HomeMy WebLinkAboutLEOFF I Disability Retirement Board Rules Policies and Procedures
JEFFERSON COUNTY & CiTY OF PORT TOwNSENd
LEOFF - I DISABILITY
RETIREMENT BOARD
Rules, Policies and
Procedures
Adopted June 03, 2025
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TABLE OF CONTENTS
Rules, Policies and Procedures
PREAMBLE ................................................................................................................................ 1
SCOPE ................................................................................................................................... 1
EFFECT OF RULES AND REGULATIONS ................................................................................ 1
PART 1 DEFINITIONS ............................................................................................................. 2
PART 2 THE BOARD ............................................................................................................... 2
2.1 Powers of the Board .......................................................................................... 2
2.2 Board Members ................................................................................................. 3
2.2.1 Term and Vacancy .................................................................................. 3
2.2.3 Voting ...................................................................................................... 3
2.2.4 Chair ....................................................................................................... 4
2.2.5 Election of Chair ...................................................................................... 4
2.3 Board Clerk, Appointment of ............................................................................. 4
2.4 Election of the Firefighter/Law Enforcement Representative ............................. 4
PART 3 GENERAL PROVISIONS OF BOARD MEETINGS ..................................................... 4
Meeting Procedures ................................................................................................... 4
3.1 Meetings, Agenda ............................................................................................. 4
3.2 Open Meetings .................................................................................................. 5
3.3 Taping Meetings ................................................................................................ 5
3.4 Examination of Records .................................................................................... 5
3.5 Oral Proceedings/Transcripts ........................................................................... 5
3.6 Subpoenas ........................................................................................................ 7
PART 4 PROCESSING APPLICATIONS AND CLAIMS GENERALLY ..................................... 7
4.1 Submission of Claims .................................................................................... 7
4.2 Reconsideration of Board Decisions .................................................................. 8
4.3 Appeal Procedure.............................................................................................. 8
PART 5 DISABILITY LEAVE AND RETIREMENT .................................................................... 9
General Procedures: .................................................................................................. 9
5.1 Applications for Disability Leave ........................................................................ 9
5.2 Forms ................................................................................................................ 9
5.3 Duration of Leave .............................................................................................10
5.4 Disability Leave Not to Exceed Six Months ......................................................10
5.5 Examination by a Physician ..............................................................................10
5.6 Applicant Re-examination .................................................................................10
5.7 Board may Postpone Decision .........................................................................11
5.8 Written Decision of the Board ...........................................................................11
5.9 Waiver of Disability Leave ................................................................................11
5.10 Physician Examination when Disability Leave Waived ..................................11
5.11 Application Denial .........................................................................................12
5.12 No Determination with Reasonable Certainty ................................................12
PART 6 OBLIGATIONS OF MEMBERS WHILE ON LEAVE .................................................. 12
6.1 Authorization to Return to Active Service from Disability ..................................12
6.2 Member Cooperation in Board Evaluation ........................................................13
6.3 Member’s Address ...........................................................................................13
6.4 Determination of Fitness...................................................................................13
6.5 Treatments .......................................................................................................14
6.6 Member to Seek Authorization to Return to Duty ..............................................14
6.7 Return to Duty ..................................................................................................14
6.8 Trial Return to Duty ..........................................................................................14
PART 7 MEMBERS ON DISABILITY RETIREMENT LEAVE ................................................. 15
7.1 Re-entry from Retirement .................................................................................15
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7.2 Periodic Re-examination of Retiree ..................................................................15
7.3 Notice of Discontinuation of a Retirement Allowance ........................................16
7.4 Findings and Conclusion, Decision ...................................................................16
PART 8 MEDICAL EXPENSE CLAIMS, PROCEDURES AND GENERAL PROVISIONS ...... 16
8.1 Medical Services ..............................................................................................16
8.2 Forms ...............................................................................................................17
8.3 Time for Filing ..................................................................................................17
8.4 Offset for Third Party Payments and Subrogation.............................................17
8.5 Criteria .............................................................................................................18
8.6 General Provisions ...........................................................................................18
8.7 Approval of Claims at Other than A Regular Meeting .......................................19
PART 9 CLAIMS FOR REIMBURSEMENT OF CERTAIN MEDICAL
TREATMENT/PROCEDURES .................................................................................. 19
9.1 General Rule ....................................................................................................19
9.2 Long Term Care ...............................................................................................19
9.3 Continuous or Periodic Treatment/Services......................................................22
9.3.1 Coverage by a Health Insurance Provider ..............................................22
9.3.2 Members Covered By A (Non-Self-Funded) Group-Plan Health Provider
22
9.3.3 Medical Expenses Exceeding Contract-Year Entitlement of A Given
Health Insurance Plan ........................................................................................23
9.4 Chiropractic Treatment/Services ......................................................................24
9.5 Mental Health Services of a Psychologist or Social Worker ..............................25
9.6 Substance Abuse Services ...............................................................................26
9.7 Vision Benefits .................................................................................................27
9.8 Medical Equipment and Supplies .....................................................................28
9.8.1 Hearing Aids ..........................................................................................28
9.8.2 Regular Maintenance .............................................................................28
9.8.3 Replacement Hearing Aids .....................................................................28
9.8.4 Other ......................................................................................................29
9.9 Dental Benefits .................................................................................................29
9.10 Miscellaneous ...............................................................................................30
9.11 Medical Marijuana .........................................................................................30
PART 10 REVIEW OF BOARD RULES: AMENDMENTS, REVISIONS PER STATE
RETIREMENT SYSTEMS ......................................................................................... 31
10.1 Periodic Review ............................................................................................31
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Jefferson County/City of Port Townsend
LEOFF-I Disability Board
RULES POLICIES AND PROCEDURES
PREAMBLE
The purpose of these rules and regulations is to establish the general operating procedures and to
reduce to writing the administrative policies of the local disability Board. The Board recognizes
that conditions may exist or come into existence which are not encompassed by these rules and
regulations. In some cases, the Board reserves the right to take whatever action is necessary
consistent with applicable statutes and State regulations.
SCOPE
These rules and regulations shall be applicable to all firefighters or law enforcement officers,
active and/or retired, covered by Chapter 41.26 RCW, unless specifically provided herein.
EFFECT OF RULES AND REGULATIONS
All fire and police personnel of Jefferson County covered by LEOFF-I shall be subject to the
policies and procedures contained herein to the extent consistent with applicable State Statutory
provisions and shall at all times follow the procedures contained herein to avoid possible loss of
benefits. In the event any policy or procedure is applied to the particular member shall be held to
be contrary to State law, such member shall not be relieved of any other requirement contained
herein and any such finding shall not relieve the member from the responsibility to comply with
all other procedures and policies contained herein. Agencies served by the Jefferson County
Disability Board are the Jefferson County Sheriff’s Office, Port Townsend Police Department
and Port Townsend Fire Department.
