HomeMy WebLinkAbout2004-2005 Policies
CITY OF A N
LA~Y ENFORCEMENT
OFFICERS'
FIRE
FIGrZ-ITERs'~LEOFF~
DIS ILI7rY BO D
POLICY
PROCED E
AL
JIM KELLY, POLICE REPRESENTATIVE AND CHAIRPERSON
_ BUD LARSON, MEMBER-AT-LARGE AND CHAIRPERSON PRO
TEMPORE
RU55 VANDVER, FIRE REPRESENTATIVE
BILL PELOZA, COUNCILMEMBER
ROGER THORDARSON, COUNCILMEMBER
2004 - 200v
Pneamble
The purpose of these policies and procedures is to establish the general operating
procedures and to reduce to writing the administrative policies of the Disability Board.
The Board recognizes that conditions may exist or come into existence which are not
properly encompassed by these policies and procedures. In such cases, the Board
reserves the right to take whatever action is necessary to properly deal with the
situation, such actions to be consistent with applicable statutes, insofar as found by the
Board to be applicable. jSee appendix for related State Code .
pose
These policies and procedures are adopted pursuant to Section 1, Chapter 294, Laws
of 1981 to implement Chapter 41.26 RCW and to provide a basis for uniform
administration of disability retirement matters. They shall be followed by each disability
board member. (As provided in WAC 415-105-020).
Effect of policieS and
JFProcedszres
All uniformed personnel and retired members covered by the aforementioned chapters
shall be subject to the policies and procedures contained herein, to the extent
consistent with applicable state statutory provisions, and shall at all times follow the
procedures contained herein. In the event any policy or procedure as prescribed to a
particular member, shall be held to be contrary to state law, such member shall not be
relieved of any other requirement contained herein, and any such findings, shall not
relieve the member from the responsibility to comply with all other policies and
procedures contained herein. A member's failure to follow these procedures may
subject such member to the loss of benefits otherwise due under the acts.
LEOFF Board Policies and Procedures
SECTION I - THE BOARD ........................................................................................................................................1
1.01 MEMBERSHrn ...................................................................................................................................................1
1.02 TEx1v1S ..............................................................................................................................................................1
1.03 VACANCY .........................................................................................................................................................1
1.04 MEETItvG ..........................................................................................................................................................1
1.05 ELECTIONS .......................................................................................................................................................2
1.06 ABSENCE OF MEMBERS ....................................................................................................................................3
1.07 VoTIrrc ............................................................................................................................................................4
1.08 BoARn PowERS ...............................................................................................................................................4
1.09 JURISDICTION OF MEMBERS .............................................................................................................................4
1.10 QUORUM ..........................................................................................................................................................4
1.11 DISABII.,ITY BOARD OFFICERS ..........................................................................................................................4
1.12 AGENDA AND ORDER OF BUSINESS ..................................................................................................................6
1.13 MItvu'['ES .................................................................................................................:........................................6
1.14 DELEGATION OF AUTHORTTY TO SECRETARY ...................................................................................................6
SECTION II DEFINITIONS .....................................................................................................................................8
I 2.01 IN LINE OF DUTY H
2.02 DISABLED OR DISABILITY .................................................................................................................................8
2.03 DISABILITy LEAVE PEIUOD ...............................................................................................................................8
2.04 BOARD DOCTOR ...............................................................................................................................................8
2.05 LEGAL COLJNSEL ..............................................................................................................................................9
2.06 MINIMUM MEDICAL AND HEALTH STANDARDS ................................................................................................9
2.07 CONDITIONAL RETURN .....................................................................................................................................9
SECTION III - DISABII,ITY LEAVE ....................................................................................................................10
3.01 APPLICATION ..................................................................................................................................................10
3.02 BURnEN OF PROOF lO
3.03 DUTY RELATED LEAVE ..................................................................................................................................10
3.04 DISABILITY LEAVE ALLOWANCE ....................................................................................................................11
3.05 PLACEMENT ON DISABILITY LEAVE ................................................................................................................11
3.06 RECUPERATION AND PLACE OF RECUPERATION .............................................................................................11
3.07 TREATMENTS .................................................................................................................................................11
3.08 MEMBER TO SEEK AUTHORIZATION TO RETURN TO DUTY .............................................................................12
3.09 PHYSICIAN'S REPORT .....................................................................................................................................12
3.10 PHYSICIAN'S LIST ...........................................................................................................................................12
3.11 APPEARANCE OF MEMBER .............................................................................................................................12
3.12 MEDICAL REPORTS .........................................................................................................................................12
3.13 EXAMINATION BY THE BOARD PHYSICIAN ......................................................................................................13
3.14 RETUxN 'ro DuTy ..........................................................................................................................................13
3.15 CONDITIONAL RETURN TO DUTY ....................................................................................................................13
SECTION IV DISABILITY RETIREMENT ..........................................................................................................14
4.01 EXAMINATION FOR DISABILITY RETIREMENT .................................................................................................14
4.02 GRANTING DISABILTI'Y RETIREMENT ..............................................................................................................14
4.03 EXECUTION ....................................................................................................................................................15
4.04 RE-EXAMINATION AND RETURN TO DUTY ......................................................................................................1$
4.05 DISCONTINUATION OF A RET[REMENT ALLOWANCE, No'ricE oF ....................................................................16
SECTION V HEARING PROCEDURES ..............................................................................................................18
5.01 PROCEDU1tES .................................................................................................................................................:18
LEOFF Board Policies and Procedures
5.02 SUBPOENAS ....................................................................................................................................................18
5.03 GENERAL PROCEDURE FOR CONDUCT OF HEARINGS ......................................................................................19
SECTION VI APPEAL ............................................................................................................................................22
6.01 DENIAL OR CANCELLATION ............................................................................................................................22
6.02 PROCEDURE FOR RECONSIDERATION OF BOARD DECISION ................................................................22
SECTION VII FALSIFICATION ...........................................................................................................................23
7.01 RECORD OR STATEMENT FALSIFICATION ........................................................................................................23
SECTION VIII MEDICAL SERVICES .................................................................................................................24
8.01 MEDICAL SERVICES PROVIDED ......................................................................................................................24
8.02 MEDICAL SERVICES - GENERAL GUIDELINES .................................................................................................24
8.03 MEDICAL SERVICES - DEFINED .......................................................................................................................26
SECTION IX LEOFF BOARD CLAIM PROCEDURE .......................................................................................28
9.01 MEDICAL CLAIM PROCEDURE ........................................................................................................................28
9.02 MEDICAL CLAIMS FOR CORRECTNE LENSES AND FRAMES ............................................................................30
9.03 MEDICAL CLAIMS FOR HEARING AIDS ............................................................................................................32
9.04 SKILLED NURSING FACILTTY CARE REIMBURSEMENT .....................................................................................32
9.05 HOME HEALTH CARE REIMBURSEMENT .........................................................................................................33
9.06 RE.IECTED CLAIMS ..........................................................................................................................................34
9.07 FILING APPEAL IN CASES INVOLVING CLAIMS FOR MEDICAL SERVICES .........................................................35
9.08 MEDICAL CLAIMS FOR SERVICES WHERE INSURANCE BENEFITS HAVE BEEN EXPENDED .............................35
9.09 MEDICAL CLAIMS FOR SERVICES WHERE TREATMENT IS NOT COVERED BY INSURANCE ..............................35
9.10 MEDICAL CLAIMS FOR BOARD REQUIRED RE-EXAMINATIONS (WAC 41 S-1 OS-09O1 ) ...................................35
SECTION X ADOPTION AND REVIEW .............................................................................................................36
10.01 BIEtvtvIA[. REViEw ..........................................................................................................................................36
10.02 FoRtvtALADOP'rIotv ........................................................................................................................................36
10.03 SEVEtzaBn,rrY CLAUSE ..................................................................................................................................36
SECTION XI ADDENDUM ....................................................................................................................................37
REvISED 6-10-83 ...........................:..............................................................................................................................37
REVisEn 6-28-84 ..........................................................................................................................................................37
REViSED 1-7-85 ............................................................................................................................................................38
REVISED 1-7-86 ............................................................................................................................................................38
REV[sED 11-15-88 ........................................................................................................................................................38
REvISED 5-1-90 ............................................................................................................................................................39
REvISED 9/3/91 ............................................................................................................................................................39
REVisEn 1-1-92 ............................................................................................................................................................39
REVisEn 12/7/92 : .........................................................................................................................................................40
REV1sED 10/4/93 ..........................................................................................................................................................40
REvISED JuLY 1995 :.....................................................................................................................................................40
REVISED 2/5/96 - EFFECTivE irr 30-DaYS ..................................................................................................................44
9.02 MEDICAL CLAIMS FOR CORRECTNE LENSES ..................................................................................................44
REVISED JuLY 22, 1996 .............................................................................................................................................44
REVISED AT THE SEPTEMBER 3, 1996 & DESIGNATED PRICE/COSTCO AS HEARING AID PROVIDER ............................44
REVISED AT THE DECEMBER 2, 1996 LEOFF BOAttD MEE'ritvG ...............................................................................44
9.01(A)(1) ....................................................................................................................................................................44
9.03 MEDICAL CLAIMS FOR HEARING AIDS ............................................................................................................44
9.04 REJECTED CLAIMS (RENUMBERED) ................................................................................................................45 ,
9.05 FILING APPEAL IN CASES INVOLVING CLAIMS FOR MEDICAL SERVICES (RENUMBERED) ................................45
LEOFF Board Policies and Procedures
9.06 MEDICAL CLAIMS FOR SERVICES WHERE INSURANCE BENEFTI'S HAVE BEEN EXPENDED .............................45
9.07 MEDICAL CLAIMS FOR SERVICES WHERE TREATMENT IS NOT COVERED BY INSURANCE (RENUMBERED)..... 45
9.08 MEDICAL CLAIMS FOR BOARD REQUIRED RE-EXAMINATIONS (WAC 415-1 OS-0901) (RENUMBERED).......... 45
REVISED JANUARY 3, 2000 ..............................................................................:............................................................45
9.04 SKILLED NURSING FACILTI'1' CARE REIMBURSEMENT .....................................................................................45
9.05 HOME HEALTH CARE REIMBURSEMENT .........................................................................................................46
9.06 RE.iECTED CLAIMS (RENUMBERED) ................................................................................................................47
9.07 FILING APPEAL IN CASES INVOLVING CLAIMS FOR MEDICAL SERVICES (RENLTMBERED) ................................47
9.08 MEDICAL CLAIMS FOR SERVICES WHERE INSURANCE BENEFTI'S HAVE BEEN EXPENDED (RENUMBERED) ....47
9.09 MEDICAL CLAIMS FOR SERVICES WHERE TREATMENT IS NOT COVERED BY INSURANCE (RENUMBERED) .....47
9.10 MEDICAL CLAIMS FOR BOARD REQUIRED RE-EXAMINATIONS (WAC 415-1 OS-0901) (RENUMBERED).......... 47
REVISED JANu.a.RY 7, 2002 ........................................................................................................................................47
1.11(E)(1) DISABII.TTl' BOARD OFFICERS ...............................................................................................................47
2.04 AND 3.12 BOARD DOCTOR AND MEDICAL REPORTS ........................................................................................47
3.13 EXAMINATION BY THE BOARD PHYSICIAN ......................................................................................................47
3.14 RE'ruxN 'ro DuTy ..........................................................................................................................................47
8.02(E) MEDICAL SERVICES - GENERAL GUIDELINES ............................................................................................47
8.03(B) MEDICAL SERVICES - DEFINED ..................................................................................................................47
9.01 MEDICAL Ci,nIM PROCEDURE ........................................................................................................................48
I 9.02 MEDICAL CLAIMS FOR CORRECTIVE LENSES AND FRAMES ............................................................................48
9.05(A)(6) HOME HEALTH CARE REIMBURSEMENT ...............................................................................................49
10.02 FORMALADOPTION ........................................................................................................................................49
REVISED Oc'roBER 6, 2003 .......................................................................................................................................49
1.01 MEMBERSHIP SUBSECTIONS CHANGED AS FOLLOWS DUE TO STATE LAW, SB5090 : ........................................49
1.05 ELECTIONS SUBSECTIONS (A) AND (13)(2) CHANGED TO READ AS FOLIAWS DUE TO STATE LAW, SB 5090: ...50
REVISED JANUARY 5, 2004 ........................................................................................................................................50
1.04 MEETING (MEETING DATE CHANGED FROM FIRST MONDAY TO FIRST TUESDAY OF THE MONTH .....................50
REVISED FEBRUAtY 3, 2004 .....................................................................................................................................50
9.02 MEDICAL CLAIMS FOR CORRECTNE LENSES AND FRAMES MODIFIED TO REFLECT FLAT RATE FOR
REIMBURSEMENT 50
SECTION XII APPENDICES INDEX ...................................................................................................................53
APPENDIX «A» BOARD MEMBERSHIP ..........................................................................................................................54
APPENDIX «B„ FORMS SAMPLES ........................................................................................................................55
City of Auburn
LEOFF Board Policies and Procedures
Section I - The Board
1.01 Membership
The Board shall consist of five (5) merrjbers, as follows
A. Two (2) members of the City legislative body to be appointed by the
Mayor.
