Common use of Benefit Determinations Clause in Contracts

Benefit Determinations. An application for the benefits of Section 207-c of the General Municipal Law shall be processed in the following manner: (a) The Sheriff shall receive the application for the benefits and make a recommendation to the Clerk of the Board of Supervisors/Self-Insurance Administrator (hereinafter "Self Insurance Administrator") as to whether the applicant is entitled to 207-c benefits pursuant to Section 207-c of the General Municipal Law and this procedure. The Self Insurance Administrator shall promptly review the Sheriff's recommendation and the application, as well as any other pertinent documents or evidence available. Should the Self Insurance Administrator determine that the officer was injured in the performance of duty or that the officer was taken sick as a result of the performance of duty so as to necessitate medical or other lawful treatment, the Self Insurance Administrator shall, pursuant to Section 207-c, direct payment of the full amount of the regular salary or wages until the disability arising therefrom has ceased and shall insure that the County, through the health insurance provided to the officer, will be responsible for the cost of medical or other lawful treatment and for any hospital care associated with such injury or illness. (It is understood that any amounts not otherwise covered by the health insurance carrier will be paid or reimbursed, as necessary, by the County.) A written notice of such determination by the Self Insurance Administrator shall be provided to the officer, placed in the officer's personnel file and provided to the County Treasurer. (b) The payment of full salary or wages may be discontinued as expressly provided by Section 207-c. Any review of eligibility for the continuation of benefits may only occur after an assessment of the medical condition of an officer or other information raises a question as to whether a disability may have ceased or whether the extent of a disability may have diminished so as to permit a light duty assignment, as the case may be. (c) In the event a question arises as to either initial eligibility for benefits or the continuation of benefits once awarded, the following procedure shall apply: (i) The Sheriff or the Sheriff's designee, and/or the Self Insurance Administrator shall promptly inquire into the fact(s) surrounding the matter at issue. An officer may be required to submit to one or more medical examinations as may be necessary to determine the existence of a disability or illness and its extent. To resolve a question of initial or continued eligibility for the benefits, the Self Insurance Administrator shall make a decision on the basis of medical evaluations and other information as may be available and/or as may be provided by the officer. An officer or his/her representative may produce any document, sworn statement, or other record relating to the alleged injury or sickness or the incident alleged to have caused such. The Self Insurance Administrator shall have the authority to employ medical specialists and other appropriate individuals; may at reasonable times and at reasonable notice, require the attendance of the officer or any witness to an incident to secure information; may require the officer to sign a release or waiver for information of his/her medical history; and may undertake any other reasonable act necessary for making a determination pursuant to this procedure (including, but not limited to, requiring the officer to submit a detailed sworn statement of the circumstances surrounding his/her alleged injury or sickness). All medical examinations directed by the Sheriff or his designee or the Saratoga County Self Insurance Administrator pursuant to this Section shall be at the expense of the Employer. (ii) The Self Insurance Administrator shall make a determination as to initial continued eligibility for benefits based upon information collected or obtained pursuant to this process. An officer shall be notified in writing of the final determination made. The basis for the determination shall be specified. Upon the request of an officer or his/her representative, a copy of any document used by the Self Insurance Administrator to determine initial or continued eligibility for any benefits afforded by Section 207-c shall be made available. In the event an officer is adversely affected by a determination, he or she may request a hearing in accordance with the procedure set forth in Section 6 of this procedure. (d) Any determination made pursuant to this Section 4, shall be rendered within fifteen (15) working days.

