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HomeMy WebLinkAbout10-03-2006City of Auburn Law Enforcement Officers and Firefighters Disability Board Tuesday October 3, 2006 - 10:00 a.m. -Council Conference Room MINUTES I. CALL TO ORDER Chair Jim Kelly called the meeti Conference Room located at Aubu Chair Kelly and the following Board Larson (member-at-large), Member and Member Bill Petersen. Also Board Secretary Danielle Daskam. ng to order at 10:00 a.m. in the Council rn City Hall, 25 West Main Street in Auburn. members were present: Chair Pro Tem Bud Roger Thordarson, Member Rich Wagner, present were Board Attorney Dan Heid and II. APPROVAL OF MINUTES A. Minutes of the September 5, 2006 Regular LEOFF Board Meeting Motion by Chair Pro Tem Larson, second by Member Thordarson to approve the September 5, 2006 minutes as distributed. MOTION CARRIED. 5-0. III. UNFINISHED BUSINESS A. Pending Disability Leave/Retirement Applications There was no pending disability leave/retirement request. 6. Medical/Hearing/Vision Claims Alan Kosko June 5, 2006 request from Alan Kosko for pre-approval of dental treatment in the amount of $475.00. On June 6, July 5 and July 31, 2006, the LEOFF Board tabled the above claim pending receipt of additional information that supports the medical necessity of the dental treatment requested. On September 5, 2006, the Board tabled Mr. Kosko's claim pending additional information regarding the cause and effect of the dental condition and treatment as it relates to the existing medical condition. Chair Kelly acknowledged receipt of a handwritten letter from Mr. Kosko dated October 1, 2006 and received by the Board Secretary on October 2, 2006 accompanied by letters from Mr. Kosko's medical doctor, Dr. Arigala dated September 29, 2006, and Mr. Kosko's dentist, Dr. Ryning dated September 14, 2006. LEOFF Board Minutes October 3, 2006 Page 1 City of Auburn Law Enforcement Officers and Firefighters Disability Board Tuesday October 3, 2006 - 10:00 a.m. -Council Conference Room Motion by Member Wagner, second by Member Thordarson to deny Mr. Kosko's claim. Member Wagner stated that he believes that the applicant has not provided sufficient proof of the cause and effect of the dental condition on Mr. Kosko's current health, and that the physician's letter states that the periodontal condition may have a possible effect on Mr. Kosko's health condition. Member Wagner also stated that, in his opinion, the information provided does not satisfy the legal requirement or the intent of the Board as it relates to dental benefits. Member Petersen spoke against the motion stating that he believes that Mr. Kosko has provided sufficient proof of medical necessity. Chair Kelly noted the LEOFF law requires that if treatment is determined medically necessary by a physician, the LEOFF Board must approve the treatment. Chair Kelly added that the LEOFF Board has the option to require the member to undergo an examination by an independent physician or expert to provide the Board with an unbiased opinion. MOTION CARRIED. 3-2. Chair Kelly and Member Petersen voted no. 2. Richard Huseby Request for pre-approval of dental expenses for other dental treatment in the amount of $1507.50. On July 5 and 31, 2006, the LEOFF Board tabled Mr. Huseby's request pending the receipt of additional information supporting the medical necessity of the dental treatment. On September 5, 2006, the Board tabled Mr. Huseby's claim pending the receipt of more specific information from a physician showing the cause and effect of the dental treatment on Mr. Huseby's current medical condition. No new information was received from Mr. Huseby. Motion by Chair Pro Tem Larson, second by Member Wagner to deny the claim due to the lack of response to the Board's request for additional information. MOTION CARRIED UNANIMOUSLY. 