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

If you were hired prior to July 29, 1992 you will participate in the Original Plan, unless you chose coverage under the Revised Plan.

Revised Plan

If you were hired after July 29, 1992 you will participate in the 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)

Helping you to Return to Work

  • Our goal is to rehabilitate members for a return to work.
  • Disability benefits are not a guaranteed benefit for life.

Eligibility for Disability Benefits

To be eligible to apply for disability benefits, you must meet the following requirements:

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:

Applying for Disability Benefits

  1. 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:

    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.

    Your physician must indicate on the Report of Physician that you are disabled in order for OPERS to continue processing your application.

    The completed packet

    You are responsible for submitting the completed application, including:

    It is highly recommended you include all diagnostic test results and/or medical documents with your disability benefits application.

    Why? Including these documents will help speed up the application process. If additional medical documents are needed, the HIPAA Authorization will be used to request those documents. Any charges related to the release of medical documents will be your responsibility.

    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

    Make sure your application is complete. Any missing or incomplete documents will lead to a delay in your application.

  2. 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, Managed Medical Review Organization (MMRO).
    • You will receive a letter stating your application has been sent to MMRO.

  3. 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

    If you are not contacted by MMRO within five business days (after receiving the letter from OPERS): Contact MMRO directly at 866-516-6676 (8:30 a.m.-5 p.m., Monday-Friday).

    Note: While your application is with MMRO, OPERS will be unable to answer any questions regarding application status. Instead you should contact MMRO directly.

    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.

  4. 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.

    Applicants are not required to attend this board meeting, and their presence will not impact the Board's decision.

  5. 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.

Estimate a Disability Benefit

You can receive a disability benefit estimate in one of two ways, by calling OPERS at 1-800-222-7377 to speak with a member services representative or by requesting an estimate through the message feature of your online account.

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

State taxes

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:

Access to additional resources

You'll also receive additional resources from MMRO's case manager to aid in rehabilitation and your eventual return to work. These include:

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.

If your benefit effective date is retroactive (up to two years) it will count toward your deadline to enroll in the rehabilitative services program.

For example

If you became disabled from an injury that occurred in 2019, but you applied for and received disability benefits in 2021, your disability benefit effective date may be two years in the past. This would mean you only have six months to enroll in the program.

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:

Complying with the Disability Program

Ongoing requirements must be met to remain in the OPERS Disability 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 MMRO, 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.

Submitting forms to OPERS

You will be responsible for submitting all form to OPERS either by fax or mail:

Ohio Public Employees Retirement System
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:

Remember: If you want to enroll in the Rehabilitative Services Program, you must enroll six months prior to the end of your third year.

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.

What happens to your HRA when your disability benefit is terminated:

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.

Although OPERS employers are legally required to rehire an employee under a leave of absence provision, this is not something OPERS has the authority to enforce.

More Information

For more information on the OPERS Disability Benefits Program, including information on the Original Plan, refer to the Disability Benefits leaflet.