A member’s failure to follow these procedures may subject him/her to the loss of benefits
otherwise due under the LEOFF Act.
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PART 1 DEFINITIONS
1.1 “Application” means a filed request by a member for Board approval of disability leave
or retirement.
1.2 “Claim” means a filed request by a member to the Board for approval of reimbursement
of expenses incurred for medical services or treatment; or the pre-approval of a medical
appliance which exceeds $150.00; or pre-approval of a surgical procedure, or pre-
approval of successive treatment.
1.3 “Conditional return” is a return to duty by a member for the purpose of determining
whether the member’s disability persists.
1.4 “Disability” means the existence of a physical or mental (psychological) condition,
which renders the member unable to discharge with average efficiency the duty of the
grade or rank to which the member belongs, or the position in which the member
regularly serves. If a member is able to perform the regular duties of any available
position to which a member of his grade or rank is normally assigned, with average
efficiency, the member is not considered disabled.
1.5 “Disability Leave Allowance” Disability leave allowance is not granted for any specific
amount of time. Such leave may encompass a period of one hour to a maximum of six
months. During this time, the member is to receive an allowance equal to his regular
salary on the first day of such leave [Per AGO No. 78.81 or the applicable portion
thereof, from his employer.
1.6 “In the line of duty” means that the member’s disability occurred as a direct result of
the performance of the member’s duties.
1.7 “Member” means a current or retired law enforcement officer or firefighter eligible for
benefits provided under RCW 41
PART 2 THE BOARD
2.1 Powers of the Board
The Board shall have the powers granted by the State legislature or necessarily implied
from such grant of powers in RCW chapter 41.26 and WAC chapters 415-105.
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2.2 Board Members
The Jefferson County Board shall consist of five members in accordance with RCW
41.26.110(b): one member shall be from and appointed by the Jefferson County
Commissioners; one member shall be appointed by the City of Port Townsend Council;
one firefighter or retired firefighter shall be elected by the firefighters employed or
retired in the county who are not employed by or retired from a city in which a disability
Board is established; one law enforcement officer or retired law enforcement officer shall
be elected by the law enforcement officers employed in or retired from the county who
are not employed by or retired from a city in which a disability Board is established; and
one member shall be from the public at large who resides within the county but does not
reside within a city in which a disability Board is established, to be appointed by the
other four members. Members shall receive no compensation for their service upon the
Board.
2.2.1 Term and Vacancy Board members shall serve a two-year term. In the event of
a vacancy, a successor shall be appointed or elected in the same manner as with
an original appointment or election to serve the remainder of the un-expired term
or to begin a new term.
1. If a member’s term expires before an election is held or an appointment is
made that member will continue to serve with full voting rights, until the
election results or an appointment is announced by the Board.
2.2.2 Absenteeism A member may be removed for cause by the Chairman of the
Board upon recommendation of a majority of the Board members. Irregular
attendance for scheduled meetings shall be grounds for a recommendation that an
individual be removed from the Board.
2.2.3 Voting Each Board member shall have one vote, which must be cast by that
member in person. Three members of the Board shall constitute a quorum.
The Board members elected by the Law Enforcement Officers and Fire Fighters
that are LEOFF 1, and subject to the jurisdiction of the board, may vote in LEOFF
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1 Disability Board elections. While LEOFF II Law Enforcement Officers and
Firefighters can be members of the Disability Board, they cannot vote in the
Board Elections.
2.2.4 Chair The Chair shall preside at all meetings and hearings of the Local disability
Board and may call special meetings. The Chair shall have the privilege of
discussing matters before the Board and voting thereon except where doing so
constitutes a violation of an appearance of fairness doctrine or a conflict of
interest. The Chair shall have all the duties normally conferred by parliamentary
procedures on such officers and shall perform such other duties as may be
requested by the Board.
2.2.5 Election of Chair The members of the Board will elect a Chair and, if
necessary, a chair pro tempore to serve in the absence of the Chair. The chair pro
tempore shall assume the duties and powers of the Chair in the Chair’s absence.
2.3 Board Clerk, Appointment of
The Board Chair shall appoint a person to serve as the Board Clerk, who shall be subject
to confirmation by the Board.
2.4 Election of the Firefighter/Law Enforcement Representative
Elected representatives shall serve a two-year term. Nominations and election commence
every two years, and are conducted by the Board clerk-secretary.
PART 3 GENERAL PROVISIONS OF BOARD MEETINGS
Meeting Procedures
3.1 Meetings, Agenda
The Board shall meet twice a year in April and October on the second Tuesday of the
month in the Jefferson County Courthouse, with the date and time determined by the
Board. If necessary, special meetings may be called by the Chair or a majority of the
Board.
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3.2 Open Meetings
The Board may, in its discretion, allow the public to attend all regular Board meetings.
However, the Board, under RCW 42.30.140(2) may close those portions of meetings
relating to consideration of specific applications or claims where consideration of the
application or claim may include discussion of sensitive personal information relating to
the member.
3.3 Taping Meetings
No one attending any Board meeting may video tape or tape record any portion of the
meeting without prior approval of the Board.
3.4 Examination of Records
Information relating to a member’s claim or application shall be released under the
following conditions:
3.4.1 Only as required by RCW 42.17, by court order, or written permission of the
member. Upon request to the Board Clerk, members may examine their disability
file at the Board office during times scheduled by the Board Clerk
3.4.2 A person requesting examination of Board records, minutes or agendas must submit
a written request and arrange with the Board Clerk an appointed time for viewing
the materials. Requests for examination must comply with the Public Information
Act. If a request would violate a member’s privacy rights, all identifying details in
the information must be deleted or the member’s permission must be obtained
before release of the information.
3.4.3 A copy of a record of proceedings, minutes, agendas, Board action, disability fill
records (with member’s permission), or any part thereof will be furnished to a
requesting party upon request and payment thereof of copy fees charged pursuant to
RCW 2.21
3.5 Oral Proceedings/Transcripts
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The Board may hold a full hearing on any matter when deemed necessary or on a
motion for reconsideration under Board Rule 4.2. At such a hearing:
3.5.1 Any person testifying before the Board may have his or her attorney present.
3.5.2 Opportunity shall be afforded all parties to respond and present relevant evidence
and argument on all issues involved.
