Section 49-21-401 - Disability benefits - Application - Eligibility(1) An eligible employee shall apply for long-term disability benefits under this chapter by: (a) completing an application form prepared by the office;(b) signing a consent form allowing the office access to the eligible employee's medical records; and(c) providing any documentation or information reasonably requested by the office.(2)(a) If an eligible employee is unable to apply on the employee's own behalf, the application may be made by a person who is:(i) the attorney for an eligible employee; or(ii) appointed as a conservator or guardian of the eligible employee.(b) A person described in Subsection (2)(a), may not make an application for a deceased employee.(3) Upon request by the office, the participating employer of the eligible employee shall provide to the office documentation and information concerning the eligible employee.(4) The office: (a) shall review all relevant information;(b) may request additional information; and(c) shall determine whether or not the eligible employee has a total disability.(5)(a) If the office determines that the eligible employee has a total disability due to accidental bodily injury or illness that is not the result of the performance of an employment duty, the eligible employee shall receive a monthly disability benefit equal to: (i) two-thirds of the eligible employee's regular monthly salary, for each month the total disability continues beyond the elimination period, not to exceed the maximum benefit period; minus(ii) any required reductions or reimbursements under Section 49-21-402.(b) For an eligible employee under an own occupation disability, the office shall, at the end of the two-year disability period or when a claim for total disability is made by an eligible employee: (i) review and determine whether the eligible employee qualifies for ongoing disability benefits;(ii) make the determination under Subsection (5)(b)(i) as of the day after the eligible employee's own occupation disability benefits end;(iii) consider only objective medical impairment that the office determines as a disabling condition on the date of disability; and(iv) exclude any new intervening causes or new diagnoses during the own occupation disability period.(6)(a) An eligible employee shall receive a monthly disability benefit equal to 100% of the eligible employee's regular monthly salary for each month the total disability continues beyond the elimination period, not to exceed the maximum benefit period, but reduced by any required reductions and reimbursements under Section 49-21-402, if the office determines that the employee meets all of the following: (i) the eligible employee has a total disability:(A) during the pilot period, due to a physical objective medical impairment or a mental objective medical impairment; or(B) except as provided in Subsection (6)(b), after the pilot period, due to a physical objective medical impairment;(ii) the objective medical impairment described in Subsection (6)(a)(i) resulted from physical, external force or violence to the body of the eligible employee in the performance of an employment duty; and(iii) the eligible employee received workers' compensation indemnity benefits for the objective medical impairment described in Subsection (6)(a)(i).(b) If an eligible employee qualifies for a total disability during the pilot period, the office shall determine whether the employee has a total disability after the pilot period due to a physical objective medical impairment or a mental objective medical impairment.(c) An eligible employee who receives workers' compensation indemnity benefits for an objective medical impairment is not guaranteed to receive the 100% monthly disability benefit described in Subsection (6)(a).(7)(a) Successive periods of disability are considered as a continuous period of disability if the period of disability:(i) results from the same or related causes;(ii) is separated by less than six months of continuous full-time work at the individual's usual place of employment; and(iii) commences while the individual is an eligible employee covered by this chapter.(b) The inability to work for a period of less than 15 consecutive calendar days is not considered as a period of disability.(c) If Subsection (7)(a) or (b) does not apply, successive periods of disability are considered as separate periods of disability.(8) The office may, at any time, have any eligible employee claiming to have a disability examined by a physician chosen by the office to determine if the eligible employee has a total disability.(9)(a) For purposes of determining whether an eligible employee has an ongoing disability, inability is determined: (i) during the pilot period, due to physical objective medical impairment or mental objective medical impairment; or(ii) except as provided in Subsection (9)(b), after the pilot period, due to a physical objective medical impairment.(b) If an eligible employee has a total disability during the pilot period, the office shall determine whether the employee has an ongoing disability after the pilot period due to a physical objective medical impairment or a mental objective medical impairment.(10) A claim brought by an eligible employee for long-term disability benefits under the Public Employee's Long-Term Disability Program is barred if it is not commenced within six months from the eligible employee's date of disability, unless the office determines that under the surrounding facts and circumstances, the eligible employee's failure to comply with the time limitations was reasonable.(11)(a) If the office denies or terminates a claim for long-term disability benefits, the eligible employee shall have the right to appeal the denial or termination:(i) to the executive director of the office within 60 days after the day of the denial or termination of long-term disability benefits; and(ii) in accordance with Section 49-11-613.(b) An appeal of a denial or termination of long-term disability benefits described in Subsection (11)(a) is barred if it is not commenced within the time limit described in Subsection (11)(a).(12) Medical or psychiatric conditions that existed before eligibility may not be a basis for disability benefits until the eligible employee has had one year of continuous eligibility in the Public Employees Long-Term Disability Program.(13) If there is a valid benefit protection contract, service credit shall accrue during the period of total disability, unless the disabled eligible employee is:(a) exempted from a system;(b) eligible to retire with an unreduced retirement allowance; or(c) otherwise ineligible for service credit.(14) Regardless of any medical evidence provided by the employee to support the application for disability, an employee is not eligible for long-term disability benefits during any period in which the employee:(a) makes a claim that the employee is able to work; or(b) has a pending action in a court or before any federal, state, or local administrative body in which the employee has made a claim that the employee is able to work.(15) Notwithstanding the provisions of Section 49-11-618, upon written request by an employer, information obtained under this part may, upon an order of a court or an administrative law judge, be released to an employer who is a party in an action under Subsection (14).(16) On or after May 1, 2025, but on or before November 1, 2025, the office shall provide a written electronic report to the Retirement and Independent Entities Committee regarding the costs and benefits of the changes to the disability benefits during the pilot period.Amended by Chapter 274, 2023 General Session ,§ 2, eff. 7/1/2023.Amended by Chapter 185, 2018 General Session ,§ 2, eff. 7/1/2018.Amended by Chapter 328, 2015 General Session ,§ 1, eff. 5/12/2015.Amended by Chapter 298, 2012 General Session ,§ 12, eff. 5/8/2012.Amended by Chapter 366, 2011, 2011 General Session
Amended by Chapter 439, 2011 General Session