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LACERA Physician Statement: Disability Retirement

Los Angeles County Employees Retirement Association members applying for disability retirement must file five forms, and the second is a statement from their treating physician supporting a service-connected or nonservice-connected claim. LACERA then investigates independently, including an exam by a LACERA panel physician, before the Board of Retirement decides.

Who completes it

The member's treating physician completes the Physician Statement after receiving the County class specification for the member's job. The member completes the Disability Retirement Application, the records release authorization, the Claims Against Third Parties form and the Missed Medical Appointment form.

Submitting and payment

How to submit it
Members apply through My LACERA, which walks them through the required forms; the complete packet goes to LACERA's Disability Retirement Services, which will not accept missing, altered, obsolete or incomplete forms.
Who pays
LACERA pays for its panel physician examination, while the member pays any missed-appointment fees.

Good to know

  • The class specification shows the physician the duties of the member's position; County class specifications are available from County human resources, the member's department or LACERA.
  • Average processing time is 12 to 15 months, and LACERA also asks the department whether it can permanently accommodate any work restrictions.
  • Members can apply while employed, within four months after service ends, or later if the disability has been continuous since the last regular pay.
  • Other California '37 Act county systems, such as OCERS, SDCERA and SBCERA, use their own physician forms rather than LACERA's.

Get the official form

Download the current version from the source each time; forms change without notice.

Physician Statement

Official page

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Los Angeles County Employees Retirement Association (LACERA) takes this form through its online services or your EMR, so there is no PDF to fill. Vero Scribe writes the visit note it draws on, so the details are ready when you complete it.

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How this list is checked

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Frequently asked questions

How does a physician get the LACERA Physician Statement?

From the member. LACERA does not post the Physician Statement as a standalone public form; members complete the disability application through My LACERA, which lists the required forms. The member should also give the physician the County class specification so the statement addresses the duties of that position.

Does LACERA rely only on the treating physician's statement?

No. LACERA independently investigates each application, obtains medical and personnel records, interviews the member and sends them to at least one board-certified LACERA panel physician. The Board of Retirement makes the final decision, and the member cannot see the panel physician's report until after that decision.

What is the difference between service-connected and nonservice-connected disability at LACERA?

Service-connected disability results from an illness or injury directly related to County employment and has no age or service requirement. Nonservice-connected disability is unrelated to County work and requires at least five years of County service credit, or combined County and reciprocal service. Both require permanent incapacity from usual duties.