ETF 50.32(4) (4) The date on which service for the participating employer terminated, for purposes of s. 40.63 (2), Stats., is the date on which the person last rendered services as defined under sub. (2).
ETF 50.32 History History: Emerg. cr. eff. 10-15-92; cr. Register, May, 1993, No. 449, eff. 6-1-93; cr. (4), Register, September, 2000, No. 537, eff. 10-1-00.
subch. III of ch. ETF 50 Subchapter III — Long-Term Disability Insurance
ETF 50.40 ETF 50.40 Purpose.
ETF 50.40(1)(1) The purpose of this subchapter is to provide long-term disability insurance coverage to participating employees as of October 15, 1992, who elect its benefits as provided in s. ETF 50.46 and to all persons who become participating employees on or after October 16, 1992.
ETF 50.40(2) (2) This subchapter replaces the disability annuity under s. 40.63, Stats., with group long-term disability insurance. Benefits under the disability annuity program under s. 40.63, Stats., are not available to participating employees to whom this subchapter applies as provided in s. ETF 50.44.
ETF 50.40 History History: Emerg. cr. eff. 10-15-92; cr. Register, May, 1993, No. 449, eff. 6-1-93.
ETF 50.42 ETF 50.42 Definitions. Words, phrases and terms used in this subchapter have the same meaning as set forth in s. 40.02, Stats., and s. ETF 10.01, except as defined in this subchapter or where the context clearly indicates a different meaning. In this subchapter:
ETF 50.42(1) (1) "Claimant" means a person making a claim for long-term disability benefits under this subchapter.
ETF 50.42(2) (2) "Earnings limit" means an amount equal to $6,573 for determinations made in the calendar year commencing on January 1, 1992, and for determinations made in subsequent calendar years, this amount shall be increased by the salary index for each subsequent year, ignoring fractions of the dollar.
ETF 50.42(3) (3) "Final average salary" or "FAS" means:
ETF 50.42(3)(a) (a) Except as provided in par. (b), a monthly rate of earnings, ignoring any fractions of a dollar, obtained by dividing 36 into the participant's total earnings received and for which contributions are made under s. 40.05 (1) and (2), Stats., during the 3 annual earnings periods (excluding any period more than 3 years prior to the effective date for any participating employer) in which the earnings were the highest.
ETF 50.42(3)(b) (b) If the claimant does not meet the minimum service requirements of s. ETF 50.50 (2) (b) and the claimant's medically determinable impairment is a result of employment as a participating employee for an employer, then the FAS is calculated as follows:
ETF 50.42(3)(b)1. 1. Divide the total earnings received by the employee in the portion of the annual earnings period in which the last day paid occurs and the 2 immediately preceding annual earnings periods by,
ETF 50.42(3)(b)2. 2. The number of months, with all fractions of a month rounded to the next higher whole number, between the last day paid and the commencement date of the earliest annual earnings period in subd. 1. or, if later, the date the claimant commenced participating employment.
ETF 50.42(3m) (3m) "Last day paid," with respect to a claimant under this subchapter, has the same meaning as in s. ETF 50.32 (1).
ETF 50.42(4) (4) "Last rendered services" means most recently performed actual work for which entitled to earnings, excluding any subsequent period on sick leave, other paid leave, vacation, compensatory time or worker's compensation temporary disability benefits.
ETF 50.42(5) (5) "Long-term disability insurance" or "LTDI" means long-term disability insurance as provided under this subchapter.
ETF 50.42(6) (6) "Medically determinable impairment" means an impairment which has medically demonstrable anatomical, physiological or psychological abnormalities. The described abnormalities are medically determinable if they manifest themselves as signs or laboratory findings apart from symptoms which are not medically determinable.
ETF 50.42(7) (7) "Recipient" means a person receiving LTDI benefits under this subchapter.
ETF 50.42(8) (8) "Substantial gainful activity" has the same meaning as stated in s. ETF 50.32 (3).
ETF 50.42(9) (9) "Totally and permanently disabled" means the inability to engage in any substantial gainful activity by reason of a medically determinable impairment, whether physical or mental, which can reasonably be expected to result in death or to be permanent, or of indefinite and long-continued duration.
ETF 50.42 History History: Emerg. cr. eff. 10-15-92; cr. Register, May, 1993, No. 449, eff. 6-1-93.
ETF 50.44 ETF 50.44 Scope and application.
ETF 50.44(1) (1) Participating employees on or after October 16, 1992. Except as provided in sub. (2), this subchapter applies to any person becoming a participating employee on or after October 16, 1992, regardless of any prior employment by a participating employer.