B. One (1) LEOFF 1 or LEOFF 2 firefighter elected by those members
subject to the jurisdiction of the Board, LEOFF 1, active or retired.
Elections for firefighter representative shall be in even numbered
years.
C. One (1) LEOFF 1 or LEOFF 2 police officer to be elected by those
members subject to the jurisdiction of the Board, LEOFF 1, active or
retired. Elections for police officer representative will be in odd
numbered years.
D. One (1) member from the public at large who resides within the City
to be appointed by the other four (4) appointed members.
1.02 Terms
Each member shall serve a two (2) Year term. The CitY le9islative
members shall serve alternating terms as well as the police and fire
representatives. (See Appendix "A" for current terms).
1.03 Vacancy
In the event a vacancy occurs in the membership, a successor will be
elected or appointed in the same manner as the original election or
appointment and shall serve the remaining unexpired term.
1.04 Meeting
The Board shall meet regularly on the first i1St) Tuesday of each month at
10:00 a.m.; provided that when the first (1S ) Tuesday falls on a municipal
holiday, the Board shall hold its meeting on the next working day at the
regular time. If necessary, special meetings may be called by the
Chairperson or a majority vote of the Board. Copies of material relevant
to the agenda items shall be prepared and distributed prior to each
meeting. Notice of ineetings shall be given to the press pursuant to RCW
42.30.060; provided, hearings and decisions on quasi-judicial matter,
including consideration of applications for disability retirements, shall be at
closed meetings unless the applicant requests an open hearing in writing.
City of Auburn
LEOFF Board Policies and Procedures
1.05 Elections
At the first (1St) meeting of each year, the members shall elect from
among the members, a member to serve as Chairperson and a member
to serve as Chairperson pro tempore.
A. The election of a LEOFF firefighter representative shall be by secret
ballot of all active and retired LEOFF 1 firefighter personnel and
shall be held during the month of December of every even
numbered year. The election of the LEOFF law enforcement officer
representative shall be by secret ballot of all active and retired
LEOFF 1 law enforcement personnel and shall be held in December
of every odd numbered year. The name of the elected LEOFF law
enforcement officer and firefighter member shall be noted in the
minutes of the next regular meeting of the Board subsequent to the
election, along with the term for which elected. Each member will
hold office for a period of two (2) years, or as soon thereafter as the
successor is elected.
B. Election procedure for election by secret ballot shall be as follows:
1. In October of each year, the Secretary to the LEOFF Board
shall prepare and mail forms for nomination of law enforcement
or firefighter representative to each active and retired law
enforcement or firefighter personnel at their last address of
record. Any active or retired member, either LEOFF I or LEOFF
II, wishing to run for representative must nominate themselves
on the form provided by the Secretary. Only those nominating
themselves will be placed on the election ballot.
2. After the November meeting and upon receipt of nominations,
the Secretary shall prepare ballot packages which shall contain:
a) ballot, b) self-addressed pre-stamped envelope for returning
the ballot, c) a letter sized envelope with no markings on it in
which the marked ballot is to be enclosed, and d) an information
sheet explaining who is running for the position and the
deadline date by which the Secretary shall have to receive all
ballots. Ballots will be mailed those LEOFF members subject to
the jurisdiction of the Board, LEOFF 1, active or retired.
3. The time between the mailing out of the ballot packets until the
deadline for receipt by the Secretary will in no case be less than
seven (7) but no more than ten (10) business days as
determined by the Chairperson.
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LEOFF Board Policies and Procedures
4. All returned ballots must be received by the Secretary through
the U.S. mail and must be postmarked by midnight of the
deadline date and mailed to the Secretary.
5. The Secretary shall be custodian of all returned ballots and
shall keep them in a safe place and assure that they remain
unopened until authorized, in a locked box.
6. The ballots shall be opened by the Secretary and assistant
Secretary and the results will then be announced after the 3-day
protest period by the Chairperson and a certification of election
results will be sent to the respective department for posting.
(Rev 5/94)
7. In the event that there are three (3) or more individuals running
for representative and one of the individuals does not receive a
simple majority of those voting, a run-off election shall be
scheduled between the two individuals receiving the highest
vote totals utilizing the same process per this section.
8. All ballots shall be retained by the Secretary for one (1) year.
After the one-year period, the Secretary shall prepare the
ballots for destruction as authorized by the State of Washington
General Records Retention Schedule & Destruction
Authorization. (Rev 5/94)
9. Any discrepancies regarding the election process shall be
submitted in writing to the Secretary of the LEOFF Board within
three (3) calendar days following the deadline date.
10. Candidates-elect shall take office at the regularly scheduled
meeting in January.
11. In the event that there is only one person nominated for police
or fire representative, balloting will not be required and the
. individual will be considered be elected. (Rev 12/7/92)
1.06 Absence of Members
In the case of absence or inability of the Chairperson to act, the
Chairperson Pro Tempore shall perform the duties and exercise the
powers of the Chairperson. Each Board member is expected to notify the
Chairperson or the Secretary prior to a scheduled meeting if that member
will not be able to attend that meeting. Such notice will serve to establish
such absence as excused. All attendance at meetings shall be recorded
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LEOFF Board Policies and Procedures
in the minutes of the meeting. An excused absence shall be construed as
either illness, work or vacation. Three (3) unexcused absences in a
period of one (1) year shall be cause for review and possible removal from
the Board by a majority vote of the Board.
1.07 Voting
Each member shall have one (1) vote which must be cast by that member
in person.
If any person(s) on the Board concludes that he/she has a conflict of
interest or an appearance of fairness problem with respect to a matter
pending before the Board so that he/she cannot discharge his/her duties,
he/she shall disqualify themselves from participating in the deliberations
and the decision-making process with respect to the matter.
1.08 Board Powers
The Board shall have the powers granted by the state legislature or
necessarily implied from such grant of powers in Chapters 41.16, 41.18,
41.20, and 41.26, Revised Code of Washington, as those chapters now
exist or may hereafter be amended and per Washington Administrative
Code 415-105.
1.09 Jurisdiction of Members
Any member who is on disabili#y leave is under the jurisdiction of the
Disability Board for all matters pertaining to his/her disability and shall not
engage in any activity which is contrary to the directives for the member's
or the Disability Board's physician or which might be detrimental to his/her
return to active service, The Board has the authority (and it may be at any
time in any case) cause an investigation to be made of the activities of
any active member or any member retired for disability to determine
whether his/her disability continues to exist, and may request the Auburn
Police Department or any other agency to make such investigation,
subject to any special instructions or conditions related to the member and
his/her condition and/or activities.
1.10 Quorum
A quorum is a simple majority and shall have the authority to conduct all
business of the Board.
1.11 Disability Board Officers
A. The elective officers of the board shall consist of a Chairperson, and a
Chairperson Pro Tempore. The City Clerk shall act as the Secretary to
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LEOFF Board Policies and Procedures
the Board. An Assistant Secretary may be selected by the Secretary with
the approval of the Board.
B. Nomination and election of officers shall be made at the regular
meeting in January of each year.
C. The elective officers shall take office at the regular meeting in
January and shall serve for a term of one (1) year.
D. Boardmembers shall serve a finro-year term. In the event of a
vacancy, a successor shall be appointed or elected in the same
manner as with an original appointment or election to serve the
remainder of the unexpired term or to begin a new term. (Rev 5/94)
E. Duties of Officers:
1. Chairperson - The Chairperson shall preside at all meetings and
public and/or disability hearings of the Disability Board and call
special meetings. The Chairperson shall have the privilege of
discussing all matters before the Board except where to do so
would constitute a conflict of interest. He/she shall have all the
duties normally conferred by parliamentary procedures on such
officers and shall perform such other duties as may be
requested by the Disability Board. During the period of time
between regular Board meetings, he/she shall also have the
authority to tentatively approve applications for disability leave;
provided, that all the required paperwork is in order, such
approval being subject to ratification by a majority of the Board
members at the next regular Board meeting.
2. Chairperson Pro Tempore - The Chairperson Pro Tempore shall
assume the duties and powers of the Chairperson in his/her
absence. If the Chairperson and the Chairperson Pro Tempore
are both absent, the Disability Board members may elect a
temporary Chairperson by a majority vote of those present at a
regular, adjourned or special meeting, who shall assume the
duties and powers of the Chairperson and Chairperson Pro
Tempore during their absence.
3. Secretary - The Secretary shall keep the minutes of all regular,
adjourned and special meetings of the Disability Board; such
minutes shall be approved by the Board and copies shall be
distributed to all members of the Board, Police and Fire Chiefs
and the Board physician. The Secretary shall give notice of all
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LEOFF Board Policies and Procedures
regular and special meetings to the board members and post all
notices of adjournment or continuance of ineetings and public
and/or disability hearings; shall prepare the agenda of regular
and special meetings; shall serve proper and legal notice of all
public and/or disability hearings; and shall draft and sign routine
correspondence of the Board, and prepare the LEOFF Board
approved claims for payment according to the policies and
procedures established by the City of Auburn's Finance
Department. The Secretary shall maintain a file of all rules,
findings, orders, recommendations and all other official records
of the Disability Board. (Rev 5/94)
4. Assistant Secretary - The duties of the Assistant Secretary shall
be as outlined in the duties of the Secretary to be performed in
the absence of the Secretary.
1.12 Agenda and Order of Business
An agenda shall be prepared by the Secretary and distributed to the
members prior to each regular monthly meeting. "Robert's Rules of
Order" shall guide the Board where the proceedings are not otherwise
governed by these policies or State law.
The Board may, in its discretion, allow the public to attend all regular
Board meetings. However, the Board, under RCW 42.30.140(2) may
close those portions of ineetings relating to consideration of specific
applications or claims where consideration of the application or claim may
include discussion of sensitive personal information relating to the
member.
1.13 Minutes
The Secretary shall take and prepare the official minutes of the City of
Auburn Disability Board containing the actions of the Board and a
summary account of the proceedings. A record of the Board members
present and absent shall be entered, and recording of action authorized
by the Board. The minutes shall be signed by the Secretary and the
Chairperson and placed on record after approval by the Board. Copies
shall be distributed to all members of the Board and the City of Auburn
Executive Office, Police Chief, Fire Chief, Finance Director, and those
persons of record who have requested such copies to the Secretary.
1.14 Delegation of Authority to Secretary
The City of Auburn Disability Board delegates to the Secretary of the
Board the authority to instigate investigative activities, including gathering, '
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LEOFF Board Policies and Procedures
collating and presenting facts regarding matters within the scope of the
Board's authority. These matters include, but are not limited to, areas of
disability leave, pensions, medical expenses and activities collateral to
them.
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LEOFF Board Policies and Procedures
Section II Defin~itions
2.01 In Line of Duty
"In line of duty" means injury, sickness or illness in consequence or as a
result of the performance of the applicant's duties.
2.02 Disabled or Disability
"Disabled" or "disability" means the existence of a physical or
psychological condition which renders the member unable to discharge
with average efficiency the duty of the grade or rank to which the member
belongs, or the position in which the member is serving. Provided, that no
member shall be entitled to a disability retirement allowance if there is an
available position to which one of such grade or rank is normally assigned
and the duties of which the member can perform.
2.03 Disability Leave Period
Disability leave period is a period six months or any portion thereof during
which a member is on leave at an allowance equal to the members' full
salary at the time he/she began his/her period of disability leave and prior
to fhe commencement of anY disabilitY retirement (as provided in RCW
41.26.030{19} and AGO 1978-8).
2.04 Board Doctor
Unless otherwise directed by the Board in specific instances the LEOFF
Board utilizes the services of Objective Medical Assessment Corporation
to request the services of a duly licensed and practicing physician or
physicians. No disability retirement shall be approved by the Board
without prior examination of the claimant by the Board doctor or a
separate specialist of his/her selection, on or near the expiration of the
disability leave period. The Board doctor shall render such other medical
service as may be requested by the Board. (As provided in WAC 415-
105-030 [1]).
In order to carry out the duties of this position, each physician appointed
or approved by the Board is required to be knowledgeable concerning the
duties, functions and general demands required of the employee being
examined. The Disability Board shall furnish to the examining physician
the job and/or position description of the applicant (As provided in WAC
415-105-030 [2]).
