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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).
ETF 50.50(4) (4)No earnings payable. The claimant is not entitled to any earnings from any participating employer. In this subsection and sub. (5), "earnings"does not include bonus compensation to which the employee is entitled under s. 25.156 (7) (a), 1997 Stats.
ETF 50.50 Note Note: Section 25.156, Stats., was repealed by 1999 Wis. Act 9, but the compensation allowed by that section is still potentially payable.
ETF 50.50(5) (5)Employer statement.
ETF 50.50(5)(a)(a) The department receives a statement from the employer certifying the information required under s. ETF 50.48 (3) (b) and certifying that the employer has paid to the employee all earnings to which the employee is entitled, and that one of the following applies:
ETF 50.50(5)(a)1. 1. The employee is on a leave of absence and is not expected to resume active service and, as a consequence, the employee is not entitled to any further earnings from the employer.
ETF 50.50(5)(a)2. 2. The employee's participating employment has been terminated and, as a consequence, the employee is not entitled to any further earnings from the employer.
ETF 50.50(5)(b) (b) The requirement of par. (a) is not met if the employer certifies the employee was terminated or on leave of absence. The LTDI benefit will be denied if the employer contests the employee's application for disability benefits under ch. ETF 50.
ETF 50.50(6) (6)Physician certifications. Except as provided in s. ETF 50.48 (6) (a) 2., the department has received certifications in writing from at least 2 licensed and practicing physicians approved or appointed by the department that the employee is disabled as described in sub. (3) or, for a protective occupation participant who meets the requirements of s. ETF 50.58 (1) (a), disabled as described in s. ETF 50.58 (1) (a) 3.
ETF 50.50 History History: Emerg. cr. eff. 10-15-92; cr. Register, May, 1993, No. 449, eff. 6-1-93; am. (1) (c) 3., Register, September, 2000, No. 537, eff. 10-1-00; correction in (4) made under s. 13.93 (2m) (b) 7., Stats., Register November 2002 No. 563; CR 02-057: am. (5) (a) (intro.) and 2., cons. and am. (5) (b) (intro.) and 1., Register November 2002 No. 563, eff. 12-1-02; CR 07-062: am. (2) (b) Register June 2008 No. 630, eff. 7-1-08.
ETF 50.52 ETF 50.52 LTDI benefits.
ETF 50.52(1)(1)Basic benefit.
ETF 50.52(1)(a)(a) Benefit amount. The basic LTDI benefit payable to recipients shall be a monthly payment of 40% of the recipient's final average salary or 50% of FAS for a recipient not personally covered under OASDHI. The basic benefit amount, once determined, shall subsequently be adjusted at the same time and by the same percentages as applicable to post-retirement annuity adjustments under s. 40.27, Stats.
ETF 50.52(1)(b) (b) Reductions and offsets.
ETF 50.52(1)(b)1.1. The department shall reduce the amount of a recipient's monthly LTDI benefits under par. (a) by the amounts in subds. 2. and 3. The amount by which any lump sum benefit or separation benefit under subd. 2. exceeds the basic monthly LTDI benefit otherwise payable shall be carried over to reduce basic LTDI benefits payable in future months until the amount of the lump sum or separation benefit has been completely offset.
ETF 50.52(1)(b)2. 2. LTDI benefits shall be offset by an amount equal to the portion of any retirement annuity or lump sum benefit or separation benefit under s. 40.23, 40.24 or 40.25, Stats., on which the recipient is subject to federal income tax. This subdivision applies to any retirement annuity or lump sum benefit or separation benefit which is paid to the recipient as a result of the recipient's application for the annuity or benefit, excluding any benefit funded by employee additional contributions. This subdivision does not apply to an annuity or lump sum benefit for which the recipient is eligible solely as a beneficiary, alternate payee or joint survivor of another participant.
ETF 50.52(1)(b)3. 3. LTDI benefits shall be offset by the amount of any normal form retirement annuity or lump sum retirement benefit under s. 40.23 or 40.25, Stats., for which the recipient is eligible, excluding the portion of any annuity or lump sum benefit on which the recipient would not be subject to federal income tax, a separation benefit or a benefit funded by employee additional contributions. This offset shall be computed as of the recipient's normal retirement age. This subdivision applies only after a recipient's normal retirement date as defined by s. 40.02 (42), Stats. This subdivision does not apply to an annuity for which the recipient is eligible solely as a beneficiary, alternate payee or joint survivor of another participant.
ETF 50.52(1)(c) (c) Proration. Initial monthly LTDI benefits beginning on other than the first day of a month and final LTDI benefits ending on other than the last day of a month are prorated based on effective date and termination date as provided in s. ETF 50.62.
ETF 50.52(2) (2)LTDI retirement supplemental benefit.
ETF 50.52(2)(a)(a) In addition to the basic LTDI benefit payable to a recipient, the LTDI program shall pay a retirement supplemental benefit in the form of an employer additional contribution to the Wisconsin retirement system for recipients qualifying under this subsection.
