HOUSTON POLICE OFFICERS PENSION SYSTEM DISABILITY BENEFIT POLICY SECTION 1000

Transcription

1 Approved date: 12/14/2017 Page 1 of 11

2 TABLE OF CONTENTS SECTION PAGE 1000 INTRODUCTION PURPOSE PROCEDURES APPLICABLE TO DISABILITY APPLICATIONS (NONDUTY-CONNECTED, DUTY-CONNECTED INJURY/ILLNESS AND CATASTROPHIC DISABILITY) CONFIDENTIALITY OF MEDICAL RECORDS AND TESTIMONY DISABILITY COMMITTEE MEETING BOARD MEETING CALCULATIONS AND PAYMENT OF DISABILITY BENEFIT RECONSIDERATION REEMPLOYMENT ANNUAL DISABILITY CONFIRMATION ANNUAL MEDICAL REEVALUATION MEDICAL REEVALUATIONS TERMINATION OF DISABILITY BENEFIT SITUATIONS WHERE DISABILITY MAY NOT BE PAID FRAUD 11 Approved date: 12/14/2017 Page 2 of 11

3 1000 Introduction HOUSTON POLICE OFFICERS PENSION SYSTEM The Board of the Houston Police Officers Pension System (HPOPS), pursuant to statutory authority under the provisions of Article 6243g-4, Vernon s Annotated Texas Statutes (VATS) and under Section 67, Article XVI, Texas Constitution, has been given the responsibility for the general administration, management, and operation of the pension system. The applicable laws governing disability benefits and HPOPS are promulgated in Article 6243g-4, Vernon's Annotated Revised Civil Statutes of Texas, and any agreements pursuant to Section 27, thereof Purpose HPOPS is committed to the efficient and effective fulfillment of the mission of HPOPS, which is to responsibly manage the system in the best interests of the members and beneficiaries so that they may have peace of mind knowing their pension benefits are secure. The purpose of this policy is to provide a documented procedure for the Disability Committee, Board of Trustees (the Board), staff and members of the Houston Police Officers Pension System ( HPOPS ) for processing applications for a disability pension, either nonduty-connected, duty-connected, catastrophic, or a disabled dependent child. The same procedures below applicable to members will also apply to disabled dependent children. This policy may change from time to time as case law and legislation develop Procedures Applicable to Disability Applications (Nonduty-Connected, Duty-Connected Injury/Illness and Catastrophic Disability) A member who believes he or she is eligible for a disability pension should contact the HPOPS office. A member may not receive a disability benefit unless the person files with the board an application for a disability benefit not later than 180 days after the date of separation from service. Article 6243g-4 Sec. 15(d) Members requesting information about disability benefits will be provided with HPOPS information packet describing the differences between nonduty-connected disability benefits, duty connected disability benefits and catastrophic disability benefits. An estimate of the amount of the disability benefit that would be paid if the application is approved will be provided to the member at the member s request In order to pursue a disability benefit, the member (or the member s legal guardian or agent under a durable power of attorney if the member is unable Approved date: 12/14/2017 Page 3 of 11

4 to personally make application) must sign the disability application form approved by the Board. The pension office will supply this form. In order to be considered for a disability benefit the member s disability must conform to Article 6243g-4, Section 15 or an applicable contract The member will be told to supply the pension system with proof that they are totally and permanently incapacitated for the performance of the member s duties as a police officer. Such proof or evidence shall include, but is not limited to: A. Fitness for duty determination, Final Order of the Commission from Civil Service Commission B. Fitness for duty determination letter from Chief of Police to HR Director C. Copies of all medical records, x-rays, etc. pertaining to the disability application, D. Letter(s) notifying the member s supervisor of the injury and the supervisor s letter (if applicable), E. City of Houston Physicians Statement(s) or the Texas Workers Compensation Commission Work Status Report (Duty Connected Injury Only), F. Instructions for Classified Service Worker Injury on the Job Form (Duty-Connected Injury Only), G. Employer s First Report of Injury or Illness Form (Duty-Connected Injury Only), H. Any correspondence or documentation to or from the HPD Health and Safety Unit, I. Supplemental Report of Injury Forms (Duty-Connected Injury Only), J. City of Houston Supplemental Report of Injury form (if applicable), K. Return to Duty Slip Form and/or physician work release document, L. Bona Fide Transitional-Duty Offer (if applicable), M. Copies of all documentation contained in the member s Personnel Concerns File located at HPD, if any, Approved date: 12/14/2017 Page 4 of 11