Benefit Determinations. An application for the benefits of Section 207-c of the General Municipal Law shall be processed in the following manner: (a) The Sheriff DOF shall receive the application for the benefits and and, within one (1) month of receipt, the Commissioner or his designee shall make a recommendation to the Clerk of the Board of Supervisors/Self-Insurance Administrator (hereinafter "Self Insurance Administrator") determination as to whether the applicant is entitled to 207-c benefits pursuant to Section 207-c of the General Municipal Law and this procedure. The Self Insurance Administrator shall promptly review the Sheriff's recommendation and the application, as well as any other pertinent documents or evidence available. Should the Self Insurance Administrator determine that the officer was injured in the performance of duty and is unable to perform his or that the officer was taken sick as a result her regular duties by reason of the performance of duty such injury. If he so as to necessitate medical or other lawful treatmentdetermines, the Self Insurance Administrator shall, pursuant to Section 207-c, direct payment of DOF shall pay the full amount of the employee’s regular salary or wages until the disability arising therefrom from the injury has ceased ceased, the employee is able to return to his or her regular duties, the employee is assigned to light duty in accordance with this procedure, or benefits are otherwise discontinued pursuant to this procedure and shall insure that the County, through the health insurance provided to the officer, GML 207-c. (b) The City will be responsible for the cost of any medical or other lawful treatment and for any hospital care associated with such the injury of any employee granted 207-c benefits under this section. The employee shall submit any medical bills or illness. (It is understood that any amounts not otherwise covered by the health insurance carrier will be paid or reimbursed, as necessary, by the County.) A written notice requests for reimbursement of such determination by the Self Insurance Administrator shall be provided medical costs to the officer, placed in the officer's personnel file and provided to the County Treasurer. (b) The payment of full salary or wages may be discontinued as expressly provided by Section 207-c. Any review of eligibility for the continuation of benefits may only occur after an assessment Worker’s Compensation Division of the medical condition of an officer or other information raises a question as to whether a disability may have ceased or whether the extent of a disability may have diminished so as to permit a light duty assignment, as the case may beNew York City Law Department. (c) In the event a question arises as order to either determine an employee’s initial or continued eligibility for benefits or Section 207-c benefits, DOF may require the continuation of benefits once awarded, the following procedure shall apply: (i) The Sheriff or the Sheriff's designee, and/or the Self Insurance Administrator shall promptly inquire into the fact(s) surrounding the matter at issue. An officer may be required employee to submit to one or more medical examinations as may be necessary to determine the existence of a disability or illness and its extent. To resolve a question of initial or continued eligibility for the benefits, the Self Insurance Administrator Sheriff shall make a decision on the basis of medical evaluations and other information as may be available and/or as may be provided by the officeremployee. An officer employee or his/her representative may produce any document, sworn statement, or other record relating to the alleged injury or sickness or the incident alleged to have caused such. The Self Insurance Administrator DOF shall have the authority to employ order an independent medical specialists and other appropriate individualsexamination by a physician of the employer’s choosing; may at reasonable times and at reasonable notice, require the attendance of the officer employee or any witness to an incident to secure information; may require the officer employee to sign a release or waiver for information of his/her medical history; and may undertake any other reasonable act necessary for making a determination pursuant to this procedure (including, but not limited to, requiring the officer to submit a detailed sworn statement of the circumstances surrounding his/her alleged injury or sickness)procedure. All medical examinations directed by the Sheriff or his designee or the Saratoga County Self Insurance Administrator pursuant to this Section DOF shall be at the expense of the Employer. (iid) The Self Insurance Administrator shall make a determination as to initial DOF may, at any time, review an employee’s continued eligibility for Section 207-c benefits. In the event it is determined the employee is no longer eligible for continued Section 207-c benefits, DOF shall direct the employee to return to his or her regular assigned duties. If the employee refuses to do so, such benefits based upon information collected or obtained pursuant will be discontinued effective the date the employee was directed to this process. An officer report for duty. (e) The employee shall be notified in writing of the final any determination made. The basis for the determination shall be specified. Upon the request of an officer or his/her representative, a copy of any document used by the Self Insurance Administrator to determine made concerning initial or continued eligibility for any benefits afforded by Section 207-c shall be made availablebenefits. In the event an officer employee is adversely affected by a determinationdenied initial or continued eligibility, he or she may request a hearing in accordance with the procedure set forth in Section 6 of this procedure. (d) Any determination made pursuant to this Section 4, shall be rendered within fifteen (15) working days.