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LEOFF Board Policies and Procedures
Re-examination of any member on disability retirement shall be conducted
by a Board appointed or approved physician. (As provided in WAC 415-
105-030 [3]).
2.05 Legal Counsel
The City Attorney is to be the legal counsel of the Board, provided, that, if
otherwise authorized, the Board may, in lieu thereof, employ as legal
counsel an attorney admitted to practice in this state. Each legal counsel
shall provide written opinions, when required by the Board, touching the
subject the Board may be required to act upon. The legal counsel, upon
request of the Board, shall review all applications for disability retirement
and prepare a summary and recommendation based upon all the
evidence in the applicant's file and submit it to the Board for review prior
to the Board entering its order granting or denying a disability retirement
allowance.
2.06 Minimum Medical and Health Standards
The minimum medical and health standards previously promulgated by
the State Retirement Board for entry or re-entry into the LEOFF System
membership were provided only to safeguard the fiscal integrity of the
pension system and are not the applicable standards for any other
purpose. (As provided in WAC 415-105-040 [3]).
This includes eligibility for disability leave or retirement benefits.
2.07 Conditional Return
"Conditional return" is a return to duty by a member for the purpose of
determining whether the member's disability persists.
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LEOFF Board Policies and Procedures
~ection III - Disability Leawe
3.01 Application
No member shall receive disability leave benefits unless he/she has
completed and signed an application for disability retirement and it has
been filed with his/her representative. In order to be considered at the
regular monthly Board meeting, applications must be received by the
Disability Board's Secretary by the Wednesday prior to the regularly
scheduled Board meeting. Also, applications must be accompanied by a
report from two (2) physicians attesting to the existence of a disabling
condition.
3.02 Burden of Proof
The burden of proving the existence of a disabling condition, and whether
or not the condition was incurred in the line of duty, shall be upon the
applicant. (As provided in WAC 415- 105-040 [2]). The degree of
persuasion is by a preponderance of the evidence. To satisfy the
preponderance of evidence standard, the Board must be persuaded that
the propositions asserted by the applicant are more probably true than not
true.
3.03 Duty Related Leave
Any member who requests disability leave because of a duty-related
disability shall submit an incident report showing the cause of disability. If
there is no incident report, the member will be responsible for submitting
evidence at the Disability Board meeting immediately following his/her
disability request to show that the injury or illness was duty related. If the
Board finds the evidence insufficient for making their decision, they may
grant disability leave showing cause as "unspecified" and arrive at a
decision on duty-relatedness at a later date.
In the event the Board finds that insufficient information is available to
make a determination, the matter may be continued to the next regular
Board meeting or be set for consideration at a special meeting. The
Board shall also advise the member of the additional information needed,
and of the member's obligation to provide additional information and the
deadline date by which such information must be provided. (As provided
in WAC 415-105-040 [5]).
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LEOFF Board Policies and Procedures
3.04 Disability Leave Allowance
Disability leave allowance is not granted for any specific amount of time.
Such leave may not encompass a period not to exceed six (6) months.
During this time, the member is to receive an allowance equal to his/her
full monthly salary commencing on the first day of such leave (per AGO
No 78-8), or the applicable portion thereof, from his/her employer.
3.05 Placement on Disability Leave
Following receipt of an application for disability benefits, the Board shall
review all relevant information pertaining to the question of the applicant's
fitness for duty, and if, in the opinion of the majority of the Board, the
evidence supports the proposition that the member is unfit for duty, such
member shall be granted disability leave, unless such leave is waived
pursuant to RCW 41.21.120 (4). In considering such application, the
Board shall consider the duties of the position, and any other evidence
that is relevant. (As provided in WAC 415-105-040 [1]).
All law enforcement officers and firefighters who qualify for disability leave
are encouraged to use department sick leave, if available, until the City of
Auburn LEOFF Board meets at its regularly scheduled meeting and has
reviewed and approved the application for disability leave.
3.06 Recuperation and Place of Recuperation
It is the intent of the Board to assure that a member, while on disability
leave, shall do all in his/her power to recuperate from such disability and
shall do nothing which reasonably appears would prolong the leave or
inhibit recovery from such disability. In case the Disability Board should
want to contact the member about matters concerning his/her disability
leave, the member's place of recuperation will be assumed to be his/her
home or a hospital where confined. The Board may, as a condition to
authorizing a place of recuperation at a great distance from the City of
Auburn, require that the member be responsible for any travel expenses
necessary to comply with an order of the Board.
3.07 Treatments
During the period of leave, the Board shall have the authority to inquire of
any examining physician as to what physical, medical or therapeutic
treatments might be employed to rehabilitate the applicant and, based
upon such evaluation, to direct the applicant to participate in rehabilitation.
If the applicant fails or refuses to submit to such treatments, the Board '
may terminate the applicant's disability benefits.
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3.08 Member to Seek Authorization to Return to Duty
It shall be the responsibility of each member granted disability leave
pursuant to RCW 41.26, to seek authorization to return to service at the
earliest possible time the applicant believes he/she is fit for duty (see
Section III, 3.14, "Return to Duty"). The Chairperson is authorized to
tentatively return an employee on disability leave to work upon receipt of
clearances from the treating physicians; provided, that all required
paperwork is in order. Should there be any discrepancies or concerns
about the required paperwork, the Chairperson may call a special Board
meeting to expedite the employee's retum to work. In the event the Board
finds that a member has not actively sought authorization to return to
active service immediately upon cessation of disability, the Board shall
have the authority to require the report of the Board-appointed physician
to determine his/her ability to return to duty and thereafter to determine
whether or not the member's disability leave allowance shall be continued.
3.09 Physician's Report
Current medical reports are required each month from all treating and/or
attending physicians. They must be received by the Wednesday prior to
the next regular Board meeting. Failure to submit reports will be cause for
the Board to recommend to the City withholding of payroll checks. (Rev
8/94)
3.10 Physician's List
Each application shall be accompanied by a list identifying by name any
physician who has been contacted within the last six (6) months for the
illness or injury for which disability has been claimed. (As provided in
WAC 415-105-040{4}).
3.11 Appearance of Member
The Board shall be authorized to demand the appearance of the member
and to request the appearance of such other persons as it deems
appropriate. (As provided in WAC 415-105-040 {6}).
3.12 Medical Reports
It shall be incumbent upon each member obtaining medical evaluations to
be used in conjunction with such disability leave and subsequent
evaluations, to advise each and every examining physician; that such
evaluation is being conducted at the direction of the Board; that any
reports relating thereto are for the benefit of the Board; that the
doctor/patient privilege may not be invoked with respect thereto; and that
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LEOFF Board Policies and Procedures
the physician may be called upon by the Board to testify as to his/her
findings. (As provided in WAC 415-105-040 {6} Part 2 of 2).
Medical evaluation reports relating to specific members shall not be
distributed to the public or media and in the event specific requests are
made for such reports pursuant to Chapter 42.17 RCW (Public Disclosure
Law) the designated official shall determine whether or not such
document is exempt from disclosure and if not, whether a court injunction
should be sought to enjoin such distribution pursuant to Chapter 42.17
RCW.
3.13 Examination by the Board Physician
The Board may, in all cases, have the member examined at any time by
the Board physician or designate. Refusal to submit to such examination
may mean forfeiture of rights to benefits.
3.14 Return to Duty
When a member returns from a disability leave, it shall be the member's
responsibility to submit to the Disability Board Secretary a written request
to return to work, together with appropriate documentation from the
attending physicians treating the disabling condition, authorizing the
member's return to work. Upon receipt of the member's request to return
to work, the Disability Board's Secretary shall forward a copy of the
request and the documentation to the Department Head. The Disability
Board shall then take appropriate action on the request.
3.15 Conditional Return to Duty
In the event the medical and any other relevant evidence is inconclusive,
the Board may specify in written order a reasonable trial service period to
determine the member's fitness for duty. The reasonable length of such
conditional return to service shall be supported by medical evidence.
Such a conditional return to service does not entitle the member to a
second six (6) month period of disability leave for the same disability if,
based upon this trial period of service, the member is found to be
disabled. (As provided in WAC 415-105-050 [2]).
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Section IY Disability
Retirement
4.01 Examination for Disability Retirement
Applicants for disability retirement shall be examined by the Board doctor
during the fifth (5th) or sixth (6th) month of disability leave, or sooner as the
Board may require, in order to determine the member's eligibility for
disability retirement, with the following exceptions: a) if the Board doctor
assures the Board that the applicant's condition has not and will not be
corrected before the end of the sixth (6th) month; or b) if the applicant
establishes that the disabling condition will be in existence for a period of
at least six (6) months and he/she voluntarily waives disability leave. No
applicant will be granted adisability retirement allowance unless
conditions imposed by this sub-section are met. (As provided in WAC
415-105-050 [1]). ((Rev 5/94))
4.02 Granting Disability Retirement
If the evidence shows to the satisfaction of the Board that the member is
physically and/or psychologically disabled from further performance of
duty and that the disability has been continuous from the date of
commencement of disability leave for a period of six (6) months, the
Board shall enter its written decision and order, accompanied by
appropriate findings of fact and conclusions of law in compliance with
RCW 41.26.120. Such written decision and order with supporting
documentation shall thereafter be forwarded to the Director, Department
of Retirement Systems, for reviews. In the event a regular meeting of the
Board precedes by no more than forty (40) days the date at which the full
six (6) months will conclude and the evidence is clear that the disability
can be expected to continue through the full six (6) month period, the
Board may make a finding of six (6) months continuance disability prior to
the actual conclusion of the six month period, so as to eliminate
unnecessary delay of receipt of retirement benefits. (As provided in WAC
415-105- 060 [1 ((Rev 5/94))
In order to receive a disability retirement allowance, the applicant will be
required to prove that he/she is physically and/or psychologically disabled
to such an extent that he/she is unable to discharge with average
efficiency the duty of the position held at the time of discontinuance of
service: "Provided, that no member shall be entitled to a disability
retirement allowance if the appropriate authority advises that there is an
available position for which the member is qualified and to which one of
such grade or rank is normally assigned and the Board determines that
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LEOFF Board Policies and Procedures
the member is capable of discharging, with average efficiency, the duties
of the position." (As provided in WAC 415-105-060 [2]).
4.03 Execution
Every order of the Disability Board granting or denying a disability
retirement allowance shall contain the following presented in clear and
concise terms:
A. Findings of fact supported by evidence in the record supporting the
granting or denying of the disability retirement allowance. When a
disability retirement is granted, findings of fact shall include:
1) Whether or not the disability was incurred in the line of duty;
2) Whether or not the disability was incurred in other employment;
3) Dates encompassing disability leave and/or dates relating to
authorized trial basis return to duty; and, in the case of return to
duty on a trial basis, the factual basis for such decision;
4) Dates encompassing waiver of disability leave, if applicable;
and that the applicant established that such disability will be in
existence for a period of six (6) months.
5) As required by the Department of Retirement Systems, if the
Board relies on the testimony of the treating physician over that
of the Board physician, a finding stating that fact.
B. Conclusions of law in accordance with law on the basis of facts in the
case.
C. Decision and order.
(Entire Section as provided in WAC 415-105-070, [1], [2] &[3])
4.04 Re-examination and Return to Duty
In the event a member is placed on disability retirement, the Board shall
determine whether or not the member is so disabled that no possibility
exists for return to duty or that there is no possibility that rehabilitation
could restore the member to fitness for duty. Further, the Board may at
any point subsequent to retirement make such a determination. A copy of
all such determinations shall be sent to the Department of Retirement
Systems. Unless the Board has made such a finding, the Board's
representative shall order a re-examination at six (6) month intervals and
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LEOFF Board Policies and Procedures
advise the Board of the results thereof with a copy to the Department of
Retirement Systems: provided, that such re-examination need not be
conducted on a member over 49.5 years of age.
Each member who is under 49.5 years of age and placed on disability
retirement is subject to periodic review, unless the Findings of Fact state
there is no chance of rehabilitation. The periodic review includes a
medical examination and completion of the Board's re-evaluation
questionnaire, every six months, to determine whether disability retirement
should be continued.
In the event the retired member is residing at a location more than one
hundred (100) miles from his/her former place of employment, the
member may be authorized to be examined by a physician in his/her
immediate area, provided, however, such physician shall first be approved
by the Board and prior to such evaluation the examining physician shall
be appraised of the basis upon which the examination is to be conducted
and the issues to be addressed in the physician's evaluation report (As
provided in WAC 415-105-090 [1]).
