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