5.40 C. Application for Disability Benefits

1. Temporary Disability Benefits

Temporary disability benefits may be claimed by submitting the following forms and records to IMRF:

1. IMRF Form entitled, ”Member's Application for Disability Benefits." The member should complete this form. Members can also apply for disability benefits via Member Access.

   If the member is unable to complete the application, a relative or other representative can complete the form. However, that individual should call IMRF and tell us that the member is unable to sign the application or other disability-related IMRF documents.

   The member can access this form by visiting the Member Access area on IMRF's website (www.imrf.org).

The member’s relative or other representative would sign the forms on the member’s behalf, e.g., Mary Smith for John Smith. If the benefit is approved, IMRF will mail the member’s relative or other representative a Representative Payee form for him or her and the member’s attending physician to complete.

If the member’s relative or other representative has ”power of attorney” for the disabled member, he or she should forward a copy of the power of attorney to IMRF for review by our Legal Counsel.

IMRF will accept agency designation under a power of attorney for property if it conforms with the requirements of the Illinois Power of Attorney Act. A copy of the entire designation must be submitted for our review. If the original designation is more than a year old, we will send the agent an affidavit that he or she must complete, sign, have notarized, and then return to our office in order for the power of attorney to be accepted.

IMRF will accept a power of attorney for property; a health care power of attorney is not acceptable. IMRF will allow a designated agent to act for the member in all aspects excluding the ability to sign a beneficiary form.

2. IMRF will preform a data collection that will collect information regarding Employer Disability Certification.
   

3. IMRF Form entitled, "Physician Statement - Temporary Disability Claim" will also be required to be submitted. A licensed and practicing physician who has examined the member and can verify the nature and extent of disability should complete this formand submit it to IMRF along with associated office visit notes/medical records.

Diagnosis, treatment dates, services rendered and dates of disability are required to process the member’s claim. The member should also ensure that the first treatment date is noted on the form. IMRF cannot accept doctor’s statements that certify a disability for a date prior to the member’s visit or for a date in the future.

4. Birth certificate or other acceptable evidence of birthdate must be submitted. The member’s Social Security Social Security coverage for IMRF members is required, except for a limited number of firefighters and police officers, by an agreement between the State of Illinois and the Commissioner of Social Security under Section 218 of the Social Security Act. IMRF members pay Social Security taxes on wages up to the wage base, and IMRF employers pay an equal amount. IMRF employers remit these taxes to the Internal Revenue Service. Applications for benefits and questions about Social Security should be directed to the local Social Security district office or representative or call 1-800-772-1213. number should be printed on the birth certificate or other evidence of birthdate.

5. IMRF may also request that the member complete IMRF Forms: ”Disability Claim Data", "Authorization for Disclosure of Health Information", "Disability Payment Agreement", "Authorization to Secure Award or Disallowance Information Authorization to Secure Social Security Retirement or Disallowance Information, Form 5.42A, Form 5.42B, Form 5.42E, or psychiatric/physical forms. (If such forms are required, IMRF will mail them directly to the member).

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