ETF 50.44(2) (2)Participating employees prior to October 16, 1992.
ETF 50.44(2)(a)(a) This subchapter does not apply to a person who is a participating employee on October 15, 1992, and continuously employed by one or more successive participating employers from that date until terminating employment or taking a final leave of absence due to a medically determinable impairment, unless the person elects to be covered by this subchapter as provided in s. ETF 50.46.
ETF 50.44(2)(b) (b) "Continuously employed" as used in this subsection means employed by successive employers without intervening periods of either unemployment or employment by anyone other than a participating employer.
ETF 50.44 History History: Emerg. cr. eff. 10-15-92; cr. Register, May, 1993, No. 449, eff. 6-1-93.
ETF 50.46 ETF 50.46 Optional election of coverage.
ETF 50.46(1) (1) Right to elect coverage. Notwithstanding s. ETF 50.44 (2) (a), any participating employee not otherwise automatically covered under this subchapter may elect to be covered under the LTDI plan in lieu of coverage under s. 40.63, Stats.
ETF 50.46(2) (2)Manner, effects and deadline.
ETF 50.46(2)(a)(a) An election must be in writing, signed by the employee and in a form approved by the department.
ETF 50.46(2)(b) (b) The election to be covered under this subchapter is an irrevocable and absolute waiver of all rights to benefits of any kind under s. 40.63, Stats., by the participating employee and on behalf of his or her dependents, beneficiaries and estate.
ETF 50.46(2)(c) (c) The election is effective upon receipt by the department.
ETF 50.46(2)(d) (d) The election must be received by the department no later than Tuesday, January 2, 1997. This deadline for making an election may be extended after consultation with the actuary by motion adopted by the group insurance board prior to that date. The group insurance board may also extend a previously adopted extension provided the extension has not yet expired.
ETF 50.46 Note Note: Form ET-5321, "LTDI Election," may be obtained at no charge by writing to: department of employee trust funds, P.O. Box 7931, Madison, Wisconsin 53707-7931, or by calling (608) 266-3285 or toll free at (877) 533-5020.
ETF 50.46 History History: Emerg. cr. eff. 10-15-92; cr. Register, May, 1993, No. 449, eff. 6-1-93.
ETF 50.48 ETF 50.48Claim for benefits.
ETF 50.48(1) (1) Claimant's application. A claimant shall establish that he or she meets all the requirements to receive benefits under this subchapter. A claimant shall apply for benefits by making an application on the form approved by the department.
ETF 50.48 Note Note: Form ET-5313, "Long-Term Disability Benefit Claim Form" may be obtained at no charge by writing to: department of employee trust funds, P.O. Box 7931, Madison, Wisconsin 53707-7931, or by calling (608) 266-3285 or toll free at (877) 533-5020..
ETF 50.48(2) (2)Medical reports. Except as the department shall otherwise direct in writing, the claimant, at his or her own cost, shall be responsible for obtaining and delivering to the department medical reports from physicians approved or appointed by the department supporting the application, as provided in s. ETF 50.50 (6).
ETF 50.48 Note Note: Form ET-5338, "LTDI Medical Report" is sent to the applicant with the LTDI claim form ET-5313. A second form is sent to the applicant by the department after the first completed form is received by the department. Form ET- 5353, "LTDI Special Disability Medical Report" will be sent with the LTDI claim form upon request of a protective occupation participant.
ETF 50.48(3) (3)Employer statement.
ETF 50.48(3)(a)(a) The department shall provide the employer with a description of the claimed disability on the department form for the employer to state the information necessary under s. ETF 50.50 (5).
ETF 50.48(3)(b) (b) Each participating employer shall provide and state the following information to the department in response to an application for LTDI benefits:
ETF 50.48(3)(b)1. 1. The employer shall state the date on which the employee last rendered services.
ETF 50.48(3)(b)2. 2. The employer shall state the employee's last day paid and provide an explanation if this date is different from the date the employee last rendered services. The employer's explanation shall expressly identify payments including accumulated sick leave, other paid leave, vacation, compensatory time or worker's compensation temporary disability benefits which caused the last day paid to follow the date the employee last rendered services.
ETF 50.48(3)(b)3. 3. The employer shall state whether the employer has paid to the employee all earnings to which the employee is entitled and provide an explanation of earnings to which the employee remains entitled.
