Obtain the Disability Retirement Application, a multi- page form
, by contacting ACERA by mail at 475 14th Street, Suite 1000,
Oakland, CA 94612, ATTN: Disability Unit, or by phone at
Step 2: Complete the Application
ACERA serves as the administrator of your Application process and
of the disability retirement allowance, should it be granted. The
ACERA Disability Unit (D.U.) is within our Benefits Department
and employs Retirement Specialists, who will facilitate your
Application process by providing you with the Application,
conducting an intake counseling session, following up with the
Medical Advisor (M.A.), the Employer, and the Board, and ensuring
the administrative process moves in accordance with applicable
law, ACERA D.U. policy, and the ACERA Disability Retirement
To achieve the goal of submitting a Completed Application, you
must carefully read and respond to all questions in the
Disability Application. Full instructions are in the
Application. Listed below are the areas of information needed for
the completion of your Application.
General Information. We need your contact
information and social security number. Please, fill it out
thoroughly. This enables us to communicate with you regarding
your case. If you change your address and or phone number,
please contact us with your new information.
Application Type. Indicate whether your
Application is SCD or NSCD. Under the SCD section, you may
indicate if you want to be considered for an NSCD, in the event
your disability is found not service connected. You must have
five years of credited service to be eligible for an NSCD.
Reciprocity. As indicated in this section of
the Application, if you are a deferred member and have filed a
disability Application with your current Employer’s retirement
system, you only need provide verification that your disability
has been approved, whether it’s SCD or NSCD, the Effective
Date, your final average salary, and benefit amount from the
reciprocal agency granting the benefit.
Each system is required to pay its proportional share of the
benefit based on the total amount that would have been paid had
all service been in one agency. If you are receiving a
disability benefit with PERS (Public Employees’ Retirement
System), speak to a Retirement Specialist about your ACERA
benefit prior to applying.
Current Status and Expedited Process. Let us
know if you are already retired or if your current state of
health will require an expedited process.
Effective Date. This will be the date you
filed your Application and it is accepted by ACERA or your last
day of compensation, whichever is later. If you file your
Application later than your last day of compensation, you may
request that an Earlier Effective Date be considered. You must
provide medical documentation, with your submitted Application,
supporting your request. It must state that your disability has
been continuous since you left service. You may also request an
Earlier Effective Date, if you believe there was an
Buy Back Option. If you are applying for an
NSCD, you must have five (5) years of credited service with
ACERA. If you do not have five (5) years, and you have eligible
service available to purchase that will provide a total of five
(5) years, the purchase of that service must be complete prior
to filing your Application. A Retirement Specialist can assist
you in determining whether or not you have eligible service
credit to purchase.
Notice of Right to Legal Representation. You
are not required to have an attorney, but you are entitled to
legal representation at your own expense. If you are
represented by legal counsel, please provide your legal
counsel’s name and contact information in this section of your
Current Employment. Your Employer will be
notified when your Application is submitted. Please provide the
current employment information requested in this section of the
Current Work Status with an ACERA Participating
Employer. Please provide accurate information
regarding your pay status, if you are still employed. This
information is important because it will assist in determining
your Effective Date and allow us to counsel you on benefit
Current Non-ACERA Employment. Provide all
information regarding current employment in the event we must
contact you regarding your current Duties, if you are working
for a non-ACERA Employer.
Injury/Illness. Tell us about your disability.
The more complete this information is, the better the Medical
Advisor (M.A.) can make a recommendation on your disability
status. If you have more than one illness/injury, you may
provide information and file the Application for both
conditions. However, you must provide independent supporting
documentation for each. You may not add an additional illness
or injury later into the process without filing a new
Permanent Incapacity from Performing Job
Duties. State the usual Duties you were actually
performing at the time you became disabled and those you were
required to perform. What Duties can you presently not perform
as a result of your injury/ illness? Is your injury/illness
permanent? How has your department accommodated you?
Safety Members’ Injury/Illness. Safety Members
with at least five years of credited service and whose
disability is based on heart trouble, cancer, blood borne
disease, or exposure to a biochemical substance may
automatically be presumed to have a Service Connected
Disability. Please complete this section, if it applies to you
All Medical Treatment within the Past Five (5)
Years. State your health plan providers and history
during the last five (5) years, as well as symptoms/conditions.
