PURPOSE: This rule clarifies when an employee is eligible for long-term disability benefits under section 104.110.8, RSMo.

1. (1) For the first twelve (12) full months after the effective date of benefits, an employee will be considered disabled and eligible for long-term disability benefits provided the following conditions are met:

   1. (A) As a result of an injury or illness, the employee is unable to perform the essential duties of his/her normal occupation. Normal occupation is the occupation, job or work performed by the employee on the date preceding the date of disability; and
   2. (B) The employee’s disability is expected to continue for at least twelve (12) months; and
   3. (C) The employee has not retained or regained his/her earning capacity. For purposes of this paragraph, earning capacity means the employee’s ability to perform the essential duties of any occupation commensurate with the employee’s education, training, or experience; and
   4. (D) Upon written request, the board may at its discretion grant an extension of up to an additional twelve (12) months of eligibility under this section provided that all of the conditions in this section are met and information acceptable to the board has been provided to show that the individual is participating in an ongoing educational, vocational, rehabilitative or retraining program.
2. (2) Unless granted an extension under subsection (1)(D), after monthly long-term disability benefits have been effective for twelve
3. (12) full months, a member will be considered disabled and continue to be eligible for long-term disability benefits provided the member has not regained his/her earning capacity. For purposes of this paragraph, earning capacity means the member’s ability to perform any occupation for which the member is or may reasonably become qualified for by training, education, or experience, including a rehabilitative program, to the extent that the member can earn at least fifty percent (50%) of his/her current annualized rate of pay for the position held by the member on the date preceding the date of the member’s disability.

AUTHORITY: sections 104.110, RSMo Supp. 1995 and 104.210.2 and 536.023.3, RSMo 1994.* Emergency rule filed Aug. 18, 1995, effective Aug. 28, 1995, expired Feb. 23, 1996. Original rule filed Aug. 18, 1995, effective Feb. 25, 1996. *Original authority 104.110, RSMo 1955, amended 1961, 1969, 1972, 1976, 1979, 1984, 1986, 1988; 104.210, RSMo 1955, amended 1983, 1988; and 536.023, RSMo 1975, amended 1976.