An eligible employee shall apply for long-term disability benefits under this chapter by:
Terms Used In Utah Code 49-21-401
Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
Contract: A legal written agreement that becomes binding when signed.
Date of disability: means the date on which a period of total disability begins, and may not begin on or before the last day of performing full-duty work in the eligible employee's regular occupation. See Utah Code 49-21-102
Eligible employee: means the following employee whose employer provides coverage under this chapter:
an employee who is covered by a retirement program offered by a public or private system, organization, or company designated by the Utah Board of Higher Education. See Utah Code 49-21-102
Elimination period: means the three months at the beginning of each continuous period of total disability for which no benefit will be paid. See Utah Code 49-21-102
Employer: means any department, educational institution, or political subdivision of the state eligible to participate in a government-sponsored retirement system under federal law. See Utah Code 49-11-102
Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
Maximum benefit period: means the maximum period of time the monthly disability income benefit will be paid under Section 49-21-403 for any continuous period of total disability. See Utah Code 49-21-102
Month: means a calendar month, unless otherwise expressed. See Utah Code 68-3-12.5
Monthly disability benefit: means the monthly payments and accrual of service credit under Section 49-21-401. See Utah Code 49-21-102
Objective medical impairment: means an impairment resulting from an injury or illness which is diagnosed by a physician and which is based on accepted objective medical tests or findings rather than subjective complaints. See Utah Code 49-21-102
Ongoing disability: means , after the elimination period and the first 24 months of disability benefits, the complete inability, as determined under Subsection (8)(b), to engage in any gainful employment which is reasonable, considering the eligible employee's education, training, and experience. See Utah Code 49-21-102
Own occupation disability: means the complete inability, due to objective medical impairment, whether physical or mental, to engage in the eligible employee's regular occupation during the elimination period and the first 24 months of disability benefits. See Utah Code 49-21-102
Regular monthly salary: means the amount certified by the participating employer as the monthly salary of the eligible employee, unless there is a discrepancy between the certified amount and the amount actually paid, in which case the office shall determine the regular monthly salary. See Utah Code 49-21-102
retirement allowance: means the pension plus the annuity, including any cost of living or other authorized adjustments to the pension and annuity. See Utah Code 49-11-102
Service credit: means :
(a)
the period during which an employee is employed and compensated by a participating employer and meets the eligibility requirements for membership in a system or the Utah Governors' and Legislators' Retirement Plan, provided that any required contributions are paid to the office; and
(b)
periods of time otherwise purchasable under this title. See Utah Code 49-11-102
State: when applied to the different parts of the United States, includes a state, district, or territory of the United States. See Utah Code 68-3-12.5
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 physical illness which 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 physical 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)
If the office determines that the eligible employee has a total disability due to psychiatric illness, the eligible employee shall receive:
(a)
a maximum of two years of monthly disability benefits equal to two-thirds of the eligible employee’s regular monthly salary for each month the total disability continues beyond the elimination period;
(b)
a maximum of $10,000 for psychiatric expenses, including rehabilitation expenses preauthorized 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 a period not to exceed five years if the eligible employee is institutionalized due to psychiatric illness.
(7)
(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 due solely to a physical objective medical impairment;
(ii)
the physical objective medical impairment described in Subsection (7)(a)(i) resulted from external force or violence as a result of the performance of an employment duty; and
(iii)
the eligible employee received workers’ compensation indemnity benefits for the physical objective medical impairment described in Subsection (7)(a)(i).
(b)
An eligible employee who receives workers’ compensation indemnity benefits for a physical objective medical impairment is not guaranteed to receive the 100% monthly disability benefit described in Subsection (7)(a).
(8)
(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 (8)(a) or (b) does not apply, successive periods of disability are considered as separate periods of disability.
(9)
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.
(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 of the denial or termination of long-term disability benefits; and
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 which existed prior to 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).
