Section 50.54. Administration.

 

(1)   Plan administrator. The department shall administer the plan established by this subchapter on behalf of the group insurance board unless otherwise expressly provided in an administrative services contract between the group insurance board and an outside administrator, in which the employee trust funds board concurs.

(2)   Effective date of benefits. The department shall begin payment of LTDI benefits on the later of the following dates:

(a) The first day of the first month beginning on or after 90 days preceding receipt of the application for LTDI benefits by the department.

(b) The first day after the date of termination of employment from the last participating employer by which the recipient was employed, as reported to the department by the employer. When the claimant is on a leave of absence, the date of termination of employment for effective date purposes shall be deemed to be the recipient's last day paid.

(3)   Periodic medical review. The department may require that any recipient shall be examined by at least one licensed and practicing physician, designated or approved by the department, during any calendar year the recipient receives benefits under this subchapter. The examining physician shall file with the department a written report of the examination which shall be in a form approved by the department and indicate whether the recipient is still totally and permanently disabled or, for a recipient qualifying under s. ETF 50.58 (1) only, whether the recipient recovered to the extent that the recipient can efficiently and safely perform the duties required by the recipient's former position as a protective occupation participant and whether the recipient recovered to the extent that the impaired condition is not likely to be permanent.

(4)   Requests for information. The department may request any information on earnings, salary, wages, earned income, compensation or OASDHI benefits or entitlements as it deems necessary to implement the provisions of sub. (2) and s. ETF 50.52 (1) , including but not limited to copies of state and federal income tax returns.

(5)   Application of anti-fraud statute. This subchapter is an employee benefit program created under ch. 40 , Stats. , through rule-making authority expressly granted in that chapter, for purposes of enforcement of the prohibitions of s. 943.395 (1) (c) , Stats. Prohibited acts include presenting or causing to be presented false or fraudulent information, including a claim or benefit application, proof in support of a claim or benefit application, or information which would affect a future claim or application.

(6)   Overpayment. Section 40.08 (4) , Stats., shall apply to obtain repayment of any overpayment of LTDI benefits.

History: Emerg. cr. eff. 10-15-92; cr. Register, May, 1993, No. 449 , eff. 6-1-93.

Note

Form ET-5909, "Recertification Medical Report," is sent to the claimant by the department as necessary. Microsoft Windows NT 6.1.7601 Service Pack 1