disability retirement services “a day in the life of an investigator” presenters: tamara...

Disability Retirement Services“A Day In the Life of an Investigator”

Presenters: Tamara Caldwell & Debbie Semnanian

Key Terms

• Service-Connected Disability

• Nonservice-Connected Disability

• Injury vs. Disability

• Permanently Incapacitating

Employer ApplicationsWhat, When, Where, How

• From the Employer (Department)– Employer Application– Class specification, list of usual and customary

duties, physical demands (current RU-91)– Duties the employee can no longer sustain

(could this be information obtained via IPM)– Written Documentation of Department’s Efforts

to Accommodate

Employer ApplicationsWhat, When, Where, How

• Supplemental Disability Allowance– Identified Position that Employee is

Willing to Accept

– Class Specification • Original Position• New Position

– List of Usual & Customary Duties

LACERA’s Steps In Processing Employer Applications

• LACERA will request the following documents before processing the application:– Physician’s Statement– Authorization to Obtain and Release Records and

Information Form – Claims Against Third Parties Form– Missed Medical Appointment Form

• Employee is given 30 days to respond.

• LACERA will not process applications if employee deemed Temporarily Disabled by a treating physician.

• These applications will be returned and the file will be closed.

• Applicant must be permanently incapacitated for application to be processed.

LACERA’s Steps In Processing Employer Applications

• From the Employee– Medical evidence supporting permanent

incapacity– All medical conditions for which they are

claiming permanent disability must be supported by medical evidence. a. To satisfy this requirement, LACERA will

request a physician’s statement;

b. An employee’s statement that they cannot perform their job is not medical evidence.

Employer ApplicationsWhat, When, Where, How

The Process

Intake

Complex cases Complex cases Further InvestigationFurther Investigation

Investigator Role Beyond Intake

• Preliminary Review of New Application– Verify type of application (SCD, NSCD,

Survivor, Priority) – Review Physician Statement

Fact-Gathering

• Request Records (Workers’ Compensation Claim File, Medical, Personnel, Return to Work)– Review records once received– Index in chronological order by specialty

Interview Process

• Used to document information concerning applicant’s claim of disability

• Gather information from applicant and witnesses

Disability Evaluation Report Preparation

• Bullet-point Reports

• Information obtained during interview presented in a summarized Disability Evaluation Report for the Panel Physician and Board of Retirement

• 2-Tier Review– Investigator Final Review– Supervisor Review/Approval

Panel Medical Examination

• File assembled for review by panel physician

• Appointments scheduled near applicant’s home

• Appointments scheduled within 2-4 weeks of request for exam

Return to Work Issues

• Permanent Work Restrictions

• Department Accommodation

Case Preparation for Board

• Must submit for approval 1-2 weeks prior to Board meeting

• 3 -Tier Review/Approval– Supervisor– Legal Counsel– Division Manager

• Board Package Complete

How Can RTW Help?

• Provide Semi-Annual Updates – RTW Rosters• Timely Response

– Witness Contact Information– Health & Safety and Personnel Files– Attendance Records– Alternative Contacts

• Written Response– Permanent Work Restrictions– Job Modifications– Department’s Ability to Accommodate

Q & A