OPERS Disability Benefits Program
Unexpected health issues and accidents happen. The OPERS Disability Program partners with you to help you return to wellness.
Disability Program Overview
OPERS has two disability programs: the Original Plan and the Revised Plan. Enrollment in either plan is based on when you became an OPERS member:
Original Plan
Revised Plan
The information on this page reflects the revised plan. For information on the original plan, please refer to the Disability Benefits leaflet (PDF opens in new tab)
Eligibility for Disability Benefits
To be eligible to apply for disability benefits, you must meet the following requirements:
- You must have five years of contributing service credit in the Traditional Pension or Combined plan. (This can include purchased service credit or other qualifying types of service credit.)
- You cannot be a retiree receiving a retirement benefit from OPERS.
- You must apply within two years of your final date of compensation with your last public employer.
Eligible Conditions
Eligible
- Illnesses and injuries that occur before you terminate public employment
- Illnesses and injuries that result from your employment but do not become evident for up to two years after you terminate employment
Not Eligible
- Illnesses or injuries caused by elective cosmetic surgery (other than reconstructive surgery)
- Illnesses or injuries caused during the commission of a felony
Law Enforcement
If you are in the Law Enforcement division of the Traditional Pension Plan, you will be:
- Eligible to apply for disability benefits immediately (after membership is established) for any on-duty illness or injury
- Evaluated under the own-occupation standard only (see the Complying with the program section)
- Ineligible to participate in the Rehabilitative Services Program
Applying for Disability Benefits
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Submit your application
Ready to apply? You, your employer and your physician(s) all submit specific applications and reports.
The forms you must complete are:
- Disability Benefit Application (PDF opens in new tab)
- Disability Benefit Application Instructions (PDF opens in new tab)
- Proof of Date of Birth (PDF opens in new tab)
- HIPAA Authorization (PDF opens in new tab)
Report of Physician
You must include a Report of Physician form, which asks your physician to describe the condition on which your application is based.
This form is completed by your physician, who must be a medical doctor (M.D. or D.O.).
Each doctor listed on your application must complete a Report of Physician form. Failure to include these forms will delay the processing of your application.
- Report of Physician form (PDF opens in new tab)
The completed packet
You are responsible for submitting the completed application, including:
- Disability Benefit Application (PDF opens in new tab)
- Proof of your date of birth (PDF opens in new tab)
- Report of Physician form (PDF opens in new tab) (one for each doctor listed on your application)
- HIPAA Authorization (PDF opens in new tab)
Where to submit the packet
You can mail the completed documents to OPERS.
Ohio Public Employees Retirement System
277 E. Town St.
Columbus, OH 43215-4642 -
OPERS receives and begins processing your application
Once OPERS receives the forms and documents, you will be sent an acknowledgment letter.
OPERS contacts your last public employer
- If OPERS has not heard from your last public employer, the employer will be contacted to request the Report of Employer for Disability Benefit Applicant form and a written job description. (PDF opens in new tab)
- Your employer will return this form directly to OPERS. No action on your part is needed.
OPERS sends the application to our third-party administrator
- OPERS sends your application (including the documents from your employer and any medical evidence you submit) to our third-party administrator, ForHealth Consulting.
- You will receive a letter stating your application has been sent to ForHealth Consulting.
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Review by third-party administrator
You will be called by the third-party administrator (typically within five business days). During this initial phone call the third-party administrator will:
- Acknowledge receipt of your application
- Go over the next steps in the process
Medical evaluation
Your information will be reviewed by the third-party administrator.
- The third-party administrator will decide if an independent medical/psychiatric examination is necessary.
- If they decide an examination is necessary, you'll be contacted to schedule the examination
Independent Medical/Psychiatric Examination
- The medical examination (if requested by the third-party administrator) is performed by an independent, credentialed physician selected by the third-party administrator.
- OPERS pays the fees for any medical examinations requested by the third-party administrator, but will not pay for any cancelled or "no-show" appointments.
Third-party administrator's recommendation
The third-party administrator will review both your application and the medical examiner's report and prepare a recommendation.
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Final review and determination
After the third-party administrator has offered its recommendation regarding your application, it will be sent to OPERS' medical consultant for review.
OPERS medical consultant's review
OPERS' medical consultant will review the third-party administrator's recommendation summary, along with all medical records and documentation, and make a recommendation to the OPERS Board of Trustees.
OPERS Board of Trustees' decision
The OPERS Board of Trustees will review the recommendation and either approve or deny your application at one of their meetings.
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Next steps
You'll be notified by mail about the Board's decision. You can also call OPERS (1-800-222-7377) on the day of your scheduled Board review to request the decision.
