Code of Massachusetts Regulations › 840 CMR - PUBLIC EMPLOYEE RETIREMENT ADMINISTRATION COMMISSION › Title 840 CMR 10.00 - Standard Rules for Disability Retirement › Section 10.06 - Proceedings for Ordinary or Accidental Disability Retirement; Applications; Additional Information

Current through Register 1525, July 5, 2024
Proceedings for ordinary or accidental disability retirement
				may be brought by filing an application with the retirement board and with the
				employer. The application shall consist of the forms prescribed by 840 CMR
				10.06, and shall be considered filed as of the date upon which the applicant
				completes and submits all the required forms to the retirement board. If the
				retirement board or PERAC believes any part of the application contains false,
				fictitious or fraudulent information, the board or PERAC shall notify the
				Attorney General or the appropriate district attorney.
(1)
Voluntary
			 Retirement
. Any member in service who becomes totally and
			 permanently unable to perform the essential duties of his or her job under the
			 circumstances described in M.G.L. c. 32, § 6 (relating to ordinary
			 disability) or § 7 (relating to accidental disability) may file an
			 application for retirement. Every member-applicant shall also file:
(a) A sworn statement indicating the members
			 intent to retire;
(b) A certificate
			 from a licensed medical doctor;
(c)
			 A written statement authorizing release of information from the Federal
			 Internal Revenue Service and the Department of Revenue relative to the annual
			 gross earned income of the member in accordance with M.G.L. c. 32, §§
			 6(1) and 7(1);
(d) If the
			 application is for accidental disability retirement, a sworn statement of the
			 circumstances of the event or hazard undergone from which the personal injury
			 was sustained upon which the disability retirement allowance is
			 claimed;
(e) The member's sworn
			 statement of the member's duties of employment and the specific duties the
			 member is now unable to perform as a result of the disability
			 claimed:
(f) A statement of the
			 member's education and training, employment history and off-duty physical
			 activities:
(g) Authorizations on
			 such other form as may be required by a person, institution or other agency
			 having custody of the member's records, for release of medical or insurance
			 records relating to the member as follows:
1.
			 records of the member's personal physicians and of the physician submitting the
			 certificate described in 840 CMR 10.06(1)(b);
2. records of all physicians or medical
			 institutions examining or treating the member for the condition or personal
			 injury upon which the application is based;
3. records of all physical examinations
			 performed within the five year period prior to the application or, if none are
			 available for that period, the most recent;
4. the member's workers' compensation records
			 or, if applicable, any records in connection with application for or receipt of
			 benefits pursuant to M.G.L. c, 41, § 111F;
5. the member's medical records for the last
			 five years;
6. the accident or
			 claim reports for the last five years of any insurer in connection with the
			 personal injury sustained or the hazard undergone upon which the application is
			 based;
(h)
			 Authorizations permitting the physicians and medical institutions described in
			 840 CMR 10.06(1)(g)2. to further explain the records, treatment performed, or
			 statement or prognosis.