Fees charged for medical evaluation report letters for required re-
examination of disability retirees under the age of 49.5 years may be
covered by health insurance providers. The Board will consider
authorizing payment for fees charged for medical reports toward fulfillment
of the periodic medical examination review which have been shown to
have first been submitted to the member's health insurance provider. The
Board will cover the amount of the billing not reimbursed by or rejected by
the health insurance provider_
4.05 Discontinuation of a Retirement Allowance, Notice of
In the event such evaluation discloses fitness to perform duties of the rank
or position held by the member at the time of disability retirement, the
member shall be entitled to a hearing before the Board, and further
consideration of the matter. Such notice of hearing shall comply with the
Administrative Procedures Act, Chapter 3404 RCW. (As provided in WAC
415-105-090 [2]). The member shall be notified of the Board's action to
discontinue or cancel his/her retirement allowance by mail, and the
notification shall contain notice of the time, place and that the hearing will
be to determine whether the member continues to be disabled.
The hearing provided by RCW 41.26.140 (2) is to be held, unless the
retiree waives such hearing, prior to actual cancellation of a disability
retirement allowance. (As provided in WAC 415-105-090 [3]).
The retirement allowance of any member who faits to submit to medical
examination as provided herein shall be discontinued and in the event
such refusal continues for one (1) year, his/her retirement allowance shall
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LEOFF Board Policies and Procedures
be canceled. Failure of the member to affirmatively respond to the
request for re-examination shall be deemed a continuing refusal. (As
provided in WAC 415-105-090 [4]).
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LEOFF Board Policies and Procedures
Mection Y I3earing Proceduress
5.01 Procedures
Whenever the Board holds a hearing pursuant to these rules or RCW
41.26, the following rules shall govern the general conduct of such
hearing and shall not be inconsistent with RCW 34.04.
5.02 Subpoenas
The Board may compel the attendance of a witness at any hearing as
follows:
A. The Board may issue a subpoena on its own motion or upon the
request of any party. The issuance and service of a subpoena may
be obtained upon the filing of an affidavit therefore, which:
1) States the name and address of the proposed witness; and,
2) Specifies the nature of the evidence sought and the
materiality thereof to the issues involved; and,
3) States that the witness has the desired evidence in his/her
possession or under his/her control.
The Board may refuse to issue a subpoena when the affidavit is
defective or incomplete in any particular. The Board's Secretary is
authorized to sign the subpoena for the Chairperson.
B. If an individual fails to obey a subpoena without lawful excuse or
refuses to testify when requested concerning any matter under
examination or investigation at the hearing or fails without lawful
excuse to produce material evidence in his/her possession or under
his/her control as required by any subpoena issued by the Board and
served upon such person, the Board may petition the superior court
of the county where the hearing is being conducted for enforcement
of the subpoena. The petition shall be accompanied by a copy of the
subpoena and proof of service, and shall set forth in what specific
manner the subpoena has not been complied with, and shall ask an
order of the court to compel the witness to appear and testify before
the Board or to produce material evidence.
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LEOFF Board Policies and Procedures
C. Any subpoena issued by the Board shall be served in the manner
provided for any civil suit according to the Washington Court Rules.
D. Witnesses subpoenaed to attend such a hearing shall be paid the
same fees and allowances, and in the same manner and under the
same conditions, as provided for witnesses in the courts of this State
by RCW 2.40 and by RCW 5.56.010, as now or hereafter amended:
Provided, that the Board shall have the power to fix the allowance for
meals and lodging in like manner as is provided in RCW 5.56.010, as
now or hereafter amended, as to courts. Such fees and allowances,
and the cost of producing records required to be produced by its
subpoena, shall be paid by the Board, or by the party requesting the
issuance of the subpoena.
5.03 General Procedure for Conduct of Hearings
A. Submission of Briefs - The member applying for retirement may
submit a brief of evidence in support of his/her application. The brief
must be submitted to the Board's Secretary three (3) working days
prior to the hearing.
B. Record - A record of the entire proceeding shall be made by tape
record. Such tape recording shall be preserved for a period of two
(2) years by the Board's Secretary. The cost of any reproduction of
the tape shall be paid by the requesting party unless requested by
the Board.
C. Continuance - The Board may grant a continuance for good cause.
Good cause is to be determined by the Board.
D. Oaths/Certification - In any proceeding under the Board's rules, any
member of the Board may administer oaths and affirmations and
may certify official acts.
E. Reasonable Dispatch - The Board and its members shall proceed
with reasonable dispatch to conduct any matter before it.
F. Rules of Evidence - Hearings need not be conducted according to
the technical rules relating to evidence and witness.
G. Oral Evidence - Oral evidence shall be taken only on oath or
affirmation.
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LEOFF Board Policies and Procedures
H. Hearsay Evidence - Hearsay evidence may be used for the purpose
of supplementing or explaining any direct evidence, but shall not be
sufficient in itself to support a finding unless it would be admissible
over objection in civil actions in courts of competent jurisdiction in
this state.
1. Admissibility of Evidence - Any relevant evidence shall be admitted if
it is the type of evidence on which responsible persons are
accustomed to rely in the conduct of serious affairs, regardless of the
existence of any common law or statutory rules which might make
improper the admission of such evidence over the objection in civil
court action in a court of competent jurisdiction in this state.
J. Exclusive Evidence - Irrelevant and unduly repetitious evidence may
be excluded by the Board.
K. Rights of the Applicant Member - The member applying for
retirement shall have these rights, among others:
1) Call and examine witnesses on any matters relevant to the
issues presented in the hearing,
2) Introduce documentary and physical evidence,
3) Cross examine witnesses on any matter relevant to the issues
of the hearing,
4) Impeach any witness regardless of who called him/her to testify,
5) Rebut the evidence against him/her,
6) To represent him/herself or to be represented by legal counsel.
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LEOFF Board Policies and Procedures
L. Presentation of Testimony
1) Order of Presentation of Testimony - The applicant member,
who bears the burden of proof shall present his/her evidence
first. Then other witnesses may testify as directed by the
Board. After any witness concludes his/her testimony, the
Board may direct questions to the witness.
2) Closing Statement - After presentation of all testimony and
evidence, the applicant member or his/her representative shall
be allowed to make a summarizing statement. The Board may
impose a reasonable time limit on such statement, but a
minimum of fifteen (15) minutes shall be allowed.
M. Official Notice
1) What May Be Noticed - In reaching a decision, official notice
may be taken either before or after submission of the case for
decision, of any fact which may be judicially noticed by the
courts of this state or of official records of the Board or
departments and ordinances of the City or rules and regulations
of the Board.
2) Applicant Member to Be Notified - The applicant member, if
present at the hearing, shall be informed of the matters to be
noticed by the Board, and these matters shall be noted in the
record, referred to therein, or appended thereto.
3) Opportunity to Refute - Any applicant member or his/her
representative, if present at the hearing, shall be given
reasonable opportunity, upon request, to refute the officially
noticed matters by evidence or by written or oral presentation of
authority, the manner of such reputation to be determined by
the Board.
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SectiOri YI
Appeal
6.01 Denial or Cancellation
If the Board denies a disability leave or disability retirement or cancels a
previously granted disability leave or retirement, the applicant shall be
immediately notified and advised of the right of appeal such decision or
order to the Director of the Department of Retirement Systems, pursuant
to RCW 41.26.200. Such notification shall be made in writing and served
by personal service or mail. Provided, that written notice need not be
given if applicant or his/her duly authorized representative is in attendance
at the meeting or hearing and is advised of the decision and of the right of
appeal (As provided in WAC 415-105-080).
6.02 Procedure for Reconsideration of Board Decision
Any party aggrieved by a decision of the Board may request the Board to
reconsider its action by filing a written request with the Board's Secretary
for reconsideration within fifteen (15) days of the decision of the Board.
The request for reconsideration shall set forth a concise statement of the
facts or errors upon which the request for reconsideration is based. The
Board may direct that a copy of the request for reconsideration be mailed
to other interested parties at least three (3) days prior to any Board
meeting to consider the request. The Board may grant or deny such
request for reconsideration at its discretion.
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SectiOn YII
Falsification
7.01 Record or Statement Falsification
All applications and other documents filed in conjunction with disability
leave or disability retirement must be accurate and truthful. RCW
41.26.300 provides as follows:
"Any employer, member or beneficiary who shall knowingly make false
statements or falsify or permit to be falsified any record or records of the
retirement system, shall be guilty of a felony".
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seC.-;t1on
lVleaical Ser~ices
8.01 Medical Services Provided
Whenever any active member, member on disability leave, member
retired for service or disability which requires medical services, such
services shall be paid for by the employer, subject to approval by the
Disability Board.
Only those medical services which are deemed necessary shall be
approved, unless the Board finds the condition which has caused the
need for such medical service was caused or brought on by dissipation or
abuse. Determinations of dissipation or abuse and the necessity of such
medical services shall be determined by the Board after considering the
medical evaluation of the Board's medical advisor together with any other
relevant evidence. Applications to the Board for medical services shall be
approved by the Board prior to receipt of services except in extraordinary
circumstances. Medical services payable shall be reduced by any amount
received or eligible to be received under Workers' Compensation,
Medicare, insurance provided by another employer, other pension plan, or
other similar sources. In the event any such alternative source of
payment is available, it shall be incumbent upon the requesting member
to apprise the Board of such source, if known to the member, and failure
to do so may result in the loss of inedical benefits. It shall be the policy of
the Board to seek repayment from other sources.
NOTE: Medical services payable by insurance provided by an
employer pursuant to RCW 41.26.150 shall not be subject to approval by
the Board.
8.02 Medical Services - General Guidelines
A. Where deemed necessary, the local Disability Board may approve
payment for any medical services which constitute preventative as
opposed to curative services. Preventative services are those which
are meant to prevent future occurrence of an illness, injury or
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City of Auburn
LEOFF Board Policies and Procedures
disabling condition, as opposed to curative services meant to restore
health or cure or correct an existing condition.
B. The Board will not consider any service of a cosmetic nature or
which is beyond that reasonably necessary to correct the condition
complained of to be a necessary medical service.
C. In the event the member has obtained medical services without
obtaining prior approval of the board, the Board may authorize
payment upon filing of such claim by the applicant.
D. Dental expenses will not be considered necessary medical services
except in those circumstances where they are incurred by a member
who sustains an accidental injury to his/her teeth and commenced
treatment within ninety (90) days after the accident, unless said
treatment can be justified by the way of curing or correcting an
existing health problem (See also section 8.03{13}).
E. The Board will authorize the payment of the expense of an eye exam
by a licensed optometrist or licensed ophthalmologist.
F. The Board may presume that each individual who has attained the
age sixty-five (65) is eligible for Medicare and will not authorize
payment for necessary medical services where such expenses are
met by Medicare, pursuant to RCW 41.26.150. Where the expense
of necessary medical services exceeds that which is paid by
Medicare, the Board may authorize the payment of the excess.
G. Members possessing insurance benefits covering the expense of
necessary medical services which would otherwise be the obligation
of the employer shall first present the claim to the appropriate
insurance carrier and only thereafter make claim to the Board for
those costs which are not paid by the insurer. The Board will
designate those services where this procedure will not be followed.
H. Upon making payment for authorized medical services, the employer
shall be subrogated to all rights of the member against any third
party who may be held liable for the member's injuries or for the
payment of the costs of inedical services in connection with a
member's sickness or disability. Such subrogation shall be to the
extent necessary to recover payments made by the employer.
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LEOFF Board Policies and Procedures
8.03 Medical Services - Defined
Medical services for persons who establish membership in the retirement
system on or before September 30, 1977, shall include the following as
minimum services to be provided. Reasonable charges for these services
shall be paid in accordance with RCW 41.26.150
A. Hospital expenses are the charges made by a hospital, in its own
behalf, for:
Board and room not to exceed semi-private room rate unless private
room is required by the attending physician due to the condition of
the patient.
Necessary hospital services, other than board and room, furnished
by the hospital.
B. Other medical expenses; Provided, that they have not been
considered hospital expenses.
The fees of the following:
A physician or surgeon licensed under the provisions of Chapter
18.71 RCW.
An osteopath licensed under the provisions of Chapter 18.51 RCW.
A chiropractor licensed under the provisions of Chapter 18.25 RCW.
The charges of a registered graduate nurse other than a nurse who
ordinarily resides in the member's home, or is a member of the
family of either the member or the member's spouse.
The charges for the following medical services and supplies as
provided in RCW 41.26.030 [22]:
Drugs and medicines upon a physician's prescription;
Diagnostic x-ray and laboratory examinations;
X-ray, radium, and radioactive isotopes therapy; ,I
Anesthesia and oxygen;
Rental of iron lung and other durable medical and surgical
equipment;
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City of Auburn
LEOFF Board Policies and Procedures
Artificial limbs and eyes, and casts, splints, and trusses;
Professional ambulance service when used to transport the member
to or from a hospital when he/she is injured by an accident or
stricken by a disease;
Dental charges incurred by a member who sustains an accidental
injury to his/her teeth and who commences treatment by a legally
licensed dentist within ninety (90) days after the accident;
Nursing home confinement or hospital care extended facility;
Physical therapy by a registered physical therapist;
Blood transfusions, including the cost of blood and blood plasma not
replaced by voluntary donors;
An optometrist licensed under the provisions of Chapter 18.53 RCW
or an ophthalmologist licensed under Chapter 18.71.RCW.
