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HomeMy WebLinkAbout03-07-2006 City of Auburn Law Enforcement Officers and Firefighters Disability Board Tuesday, March 7, 2006 -10:00 AM - Council Conference Room MINUTES I. CALL TO ORDER Chair Jim Kelly called the meeting to order at 10:00 a.m. in the Council Conference Room located at Auburn City Hall, 25 West Main Street in Auburn. Chair Kelly and the following Board members were present: Chair Pro Tem Bud Larson (member-at-Iarge), Member Roger Thordarson, Member Rich Wagner, and Member Russ Vandver. Also present were Board Attorney Joseph Beck and Board Secretary Danielle Daskam. II. APPROVAL OF MINUTES A. Minutes of the February 7.2006 Reoular LEOFF Board Meetino Motion by Chair Pro Tem Larson, second by Member Thordarson to approve the February, 2006 minutes as distributed. MOTION CARRIED. 5-0. III. UNFINISHED BUSINESS A. Pendino Disability Leave/Retirement Applications 1. Russ Vandver Effective Date of Disability: November 1, 2005 Last Day of Service: October 31, 2005 On November 1, 2005, the LEOFF Board approved disability leave for Mr. Vandver effective November 1, 2005 with last day of service on October 31, 2005. Mr. Vandver submitted physician's statements from Dr. Sands dated January 23, 2006 and from Dr. Williard dated February 27, 2006. Mr. Vandver was in attendance and reported on the status of his condition and treatment. Mr. Vandver will be referred to the University of Washington for further treatment. Motion by Chair Pro Tem Larson, second by Member Thordarson to continue Mr. Vandver's disability leave for an additional month or until cessation of disability, whichever occurs first. MOTION CARRIED. 4-0. Member Vandver abstained from voting. LEOFF Board Minutes March 7, 2006 Page 1 City of Auburn Law Enforcement Officers and Firefighters Disability Board Tuesday, March 7, 2006 -10:00 AM - Council Conference Room Chair Kelly spoke regarding the policy requirement to have the Board physician examine applicants for disability retirement during the fifth month of disability leave. Board members discussed Mr. Vandver's existing record of disability and whether an additional examination by the Board physician is necessary or of any further value. Board Attorney Beck spoke regarding the Board's need to determine whether the disability was incurred in the line of duty or not. According to the statute, the Board must consider the following factors when determining whether the disability is an occupational disease incurred in the line of duty: use of tobacco products, lifestyle, physical fitness and weight, heredity factors, and other exposure sources. Chair Kelly suggested that Mr. Vandver be directed to obtain the necessary information, which would otherwise be obtained from an independent examination, from his treating physicians for review by the Board at the next meeting. Motion by Chair Pro Tem Larson, second by Member Wagner to address correspondence to Mr. Vandver directing him to obtain the necessary information, which would otherwise be obtained from an independent examination, from his treating physician(s) for review by the Board at the next meeting. Mr. Vandver requested that the Board continue to consider his original cause for disability leave as well as his most recently diagnosed condition. Board Attorney Beck suggested that each condition be evaluated separately. Chair Pro Tem Larson explained that the intent of his motion is to obtain evidence from Mr. Vandver's treating physicians to determine disability leave retirement rather than utilizing the Board's physician. MOTION CARRIED. 4-0. Member Vandver abstained from voting. B. Medical/HearinoNision Claims There was no pending claim. IV. NEW BUSINESS LEOFF Board Minutes March 7, 2006 Page 2 City of Auburn Law Enforcement Officers and Firefighters Disability Board Tuesday, March 7, 2006 -10:00 AM - Council Conference Room A. Disability Leave/Retirement Applications No new application for disability leave/retirement was received. B. Appeals/Reauests for Reconsideration No appeal or request for reconsideration was filed. C. Medical/HearinoNision Claims 1. Stan Laatsch Request for reimbursement of vision expenses (lenses) in the amount of $97.00 dated January 24, 2006. (Mr. Laatsch has not received vision expense reimbursement within the last year.) Motion by Chair Pro Tem Larson, second by Member Vandver to approve Mr. Laatsch's claim in the amount of $97.00 MOTION CARRIED UNANIMOUSLY. 