49-21-401 - Disability benefits -- Application -- Eligibility.
49-21-401. Disability benefits -- Application -- Eligibility.
(1) An eligible employee shall apply for long-term disability benefits under this chapterby:
(a) completing an application form prepared by the office;
(b) signing a consent form allowing the office access to the eligible employee's medicalrecords; 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, theapplication 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 deceasedemployee.
(3) Upon request by the office, the participating employer of the eligible employee shallprovide to the office documentation and information concerning the eligible employee.
(4) The office shall review all relevant information and determine whether or not theeligible employee is totally disabled.
(5) If the office determines that the eligible employee is totally disabled due to accidentalbodily injury or physical illness which is not the result of the performance of an employmentduty, the eligible employee shall receive a monthly disability benefit equal to two-thirds of theeligible employee's regular monthly salary, for each month the total disability continues beyondthe elimination period, not to exceed the maximum benefit period.
(6) If the office determines that the eligible employee is totally disabled due topsychiatric illness, the eligible employee shall receive:
(a) a maximum of two years of monthly disability benefits equal to two-thirds of theeligible employee's regular monthly salary for each month the total disability continues beyondthe elimination period;
(b) a maximum of $10,000 for psychiatric expenses, including rehabilitation expensespreauthorized by the office's consultants, paid during the period of monthly disability benefits;and
(c) payment of monthly disability benefits according to contractual provisions for aperiod not to exceed five years if the eligible employee is institutionalized due to psychiatricillness.
(7) If the office determines that the eligible employee is totally disabled due to a physicalinjury resulting from external force or violence as a result of the performance of an employmentduty, the eligible employee shall receive a monthly disability benefit equal to 100% of theeligible employee's regular monthly salary, for each month the total disability continues beyondthe elimination period, not to exceed the maximum benefit period.
(8) (a) Successive periods of disability are considered as a continuous period of disabilityif 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'susual 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 (8)(a) or (b) does not apply, successive periods of disability areconsidered as separate periods of disability.
(9) The office may, at any time, have any eligible employee claiming disability examinedby a physician chosen by the office to determine if the eligible employee is totally disabled.
(10) A claim brought by an eligible employee for long-term disability benefits under thePublic Employee's Long-Term Disability Program is barred if it is not commenced within oneyear from the eligible employee's date of disability, unless the office determines that under thesurrounding facts and circumstances, the eligible employee's failure to comply with the timelimitations was reasonable.
(11) Medical or psychiatric conditions which existed prior to eligibility may not be abasis for disability benefits until the eligible employee has had one year of continuous eligibilityin the Public Employees Long-Term Disability Program.
(12) If there is a valid benefit protection contract, service credit shall accrue during theperiod of total disability, unless the disabled eligible employee is exempted from a system, or isotherwise ineligible for service credit.
(13) Regardless of any medical evidence provided by the employee to support theapplication for disability, an employee is not eligible for long-term disability benefits during anyperiod 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 state or local administrative body inwhich the employee has made a claim that the employee is able to work.
(14) Notwithstanding the provisions of Section 49-11-618, upon written request by anemployer, information obtained under this part may, upon an order of a court or an administrativelaw judge, be released to an employer who is a party in an action under Subsection (13).
Amended by Chapter 321, 2010 General Session