If your application is approved
Your disability benefit will become effective the first day of the month following the later of:
- The last day for which compensation was paid
- The attainment of eligibility
You and your employer may be asked to submit additional documentation to OPERS. Specific details will be included in an approval letter sent to you.
You will be required to meet OPERS' definitions of disability throughout your benefit term. See the Complying with the Program section below
If your application is denied
You have the option to appeal the Board's decision. You will receive a denial letter in the mail detailing the steps you could take to appeal the decision. OPERS will also notify your employer if your application is denied.
You have 30 days from the date of the letter notifying you of the denial or termination to submit the Disability Benefits Appeal Request form. You have 45 days to submit a Report of Physician form, along with any medical evidence in support of the appeal. Within that initial 45-day period, you may request one 45-day extension by which to submit the appeal information. If the extension is not timely and/or the appeal deadline expires before OPERS receives the necessary appeal information, the Board's action shall be final.
- Disability Benefits Appeal Request form (PDF opens in new tab)
- Report of Physician form (PDF opens in new tab)
Receiving Disability Benefits
Once your application has been approved, you can expect to receive your first payment within 10 days of OPERS receiving all required information. Your second check (and all checks going forward) will be paid on the next scheduled benefit payment date.
Direct deposit
Monthly disability benefits will be deposited directly into your savings or checking account. Direct deposit is required.
State and federal tax withholding
Federal and/or state of Ohio income taxes can be taken out of your monthly disability payment.
Changes can be made to your withholding amounts at any time through your online account.
Federal taxes
- If you do nothing, federal income tax will be withheld from your benefit payments using withholding rates applicable to a single individual with no adjustments.
- Even if you elect not to have federal income tax withheld, you are liable for payment of federal income tax on the taxable portion of your payments.
State taxes
- The payments may be subject to Ohio state income tax and you may elect to have Ohio state income tax withheld.
Access to health care
Disability benefit recipients are eligible for the OPERS Health Care Program. For more information, refer to the Health Care section of the OPERS website or the OPERS Health Care Program Guide (PDF opens in new tab).
Eligibility for OPERS health care is limited to the first five years you're receiving a disability benefit. After five years, you must meet the minimum age and service requirements for health care or be enrolled in Medicare to remain enrolled in OPERS health care.
Check with the Centers for Medicare and Medicaid Services regarding your eligibility for continued health care coverage. You may qualify for coverage through the Centers for Medicare and Medicaid Services even if you are not eligible to apply for a Social Security Disability Insurance benefit.
Rehabilitative Services Program
For many getting back to work and getting well is the most important thing. That's why OPERS disability recipients (whose disability applications were received on or after January 7, 2013) have the option of taking part in the Rehabilitative Services Program.
If you select to participate in the Rehabilitative Services Program, you will receive frequent phone calls to discuss your disabling conditions and goals to improve those conditions. Your individualized case management plan is based on your disabling condition, and information provided by you and your treating physician. Additionally, you may be provided vocational resources to assist with your self-directed job search.
Benefits of the Rehabilitative Services Program
This program gives you significant advantages:
- Your leave of absence period will be extended by two years (from three to five).
- You'll continue to be evaluated under the own occupation standard for two additional years (from three to five).
Access to additional resources
You'll also receive additional resources from ForHealth Consulting's case manager to aid in rehabilitation and your eventual return to work. These include:
- Medically-based information about how to manage and treat your condition.
- Job opportunities and educational offerings specific to your condition and skill set.
- Rehabilitative Service Information Sheet (PDF opens in new tab)
- Rehabilitative Services FAQs (PDF opens in new tab)
How to enroll in the program
When you apply for disability, you can opt into the Rehabilitative Services Program by checking a box on the Disability Benefit Application.
You can also complete the Rehabilitative Services Selection form any time during the first three years from your benefit effective date, but it must be no later than six months prior to the end of that third year.
- Rehabilitative Services Selection form (PDF opens in new tab)
Additional requirements for the Rehabilitative Services Program
If you participate in rehabilitative services, you'll be asked to meet additional requirements to remain in the program:
- You are required to follow your physician-directed medical treatment plan inclusive of, but not limited to, doctor appointments, prescribed treatment plans, medication regimens, and resource programs.
- You are required to respond to your case manager within 14 days from his/her written request for documentation or a request for a return phone call.
Complying with the Disability Program
Ongoing requirements must be met to remain in the OPERS Disability Program:
- Medical reviews will be required to determine if you continue to meet required standards for disability.
- You'll be asked to provide certain forms and documents supporting your disabling condition.