5-0. 2. Russ Vandver a. Claim for Regence Explanation of Benefits Statement #0601332386400 processed on January 25, 2006 for medical services received on October 5 and December 13, 2005 in the amount of $118.43. Motion by Chair Pro T em Larson, second by Member Thordarson to approve Mr. Vandver's claim in the amount of $118.43. MOTION CARRIED. 4-0. Member Vandver abstained. b. Claim for reimbursement of medical expenses incurred on January 31,2006 in the amount of $120.00 Chair Kelly noted that the claim was not accompanied by an explanation of benefits statement. Mr. Vandver explained that the billing was not transmitted to Regence as it was not a covered expense. The billing is for the dictation and transcription of a letter by one of his treating physicians as requested by the Board. Motion by Chair Pro Tem Larson, second by Member Thordarson to waive the requirement for the explanation of LEOFF Board Minutes March 7, 2006 Page 3 City of Auburn Law Enforcement Officers and Firefighters Disability Board Tuesday, March 7, 2006 - 10:00 AM - Council Conference Room benefits statement and approve the claim in the amount of $120.00. Upon further discussion and review of the Board policies, Chair Pro Tem Larson withdrew his motion. Motion by Chair Pro T em Larson, second by Member Thordarson to table the claim and request that the claimant, Mr. Vandver, submit the expense to Regence and submit the explanation of benefits statement to the Board. MOTION CARRIED. 4-0. Member Vandver abstained. 3. Ed Henderson Request for reimbursement of vision expenses in the amount of $212.01 dated February 27, 2006. (Mr. Henderson has not received vision expense reimbursement within the last year.) Motion by Member Thordarson, second by Chair Pro Tem Larson to approve the claim in the amount of $200 pursuant to Board policy. MOTION CARRIED UNANIMOUSLY. 5-0. D. Discussion 1. Policy and Procedure Manual Review LEOFF Board reviewed the following proposed amendments to the LEOFF Board Policy and Procedure Manual: . Policy 1.11 (E)(1) delete the word "and" at the end of the first line of the paragraph. . Amend Policy 3.05, second paragraph, to read as follows: All law enforcement officers and firefighters who qualify for disability leave mayare 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. Sick leave is not reimbursed upon approval of disability leave. . Amend Policy 8.02(D) to read as follows: LEOFF Board Minutes March 7, 2006 Page 4 City of Auburn Law Enforcement Officers and Firefighters Disability Board Tuesday, March 7, 2006 -10:00 AM - Council Conference Room Dental expenses will not be considered necessary medical services except in those circumstances 'Nhere 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 v.'ay of curing or correcting an existing health problem (See also section 8.03{B}). Dental Expenses: The Board recoonizes that there is an increasino amount of medical evidence to support the assertion that poor dental health can result in a wide variety of other medical problems. Therefore, the followino dental benefits are provided: 1) Dental charoes incurred by a member who sustains an accidental iniury to his or her teeth shall be paid. 2) The expense of one (1) oeneral dental checkup each year will be covered for each member up to an annual maximum amount of $ 3) No more than two (2) dental c1eaninos each year will be covered for a member, unless it is determined, in the discretion of the Board, that a more freQuent c1eanino schedule is medically necessary in a particular case or for a particular member. Routine cleaninos will be reimbursed at an annual maximum amount of $ 4) The dental expenses incurred by a member for routine dental and periodontal work, as may be found by the Board to be medically necessary, will be covered. 5) No dental expenses incurred by a member for dental services or work which is purely cosmetic in nature will be approved or paid, except in unusual circumstances. and then only with the prior written approval of the Board and based upon medical necessity. 6) Dental expenses incurred by a member for teeth whitenino will not be approved. 