Agency/Department Statement Related to Application for Disability Retirement Form
Provided to your Employer by ACERA requesting identifying, job duty, and related information from your Department. A completed form also includes a detailed statement about all efforts undertaken to find alternative employment for you within your capacity to perform, the results of this effort, or a detailed explanation why such efforts were not undertaken.
The person or entity filing the disability Application, including an Alameda County Employees’ Retirement Association Member, the Employer, the Board or its agents, or any other person on your behalf who is entitled to claim disability retirement benefits on behalf of a Member.
The date your Application meets all requirements and is filed and accepted by ACERA.
Application for Disability Retirement
The disability retirement Application forms and associated documents you submit to ACERA to identify the exact nature of your incapacity.
Authorization to Obtain and Release Records and Information Form
Legal release providing permission to release relevant medical and employment records and information to ACERA ensuring a full evaluation of your Application.
A person or entity designated to receive an ACERA benefit as a result of a legal arrangement or instrument
ACERA Board of Retirement
Burden of Proof
The Burden of Proof is on the Applicant throughout the entire disability retirement Application process. This means you must prove your case throughout the Application process by a preponderance of the evidence. This includes showing a permanent incapacity (physical or mental) from your performance of duty by demonstrating substantial inability to perform your usual Duties.
The Burden of Proof for Non-Service Connected Disability: You must demonstrate permanent incapacity from substantially performing your regularly assigned job Duties. For Service Connected Disability retirement, you must also demonstrate that the employment contributed substantially to the disability.
Burden of Proof for Safety Members with five (5) or more years of serviceCertain diseases/disabilities are presumed to arise out of and in the course of employment. For these Applicants, it is presumed that your usual job Duties caused your injury/illness and the burden is now on your Employer to prove that the Duties did not cause your injury/illness.
Chief Executive Officer (formerly known as the General Manager (G.M.)
Appointed by the Board as executive manager of ACERA.
An Application for Disability Retirement reviewed and determined by the D.U. to include all necessary attachments and information to support your claim.
Letter from the D.U. confirming your Application is received and has been accepted as complete; or a letter accompanying your returned Application because it is incomplete and further information is required to process your claim.
A decision and/or recommendation objected to or opposed by a Party.
Continuing Disability Questionnaire Form
May be required if you are under 55-years-old and granted a disability retirement.
Continuation of Disability Retirement Proceedings After Death of Member Form
Used by spouse/domestic partner or minor who may be entitled to pursue a deceased Member’s pending disability benefit by completing this form.
Office of the County Counsel of Alameda County that represents and advises the County in legal matters.
Calendar days are every day on the calendar, Sunday through Saturday. When “days” is intended to refer only to business days, Monday through Friday, it is noted.
Delayed Disability Application Affidavit
Submitted when applying for disability retirement more than four months after discontinuation of service to address whether disability has been continuous since the last date of service.
Designation of Legal Representation Form
Filed with the Disability Unit (D.U.) providing notice of your legal representation.
Disability Counseling Worksheet
Used by staff and signed by you, during your counseling session, to ensure all critical elements of the Application process have been reviewed with you.
All relevant documentation received during the Application process, including the Completed Application.
Disability Unit (D.U.)
A team of ACERA employees who handle the processing of disability matters. The D.U. includes Disability Retirement Specialists and the Disability Manager.
The usual Duties of your position that you must be able to perform, with or without reasonable accommodations.
Earlier Effective Date
The disability retirement allowance begins the date your Application is deemed complete by the D.U. or the date after the last date you received regular compensation, whichever is later. You may request that your allowance start at an earlier date by completing section 5 of the Application for Disability Retirement Form and attaching documentation showing 1) when you left service, 2) an inability to ascertain the permanency of your incapacity, and 3) that you have been continuously disabled since you left service. This is the date after the last date you received regular compensation.
The disability retirement allowance begins the date your Application is deemed complete by the D.U. or the date after the last date you received regular compensation, whichever is later, unless an Earlier Effective Date is granted.
The public agency, including the County of Alameda or Participating Employer, by which the Member is employed at the time or immediately before, the Application is submitted to ACERA.
Essential Functions Job Analysis (EFJA) Form
An Employer’s summary of the Duties and requirements of any particular job, including mental and physical demands. This document is generally shared with the Medical Advisor and is used to determine which job(s) within a department, if any, you are capable of performing.
