Disability Application

  • What form should I use to apply for disability retirement?
    Whether you are applying for accidental or ordinary disability retirement or both (because of uncertainty about which is appropriate for your circumstances), you must file a Member's Application for Disability Retirement with your retirement board.
  • Where can I obtain a Member's Application for Disability Retirement and guidance in how to complete it?
    Your retirement board will provide you with a copy of the application. The retirement board staff will help you to understand the process, and will respond to your questions as things progress. You may also download a copy of the application form from PERAC's Home Page on the Internet: www.mass.gov/perac.
  • What information must I include in my Member's Application for Disability Retirement?
    The Member's Application for Disability Retirement is a multi-page form. In order to complete your application, you must provide:
    • A statement of your job duties
    • Your employment history
    • Statements about your background, qualifications, and recent physical activities
    • The reason for accidental disability
    • Information about incident reports and witnesses
    • Information about filing for a grievance, Workers' Compensation, or Section 111F benefits
    • Information about emergency medical treatment
    • A listing of all hospitals and medical facilities from which you sought treatment within the last five years
    • A listing of physicians with whom you have consulted or from whom you sought treatment within the last five years
    • The name and address of your personal physician
    • If you are represented by an attorney in connection with your application, the name and address of your attorney
    • The name and address of relevant insurance carriers
    • Authorizations for release of insurance records, medical records, and tax records
    • Your regional medical panel selection choice

Date of Application
You must complete the Member's Application for Disability Retirement in its entirety and file it with your retirement board. Until all of the required information has been submitted, your retirement board cannot assign a date of application, which will be very important in determining your effective date of retirement and your retirement allowance date.

Information From Other Parties
Upon receipt of your disability retirement application, your retirement board will request written information from your employer on a prescribed form about the essential duties that you are required to perform in your current position and other information. The retirement board will ask your personal physician to complete a form that contains a diagnosis of your condition, as well as information about your medical treatment and history. He or she will be asked to assess your ability to perform your job duties, and to discuss whether or not your disability is likely to be permanent. Please note that, if you choose to do so, you may personally convey the form to your physician. Your board will request copies of records from the other physicians, hospitals, and insurance companies that you identified in your application.

When all of the required documents have been received, your retirement board will ask PERAC to appoint a medical panel to examine you.

  • What time frames govern the disability retirement application and determination process?
    The regional medical panel should meet within 60 days of being appointed by PERAC to conduct its examination.
    • You will be given 14 days notice of the scheduled examination.
    • The regional medical panel will report their findings and recommendations to PERAC within 60 days of completing their examination(s)
    • Within 5 days of receipt of a properly completed medical report, PERAC will forward the report to your retirement board.
    • Within 30 days of its receipt of the report, your retirement board will notify you of the panel's findings and provide you with a copy  of all of the documents completed by the regional medical panel.
    • Your retirement board has the option at this point of requesting further information or a clarification from the regional medical panel if they determine that it would be helpful.
    • If the determination of the regional medical panel precludes retirement for the disability you claimed, your retirement board will either deny your application or they will ask PERAC for a new regional medical panel if they believe that circumstances warrant it.
    • If PERAC declines to schedule a new examination, your retirement board will deny your application.
    • If the determination of the regional medical panel permits retirement for the disability you claimed, your retirement board shall determine whether or not to approve the application. A hearing may be held on any disability retirement application, and must be held upon your request.
    • If a hearing is scheduled, your board must give you at least 30 days notice of the time and place for the hearing and the issues involved.
    • Your retirement board's decision about your eligibility for disability retirement must be made no later than 180 days after you file your completed application, unless PERAC grants an extension.
    • If your retirement board approves your application, it will be transmitted to PERAC for final action. PERAC must act on your application within 30 days of its receipt.
    • PERAC will either approve your application, or remand your application to the retirement board for further action.
    •  If your retirement board denies your application, your retirement board will advise you of your right to appeal the decision.


Date published: July 1, 2015