ETF 50.52(2)(b) (b) The LTDI retirement supplemental benefit due shall be 7% of the recipient's FAS for each month a recipient qualifies under par. (d). Except as provided in sub. (1) (c), the LTDI retirement supplemental benefit is not prorated. If a recipient is not qualified for the LTDI supplemental benefit on any day during a month, no LTDI supplemental benefits are payable for that month. The supplemental LTDI benefit amount, once determined, shall subsequently be adjusted at the same time and by the same percentages as applicable to post-retirement annuity adjustments under s. 40.27, Stats.
ETF 50.52(2)(c) (c) As of December 31 each year, the supplemental LTDI benefit due for each of the preceding 12 months during which the recipient qualified under par. (d) to receive the retirement supplemental LTDI benefit shall be credited to the recipient's WRS employer additional contributions account.
ETF 50.52(2)(d) (d) A recipient qualifies for retirement supplemental LTDI benefits if all of the following apply:
ETF 50.52(2)(d)1. 1. LTDI benefits have not been terminated or suspended under s. ETF 50.56.
ETF 50.52(2)(d)2. 2. The recipient does not earn any creditable service.
ETF 50.52(2)(d)3. 3. Payment of the LTDI retirement supplemental benefit would not exceed any limitation on additional contributions or cause the Wisconsin retirement system to fail to meet requirements for a qualified plan under the U.S. internal revenue code, applicable regulations adopted under the U.S. internal revenue code, including proposed regulations in force pending adoption, or rules of the department.
ETF 50.52(2)(d)4. 4. The recipient has not applied for any retirement annuity or lump sum retirement or separation benefit from the Wisconsin retirement system, other than a benefit funded by employee additional contributions or from a Wisconsin retirement system account held as an alternate payee. Qualification ceases on the effective date of a retirement annuity or other benefit or the approval date of a separation benefit. This subdivision shall not apply if the application is withdrawn, void, canceled or not granted.
ETF 50.52(2)(d)5. 5. The recipient is not qualified to receive duty disability benefits under s. 40.65, Stats., regardless of the amount of duty disability benefits actually received.
ETF 50.52(2)(e) (e) Monthly LTDI retirement supplemental benefits due are prorated based on the effective beginning date and termination date as provided in s. ETF 50.62.
ETF 50.52(3) (3)Continuation of group health insurance coverage for state employees. Pursuant to s. 40.51 (3), Stats., a recipient of LTDI benefits under this subchapter who is an insured employee under any group health insurance plan for state employees insured directly by the public employee trust fund shall also be entitled to continuation of that group health insurance in the same manner and to the same extent as is a disability annuitant under s. 40.63, Stats. Effective no later than January 1, 1993, contracts between the group insurance board and other insurers of group health insurance plans covering state employees shall provide the same continuation rights for recipients insured under those plans.
ETF 50.52 History History: Emerg. cr. eff. 10-15-92; cr. Register, May, 1993, No. 449, eff. 6-1-93; CR 11-040: am. (2) (a) Register July 2012 No. 679, eff. 8-1-12.
ETF 50.54 ETF 50.54 Administration.
ETF 50.54(1)(1)Plan administrator. The department shall administer the plan established by this subchapter on behalf of the group insurance board unless otherwise expressly provided in an administrative services contract between the group insurance board and an outside administrator, in which the employee trust funds board concurs.
ETF 50.54(2) (2)Effective date of benefits. The department shall begin payment of LTDI benefits on the later of the following dates:
ETF 50.54(2)(a) (a) The first day of the first month beginning on or after 90 days preceding receipt of the application for LTDI benefits by the department.
ETF 50.54(2)(b) (b) The first day after the date of termination of employment from the last participating employer by which the recipient was employed, as reported to the department by the employer. When the claimant is on a leave of absence, the date of termination of employment for effective date purposes shall be deemed to be the recipient's last day paid.
ETF 50.54(3) (3)Periodic medical review. The department may require that any recipient shall be examined by at least one licensed and practicing physician, designated or approved by the department, during any calendar year the recipient receives benefits under this subchapter. The examining physician shall file with the department a written report of the examination which shall be in a form approved by the department and indicate whether the recipient is still totally and permanently disabled or, for a recipient qualifying under s. ETF 50.58 (1) only, whether the recipient recovered to the extent that the recipient can efficiently and safely perform the duties required by the recipient's former position as a protective occupation participant and whether the recipient recovered to the extent that the impaired condition is not likely to be permanent.
ETF 50.54 Note Note: Form ET-5909, "Recertification Medical Report," is sent to the claimant by the department as necessary.
ETF 50.54(4) (4)Requests for information. The department may request any information on earnings, salary, wages, earned income, compensation or OASDHI benefits or entitlements as it deems necessary to implement the provisions of sub. (2) and s. ETF 50.52 (1), including but not limited to copies of state and federal income tax returns.
ETF 50.54(5) (5)Application of anti-fraud statute. This subchapter is an employee benefit program created under ch. 40, Stats., through rule-making authority expressly granted in that chapter, for purposes of enforcement of the prohibitions of s. 943.395 (1) (c), Stats. Prohibited acts include presenting or causing to be presented false or fraudulent information, including a claim or benefit application, proof in support of a claim or benefit application, or information which would affect a future claim or application.
