CHAPTER 15

DISABILITY RETIREMENT

ARTICLE 1

GENERAL

Section 1. Authority. The Wyoming Retirement Board, pursuant to W.S. 9-3-409(a), is autho- rized to adopt rules and regulations for the administration of the retirement system. This Chapter applies to disability benefits for members of systems covered under W.S. 9-3-422, W.S. 9-3-611, W.S. 15-5-204 and W.S. 15-5-405, as well as the review of the benefit recipients under W.S. 9-3-423, W.S. 9-3-612, and W.S.

15-5-204(e).

Section 2. Purpose. Disability Retirement is a benefit of the system and the Wyoming Retire- ment Board as part of its fiduciary responsibilities will evaluate all disability applicants to determine the existence of a disability and will review all recipients to determine the continued existence of the disability.

The procedures for determining the eligibility, application, evaluation and the hearing process to contest an adverse ruling by the system, the committee or the board are established by these rules.

Section 3. Definitions.

1. (a) As used in both W.S. 9-3-422(a) and in this Chapter “in service” means a member who is deemed to be disabled while working in employment covered by the system and is making contributions to the system, or is receiving worker’s compensation payments, or is receiving disability payments under an employer’s disability insurance policy, or is on sabbatical or other leave authorized by the member’s em- ployer.

2. (b) As used in this Chapter:

   1. (i) “Applicant” means any member who has applied for disability retirement;
   2. (ii) “Board” means the Wyoming Retirement Board established by W.S. 9-3-404;
   3. (iii) ”Committee” means the disability committee of the system which shall be appointed by the Board Chairman and shall consist of three members with two alternates to replace any member who disqualifies himself from voting on any disability retirement;

   4. (iv) “System” means the Wyoming Retirement System established by W.S. 9-3-403, including the system staff.

      ARTICLE 2

      ELIGIBILITY, APPLICATION AND EVALUATION

Section 1. Eligibility Determination.

1. (a) A member covered under W.S. 9-3-422 must have made contributions for at least one- hundred twenty (120) months prior to applying for a disability and be in service at the time of application.
2. (b) A law enforcement member covered under W.S. 9-3-422 who is injured in the scope of employment causing a disability is eligible for disability retirement.
3. (c) A member covered under W.S. 9-3-611 who suffers a partial or total disability resulting from a single and specific act, the type of which would normally occur only while employed as an em- ployee, is eligible for a duty-connected disability allowance. A member who is not eligible for a duty- connected disability must have one-hundred twenty (120) contributions to the system and be a contributing member at the time of application.
4. (d) A member covered under W.S. 15-5-204 or W.S. 15-5-405 is eligible while making contri- butions to the system.

Section 2. Application Procedure.

1. (a) Any member who meets the eligibility requirements of Section 4. of this Chapter may apply to the system for a disability benefit. Upon a member’s request for a disability retirement, the system shall provide the member with an official application, three (3) physician’s medical record release forms and an estimate of the disability benefit.

2. (b) The applicant shall:

   1. (i) Complete the disability application;

   2. (ii) Designate three physicians who:

      1. (A) Are familiar with the applicant’s physical or mental condition as it relates to the disability;
      2. (B) Have examined the applicant within ninety (90) days prior to the date of application, provided if circumstances warrant, the System may require a more current examination or may accept examination results prior to ninety (90) days before application; and
      3. (C) Will provide the System with the appropriate medical information attesting to the applicant’s physical or mental condition, as the case may be;
   3. (iii) Sign all three (3) medical record release forms; and
   4. (iv) Return the completed application and the signed release forms to the system.

Section 3. Evaluation Procedure.

1. (a) Upon receipt of the release forms for the designated physicians’ medical records, the sys- tem shall contact the designated physicians and request copies of their records and any other relevant information relating to the disability under consideration. The system is not responsible for any costs associated with obtaining the applicant’s medical records.
2. (b) After the medical records and other relevant information is received, the system shall re- view the applicant’s medical records.
3. (c) The system shall also retain a physician to review the applicant’s medical records and in consultation with that physician shall determine whether the applicant is entitled to a full disability, a partial disability or no disability.
4. (d) In making its determination, the system may require the applicant to submit further evi- dence of the disability or it may require the applicant to submit to a medical or other relevant examination or test, including but not limited to a functional capacity evaluation, by an appropriate medical or other specialist of the system’s choice. The cost of any examination or test required pursuant to this subsection shall be borne by the system.
5. (e) Once a determination is made, the system shall notify the applicant of its decision by certi- fied mail, return receipt requested.