Previous Claims Filed. Provide information on
workers’ compensation, state disability, social security, or
other benefits you have applied for.
Additional Information. Add anything that
might help the Board decide your case
Declaration. Your signature indicates you have
reviewed the above with a Retirement Specialist
Your Application is considered complete when you also include the
Essential Functions Job Analysis (EFJA) requested from your
Employer; this is a summary of the usual Duties of your job. If
you need assistance in obtaining an EFJA, please contact your
All medical documents supporting your Application, including
your Medical Provider Statement(s). Give this form to your
treating physician for their use in providing a medical report
supporting your claim.
Authorization to Obtain and Release Records: permission to
release relevant records and information to ACERA for a full
evaluation of your Application.
Attention to detail and thoroughness with your document
submissions are of high importance. An incomplete or altered
Application will not be accepted and will be returned to you in
its entirety. This can result in a delay in processing your
Step 3: Schedule Intake Counseling
Contact ACERA to schedule an intake
counseling appointment. Bring your Completed Application to the
session. All Applicants are counseled in-person by a Disability
Unit Retirement Specialist who assists you throughout the
Phone intake counseling is available if you are physically unable
to come to the office.
During counseling, the following critical topics will be
Eligibility Requirements: Service Connected or Non-Service
Service Retirement Eligibility and Benefits
Effective Date of Disability Benefits
Retirement Allowance Estimates
Tax Withholding/Reporting 1099®
Final Retirement Allowance/Option Contract and Timeline
Current Pay Status/Accruals
Safety Member Presumption of Disability
Documentation Needed to Process Benefits
Health, Dental, and Vision Plan Coverage
Current Beneficiary Designation and Death Benefits
D.U. staff will review your Application for completeness and send
a Confirming Letter stating the acceptance of your Application
requesting further documentation, as needed. When complete, staff
will prepare your Disability Packet and send it to your Employer
for review and Comment Paper submission. You will receive the
same Packet and opportunity to comment. See Step 4.
Information will be sought from your Employer about your job
Duties, injury/illness, and other pertinent data. We may need
Pre-Employment Examination Report, Agency/Department Statement
Form, Occupational Injury/Illness reports, and Medical records.
Your Employer must submit the Statement to us within thirty (30)
days of receiving the request.
Step 4: Employer and Applicant Review of your Disability Packet
Your Employer’s Role
Your ACERA benefits are sponsored by your Employer. Therefore,
your Employer is a Party to your case and has an interest in
whether or not your disability benefit is granted.
Disability Packet and Employer Notification of Application
The Disability Packet contains the Completed Application,
supporting documentation, and related information, as well as a
calculation of your qualifying years of service. It is sent to
you and to your Employer for review.
Comment Papers (30 days)
Once the Disability Packet is received by you and your Employer,
a Comment Paper may be submitted to the D.U. outlining your
respective positions on the Completed Application. Possible
Comment Paper topics from your Employer may include their
assessment of your incapacity, a request for more information, or
that the M.A. examine certain documents more closely. Possible
Comment Paper topics from you may include a letter expressing
your views on the Disability Packet or your current health
Comment Papers must be submitted within thirty (30) days of
receipt of the Disability Packet. They will be marked and become
a part of the Disability Packet. Please notify the D.U. in
writing or by email, if you decide not to submit a Comment Paper.
First Possible I.M.E. Referral
During your Employer review period, your Employer may refer you
for an Independent Medical Evaluation (I.M.E.). The Employer may
also choose the health care professional who conducts the I.M.E.
It is at no cost to you.