5-0. LEOFF Board Minutes October 3, 2006 Page 2 rt City of Auburn Law Enforcement Officers and Firefighters Disability Board Tuesday October 3, 2006 - 10:00 a.m. -Council Conference Room 3. M. Eric Bearscove Request for reimbursement of dental treatments in the amount of $495.00. On July 5 and 31, 2006, the LEOFF Board tabled Mr. Bearscove's request pending the receipt of additional information supporting the medical necessity of the dental treatment. On September 5, 2006, the Board tabled Mr. Bearscove's claim pending the receipt of additional information from Mr. Bearscove's physician regarding the medical necessity of the treatment, including evidence of the cause and effect of the dental treatment on Mr. Bearscove's current medical condition. Chair Kelly acknowledged the receipt of a letter dated September 22, 2006 addressed to the LEOFF Board from Sean Wittmer, DMD (Endodontics) regarding the treatment of Mr. Bearscove distributed prior to the meeting. Motion by Member Wagner, second by Member Thordarson to deny the claim. MOTION CARRIED UNANIMOUSLY. 5-0. 4. Roc1er H. Lee Request for reimbursement in the amount of $110.00 per Regence Explanation of Benefits Claim #0613995027101 for medical services received on April 26, 2006. On July 31, 2006 the Board denied the above claim finding that the medical services were preventative. On August 16, 2006, Mrs. Lee, on behalf of retiree Roger Lee, submitted a request for reconsideration and additional information from Mr. Lee's physician. On September 5, 2006, the LEOFF Board tabled Mr. Lee's claim pending the receipt of specific medical information regarding the reasons and issues for the medical treatment, including, but not limited to, the existing medical condition and the reason for the exam. Mr. Lee submitted a letter from Dr. Nancy Pang in response to the Board's request. Motion by Member Petersen, second by Chair Pro Tem Larson to approve the claim in the amount of $110.00 MOTION CARRIED UNANIMOUSLY. 5-0. 5. Ray Nixon LEOFF Board Minutes October 3, 2006 Page 3 City of Auburn Law Enforcement Officers and Firefighters Disability Board Tuesday October 3, 2006 - 10:00 a.m. -Council Conference Room a. Request for reimbursement of dental x-ray and exam (July 11, 2006) in the amount of $76.00 and tooth extraction (August 9, 2006) in the amount of $128.00 for a total claim in the amount of $204.00. On September 5, 2006, the Board tabled the claim pending receipt of proof of medical necessity for the dental treatment involving the tooth extraction and confirmation whether Mr. Nixon had previously been reimbursed for a dental examination and x- rays. The Board Secretary confirmed that Mr. Nixon has not received any previous dental expense reimbursement. No new information was submitted by Mr. Nixon regarding the tooth extraction. Motion by Chair Pro Tem Larson, second by Member Petersen to approve reimbursement of the dental exam and x-rays in the amount of $76.00. MOTION CARRIED UNANIMOUSLY. 5-0. Motion by Member Wagner, second by Member Petersen to table Mr. Nixon's request for reimbursement of the claim for tooth extraction in the amount of $128.00 pending receipt of the additional information previously requested. MOTION CARRIED UNANIMOUSLY. 5-0. b. Request for reimbursement of dental surgical expenses (July 14, 2006) in the amount of $963.00. On September 5, 2006, the LEOFF Board tabled the claim pending receipt of proof of medical necessity for the dental/oral surgery including more specific information from Mr. Nixon's physician regarding the medical necessity for the treatment, including evidence of the cause and effect of the dental treatment on Mr. Nixon's current medical condition. No new information was received from Mr. Nixon regarding his claim. Motion by Member Wagner, second by Member Petersen to table Mr. Nixon's claim pending receipt of the additional information previously requested. LEOFF Board Minutes October 3, 2006 Page 4 City of Auburn Law Enforcement Officers and Firefighters Disability Board Tuesday October 3, 2006 - 10:00 a.m. -Council Conference Room MOTION CARRIED UNANIMOUSLY. 5-0. 6. John Baker Request for reimbursement of dental expenses in the amount of $2,000.00. On September 5, 2006, the LEOFF Board tabled Mr. Baker's claim pending further information on previous reimbursements, if any. Mr. Baker has not received any prior reimbursement for dentures. Motion by Member Wagner, second by Chair Pro Tem Larson to approve reimbursement of one denture plate in the amount of $1,387.00. MOTION CARRIED UNANIMOUSLY. 