Pennsylvania state employees applying for SERS disability retirement ask each treating physician to complete this four-page report. A reviewing physician contracted by the commonwealth bases the disability recommendation entirely on these reports and attachments, without an independent exam, so the history, findings, studies, diagnoses, treatment and evaluation must address the duties in the member's position description.
Each treating physician completes the Initial Medical Report on pages 2 to 4 and signs; page 1 is the notice to the physician. The member supplies the employment position description for the physician to evaluate.
Download the current version from the source each time; forms change without notice.
Defined Benefit Plan Medical Report
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No. The reviewing physician contracted by the commonwealth does not conduct an independent medical examination. The recommendation to SERS rests exclusively on the Medical Report forms and accompanying documentation from the treating physicians.
The assessment and supporting documentation should be based on examinations and tests completed within the past 60 days, so the report reflects the patient's current condition rather than an older baseline.
A copy of their employment position description. The physician evaluates the patient's ability to perform the duties listed there and explains in the Evaluation section which duties cannot be performed and the reasons for that opinion.