Step 5: Medical Advisor (M.a.) Evaluation And Recommendation
Next, the D.U sends the Disability Packet, any Comment Papers,
and any I.M.E. reports to the Medical Advisor (M.A.) for analysis
and recommendation. The M.A. is an unbiased independent
consultant, who reviews the file and provides a written Report
and Recommendation to ACERA’s Board of Retirement to grant or
deny the Application within 45 business days of receiving the
The M.A. Report and Recommendation addresses whether you are
Physically or mentally capable of substantially performing
the usual Duties of your job
Incapacitated and the source is Service Connected or
Physically or mentally capable of substantially performing
the usual Duties of your job from the date you discontinued
service and have been continuously disabled since that time
Capable of performing another position based on the treating
If you are recommended for disability, the M.A. Report also
addresses whether you will be required to undergo annual
Second Possible I.M.E. Referral
The M.A. may request additional documents/information from the
D.U and make referrals for your examination by an I.M.E. An
extension of time for the M.A. Report and Recommendation is
triggered by a consultation referral or requests for information.
Step 6: Notice of M.A. Recommendation
Within ten (10) days of receipt of the M.A. written Report and
Recommendation (Report), the D.U. will send a copy of the M.A.
Report to all Parties, along with a Request for Hearing Form.
The case can go in one of two directions at this point in your
Application process as stated below:
The M.A. will recommend you for a disability retirement and
if there is no objection from any Party, the case will go before
the Retirement Board. If this occurs, proceed to Step 8; or
The M.A. does not recommend you for disability retirement or
your case in contested by a Party, proceed to Step 7.
Step 7: Legal Hearing
If your case is contested or the M.A. does not recommend a
disability benefit, you may choose to have your case heard before
a Hearing Officer. Your Employer may request a Hearing, as well,
if they do not agree with the M.A. recommendation.
If any Party desires that their case be heard before a Hearing
Officer they must request it within fourteen (14) days of service
M.A. Report and Recommendation. If you or another Party desires a
Hearing, fill out the Request for Hearing Form. The request must
be signed by the Party requesting the Hearing.
Role of the Hearing Officer
The H.O. conducts a Hearing when the M.A. Recommendation on an
Application is disputed and a Hearing is requested. Hearing
Officers are obtained from a panel of an independent arbitration
system, such as the American Arbitration Association. The H.O.
must be a current member of the State Bar of California whose
name is contained on ACERA’s approved Hearing Officer panel.
Notice of Proposed Hearing Officer
This Notice is sent by the D.U. and identifies the next assigned
Hearing Officer in rotation. Parties have ten (10) days, from
service of the Notice, to challenge the named Hearing Officer in
writing. If a Party exercises a challenge, the next Hearing
Officer in the rotation shall be assigned the case. The other
Party will have ten (10) days from the service of the Notice to
challenge the H.O. in writing.
Withdrawing with and without Prejudice
You may withdraw your Application at any time. However, if you do
so after you are assigned a Hearing Officer, you withdraw with
Prejudice. This precludes you from filing a future Application
based on the same injury/illness.
Withdrawal without Prejudice
You may withdraw your Application without prejudice prior to an
H.O. assignment. An Application withdrawn without prejudice 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.
Notice of Original Hearing Date
Once selection of a Hearing Officer is final, the ACERA Office of
Chief Counsel offers all Parties the option of three Hearing
within ninety (90) days. Once selected, the Hearing date is
dubbed the “Original Hearing Date.” The ACERA Chief Counsel
issues a Notice of Original Hearing Date to the Parties and the
Hearing Officer stating the time and place of the Hearing. ACERA
arranges for a stenographic reporter and interpreter, if needed,
and use of a Hearing room.
Hearings are held at ACERA’s offices. The Hearing Officer must
hold a Hearing within ninety (90) days from the date of their
final selection, except when the ACERA Office of Chief Counsel
authorizes a delayed Hearing date. Without this authorization,
the appointment of the Hearing Officer is vacated and a new
Hearing Officer is appointed.
The Hearing Officer has sixty (60) days from the Original Hearing
Date to receive all of the evidence, both testimonial and
documentary, to complete the Hearing (including any closing
arguments and final briefing), and to close the record.
Hearing Officer’s Decision
The Hearing Officer will send a written report to the D.U.
summarizing the evidence, findings of fact, and making a
recommendation to the Board within forty-five (45) days after the
Hearing is concluded and the record is closed. The document is
called the Proposed Findings of Fact and Recommended Decisions
and complies with the legal requirements of a civil
administrative decision. The D.U. provides all Parties with a
copy, once received at ACERA.
