27 Miss. Code. R. 210-45A-105

Current through December 10, 2024
Section 27-210-45A-105 - Medical determination of eligibility for disability benefits
1. The employer must provide the following information that will be considered by the Medical Board in its determination for eligibility:
a. The job description and duties of the member; § 25-11-113(1)(a)
b. Whether the employer has offered the member other duties without material reduction in compensation; § 25-11-113(1)(a)
c. Whether the employer has complied with the applicable provisions of the Americans with Disabilities Act in affording reasonable accommodations that would allow the employee to continue employment; § 25-11-113(1)(a) and
d. In the case of an application for duty-related disability benefits, the employer shall certify whether, to the best of its knowledge, a physical injury was sustained from an accident or a traumatic event caused by external violence or physical force that occurred in the performance of duty. § 25-11-114(6)
2. The member shall submit medical evidence of the disability to the Medical Board for review. The Medical Board may require an independent medical evaluation or such other examination or report as is necessary to determine the member's eligibility for benefits. Failure to provide the requested information within 90 days of such request or refusal to submit to an examination shall result in the member's application being considered void. The executive director may extend the 90-day period if the applicant can demonstrate that failure to submit to such examination or to provide the requested information or report(s) was due to circumstances beyond his or her control. § 25-11-113(1)(f)

To be considered eligible for disability benefits, the Medical Board must certify to the Board of Trustees (i) that the member is mentally or physically incapacitated for the further performance of duty, (ii) that such incapacity is likely to be permanent, and (iii) that the member should be retired.

The Board of Trustees does not automatically accept a Social Security Administration disability determination as evidence of disability benefit eligibility. If, however, a Social Security Administration disability benefit determination has been received during the medical evaluation process, such determination along with (i) the supporting medical documentation, (ii) the condition upon which PERS disability benefits are claimed, and (iii) the facts of the case will be taken into consideration as a part of the Medical Board's independent evaluation and determination. § 25-11-113(1)(a)

3. For purposes of § 25-11-113, medical evidence shall be defined as "objective medical evidence," which means: reports of examinations or treatments; medical signs which are anatomical, physiological, or psychological abnormalities that are observed and documented by medical professionals; psychiatric signs which are medically demonstrable phenomena indicating specific abnormalities of behavior, affect, thought, memory, orientation, or contact with reality; or laboratory findings which are anatomical, physiological, or psychological phenomena that are shown by medically acceptable laboratory diagnostic techniques, including, but not limited to, chemical tests, electrocardiograms, electroencephalograms, X-rays, and psychological tests. Non-medical information not documented by test results, such as an applicant's description of pain, is not considered objective medical evidence.
4. The applicant is responsible for providing sufficient objective medical documentation to the Medical Board in support of his or her claim for disability. PERS does not have the burden of proving that an applicant is not disabled. The Medical Board shall certify to the Board of Trustees whether, based on the objective medical evidence, the member is mentally or physically incapacitated for further performance of duty and that such incapacity is likely to be permanent and whether, based on all other facts, the member should be retired on a disability allowance. In making this determination, the Medical Board shall use the following definition:

Disability shall be defined as the inability to perform the usual duties of employment or the incapacity to perform such lesser duties, if any, as the employer in its discretion may assign without material reduction in compensation or the incapacity to perform the duties of any employment covered by the PERS that is actually offered and is within the same general territorial work area without material reduction in compensation. § 25-11-113(1)(a) As part of the determination process, the Medical Board shall consider certification from the employer as to whether reasonable accommodations have been requested by the employee and agreed to by the employer as provided under the Americans with Disabilities Act.

For purposes of disability determination, a material reduction in compensation shall be defined as a salary not in excess of 10 percent less than the current salary of the applicant.

5. In applying for duty-related disability benefits, a member must provide medical proof satisfactory to the Medical Board that his or her disability is a direct result of a physical injury sustained from an accident or a traumatic event caused by external violence or physical force occurring in the performance of duty. In addition, permanent and total disability resulting from a cardiovascular, pulmonary, or musculoskeletal condition that was not a direct result of a physical injury sustained from an accident or a traumatic event caused by external violence or physical force occurring in the performance of duty shall be deemed an ordinary disability. A mental disability based exclusively on employment duties occurring on an ongoing basis shall be deemed an ordinary disability. Further, the employer must certify on a form prescribed by PERS or by means of other acceptable documentation that an accident or injury has occurred in the performance of duty which precipitated the employee's claim for disability benefits. Acceptable documentation may include an accident or injury report, a Workers' Compensation claim form, or such other similar document signed by an authorized representative of the employing agency as proof of the occurrence of an event in the nature of an accident or injury while on the job. A duty-related disability benefit determination by PERS is independent of any determination of benefit eligibility that may be made by an insurance company or other agency of the State. § 25-11-114(6)
6. No inactive member shall be eligible to apply for duty-related disability benefits regardless of years of service if withdrawal from service occurred before July 1, 1984, which was the date that such benefits were first authorized.
7. Any active or inactive member must provide a statement certifying all gainful employment at the time the disability is claimed, whether such employment is covered employment or not.
a. Any inactive member applying for disability after one calendar year from date of termination from covered service must provide copies of tax returns with corresponding income documentation to provide information as to the type of employment and income from any gainful occupation during the period of inactive service.
b. Where the inactive member is found to have engaged in any gainful occupation paying an amount equal to or more than the average compensation used in calculating the benefits, the inactive member shall be deemed ineligible for benefits.
8. If the Medical Board determines that a member is not eligible for disability benefits, a final administrative determination will be issued to the member. The member may appeal the determination to the Board of Trustees in accordance with the provisions of Board Regulation 42, Rules of Hearing Practice and Procedure before the Board of Trustees, and Miss. Code Ann. § 25-11-120 (1972, as amended).
9. Upon certification of eligibility by the Medical Board, if the Board of Trustees concurs with such report of eligibility, the member will be added to the retiree payroll. The Board of Trustees authorizes the executive director to initiate benefits on behalf of the members who are certified by the Medical Board as being disabled in accordance with the statutes to ensure timely payment of benefits to such members, provided that the executive director shall present such approved members along with any supporting information to the Board of Trustees for ratification at a subsequent meeting of the Board.
10. A disability determination will be made based on the member's inability to perform the job duties associated with a covered position and not a second position where only wages are covered pursuant to Miss. Code Ann. § 25-11-103(k) (1972, as amended); however, the average compensation will be calculated taking into consideration all covered wages from all positions.

27 Miss. Code. R. 210-45A-105

Amended 10/1/2016
Amended 2/1/2022