Ohio Public Employees Retirement System disability benefit recipients send this form every six months during the first three years after their benefit begins, unless they are in the Rehabilitative Services Program. The attending MD or DO reports treatment, findings by body system or mental status, and whether the recipient remains permanently disabled from their last public employment position.
The recipient completes Step 1, personal information. A licensed and practicing MD or DO completes Steps 2 through 6: physician information, patient information, the physician determination, physician findings and continued medical treatment.
Download the current version from the source each time; forms change without notice.
Disability Continued Medical Treatment Form
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Every six months during the first three years after the disability benefit effective date, for recipients not enrolled in the Rehabilitative Services Program. After year three the form is no longer required, though OPERS still conducts periodic medical re-reviews every three years.
No. The physician steps must be completed by the member's attending physician who is a licensed and practicing MD or DO, and the physician marks MD or DO next to the signature in the determination step.
All medical and psychological records from the last six months: office notes, clinic and ER visits, labs, all test results and discharge summaries. OPERS cannot accept digital media such as image discs, so the attachments should be report findings only.