5-0. The following claim was added to the agenda. John Baker Request for reimbursement of vision expenses for lenses and frames in the amount of $210.40. Mr. Baker has not received vision reimbursement in the last year. Motion by Member Wagner, second by Member Petersen to approve the claim in the amount of $210.40. MOTION CARRIED UNANIMOUSLY. 5-0. IV. NEW BUSINESS A. Disability Leave/Retirement Applications No new application for disability leave/retirement was filed. B. Appeals/Requests for Reconsideration No appeal or request for reconsideration was filed. C. Medical/Hearing/Vision Claims 1. Fred Fisher Request for reimbursement of dental expenses incurred on June 20 and August 29, 2006: Dental Examination $15.00 LEOFF Board Minutes October 3, 2006 Page 5 City of Auburn Law Enforcement Officers and Firefighters Disability Board Tuesday October 3, 2006 - 10:00 a.m. -Council Conference Room Dental Cleaning $45.00 Motion by Chair Pro Tem Larson, second by Member Petersen to approve the claim in the amount of $60.00. MOTION CARRIED UNANIMOUSLY. 5-0. 2. Vern Fitzgerald Request for reimbursement of dental expenses incurred on July 12 and August 29, 2006 Dental Examination $156.90 Cleaning $ 75.00 Request for reimbursement of dental expenses incurred on September 1, 2006 in the amount of $260.00 LEOFF Board members reviewed the claim for what appears to be examinations and x-rays by two different dentists. Motion by Chair Pro Tem Larson, second by Member Petersen to table the claim pending clarification of the claim. MOTION CARRIED UNANIMOUSLY. 5-0. D. Discussion 1. Proposed Clarification of Policy Section 8.02(D)(4) Chair Kelly explained that prior to the meeting Member Wagner distributed his original draft of a memo addressed to LEOFF 1 members regarding dental expense reimbursement benefit. The agenda packet included a revised memo as edited by Board Attorney Beck. The intent of the memo is to clarify language contained in LEOFF Board Policy 8.02(D). Board members reviewed the two versions of the memo and the policy provisions. Chair Kelly suggested the Board consider a flat rate, such as $1,000, per year for dental expenses. Upon further discussion, the Board members suggested amending Policy 8.02 as follows: LEOFF Board Minutes October 3, 2006 Page 6 City of Auburn Law Enforcement Officers and Firefighters Disability Board Tuesday October 3, 2006 -10:00 a.m. -Council Conference Room D. Dental Expenses: in •. ~nrirtn ~r•-.ri~y~r~~~mn~~i~l r-~r~~. ~Tre-rr°cfvr°c~ thi~°-frv~ir vvnnry 1) Dental charges incurred by a member who sustains an accidental injury to his or her teeth shall be paid. lie-~.~~ef~-~$~et~~h-~-}e~-1~~ °cr-u p tcv-'a -aTrn'a ° I m~ v i m ~~ m ~$~fef~---f81~ a~-~.-,~f,,~e~l~°rcr~-ci'~-rniT,e~~av~-ii-r~°a°ct°crm'rrnref~, '---rn-trV'r~ di'~g'iE~ti'~W'~ CI~-tL~--vva~i v~ t'1-tt'~~i-R--rITP T° f rn ~ i ~ n n t n I n o n i n~ 2~) 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. 36) Dental expenses incurred by a member for teeth whitening will not be approved. 4~) Dentures may be approved; however, prior authorization by _ the Board is required. Dentures will be reimbursed to a maximum amount of $1,387.00 per plate. 5~ Dental related expenses up to an annual amount of $1,000 will be covered. Dental expenses above this amount will be the responsibility of the member. The annual term runs from January 1 of each calendar year to December 31 of the same year. 2. Discussion of medical records at LEOFF Board meetings. Chair Kelly acknowledged a City Attorney Opinion dated September 7, 2006 regarding discussion of medical records at LEOFF Board meetings. 3. Election of Fire LEOFF Board Representative LEOFF Board Minutes October 3, 2006 Page 7 City of Auburn Law Enforcement Officers and Firefighters Disability Board Tuesday October 3, 2006 -10:00 a.m. -Council Conference Room Chair Kelly announced that the election process for the Fire LEOFF Board representative two-year term will begin in October. Requests for nomination will be mailed in October. V. ADJOURNMENT There being no further business to come before the Board, the meeting adjourned at 10:55 a.m. APPROVED THE f7~ DAY OF NOVEMBER, 2006. Ot~W~ Jim elly, Chair u~ "~--- Danielle Daskam, Secretary LEOFF Board Minutes October 3, 2006 Page 8