§ 49-21-401 — Disability benefits -- Application -- Eligibility.

Utah § 49-21-401

• Jurisdiction: Utah
• Title 49: Utah State Retirement and Insurance Benefit Act
• Ch. 49-21: Public Employees' Long-Term Disability Act
• Part 49-21-4: Disability Benefits

Text

(1) An eligible employee shall apply for long-term disability benefits under this chapter by:
(1)(a) completing an application form prepared by the office;
(1)(b) signing a consent form allowing the office access to the eligible employee's medical records; and
(1)(c) providing any documentation or information reasonably requested by the office.
(2) (2)(a) If an eligible employee is unable to apply on the employee's own behalf, the application may be made by a person who is:
(2)(a)(i) the attorney for an eligible employee; or
(2)(a)(ii) appointed as a conservator or guardian of the eligible employee.
(2)(b) A person described in Subsection (2)(a), may not make an application for a deceased employee.
(3) Upon request by the office, the participating employer of the eligible employee shall provide to the office documentation and information concerning the eligible employee.
(4) (4)(a) Upon receipt of the items described in Subsection (1) and any documentation or information the office requests under Subsection (3), the office:
(4)(a)(i) shall review all relevant information;
(4)(a)(ii) may request additional information; and
(4)(a)(iii) shall determine whether the eligible employee has a total disability.
(4)(b) In evaluating any claim for disability benefits, the office shall:
(4)(b)(i) determine whether the eligible employee has a total disability as of the date the office makes the determination; and
(4)(b)(ii) consider only objective medical impairment that the office determines as a disabling condition on the date of disability.
(5) (5)(a) If the office determines that the eligible employee has a total disability due to accidental bodily injury or illness that is not the result of the performance of an employment duty, the eligible employee shall receive a monthly disability benefit equal to:
(5)(a)(i) two-thirds of the eligible employee's regular monthly salary, for each month the total disability continues beyond the elimination period, not to exceed the maximum benefit period; minus
(5)(a)(ii) any required reductions or reimbursements under Section 49-21-402.
(5)(b) For an eligible employee receiving own occupation disability benefits, if the office reviews the eligible employee's claim for own occupation disability benefits, the office may not consider any condition unrelated to the condition the office relied upon in awarding the own occupation disability benefits, including any new intervening cause or new diagnosis during the own occupation disability period.
(6) (6)(a) At the end of the 24-month own occupation disability period or when the eligible employee makes a claim for ongoing disability, the office shall evaluate the eligible employee's eligibility for ongoing disability benefits.
(6)(b) An eligible employee shall receive a monthly disability benefit equal to 100% of the eligible employee's regular monthly salary for each month the total disability continues beyond the elimination period, not to exceed the maximum benefit period, but reduced by any required reductions and reimbursements under Section 49-21-402, if the office determines that the employee meets all of the following:
(6)(b)(i) the eligible employee has a total disability:
(6)(b)(i)(A) during the pilot period, due to a physical objective medical impairment or a mental objective medical impairment; or
(6)(b)(i)(B) except as provided in Subsection (6)(c), after the pilot period, due to a physical objective medical impairment;
(6)(b)(ii) the objective medical impairment described in Subsection (6)(b)(i) resulted from physical, external force or violence to the body of the eligible employee in the performance of an employment duty; and
(6)(b)(iii) the eligible employee received workers' compensation indemnity benefits for the objective medical impairment described in Subsection (6)(b)(i).
(6)(c) If an eligible employee qualifies for a total disability during the pilot period, the office shall determine whether the employee has a total disability after the pilot period due to a physical objective medical impairment or a mental objective medical impairment.
(6)(d) An eligible employee who receives workers' compensation indemnity benefits for an objective medical impairment is not guaranteed to receive the 100% monthly disability benefit described in Subsection (6)(b).
(6)(e) An eligible employee may receive a disability benefit for a total disability due to a mental objective medical impairment in accordance with this subsection only if the eligible employee is a state employee or an employee of a participating employer who has not opted out of providing a disability benefit for a total disability due to a mental objective medical impairment.