3.5.3 Unless precluded by law, informal disposition may also be made of any contested
case by stipulation, agreed settlement, consent order, or default.
3.5.4 The record of a hearing shall include:
1. All pleadings, motions, intermediate rulings;
2. Evidence received or considered;
3. A statement of matters officially noticed, if any;
4. Questions and offers of proof, objections, and ruling thereon, if any;
5. Proposed findings and exceptions, if any; and
6. Any decision, opinion, or report by the Disability Board.
3.5.5 All oral proceedings before the Board shall be recorded by a Board Clerk. A copy
of the record, or any part thereof, shall be transcribed by the clerk. Transcriptions
may be furnished to a requesting party upon request to the clerk and payment of
the cost thereof for transcriptions will be assumed by the requesting party.
Transcriptions of oral testimony will not be ordered by the Board unless it is
requested by the Board or the State retirement systems for review.
3.5.6 Findings of fact shall be based exclusively on the evidence and on matters
officially noticed.
3.5.7 The Disability Board may:
1. Administer oaths and affirmations, examine witnesses, and receive evidence;
2. Issue subpoenas as provided in Board Rule 3.6;
3. Rule upon offers of proof and receive relevant evidence;
4. Take or cause depositions to be taken pursuant to rules promulgated by the
Board;
5. Regulate the course of the hearing.
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3.6 Subpoenas
The Board may compel the attendance of a witness at any hearing as follows:
3.6.1 The Board may issue a subpoena on its own motion or on the request of any party;
3.6.2 If an individual fails to obey a subpoena, or obeys a subpoena but refuses to
testify when requested concerning any matter under examination or investigation
at the hearing, the Board may petition the superior court of the county where the
hearing is being conducted for enforcement of the subpoena. The petition shall be
accompanied by a copy of the subpoena and proof of service, and shall set forth in
what specific manner the subpoena has not been complied with, and shall ask an
order of the court to compel the witness to appear and testify before the Board.
3.6.3 Witnesses subpoenaed to attend such a hearing shall be paid the same fees and
allowances, in the same manner and under the same conditions, as provided for
witnesses in the courts of this State by RCW 2.40 and by RCW 5.56.010, as now
or hereafter amended: Provided, that the Board shall by the power to fix the
allowance for meals and lodging in like manner as is provided in RCW 5.56.010,
as now or hereafter amended, as to courts. Such fees and allowances, and the cost
of producing records required to be produced by its subpoena, shall be paid by the
Board, or by the party requesting the issuance of the subpoena.
PART 4 PROCESSING APPLICATIONS AND CLAIMS
GENERALLY
4.1 Submission of Claims
All applications and claims shall be submitted to the Board Clerk and:
4.1.1 Shall be made on forms provided by the Board;
4.1.2 Be first submitted through the member’s employer/department; that will then
forward complete forms to the Board office;
4.1.3 To be considered in connection with any application or claim, it must be
complete, legible, and submitted to the Board office at least 10 calendar days
prior to a scheduled Board meeting to be placed on the current meeting agenda.
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Untimely submitted material may be considered at the discretion of the Board or
placed on the next available agenda.
4.1.4 Material, which is handwritten, will be considered at the discretion of the Board
and may not necessarily be accepted as admissible evidence for a claim. Illegible
material will not be considered.
4.2 Reconsideration of Board Decisions
The Board’s decision to approve or deny applications or claims may be made without a
full hearing solely on the basis of the written information submitted to the Board. Any
member aggrieved by a decision made without a full hearing may file with the Board a
request for reconsideration and receive an opportunity for a full hearing on the matter.
4.2.1 Such a request must be filed in writing within 14-days of notification of the
decision. Upon receipt of such a written request, the Board will set a hearing date
and time at the next available Board meeting. Notice will be sent to the member at
least 10-days before the hearing date.
4.2.2 At a scheduled hearing, a member and/or a representative will be afforded
approximately 15 minutes to present information or testimony before the Board.
In addition to, or in lieu of, verbal testimony, any written material must be
submitted to the Board office ten (10) days before the bearing date to be included
with the regular agenda. Written material submitted at the time of a hearing will
be considered at the discretion of the Board.
4.3 Appeal Procedure
4.3.1 Any member aggrieved by an order of the local Disability Board, which is within
the jurisdiction of the State Retirement Systems, shall comply with the provisions
of RCW 41.26.200 in perfecting such an appeal to the State Retirement Systems
director.
4.3.2 In the event a final determination of the local Disability Retirement Board is not
within the jurisdiction of the State Retirement Systems director, the interested
member is hereby required to file his/her motion for review with the Jefferson
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County Superior Court within the appropriate time frame.
4.3.3 In accordance with RCW 41.26.125(3), the director of the State Retirement
Systems does not review a Board finding that a disability retirement was not
incurred in the line of duty. Direct review, however, may be sought from the
United States Department of the Treasury, Internal Revenue Service, concerning
any federal tax consequences of a Board finding that a disability was not incurred
in the line of duty.
PART 5 DISABILITY LEAVE AND RETIREMENT
General Procedures
5.1 Applications for Disability Leave
Applications for Disability Leave shall be submitted on forms provided by the Board
together with all supporting information required on that form. (refer to Part 3.) Under
the provisions of RCW 41.26.120 and .125, an applicant is not entitled to be granted
disability leave until he or she has discontinued service.
5.1.1 Sick leave or vacation leave and disability leave are mutually exclusive; a person
cannot be on sick leave or vacation leave and disability leave at the same time.
5.1.2 An applicant who is on sick leave or vacation leave is still in service because the
member is receiving salary. On the other hand, an applicant who has been
granted disability leave receives an allowance equal to salary.
5.2 Forms
All applications for disability retirement shall be submitted on forms provided by the
Board, together with statements from two (2) doctors and the employer’s statement and
report on the application for disability retirement, and:
5.2.1 If the disability claimed is the result of an accident, a detailed statement, including
date, time and place, shall be submitted with the application;
5.2.2 If the disability claimed was incurred in the line of duty, proper evidence must be
submitted substantiating this claim, per WAC 4 15-105-040(2): “The burden of
proving the existence of a disabling condition, and whether or not the condition
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was incurred in line of duty, shall be upon the applicant.”
5.3 Duration of Leave
Where the duration of a disability leave is uncertain the Board will estimate the duration
of the leave when considering the application. In such cases the Board may later act to
modify the duration of the leave allowed. (See 5.12)
5.4 Disability Leave Not to Exceed Six Months
Each application for disability retirement shall be deemed to be an application for
disability leave not to exceed six months and disability retirement benefits, unless
otherwise provided.