ETF 50.48(3)(b)4. 4. The employer shall describe the employee's present employment status, expressly including, if applicable, a statement that the claimant's employment is terminated or that the claimant is on a leave of absence and is not expected to resume active service. The statement shall include the date of the termination or of commencement of leave of absence, as applicable.
ETF 50.48(3)(b)5. 5. The employer shall state in writing on the employer statement form it intends to contest the employee's application for disability benefits as provided in ch. ETF 50.
ETF 50.48(3)(b)6. 6. For a claimant who is an elected official only, the employer shall state the date of the end of the elected official's term of office.
ETF 50.48(3)(c) (c) If an employer fails to provide the required report within 90 days of the department's request for an employer statement, the department may charge the employer $20 for each calendar day following until the report is received by the department, plus interest at 0.04% per day on the unpaid balance of any charges under this paragraph as provided in s. 40.06 (3), Stats. This paragraph shall not in any way limit the employer's liability to a claimant whose application is void under sub. (5) as a result of the employer's failure to provide information required under this subsection.
ETF 50.48 Note Note: Form ET-5315, "Employer Statement (LTDI)," is sent to the employer by the department after a claim form is received.
ETF 50.48(4) (4)Department determination.
ETF 50.48(4)(a)(a) The department shall report its determination to grant or deny each application for LTDI benefits to the employer and the claimant. A claimant or employer who wishes to contest the department's findings shall make a timely appeal to the group insurance board. If no timely appeal is filed, the department's determination to grant or deny the application for LTDI benefits shall be final.
ETF 50.48(4)(b) (b) The department shall deny the application for LTDI benefits if it determines the claimant does not meet the applicable requirements or if any of the following apply:
ETF 50.48(4)(b)1. 1. The department receives a statement from the employer certifying that the employee's participating employment has not been terminated, or the employee is on a leave of absence and is expected to resume active service.
ETF 50.48(4)(b)2. 2. The department determines the claimant fails to meet the minimum service requirements under s. ETF 50.50 (2) (b) and the physicians deny that the medically determinable impairment described in the claimant's application is a result of employment as a participating employee with the employer.
ETF 50.48(4)(b)3. 3. The department receives a written statement from the employer on the employer statement form indicating they wish to contest the employee's application for disability under ch. ETF 50.
ETF 50.48(4)(c) (c) If the department's denial is based solely on par. (b) 1. or 3., or both, the claimant may appeal to the group insurance board. The group insurance board's decision shall include a finding as to whether the employer's certifying non-termination or contesting approval of the employee's disability claim was reasonable and correct. If the group insurance board determines that the employer's action was unreasonable and incorrect, the group insurance board decision shall include an order to the employer to amend the statement and an order to the department to process the LTDI application when the amended statement is received.
ETF 50.48(5) (5)Incomplete application void. Except as provided in sub. (6), if any of the evidence required by subs. (1) to (3) and s. ETF 50.50 (1) to (6) is not received within 12 months after the date the claimant's application for LTDI benefits is received by the department, the application shall be canceled and void. The claimant may reapply for LTDI benefits if otherwise still eligible.
ETF 50.48(6) (6)Death of claimant.
ETF 50.48(6)(a)(a) If a claimant dies prior to the date a decision regarding the approval or disapproval of an application for LTDI benefits becomes final under sub. (4) (a), the application is deemed to have been approved prior to the claimant's death if all of the following apply:
ETF 50.48(6)(a)1. 1. The claimant was eligible for the disability benefit.
ETF 50.48(6)(a)2. 2. Prior to the date of the claimant's death, the department received an application for LTDI benefits in the form approved by the department and at least one written qualifying medical certification under s. ETF 50.50 (6).
ETF 50.48(6)(a)3. 3. The claimant died on or after the date which would have been the effective date of the LTDI benefits.
ETF 50.48(6)(b) (b) For the purposes of this subsection, a claimant is conclusively presumed not eligible for LTDI benefits if the application is based on an alleged medically determinable impairment which was the basis for a previous application which the department denied.
ETF 50.48(6)(c) (c) This subsection shall not be construed to create any entitlement for any person to receive LTDI benefits for any period beyond the applicable termination date under s. ETF 50.56.
ETF 50.48(6)(d) (d) Payment for LTDI benefits owed to the deceased claimant under this subsection shall be made to the claimant's estate, regardless of any beneficiary under s. 40.02 (8), Stats.
ETF 50.48 History History: Emerg. cr. eff. 10-15-92; cr. Register, May, 1993, No. 449, eff. 6-1-93; cr. (4) (c), Register, December, 1998, No. 516, eff. 1-1-99; CR 02-057: am. (3) (a), (b) and (c) and (4) (b) 1. to 3. and (c), r. and recr. (3) (b) 5. and 6, r. (3) (b) 7., to 10., Register November 2002 No. 563, eff. 12-1-02.
