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Disability Benefits: Application Process
Rules to Apply for Disability Leave Benefits
Ohio Administrative Code 123:1-33-02
- Your claim must be filed within 20* calendar days of your date last worked to your agency’s personnel office or benefits coordinator.
- If you are disability separated you have a filing deadline of 20* calendar days from the date of your separation.
- You are responsible for providing medical documentation to substantiate your disabling condition.
- You must file for disability retirement if your attending physician has deemed your disabling condition to be permanent.
- You have 20* calendar days from your notification, or within 20* calendar days of your ending date of benefits, to submit additional information.
- You have 30* calendar days from your notification to request an appeal if your claim is denied or if you disagree with the decision rendered.
- You may submit a written statement explaining extenuating circumstances if you are unable to meet the filing deadlines.
- You are responsible for informing your agency or the Department of Administrative Services of any change in your mailing address.
* Contract exceptions for filing FOP 46 & FOP 48, please refer to your contract.
Steps for Applying for Disability Leave Benefits
Step1
Follow your agency’s standard reporting procedure.
Step 2
Obtain from your personnel office or agency benefits coordinator the Initial Application for Disability Leave (Form ADM4310).
Step 3
Employee completes Pages 2 and 3 of the Initial Application for Disability Leave (Form ADM4310 - the Employee Statement section).
Step 4
Provide the ADM4310 to your health care provider to complete Pages 4 and 5 of the ADM4310 Form (the Attending Physician Statement).
Step 5
The employee must submit Pages 2 through 5 to their personnel office or agency benefits coordinator within 20* calendar days from the employee's date last worked (the application is not considered complete or timely without Pages 2 through 5).
Step 6
Your personnel office or agency benefits coordinator must complete the Application for Disability Leave Benefits - Employer Statement (Form ADM 4312) within five days of receipt of an employee’s application and must submit all paperwork to the Department of Administrative Services.
Step 7
If you are asked to submit additional information, if you need to be off longer than anticipated or there is a change in your condition, you must obtain from your personnel office or agency benefits coordinator the Supplemental Report for Disability Leave - Employee Statement (Form ADM4311).
- Employee completes Page 2.
- Employee’s physician completes Pages 3 and 4 (Supplemental Report Attending Physician Statement).
- The employer must complete the Application for Disability Leave Benefits -Employer Statement (Form ADM 4312) or the Disability Supplemental Information Form prior to submitting the application to the Department of Administrative Services.
Note: Additional information must be submitted within 20* calendar days from the date of the letter or 20* calendar days from the ending date of benefits, whichever is the greater date.
* Contract exceptions for filing FOP 46 & FOP 48 - please refer to your contract.
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