Evaluation of Disability Retirees
Findings
- Is a disability retiree required to be evaluated by PERAC after his or her disability retirement becomes effective?
After PERAC consults with a member's retirement board, any member retired for ordinary or accidental disability will be required by PERAC to participate in an evaluation to determine whether: - the member is able to perform the essential duties of the position from which he or she retired, or a similar job within the same department for which he or she is qualified,
or - whether the member's return to his or her former or similar job would likely be expedited by participation in a medical or vocational rehabilitation program.
Evaluation Schedule
- How frequently will such evaluations be scheduled?
PERAC may require an evaluation once per year during the first two years after retirement, and once every three years thereafter, or at any time upon the written request of a disability retiree. No member will be evaluated more frequently than once in any twelve-month period.
Records Review
- How is the evaluation process begun?
PERAC begins this process by reviewing a retiree's records. PERAC's Disability Unit Case Manager may also contact the retiree and his or her retirement board. Once all appropriate information is obtained, a determination will be made by PERAC as to the need for a comprehensive medical evaluation to be conducted by a physician. - Which records will PERAC review?
The medical records pertaining to those examinations, tests, and studies performed since your disability retirement became effective are of crucial importance. With access to all up-to-date medical information, PERAC is better able to make an assessment without requiring the duplication of medical tests and studies to produce relevant data. If you advise PERAC that no additional medical records are available, PERAC will schedule you for a comprehensive medical evaluation with a physician. - What are the possible outcomes of a records review by PERAC?
- PERAC may find that the catastrophic nature of your illness or injury is such that you do not need to be scheduled for any further review of records or any comprehensive medical evaluations in the future.
or - PERAC may find that you are currently unable to perform the essential duties of your former position or a similar job. You will not be scheduled for a comprehensive medical evaluation. You will be scheduled for another records review in the future.
or - PERAC may find that a comprehensive medical evaluation must be scheduled in order to complete an assessment of your current ability to return to work, with or without rehabilitation. You will be given 14 days notice of the time(s) and place(s) of the evaluation. Your retirement board will also be notified.
Comprehensive Medical Evaluation
- What can be included in a comprehensive medical evaluation?
A comprehensive evaluation may include mental or physical medical examinations, vocational testing, meetings and consultations with medical professionals, including your treating physician and vocational rehabilitation counselors. The goal is to provide objective data pertaining to your ability to safely perform the essential duties of your former or similar job, and whether or not your return to employment is likely to be facilitated by participation in a rehabilitation program.
The physician who coordinates this evaluation process will have copies of all of the available medical information and a copy of the current job description associated with the position you held at the time of retirement. If you are a retired police officer or firefighter, a copy of the medical standards established by the Commonwealth's Human Resources Division (HRD) for those positions will also be given to the physician.
The physician will submit his findings in a written report to PERAC. If the physician has concluded that you may benefit from rehabilitation, the doctor will include a rehabilitation plan with the report. - What happens if I refuse to participate?
If you refuse to participate in the evaluation without good cause, your retirement board must terminate your allowance. You must first be given written notice and an opportunity to be heard by the board. - May I appeal a determination made by a comprehensive medical evaluation physician about my ability to perform the essential duties of the position from which I retired?
Yes. You or any other party to the comprehensive medical evaluation process may appeal any decision to the Contributory Retirement Appeal Board (CRAB). Upon request, a member's retirement board must assist the member in the filing of an appeal.
Restoration to Service Examinations
- What happens if the physician who performs the comprehensive medical evaluation determines that I am able to perform the essential duties of the position from which I retired?
PERAC will schedule you for restoration to service (RTS) examinations with three different physicians. These examinations are not conducted on a joint basis. Each physician will conduct a separate examination.
At least one of the physicians will be a specialist in the medical field related to the condition for which you retired. The other physician(s) will specialize in fields whose relevancy is determined by PERAC.
Your physician, legal counsel, and a person of your choosing may attend your RTS examinations. Your former employer's physician and legal counsel designated by your former employer, may also be present. - What happens after the RTS examinations have been conducted?
The physicians complete the RTS certificates and narrative reports and send them to PERAC within 60 days of conducting their examinations. You and your retirement board will receive copies of the certificates and narrative reports from PERAC. If the unanimous outcome of the RTS examination is that you should be restored to service, PERAC will notify your retirement board. Your retirement board must notify your former employer and the state's HRD that you must be restored to service. - May I appeal a determination made by a restoration to service examination physician about restoring me to active service?
You or any other party to the RTS examination process may appeal any decision to the Superior Court. Upon request, a member's retirement board must assist the member in the filing of an appeal.
Rehabilitation Programs
- What is the next step if the physician determines that my return to service would be facilitated by my participation in a rehabilitation program?
If PERAC determines that you would benefit from a rehabilitation program, and that such a program is cost-effective, your retirement board must provide the rehabilitation program for you. - Who will pay for the rehabilitation program?
Your retirement board must pay for the cost of the program, less any benefits payable under your insurance policies, and less any scholarships or grants otherwise available. - What services will be included in the rehabilitation program?
Any rehabilitation program will include only those services that are aimed toward returning you to your former position, or a similar position in the same department.
All rehabilitation programs will include a determination of your functional capacity, age, education, and experience. - Are there any consequences associated with failure to complete a rehabilitation program?
Your retirement allowance will be suspended if you fail to complete the program without good cause.
Examination Following Rehabilitation
- Must I be evaluated after I complete a rehabilitation program?
Following completion of rehabilitation, PERAC will convene a Comprehensive Medical Exam to examine you to determine if you can perform the essential duties of the position from which you retired.
Voluntary Rehabilitation Programs
- If a disability retiree wants to volunteer for rehabilitation, how will his or her request be processed?
A member may initiate the rehabilitation process under Section 21 of Chapter 32. PERAC may require the member to be examined by a physician qualified to render rehabilitation services, or a vocational counselor, or both, for a recommendation as to the need and nature of rehabilitation.
| Date published: | July 1, 2015 |
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