(7) (7)(a) Successive periods of disability are considered as a continuous period of disability if the period of disability:
(7)(a)(i) results from the same or related causes;
(7)(a)(ii) is separated by less than six months of continuous full-time work at the individual's usual place of employment; and
(7)(a)(iii) commences while the individual is an eligible employee covered by this chapter.
(7)(b) The inability to work for a period of less than 15 consecutive calendar days is not considered as a period of disability.
(7)(c) If Subsection (7)(a) or (b) does not apply, successive periods of disability are considered as separate periods of disability.
(8) The office may, at any time, have any eligible employee claiming to have a disability examined by a physician chosen by the office for purposes of the office's review and determination of whether the eligible employee has, or continues to have, a total disability.
(9) (9)(a) For purposes of determining whether an eligible employee has an ongoing disability, inability is determined:
(9)(a)(i) during the pilot period, due to physical objective medical impairment or mental objective medical impairment; or
(9)(a)(ii) except as provided in Subsection (9)(b), after the pilot period, due to a physical objective medical impairment.
(9)(b) If an eligible employee has a total disability during the pilot period, the office shall determine whether the employee has an ongoing disability after the pilot period due to a physical objective medical impairment or a mental objective medical impairment.
(10) A claim brought by an eligible employee for long-term disability benefits under the Public Employee's Long-Term Disability Program is barred if it is not commenced within six months from the eligible employee's date of disability, unless the office determines that under the surrounding facts and circumstances, the eligible employee's failure to comply with the time limitations was reasonable.
(11) (11)(a) If the office denies or terminates a claim for long-term disability benefits, the eligible employee shall have the right to appeal the denial or termination:
(11)(a)(i) to the executive director of the office within 60 days after the day of the denial or termination of long-term disability benefits; and
(11)(a)(ii) in accordance with Section 49-11-613.
(11)(b) An appeal of a denial or termination of long-term disability benefits described in Subsection (11)(a) is barred if it is not commenced within the time limit described in Subsection (11)(a).
(12) Medical or psychiatric conditions that existed before eligibility may not be a basis for disability benefits until the eligible employee has had one year of continuous eligibility in the Public Employees Long-Term Disability Program.
(13) If there is a valid benefit protection contract, service credit shall accrue during the period of total disability, unless the disabled eligible employee is:
(13)(a) exempted from a system;
(13)(b) eligible to retire with an unreduced retirement allowance; or
(13)(c) otherwise ineligible for service credit.
(14) Regardless of any medical evidence provided by the employee to support the application for disability, an employee is not eligible for long-term disability benefits during any period in which the employee:
(14)(a) makes a claim that the employee is able to work; or
(14)(b) has a pending action in a court or before any federal, state, or local administrative body in which the employee has made a claim that the employee is able to work.
(15) Notwithstanding the provisions of Section 49-11-618, upon written request by an employer, information obtained under this part may, upon an order of a court or an administrative law judge, be released to an employer who is a party in an action under Subsection (14).
(16) (16)(a) Subject to Subsection (16)(b), if an eligible employee is receiving long-term disability benefits on the date of the eligible employee's death, the program shall pay the eligible employee's beneficiary, as defined in Section 49-11-102, a lump sum payment equal to three months of the eligible employee's monthly disability benefit.
(16)(b) Section 49-21-402 does not apply to a lump sum payment described in Subsection (16)(a).
(17) An eligible employee receiving long-term disability benefits is eligible for any life assistance counseling that the program offers.
(18) On or after May 1, 2025, but on or before November 1, 2025, the office shall provide a written electronic report to the Retirement and Independent Entities Committee regarding the costs and benefits of the changes to the disability benefits during the pilot period.

Legislative History

Amended by Chapter 65, 2025 General Session