Oregon Administrative Rules › Chapter 459 - OREGON PUBLIC EMPLOYEES RETIREMENT SYSTEM › Division 76 - OPSRP DISABILITY BENEFIT › Section 459-076-0050 - Periodic Reviews

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Members
			 receiving a disability benefit are subject to periodic reviews of their
			 disabled status until the member reaches normal retirement age or staff
			 determines that periodic reviews are no longer warranted.
(2) Periodic reviews will be used to
			 determine that continued disability benefits are warranted. In recommending the
			 continuance or discontinuance of a disability benefit, PERS will follow the
			 criteria established under OAR 459-076-0005  for the original approved disabling
			 condition or a new medical condition. If a member receiving a disability
			 benefit becomes employed, the member's disability benefit will be terminated as
			 provided in OAR 459-076-0005.
(3)
			 For a duty disability, the periodic review will not revisit the original
			 determination that the injury or disease was duty caused, unless there is
			 evidence of misrepresentation or fraud.
(4) PERS will establish review dates for each
			 member subject to a periodic review depending on type of disability, extent of
			 disability, and medical reports unique to each individual case:
(a) The reviews may be medical or vocational
			 in nature, or both;
(b) Upon
			 review, PERS may accept or require:
(A) New
			 treating or consulting physician or specialist reports;
(B) Updated physician or specialist
			 reports;
(C) Independent medical or
			 vocational examinations; or
(D)
			 Employment and wage information, including but not limited to, tax returns or
			 information from the State Employment Department.
(c) PERS may immediately discontinue the
			 disability benefit of any person who fails to provide current medical evidence;
			 submit requested employment, wage, income, or tax information; or refuses to
			 submit to a medical or vocational examination.
(A) If the disability claim is discontinued,
			 the staff shall issue an Intent to Discontinue letter by regular and certified
			 mail, return receipt requested. The Intent to Discontinue letter shall advise
			 the applicant that additional information to substantiate the claim, or a
			 request for an extension of 30 days to present additional information, may be
			 submitted to the staff in writing within 30 days of the date of the Intent to
			 Discontinue letter;
(B) Following
			 the issuance of an Intent to Discontinue letter, staff will review any
			 additional information which is submitted within 30 days:
(i) If the additional information results in
			 a recommendation to continue the disability benefit, staff shall resubmit the
			 disability claim to the Director, or the Director's designee, with the
			 recommendation;
(ii) If the
			 additional information does not result in a recommendation to continue the
			 disability benefit, PERS will issue a final discontinuation letter by regular
			 and certified mail, return receipt requested.
(C) If no additional information is received
			 within 30 days, PERS will issue a final discontinuation letter by regular and
			 certified mail, return receipt requested;
(D) The final discontinuation letter will
			 provide the applicant with notification of the right to request a contested
			 case hearing as provided for in OAR 459-015-0030  and 459-001-0035.