may receive disability benefits for a period of 36 consecutive months, subject to this plan, if the administrator finds that:
(A) the employee has incurred an initial service-connected disability; and
(B) for an accidental injury that does not cause mental impairment, the employee:
(i) reports the claimed accidental injury as soon as practicable, but no later than one year after the applicant knew or should have known that the injury is likely to be disabling; or
(ii) submits a claim for Workers’ Compensation benefits for the accidental injury that is not dismissed as untimely.
(C) The time periods for reporting in subparagraphs (i) and (ii) do not begin while the applicant is unable to report because of incapacitating injuries.
(D) For an accidental injury that occurs after July 1, 2009, the applicant must apply for disability benefits within one year after separation from County service or before July 1, 2010, whichever is later.
(E) An employee who has committed an offense that would justify termination for misconduct must not receive service-connected disability benefits.
(e) Continued service-connected disability benefits.
(1) Before the end of the distribution period for initial service-connected disability benefits, the administrator must re-evaluate the employee to determine if the employee satisfies the requirements for a continued service-connected disability. If the employee does not meet the requirement for a continued service-connected disability, the payment of disability benefits must stop. If the employee meets the requirements for a continued service-connected disability, the payment of disability benefits must continue subject to this plan.
(2) The Chief Administrative Officer may offer a 5-percent salary increase to an employee who:
(A) is eligible to receive continued service-connected disability benefits; and
(B) accepts an alternative position within the County government for which the employee is qualified.
(3) The employee’s salary in the alternative position must not exceed the maximum salary of the pay grade assigned to the position.
(4) A member of the Office, Professional and Technical Bargaining Unit or the Service, Labor and Trades Bargaining Unit who accepts an alternative placement incentive is not eligible to receive continued service connected disability benefits based on the disability for which the alternative placement was made.
(5) If a member applies for continued service-connected disability benefits instead of accepting an alternative placement incentive, the member’s failure to accept the incentive must not:
(A) be included in the information considered by the Disability Review Panel, Chief Administrative Officer, or Disability Arbitration Board;
(B) be considered at any time by the Disability Review Panel, Chief Administrative Officer, or Disability Arbitration Board; or
(C) affect the member’s eligibility for continued service-connected disability benefits or the amount of the continued service-connected disability benefits.
(f) The Disability Review Panel must recommend a finding of total incapacity if the member’s service-connected disability is severe enough to meet the Social Security Administration’s requirements for disability, meaning that the member is unable to engage in any substantial gainful activity because of a medically determinable physical or mental impairment that can be expected to end in death or has lasted, or can be expected to last, for a continuous period of at least 12 months. The member does not have to qualify for Social Security disability benefits to be eligible for benefits under this subsection.
(1) The Panel must base its determination of whether an individual is able to engage in any substantial gainful activity on an assessment from an independent vocational expert that considers the member’s age, education, work experience, transferable skills, and residual functional capacity.
(2) The Panel must determine the member’s residual functional capacity and provide this information to the independent vocational expert.
(3) A Panel determination that the member’s service-connected disability is severe enough to be considered a disability by the Social Security Administration is not a recommendation that the member is entitled to, or should be granted, a disability benefit by the Social Security Administration.
(4) If a member has already been granted disability benefits by the Social Security Administration when the member applies for a service-connected disability pension, the County must give the member a total incapacity benefit if the Disability Review Panel finds that the award of disability benefits from the Social Security Administration was based primarily on the same medically determinable physical or mental impairment on which the Disability Review Panel awards the member a service-connected disability benefit.
(g) The Disability Review Panel must recommend a finding of partial incapacity if:
(1) the member meets the standards to receive a service-connected disability benefit; and
(2) the member is not eligible to receive a benefit for total incapacity under subsection (f).
(h) The County must increase the partial incapacity service-connected disability pension benefit of a member to a total incapacity benefit if:
(1) the Social Security Administration awards disability benefits to the member;
(2) the member submits all relevant information about the award of disability benefits from the Social Security Administration to the Disability Review Panel within 60 days after the member receives the award;
(3) the Disability Review Panel finds that the award of disability benefits from the Social Security Administration was based primarily on the same medically determinable physical or mental impairment on which the Disability Review Panel originally awarded the member a service-connected disability benefit; and
(4) the member applies for disability benefits with the Social Security Administration within 90 days after the Chief Administrative Officer notified the member that the service-connected disability pension benefit would be calculated as a partial incapacity.
(5) If a member qualifies for an increased pension benefit under subsection (h), the County must increase the member’s service-connected pension retroactively to the date when the pension began.
(i) Role of the Disability Review Panel.
(1) The Disability Review Panel must consider an application for disability benefits to determine if the applicant is eligible for disability benefits under subsection (a), (b), (c), (d), (e), (f), (g), or (h). The Panel may consider any information or material submitted by the applicant, the certified representative, or the County. Within 60 days after the application is filed, the Panel must meet in person, by telephone conference, or by video conference, to review all evidence submitted to the Panel. A Panel must include either 2 or 3 members. At least 2 members must vote in favor of a decision to take any action under this Section.
(2) Before the Panel meets to review the application, the Panel must advise each party of the deadline date for submitting information to the Panel. The Panel must allow a reasonable amount of time for the parties to submit additional information, and may extend the deadline at the request of the applicant for good cause shown.
(3) The Panel must not accept or consider information from a certified representative representing an applicant if the information is received after the established deadline date unless the information is related to:
(A) the applicant’s reinjury that occurred or was diagnosed after the deadline date; or
(B) a change in the applicant’s medical condition that occurred or was diagnosed after the deadline date.
(4) Within 30 days after the Panel’s last meeting to consider the application, the Panel must issue a written recommendation to the Administrator on whether the applicant qualifies for disability benefits.
(5) Before making its recommendation, the Panel must require the applicant to complete a medical examination, including relevant medical tests, by a medical doctor who is not a member of the Disability Review Panel, unless the Panel finds that a medical examination is unnecessary because of the nature and severity of the injury or illness. The County must pay the cost of the examination. The results of the examination must be given to the applicant or the applicant’s representative immediately after the County or the Panel receives it. The panel must issue its written recommendation within 30 days after the medical doctor reports to the Panel.
(6) Within 20 days after the Administrator receives the Panel’s recommendation, the Administrator must issue a final decision on whether the applicant is eligible for disability benefits under this Section. (1994 L.M.C., ch. 13, § 2; 1998 L.M.C., ch. 30, § 1; 1999 L.M.C., ch. 26, § 1; 2009 L.M.C., ch. 11, § 1; 2011 L.M.C., ch. 13, § 1.)