Ohio Administrative Code › Title 123:1 - Division of Human Resources › Chapter 123:1-33 - Disability Leave › Section 123:1-33-02 - Application for disability leave benefits

Current through all regulations passed and filed through July 1, 2024
(A) Filing an application. The employee, a
			 member of the employee's family, or a representative of the employee,
			 including the appointing authority on behalf of the
			 employee, may file an application for disability leave benefits with the
			 employee's appointing authority. The application shall be filed on a form
			 designated by the director and shall be filed, completed in its entirety, with
			 the appointing authority within twenty calendar days of the last day the
			 employee worked. An application is not completed in its entirety until the
			 disabling illness, injury, or condition for which the employee is requesting
			 disability leave benefits occurs. Where extenuating circumstances prevent an
			 employee from filing an application for disability leave benefits within the
			 required time frame, a written statement from the party
			 responsible for the delay explaining such extenuating circumstances must
			 be filed within fifteen calendar days after the twenty-day time period
			 has expired. Appropriate extenuating circumstances shall be accepted as an
			 extension of the time limit to file an application for disability benefits. The
			 appointing authority shall, within five days of receipt of the application,
			 forward the application and the recommendation of the appointing authority to
			 the director or designee. If there will be a filing
			 delay due to the completion of the attending physician statement, Employee
			 Statements are to be submitted to the appointing authority within twenty
			 calendar days of the last day worked, and the claim will be considered timely
			 filed. The employee will then be granted an additional ten calendar days to
			 submit the attending physician statement and other supporting medical
			 documentation.
Any employee who is given a disability separation under the
				provisions of rule
				123:1-30-01
				or rule
				123:1-30-02
				of the Administrative Code and who is eligible to receive disability leave
				benefits under the provisions of Chapter 123:1-33 of the Administrative Code
				may apply for disability leave benefits within twenty calendar days after the
				date the employee is given a disability separation. The approval of a claim for
				disability leave benefits shall be governed by the provisions of Chapter
				123:1-33 of the Administrative Code.
(B) Documentation. In addition to the
			 application, it shall be the employee's responsibility to provide written
			 documentation to substantiate the cause, nature, and extent of the disabling
			 illness, injury, or condition for which the employee is requesting disability
			 leave benefits. A medical examination report shall be required prior to the
			 granting of disability leave benefits and the employee shall be responsible for
			 the cost of obtaining such report. If deemed necessary, the director or
			 designee may order a medical examination conducted by a physician. The employee
			 may request that the physician be mutually agreed to by the state and the
			 employee's attending physician to resolve conflicting issues. The specialty of
			 the physician conducting the examination will be based upon the employee's
			 diagnosed condition, but for an application for disability benefits based on a
			 diagnosis of a mental disorder, including but not limited to, psychosis, mood
			 disorders, and anxiety, must be confirmed by a licensed mental health provider.
			 The cost of such examination shall be paid from the disability fund. If the
			 employee fails to attend the scheduled examination and does not provide at
			 least seventy-two hours advance notice of the employee's inability to attend the scheduled
			 examination, the employee may be responsible for any costs associated with the
			 missed examination.
(C)
			 Notification of initial disability decision by the director
			 or designee. The employee shall be notified in
			 writing of the disability determination within forty-five days of receipt of
			 the application by the director or designee and shall also be advised of the
			 right of appeal pursuant to rule
			 123:1-33-04 of
			 the Administrative Code.
If a determination cannot be made within forty-five days of
				receipt of the application, then the director or designee shall notify the
				employee of the delay.
(D)
			 Notification of requirement to file for disability retirement benefits. An
			 employee eligible to apply for disability retirement benefits shall be notified
			 by the director or designee in writing of the requirement to file for
			 disability retirement benefits in order to receive continued disability leave
			 benefits. This applies to disability retirement
			 eligible employees who are nearing six months of continuous disability leave
			 payments, whose physicians have deemed them permanently disabled, or whose
			 total disability will exceed twelve months. Upon notification, the
			 employee shall submit an application to a state employees' retirement system,
			 comply with all retirement system requirements, and submit all information
			 required by the retirement system for disability retirement benefits.
			 Eligible employees who fail to comply with this
			 requirement may result in the denial of additional disability leave
			 benefits.
(E) Submission of
			 additional information. If the employee disagrees with the determination
			 regarding the employee's request for disability leave benefits, the employee
			 may submit additional information to the appointing authority.
Such information must be submitted within twenty days from the
				date of notification of the determination or within twenty days from the ending
				date of approved disability benefits, whichever is later. The appointing
				authority shall, within five days of receipt of such additional information,
				forward it to the director. Where extenuating circumstances prevent an employee
				from providing additional information within the required time frame, a written
				statement from the party responsible for the
				delay explaining such extenuating circumstances must be filed within
				fifteen calendar days after the twenty-day time period has expired.
				Appropriate extenuating circumstances shall be accepted as an extension of the
				time limit to provide additional information. If there
				will be a filing delay due to the completion of the attending physician
				statement, Employee statements are to be submitted to the appointing authority
				within twenty calendar days of the last day worked, and the claim will be
				considered timely filed. The employee will then be granted an additional ten
				calendar days to submit the attending physician statement and other supporting
				medical documentation. By exercising the right to submit additional
				information, the employee does not waive his or her right to appeal the
				determination pursuant to rule
				123:1-33-04 of
				the Administrative Code. The appeal must still be filed within thirty days of
				the original notification of the denial.
(F) Address change. An employee receiving
			 disability leave benefits shall be responsible for keeping a current address on
			 file with the appointing authority.