He, him, his, Chairman
Used for convenience and intended that each gender is given exactly equal respect and treatment throughout.
The presentation of evidence to a Hearing Officer (H.O.) toward the development of H.O. Proposed Findings of Fact and Recommended Decisions for consideration of your Application by the Board.
Hearing Officer (H.O.)
Conducts a hearing when the Board Medical Advisor’s Recommendation on an Application is disputed and a hearing is requested. Hearing Officers are obtained for the panel from an independent arbitration system, such as the American Arbitration Association. An H.O. must be a current member of the State Bar of California whose name is contained on the approved Hearing Officer panel.
Independent Medical Examination (I.M.E.)
You may be required by your Employer, the Board of Retirement, or the M.A. to submit to a medical exam by a physician, psychologist, or specialist in the medical condition identified in your Completed Application at no cost to you.
Medical Advisor (M.A.)
The physician(s) advising the Board on disability claim medical matters
Medical Provider Statement
A brief (4 questions), but mandatory, written opinion from your physician addressing whether you are permanently incapacitated from performing your usual Duties. This must be filed with your Application.
An unmarried/unregistered person either 1) under age 18 or 2) under age 22 and regularly enrolled as a full-time student in an accredited school.
Non-Service Connected Disability (NSCD)
A type of disability retirement awarded if you are found permanently incapacitated from performing your usual Duties from a cause unrelated to your employment. You must have completed five (5) years of service and must not have waived retirement in respect to your particular incapacity or aggravation.
Notice of Hearing Officer
Communication used to state the next assigned Hearing Officer (H.O.) assigned to your case; H.O.s are assigned on a rotating basis.
Notice of Original Hearing Date
Communication used to state the time and place of your Hearing.
Employers with staff who are ACERA Members: Alameda County, Alameda County Children and Families, Alameda County Housing Authority, Alameda County Medical Center, Alameda County Office of Education, Livermore Area Parks and Recreation, and Superior Court of California.
The Member who is the subject of the Application, the person preparing and submitting the Application (Applicant, and the Employer.
Prehearing Statement Form
You must complete and serve this form on the H.O. and all other Parties. It must contain 1. a statement of contested issues and party position, 2. witness information and their testimony, and 3. documentary evidence not included in the Disability Packet.
Proposed Findings of Fact and Recommended Decisions
The Hearing Officer’s report on your disability Application summarizing the evidence, findings of fact, and making a recommendation to the Board.
Retirement systems that have established reciprocity with ACERA for providing retirement benefits. Reciprocal Systems are the CERL ’37 Counties, the Public Employees’ Retirement Systems (“PERS”), the State Teachers’ Retirement System, the Judges’ Retirement System, and retirement systems of any other public agency of the State of California that have established reciprocity with PERS by meeting all necessary statutory requirements.
Report and Recommendation
M.A. written analysis recommending the granting or denial your Application.
Request for Hearing Form
Signed by you to request a Hearing before a Hearing Officer.
Service Connected Disability (SCD)
A type of disability retirement awarded if you are found permanently incapacitated from performing your usual Duties. The incapacity must result from an injury/illness arising out of and in the course of your employment, and such employment must have contributed substantially to your incapacity.
Contains your retirement records, such as, enrollment questionnaire, beneficiary information, birth certification, etc.
Supplemental Disability Allowance
A monthly allowance paid in lieu of a full disability allowance, if you have been granted a disability benefit and have accepted alternative County or ACERA Participating Employer work with lower pay. It is equal to the difference between your salary in the former position, for which you were found disabled, and the salary of the new position. It will not to exceed the amount of the full disability benefit.
Treating Physician Narrative Form
An optional, but recommended, detailed (13 questions) written opinion from your physician addressing whether you are permanently incapacitated from performing your usual Duties. This must be filed with your Application.
A decision and/or recommendation that is not objected to or opposed. Uncontested does not necessarily mean all Parties are in agreement with the decision and/or recommendation. The Board retains the discretion to grant or deny an uncontested recommendation.
Withdrawal with Prejudice
Precludes you from filing a future Application based on the same disability or injury/illness. An application withdrawn after an H.O. is assigned is deemed withdrawn with prejudice.
Withdrawal without Prejudice
An application withdrawn at anytime prior to an assignment of an H.O. is treated as though it was never submitted. A subsequent Application, including resubmission of the withdrawn Application, is considered a new Application and must meet all requirements, including timely filing requirements.