Section 4. Appeal to Committee; hearing; review by Board; appeal to district court.

1. (a) If the applicant is aggrieved by the decision of the system, the applicant may request a hearing before the committee. The request shall be made to the system in writing not more than fifteen (15) days from the date of receipt of the system’s decision pursuant to Section 6 of this Chapter.
2. (b) Following receipt of a request for hearing, the system shall schedule a hearing at a conve- nient time for the applicant.
3. (c) The hearing shall be conducted by the committee in accordance withChapter 3 of the Wyo- ming Retirement System Rules relating to contested cases.
4. (d) A majority vote of the committee is necessary to grant a full or partial disability or to deny disability. The committee shall issue its decision within a reasonable period following the hearing. The decision shall be mailed to the applicant by certified mail, return receipt requested.
5. (e) The decision of the committee is a recommended decision to the Board. All parties shall be afforded a reasonable opportunity to file exceptions to the recommended decision. The parties shall be allowed to file briefs with the Board. Thereafter, the Board shall make a final decision.
6. (f) The applicant shall be notified of the Board’s decision not later than ten (10) days from the date thereof by certified mail, return receipt requested.

7. (g) Any Board decision adverse to the applicant is appealable to the district court for the First Judicial District, State of Wyoming.

   ARTICLE 3

   DISABILITY REVIEW

Section 1. REVIEW OF DISABILITY STATUS.

1. (a) The following procedure shall be used to evaluate the disability status of each recipient in the system and to establish whether further action is required:

   1. (i) The system shall keep on file a record of each disability recipient’s date of birth, date of disability, address, age, medical background and type and amount of benefit;
   2. (ii) Annually the system shall review the file with the assistance of the system’s medi- cal advisor to establish whether or not a recipient has the potential for recovery, what type of physical review is necessary and what process is needed to complete that review;
   3. (iii) At a minimum the system shall require that an update of the medical records from the recipient’s primary physician be obtained and reviewed;
   4. (iv) The System may require the recipient to submit to a functional capacity evaluation, physical examination, or other examination performed by a qualified evaluator as selected by the system at the system’s expense;
   5. (v) If the result of any procedure specified in this section indicates that the recipient is no longer disabled, all records of the evaluation plus those of the originaldisability discovery shall be sent to the disability committee for review and advisement;
   6. (vi) Not less than quarterly, the system shall notify the disability committee of all re- views commenced and completed during the immediately preceding quarter and the outcome of each such review.
2. (b) In addition to the disability reviews specified in subsection (a) of this section, any disability recipient who has been granted a disability conditioned upon further review at a future date shall be sched- uled for review by the System in accordance with the condition specified in the disability award. The review shall be conducted in accordance with the specified condition or the provisions of subsection (a) of this section, as may be applicable, and disability committee members shall be notified of the results and timeliness of each such review.
3. (c) No review shall be conducted of any disability recipient who has attained age sixty (60) or who, by virtue of the medical record, is deemed by the system in consultation with the system’s medical advisor to have a terminal condition or a permanent, total disability.

Section 2. CANCELLATION OF BENEFIT.

1. (a) If the review of a disability results in cancellation of a disability retirement benefit, the recipient shall be informed by certified mail, return receipt requested, of the reason for the cancellation and the options available for appeal. The benefit shall be canceled as of the date of the notification.

2. (b) If a benefit recipient fails or refuses to either provide required medical information or sub-

   mit to any procedure specified in Section 1. (a)(iv) of this policy, or both, within sixty (60) days from the date the system requests such information or procedure, the recipient’s benefit shall be canceled immedi- ately and the recipient shall be notified of the cancellation by certified mail, return receipt requested. Any person aggrieved by a decision pursuant to this subsection may appeal to the district court for the First Judicial District, State of Wyoming.