Why Isn’t Your Ohio State Retirement Plan Paying Your Disability Claim?

Why Isn’t Your Ohio State Retirement Plan Paying Your Disability Claim?

Eligibility for Social Security Disability Insurance or workers’ compensation payments can derail a claim for Ohio state retirement plan benefits. Another problem could involve insufficient medical evidence for a claim disability. Working with an Ohio disability attorney can help a state employee overcome these challenges.

State retirement plans in Ohio generally reject applications for disability benefits based on one of two reasons:

  • Dual eligibility, or
  • Insufficient medical evidence.

As short- and long-term disability attorneys in Cleveland, the lawyers with Agee Clymer Mitchell & Portman have encountered each circumstance. The good news is that both hurdles can be surmounted by knowing which program to apply to and carefully preparing applications and, when necessary, appeals.

Eligibility for Social Security and State Retirement Benefits

State and local government employees in Ohio do not participate in the federal Social Security program. Depending on where they work and what they do, they may be covered, instead, by a plan like the Ohio Public Employees Retirement System (OPERS), the State Teachers Retirement System of Ohio, or the School Employees Retirement System of Ohio.

Ohio Public Employees Retirement System (OPERS)

OPERS has the most participants, as it includes all non elected employees of state agencies, most police and emergency personnel, many public college and university faculty members, and many public hospital staff members. Like Social Security-eligible private sector and nonprofit workers, OPERS participants and people enrolled in similar state retirement plans make contributions from their paychecks in return for receiving benefits after they reach retirement age and, so they qualify to apply to receive payments if they become too disabled to continue working.

Many individuals work for both the State of Ohio, an Ohio city or county, and a number of private or nonprofit employers over the course of their adult lives. This creates the most common reason that OPERS or a similar state retirement plan rejects an application for disability benefits.

Social Security Disability Insurance is considered “primary” for all long-term disability claims. Similarly, workers’ compensation of a personal disability insurance plan is considered primary for short-term disability.

This means that only state employees who have no Social Security or workers’ comp eligibility should apply first to the state retirement plan in which they participated. Consulting with an Ohio disability attorney will help clarify where to direct a first-time application for benefits.

Demands for Proof of Disability

Each application for state retirement plan disability benefits must be accompanied by extensive medical evidence. Plan personnel will review that medical evidence closely, applying criteria that provide a large number of reasons to deem it untrustworthy or insufficient.

Enlisting the assistance of an Ohio disability attorney while preparing an application to OPERS or a similar plan will help a disabled state worker make sure that the physicians who make diagnoses and issue prognoses are considered qualified by the plan, that rehabilitation programs are considered adequate, and that all necessary paperwork gets submitted. Missing or incomplete forms are often deemed as damaging to a claim as lack of medical evidence.

When a disability claim is denied — as often happens — the disabled worker has the right to appeal. That would be the time to work with a lawyer who has handled state retirement plan disability cases for other clients. A SSI attorney can assist with figuring out exactly why the plan did not approve the application, with gathering and submitting additional medical evidence, and by representing the disabled worker during a benefits hearing.


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1 Comment

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