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IMRF is authorized to determine continuing eligibility If you are granted IMRF disability benefits, IMRF is authorized to conduct periodic checks/investigations to determine continuing eligibility. These periodic checks/investigations may result in a determination of ineligibility. IMRF is not legally authorized to pay a benefit to an ineligible member. If IMRF finds you ineligible, your benefit will stop the month after this determination. You will have an opportunity to appeal to the IMRF Benefit Review Committee under IMRF’s disability appeal procedures. By applying for these benefits and signing the "Members Application for IMRF Disability Benefits" form, you indicate you understand your benefits may be terminated if a written report by an IMRF-appointed physician finds that you are no longer disabled, as defined by the Illinois Pension Code. |
Extent/degree of disability test
All disability claims are subject to an extent or degree of disability test. An extent or degree of disability investigation may include:
- Requesting hospital records and getting additional medical information from your attending physician(s) and
- Possibly having you examined by a physician chosen and paid for by IMRF.
If your claim appears to involve an extent or degree of disability condition, an IMRF Claims Examiner will review your claim.
If you applied for temporary disability benefits
If IMRF’s medical consultant believes that your medical condition is disabling and prevents you from performing the duties and responsibilities of any position which might reasonably be assigned by your current IMRF employer, IMRF will approve your claim and process your payment.
If IMRF’s medical consultant believes that your medical condition is not disabling and does not prevent you from performing the duties and responsibilities of any position which might reasonably be assigned by your current IMRF employer, your claim is then denied. If you decide that you wish to appeal the denial of benefits, your claim will be presented to the IMRF Board of Trustee’s Benefit Review Committee. The Benefit Review Committee:
- Reviews the file and the medical consultant’s opinion
- Makes a recommendation to approve or deny your claim.
- Presents the recommendation to the full Board for a final decision.
If your claim is being reviewed for total and permanent disability benefits
If IMRF’s medical consultant believes that your medical condition is disabling and prevents you from working in any gainful activity for any employer, IMRF will approve your claim and process your payment.
If IMRF’s medical consultant believes that your medical condition is not disabling and does not prevent you from working in any gainful activity for any employer, your file is then denied. If you decide that you wish to appeal the denial of benefits, your claim will be presented to the IMRF Board of Trustee’s Benefit Review Committee. The Benefit Review Committee
- Reviews the file and the medical consultant’s opinion
- Makes a recommendation to approve or deny your claim.
- Presents the recommendation to the full Board for a final decision.
Pre-existing condition investigation
Your disability claim will be investigated for a pre-existing condition if you have less than five years of IMRF service credit as of the date of disability.
This investigation includes the following steps:
- IMRF will request information to determine if you had the disabling condition before your earliest date of uninterrupted IMRF participation. (For example, if you began participation in 2008, but have a two-month gap in 2009, IMRF will investigate the period of time prior to that two-month gap).
- You will be required to complete:
- IMRF Form 5.40A, “Disability Claim Data Instruction Sheet.” You must provide the requested medical history and complete all the requested information on the 5.40A. Failure to provide the requested information and fully complete the 5.40A will result in your claim being closed permanently or denied.
- IMRF Form 5.46, “Authorization for Disclosure of Health Information,” which gives IMRF permission to request additional information and to write to your attending physician(s).
If your claim appears to involve a pre-existing condition
If your claim appears to involve a pre-existing condition, an IMRF Claims Examiner will review your claim. If the Claims Examiner determines that your disability is the result of a pre-existing condition, IMRF will advise you that your claim for IMRF total and permanent disability benefits is being denied.
If you disagree with that decision, you can request a hearing before the Benefit Review Committee of the IMRF Board of Trustees. Click here for more information about appeals.
In some cases, IMRF compiles a written summary of your medical history for review by IMRF’s medical consultant.
- If it is IMRF’s medical consultant’s opinion that your disability is not the result of a pre-existing condition:
Your claim will be sent to the disability claims examiner for payment processing. - If it is the opinion of the IMRF staff and the IMRF medical consultant that your disability is the result of a pre-existing condition:
- You will be advised that your claim for IMRF total and permanent disability is being denied.
- You will also be advised of your right to request a hearing before the Benefit Review Committee of the IMRF Board of Trustees if you disagree with the denial.
- The Committee’s recommendation to approve or deny your claim is then presented to the full Board for a final decision.
Pre-Existing Conditions
Pre-existing condition investigations apply only to total and permanent disability benefits. Temporary disability benefits are not subject to pre-existing condition investigations.
Your disability claim will not be investigated for a pre-existing condition if:
– You have five or more years of service credit prior to the date of disability
AND
– During that time you did not receive IMRF disability benefits.