Law Enforcement Officers' and Fire Fighters' System (LEOFF-1) member information

The board reviews claims for reimbursement of expenses not covered by your health insurance after your jurisdiction submits them to the board for consideration and review. The board then makes a recommendation to your jurisdiction based on the board rules and regulations in effect at the time. Ultimately, however, it is up to your jurisdiction to approve and reimburse you for medical expenses.

Your completed claim forms must be submitted to the board's office so that they are received by the second Wednesday of the month in which you want your claim to be reviewed. Send your claim forms to King County Disability Retirement Board, The Chinook Building CNK-ES-0240, 401 Fifth Avenue, Seattle, WA 98104-2333. The board meets on the last Wednesday of the month.

Your claim must be submitted to your employer within six months of your receipt of the original billing. A claim submitted after this time will only be approved by the board if it is submitted late due to circumstances not within the control of the member.

If your claim is submitted by the second Wednesday of the month in which you want your claim reviewed, the board will usually be able to make a determination on your claim during its meeting on the last Wednesday of that month. However, if your claim is incomplete or the board needs additional information concerning your claim, the board's determination may take longer.

The board rules on claims once a month at the regular meeting scheduled for the last Wednesday of each month. If the claim is complete, with all required documentation, the board can make a decision right away. However, if insufficient medical information is provided, the board may need to defer action and request submission of additional materials. In any case, the board chairman will send you a letter with the board's determination within a week of the board meeting. A copy is sent to your LEOFF-1 employer at the same time.

If you have Medicare, or are enrolled in insurance through your employment or spouse, your expenses must be submitted to these sources before submission to the board. Obtaining reimbursement from insurance and/or Medicare can take as much as months and thus add to the time before the board can review your claim.

To allow enough time, plan on submitting all claim information, with proof of prior insurance reimbursement, to your LEOFF-1 employer so the completed claim can reach the board office at least 10 days before the next board meeting.

Due to the sensitive personal information often contained in a claim, portions of the meetings relating to specific applications are not open to individual members, employers or the general public. Determinations are made on the basis of written contents of the claim, supportive documentation submitted with it and the medical evidence provided. Therefore, your presence is not necessary. However, should you want to appeal a board decision, you may request reconsideration, come before the board, and have a full hearing.

For further information, review the Rules, Policies and Procedures document and search for sections 4.2 and 4.3.

To do so, a written request for such reconsideration must be submitted and filed with the board within 14 days from receipt of the retirement notification date.

Any health insurance plan you may be enrolled in, including Medicare or spouse's coverage, acts as primary coverage. That means all expenses must be submitted to and approved by primary coverage before submission to the board. The board will consider only those amounts not covered by or paid for by health care plans furnished by your employer, your spouse or Medicare.

Proof of prior submittal to insurance and/or Medicare is required. Therefore, you will need to attach the insurance "Explanation of Benefits" to your claim.

Yes and no. Each employing fire and public safety district sets the rules on this. Whether you must exhaust other leave before you may apply for disability leave is determined by your LEOFF-1 employer's personnel policies. You must check with your personnel officer and follow the policy set for using sick or other leave.

However, when you are off-duty due to disability, you will need to put in your application for LEOFF-1 disability leave benefits within a time specified by your employer. Check with your LEOFF-1 personnel officer to confirm the current leave policy in effect and requirements for notifying your employer of absence.

Claims for reimbursement of medical or dental expenses must be submitted to your employer within six months of your receipt of the original bill.

The board's award of disability retirement is subject to final consideration and affirmation by the Washington State Department of Retirement Systems (DRS). A copy of this board's findings and your file records will be forwarded to DRS. You will be notified by that office of its final action.

DRS will review the materials sent by the board and will take one of three actions: your retirement award will be approved, your claim will be returned to the board for further proceedings, or the board's decision may be denied.

In any case, DRS will notify you within 10 days to two weeks of the next action and will request additional information from you.

Questions about the disability retirement process should be addressed to DRS in Olympia at 800-547-6657.

When the Washington State Department of Retirement Systems (DRS) has finished its review of the board's decision and approved your retirement, it will send you notice of its approval in an "Order of Affirmation." That notice will also give you a date on which you can expect to receive your first pension check. The pension check will be retroactive to the first day of retirement.

In some cases, the six months of disability leave may expire before the board can make its determination. If your time is up, there could be a waiting period between the effective date of your retirement and the date your pension check is first issued.

If this happens, you may be in the position to use accrued vacation time or compensatory time to ensure a regular paycheck is issued to you until the first pension check is cut.

When issued, the first pension check will be retroactive to the first day of retirement.

Continuation of coverage under your employer's medical, vision and or dental plans may be a benefit your LEOFF-1 employer provides. You will need to check with the personnel officer at your LEOFF-1 place of employment to confirm coverage options available to you upon retirement.

If you are eligible for Medicare, you are advised to seek coverage under both Parts A and B. Claims for medical expenses will first be reduced by the portion covered by Medicare or other health insurance available to you.

Note: If you are eligible for Medicare and fail to obtain coverage, neither the employer nor the board will be obligated to authorize payment.

Note: You my seek reimbursement of Medicare Part B premiums as well as premiums for medigap medical insurance by submitting a claim to the board. For more details, review the board's Rules, Policies and Procedures document and search for Rule 8.8A-B.

Private or supplemental insurance must be exhausted before LEOFF-1 benefits can be used regardless of who is paying the insurance premiums. If a LEOFF-1 service or procedure has a fixed benefit, such as dental, that amount will be offset by the insurance benefit only if the employer is paying the premiums on the additional coverage.

If your disability retirement is approved, you will be entitled to a basic monthly allowance of 50% of final average salary (FAS). The allowance will be increased by 5% of FAS for each eligible child to a maximum combined benefit of 60% of FAS.

An eligible child is one who is unmarried and under age 18, or up to and including age 20 years and 11 months while attending any approved education institution, or mentally or physically handicapped (as determined by the Washington State Department of Retirement Systems) and not in full-time care of a state institution.

If you have questions about the amount of your pension, you may contact DRS at 800-547-6657. For an online estimate, check out the DRS Retirement Benefit Estimator.

Continued eligibility for disability leave and disability retirement benefits is contingent upon proof of continuous disability that keeps you from performing your LEOFF-1 duties with average proficiency. Throughout the six-month period of disability leave, the board will ask for a status report of your medical or psychological condition and require proof of ongoing disability from your provider to determine if you are still eligible for these benefits.

In the fifth or sixth month of your disability leave, a final report letter will be requested from your provider and an independent examination scheduled for you with a board specialist. This final report from your physician and the findings of the independent medical examiner, in addition to accumulated materials in your file, will provide the foundation on which the board will make its final decision to grant or deny you disability retirement.

The burden of proof lies upon you, the applicant. Therefore, it is important to the success of your claim to obtain the medical evidence from your provider when requested and submit it to the board in time for its next available meeting.