5.5 Examination by a Physician
When the Board receives an application for a disability retirement, arrangements shall be
made to have the applicant examined before the sixth month of leave by a physician
designated by the Board. The report of the designated physician as well as all information
submitted by the applicant shall then be reviewed by the Board’s consulting physician
and he shall submit an analysis, either orally or in writing, of the applicant’s condition to
the Board.
5.6 Applicant Re-examination
Applicants for disability retirement will be re-examined by a physician during the fifth or
the sixth month of disability leave in order to determine their eligibility for disability
retirement, except in conditions where:
5.6.1 The Board physician assures the Board that the applicant’s condition is
continuous and unrecoverable, such that it has not and will not be corrected before
the end of the sixth month, whereby, Rule 5.5 will not necessarily apply, or
5.6.2 If the applicant establishes that the disabling condition is continuous and
unrecoverable for the duration of six months leave and voluntarily waives all or
any portion of disability leave.
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No applicant will be granted a disability retirement unless these conditions are met.
5.7 Board may Postpone Decision
The Board may, in its discretion, postpone any decision and request additional
information or a hearing under Board Rule 4.2.
5.8 Written Decision of the Board
If the evidence shows to the satisfaction of the Board that the member is disabled and
that the disability will be continuous from the date of commencement of disability leave
for a period of six months, the Board shall enter its written decision and order which shall
contain the following presented in clear and concise terms:
5.8.1 Findings of fact supported by substantial evidence in the record that support the
grant of a disability retirement allowance. Findings of fact shall also include:
1. Whether the disability was incurred in other employment, if applicable.
2. Dates encompassing disability leave and/or dates relating to approved
conditional return to duty.
3. Whether applicant waived disability leave under Board Rule 5.9.
5.8.2 Conclusions of law on the basis of the facts in the case.
5.8.3 A finding of whether or not the disability was incurred in the line of duty.
5.8.4 Such written decision and order with supporting documentation shall thereafter be
forwarded to the State Retirement Board for review.
5.9 Waiver of Disability Leave
If an applicant established that the disabling condition will be in existence for at least six
months and he or she voluntarily waives disability leave, the applicant will immediately
be granted a disability retirement allowance by the Disability Board. (WAC 415-105-050
(1) and RCW 41.26.120 (4) and .125 (4)).
5.10 Physician Examination when Disability Leave Waived
When the Board receives an application for a disability retirement where the applicant
voluntarily waives his/her right to disability leave, arrangements shall be made to have
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the applicant examined as soon as practicable by a physician designated by the Board.
5.11 Application Denial
If an application for disability retirement is denied, the Board shall enter a written
decision and order which shall contain findings of fact and conclusions of law. The
applicant and employer will be promptly notified of the decision and of the applicant’s
rights to request for reconsideration to the Board under Rule 4.2, if applicable, or to
appeal to the State Retirement Board.
5.12 No Determination with Reasonable Certainty
If, after examination for disability retirement and review of the medical and other
relevant evidence, the Disability Board still cannot determine with reasonable certainty
whether the applicant should or should not be granted a disability retirement allowance,
the Disability Board may specify, in a written order, a reasonable period of trial service
to determine the applicant’s fitness for active duty. During the period of trial service the
applicant is to return to the same duties in the same position held at the time of
discontinuance of service. The trial period would serve no useful purpose in determining
the applicant’s fitness for the duties of the position held if he or she were required to
perform only “light duty” tasks or the duties required of a different position.
5.12.1 The length of any trial service must be for a reasonable period and must be
supported by Medical evidence. If, based on a period of trial service, the
applicant is found to be disabled, he or she is not entitled to a second six-month
period of disability leave, but will return to disability leave status for the
remainder of the initial six-month leave. (see WAC 415-105-050(3))
PART 6 OBLIGATIONS OF MEMBERS WHILE ON LEAVE
6.1 Authorization to Return to Active Service from Disability
6.1.1. It shall be incumbent upon all members granted disability leave to seek
authorization from their physician and employer to return to active service at the
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earliest possible time. In the event the Board finds that a member has not sought
authorization from his/her physician and employer to return to active service
immediately upon cessation of disability, the Board may retroactively cancel the
member’s disability leave allowance for the period in question.
6.1.2 In the event the medical and other relevant evidence is inconclusive, the Board
may specify, in a written order, a reasonable period for a trial return to service to
determine the member’s fitness for active duty. (See 5.12)
6.2 Member Cooperation in Board Evaluation
While on disability leave, the member shall be obligated to comply with the directive of
the Board. Such directives may include, but are not limited to, requests for medical or
physiological evaluation or testing; requests for submittal of other relevant reports; and
orders to appear before the Board. If the Board finds compliance with such a request was
within the control of the member and he failed to comply, it will presume compliance
with the request would have shown the member to have recovered. This presumption can
be overcome by competent medical evidence provided by the member to the Board.
Each member shall, as a condition precedent to returning to active service or being
placed on disability retirement, sign a sworn statement that all information provided to
the Board is truthful. Any person knowingly making a false statement to the Board shall
be guilty of a felony, pursuant to RCW 41.26.300.
6.3 Member’s Address
If a member in receipt of disability leave allowance moves to a location more than one
hundred (100) miles from the location of the Disability Board, any travel expenses
incurred to appear before the Board or its designated physician shall be borne by the
member. A member shall keep the Board advised of his or her current address.
6.4 Determination of Fitness
Any medical standards designed to set minimum health qualifications before a firefighter
or law enforcement officer is hired, issued by the State Department of Retirement
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Systems or used by an employer, are not the applicable standards for determining
eligibility for disability leave or retirement benefits.
6.5 Treatments
During the period of leave, the Board shall have the authority to inquire of any
examining physician as to what physical, medical, or therapeutic treatments might be
employed to rehabilitate the applicant and, based upon such evaluation, to direct the
applicant to participate in rehabilitation. If the applicant fails or refuses to submit to such
treatments, the Board may terminate the applicant’s disability benefits.
6.6 Member to Seek Authorization to Return to Duty
It shall be the responsibility of each member granted disability leave pursuant to RCW
41.26, to seek authorization from his/her physician and employer to return to active
service at the earliest possible time the member believes he/she is fit for duty (see part
6.7--”Return to Duty”). In the event the Board finds that a member has not actively
sought authorization from his/her physician and employer to return to active service
immediately upon cessation of disability, the Board shall require the member to report to
a Board-approved physician to determine the member’s ability to return to duty.
Thereafter, the Board shall determine whether or not the member’s disability leave
allowance shall be continued.