(This entire section as provided in RCW 41.26.030 [22]).
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LEOFF Board Policies and Procedures
SectiOn IX
LEOFF Board Claim
Procedure
9.01 Medical Claim Procedure
A. Obtain prior LEOFF Board approval for any necessary medical
expense not covered by insurance, Medicare or other similar
sources. All medical expenses incurred and claimed for
reimbursement by the member will be submitted through the
member's health insurance provider(s) BEFORE the claim is sent to
the Board for approval. The medical expenses claim submitted for
reimbursement is to be that portion NOT covered by the existing
health insurance provider(s).
1. The Board may presume that each individual who has attained
the age of sixty-five (65) is eligible for Medicare and will not
authorize payment for necessary medical services where such
expenses are met by Medicare, pursuant to RCW 41.26.150. It
is each members' responsibility to obtain Medicare insurance
whether or not the employer pays the premiums. Pursuant to
RCW 41.26.150(5) Medicare premiums supplementing other
medical insurance coverage are authorized for reimbursement
upon receipt of Form SSA-1099, Social Security Benefit
Statement, showing annual Medicare premiums paid for
individual members.
2. Members are advised to consult their employer or personnel
office regarding eligibility for Medicare health insurance
coverage, Parts A and B. Where the expense of necessary
medical services exceeds that which is paid by Medicare, the
Board will authorize the payment of any balance which may
exist after coordination of benefits with the provided medical
insurance carrier.
B. Process all medical expenses through the appropriate insurance
carriers. Members are advised to consult first with their health
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City of Auburn
LEOFF Board Policies and Procedures
insurance providers or their employer/personnel officer to learn what
is or is not covered in existing health insurance BEFORE incurring
treatment services. Elective medical procedures, surgery and/or
appliances/supplies may not be covered by the health insurance
provided by the employer or authorized by the Board.
,
C. If the medical expense is not covered by insurance, a claim can be
submitted to the LEOFF Board for payment. The burden is upon the
claimant to establish necessity of a provided medical service and that
the reasonableness of the service charge in order for the Board to
consider the claim for payment,
D. Complete a Claim for Payment form and attach all explanation of
benefits insurance documentation forms showing the amount they
paid and/or rejected and any physician documentation necessary to
support a claim.
E. Submit the claim with the above information to your LEOFF
Representative by the last Tuesday of the month. LEOFF Board
agendas are prepared the last Wednesday of the month and mailed
to each Board member at their last address of record. Any claims
submitted after that date will be held until the next regularly
scheduled LEOFF Board meeting, the first Monday of each month.
F. If the LEOFF Board approves the claim for payment, the claim will be
processed according to established Finance Department policies and
procedures.
G. Claims which do not have complete documentation shall be tabled
until the next LEOFF Board meeting or until the required
documentation is provided so it is crucial to have the required
paperwork. Only those medical services which are deemed
necessary shall be approved, unless the Board finds the condition
which has caused the need for such medical service was caused or
brought on by dissipation or abuse. Determinations of dissipation or
abuse and the necessity of such medical services shall be
determined by the Board after considering the medical evaluation of
the Board's medical advisor together with any other relevant
evidence.
H. All claims for hearing aids must have prior authorization by the
LEOFF Board. Failure to obtain advance authorization may result in
only partial reimbursement or rejection of the claim at the Boards
discretion.
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City of Auburn
LEOFF Board Policies and Procedures
1. All claims, except prescription claims, shall be submitted to the Board
within ninety (90) days of date processed/paid by the insurance
documentation. Failure to comply may result in rejection of the
claim.
J. Prescription claims shall be submitted to the Board within twelve (12)
months from date of purchase. This policy shall apply to all
prescription claims purchased on or after January 1, 2002.
K. All medical expenses are the member's responsibility to pay. Claims
for necessary medical services submitted to the Board shall be
reimbursed to the member in the amount approved by the Board.
L. Upon making payment for authorized medical services, the employer
shall be surrogated to all rights of the member against any third party
who may be held liable for the member's injuries or for the payment
of the costs of inedical services in connection with a member's
sickness or disability. Such subrogation shall be to the extent
necessary to recover payments made by the employer.
M. The Board may approve a maximum one-time only $500 weight loss
program fee if the member submits a description of a physician
monitored and prescribed weight loss program documenting a
medical necessity of losing at least 60 pounds. The Board will not
consider payment or costs of food supplements/replacements.
9.02 Medical Claims for Corrective Lenses and Frames
A. Active LEOFF 1 Members
Vision insurance coverage is provided for active LEOFF 1 members
through Vision Service Plan. If any balance remains after Vision
Service Plan, or any other vision plan the LEOFF I member is
enrolled in, has paid its benefit, the member should forward a copy of
the Explanation of Benefits statement together with a completed
Corrective Lenses and Frames Worksheet to the LEOFF Board for
consideration. The LEOFF Board will reimburse up to the amounts
described below. The reimbursement rates apply after all insurance
coverages have been applied. Any balance due after the LEOFF
Board reimbursement is the responsibility of the LEOFF I member.
B. Retired LEOFF I Members
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City of Auburn
LEOFF Board Policies and Procedures
Eye examinations for retired LEOFF I members are to be charged to
Regence BlueShield. The retired LEOFF I member may purchase
from the optician or ophthalmologist of his or her choice.
The member should forward a completed Corrective Lenses and
Frames Worksheet to the LEOFF Board for consideration for any
lenses and frames expense. The LEOFF Board will reimburse up to
the amounts described below. The reimbursement rates apply after
all, if any, insurance coverages have been applied. Any balance due
after the LEOFF Board reimbursement is the responsibility of the
LEOFF I member.
C. Vision Benefits
Payments for eyeglasses and contact lenses, plus the reasonable
costs of necessary eye examination services of a licensed
ophthalmologist or optometrist, will be approved pursuant to the
authority granted to the Board under RCW 41.26.150, if eyeglasses
are prescribed by an ophthalmologist or optometrist.
The Board will approve payment for one pair of eyeglasses or
contact lenses, at the member's option or as prescribed, to correct
vision when required for a new prescription in accordance with the
following schedule:
1. Eveglass Lenses and Frames: $200.00 maximum per single
set of frames and pair of lenses not more than once every twelve
(12) consecutive months. Lenses covered include single vision,
bifocal, or trifocal lenses.
2. Second Pair: A second pair of monofocal (i.e. computer)
glasses shall be approved only if prescribed by a ophthalmologist or
licensed optometrist. The maximum cost of the second pair shall not
exceed $200 per single set of frames and pair of lenses not more
than once in a twenty-four (24) consecutive months.
3. Contact Lenses: $100.00 per lens not to exceed $200
maximum during any twelve (12) month period including disposable
contact lenses.
4. Replacement: Claims for replacement pair of eyeglass
frames and/or lenses or contacts will be allowed if proof of damage is
provided and shown to have been incurred in the perFormance of a
member's fire or law enforcement duties. Only one replacement pair
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City of Auburn
LEOFF Board Policies and Procedures
per year, due to accidental damage, will be allowed, not to exceed
the amount allowable above.
5. Additional/Spare Pair: No reimbursement will be made for a
spare pair of glasses ar contact lenses.
D. Laser Vision Correction
The Board will reimburse the member the amount of $700 per eye
for Radial Keratotomy (RK) surgery or laser eye surgery (LASIK and
RK). If a member is reimbursed the $700 per eye for the surgery, he
or she will not be reimbursed for eyeglasses or contact lenses during
the subsequent two calendar years, unless eyeglasses or contact
lenses are medically necessary.
9.03 Medical Claims for Hearing Aids
The City of Auburn LEOFF Board will authorize a payment for hearing
aid(s) up to an amount determined by the LEOFF Board designated
hearing aid provider (Price/Costco as of 1/1 /97). The LEOFF Board will
consider payments for a hearing aid device every five (5) years. Any
claim submitted by a member who chooses not to use the LEOFF Board
designated hearing aid provider or lives outside the service area is subject
to review by the LEOFF Board's designated hearing provider and will be
limited to reimbursement up to what the designated hearing aid provider
would charge. Hearing aids prescribed due to injury, disease or other
unusual circumstances will be considered on a case by case basis for
exception to this policy. The Board will also authorize the cost of
necessary repairs, however, routine maintenance and batteries shall be
the members responsibility.
9.04 Skilled Nursing Facility Care Reimbursement
A. The City of Auburn LEOFF Board will provide reimbursement for
the reasonable expenses incurred by a LEOFF I member needing
the services of a skilled nursing facility. Expenses which shall be
reimbursed may include:
1. An amount not to exceed the daily benefit for nursing care
under the City's existing long term care insurance.
2. The semi-private room and board rate plus the "level of
care" charge where charged separately by a skilled nursing ~
facility so long as the total does not exceed the Board
allowed rate.
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City of Auburn
LEOFF Board Policies and Procedures
3. Charges for medically necessary physician prescribed
medications, medical services (e.g. x-rays) and other
medically necessary physician prescribed supplies.
B. Non-medical charges, including but not limited to hair care,
personal toiletries and sundries, bed holds, and recreational events
organized by the skilled nursing facility shall not be reimbursed.
C. Before any skilled nursing facility charges may be reimbursed, the
Board must be provided with a letter from the member's attending
physician stating medical necessity for and estimated duration of
skilled nursing facility care. Private room charges may be
reimbursed provided the Board is supplied with written
documentation of inedical necessity for the same from the
member's attending physician. The question of inedical necessity
for skilled nursing facility care may be subject to annual or more
frequent review by the Board at the Board's discretion.
D. All charges must be submitted to the appropriate insurance
carriers, Medicare, Medicaid or other available long-term care
insurance before submission to the Board. The Board may reduce
the amount of reimbursement for skilled nursing facility care by the
amount a LEOFF I member receives from these other sources.
E. The Board reserves the right, at its sole discretion based on the
record before it, to approve or disapprove reimbursement for skilled
nursing facility care incurred by a LEOFF I member.
F. The Board shall only reimburse for services rendered; advance
payment of any charges will not be made by the Board.
9.05 Home Health Care Reimbursement
A. The City of Auburn LEOFF Board may provide reimbursement for
the reasonable expenses incurred by a LEOFF I member needing
the services of home health care. It is the intent of this policy to
reduce the amount paid for skilled nursing facility care.
1. Before any home health care charges may be reimbursed,
the Board must be provided with a"Medical Request for
Home Health Care" form completed by the member's
attending physician. The physician shall state the medical
necessity and the estimated length of time during which
home health care will be required and the type of care
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City of Auburn
LEOFF Board Policies and Procedures
required (medical, daily living, and/or other). This form may
be obtained from the LEOFF Board Secretary. The
attending physician must provide to the Board a description
of work to be perFormed by the home health care provider.
This description is to be as detailed as possible. The
question of inedical necessity for home health care may be
subject to annual or more frequent review by the Board, at
the Board's discretion.
2. The total amount allowed shall not exceed the current Board
allowed rate for skilled nursing home care as provided for in
the Skilled Nursing Facility Care Reimbursement Policy.
3. All charges must be submitted to the appropriate insurance
carriers, Medicare and other available long-term care
insurance before submission to the Board.
4. The Board shall only reimburse for services rendered;
advance payment of any charges will not be made by the
Board.
5. The Board reserves the right to have an independent
assessment agency evaluate the member's home health
care needs. The Board also reserves the right to approve or
deny home health care reimbursement based upon the
findings of the independent assessment agency.
6. The Board will not reimburse for home health care provided
by an individual who ordinarily resides in the member's
home, or is a member of the family of either the member or
the member's spouse, unless the individual is a licensed
home health care provider.
7. Requests for reimbursement shall be made on a Claim for
Payment form. All explanations of benefits insurance
documentation forms showing the amount paid and/or
rejected and any physician documentation necessary to
support the claim must be attached.
8. The Board reserves the right, at its sole discretion based on
the record before it, to approve or disapprove
reimbursement for home health care expenses incurred by a
LEOFF I member.
9.06 Rejected Claims
The Board shall act upon all claims promptly, advising the claimant in
writing of any claim that is rejected, together with the reason for rejection.
