Section Ret 305.03 - Filing for Benefits(a) Each applicant shall complete and file the appropriate forms which may be obtained at the NHRS office, or from the employer, for the type of benefit requested not less than 30 nor more than 90 days prior to the effective date of retirement, except in the case of a vested deferred retirement benefit.(b) Service and vested deferred retirement benefits as described in RSA 100-A:5 and RSA 100-A:10 shall be approved providing minimum requirements for age and service pursuant to those statutes have been met.(c) A member applying for disability retirement pursuant to RSA 100-A:6 shall complete and file an "Application for Ordinary/Accidental Disability Retirement for Group I (Teachers and Employees)" (NHRS Form MB-16 Rev. 9/2015) or an "Application for Ordinary/Accidental Disability Retirement for Group II (Police and Fire)" NHRS Form MB-20 (Rev. 03/2015).(d) Within 120 days of such filing the member shall provide the following: (1) A completed "Employee's Statement of Disability" NHRS Form CNHRS (Rev. 3/2006);(2) For accidental disability retirement only, proof that the applicant's injury or illness was found compensable by the employer, the employer's insurance carrier, or the commissioner of labor pursuant to RSA 281-A:43;(3) A position description for the position last held by the applicant prior to making his or her application;(4) All pertinent medical records that the applicant wishes to have considered by NHRS in making its determination;(5) A completed "Treating Physician's Statement" (Rev. 11/2015);(6) A completed "Authorization to Release Medical and Hospital Records" NHRS Form CNHRS 6 (Rev 3/2006);(7) A completed "Certification" NHRS Form MEDDOC (Rev. 3/28/2016) certifying that the applicant has submitted all the medical documentation the he or she intends to submit for consideration by NHRS;(8) A completed "Wage and Personnel Records Authorization" NHRS Form MS-41 (Rev 4/2018);(9) A completed "Mandatory Acknowledgement/Certification NHRS Form MS-27 (Rev. 10/2016);(10) The birth certificates for the applicant and beneficiaries;(11) A marriage certificate for group II members only;(12) The Social Security identification numbers for the applicant and beneficiaries and either a copy of the applicant's Social Security card or a completed IRS Form W-9;(13) A completed federal tax withholding form (IRS Form W-4P);(14) A completed "Electronic Direct Deposit (EDD)" form NHRS Form RS-6, (Rev. 08/2017 PB);(15) A completed "Health Insurance Pre-Application" Department of Administrative Services, Risk Management Form Rev (08/2017 PB) for state employees only; and(16) A completed "Payment Options for Additional Contributions Form" NHRS Form Acct-06 (Rev. 6/2016).if the member is in the additional contributions program (d) The application for disability retirement shall be deemed to have been withdrawn if the applicant fails to provide all of information required by (c) within 120 days of filing the application, unless the applicant can establish good cause, as defined on Ret 201.02(d), for such failure. If the application is deemed to have been withdrawn, the applicant may re-apply for disability retirement benefits in accordance with Ret 305.05(f)-(j).(e) The NHRS shall refer the applicant's "Treating Physician's Statement" and all medical records to the IME within 60 days of receipt of the applicant's "Certification" form as provided in (c)(7). In the case of all psychological disabilities and all accidental disability retirement applications the "independent medical examiner" (IME) shall review the "Treating Physician's Statement" and medical records and conduct an examination of the applicant. In the case of all physical disabilities, the IME shall conduct an examination only if, in the IME's professional opinion, the "Treating Physician's Statement" and medical records do not conclusively indicate that the applicant is incapacitated and that such incapacity is likely to be permanent. The IME shall complete an "Independent Medical Examiner's Statement" (Rev 10/2015) and submit it to NHRS staff which shall prepare a recommendation for consideration by the board of trustees. The board of trustees shall rule upon the applicant's request based on proof of total and permanent incapacity to perform the duties of the position held taking into consideration the medical records submitted by the applicant, the disability certification provided by the applicant's physician and, the recommendation of the IME. In addition, in the case of an application for accidental disability retirement, the board of trustees shall also rule whether such incapacity occurred in the line of duty as provided in RSA 100-A:6, I(c)(1)(A)-(C) or RSA 100-A:6, II(c)(1)(A)-(C).(f) A member shall be "in service" if, as a result of employment with a NHRS participating employer, the member is both receiving earnable compensation as defined by RSA 100-A:1, XVII and earning NHRS creditable service for which the NHRS receives payment of full employer and member retirement contributions pursuant to RSA 100-A:16.(g) Notwithstanding the provisions of (f), a member who, as a result of employment with an NHRS participating employer, is receiving workers' compensation disability payments pursuant to RSA 281-A:28, RSA 281-A:28-a or RSA 281-A:31 in lieu of earnable compensation and whose employment has not been terminated by the participating employer shall be considered during the time period in which both of these conditions are met to be "in service".(h) Notwithstanding the provisions of (f) a member who is on leave under the provisions of the Federal Family and Medical Leave Act of 1993 shall be considered to be "in service".(i) The requirement that an application for disability retirement benefits be filed while a member is in service shall be waived in accordance with RSA 100-A:6, V for a member who files an application for ordinary or accidental disability retirement benefits within one year of the member's last date of creditable service for which the NHRS has received and posted, on behalf of the member, full retirement contributions pursuant to RSA 100-A:16.(j) The fact that a member is deemed to have met in service requirement for the filing of a disability retirement application under Ret 305 shall not affect whether the member meets the requirements for actual receipt of service credit under Ret 307.(k) If an applicant requests a rehearing or reconsideration pursuant to Ret 202.10, the applicant shall provide any additional medical records no later than 60 days after the date on which NHRS provides acknowledgement to the applicant that it has received his or her request, unless the applicant can establish good cause, as defined on Ret 201.02(d), for failure to provide the information by that deadline. If additional medical records are not submitted, the determination on rehearing or reconsideration shall be made based on the original records submitted by the applicant, the Treating Physician's Statement, the IME Statement and any testimony or pleadings filed during the rehearing or reconsideration proceeding.(l) In the case of an application for a service retirement or a deferred vested retirement, the applicant shall provide the following information: (1) A completed "Application for Service/Vested Deferred Retirement for Group I (Employee and Teacher)" NHRS Form MB-14 (Rev. 3/2015) or an "Application for Service/Vested Deferred Retirement for Group II (Police and Fire)" NHRS Form MB-15 (Rev. 3/2015);(2) A completed "Mandatory Acknowledgement/Certification NHRS Form MS-27 (Rev. 10/2016);(3) The birth certificates for the applicant and beneficiaries;(4) A marriage certificate for group II members only;(5) The Social Security identification numbers for the applicant and beneficiaries and either a copy of the applicant's Social Security card or a completed IRS Form W-9;(6) The federal tax withholding form (IRS Form W-4P);(7) A completed "Electronic Direct Deposit (EDD)" form NHRS Form RS-6, (Rev. 08/2017)(8) "Health Insurance Pre-Application" Department of Administrative Services, Risk Management Form Rev (08/2017 PB) for state employees only; and(9) A completed "Payment Options for Additional Contributions Form" NHRS Form Acct-06 (Rev. 6/2016) if the member is in the additional contributions program.N.H. Admin. Code § Ret 305.03
#1953, rpld 2-9-82 (rule Ret 305.3 )
Amended by Volume XXXIX Number 06, Filed February 7, 2019, Proposed by #12707, Effective 1/9/2019, Expires 1/9/2029.