6.7 Return to Duty
The original claim form signed by a member will serve as his agreement that, if the
member returns to duty for a trial period, any further leave due to the same disability is to
be counted as a continuation of the prior leave claim and does not begin a new six-month
leave period.
6.8 Trial Return to Duty
If, at the end of the trial return period, the employee is performing his duties with average
efficiency, the trial return period will cease. The member or employer will contact the
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Board at the end of the trial return period. If the member has not been able to perform his
duties with average efficiency during the trial return period, the member or employer will
notify the Board, The Board will then make its decision on the member’s retirement,
pursuant to Section 5.
PART 7 MEMBERS ON DISABILITY RETIREMENT LEAVE
7.1 Re-entry from Retirement
In the event a member is placed on retirement, in addition to the findings described in
Board Rule 5.8, the Board may determine that the member’s disability is continuous and
unrecoverable, such that no possibility exists for return to duty or there is no possibility
rehabilitation could restore the member to fitness for duty. In the event the Board finds
that periodic examination is needed, it shall be incumbent upon the Board to order such
reexamination.
In the event the retired member is residing at a location more than 100 miles from his
former place of employment, the member may be authorized to be examined by a
physician in his immediate area. Such physician shall first be approved by the Board and
prior to such evaluation the examining physician shall be apprised by the Board of the
basis upon which the examination is to be conducted and the issues to be addressed
within his evaluation report. The retirement allowance of any member who fails to
submit to medical examination as provided above shall be discontinued or suspended
until the required medical information to justify continuation of a retirement allowance is
provided by the member. In the event such refusal continues for one (1) year, his
retirement allowance shall be cancelled. Failure of the member to affirmatively respond
to the request for reexamination shall be deemed a continuing refusal.
7.2 Periodic Re-examination of Retiree
Each member placed on disability retirement who is under 49.5 years of age is subject to
periodic review, to include a medical examination and completion of the board’s re-
evaluation questionnaire, approximately every six months, to determine whether
disability retirement should be continued.
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7.2.1 If the retiree refuses to submit to medical reexamination, the allowance is to be
discontinued until the retiree complies with the examination requirement.
7.2.2 If the retiree continues for one year to refuse to undergo reexamination, the
Disability board must cancel his or her retirement allowance.
7.2.3 The cancellation of the retirement allowance can be appealed to the director
pursuant to RCW 41.26.200 (see WAC 415-105-090)
7.3 Notice of Discontinuation of a Retirement Allowance
Where a periodic reexamination determines that retired member may no longer be
disabled or the member requests to return to duty, the member shall be notified of the
Board’s action to discontinue or cancel his retirement allowance by mail. The notification
shall contain notice of the time, place and nature of a hearing to be held under Board
Rules Part 3. The purpose of the hearing will be to determine whether the member
continues to be disabled.
7.4 Findings and Conclusion, Decision
Every decision and order revoking a disability retirement shall be in writing or stated in
the record and shall be accompanied by findings of fact and conclusions of law. The
appellant shall be notified of the decision and order in person, by phone or by first class
and/or certified mail.
PART 8 MEDICAL EXPENSE CLAIMS, PROCEDURES AND
GENERAL PROVISIONS
8.1 Medical Services
Medical services are defined by RCW 41.26.030(20) to be the minimum services legally
required to be furnished or authorized by the Board. Medical services not listed in that
section, may, in discretion of the Board, be considered for authorization on a case to case
basis.
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8.2 Forms
Claims for payment of medical services shall be submitted on forms provided by the
Board, together with any supporting information and an employer’s Statement [refer to
Part 4 of these rules).
8.3 Time for Filing
All claims must be submitted to the member’s employer within six months of the
member’s receipt of original billing. Claims submitted after this time will only be
approved by the Board if it was submitted late due to circumstances not within the
control of the member. No claim will be allowed before the expenses are actually
incurred, except as specifically authorized in these rules.
8.4 Offset for Third Party Payments and Subrogation
8.4.1 Payment of claims shall be reduced by any amount received or eligible to be
received under workmen’s compensation, social security, Medicare, insurance
provided by another employer, pension plan, or other similar source in accordance
with RCW 41.26.150(2). Members possessing insurance benefits covering the
expenses of necessary medical services, which would otherwise be the obligation
of the employer, shall first present the claim to the appropriate insurance carrier
and, only thereafter, make claim to the Board for these costs which are not paid
by the insurer.
8.4.2 “Eligible to be received” means if the retiree could have or should have covered
Him/Herself and did not then LEOFF will only cover that amount over and above
what the primary insurance would have covered.
Employers shall have the subrogation rights described in RCW 41.26.150(3). The
employer may provide for the payment of approved medical claims by insurance,
self-funded medical benefit plan, enrollment of the member in an HMO (Health
Maintenance Organization) or PPO (Preferred Provider Organization), or any
other method chosen by the employer.
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8.5 Criteria
For each claim, the Board shall determine if the criteria listed in paragraph A of Subpart
8.6 and in any applicable provision of these rules are met. If there is a doubt as to the
reasonableness of a medical service charge, the burden is upon the claimant to establish
reasonableness.
8.6 General Provisions
The following rules apply to all claims for medical services- as defined in RCW 4
1.26.030(20) and as authorized under these rules.
8.6.1 The Board will allow claims under the conditions set forth in RCW 4 1.26.150
and RCW 41.26.020 (20). Thus, claims for medical services will be approved
only if they meet the following conditions:
1. The sickness or disability for which services are rendered was not brought on
by dissipation or abuse.
2. The medical services are necessary.
3. The charges are reasonable, unless a provision in these rules provides for
reimbursement of a lesser amount.
4. If the member belongs to a pre-paid health plan, he/she could not have
obtained reasonably equivalent services at no additional charge through such
plan. The Board will decide which services are reasonably equivalent.
8.6.2 Vasectomies and cosmetic surgery (other than post-trauma reconstructive surgery)
are not considered necessary medical services.
8.6.3 An employer may provide the Board with any information which it believes will
assist the Board in determining whether the criteria set forth in Rule 8.6 and any
applicable provision of these rules are met for any medical claim submitted to the
Board. Such information may include the reasons for denial of a claim or
limitations on a member’s coverage by a third party payer.
8.6.4 The Board will not allow claims for interest on delinquent accounts or charges for
missed appointments.
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8.6.5 Pursuant to the authority granted to the Board under 41.26.150(1) to designate
medical services payable by the employer in addition to those listed in RCW
41.26.030(20), the Board designates in Part 9 herein, additional medical services
for members, subject to the conditions and limitations set forth in these rules and
given statutes.
