Section 1600.320  Procedures to be Followed in Medical Evaluation of Disability Claims

a)         Section 15-150 of the Code provides that a participant shall be considered disabled only during the period for which the Board has received a written certificate by at least 2 licensed and practicing physicians appointed by the Board stating that the participant is disabled and unable to reasonably perform the duties of his or her assigned position and  a written certificate by the employer that the participant is unable to perform the duties of his or her assigned position.

b)         The Code authorizes the Board to employ medical services as shall be required for the efficient administration of SURS.

c)         Appointment of Medical Director.  The Board has appointed a Medical Director whose responsibility is to review the medical reports received from the examining physicians, and to advise the Board as to whether the medical requirements of the Code have been met.

d)         Appointment of Examining Physicians

1)         Unless otherwise authorized by the Executive Committee or the Board on recommendation of the Medical Director, the following shall be the examining physicians:

A)        The attending physician or physicians designated by the participant; and

B)        The health officer of the employer or some other physician who is designated by the employer.

2)         If the participant has not been examined by the employer's health officer or by some other physician who is designated by the employer, the Medical Director shall appoint some other physician to conduct the examination and to submit a recommendation regarding the disability of the participant.

3)         If, in the opinion of the Medical Director, the nature of the disability or other circumstances justify the appointment of someone other than the participant's attending physician or employer's health officer as the examining physicians, the Medical Director shall appoint a special examining physician or physicians.

e)         Determination of Disability.  If the examining physicians certify that the participant is disabled, the participant shall be considered disabled.

f)          Disagreement among Examining Physicians.  If the examining physicians are not in agreement as to whether the participant is disabled, the Medical Director shall appoint some other licensed and practicing physician to conduct a special medical examination and submit a recommendation as to whether the participant is able to perform the duties of his or her assigned position.  If the special examining physician agrees that the participant is disabled, the Medical Director shall recommend that the claim be approved.

g)         Certification of Disability by the Employer.  The Code provides that a participant may qualify for disability benefits only if the employer certifies that the participant is unable to perform the duties of his or her assigned position.  This certification shall be completed by any officer authorized by the employer to make this certification.  The certification of the employer may be based upon a medical examination given by the employer's health officer or upon medical reports submitted to the health officer by other examining physicians.

h)         Subsequent Reexamination of Disabled Participants

1)         It shall be the responsibility of the Medical Director to secure from examining physicians, periodically, reports concerning the continued disability of the participant.  The date of reevaluation of the participant's ability to perform his or her duties shall be determined by the Medical Director on the basis of the medical reports received previously, the nature of the disability, or other relevant information.

2)         In reevaluation of disability claims, the examining physician shall be the attending physician designated by the participant, but, if, in the opinion of the Medical Director, the nature of the disability or other circumstances justify the appointment of someone other than the participant's attending physician as the examining physician, the Medical Director shall make the appointment.  The certification of disability by the employer may be based upon the medical reports received from the employer's health officer or other physicians.  All other procedures that may be applicable in processing the initial claim for disability benefits shall be followed in reevaluation of the claim.

i)          Amendment or Repeal of Medical Evaluation Regulations.  This Section is issued by the Board in accordance with the provisions of the Code.  The right is reserved to rescind or amend this Section in whole or in part at anytime.  However, no rescission or amendment shall be effective until the rescission or amendment has been filed with the Secretary of State.  Amendment or repeal will be made in accordance with the Illinois Administrative Procedure Act [5 ILCS 100].

(Source:  Amended at 32 Ill. Reg. 16515, effective September 25, 2008)