7) Dentures? Board members reviewed the cost survey for annual dental exams, x-rays, c1eanings and dentures. Members suggested averaging the regional survey of costs for a routine exam and x-rays as one benefit amount for one LEOFF Board Minutes March 7, 2006 Page 5 City of Auburn Law Enforcement Officers and Firefighters Disability Board Tuesday, March 7, 2006 -10:00 AM - Council Conference Room LEOFF Board Minutes March 7, 2006 Page 6 annual dental checkup. Additionally, the Board recommended averaging the regional survey of costs for c1eanings to determine the maximum annual benefit for c1eanings. Board members suggested changing item 4 above to read as follows: "Dental expenses incurred by a member for routine dental and periodontal work must be medically necessary and receive prior approval of the Board." Board members suggested providing for the following language for dentures under item 7 above: "Dentures may be approved; however, prior authorization by the Board is required. Dentures will be reimbursed to a maximum amount of (average of regional cost survey as provided in March 7, 2006 agenda packet) per plate." . Amend Policy 8.03(B) regarding dental charges as follows: Dental charges incurred by a member who sustains an accidental injury to his/her teeth and '.vho commences treatment by a legally licensed dentist '.vithin ninety (90) days after the accidentDental expenses as identified in Policy 8.02(D); . Amend Policy 8.03(B) regarding nursing home confinement to read as follows: Nursing home confinement or hospital care extended facility (see policy 9.04 and 9.05); . Amend Policy 9.04(D) to read as follows: 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. Additionally. if an eligible member elects to not subscribe or participate in a City-provided lono- term care insurance plan. benefits under this section may be reduced or reiected. City of Auburn Law Enforcement Officers and Firefighters Disability Board Tuesday, March 7, 2006 -10:00 AM - Council Conference Room LEOFF Board Minutes March 7, 2006 Page 7 . Amend Policy 9.05(A) to add the following item: 9. If an elioible member elects to not subscribe or participate in a City-provided home health care insurance plan or lono-term care insurance plans that provides home health care benefits, benefits under this section may be reduced or reiected. . Amend Policy 9.01 (E) to reflect the current meeting day as follows: 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 Tuesday of each month. . Amend Policy 9.02(C)(1), (2) and (3) (reimbursement rates) as follows: 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. Eyeolass Lenses and Frames: $200225.00 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 (Le. computer) glasses shall be approved City of Auburn Law Enforcement Officers and Firefighters Disability Board Tuesday, March 7, 2006 -10:00 AM - Council Conference Room only if prescribed by an ophthalmologist or licensed optometrist. The maximum cost of the second pair shall not exceed $~225 per single set of frames and pair of lenses not more than once in a twenty- four (24) consecutive months. 3. Contact Lenses: $-Um125.00 per lens not to exceed $2QQ-250 maximum during any twelve (12) month period including disposable contact lenses. Board members reviewed the regional survey cost of vision lenses and frames and agreed with the above-reflected adjusted reimbursement rates. . Amend Policy 9.02(D) laser vision correction reimbursement rate as follows: 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 $+00-725 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 . Board members reviewed the survey of laser vision costs and agreed with the proposed adjustment in the reimbursement rate. . Appendix A and the manual's cover page will be amended to reflect the current membership and member information. . Incorporate amendments to Policy 8.03(B) and Policy 9.01 (I) adopted during 2005. The final draft of the proposed amendments will be presented to the Board for adoption at the April 4, 2006 meeting. V. ADJOURNMENT There being no further business to come before the Board, the meeting adjourned at 11 :06 a.m. LEOFF Board Minutes March 7, 2006 Page 8 City of Auburn Law Enforcement Officers and Firefighters Disability Board Tuesday, March 7, 2006 -10:00 AM - Council Conference Room APPROVED THE L\. --\-~ DAY OF APRIL, 2006. , iUS:ttIJa~J LEOFF Board Minutes March 7, 2006 Page 9