8.7 Approval of Claims at Other than A Regular Meeting
A quorum of the Board may, at other than regular Board meetings, approve payment of
claims. Issues regarding reasonableness of charges may be resolved by referring to the
maximum fees stipulated in the State Industrial Schedule WAC 296-20 through 23.
PART 9 CLAIMS FOR REIMBURSEMENT OF CERTAIN
MEDICAL TREATMENT/PROCEDURES
9.1 General Rule
The Board will approve payment of claims for all medical services defined in RCW
41.26.030 under the conditions set forth in RCW 41.26.150, and Part 8 of these rules.
9.2. Long Term Care
The LEOFF statute provides that a LEOFF 1 member is entitled to reimbursement for the
medically “reasonable charges” incurred for Long Term Care (LTC) that are not
otherwise covered by Medicare, insurance or any similar source.
Home Based Care, Assisted Living or Group Home Care for members who are unable to
perform two or more ADLs (Activities or Daily Living) is deemed superior alternatives
to Nursing Home Care as long as it is practical and effective.
9.2.1 The Board has determined that it is appropriate to establish a cap on reimbursing
LTC charges that presents a reasonable charge for these services. This cap is
based on The Genworth Cost of Care Survey, a nationally recognized survey of
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average costs for LTC adjusted annually in March of each year. The survey
provides average costs by geographic region.
1. For services listed in the survey, the Board will reimburse up to the average
cost for the geographic region in which the member lives or up to 100% of the
average cost of the Jefferson County region; whichever is less.
2. The cap may be adjusted based on a periodic survey conducted by Board staff.
3. The average monthly total cost for Home-based Care (including Homemaker
Services, Home Health Aid Service and Adult Day Care) reimbursements
shall not exceed the average monthly rate for a one bedroom unit in an
Assisted Living Facility.
4. The maximum reimbursement rates for the following Long Term Care is
based on the following:
a. Assisted Living Facility: one bedroom unit.
b. Nursing Home Facility: semiprivate room.
c. Home Based Care Reimbursement: Home Health Aide, Homemaker
Services or Adult Day Health Care.
5. LTC reimbursements must be pre-approved.
6. All forms of LTC require a letter from a physician outlining the medical
necessity of this type of care, specific needs of the member and the ADLs the
member is unable to perform. The physician will designate the qualifications
necessary to assist the member.
7. Itemized billings must be submitted. Expenses that are not medically
necessary for the member shall not be reimbursed, including, but not limited
to personal care items, recreational charges and TV/Cable.
8. The Board will not reimburse for home based care provided by an individual
who ordinarily resides in the member’s home or is a member of the family of
either the member or the member’s spouse, unless the individual is a currently
licensed home health care provider and the individual is providing the services
as part of his or her employment working for an agency/employer who
normally provides such services.
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9. Deposits that are refundable to the member will not be reimbursed, however,
if a deposit is for a medically necessary service and is “non-refundable” the
cost may be reimbursed by the agency on a case by case basis. Documentation
explaining the purpose of the non-refundable deposit must be submitted to the
Board for review and a decision on reimbursement.
a) A fee charged by a facility to hold a bed open for a patient who is in a
hospital and is waiting to be released, commonly referred to as a “bed
hold”, is not a refundable medical expense.
b) Under extraordinary circumstances the Board will consider reimbursing
above the established maximum where the member can show that he or
she cannot obtain the necessary medical service at the established
maximum rate.
c) The Board reserves the right to have an independent assessment agency
evaluate the member’s home based care needs. The Board also reserves
the right to approve or deny home health care reimbursement based upon
the findings of the independent assessment agency.
d) LTC Definitions:
(1) Homemaker Services: Service providing help with house hold tasks
that cannot be managed alone. Homemaker services include “hands-
off” care such as cooking, cleaning and running errands.
(2) Home Health Aide Services: Home health aides offer services to
people who need more extensive care. It is “hands-on” personal care,
but not medical care. This is the rate charged by a non-Medicare
certified, licensed agency and includes respite care.
(3) Adult Day Health Care: Provides social and support services in a
community-based, protective setting. Various models are designed to
offer socialization, supervision and structured activities. Some
programs may provide personal care, transportation, medical
management and meals.
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(4) Assisted Living Facility (ALF): Residential arrangements providing
personal care and health services. The level of care may not be as
extensive as that of a nursing home, or an intermediate level of long
term care and includes Boarding Houses and Continuing Care
Retirement Communities at the Assisted Living Level.
(5) Nursing Home Care: These facilities often provide a higher level of
supervision and care than Assisted Living Facilities. They offer
residents personal care assistance, room and board, supervision,
medication, therapies and rehabilitation, and on-site nursing care 24
hours a day. This includes Adult Family Homes, Hospice Care,
Alzheimer Care and Continuing Care Retirement Community at the
Nursing Home Level.
9.3 Continuous or Periodic Treatment/Services
Treatment services of psychological counseling and/or substance abuse and chiropractic
services, and other remedies, requiring consecutive treatment, are subject to provisions
set forth herein. Claims for such treatment must be submitted for prior approval before a
member undertakes treatment. A claim for reimbursement of the cost of treatment taken
without the Board’s prior approval by a member’s own volition will be considered at the
Board’s discretion.
9.3.1 Coverage by a Health Insurance Provider
When a member is covered by a health insurance provider, the member is
required to submit claims to their health insurance provider for payment or
rejection. [Certain health insurance providers will pay for medical services up to a
specified amount subject to the contract year entitlement.] Once medical service
costs exceed the contract year’s entitlement, the uncovered portion rejected by a
health insurance provider may be submitted to the Board for their consideration.
(Refer to 9.3.3. below).
9.3.2 Members Covered By A (Non-Self-Funded) Group-Plan Health Provider
When a comprehensive group-health insurance provider covers a member, the
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member should first seek medical services from their own health insurance
provider since they are known to have medical staff/specialists.
If this health insurance provider’s physician certifies that specific medical
services are unable to be provided through their facility, the member should seek
a referral by their health insurance provider’s physician to a physician/specialist
outside of that group-plan health facility. When there is a referral, such group-
plan health insurance provider is required to pay up to an aggregate maximum
dollar amount per contract year for specific services. If a physician of a group-
plan health insurance provider refuses to make such a referral, the reasons for the
refusal should be reported in writing to the Board since the reasons could bear
upon the issue of necessity of such services. If such a referral is not provided with
a claim, the Board will construe the medical services provided outside of a
member’s group-plan health facility as elective on the part of the member and
may deny such claim.
