Agency/Department Statement Related to Application for Disability
Retirement Form
Provided to your Employer by ACERA requesting identifying, job
duty, and related information from your Department. A completed
form also includes a detailed statement about all efforts
undertaken to find alternative employment for you within your
capacity to perform, the results of this effort, or a detailed
explanation why such efforts were not undertaken.
Applicant
The person or entity filing the disability Application, including
an Alameda County Employees’ Retirement Association Member, the
Employer, the Board or its agents, or any other person on your
behalf who is entitled to claim disability retirement benefits on
behalf of a Member.
Application Date
The date your Application meets all requirements and is filed and
accepted by ACERA.
Application for Disability Retirement
The disability retirement Application forms and associated
documents you submit to ACERA to identify the exact nature of
your incapacity.
Authorization to Obtain and Release Records and Information Form
Legal release providing permission to release relevant medical
and employment records and information to ACERA ensuring a full
evaluation of your Application.
Beneficiary
A person or entity designated to receive an ACERA benefit as a
result of a legal arrangement or instrument
Board
ACERA Board of Retirement
Burden of Proof
The Burden of Proof is on the Applicant throughout the entire
disability retirement Application process. This means you must
prove your case throughout the Application process by a
preponderance of the evidence. This includes showing a permanent
incapacity (physical or mental) from your performance of duty by
demonstrating substantial inability to perform your usual Duties.
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The Burden of Proof for Non-Service Connected
Disability: You must demonstrate permanent incapacity
from substantially performing your regularly assigned job
Duties. For Service Connected Disability retirement, you must
also demonstrate that the employment contributed substantially
to the disability.
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Burden of Proof for Safety Members with five (5) or
more years of serviceCertain diseases/disabilities are
presumed to arise out of and in the course of employment. For
these Applicants, it is presumed that your usual job Duties
caused your injury/illness and the burden is now on your
Employer to prove that the Duties did not cause your
injury/illness.
Chief Executive Officer (formerly known as the General Manager
(G.M.)
Appointed by the Board as executive manager of ACERA.
Completed Application
An Application for Disability Retirement reviewed and determined
by the D.U. to include all necessary attachments and information
to support your claim.
Confirming Letter
Letter from the D.U. confirming your Application is received and
has been accepted as complete; or a letter accompanying your
returned Application because it is incomplete and further
information is required to process your claim.
Contested
A decision and/or recommendation objected to or opposed by a
Party.
Continuing Disability Questionnaire Form
May be required if you are under 55-years-old and granted a
disability retirement.
Continuation of Disability Retirement Proceedings After Death of
Member Form
Used by spouse/domestic partner or minor who may be entitled to
pursue a deceased Member’s pending disability benefit by
completing this form.
County Counsel
Office of the County Counsel of Alameda County that represents
and advises the County in legal matters.
Days
Calendar days are every day on the calendar, Sunday through
Saturday. When “days” is intended to refer only to business days,
Monday through Friday, it is noted.
Delayed Disability Application Affidavit
Submitted when applying for disability retirement more than four
months after discontinuation of service to address whether
disability has been continuous since the last date of service.
Designation of Legal Representation Form
Filed with the Disability Unit (D.U.) providing notice of your
legal representation.
Disability Counseling Worksheet
Used by staff and signed by you, during your counseling session,
to ensure all critical elements of the Application process have
been reviewed with you.
Disability Packet
All relevant documentation received during the Application
process, including the Completed Application.
Disability Unit (D.U.)
A team of ACERA employees who handle the processing of disability
matters. The D.U. includes Disability Retirement Specialists and
the Disability Manager.
Duties
The usual Duties of your position that you must be able to
perform, with or without reasonable accommodations.
Earlier Effective Date
The disability retirement allowance begins the date your
Application is deemed complete by the D.U. or the date after the
last date you received regular compensation, whichever is later.
You may request that your allowance start at an earlier date by
completing section 5 of the Application for Disability Retirement
Form and attaching documentation showing 1) when you left
service, 2) an inability to ascertain the permanency of your
incapacity, and 3) that you have been continuously disabled since
you left service. This is the date after the last date you
received regular compensation.
Effective Date
The disability retirement allowance begins the date your
Application is deemed complete by the D.U. or the date after the
last date you received regular compensation, whichever is later,
unless an Earlier Effective Date is granted.
Employer
The public agency, including the County of Alameda or
Participating Employer, by which the Member is employed at the
time or immediately before, the Application is submitted to
ACERA.
Essential Functions Job Analysis (EFJA) Form
An Employer’s summary of the Duties and requirements of any
particular job, including mental and physical demands. This
document is generally shared with the Medical Advisor and is used
to determine which job(s) within a department, if any, you are
capable of performing.
