New York City employees applying for disability retirement through NYCERS need their treating physician to complete this two-page report for the NYCERS Medical Board. The physician certifies the diagnosis and its duration, the accident if one caused it, objective and subjective evidence, treatment and result, and when, if ever, the member may return to the full duties of their title.
The member's treating physician (MD, DO, DC or similar) completes pages 1 and 2 and signs. The applicant signs the authorization for release of information at the bottom of page 2.
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Physician's Report of Disability
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The member's treating physician. The form lists MD, DO and DC as examples of the physician's title. The physician addresses the report to the NYCERS Medical Board and signs page 2, and the applicant signs the release authorization below it.
All disability applicants also file Form 608, the General Authorization for Medical Information, Form 609, the Questionnaire for Disability Retirement Applicants, and Form 615, the Authorization for Release of Information. NYCERS also asks for medical evidence such as imaging and private physician reports, and the case cannot move forward without all required documents.