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City of Auburn
LEOFF Board Policies and Procedures
9.07 Filing Appeal in Cases Involving Claims for Medical
Services
Any person feeling aggrieved by any denial of payment of a claim for
medical services by the Board shall have the right to request the Board to
reconsider its decision and the Board may grant or deny such request at
its discretion. A request for reconsideration must be filed with the Board
Secretary within thirty (30) days following the denial of the claim by the
Board. The Board will set a date and time for reconsideration at which
time the member may present such evidence deemed relevant. If the
denial of the claim is sustained by the Board, the member has the right of
judicial review.
9.08 Medical Claims for Services Where Insurance Benefits
Have Been Expended
In instances where insurance benefits have been exhausted or where
treatment is not covered by insurance, the Board may require a written
report from the claimant's physician or, at the Board's discretion, be
referred to the Board doctor requesting information on the diagnosis,
prognosis, and recommended treatment for the medical problem.
9.09 Medical Claims for Services Where Treatment is Not
Covered by Insurance
In instances where insurance does not cover treatment, the member must
seek prior authorization by the Board prior to commencing treatment.
Failure to do so may cause denial or only partial approval of the medical
claim.
9.10 Medical Claims for Board Required Re-examinations (WAC
415-105-0901) .
Upon receipt of proper documentation for medical claims for Board
required re-examinations, the Board shall authorize the Secretary to
institute the process to pay the bill to the provider according to established
Finance Department policies and procedures.
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City of Auburn
LEOFF Board Policies and Procedures
SectiOn X
Adoption and ReYie~
10.01 Biennial Review
These policies and procedures shall be reviewed in even years in January
to assure that:
A. Provisions herein remain in conformance with Washington Statutory
and Administrative Codes.
B. Dollar amounts specified in schedules of benefits reflect current
average charges in the local area.
C. Provisions herein reflect current philosophy and intent of the Board.
10.02 Formal Adoption
Revisions of the Board's policies and procedures shall be adopted no later
than the regularly scheduled Board meeting in February of the year of
review.
10.03 Severability Clause
The LEOFF Board Policies and Procedures are declared to be separate
and severable. The invalidity of any clause, sentence, paragraph,
subdivision, section or portion of these policies, or the invalidity of the
application thereof to any person a circumstance shall not affect the
validity of the remainder of these policies, or the validity of its application
to other persons or circumstances.
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City of Auburn
LEOFF Board Policies and Procedures
SectiOri XI
AdaenaXXX-%V
Revised 6-10-83
1.05 Elections - Wording has beerr added to designate years the elections will be held and procedure
for election by secret ballot.
1.11 Disability Board Officers - Adds an Assistant Secretary.
3.01 Application - Requires reports from two (2) physicians when applying for disability
leave/retirement.
3.09 Physician's Reports - Changes date monthly disability leave reports are due from Monday to
Wednesday preceding the LEOFF Board meeting.
3.14 Return to Dutv - Clarifies the procedure to return to duty from disability leave.
5.01 Procedures (Hearinas) - Adds State hearings procedures statute reference.
6.01 Denial or Cancellation - Corrects RCW reference typographical error.
8.02 D/E Medical Services - General Guidelines - Corrects references to other sections.
9.01 Procedure to File Medical Claims - Title change to Medical Claim Procedure and further clarifies
procedure. Also requires prior Board approval for hearing aids.
9.02 General Information on Medical Claims - Title change to Medical Claims for Corrective Lenses.
Changes LEOFF guidelines for payment limitations for corrective lenses to a flat fee of $120.00
every two (2) years, or sooner if correction is required, minus any insurance benefits available.
Revised 6-28-84
1.01 B Designates even numbered years for fire fighter representative elections.
1.01 C Designates odd numbered years for law enforcement officer representative elections.
1.05 66 Permits Secretary and Assistant Secretary to schedule date to open ballots.
2.03 Corrects typographical error.
3.05 Clarifies disability leave will be retroactive and sick leave restored when applicant is placed on
disability leave.
3.08 Authorizes Chairperson to return employee to work from disability leave if clearances are in order,
or call for a special meeting.
3.09 Changes due date of physician's reports for employees on disability leave to the Wednesday
before Board meetings.
6.01 Corrects 41.16.200 to 41.26.200.
9.01 H Sets time limitation on submission of inedical claims.
9.02 Changes allowance for corrective lenses to include exam fee of up to $50.00 for a total of up to
$170.00.
Page 30 Updates Board membership list.
Page 37
City of Auburn
LEOFF Board Policies and Procedures
Revised 1-7-85
1.05 B Provides new procedure to nominate Fire/Police representatives.
Revised 1-7-86
1.05 63 Changes time between the mailing out of ballot packets and the receipt by the Secretary to no
less than seven (7) but no more than ten (10) business days.
Revised 11-15-88
Entire All references in the masculine gender only were revised to include the feminine and/or neuter
gender where appropriate.
Entire All cursive numerical references were revised to include the analog number and vice-versa.
Index The index was revised to reflect current page numbers.
Index Section X- Annual Review was revised to Biennial Review.
1.01 B/C Revised to include retired police and fire.
1.04 Changed meeting date to third (3`d) Tuesday of each month.
1.05 A Active and retired employees may vote for LEOFF representative.
1.05 61 Add retired and LEOFF II members may serve on Board.
1.05 62 Include a security envelope in ballot packages.
1.05 B7 Makes provision for run-off election in the event one candidate does not receive a simple majority
of those voting.
1.08 Includes WAC 415-105 in the Board's powers and authority. ~
1.11 E1 Gives Chairperson authority to tentatively approve disability leave applications between
regular Board meetings.
2.04 Removes reference to City Health Officer.
3.01 Specifies the date that agenda items must be received by the secretary.
3.05 Encourages use of employee sick leave until the Board meets and approves disability leave and
removes restoration of sick leave so used.
3.08 Clarifies that the Chairperson's actions returning a member from disability leave between
meetings as tentative.
9.01 A Specifies advance approval for medical services.
9.01 G Claims submitted without complete documentation will be tabled.
9.01 H Faiture to obtain advance authorization penalties.
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City of Auburn
LEOFF Board Policies and Procedures
9.01 J Medical bills are the member's responsibility to pay.
10.01 Changes annual review of policies and procedures to biennial review.
Revised 5-1-90
1.04 Meetin - Changes regularly scheduled monthly meeting from the third (3`d ) Tuesday of each
month to the first (1 St) Monday of each month.
8.02(E) Medical Services - General Guidelines - Authorizes the Board to pay for the eye exam by an
optometrist.
9.01(E) Medical Claim Procedure - Changes the LEOFF Board meeting from the third (3`d) Tuesday of
each month to the first (1 Monday of each month.
9.02 Medical Claims for Corrective Lenses - Changes the flat maximum fee of $170.00 to $175.00 and
deletes "(includes $50.00 for exam) reference
App A Deletes Jim Walters from membership. Adds Pat Burns to membership. Changes Stacey
Brothers contact information.
App B Deletes "Active" reference on claim forms.
Revised 9/3/91
9.01(H) Designates Northwest Hospital as the LEOFF Board approved hearing aid clinic.
Revised 1-1-92
1.05(6.7) Deletes "The election shall be conducted at the respective department during a two (2)
hour period following appropriate notification." Revises to read ..a run-off election shall
be scheduled between the two individuals receiving the highest vote totals utilizing the
same process per this section."
App A City Legislative Appointments of Trish Borden and Jeanne Barber with term expiration
dates of 12-31-93 and 92. Police Representative Bob Phillips with term expiration date of
12-31-93.
2.02 Corrects last sentence from ..."member is can perform." to "member can perform."
3.08 Corrects ..."receipt of clearances from the Secretary;"... to "receipt of clearances from the treating
PhYsicians;"...
4.02 Changes ..."physically or mentally disabled"... to "physically and/or mentally disabled"
9.01(D) Changes "-Documentation from the insurance carrier(s) showing the amount they paid and/or
rejected" to "King County Medical Explanation of Benefits documentation form (and other
insurance carrier(s) showing the amount they paid and/or rejected."
9.06 Adds section for medical claims for services where treatment is not covered by insurance.
10.01 Changes Biennial Review every two years to even years.
Page 39
City of Auburn
LEOFF Board Policies and Procedures
Revised 12/7/92:
1.05(B.11) Adds "If only one person nominated, balloting will not be required and the individual will be
considered elected.
9.02 Changes corrective fee to $175.00 every two (2) years.
10.01A Adds "and Administrative Codes".
App A Mick Crawford Term expires 12-31-94; Bud Larson Member-at-Large, adds address and phone
number, selected 1-4-93, term expires 12/31/94; Trish Borden term expires 12-31-95; Jeanne
Barber term expires 12-31-94, Jim Kelly adds home phone number, elected 6-1-93, term expires
12-31-95 (Bob Phillips resigned, Jim Kellyfulfills end of term); Mick CrawFord appointed Chairman
at 1-94 meeting, Bud Larson appointed Pro-tem at 1-94 meeting.
Claim Form Adds to Instruction #3: "NOTE: A copy of the bill and insurance explanation of benefits
must accompany your claim."
Revised 1014/93
Claim Form Deletes the sentence "I hereby assign all benefits to the physician or purveyor."
Revised July 1995:
1.05 (B) Election procedure for election by secret ballot change are as follows:
6. The ballots shall be opened by the Secretary and assistant Secretary and the results will
then be announced after the 3-dayprotest period by the Chairperson and a certification of
election results will be sent to the respective department for posting.
8. All ballots shall be retained by the Secretary for one (1) year. After the one-vear period.
the Secretary shall prepare the ballots for destruction as authorized bv the State of
Washin ton General Records Retention Schedule & Destruction Authorization.
1.11 Disability Board Officers
D.
. Boardmember shall serve a two-year term. In the
event of a vacancy, a successor shall be apqointed or elected in the same manner as with
an original appointment or election to serve the remainder of the unexpired term or to
beQn a new term. (Rev 5/94)
3. Secretary - The Secretary shall keep the minutes of all regular, adjourned and special
meetings of the Disability Board; such minutes shall be approved by the Board and copies
shall be distributed to all members of the Board, Police and Fire Chiefs and the Board
physician. The Secretary shalt give notice of all regular and special meetings to the board
members and post all notices of adjournment or continuance of ineetings and public
and/or disability hearings; shall prepare the agenda of regular and special meetings; shall
serve proper and legal notice of all public and/or disability hearings; and shall draft and
sign routine correspondence of the Board, and prepare the LEOFF Board approved
claims for pavment accordinq to the policies and procedures established bv the Citv of
Auburn's Finance Department. The Secretary shall maintam a file of all rules, findings,
orders, recommendations and all other official records of the Disability Board.
Page 40
City of Auburn
LEOFF Board Policies and Procedures
1.13 Minutes
The Secretary shall take and prepare the official minutes of the City of Auburn Disability Board
containing the actions of the Board and a subsEanE+a4 summarv account of the proceedings. A
record of the Board members present and absent shall be entered, oth thB ayes, along . and recordin4 of action authorized bv the Board. The
minutes shall be signed by the Secretary and the Chairperson and placed on record after approval
by the Board. Copies shall be distributed to all members of the Board and the City of Auburn
Executive Office, Police Chief, Fire Chief, Finance Director, those persons of
record who have reauested such copies to the Secretarv.
2.03 Adds 2.03, Disability Leave Period
Disabilitv leave aeriod is a period six months or anv portion thereof durinp which a member is on
leave at an allowance eaual to the members' full salarv at the time he/she beaan his/her qeriod of
disabditv leave and prior to the commencement of anv disabilitv retirement (as provided in RCW
41 26 030{191 and AGO 1978-8).
2.04 Adds, Unless otherwise directed b the Board in s ecific instances the LEOFF Board utilizes the
services of Ob'ective Medical Assessment Cor oration to re uest the services of licensed and
practicina a" dulyphvsician or phvsicians •
2.07 Adds new section, Conditional Return
"Conditional return" is a return to duty bv a member for the purqose of determininq whether the
member's disability persists.
3.02 Adds to existing section the following: The dearee of persuasion is by a preponderance of the
evidence To satisfv the preponderance of evidence standard the Board must be persuaded that
the propositions asserted bv the applicant are more qrobablv true than not true.
3.14 When a member returns from a disabiliry leave, he/she must submit a signed slip from all
attending physicians treating the disabling condition to the Disabilitv Board Secretary authorizing
his/her return. ,
Insert, The Disabilitv Board Secretarv shall then notifv the apqropriate
Department Head Personnel Director and other staff Upon receipt of the reauest to return to
work the Deqartment Head shall submit his/her written recommendation to the Disabilit Board.
The Disabilitv Board shall then take approqriate action on the request.
4.01 Adds to the first sentence, ...disability leave, or sooner as the Board mav reauire, in order to
determine #he# the member's eligibility for disability...(As provided in WAC 415-105-050[1].
4.02 Replaces the word, ...If the evidence shows to the satisfaction of the Board that the member is
physically and/or rnentally ((psychologically)) disabled from further performance of duty and that
the disability has...
