Chapter ETF 52

Chapter ETF 52

DUTY DISABILITY BENEFITS

ETF 52.01   Purpose and scope.

ETF 52.02   Definitions.

ETF 52.04   Department authority and duties.

ETF 52.06   Application for duty disability benefits.

ETF 52.07   Disability.

ETF 52.08   Qualifying date.

ETF 52.10   Effective date of duty disability benefits.

ETF 52.12   Monthly salary and subsequent adjustments.

ETF 52.14   Duty disability benefits for state employees.

ETF 52.15   Reduction of duty disability monthly salary based on years of service.

ETF 52.16   Reductions in monthly duty disability benefits.

ETF 52.18   Establishing estimated monthly reductions.

ETF 52.20   Collection of excess benefits paid in error.

ETF 52.22   Death benefits.

ETF 52.24   Required reporting by duty disability recipients; failure to submit.

ETF 52.26   Termination of duty disability benefits.

ETF 52.28   Appeals.

Ch. ETF 52 Note Note: Corrections made under s. 13.93 (2m) (b) 6., Stats., Register, January 2004 No. 577.

ETF 52.01 ETF 52.01 Purpose and scope.

ETF 52.01(1) (1) Scope. This chapter applies to the administration of the duty disability program under s. 40.65, Stats.

ETF 52.01(2) (2) Purpose. The purpose of this chapter is to codify the interpretations of s. 40.65, Stats., and general policies adopted by the department with respect to its administration of the duty disability benefit program under s. 40.65 (2) (a) and (b), Stats.

ETF 52.01 History History: Cr. Register, September, 1998, No. 513, eff. 10-1-98.

ETF 52.02 ETF 52.02 Definitions. Unless the context clearly requires otherwise, words, phrases and terms shall have the meanings set forth in s. 40.02, Stats., and s. ETF 10.01. In this chapter:

ETF 52.02(1) (1) “Effective date” means the date determined under s. ETF 52.10.

ETF 52.02(1m) (1m) “Fire fighter” means an employee of the fire department of a participating employer who was classified for that employment as a protective occupation participant as defined in s. 40.02 (48) (b) (2), Stats.

ETF 52.02(2) (2) “Light duty” means the limiting of the participant’s job duties as determined by the employer or the participant’s physician because of medically imposed restrictions associated with an apparent disability, or the employer’s assignment of the participant to another position, the duties of which the participant is capable of performing notwithstanding the apparent disability, and which does not cause the participant to be reclassified to a category other than protective occupation participant.

ETF 52.02(3) (3) “Lump sum payment” means a payment, or that portion of a payment, which covers a period other than the current benefit payment period established for those benefits.

Example: Worker’s compensation benefits are payable in weekly payments. If a worker’s compensation payment covered this week and the previous 2 weeks, the portion covering the previous 2 weeks would be a lump sum payment. Wisconsin retirement system annuities are payable monthly. A payment covering the previous 12 months, but not the current month, would be a lump sum payment.

ETF 52.02(4) (4) “Medical report” means a written certification on the form prescribed by the department by a physician, as defined in s. 448.01 (5), Stats., who practices in this state, concerning the medical evaluation, diagnosis, prognosis and causal factors of the condition of an applicant for duty disability benefits.

ETF 52.02 Note Note: “Duty Disability Medical Report,” form ET-5312.

ETF 52.02(5) (5) “Protective occupation participant” as used in s. 40.65 (4) (intro.), Stats., means a person who was a protective occupation participant within the meaning of s. 40.02 (48), Stats., on the date the injury occurs, or the disease is contracted, which leads to the disability under s. 40.65 (4), Stats.

ETF 52.02(6) (6) “Qualifying date” means the date on which a participant became disabled under s. 40.65 (4), Stats., as determined under s. ETF 52.08.

ETF 52.02(7) (7) “Qualifying medical report” means a medical report, consistent with attached medical records, which certifies that an applicant for duty disability benefits is disabled as described by s. 40.65 (4), Stats.

ETF 52.02(8) (8) “Receiving duty disability benefits” as used in this chapter, or “receiving a benefit under this section” as used in s. 40.65 (6), Stats., refers to a person who has applied for and been found eligible to receive duty disability benefits under s. 40.65, Stats., regardless of the effect of any monthly reductions on the net duty disability benefit payable.

ETF 52.02 History History: Cr. Register, September, 1998, No. 513, eff. 10-1-98; CR 13-029: renum. (4m) to (1m) and am., am. (2) Register November 2013 No. 695, eff. 12-1-13.