ETF 50.50 ETF 50.50 Eligibility for LTDI benefits. Any participant in the Wisconsin retirement system is entitled to LTDI benefits if all of the following requirements are met:
ETF 50.50(1) (1)Participating employee.
ETF 50.50(1)(a)(a) The claimant is a participating employee or deemed to be a participating employee under par. (c).
ETF 50.50(1)(b) (b) A participating employee may file an application for LTDI benefits as if the last day worked were the last day paid, provided the employer certifies that the employee's date of termination of employment is being extended past the last day worked due to a payment for accumulated sick leave, vacation, compensatory time, or payment of worker's compensation temporary disability benefits.
ETF 50.50(1)(c) (c) A claimant who terminated employment with an employer prior to applying for LTDI benefits is deemed to be a participating employee for purposes of this subsection if all of the following apply:
ETF 50.50(1)(c)1. 1. The termination of active service for the participating employer was due to a medically determinable impairment.
ETF 50.50(1)(c)2. 2. The claimant is not employed by any employer. "Employer" as used in this subdivision shall have its broadest plain meaning and is not limited to the definition in s. 40.02 (28), Stats.
ETF 50.50(1)(c)3. 3. Excluding earnings from the claimant's last participating employer, the claimant has not received aggregate earnings, wages, salary and other earned income in any 12 consecutive calendar months beginning with the first of the month following the date the claimant last rendered services to the participating employer exceeding the annual dollar amount determined under s. ETF 50.32 (3) that is in effect at the end of the 12 consecutive calendar month period.
ETF 50.50(2) (2)Service qualifications.
ETF 50.50(2)(a)(a) Minimum period of employment. An employee must first qualify as a participating employee to be eligible for benefits under this subchapter. Notwithstanding s. 40.22 (6), Stats., or sub. (1), no employee who terminates employment with an employer after a period of less than 30 calendar days is eligible for benefits under this subchapter.
ETF 50.50(2)(b) (b) Minimum creditable service. Except as provided in par. (c), the claimant must have earned at least 0.33 years of creditable current service or prior service, or both, in each of at least 5 calendar years not including any calendar year preceding by more than 7 calendar years the year in which the claim for LTDI benefits is received by the department. Service credit purchased under s. 40.285 (2) (a), Stats., may be counted towards this requirement only if the service itself was rendered during the calendar year of the application or the preceding 7 calendar years. For this purpose, the service credit purchased under s. 40.285 (2) (a), Stats., shall be allocated to the specific year or years as the forfeited service was originally credited. Purchase of forfeited service may not qualify a person under this paragraph if the person would not have qualified had no service been forfeited. Creditable military service granted under s. 40.02 (15) (a), Stats., or the federal uniformed services employment and reemployment rights act is counted towards this requirement as if the employee had been employed by a participating employer during the period of service. Creditable military service granted under s. 40.02 (15) (c), Stats., does not satisfy this requirement.
ETF 50.50 Note Note: The use of purchased service credit to meet this requirement for creditable service in certain annual earnings periods is an express exception to the general rule of s. ETF 20.17 (1) (d) 4.
ETF 50.50(2)(c) (c) Creditable service; previous disability annuity. For purposes of par. (b) only, if a claimant was previously receiving a disability annuity under s. 40.63, Stats., which was terminated, or LTDI benefits which were terminated for reasons other than fraud, misrepresentation, error, mistake or failure to provide required information, the claimant is deemed to have received creditable service for any month or portion of a month for which the terminated disability annuity or LTDI benefit was paid.
ETF 50.50(2)(d) (d) Waiver for work-related disability. The minimum creditable service requirement of par. (b) is waived if the claimant meets both of the following qualifications:
ETF 50.50(2)(d)1. 1. The claimant's medically determinable impairment is a result of employment as a participating employee for an employer.
ETF 50.50(2)(d)2. 2. The claimant last rendered services as an employee to a participating employer not more than 2 years prior to the date the claim for LTDI benefits is received by the department.
ETF 50.50(3) (3)Totally and permanently disabled. The claimant is totally and permanently disabled and suffered the medically determinable impairment associated with the disability in the time period during which the claimant was a participating employee.
ETF 50.50 Note Note: For claimant who is a protective occupation participant, see alternative degree of disability in s. ETF 50.58 (1) (a).
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