Objection to the Hearing Officer’s Decision
Any Party objecting to a Hearing Officer’s recommendation has ten
(10) days after service of the Proposed Findings of Fact and
Recommended Decisions to submit written objections to the D.U.
The D.U. will send any objections to all Parties and provide a
courtesy copy to the Hearing Officer. All Parties have five (5)
days to respond, in writing, to objections, which will be
incorporated into the record for consideration by the Board.
ACERA’s Chief Counsel has sole discretion to return the matter
back to the Hearing Officer for consideration of the objections
and modification to the Proposed Findings and of Fact and
Recommended Decisions prior to the Board Consideration Date.
I Do Not Want a Hearing
If you do not submit your request for Hearing to the D.U. within
the 14-day limit, the D.U. will place the matter on the calendar
for the next available Board meeting, with at least fifteen (15)
days notice to all Parties of the Board Consideration Date. The
Disability Packet and all subsequent documentation will be
submitted to the Board for consideration, along with an
Step 8: Disability Unit Board Preparation
Before your Completed Application, including a copy of all the
M.A. Recommendations and any Hearing Officer Proposed Findings of
Fact and Recommended Decisions, is sent to the Board for a
decision, the D.U. reviews the file and prepares a written report
to the Board addressing the following matters:
Permanent Disability whether the M.A. Recommendation and the
H.O. Findings support a Board decision determining permanent
incapacity from performing your usual Duties
Service Connected Disability whether the M.A. Recommendation
and the H.O. Findings substantiate the incapacity results from
injury/illness or disease arising out of and in the course of
Non-Service Connected Disability summary of the M.A.
Recommendation(s), and any H.O. Proposed Findings of Fact and
Recommended Decisions regarding the disability not being service
connected. This summary also includes a discussion about the
disability being attributed to intemperate use of alcoholic
liquor or drugs, willful misconduct or violation of law. If you
joined ACERA on or after January 1, 1988, the summary also
addresses whether the disability is due to conviction of a felony
or criminal activity.
Return to Work whether the opportunity for accommodation or
returning to work is supported by the applicable legal standard
Annual Examinations if you are under age 55, whether the M.A.
Recommendation and the H.O. Findings determine that annual
medical exams should be required following disability retirement
Effective Date of Disability recommendation of the date
your disability retirement begins, which is one of three
the date your Application is deemed complete by the D.U.;
the date after the last date you received regular
compensation, whichever date is later; or
if an Earlier Effective Date is requested.
Step 9: Board Action
Consent Calendar Cases
If all Parties are in agreement with the M.A. Recommendation for
granting your disability retirement, your case will be included
on the Board Agenda as a consent item. Consent items are normal
business items that are grouped together and approved as one,
including service retirements and death benefit payments. They
are not addressed individually during the Board meeting. However,
if a Board member or the Employer chooses to address your case,
it will be postponed to the following month so it can be added as
a regular agenda item.
Board Consideration Date: Hearing Cases
All Parties receive notice for the Board Consideration Date,
regardless of a Hearing. ACERA presents your Disability Packet to
the Board on the date noticed to all Parties. The Board may
immediately vote and take action or request that any Party, ACERA
staff, and/or the M.A. respond to questions.
Any Party or their counsel may ask to orally present to the Board
on this date and the Board has sole discretion to grant this
request. Oral presentations are limited to ten (10) minutes and
any other Party can immediately orally respond, but must do so
within a five (5) minute time limit. Additional time for oral
presentation or response is also in the Board’s discretion. New
evidence or witness testimony will not be heard or received by
the Board on this date.
Each decision is based on all admissible evidence presented to
the Board, including but not limited to the M.A. Recommendation
and Hearing Officer Proposed Findings of Fact and Recommended
Decisions. The D.U.’s written administrative report alone is not
deemed evidence by the Board.