ETF 52.04 ETF 52.04 Department authority and duties.

ETF 52.04(1) (1) Administer. The department shall administer the duty disability benefit program on behalf of the Wisconsin retirement board under s. 40.65, Stats., and this chapter.

ETF 52.04(2) (2) Request information. The department may request any income or benefit information, or any information concerning a person’s marital status, which it considers to be necessary to determine the amount of each monthly benefit payable under s. 40.65, Stats., and its effective date. The department may require a participant receiving duty disability benefits to submit a copy of his or her state or federal income tax return.

ETF 52.04 Note Note: This rule (CR 09-057) amends s. ETF 52.04 (2) to conform to the treatment of s. 40.65 (3) by 2007 Wis. Act 131 by removing the mandate for the department to obtain a certified copy of each duty disability recipient’s tax return each year and treating a failure to provide a tax return, if requested, in the same manner as other refusals to provide requested information.

ETF 52.04(3) (3) Determine benefits. The department shall determine the amount of each monthly benefit payable under this chapter and its effective date. The department shall periodically review the dollar amount of each monthly benefit and adjust it to conform with the provisions of this chapter. The department shall notify the participant of a determination under this subsection.

ETF 52.04(4) (4) Pay benefits. The department shall pay the net duty disability benefits payable to a participant, spouse or domestic partner, or to an adjudicated guardian, as applicable. Payment shall be made on the first day of each month for the previous month.

ETF 52.04 History History: Cr. Register, September, 1998, No. 513, eff. 10-1-98; CR 09-057: am. (2) Register May 2010 No. 653, eff. 6-1-10; CR 13-029: am. (4) Register November 2013 No. 695, eff. 12-1-13.

ETF 52.06 ETF 52.06 Application for duty disability benefits.

ETF 52.06(2) (2) Receipt date. An application for duty disability benefits is initiated on the date the completed form, currently prescribed by the department for that purpose, is received by the department in accord with s. ETF 10.82.

ETF 52.06(3) (3) Criteria to be specified. An applicant shall specify which of the following eligibility criteria under s. 40.65 (4) (c), Stats., are satisfied:

ETF 52.06(3)(a) (a) Terminated employment due to disability.

ETF 52.06(3)(b) (b) Assigned to light duty by employer or physician due to disability, on other than a temporary basis regardless of whether a light duty position is available.

ETF 52.06(3)(c) (c) Pay reduced due to disability, on other than a temporary basis.

ETF 52.06(3)(d) (d) Position reduced due to disability, on other than a temporary basis.

ETF 52.06(3)(e) (e) Promotion specifically prohibited due to disability by employer rules, ordinances, policies or written agreements, on other than a temporary basis. The rule, ordinance, policy, or agreement shall be written and expressly identified or a copy attached to the application.

ETF 52.06(4) (4) Employment status. A person who was not both a participating employee and a protective occupation participant both at the time he or she became injured or contracted an occupational disease and when he or she became disabled as described by s. 40.65 (4), Stats., is not eligible for duty disability benefits. For purposes of this subsection only, aggravation of an existing injury or disease is deemed the same as being injured or contracting a disease.

ETF 52.06(5) (5) Application materials; medical reports.

ETF 52.06(5)(a) (a) Upon request, the department shall provide a blank copy of the currently approved application form and a blank copy of the currently approved medical report form to a participant. The applicant shall provide 2 medical reports at the applicant’s expense. One report must be from a physician who specializes in the area of disability. If the first medical report received by the department is not a qualifying medical report, the department shall advise the applicant that the department will deny the application but that the applicant may nevertheless wish to obtain the second medical report from another physician to include in the applicant’s file as supporting evidence if the applicant chooses to file an appeal under s. ETF 52.28. The department may, by written notice to the applicant, establish a time limit of at least 60 days for submission of the second report.

ETF 52.06(5)(b) (b) The department may request and consider any information from the physician who completed a medical report which the department deems necessary to supplement or clarify the physician’s opinion, evaluation, diagnosis and prognosis concerning the participant’s condition and qualification for duty disability benefits.

ETF 52.06 Note Note: The “Duty Disability Application,” form ET-5311, and “Duty Disability Medical Report,” form ET-5312, are available free upon request from the Department of Employee Trust Funds, P.O. Box 7931, Madison WI 53707. Outdated versions should not be used and may be rejected.