9.3.3 Medical Expenses Exceeding Contract-Year Entitlement of A Given Health
Insurance Plan
In the event the cost of specific medical services exceeds the aggregate contract
year entitlement provided by a health insurance provider, the claimant should
submit a proposed treatment plan for the Board’s pre-approval, prior to receiving
services over and above the designated contract maximum.
1. Medical treatment/services found unreasonable. If such treatment plan or
charges thereof is found to be unreasonable, excessive or continuous, such
that a member elects to continue treatment for relief of pain symptoms only,
the Board will require a member to undergo specific medical examination and
provide a medical evaluation from an independent physician/or specialist. If a
member fails to undergo such an examination, the Board will construe such
services as elective on the part of the member and may deny such claim.
2. Unrelated or additional medical service/treatment. If the aggregate
contract entitlement amount has been reached and medical services are sought
for treatment of an injury/condition, not related to the reason for which
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original medical services were rendered, the member may have two visits to a
physician or specialists for such injury/condition prior to submitting a
treatment plan for such additional services to the Board for prior approval.
The Board must approve Treatment/services in excess of two in advance.
9.4 Chiropractic Treatment/Services
Claims for chiropractic services are subject to the provisions set forth in Rule 9.3, [Refer
to Rule 9.3, concerning coverage by a member’s health insurance provider.]
9.4.1 Certain health insurance providers will pay for chiropractic services up to a
specified amount subject to the contract year entitlement. Once chiropractic
service costs exceed the contract year’s entitlement, the uncovered portion
rejected by a health insurance provider may be submitted to the Board for their
consideration.
9.4.2 When a member is covered by a comprehensive group health insurance provider,
the member should first apply to their own health insurance provider since
they are known to have chiropractors on staff. If this health insurance provider’s
chiropractor certifies that services are unable to be provided through their facility,
the member should seek a referral by their health insurance provider’s physician
to a chiropractor outside of that group health facility. When there is a referral,
such group health insurance provider is required to pay up to an aggregate
maximum dollar amount per contract year for chiropractic services. If that group
health provider physician refuses to make such a referral, the reasons for the
refusal should be reported to the Board since the reasons could bear upon the
issue of necessity of such services. If such a referral is not provided with a claim,
the Board will construe such services were elective on the part of the member and
may deny such claim.
9.4.3 In the event the cost of chiropractic services exceeds the aggregate contract
year entitlement provided by a health insurance provider, the claimant
should submit a proposed treatment plan for the Board’s pre-approval, prior
to receiving services over and above the designated contract maximum.
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If such treatment plan or charges thereof is found to be unreasonable, excessive or
continuous, such that a member elects to continue treatment for relief of pain
symptoms only, the Board will require a member to undergo an independent
medical examination and provide a medical evaluation from an orthopedic
specialist/or physician.
9.4.4 If the aggregate contract entitlement amount has been reached and chiropractic
services are sought for treatment of an injury/condition not related to the reason
for which original chiropractic services were rendered, the member may have two
visits with a chiropractor prior to submitting a treatment plan for which services
to the Board for prior approval. Treatments/services in excess of two must have
been approved in advance by the Board.
9.5 Mental Health Services of a Psychologist or Social Worker
Claims for psychological/counseling services are subject to the provisions set forth in
Rule 9.3. [Refer to Rule 9.3, concerning coverage by a member’s health insurance
provider.]
Payments for mental health counseling services provided to a member by a psychologist
or social worker, during a continuous 12-month period, will be approved only under the
following conditions:
9.5.1 The member’s physician or department administrative officer has:
1. Recommended such services prior to the time services were provided and,
2. Provides a written statement, to be submitted with the medical claim,
confirming the recommendation, and setting forth, the date the
recommendation was made.
9.5.2 The mental health services were provided by a psychologist licensed by the State
of Washington or a clinical social worker certified by the National Registry of
Health Care Providers in Clinical Social Work or the NASW (National
Association of Social Workers) Register of Clinical Social Workers.
9.5.3 The service provider submits an initial treatment plan which was prepared within
one month of commencement of treatment and reports the progress of the member
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at least once every six months if treatment continues for six months or more. If
the member will be under treatment for more than 12 months, a second treatment
plan must be submitted within 13 months after commencement of treatment. The
Board will review the progress reports and treatment plans to determine whether
costs for such treatment should continue to be paid.
9.5.4 Nothing in this rule relieves a member from complying with the requirement in
Rule 8.3 that claims be submitted within six months of the member’s receipt of
the original billing; and to rule 9.3 above.
9.6 Substance Abuse Services
Claims for psychological/counseling services are subject to the provisions set forth in
Rule 9.3. [Refer to Rule 9.3, concerning coverage by a member’s health insurance
provider.]
The Board will approve a member’s treatment cost for substance abuse (alcoholism drug
abuse) in a program, either outpatient or inpatient, if the service provider is approved by
the Bureau of Alcohol and Substance Abuse, State of Washington, per WAC chapter
248-26, up to a maximum cost of $2,000 per year for three (3) consecutive years,
provided that the following conditions are met:
9.6.1 A member’s physician, personnel officer or commanding officer has: a)
recommended such treatment, and b) provided a written Statement, to be
submitted with the claim, confirming the recommendation and stating when the
recommendation was made.
9.6.2 The service provider submits to the Board a written treatment plan, which was
prepared within five (5) business days of the member’s admission to such
program. The plan must include a recommendation concerning the required length
of time that the member remains in the program/facility.
The Board in determining whether the conditions set forth in Rule 8.6.1 are met
for these services will use the plan. The plan must be submitted with the
member’s claim for payment of such medical services. Nothing in this rule
relieves a member from complying with the requirement in Rule 8.3 that all
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claims be submitted within six months of the member’s receipt of the original
billing.
9.6.3 Subject to the dollar limitation set forth above, the member remains in the
program for the recommended length of time, and the service provider submits to
the Board a written statement confirming this. If the member leaves the program
against medical advice or before the recommended length of treatment, the Board
will approve reimbursement of only a pro rata portion of the reasonable costs of
such program based on the time the member spent in the program.
9.7 Vision Benefits
Payments or reimbursements will be made for the cost of an annual (once per year) eye
examination performed by a licensed ophthalmologist or optometrist, pursuant to the
authority granted to the Board under RCW 41.26.150.
The Board will approve payments or reimbursements for eyeglasses (lenses and frames)
and contact lenses prescribed to correct vision when required in accordance with the
following schedule, which may be revised from time to time.
9.7.1 Eyeglass lenses: 100% of usual and reasonable charges, once every twelve (12)
consecutive months for two lenses, bifocals, trifocals or lenticular lenses.