Replaces the word in the second paragraph, ...In order to receive a disability retirement
allowance; the applicant will be required to prove that he/she is physically and/or Fnentall
psvchologicallv disabled to such an extent...
4.03 Adds: Unless the Board at its discretionaryapproval chooses to relv upon the opinion of the
treatinp phvsician everv decision and order revokma a disabilitv retirement shall be in writina or
Page 41
City of Auburn
LEOFF Board Policies and Procedures
stated in the record and shall be accomeanied bv findings of fact and conclusions of law. The
member shall be notified of the decision and order by certified mail return receipt.
4.04 Added a second paragraph to read: Each member who is under 49.5 years of age and placed on
disability retirement is subject to periodic review, unless the Findings of Fact state there is no
chance of rehabilitation. The periodic review includes a medical examination and completion of
the Board's re-evaluation questionnaire, every six months, to determine whether disability
retirement should be continued.
Adds paragraph four to read: Fees charged for medical evaluation report letters for required re-
examination of disability retirees under the age of 49.5 years may be covered by health insurance
providers. The Board will consider authorizing payment for fees charged for medical reports
toward fulfillment of the periodic medical examination review which have been shown to have first
been submitted to the member's health insurance provider. The Board will cover the amount of
the billing not reimbursed by or rejected by the health insurance provider.
4.05 Adds Section 4.05, Discontinuation of a Retirement Allowance. Notice of, to Policies and
Procedures and moves paragraphs two, three and four of Section 4.04 to Section 4.05.
Paragraph two in Section 4.05 is moved to Paragraph one. Paragraph three in Section 4.04 is
moved to Section 4.05, Paragraph two. Paragraph four of Section 4.04 is moved to Section 4.05,
paragraph three.
In Paragraph 1, adds, The member shall be notified of the Board's action to discontinue or cancel
his/her retirement allowance by mail, and the notification shall contain notice of the time, place
and that the hearing will be to determine whether the member continues to be disabled.
5.02 This section was revised to the following:
Subpoenas
The Board may compel the attendance of a witness at any hearing as follows:
A. The Board may issue a subpoena on its own motion or on the request of any party;
B. If an individual fails to obey subpoena, or obeys a subpoena but refuses to testify when
requested concerning any matter under examination or investigation at the hearing, the Board
may petition the superior court of the County where the hearing is being conducted for
enforcement of the subpoena. The petition shall be accompanied by a copy of the subpoena
and proof of service, and shall set forth in what specific manner the subpoena has been
complied with, and shall ask an order of the court to compel the witness to appear and testify
before the Board.
C. Witnesses subpoenaed to attend such a hearing shall be paid the same fees and allowances,
and in the sam.e manner and under the same conditions, as provided for witnesses in the
courts of this State by RCW 2.40 and by RCW 5.56.010, as now or hereafter amended:
Provided, that the Board shall have the power to fix the allowance for meals and lodging in
like manner as is provided in RCW 5.56.010, as now or hereafter amended, as to courts.
Such fees and allowances, and the cost of producing records required to be produced by its
subpoena, shall be paid by the Board, or by the party requesting the issuance of the
subpoena.
8.02(F) Corrects the first sentence to read, The Board may presume that each individual who has
attained the age sixty-five (5) LQ5) is eligible for Medicare...
Corrects the last sentence to read, ...which is paid by Medicare, the Board w+41 mav authorize
the payment of the excess.
Page 42
City of Auburn
LEOFF Board Policies and Procedures
8.03(B) Adds, ...The Charges for the following medical services and supplies as provided in RCW
41.26.030 f221:
9.01(A) Adds to the first paragraph, All medical expenses incurred and claimed for reimbursement by
the member will be submitted throuQh the member's health insurance provider(s) BEFORE
the claim is sent to the Board for approval The medical exqenses claim submitted for
reimbursement is to be that portion NOT covered bv the existmp health insurance
provider(s))).((Rev 8/94))
9.01(A)(1) Adds Subsection 1, The Board mav presume that each individual who has attained the aae of
sixty-five (65) is eliqible for Medicare and will not authorize pavment for necessarv medical
services where such expenses are met by Medicare pursuant to RCW 41.26.150. It is each
members' responsibility to obtain Medicare insurance whether or not the emplover pavs the
premiums.
9.01(A)(2) Adds Subsection 2 Members are advised to consult their employer or personnel office
reqarding eligibilitv for Medicare health insurance coveraae Parts A and B. Where the
expense of necessarv medical services exceeds that which is paid by Medicare, the Board will
authorize the payment of anv balance which may exist after coordmation of benefits_with the
provided medical insurance carrier.
9.01(B) Adds the following at the end of the first sentence, Members are advised to consult first with
their health insurance providers or their employer/personnel officer to learn what is or is not
covered in existinq health insurance BEFORE incurnng treatment services. Elective medical
procedures suraerv and/or aqpliances/supplies mav not be covered by the health insurance
provided by the emplover or authorized bv the Board.
9.010 Adds, The burden is upon the claimant to establish necessity of a provided medical service
and that the reasonableness of the service charge in order for the Board to consider the claim
for navment.
9.01(D) Adds, ...all explanation of benefits insurance documentation forms showing the amount they I
paid and/or rejected and any physician documentation necessary to support a claim.
Deletes the following:
. A copy of the doctor(s) bill(s)
. King County Medical Explanation of Benefits documentation form (or other insurance
carrier(s) showing the amount they paid and/or rejected,
9.01(E) Adds and deletes the following: Submit the claim with the above information to your LEOFF
Representative by the last Tuesdav of the month. oOF tO the FegulaFly sGhedt
LE`~ Q LEOFF Board agendas are
prepared the last Wednesdav of the month and mailed to each Board member at their last
address of record. Any claims submitted after that date will be held until the next regularly
scheduled LEOFF Board meeting the first Monday of each month.
9.01(F) Adds and deletes the following: If t" a,., the LEOFF Board approves
the claim for payment, the claim will be processed~ ((accordincLto established Finance
Departrrient policies and procedures.)) (Rev 5/94)
9.01(K) This section is added.
9.01(L) This section is added.
10.03 This section is added:
SeverabilitYClause
The LEOFF Board Policies and Procedures are declared to be separate and severable. The
invalidity of any clause, sentence, paragraph, subdivision, section or portion of these policies,
or the invalidity of the apptication thereof toany person a circumstance shall not affect the
Page 43
City of Auburn
LEOFF Board Policies and Procedures
validity of the remainder of these policies, or the validity of its application to other persons or
circumstances.
Claim Form: Added a statement to the Claim For Payment Form to read, " The medical provider first
submits to the members insurance.provider any costs for medical evaluations and/or
medical reports. After the member's insurance provider has made a determination on the
claim, the LEOFF member then submits to the LEOFF Board Secretary a claim for any
unpaid costs.
REVISED 215/96 - Effective in 30-davs
8.02 (E), Medical Services - General Guidelines
The Board will authorize the payment of the expense of an eye exam by an
optometrist.
9.02 Medical Claims for Corrective Lenses
The City of Auburn LEOFF Board will authorize a flat payment of prescription corrective
lenses including frames up to $175.00 every two (2) years. Lenses for glasses which
involve special prescription due to injury, disease or other unusual circumstances will be
considered on a case-by-case basis for exception to the $175.00 maximum limit. Any
insurance benefits provided by the City or other sources will be applied toward the
$175.00. Any amount o.ver the $175.00 will be the responsibility of the applicant.
1.) $100.00 for frames every two years (24 months).
2.) $ 75.00 prescription lenses every 1 year (12 months).
3.) $175 for prescription contact lenses every 2 years (24 months).
REVISED July 22, 1996
9.02, Medical Claims for Corrective Lenses
. Any amount over the $1.75.00 will be the responsibility of the applicant except as
indicated above.
REVISED at the September 3, 1996 & designated Price/Costco as hearing aid provider
REVISED at the December 2, 1996 LEOFF Board Meeting
9.01 (A)(1)
Pursuant to RCW 41.26.150(5) medicare premiums supplementing other medical
insurance coverage are authorized for reimbursement upon receipt of Form SSA-1099,
Social Security Benefit Statement, showing annual medicare premiums paid for individual
members.
9.03 Medical Claims for Hearing Aids
The City of Auburn LEOFF Board will authorize a payment for hearing aid(s) up to an
amount determined by the LEOFF Board designated hearing aid provider (Price/Costco
Page 44
City of Auburn
LEOFF Board Policies and Procedures
as of 1/1/97). The LEOFF Board will consider payments for a hearing aid device every
five (5) years. Any claim submitted by a member who choses not to use the LEOFF
Board designated hearing aid provider or lives outside the service area is subject to
review by the LEOFF Board's designated hearing provider and will be limited to
reimbursement up to what the designated hearing aid provider would charge. Hearing
aids prescribed due to injury, disease or other unusual circumstancess will be considereci
on a case by case basis for exception to this policy. The Board will also authorize the cost
of necessary repairs however, routine maintenance and batteries shall be the members
responsibilitv.
9.04 Rejected Claims (renumbered)
9.05 Filing Appeal in Cases Involving Claims for Medical Services (renumbered)
9.06 Medical Claims for Services Where Insurance Benefits Have Been Expended
(renumbered)
9.07 Medical Claims for Services Where Treatment is Not Covered by Insurance
(renumbered)
9.08 Medical Claims for Board Required Re-examinations (WAC 415-105-0901)
(renumbered)
Revised January 3, 2000
9.04 Skilled Nursing Facility Care Reimbursement
A. The City of Auburn LEOFF Board will provide reimbursement for the reasonable
expenses incurred by a LEOFF I member needing the services of a skilled
nursing facility. Expenses which shall be reimbursed may include:
1. An amount not to exceed the daily benefit for nursing care under the
City's existing long term care insurance.
2. The semi-private room and board rate plus the "level of care" charge
where charged separately by a skilled nursing facility so long as the total
does not exceed the Board allowed rate.
3. Charges for medically necessary physician prescribed medications,
medical services (e.g. x-rays) and other medically necessary physician
prescribed supplies.
B. Non-medical charges, including but not limited to hair care, personal toiletries and
sundries, bed holds, and recreational events organized by the skilled nursing
facility shall not be reimbursed.
C. Before any skilled nursing facility charges may be reimbursed, the Board must be
provided with a letter from the member's attending physician stating medical
necessity for and estimated duration of skilled nursing facility care. Private room
charges may be reimbursed provided the Board is supplied with written
Page 45
City of Auburn
LEOFF Board Policies and Procedures
documentation of inedical necessity for the same from the member's attending
physician. The question of inedical necessity for skilled nursing facility care may
be subject to annual or more frequent review by the Board at the Board's
discretion.
D. All charges must be submitted to the appropriate insurance carriers, Medicare,
Medicaid or other available long-term care insurance before submission to the
Board. The Board may reduce the amount of reimbursement for skilled nursing
facility care by the amount a LEOFF I member receives from these other sources.
E. The Board reserves the right, at its sole discretion based on the record before it,
to approve or disapprove reimbursement for skilled nursing facility care incurred
bY a LEOFF I member.
F. The Board shall only reimburse for services rendered; advance payment of any
charges will not be made by the Board.
9.05 Home Health Care Reimbursement
A. The City of Auburn LEOFF Board may provide reimbursement for the reasonable
expenses incurred by a LEOFF I member needing the services of home health
care. It is the intent of this policy to reduce the amount paid for skilled nursing
facility care.
1. Before any home health care charges may be reimbursed, the Board
must be provided with a"Medical Request for Home Health Care" form
completed by the member's attending physician. The physician shall
state the medical necessity and the estimated length of time during which
home health care will be required and the type of care required (medical,
daily living, and/or other). This form may be obtained from the LEOFF ~
Board Secretary. The attending physician must provide to the Board a
description of work to be performed by the home health care provider.
This description is to be as detailed as possible. The question of inedical
necessity for home health care may be subject to annual or more
frequent review by the Board, at the Board's discretion.
2. The total amount allowed shall not exceed the current Board allowed rate
for skilled nursing home care as provided for in the Skilled Nursing
Facility Care Reimbursement Policy.
3. All charges must be submitted to the appropriate insurance carriers,
Medicare and other available long-term care insurance before
submission to the Board.
4. The Board shall only reimburse for services rendered; advance payment
of any charges will not be made by the Board.
5. The Board reserves the right to have an independent assessment agency
evaluate the member's home health care needs. The Board also
reserves the right to approve or deny home health care reimbursement
based upon the findings of the independent assessment agency.
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City of Auburn
LEOFF Board Policies and Procedures
6. The Board will not reimburse for home health care provided by an
individual who ordinarily resides in the member's home, or is a member
of the family of either the member or the member's spouse.