ETF 50.54(6) (6)Overpayment. Section 40.08 (4), Stats., shall apply to obtain repayment of any overpayment of LTDI benefits.
ETF 50.54 History History: Emerg. cr. eff. 10-15-92; cr. Register, May, 1993, No. 449, eff. 6-1-93.
ETF 50.56 ETF 50.56 Termination of benefits.
ETF 50.56(1) (1)Duration of benefits. Except as otherwise provided in this section:
ETF 50.56(1)(a) (a) For a recipient whose LTDI benefit effective date is prior to the date the recipient attains age 61, all LTDI benefits terminate at the end of the month in which the recipient attains age 65.
ETF 50.56(1)(b) (b) For a recipient whose LTDI benefit effective date is on or after the date the recipient attains age 61 and prior to the date the recipient attains age 63, all LTDI benefits terminate at the end of the month in which the recipient attains age 66.
ETF 50.56(1)(c) (c) For a recipient whose LTDI benefit effective date is on or after the date the recipient attains age 63 and prior to the date the recipient attains age 65, all LTDI benefits terminate at the end of the month in which the recipient attains age 67.
ETF 50.56(1)(d) (d) For a recipient whose LTDI benefit effective date is on or after the date the recipient attains age 65 and prior to the date the recipient attains age 67, all LTDI benefits terminate at the end of the month in which the recipient attains age 68.
ETF 50.56(1)(e) (e) For a recipient whose LTDI benefit effective date is on or after the date the recipient attains age 67 and prior to the date the recipient attains age 68, all LTDI benefits terminate at the end of the month in which the recipient attains age 69.
ETF 50.56(1)(f) (f) For a recipient whose LTDI benefit effective date is on or after the date the recipient attains age 68 and prior to the date the recipient attains age 69, all LTDI benefits terminate at the end of the month in which the recipient attains age 70.
ETF 50.56(1)(g) (g) For a recipient whose LTDI benefit effective date is on or after the date the recipient attains age 69, all LTDI benefits terminate 12 months after the LTDI benefit effective date.
ETF 50.56(1)(h) (h) Notwithstanding pars. (a) to (g), no LTDI benefits shall be payable for any date after the recipient's death.
ETF 50.56(1)(i) (i) The effective date used to determine the duration of LTDI benefits is the effective date of the benefits being paid, not the effective date of terminated LTDI benefits paid under a previous application.
ETF 50.56(1)(j) (j) The duration of LTDI benefits for recipients whose LTDI benefit effective date is on or after the date the recipient attains age 61 shall be periodically reviewed and may be revised based on the actuary's determinations, as approved by the employee trust funds board, so as to provide LTDI benefits meeting equal cost standards under federal age discrimination law. As part of the regular 3-year general investigation under s. 40.03 (5) (b), Stats., beginning with the investigation based on data through 1996, the actuary shall determine the appropriate duration for LTDI benefits beginning at and after age 61. The employee trust funds board shall be responsible for approving any change to the duration of LTDI benefits. If the duration of LTDI benefits is changed, the duration of LTDI benefits being paid as the result of an application received by the department prior to the effective date of the change shall not be affected. Any such revision shall be effective upon promulgation as an amendment to this rule by the group insurance board.
ETF 50.56(2) (2)Termination for fraud, misrepresentation, error or mistake.
ETF 50.56(2)(a)(a) Payment of LTDI benefits may be terminated immediately and overpayment recovered upon a department determination of either of the following:
ETF 50.56(2)(a)1. 1. LTDI benefits were granted as the result of fraud or misrepresentation in the application or in required evidence of eligibility.
ETF 50.56(2)(a)2. 2. LTDI benefits were granted due to an error or mistake by the department or due to an error or mistake in the information supplied by the employer used for determining eligibility, effective date or amount of LTDI benefits.
ETF 50.56(2)(b) (b) A department determination under par. (a) shall be treated as a department denial of the application for LTDI benefits as provided in s. ETF 50.48 (4).
ETF 50.56(2)(c) (c) The amount of monthly LTDI benefits may be altered upon a determination that the amount of LTDI benefits was computed in error.
ETF 50.56(2)(d) (d) LTDI benefits may be terminated effective upon a determination by the department that the recipient has made misrepresentations or submitted false or fraudulent information regarding continued disability, earnings, wages, salary or other earned income.
ETF 50.56(2)(e) (e) If the department alters the amount of monthly LTDI benefits under par. (c) or terminates payment of LTDI benefits under par. (d), the department shall send notice of the action to the recipient. The notice shall be in the form of a written determination stating the reasons for the termination. The recipient may file a timely appeal of the alteration or termination with the group insurance board as provided in ch. ETF 11. If no timely appeal is filed, the alteration or termination of LTDI benefits is final.
ETF 50.56(3) (3)Termination upon recovery or for failure to furnish information.
ETF 50.56(3)(a)(a) The payment of LTDI benefits shall be terminated based on a determination by the department of any of the following:
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