Utah Code 49-21-402 v2. Reduction or reimbursement of benefit — Circumstances — Application for other benefits required

Effective 7/1/2023

49-21-402. Reduction or reimbursement of benefit — Circumstances — Application for other benefits required.

(1)

A monthly disability benefit may be reduced, suspended, or terminated unless:

Terms Used In Utah Code 49-21-402 v2

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:

(i)

(A)	any regular full-time employee as defined under Section 49-12-102, 49-13-102, or 49-22-102;

(B)	any public safety service employee as defined under Section 49-14-102, 49-15-102, or 49-23-102;

(C)	any firefighter service employee or volunteer firefighter as defined under Section 49-23-102 who began firefighter service on or after July 1, 2011;

(D)	any judge as defined under Section 49-17-102 or 49-18-102; or

(E)	the governor of the state;

(ii)	an employee who is exempt from participating in a retirement system under Subsection 49-12-203(4), 49-13-203(4), 49-14-203(1), or 49-15-203(1); and

(iii)

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

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.

Monthly disability benefit: means the monthly payments and accrual of service credit under Section 49-21-401. See Utah Code 49-21-102

Office: means the Utah State Retirement Office. See Utah Code 49-11-102

Program: means the Public Employees' Insurance Program created under Chapter 20, Public Employees' Benefit and Insurance Program Act, or the Public Employees' Long-Term Disability program created under Chapter 21, Public Employees' Long-Term Disability Act. See Utah Code 49-11-102

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

Rehabilitative employment: means any occupation or employment for wage or profit, for which the eligible employee is reasonably qualified to perform based on education, training, or experience. See Utah Code 49-21-102

Retirement: means the status of an individual who has become eligible, applies for, and is entitled to receive an allowance under this title. See Utah Code 49-11-102

Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.

Total disability: means :

(a)	own occupation disability; or

(b)	ongoing disability. See Utah Code 49-21-102
(a)	the eligible employee participates in ongoing care and treatment in accordance with Subsection 49-21-406(3) or (4); and

(b)	the eligible employee provides the information and documentation requested by the office.

(2)

(a)

The monthly disability benefit shall be reduced or reimbursed by any amount received by, or payable to, the eligible employee for the same injury or illness that is the basis for the monthly disability benefit from the following sources:

(i)	workers’ compensation indemnity benefits, regardless of whether the amount is received as an ongoing monthly benefit, as a lump sum, or in a settlement with a workers’ compensation indemnity carrier;

(ii)	any money received by judgment, legal action, or settlement from a third party liable to the employee for the monthly disability benefit;

(iii)

automobile no-fault, medical payments, or similar insurance payments;

(iv)	any money received by a judgment, settlement, or other payment as a result of a claim against an employer; or

(v)	annual leave or similar lump-sum payments.

(b)

The monthly disability benefit shall be reduced or reimbursed by any amount received by, or payable to, the eligible employee for the same period of time during which the eligible employee is entitled to receive a monthly disability benefit from the following sources:

(i)	social security disability benefits, including all benefits received by the eligible employee, the eligible employee’s spouse, and the eligible employee’s children as determined by the Social Security Administration;

(ii)	unemployment compensation benefits;

(iii)

sick leave benefits; or

(iv)	compensation received for employment, including self-employment, except for eligible amounts from approved rehabilitative employment in accordance with Section 49-21-406.

(3)

The monthly disability benefit shall be reduced by any amount in excess of one-third of the eligible employee’s regular monthly salary received by, or payable to, the eligible employee from the following sources for the same period of time during which the eligible employee is entitled to receive a monthly disability benefit:

(a)	any retirement payment earned through or provided by public or private employment; and

(b)	any disability benefit, other than social security or workers’ compensation indemnity benefits, resulting from the disability for which benefits are being received under this chapter.

(4)	After the date of disability, cost-of-living increases to any of the benefits listed in Subsection (2) or (3) may not be considered in calculating a reduction to the monthly disability benefit.

(5)	Any amounts payable to the eligible employee from one or more of the sources under Subsection (2) are considered as amounts received whether or not the amounts were actually received by the eligible employee.

(6)

(a)	An eligible employee shall first apply for all disability benefits from governmental entities under Subsection (2) to which the eligible employee is or may be entitled, and provide to the office evidence of the applications.

(b)	If the eligible employee fails to make application under this Subsection (6), the monthly disability benefit shall be suspended.

(7)

During a period of total disability, an eligible employee has an affirmative duty to keep the program informed regarding:

(a)	the award or receipt of an amount from a source that could result in the monthly disability benefit being reduced or reimbursed under this section within 10 days after the day of the award or receipt of the amount; and

(b)	any employment, including self-employment, of the eligible employee and the compensation for that employment within 10 days after beginning the employment or a material change in the compensation from that employment.

(8)	The program shall use commercially reasonable means to collect any amounts of overpayments and reimbursements.

(9)

(a)	If the program is unable to reduce or obtain reimbursement for the required amount from the monthly disability benefit for any reason, the employee will have received an overpayment of monthly disability benefits.

(b)

If an eligible employee receives an overpayment of monthly disability benefits, the eligible employee shall repay to the office the amount of the overpayment, plus interest as determined by the program, within 30 days from the date the overpayment is received by:

(i)	the eligible employee; or

(ii)	a third party related to the eligible employee.

(c)	The executive director may waive the interest on an overpayment of monthly disability benefits under Subsection (9)(b) if good cause is shown for the delay in repayment of the overpayment of monthly disability benefits.

Amended by Chapter 37, 2023 General Session
Amended by Chapter 274, 2023 General Session

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