Opinion ID: 1905700
Heading Depth: 2
Heading Rank: 2

Heading: Medical Exam

Text: [¶ 17] The statutory provisions governing Kelley's disability benefits are set forth in 5 M.R.S. §§ 17901-17911 (2008). [7] Title 5 M.R.S. § 17907 provides the manner in which disability payments are commenced, in section 17907(1), and terminated, in section 17907(2). Kelley argues that section 17907(2)(B)(4) confers upon her the right to an independent medical exam before her disability benefits may be discontinued. [¶ 18] Section 17907(2) provides that the [p]ayment of disability retirement benefits shall continue so long as the person is disabled, except that ... (emphasis added). The general rule is that as long as a person is disabled, he or she will continue to receive disability benefits. [8] By stating except that, however, the Legislature has set forth other instances, apart from a person no longer being disabled, when disability benefits will be terminated. The first instance arises when the beneficiary becomes eligible for service retirement benefits. 5 M.R.S. § 17907(2)(A). The second instance arises when a disability no longer renders the beneficiary unable to engage in any substantially gainful activity for which the beneficiary is qualified by training, education or experience. 5 M.R.S. § 17907(2)(B). According to the statute, even if the disability of an individual persists, benefits can still be terminated if the individual satisfies the eligibility requirements for service retirement benefits, or the individual can engage in substantially gainful activity as defined by statute. [¶ 19] Here, Kelley's disability retirement benefits were discontinued not because she was unable to demonstrate that she was disabled, but because she had not demonstrated an inability to engage in substantially gainful activity. The purpose of the medical examinations or tests referenced in section 17907(2)(B)(1) is  to determine the disability of the beneficiary, not to determine the beneficiary's ability to engage in substantially gainful activity. (Emphasis added.) Thus, if there is an issue as to whether an individual continues to be disabled, a medical exam may be required. The plain language of the statute, however, does not make an independent medical exam mandatory when the issue upon review is whether an individual can engage in substantially gainful activity. [9] Because Kelley's disability was not in question, section 17907(2)(B)(1) is not applicable and section 17907(2)(B)(4) is not invoked. [¶ 20] The statute clearly provides for the cessation of benefits when: (1) an individual is no longer disabled, as determined by medical exams or tests; (2) an individual has become eligible for service retirement benefits; or (3) an individual can engage in substantially gainful activity. The statute does not require a medical examination to determine a beneficiary's ability to engage in substantially gainful activity. [10] Therefore, the termination of Kelley's benefits without an independent medical exam was proper.