After presentations, including consent calendar cases, the Board
may take any of the following actions on your Application:
Approve your Application
Deny your Application
Approve and adopt H.O. Proposed Findings of Fact and
Refer Back to H.O. for further proceedings
Refer to M.A. for additional advice or further information
Refer to D.U. with instructions, such as return the matter
back with specific instructions to the presiding H.O.
Assign the next available H.O., if the matter has not already
been heard before an H.O., with specific instructions to consider
all or limited issues
Take any other action which may assist the Board in making
a decision on the Completed Application.
Receive and review all evidence considered by the H.O.
(including transcripts and affidavits, if any) and make a
decision based on its own independent review of the
testimony and evidence. In doing so, the Board may reject
the decisions of the H.O. and make its own determinations.
Conduct a Board Hearing by setting the matter for a Hearing
and deciding the matter as if it had not been referred to
the H.O. If the Board holds the Hearing itself, the Board
will render its decision by the second regular meeting after
your case is submitted.
A tie vote results in a failure to find in your favor and
constitutes a denial of the Complete Application or the portion
of the Completed Application on which the vote is taken.
Notice of Board’s Action
The D.U. notifies the Parties and their representatives of the
Board’s decision within ten (10) days of the Board Consideration
Date. The Notice of Board Decision includes the decision, the
date the decision was rendered, and notice of the right to
judicial review. The Notice of Board Decision is sent by
certified mail, return receipt requested.
Step 10: Disability Retirement Granted and Calculated
Your granted disability retirement can be Service Connected or
Non- Service Connected and the calculations depend on the
particulars of your case.
Service Connected Calculations
When you retire for Service Connected Disability, you will
receive a lifetime retirement allowance payable in monthly
installments, equal to one-half (50%) of your final average
salary. Or, if qualified for a service retirement, you will
receive your service retirement allowance, if it is greater. Your
benefit amount will not exceed the limitation set forth by
applicable law. Generally, each Reciprocal System calculates its
respective obligations based upon your service with that entity
and each adjusts its payment on a pro rata basis. No retirement
system or political entity is liable for more than its just
financial obligation. Your combined reciprocal benefit will not
be higher than it would have been were all service credit earned
in one system.
Non-Service Connected Calculations
An NSCD benefit is typically one-third (1/3) of your final
average salary. However, this amount will depend on your age and
service credit and is paid in monthly installments during your
Cost of Living Adjustments (COLA)
COLA is equally applied to disability retirement grantees and
regular service retirees.
Step 11: Appealing the Board’s Decision
Any Party may obtain review of the Board’s decision in a court of
law by filing a Petition for Writ of Mandate (Petition) with the
Superior Court of Alameda County (Superior Court) no later than
the ninetieth (90th) day following the date the Board’s decision
is finalized. An extension will be granted if you request the
record within ten (10) days of the decision.
A copy of any Petition filed must be served on all Parties and
the ACERA Office of Chief Counsel.
The process of seeking judicial review through a petition is a
complex legal proceeding and it is beyond the scope of this
website section or the Handbook. However, ACERA recommends that
you seek the advice of an attorney. Please note that strict
deadlines apply to petitions, so you must act promptly to avoid
waiving valuable rights.
Non-Service Connected Disability Retirement Pending Review of
Right to Service Connected Disability Benefits
If the Board determines you are entitled to a Non-Service
Connected Disability retirement, you may accept a Non-Service
Connected Disability retirement benefit while you are pursuing a
rehearing or judicial review concerning your right to Service
Connected Disability retirement. If later determined that you are
entitled to a Service Connected Disability retirement,
appropriate adjustments will be made to your retirement allowance
retroactive to the Effective Date.
Step 12: Reexaminations
The Board may require you to undergo annual reviews and medical
examinations, at ACERA’s expense, if you are under age 55 and
granted a disability retirement. You will be required to complete
a Continuing Disability Questionnaire Form, as part of this
review. These examinations and records are reviewed by the M.A.
who makes a recommendation to the Board regarding whether you
remain permanently incapacitated for the performance of duty. The
Board will determine if you are unable to perform the usual
Duties of the position you held when your disability retirement
Your retirement allowance will be cancelled, if, over a period of
one year, you refuse to submit to a medical examination,
requested information, or provide requested release forms.