105 KAR 1:310. Fred Capps Memorial
Act.
RELATES TO: KRS 16.505-16.652,
61.510-61.705, 78.510-78.852
STATUTORY AUTHORITY: KRS 61.645(9)(g)
NECESSITY, FUNCTION, AND CONFORMITY: KRS
61.621, The Fred Capps Memorial Act, enables an employee of a state-administered
retirement system who is killed or disabled from a duty-related injury to
receive death or disability benefits equal to those received by hazardous
employees under KRS 16.582. This administrative regulation establishes the
application and appeal procedure for duty-related death or injury benefits for
nonhazardous employees.
Section 1. Application for Duty-related
Injury Death Benefits. (1)(a) A written request for duty-related injury death
benefits may be made by the surviving spouse, or dependent child, or parent or
guardian of dependent child at the Frankfort office of the Kentucky Retirement
Systems.
(b) A claim for duty-related injury death
benefits shall be verified by the deceased employee's immediate supervisor and
agency head on the "Form 6800, Application for Death Benefits Duty Related/In
Line of Duty".
(2)(a) The employer, surviving spouse, or
dependent child shall submit the following documents:
1. A copy of the death certificate;
2. The employer death investigation
report; and
3. An employee job description.
(b) The retirement system may request
additional information or medical records, including hospital, emergency room,
autopsy, or other related records, and police or other crime report, if
necessary, from the employer, surviving spouse, or dependent child.
(3) The application for duty-related
injury death benefits shall be reviewed by the board’s medical examiners and
administered in the same manner as provided in KRS 16.582 and 61.665.
Section 2. Application for Duty-related
Injury Disability Benefits. (1)(a) A claim for duty-related injury disability
benefits shall be filed by the employee at the Frankfort office of the Kentucky
Retirement Systems.
(b) An application for duty-related
injury disability benefits shall be made by the employee on the "Form
6000, Notification of Retirement".
(2) The application for duty-related
injury disability benefits shall be reviewed by the board’s medical examiners
and administered in the same manner as provided in KRS 16.582 and 61.665.
Section 3. Time Period for Filing. (1)(a)
The application or reapplication for duty-related injury death or duty-related
injury disability benefits shall be filed at the retirement office within
twenty-four (24) months from the employee’s last day of paid employment in a
regular full-time position.
(b) The filing period shall begin on the
day after the last day of paid employment in a regular full-time position and
shall end at close of business on the following 730th calendar day.
(c) If the last day of the filing period
is a Saturday, Sunday, or a state or federal holiday, then the application
shall be timely filed if received in the retirement office by the close of the
next business day following the weekend or holiday.
(2) If rejected, an employee’s
reapplication for duty-related injury disability benefits based on the same
claim of incapacity shall be reconsidered for disability if accompanied by new
objective medical evidence. The reapplication shall be filed at the retirement
office within twenty-four (24) months from the employee’s last day of paid
employment in a regular full-time position.
Section 4. (1) If the retirement systems
requires an applicant to submit to a medical or psychological examination under
KRS 61.665(2)(j) or (3)(c), the retirement systems shall reimburse the
applicant for mileage from the applicant’s home address as it is on file at the
retirement systems, to the place of the examination or evaluation, and
returning to the applicant’s home address on file at the retirement systems.
The applicant shall be reimbursed for the most direct and usually traveled
routes.
(2) Mileage shall be based on the
"Kentucky Official Highway Map", mileage software, or the most recent
edition of the "Rand McNally Road Atlas." The applicant shall
complete and submit a Form 8846, Independent Examination Travel Voucher
indicating the mileage the applicant traveled from the applicant’s home address
as it is on file at the retirement systems, to the place of the examination or
evaluation, and returning to the applicant’s home address on file at the
retirement systems. The applicant shall use the most direct and usually
traveled routes.
(3) The mileage certified by the
applicant shall not be greater than the mileage indicated by the "Kentucky
Official Highway Map", mileage software, or the most recent edition of the
"Rand McNally Road Atlas" for the most direct and usually traveled
route from applicant’s home address as it is on file at the retirement systems,
to the place of the examination or evaluation, and returning to the applicant’s
home address on file at the retirement systems. If the mileage certified by the
applicant is greater than the mileage indicated by the "Kentucky Official
Highway Map", mileage software, or the most recent edition of the
"Rand McNally Road Atlas" the retirement systems shall pay the
applicant the mileage indicated by the "Kentucky Official Highway
Map", mileage software, or the most recent edition of the "Rand
McNally Road Atlas."
(4) Reimbursement for use of a privately
owned vehicle shall be made at the IRS established standard mileage rate which
changes periodically; and shall not exceed the cost of commercial coach fare.
(5) Actual costs for parking shall be
reimbursed upon submission of receipts. The applicant shall submit the
originals of the parking receipts along with a written request for reimbursement.