5 N. Copies of any document contained in an HPD IAD or any other personnel file, whether on a Divisional or Department level, that involves conduct related to any injury, O. Any Houston Police Department APC records pertaining to the member s disability and, P. Any other applicable form(s) or document(s) from the employer, Texas Department of Insurance Division of Worker s Compensation or pertaining to workers compensation, if any Under no circumstances will the member be scheduled for the physician s evaluation until HPOPS receives the documents specified in Section A and B The member will be told that he or she must be examined/evaluated by a physician selected by the Board. In order to expedite the medical evaluation procedure, he or she must provide proof of their disability as described in section of this policy. In the event the member cannot obtain copies of all the records, etc., the member will be required to sign a records release form prior to the time an appointment is made with the HPOPS physician. HPOPS staff will forward the release form(s) to the appropriate entity to obtain copies of the necessary documents or view the necessary documents An appointment will be scheduled for the member with the System s physician. The member will be notified of the impending appointment The System s physician, not later than the 90th day after the date the member files the application that has been approved by HPOPS staff, will perform a medical evaluation and provide a written report on the member seeking a disability benefit, which concludes with an opinion as to whether the member meets the criteria for a disability benefit and which type of benefit for which the member qualifies. Article 6243g-4 Sec. 15(d) In the event there are questionable findings in the physician s written report the Disability Committee may request two additional medical evaluations and written reports Confidentiality of Medical Records and Testimony The medical records relating to the member s application will be kept confidential at all times by the pension staff and the members of the Board All testimony and discussion regarding the member s medical records by the Disability Committee or the Board will be done in closed session. In order to hold a closed session the Disability Committee or the Board shall Approved date: 12/14/2017 Page 5 of 11

6 first convene in an open meeting for which notice has been given as required by Chapter 551 of the Government Code and during which the presiding Officer publicly announces that a closed session will be held pursuant to Section of the Texas Government Code to consider the medical records of an applicant, or applicants, for a disability benefit. However, any recommendation of the Disability Committee and the voting by the Board will be made in open session The Executive Director will ensure internal procedures are developed and maintained that sufficiently control the record keeping, dissemination and destruction of member s medical information within the limitations of Chapter 552 of the Texas Government Code Disability Committee Meeting The Disability Committee will meet on the date and time designated by the Committee Chairperson in compliance with Chapter 551 of the Government Code Prior to the meeting date, the written report from the System s physician must be forwarded to the Disability Committee members The applying member will be notified of the date and time of the Disability Committee meeting and must attend the meeting if physically able or the application will not be considered The member may appear in both the open and closed sessions of the Disability Committee meeting while the application is being considered The Disability Committee will develop and render a recommendation in accordance with the provisions of Article 6243g-4, and the policies established by the Board, to grant or deny the application for a disability pension and, if applicable, whether to grant or deny a duty-connected or catastrophic injury disability benefit. The Committee shall not make a recommendation to the Board until: A. The member has been medically separated from employment with the City of Houston and; B. HPOPS has received the document referenced in Section A and B of this policy and; C. HPOPS has received and provided to the evaluating physician all medical records necessary to perform a medical evaluation and; D. HPOPS physician has provided HPOPS a written report of the medical evaluation. Approved date: 12/14/2017 Page 6 of 11

7 E. The member (if physically able) has attended the Disability Committee meeting and provided testimony regarding the member s disability The member shall be notified of the date and time the Board will meet in order to consider the Committee s recommendation Board Meeting At the next board meeting after the Disability Committee meeting, the Disability Committee Chairperson will review the Committee s activities and make the Committee s recommendation to grant or deny the member s disability application The member and/or the member s legal guardian or agent under a durable power of attorney may attend both the open and closed sessions of the meeting while the application is being considered and may make comments during the public comments section of the meeting or during open and closed sessions of the meeting pertaining to the member The Board will vote to grant or deny the Disability Committee s recommendation Calculations and Payment of Disability Benefit Benefit payments for members receiving a disability benefit will have an effective date the later of: the eligibility date (first day after member is off the City s payroll as a classified officer) or the date the member signs the application. Article 6243g-4 Sec. 15(k) Members who were on a duty-connected disability benefit on or before May 16, 2000, and subsequently have their status changed to a catastrophic disability will have an effective payment date for the catastrophic disability benefit of May 1, Article 6243g-4 Sec. 15(i) The disability benefit Final Average Pay will be calculated as of the date of termination and not the date that the application for disability is approved by the Board. No disability payments will be distributed to those disabled members who have not terminated service with the Houston Police Department Disability benefits will be calculated by multiplying the service percentage, as determined below, by the member s Final Average Pay. A. Member hired/rehired before October 9, Duty Connected greater of 55% or accrued service percentage; 100% if injury/illness is determined to be Catastrophic Approved date: 12/14/2017 Page 7 of 11

