OAR 459-076-0010
Criteria for Granting and Denying Disability Benefits
(1)
Medical documentation is required by PERS. Each disability benefit applicant shall supply any treating or consulting physician’s examination report or other medical information requested by PERS. PERS may base its determination on either a treating or consulting physician’s medical examination report or have the applicant examined by one or more physicians selected by PERS, or both.(2)
All claims of a disability must be supported by at least one physician’s report, resulting from a physical examination, documenting how the injury or disease incapacitates the member.(3)
In addition, a disability benefit applicant shall be required to furnish the following:(a)
For claims of mental or emotional disorder, at least one report of examination by a psychiatrist or at least one report of evaluation by a psychologist when accompanied by a report of physical examination by a treating or consulting physician;(b)
For claims of orthopedic injury or disease, at least one report of a treating or consulting orthopedic specialist;(c)
For claims of neurological or neurosurgical injury or disease, at least one report of a treating or consulting neurologist or neurosurgeon;(d)
For claims of fibromyalgia, at least one report of a treating or consulting rheumatologist; and(e)
Any other specialized physician’s report PERS deems necessary.(4)
To demonstrate that he or she is unable to perform any work for which qualified, as defined in OAR 459-076-0001 (Definitions)(1), the applicant shall document how the injury or disease incapacitates the applicant. The standard is subjective (that is, whether the applicant is actually incapacitated) not objective (that is, whether a “normal” member would have been incapacitated by the same events).(a)
In determining what work for which a member is qualified, the following factors shall be considered:(A)
Previous employment experience;(B)
Formal education;(C)
Formal training;(D)
Transferable skills;(E)
Age; and(F)
Physical or mental impairment.(b)
In determining what work for which a member is qualified, PERS may request, at PERS’ expense, a vocational evaluation be done by a vocational consultant who is fully certified as set forth in OAR 459-076-0001 (Definitions)(2).(c)
The inability of the applicant to perform the duties of his or her last job, in itself, does not satisfy the criterion.(5)
When there is a dispute among medical experts, more weight will be given to those medical opinions that are both well-reasoned and based on complete information.(6)
The Board may deny any application or discontinue any disability benefit if an applicant:(a)
Refuses to submit to an independent medical or vocational examination; or(b)
Refuses to submit to any medical examination or supply a completed application or review form.
Source:
Rule 459-076-0010 — Criteria for Granting and Denying Disability Benefits, https://secure.sos.state.or.us/oard/view.action?ruleNumber=459-076-0010.