Section 1600.555  Disability Retirement Annuity Claims Procedure

a)         Pursuant to Section 15-153.2 of the Code, a participant whose disability benefits are discontinued under the provisions of clause (6) of Section 15-152 of the Code and who is not a participant in the Retirement Savings Plan is entitled to a disability retirement annuity of 35% of the basic compensation which was payable to the participant at the time the regular disability began under Section 15-153(a) of the Code, or 65% of the basic compensation that was payable to the participant at the time the line-of-duty disability began under Section 15-153(b) of the Code, provided that the Board determines that the participant has a medically determinable physical or mental impairment that prevents him or her from engaging in any substantial gainful activity, and which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.  This determination shall be based upon:

1)         a written certificate from one or more licensed and practicing physicians appointed by or acceptable to the Board, stating that the participant is unable to engage in any substantial gainful activity; and

2)         any other medical examinations, hospital records, laboratory results, or other information necessary for determining the employment capacity and condition of the participant.

b)         Application Filing Requirements

1)         An application for a disability retirement annuity must include the certification described in subsection (a)(1) and supporting documentation described in subsection (a)(2), all as explained in more detail in this Section, for each disabling condition as well as for the entire period of the disability retirement annuity. 

2)         The application for a disability retirement annuity must be filed within one calendar year after the date on which the disability benefits are discontinued under clause (6) of Section 15-152 of the Code.  The application is deemed to have been filed on the date on which the System first receives any part or section of the application.  An untimely application shall render the participant ineligible for a disability retirement annuity.  This limitation may be waived upon a showing of good cause, including, but not limited to, extenuating circumstances in which the applicant was under a significant physical, mental or medical infirmity or legal status that prevented the applicant from filing within the time period.

c)         Certification By Physicians. For purposes of subsection (a)(1), the following shall apply:

1)         Physicians acceptable to the Board are attending physicians, physicians designated by the participant and physicians to whom the participant was referred by the attending or designated physician. Physicians appointed by SURS staff to examine the participant are deemed to be physicians appointed by the Board. The physician must be licensed to practice and be currently practicing in the field of expertise related to the underlying physical or mental condition for which disability benefits are sought.

2)         The certification must be signed by a physician described in subsection (c)(1) or an authorized representative of the physician and must state the following:

A)        the medical diagnosis of the physical or mental condition;

B)        the prognosis of the physical or mental condition; and

C)        that the participant has a medically determinable physical or mental impairment that prevents the participant from engaging in any substantial gainful activity and can be expected to result in death or has lasted or can be expected to last for a continuous period of not less than 12 months.

3)         The certification must be accompanied by a report containing the following:

A)        the date of examination;

B)        the medical history of the participant;

C)        the results of any diagnostic tests used;

D)        the diagnosis of the physical or mental condition;

E)        the plan of treatment for the physical or mental condition and prognosis in response to the treatment plan;

F)         an evaluation of the physical or mental condition that prevents the participant from engaging in any substantial gainful activity and that can be expected to result in death or has lasted or can be expected to last for a continuous period of not less than 12 months; and

G)        any existing documentation of objective medically demonstrable anatomical, physiological or psychological abnormalities manifested as test results or laboratory findings apart from self-reported symptoms.

d)         Determination of Disability Retirement Annuity.  If the participant whose disability benefits are discontinued under the provisions of clause (6) of Section 15-152 of the Code establishes, by a preponderance of the evidence, that the participant has a medically determinable physical or mental impairment that prevents the participant from engaging in any substantial gainful activity and can be expected to result in death or has lasted or can be expected to last for a continuous period of not less than 12 months, the participant shall be determined eligible for a disability retirement annuity under Section 15-153.2 of the Code. Participants in the Retirement Savings Plan are not eligible to receive disability retirement annuity benefits.

1)         SURS staff shall determine whether the certifications made under subsection (a)(1) and supporting documentation described in subsection (a)(2) establish eligibility for a disability retirement annuity.

2)         At the discretion of SURS staff, the participant may be required to submit to additional examinations by staff appointed physicians or specialists to aid in the determination process.

e)         Subsequent Re-examination of Disability Retirement Annuity Recipients

1)         SURS staff shall secure from one or more physicians, periodically, re-evaluation reports concerning the continued disability of the participant or the recipient. The date of re-evaluation shall be determined by SURS staff on the basis of the medical reports received previously, the nature of the disability, and other relevant information.

2)         In the re-evaluation of disability retirement annuity claims, the examining physician shall be the attending physician or the physician designated by the participant or the recipient.  However, if the nature of the disability or other circumstances justifies the appointment of someone other than the participant's or recipient's attending physician or designated physician as the examining physician, SURS staff shall make the appointment. All other procedures that may be applicable in processing the initial claim for a disability retirement annuity shall be followed in re‑evaluation of the claim.

f)          Release of Medical Information. The participant or the recipient may be required to authorize the release of all medical or other information related to the disability retirement annuity claim, including, but not limited to, medical reports, hospital records, Department of Employment Security earnings statements, income tax records, unemployment records, and any record deemed necessary to the administration of the disability retirement annuity claim. The failure of the participant or the recipient to submit to a re-evaluation examination or a treatment plan, to produce records, or to approve release of information required shall result in the discontinuance of disability retirement annuity payments payable to the participant or recipient who failed to comply pursuant to Section 15-153.2(d) of the Code or suspension under Section 1600.160, as applicable.

g)         The terms "substantial gainful activity" and "medically determinable physical or mental impairment" shall have the meanings ascribed to them under 20 C.F.R. 404.1510 and 404.1521, respectively.

(Source:  Added at 49 Ill. Reg. 3321, effective February 26, 2025)