- There are additional compliance requirements for members who choose to enroll in the Rehabilitative Services Program.
Medical reviews
Periodic medical reviews for the OPERS disability program are conducted every three years from your benefit effective date. There can also be instances when a review is required at any time.
Medical reviews are completed by ForHealth Consulting, not an independent medical examiner.
Reviews are conducted under one of two standards: the any occupation standard or the own occupation standard. The standard upon which your review is based is determined by the length of time you've been enrolled in the disability program and whether or not you choose to participate in the Rehabilitative Services Program.
You will be responsible for submitting all form to OPERS either by fax or mail:
277 E. Town St.
Columbus, OH 43215-4642
Meeting the disability requirements – years one to three
For the first three years from your benefit effective date, you will:
- Be evaluated under the own occupation standard.
- Be on a leave of absence from your employer.
- Be required to submit a Continued Medical Treatment form (PDF opens in new tab) every six months. (members enrolled in the Rehabilitative Services Program do not have to send in a Continued Medical Treatment Form
- Be subject to a medical review under the any-occupation standard at the end of year three.
Meeting the disability requirements – years four to five
The requirements are different for those who choose to participate in rehabilitative services, and those who do not.
Disability Recipients
(Rehabilitative Services Program)
Three years after your disability benefit effective date:
- Your leave of absence period will continue.
- You will continue to be evaluated under the own occupation standard.
- Because your case manager will regularly be requesting medical records, you do not need to submit the Continued Medical Treatment form.
Disability Recipients
(Continued medical treatment)
Three years after your disability benefit effective date:
- Your leave of absence period will end.
- Your periodic evaluations will be under the any occupation standard.
- You are no longer required to submit a Continued Medical Treatment form every six months.
Meeting the disability requirements (years five and beyond)
Rehabilitative services is a five-year program, so after year five your participation ends.
After year five, all disability recipients will be evaluated under the any occupation standard.
Disability Recipients
(Rehabilitative Services Program)
Five years after your disability benefit effective date:
- Participation in the Rehabilitative Services Program ends.
- Your leave of absence period will end.
- You'll be evaluated under the any occupation standard.
Disability Recipients
(Continued medical treatment)
Five years after your disability benefit effective date:
- You'll continue to have periodic medical reviews every three years under the any occupation standard.
If the OPERS medical consultant determines your disabling condition is terminal and there's little chance of recovery, your periodic medical reviews will be waived.
Termination of Disability Benefits
If your disability benefits end or are terminated because you're no longer found to be disabled you have several options.
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Appeal the decision
You have a right to appeal. Here's how:
- Within 30 days: Complete and return the Disability Benefits Appeal Request form (PDF opens in new tab) to request an appeal of the Board's termination.
- Within 45 days: You must submit a Report of Physician form and any additional medical evidence from your physician supporting your appeal. The Report of Physician form you must complete will be included with the acknowledgement letter OPERS sends to you once we've received your Disability Benefits Appeal Request.
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Apply for retirement
If you are eligible, you may apply for a retirement benefit.
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Leave your account on deposit
You may leave your account on deposit with OPERS until you choose to take a refund of your account, receive a retirement benefit, attain age 72 or until your death.
If you leave your account on deposit, you may be eligible to receive a retirement benefit when you reach certain eligibility requirements.
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Refund
You may be eligible for a lump-sum refund of your account. Please note that if you have an HRA balance, it will be immediately forfeited upon refund.
What happens to your HRA when your disability benefit is terminated:
- HRA deposits stop
- OPERS vision and/or dental plans terminate (if enrolled)
- An HRA spend down period of 24 months begins
You can submit qualified medical expenses for reimbursement within those 24 months to use up the remaining balance in your HRA or it will forfeit without the ability to be reinstated. Qualified medical expenses must be incurred during the period in which you received your disability benefit.
For more information on what happens to your HRA if your disability benefit is suspended or terminated, refer to the Health Care Information for Disability Benefit Recipients (PDF opens in new tab) fact sheet.
Returning to work
Our goal is to help you return to wellness and get back to work. Once you are found to be capable of returning to work your benefits will end and OPERS will notify your employer that you are no longer disabled.
If this occurs during your approved leave of absence period, your employer will be legally required to allow you to return to your job or to a similar occupation with similar pay.
If you are found capable of returning to work after your leave of absence has ended, your employer is no longer legally obligated to rehire you.
More Information
For more information on the OPERS Disability Benefits Program, including information on the Original Plan, refer to the Disability Benefits leaflet.
- Disability Benefits leaflet (PDF opens in new tab)