7. Requests for reimbursement shall be made on a Claim for Payment form.
All explanations of benefits insurance documentation forms showing the
amount paid and/or rejected and any physician documentation necessary
to support the claim must be attached.
8. The Board reserves the right, at its sole discretion based on the record
before it, to approve or disapprove reimbursement for home health care
expenses incurred by a LEOFF I member.
9.06 Rejected Claims (renumbered)
9.07 Filing Appeal in Cases Involving Claims for Medical Services (renumbered)
9.08 Medical Claims for Services Where Insurance Benefits Have Been Expended
(renumbered)
9.09 Medical Claims for Services Where Treatment is Not Covered by Insurance
(renumbered)
9.10 Medical Claims for Board Required Re-examinations (WAC 415-105-0901)
(renumbered)
REVISED January 7, 2002
1.11(E)(1) Disabitity Board Officers
Correct typographical error to insert period.
2.04 and 3.12 Board Doctor and Medical Reports
Change "his" to "his/her".
3.13 Examination by the Board Physician
Delete the words "his/her"
3.14 Return to Duty
First line, change the period to a comma.
8.02(E) Medical Services - General Guidelines
An optometrist licensed under the provisions of Chapter 18.53 RCW or an
ophthalmolo4ist licensed under Chapter 18.71 RCW.
8.03(B) Medical Services - Defined
An optometrist licensed under the provisions of Chapter 18.53 RCW or an
ophthalmologist licensed under Chapter 18.71 RCW.
Page 47
City of Auburn
LEOFF Board Policies and Procedures
9.01 Medical Claim Procedure
9.01(I) Change first line to read in part: "All claims, except prescription claims, shall be submitted
to the Board within ninety (90) days of
9.01(J) Adds new paragraph "J" to read: Prescription claims shall be submitted to the Board
within twelve (12) months from date of purchase. This policy shall applv to all prescription
claims purchased on or after January 1. 2002.
9.01 Re-letter paragraphs J, K and L to paragraphs K, L and M, respectively.
9.02 Medical Claims for Corrective Lenses and Frames
Replaces existing section with the following: Medical Claims for Corrective Lenses and
Frames
Reimbursement rates for corrective lenses and frames are based on the Board's
desiqnated corrective lenses and frames service provider. Costco, and will be reviewed .
everv two years. Any claim submitted by a member who chooses not use the LEOFF
Board desianated corrective lenses and frames service provider or lives outside the
service area will be limited to reimbursement up to what the designated corrective lenses
and frames service provider would charge.
A. Lenses and Frames. '
1. Active LEOFF 1 Members '
Vision insurance coveraqe is provided for active LEOFF 1 members
throuqh Vision Service Plan. If any balance remains after Vision Service
Plan, or any other vision plan the LEOFF I member is enrolfed in, has
paid its benefit, the member should forward a copy of the Explanation of
Benefits statement together with a completed Corrective Lenses and
Frames Worksheet to the LEOFF Board for consideration. The LEOFF
Board will reimburse up to the amounts described below. The
reimbursement rates apply after all insurance coveraqes have been
. applied. Any balance due after the LEOFF Board reimbursement is the
responsibility of the LEOFF I member.
Single Vision $ 40.00
Bifocal $ 60.00
Trifocal $ 80.00
Progressive $100. 00
Contacts (must be medically necessarx):
Hard $ 40.001pair
Soft $ 15.001six pack
Frames $ 90.00
Corrective lenses will be elipible for reimbursement every vear (12
months). Frames will be eligible for reimbursement every two years (24
months .
2. Retired LEOFF I Members
Eye examinations for retired LEOFF I members are to be charaed to
Reqence BlueShield. The retired LEOFF I member maY purchase from
the optician or oi)hthalmologist of his or her choice.
Page 48
City of Auburn
LEOFF Board Policies and Procedures
The member should forward a completed Corrective Lenses and Frames
Worksheet to the LEOFF Board for consideration for any lenses and
frames exaense. The LEOFF Board will reimburse up to the amounts
described below. The reimbursement rates applv after all if any,
msurance coveraqes have been applied Any balance due after the
LEOFF Board reimbursement is the responsibilitv of the LEOFF I
member.
Sinale Vision $ 40 00
Bifocal $ 60 00
Trifocal $ 80 00
Proaressive $100 00
Contacts (must be medically necessarx) •
_ Hard $ 40 00/pair
Soft $ 15 001six aack
Frames $ 90 00
Corrective lenses will be eliqible for reimbursement every vear (12
months . Frames will be elipible for reim
bursement everv two years,124
months .
B. Laser Vision Correction
The Board will reimburse the member the amount of $700 per eye for Radial
Keratotomv (RK) surqerv or laser eye surgerv (LASIK and RK) If a member is
reimbursed the $700 per eve for the surqery, he or she will not be reimbursed for
eveplasses or contact lenses durin4 the subsequent two calendar years unless
evealasses or contact lenses are medicallv necessary
9.05(A)(6) Home Health Care Reimbursement
Changed to read:
The Board will not reimburse for home health care provided by an individual who
ordinarily resides in the member's home, or is a member of the family of either the
member or the member's spouse, unless the individual is a licensed home health care
rovider.
10.02 Formal Adoption
Changed to read:
Revisions of the Board's policies and nrocedures shall be adopted no later than the
reqularlv scheduled Board meeting in February of the year of review "
Appendix A Amended to reflect current membership and member information.
Appendix B To include new Corrective Lenses and Frames claim form.
REVISED October 6, 2003
1.01 Membership subsections changed as follows due to state law, S65090:
B. One (1) LEOFF 1 or LEOFF 2 firefighter te-be elected by wo•,;.e u„a--,etoreQ
i ' those members subject
to the iurisdiction of the Board LEOFF 1 active or retired. Elections for firefighter
representative shall be in even numbered years.
Page 49
City of Auburn
LEOFF Board Policies and Procedures
C. One (1) LEOFF 1 or LEOFF 2 police officer te-be elected by a^+^•° ^^d F°+;r^a
those members
subject to the jurisdiction of the Board. LEOFF 1, active or retired. Elections for
police officer representative will be in odd numbered years.
1.05 Elections subsections (A) and (13)(2) changed to read as follows due to state law,
SB 5090:
A. The election of a LEOFF firefighter representative shall be by secret ballot of all
active and retired LEOFF 1 firefighter personnel and shall be held during the
month of December of every even numbered year. The election of the LEOFF
law enforcement officer representative shall be by secret ballot of all active an
retired LEOFF 1 law enforcement personnel and shall be held in December of
every odd numbered year. The name of the elected LEOFF law enforcement
officer and firefighter member shall be noted in the minutes of the next regular
meeting of the Board subsequent to the election, along with the term for which
elected. Each member will hold office for a period of two (2) years, or as soon
thereafter as the successor is elected.
B. Election procedure for election by secret ballot shall be
2. After the November meeting and upon receipt of nominations, the I
Secretary shall prepare ballot packages which shall contain: a) ballot, b)
self-addressed pre-stamped envelope for returning the ballot, c) a letter
sized envelope with no markings on it in which the marked ballot is to be
enclosed, and d) an information sheet explaining who is running for the
position and the deadline date by which the Secretary shall have to i
receive all ballots. Ballots will be mailed to those LEOFF members
subject to the jurisdiction of the Board. LEOFF 1 members, active or
retired.
REVISED January 5, 2004
1.04 Meeting (meeting date changed from first Monday to first Tuesday of the month
REVISED February 3, 2004
9.02 Medical Claims for Corrective Lenses and Frames modified to reflect flat rate for
reimbursement
A. Active LEOFF 1 Members
Vision insurance coverage is provided for active LEOFF 1 members through Vision
Service Plan. If any balance remains after Vision Service Plan, or any other vision
plan the LEOFF I member is enrolled in, has paid its benefit, the member should
forward a copy of the Explanation of Benefits statement together with a completed
Corrective Lenses and Frames Worksheet to the LEOFF Board for consideration.
The LEOFF Board will reimburse up to the amounts described below. The
Page 50
City of Auburn
LEOFF Board Policies and Procedures
reimbursement rates apply after all insurance coverages have been applied. Any
balance due after the LEOFF Board reimbursement is the responsibility of the
LEOFF I member.
nn
2 wn. ~
w T~
aweeal Q an nn
T •1beai Q nn•nn
-~-r
PrvgressfV - yQ,100.0n
u ,,r $ ro nn~:r
c a Q 15 n":
Fmn.es $90. nn
2B. Retired LEOFF I Members
Eye examinations for retired LEOFF I members are to be charged to Regence
BlueShield. The retired LEOFF I member may purchase from the optician or
ophthalmologist of his or her choice.
The member should forward a completed Corrective Lenses and Frames Worksheet
to the LEOFF Board for consideration for any lenses and frames expense. The
LEOFF Board will reimburse up to the amounts described below. The
reimbursement rates apply after all, if any, insurance coverages have been applied.
Any balance due after the LEOFF Board reimbursement is the responsibility of the
LEOFF I member.
Single V;sie Q 40.00
~oc-al c an nn
T 'F / N 80/1/1
R{'-ogre$$j Q700.00-
u „r Q 40nni ai.
c t+ Q Ign";.,
' "'r_'_._
,~-~c.,,,,~ ~ aon•nn
C. Vision Benefits
Payments for eyealasses and contact lenses plus the reasonable costs of necessarv
eye examination services of a licensed ophthalmoloaist or optometrist, will be
agQroved oursuant to the authority aranted to the Board under RCW 41.26.150, if
eyealasses are prescribed by an ophthalmoloQist or optometrist.
The Board will approve payment for one pair of eyeglasses or contact lenses, at the
member's option or as prescribed to correct vision when reauired for a new
prescription in accordance with the followina schedule:
1 Eye4lass Lenses and Frames: $200 00 maximum per single set of frames and
qair of lenses not more than once ever rLtwelve (12) consecutive months. Lenses
covered include single vision, bifocal, or trifocal lenses.
Page 51 '
City of Auburn
LEOFF Board Policies and Procedures
2. Second Pair: A second pair of monofocal (i.e. computer) qlasses shall be
approved onlv if prescribed by a ophthalmologist or licensed oqtometrist. The
maximum cost of the second pair shall not exceed $200 per single set of frames and
pair of lenses not more than once in a twenty-four (24) consecutive months.
3. Contact Lenses: $100.00 per lens not to exceed $200 maximum during any
twelve (12 month period includinq disposable contact lenses.
4. Replacement: Claims for rei)lacement pair of eyeqlass frames and/or lenses or
contacts will be allowed if proof of damage is provided and shown to have been
incurred in the perFormance of a member's fire or law enforcement duties. Only one
replacement pair per year, due to accidental damaae, will be allowed, not to exceed
the amount allowable above.
5. Additional/Spare Pair: No reimbursement will be made for a spare pair of plasses
or contact lenses.
13.D Laser Vision Correction
The Board will reimburse the member the amount of $700 per eye for Radial
Keratotomy (RK) surgery or laser eye surgery (LASIK and RK). If a member is
reimbursed the $700 per eye for the surgery, he or she will not be reimbursed for
eyeglasses or contact lenses during the subsequent two calendar years, unless
eyeglasses or contact lenses are medically necessary.
Page 52
City of Auburn
LEOFF Board Policies and Procedures
sec~tion xII
Ikpp4eaxdices Index
12.01 Appendix "A" - Board Membership
Appendix "B" - Forms Samples
R.C.W. 41.26 and W.A.C. 415-105 are available to view at Auburn Public Library. RCW 41.26 is also
available to view at the City Clerk's office. WAC 415-105 is also available to view at the City
Attorney's office.
Page 53
City of Auburn
LEOFF Board Policies 4&
Procedures
Appendix "A"
Board Membership
,
.
Jim Kelly* Police November 22, 1993 December 31, 2005
Police Dept Representative January 1, 1996
(253)931-3081 January 1, 1998
January 1, 2000
January 1, 2002
Janua 1, 2004
Clarence "Bud" Member-at-Large January 4, 1993 December 31, 2004
Larson** January 4, 1999
121 K Street NE January 2, 2001
Auburn, wA 98002 January 6, 2003
Home: 833-5485
Cellular: (206)970-3246
E-mail:
BudCTL comcast.net
Bill Peloza City Legislative January 2004 December 31, 2005
11203 SE 327th St
Auburn WA 98092
Roger Thordarson City Legislative January 2004 December 31, 2004
1111 Pike St NE
Auburn WA 98002
Russ Vandver Fire Representative January 1, 1999 December 31, 2004
Fire Department January 1, 2001
253 931-3060 Janua 1, 2003
*Chair erson Elected Janua 5, 2004
**Chairperson Elected January 5, 2004
ProTem ore
APPENDIX "B"
FORMS SAMPLES