(A) Waiver of annual medical examination
requirement
(1) For those members who are
subject to the terms of division (C)(2)(a) of section
742.40
of the Revised Code (i.e., a disability benefit recipient who has been a member
of Ohio police and fire pension fund ("OP & F") for less than twenty-five
years and has not attained age forty-eight, such disability benefit recipient
shall submit to an annual medical examination by
OP
& F's physician
a physician designated by
OP & F, unless the
DEP
disability committee medical advisor certifies
that a disability benefit recipient's disability is ongoing and the board
waives the requirement that the disability benefit recipient undergo an annual
medical examination.
(2) If the
requirement that a disability benefit recipient undergo an annual medical
examination by an OP & F physician is
waived, the recipient shall thereafter be relieved from submitting to an annual
medical examination until otherwise notified in writing by OP & F. However,
any waiver granted shall not waive any rights the board may have to request a
medical examination in accordance with the terms of division (C)(2)(b) of
section
742.40
of the Revised Code.
(B)
Annual medical examinations
For a disability benefit recipient who has been requested by
the board to undergo a medical examination pursuant to the terms of division
(C)(2)(a) or division (C)(2)(b) of section
742.40
of the Revised Code:
(1)
OP & F shall notify the
The disability benefit recipient
shall be notified of the need to schedule the
medical examination and
provide the disability
benefit recipient
be provided with at
least thirty days prior written notice of the time and place of the scheduled
examination.
(2) Unless for good
cause shown, the disability benefit recipient shall be presumed to have refused
to submit to the medical examination
by an OP &
F physician if OP & F has scheduled such examinations
if such examination has been scheduled three
times and the disability benefit recipient has either canceled, rescheduled, or
failed to submit to the scheduled medical
examinations
examination, as documented by OP & F's books and
records.
(3) The refusal of a
disability benefit recipient to submit to the medical examination requested
pursuant to the terms of division (C)(2)(a) or division (C)(2)(b) of section
742.40
of the Revised Code, whether documented by OP & F's books and records or as
presumed under the terms of paragraph (B)(2) of this rule, shall result in the
suspension of disability benefits upon ninety days prior written notice to the
disability benefit recipient and shall continue until compliance.
(a) If the disability benefit recipient has
not submitted to the medical examination by an OP
& F physician within the aforementioned ninety day notice period,
the suspension of disability benefits shall be effective on the first day of
the month immediately following the expiration of the ninety day notice
period.
(b) In the event the
disability benefit recipient submits to the required medical examination
by physician an OP & F physician after
the ninety day notice period, OP & F will reinstate the recipient's
disability benefits on the first day of the month immediately following the
disability benefit recipient's submission to the required medical examination.
The recipient shall be entitled to retroactive coverage of disability benefits
during that time in which the benefits were suspended.
(c) If the refusal of a disability benefit
recipient to submit to any medical examination under section
742.40
of the Revised Code continues for one year, whether documented by OP & F's
books and records or as presumed under the terms of this rule, then the
disability benefits recipient's disability benefits shall be forfeited, as
required by division (C)(2)(c) of section
742.40
of the Revised Code, effective as of the date of the original suspension. OP
& F shall notify the disability benefit recipient by certified mail, return
receipt requested of the termination of benefits and the date that his or her
benefits shall be terminated.
(C) Board's concurrence in physician's
certification that recipient no longer meets disability standards
(1) For those disability benefit recipients
who undergo the medical examination pursuant to division (C) of section
742.40
of the Revised Code, the board will review the physician's report. If the board
concurs with the physician's certification that the recipient no longer meets
the disability standards set forth in division (D) of section
742.38
of the Revised Code or division (C)(2), (C)(3), or (C)(5) of former section
742.37
of the Revised Code, the disability benefits shall terminate ninety days after
the board concurs with the physician's certification or upon employment by the
benefit recipient as a police officer or firefighter, as defined in rule
742-3-20
of the Administrative Code.
(2) OP
& F shall notify the disability benefit recipient by certified mail, return
receipt requested of the board's concurrence with the physician's
certification, the date that his or her benefit shall be terminated and of his
or her right to appeal.
(D) Appeal of the board's concurrence with
physician certification
(1) In order to appeal
any determinations of the board under paragraph (C) of this rule, the
disability benefit recipient shall file the notice of disability appeal form
provided by OP & F within ninety days of receipt of OP & F's notice of
termination of benefits.
(2) Within
sixty days of the filing of the notice of appeal, the member shall submit to OP
& F all materials in support of the appeal including, but not limited to,
medical records, doctors' reports, and documentation substantiating earnings
and income. Failure to submit supporting materials will be sufficient cause for
the director of member services
OP & F to dismiss the appeal provided OP
& F gives the member prior written notice of such dismissal and a deadline
date by which all materials must be filed with OP & F, and the member fails
to file the required documentation with OP & F before the designated
deadline.
(3) OP & F shall
schedule the appeal hearing after receipt of the supporting materials and give
the member reasonable notice of the date, time, and place thereof in writing.
The member shall be given the opportunity to be present, with counsel or other
representation if he or she chooses, at the hearing. A recording of the hearing
will be made to provide the board and the medical advisor with a record for
further review. Such recording of the hearing shall be available to the member
and to those individuals who are authorized by the member to receive such
information on the authorization to release medical records form provided by OP
& F.
(4) Following the hearing
on appeal, the board may choose to:
(a) Affirm
the original concurrence in the physician's certification;
(b) Reverse the original concurrence in the
physician's certification; or
(c)
Postpone a decision pending additional examinations or documentation.
The board's decision on appeal shall be the final determination
of the member's disability.
(5) The applicant shall be advised of the
board's action within thirty days after the board's determination and such
notice shall be sent by certified mail, return receipt requested.
(6) Benefits shall be terminated pending
appeal if a favorable decision on the appeal is not made within ninety days of
the board's concurrence with the physician's certification.
(E) Unless otherwise provided in
this rule, all notices provided to the disability benefit recipient under this
rules shall be sent by first class U.S. mail, postage prepaid and addressed to
the disability benefit recipient at the address on file with OP & F. All
notices to OP & F shall be addressed at its principal place of
business.
Notes
Ohio Admin. Code
742-3-10
Five Year Review (FYR) Dates:
2/5/2024 and
02/05/2029
Promulgated
Under: 111.15
Statutory Authority: 742.10
Rule
Amplifies: 742.40
Prior Effective Dates: 11/30/1995 (Emer.),
02/10/1996, 09/16/1998 (Emer.), 12/10/1998, 07/17/2004, 08/01/2008 (Emer.),
10/16/2008, 08/02/2010 (Emer.), 10/17/2010, 01/17/2016, 01/01/2019 (Emer.),
03/29/2019, 05/31/2020, 09/22/2022
Effective: 9/22/2022
Five Year Review
(FYR) Dates: 1/4/2024
Promulgated Under:
111.15
Statutory Authority:
742.10
Rule Amplifies:
742.40
Prior Effective Dates: 11/30/1995 (Emer.), 02/10/1996, 09/16/1998
(Emer.), 12/10/1998, 07/17/2004, 08/01/2008 (Emer.), 10/16/2008, 08/02/2010
(Emer.), 10/17/2010, 01/17/2016, 01/01/2019 (Emer.), 03/29/2019,
05/31/2020