8 2. Non Duty Connected greater of 27.5% or accrued benefit percentage Members hired /rehired after October 9, Duty Connected greater of 45% or accrued service percentage; 100% if injury/illness is determined to be Catastrophic ; C. 2. Non Duty Connected greater of 22.5% or accrued benefit percentage If a member with less than 10 years of credited service becomes eligible for a non-duty disability, the member will be eligible for a disability benefit calculation based on 10 years of service. (Article III of the 2001 Agreement between the HPOPS and the City of Houston) A disability pension granted by the board shall be paid to the member for the remainder of the member s life or for as long as the incapacity remains. Article 6243g-4 Sec. 15(a-1) Reconsideration A member may request that the Board reconsider a decision relative to the application for a disability benefit. The Board has discretion as to whether it will review the member s request for reconsideration The request for reconsideration must be in writing and must be received by the Executive Director of HPOPS The member s request for reconsideration must outline the facts as to why the member believes the Board should reconsider its decision and attach any and all supporting documentation The Board may, at its discretion, review the documentation supporting the member s request for reconsideration and render a decision to grant or deny the member s request for a disability pension benefit. This decision shall be communicated to the member in writing and is final. The Board may periodically review the status of members with a disability benefit in accordance with the provisions of Article 6243g-4 Section 15 (e) Reemployment If a member, who has not reached normal retirement age, is reemployed by the City of Houston and receives a salary as an active City employee, the payment of any disability benefit the member might be receiving from the HPOPS will automatically cease to be paid until such time that the member no longer receives a salary as an active City employee. Approved date: 12/14/2017 Page 8 of 11

9 1009 Annual Disability Confirmation In May of each year all members receiving a disability pension as described in Section 15 of Article 6243g-4, except those receiving a Catastrophic Disability Benefit or who are 60 years of age or older, will be mailed a form that is approved by the Board asking the member to confirm their medical disability The Disability Confirmation form shall be returned to the pension office by the member receiving the disability pension no later than June 30 of each year The Executive Director shall make a report to the Disability Committee in July of each year summarizing the results obtained from the returned Disability Confirmation forms HPOPS will send members who indicate that they are able to perform the essential functions of a Houston police officer to be reevaluated as specified in Section 1011 of this policy Annual Medical Reevaluation Medical reevaluation occurs when the HPOPS physician recommends follow-up evaluations or by random selection that will occur each year in October In October of each year all members receiving a disability pension, except those receiving a Catastrophic Disability Benefit or who are 60 years of age or older, will be put onto a list. HPOPS staff will randomly select five members to be scheduled for a physician s appointment, with the pension system s physician, for reevaluation Once a member has been selected and participated in a reevaluation the member will be removed from the random selection pool for a period of 5 years The procedure for medical reevaluation will be the same as described in 1011 of this policy as applicable Medical Reevaluations The Disability Committee may require medical reevaluation of any member receiving a disability pension at any time The procedure for medical reevaluation will be the same as described in 1002 of this policy, as applicable, except the physician is only evaluating whether the member is disabled and to what extent. There needs to be no Approved date: 12/14/2017 Page 9 of 11

10 determination of whether the disability was caused by a duty-related injury or illness Members refusing to submit to medical reevaluation within the time frame communicated to them shall have the payment of their benefit stopped as ordered by the Board. Article 6243g-4 Sec. 15(e) The physician will provide HPOPS a written report. The report shall indicate whether the member has recovered from the disability for which the member is receiving a disability benefit Upon reinstatement or an offer of reinstatement to the classified position or to a classified position reasonably comparable in rank and responsibility as that classified position held with the Houston Police Department at the time of separation from service or hired by another law enforcement agency to a comparable position, the Board shall order the member s disability pension stopped. Article 6243g-4 Sec. 15(e) The Executive Director will communicate to the member the Board s resulting action of the medical reevaluation process Termination of Disability Benefit Should a member s disability benefit be terminated by the Board, the member may apply for a normal retirement benefit if eligible. Article 6243g-4 Sec. 15(e) Situations Where Disability May Not Be Paid A disability pension may not be paid to a member for any disability if: A. the disability resulted from an intentionally self-inflicted injury or a chronic illness resulting from: 1. an addiction by the member through a protracted course of non-coerced ingestion of alcohol, narcotics, or prescription drugs not prescribed to the member; or 2. other substance abuse; or B. the disability was a result of the member's commission of a felony. Article 6243g-4 Sec. 15(l) The board may waive subsection (B) this section if the board determines that facts exist that mitigate denying the member's application for a disability pension. Article 6243g-4 Sec. 15(m). Approved date: 12/14/2017 Page 10 of 11

11 1014 Fraud HOUSTON POLICE OFFICERS PENSION SYSTEM Members who fraudulently apply or receive a disability benefit may be subject to criminal and civil prosecution. Article 6243g-4 Sec. 15(n). Approved date: 12/14/2017 Page 11 of 11