He, him, his, Chairman
Used for convenience and intended that each gender is given
exactly equal respect and treatment throughout.
Hearing
The presentation of evidence to a Hearing Officer (H.O.) toward
the development of H.O. Proposed Findings of Fact and Recommended
Decisions for consideration of your Application by the Board.
Hearing Officer (H.O.)
Conducts a hearing when the Board Medical Advisor’s
Recommendation on an Application is disputed and a hearing is
requested. Hearing Officers are obtained for the panel from an
independent arbitration system, such as the American Arbitration
Association. An H.O. must be a current member of the State Bar of
California whose name is contained on the approved Hearing
Officer panel.
Independent Medical Examination (I.M.E.)
You may be required by your Employer, the Board of Retirement, or
the M.A. to submit to a medical exam by a physician,
psychologist, or specialist in the medical condition identified
in your Completed Application at no cost to you.
Medical Advisor (M.A.)
The physician(s) advising the Board on disability claim medical
matters
Medical Provider Statement
A brief (4 questions), but mandatory, written opinion from your
physician addressing whether you are permanently incapacitated
from performing your usual Duties. This must be filed with your
Application.
Minor
An unmarried/unregistered person either 1) under age 18 or 2)
under age 22 and regularly enrolled as a full-time student in an
accredited school.
Non-Service Connected Disability (NSCD)
A type of disability retirement awarded if you are found
permanently incapacitated from performing your usual Duties from
a cause unrelated to your employment. You must have completed
five (5) years of service and must not have waived retirement in
respect to your particular incapacity or aggravation.
Notice of Hearing Officer
Communication used to state the next assigned Hearing Officer
(H.O.) assigned to your case; H.O.s are assigned on a rotating
basis.
Notice of Original Hearing Date
Communication used to state the time and place of your Hearing.
Participating Employers
Employers with staff who are ACERA Members: Alameda County,
Alameda County Children and Families, Alameda County Housing
Authority, Alameda County Medical Center, Alameda County Office
of Education, Livermore Area Parks and Recreation, and Superior
Court of California.
Party
The Member who is the subject of the Application, the person
preparing and submitting the Application (Applicant, and the
Employer.
Prehearing Statement Form
You must complete and serve this form on the H.O. and all other
Parties. It must contain 1. a statement of contested issues and
party position, 2. witness information and their testimony, and
3. documentary evidence not included in the Disability Packet.
Proposed Findings of Fact and Recommended Decisions
The Hearing Officer’s report on your disability Application
summarizing the evidence, findings of fact, and making a
recommendation to the Board.
Reciprocal Systems
Retirement systems that have established reciprocity with ACERA
for providing retirement benefits. Reciprocal Systems are the
CERL ’37 Counties, the Public Employees’ Retirement Systems
(“PERS”), the State Teachers’ Retirement System, the Judges’
Retirement System, and retirement systems of any other public
agency of the State of California that have established
reciprocity with PERS by meeting all necessary statutory
requirements.
Report and Recommendation
M.A. written analysis recommending the granting or denial your
Application.
Request for Hearing Form
Signed by you to request a Hearing before a Hearing Officer.
Service Connected Disability (SCD)
A type of disability retirement awarded if you are found
permanently incapacitated from performing your usual Duties. The
incapacity must result from an injury/illness arising out of and
in the course of your employment, and such employment must have
contributed substantially to your incapacity.
Service File
Contains your retirement records, such as, enrollment
questionnaire, beneficiary information, birth certification, etc.
Supplemental Disability Allowance
A monthly allowance paid in lieu of a full disability allowance,
if you have been granted a disability benefit and have accepted
alternative County or ACERA Participating Employer work with
lower pay. It is equal to the difference between your salary in
the former position, for which you were found disabled, and the
salary of the new position. It will not to exceed the amount of
the full disability benefit.
Treating Physician Narrative Form
An optional, but recommended, detailed (13 questions) written
opinion from your physician addressing whether you are
permanently incapacitated from performing your usual Duties. This
must be filed with your Application.
Uncontested
A decision and/or recommendation that is not objected to or
opposed. Uncontested does not necessarily mean all Parties are in
agreement with the decision and/or recommendation. The Board
retains the discretion to grant or deny an uncontested
recommendation.
Withdrawal with Prejudice
Precludes you from filing a future Application based on the same
disability or injury/illness. An application withdrawn after an
H.O. is assigned is deemed withdrawn with prejudice.
Withdrawal without Prejudice
An application withdrawn at anytime prior to an assignment of an
H.O. is treated as though it was never submitted. A subsequent
Application, including resubmission of the withdrawn Application,
is considered a new Application and must meet all requirements,
including timely filing requirements.