(6) Actual bridge and highway toll
charges shall be reimbursed if the bridge or highway is on the most direct and
usually traveled route. The applicant shall submit the originals of the bridge
and highway toll receipts along with a written request for reimbursement.
(7) The applicant shall file at the
retirement office a completed Form 8846, Independent Examination Travel
Voucher, within fifteen (15) days of the date of the examination or evaluation
in order to receive reimbursement for travel expenses.
Section 5. Benefit Payment Procedures.
(1) If the employee’s application for duty-related injury disability benefits
is approved, the employee’s disability benefit shall be paid retroactive to the
month following the month of the employee’s last day of paid employment in a
regular full-time position.
(2) If the employee did not receive early
retirement benefits or disability retirement benefits under KRS 61.600, upon
the employee’s selection of a payment option, the retirement office shall pay
the employee the total monthly retirement allowances owed.
(3)(a) If the employee did receive early
retirement benefits or disability retirement benefits under KRS 61.600, the
retirement office shall calculate and pay to the employee the difference
between the early retirement benefit or disability retirement benefit which was
paid to the employee and the duty-related disability benefit.
(b) The employee shall not change his
payment option.
(4) If benefits are payable to a
dependent child, the child's parent or guardian shall submit the following
documents:
(a) A "Form 6456, Designation of
Dependent Child";
(b) If the child is age eighteen (18) or
over, verification of full-time student status;
(c) A copy of the birth certificate of
each dependent child; and
(d) If a dependent child is a minor, a
"Form 6110, Affidavit of Authorization to Receive Funds on Behalf of
Minor". If the minor has a court appointed guardian or conservator and the
court appointed guardian or conservator completed the Form 6110, Affidavit of Authorization
to Receive Funds on Behalf of Minor, the guardian or conservator shall submit a
copy of the court order appointing the guardian or conservator;
(e) The parent or guardian shall:
1. Notify the retirement system of the
death or marriage of a dependent child or if the dependent child ceases to be a
full-time student; and
2. Submit a copy of the dependent child’s
verification of full-time student status with the retirement system for each
semester of study within thirty (30) days following the start and within thirty
(30) days following the end of each semester.
(5) Any increases provided to recipients
under KRS 61.691 shall be applied to the employee’s disability benefit and payments
to a dependent child in determining the total retroactive payments owed to the
employee and dependent child.
(6) If upon review in accordance with KRS
61.610 or other applicable statute, the board determines that an employee receiving
duty-related injury disability benefits no longer meets eligibility requirements,
then the board shall determine if the employee is eligible for disability
benefits under KRS 61.600.
Section 6. (1) A recipient shall complete
a "Form 6130, Authorization for Deposit of Retirement Payment", to
have the monthly retirement allowance deposited to an account in a financial
institution.
(2) The recipient and the financial
institution shall provide the information and authorizations required for the
electronic transfer of funds from the State Treasurer's Office to the designated
financial institution.
(3)(a) At any time while receiving a
retirement allowance, the recipient may change the designated institution by completing
a new "Form 6130, Authorization for Deposit of Retirement Payment",
and filing the form at the retirement office in Frankfort.
(b) The last "Form 6130,
Authorization for Deposit of Retirement Payment", on file at the
retirement office shall control the electronic transfer of the recipient's
retirement allowance.
(4) The recipient may complete a
"Form 6135, Request for Payment by Check".
(5) The retirement office shall not
process the retirement allowance until the recipient has filed a completed
"Form 6130, Authorization for Deposit of Retirement Payment", or
filed a completed "Form 6135, Request for Payment by Check".
Section 7. Incorporation by Reference.
(1) The following material is incorporated by reference:
(a) Form 6800, "Application for
Death Benefits Duty Related/In Line of Duty", April 2003;
(b) Form 6000, "Notification of
Retirement", July 2004;
(c) Form 6110, "Affidavit of
Authorization to Receive Funds on Behalf of Minor", May 2003;
(d) Form 6456, "Designation of
Dependent Child", July 2004;
(e) Form 6130, "Authorization for
Deposit of Retirement Payment," May 2008; and
(f) Form 6135, "Request for Payment
by Check", February 2002.
(2) This material may be inspected,
copied, or obtained, subject to applicable copyright law, at the Kentucky
Retirement Systems, Perimeter Park West, 1260 Louisville Road, Frankfort,
Kentucky 40601, Monday through Friday, 8 a.m. to 4:30 p.m. (28 Ky.R. 1002; eff.
12-19-2001; 29 Ky.R. 778; 1255; eff. 11-12-2002; 32 Ky.R. 393; eff. 11-5-2004;
35 Ky.R. 121; Am. 542; eff. 10-3-2008.)