9.7.2 Eyeglass frames: $200.00 maximum during any 24-month period.
9.7.3 Contact lenses: $100.00/per eye (not to exceed $200/pair maximum during any
12-month period).
9.7.4 Replacement Only one (1) replacement pair per year, due to accidental damage
(proof of damage must be provided), will be allowed, not to exceed the amount
allowable above.
9.7.5 No reimbursement will be made for oversized, tinting, coloring, photo sun, or
other options until there is a medical necessity as prescribed by a licensed
ophthalmologist or optometrist.
9.7.6 No reimbursement will be made for a spare pair of glasses or contact lenses,
unless the request for reimbursement for a spare pair of glasses or contact lenses
is submitted in conjunction with an approvable request for reimbursement for a
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primary pair of glasses or contact lenses and the total reimbursement for both the
primary and spare pair of glasses or contact lenses does not exceed the total
allowable cost(s) prescribed under 9.7.1, 9.7.2, and/or 9.7.3.
9.7.7 Blepharoplasty surgery, Refractive Keratotomy or Laser surgery are not covered
unless prescribed by licensed ophthalmologist or optometrist by a physician as a
medical necessity at which time it would be covered at 100%.
9.8 Medical Equipment and Supplies
In addition to the rental of durable equipment provided for in RCW 41.26.030(20) (b)
(iii) (E), the Board will approve claims for the purchase of durable, medical equipment
and supplies upon the following conditions:
9.8.1 Hearing Aids
Claims for hearing aids will be covered in accordance with the following
requirements and schedule. Approved payment will be for cost of hearing aid(s)
of average quality and serviceability and will include a minimum two (2) year
Manufacturer Repair Warranty covering all parts and labor. Any difference in the
reimbursement amount allowed by the Board and the cost of the hearing aid(s)
purchased by the member shall be the responsibility of the member. Reasonable
cost for the services of a State Licensed Audiologist will also be allowed. The
replacement of hearing aids will not be more frequent than once every five (5)
years. Claims for hearing aids will be approved up to a maximum of $3,000 per
ear. Requests exceeding this amount may be considered by the Board if supported
by medical necessity. The Board may request additional cost estimates as part of
its review, if deemed necessary.
9.8.2 Regular Maintenance
The cost of regular maintenance fees beyond the two (2) year warranty period that
are reasonable and necessary and NOT due to the member’s negligence, are
covered including ear molds and tubing. Batteries at a reasonable cost are also
eligible for reimbursement.
9.8.3 Replacement Hearing Aids
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A claim for replacement hearing aids submitted before the end of the five (5) year
replacement cycle may be submitted with verification from a State Licensed
Audiologist. This type of claim will only be approved in instances of additional
severe hearing loss which has occurred since and was unanticipated at the time
the original hearing aids were prescribed. The claim must be submitted to the
Board in advance of the purchase. Such claims will be considered on a case by
case basis.
9.8.4 Other
The Board will not approve any claims for equipment or supplies, which have a
non-medical use or function.
9.9 Dental Benefits
9.9.1 Routine Dental Care
Claims for out of pocket expenses for dental check-ups, cleanings, fillings,
denture relining, or other standard dental care will be approved up to a total of
$1,500 every two (2) calendar years. Requests exceeding this amount may be
considered by the Board if supported by documentation of medical necessity.
9.9.2 Dentures and Crowns
Dentures, crowns and their replacement or repair will be covered if medically
necessary to maintain the health of the LEOFF 1 member. The usual and
customary cost for a set of dentures and/or crown in the local area will be
considered by the Board in determining the amount of reimbursement.
9.9.3 Orthodontic Work
Claims for orthodontic work will be covered if the work is medically necessary
for an identifiable physical/medical disorder requiring medical treatment.
Documentation from a licensed physician must be submitted for review and
approval by the Board prior to the work being done.
9.9.4 Accidental Injury
Dental expenses will be approved if incurred by a member who sustains an
accidental injury to his or her teeth and commenced treatment within 90 days
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after the accident, or said treatment can be justified by way of curing or
correcting an existing health problem. An accidental injury does not include teeth
broken, damaged, or caused by the act of normal chewing or biting, or by the
neglect of dental hygiene. A claim for treatment of periodontitis will be allowed
only if it is for treatment for the first occurrence of that condition.
9.9.5 Exclusions Related to Dental Hygiene Neglect
Except for preventative dental care, treatment costs resulting from neglect of
dental hygiene will not be covered. Claims for treatment of periodontitis will be
approved only for the first documented occurrence of the condition.
9.10 Miscellaneous
9.10.1 Weight Loss Programs: In determining whether the expenses of membership in
weight loss programs, physical fitness clubs, health spas, or other programs of this
nature are allowable, the Board will consider whether programs are prescribed by
a physician and whether reasonable equivalent benefits from such programs could
not be obtained at less expense. Such programs are not considered necessary
medical expenses.
9.10.2 Smoking Cessation Programs/Patches: If prescribed by licensed physician, cost of
program will be reimbursed up to $300 maximum, one-time-only.
9.11 Medical Marijuana
Claims for coverage for the use of Medical Marijuana shall be allowed under the
following circumstances.
1. That the member is a qualifying patient under the care of a Health Care
Professional as outlined in RCW 69.51A.010 (5) and (19);
2. That the member has been diagnosed as having a condition that is either terminal
or debilitating, as defined in RCW 69.51A.010 (24);
3. That the member is in possession of a valid document/prescription as defined by
RCW 69.51A.010 (1), and is reissued on an annual basis;
4. That the member has complied with Part 8 of the LEOFF 1 Disability Retirement
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Board Policies and Procedures Manual.
5. Reimbursement will be made at a maximum amount of $200 per month.
PART 10 REVIEW OF BOARD RULES: AMENDMENTS,
REVISIONS PER STATE RETIREMENT SYSTEMS
10.1 Periodic Review
These local Board rules and regulations shall be accordingly reviewed and revised,
periodically or as often as necessary, subject to the recommendations of the State
Retirement Systems usually provided in their annual pension seminar, to assure that:
10.1.1 Provisions herein remain to conform to Washington statutory and administrative
codes;
10.1.2 Dollar amounts specified in schedule of benefits reflect current and reasonable
average charges in the local area;
10.1.3 Provisions herein reflect current philosophy and intent of the Board.
Member claims are subject to the last revised rulings adopted and exceptions will not be made.
Any newly revised rulings and statues supersedes previous policies and makes obsolete any prior
existing rule or statute therefore claims may not be made to apply to obsolete policies.