Application and Decision Process (2024)

Rules to Apply for Disability Leave Benefits

Ohio Administrative Code 123:1-33-02

  • Your claim must be filed within 20* calendar days of your date last worked to your agency’s personnel office or benefits coordinator.
  • If you are disability separated you have a filing deadline of 20* calendar days from the date of your separation.
  • You are responsible for providing medical documentation to substantiate your disabling condition.
  • You must file for disability retirement if your attending physician has deemed your disabling condition to be permanent.
  • You have 20* calendar days from your notification, or within 20* calendar days of your ending date of benefits, to submit additional information.
  • You have 30* calendar days from your notification to request an appeal if your claim is denied or if you disagree with the decision rendered.
  • You may submit a written statement explaining extenuating circ*mstances if you are unable to meet the filing deadlines.
  • You are responsible for informing your agency or the Department of Administrative Services of any change in your mailing address.

Contract exceptions for filing FOP 46 & FOP 48, please refer to your contract.

Steps for Applying for Disability Leave Benefits

Step 1:Follow your agency’s standard reporting procedure.

Step 2:Log in to myOhio>My Workspace>myBenefits>Create/Extend a Disability claim to start the online disability application or obtain from your personnel office or agency benefits coordinator the Initial Application for Disability Leave Benefits (Form ADM4310) if you are unable to file your disability claim online.

Step 3:Follow the instructions to complete the online Employee Statement, or if filing a paper application, employee completes Pages 2 and 3 of Form ADM4310 – the Employee Statement section. Your treating physician should complete Pages 4 and 5 of Form ADM4310, Attending Physician Statement.

Step 4:Attach the completed Attending Physician Statement or any medical documentation to the online form, or provide the document directly to your agency human resources representative if you are unable to upload.

Step 5:Forward your online application to your agency human resources representative by hitting the Submit button. If filing a paper application, the you must submit Pages 2 through 5 to their personnel office of agency benefits coordinator. Your disability claim (online or paper) must be submitted to your agency human resources representative within 20* calendar days from the employee’s date last worked. If filing a paper form, the application is not considered complete or timely without Pages 2 through 5.

Step 6:Your personnel office or agency benefits coordinator will complete the Application for Disability Leave Benefits - Employer Statement (ADM4312) within five days of receipt of an your application and will submit all paperwork to the Ohio Department of Administrative Services.

Step 7:If you are asked to submit additional information, need to be off longer than anticipated or there is a change in your condition, you must go log in to myOhio>My Workspace>myBenefits>Create a Disability Claim – Supplemental Report. If you are filing using a paper application, obtain from your agency human resources representative or agency benefits coordinator the Supplemental Report for Disability Leave – Employee Statement (Form ADM4311).

  • Employee completes the Supplemental Report online, or if filing a paper application, complete Page 2 of Form ADM4311. The employee's physician completes Pages 3 and 4 (Supplemental Report Attending Physician Statement). Submit the documents online, or provide the paperwork to your personnel office or agency benefits coordinator if you are unable to upload or filing a paper application.
  • The employer will complete the Supplemental Report for Disability Leave – Employer Statement (Form ADM 4312) and submit the supplemental application and/or additional medical information to the Department of Administrative Services.
    Note: Additional information must be submitted within 20* calendar days from the date of the decision letter or 20* calendar days from the ending date of benefits, whichever is the greater date.
  • Contract exceptions for filing FOP 46 and FOP 48, please refer to your contract.

The Statement of Psychiatric Disability (ADM4316)is to be used when filing for disability benefits for mental/behavioral health disability. This should be used in addition to ADM 4310.

TheDisability Agreement(ADM 4313) is used when filing for disability as an advancement of workers' compensation.

Decision Process

  • If your claim is approved you must serve a mandatory 14* consecutive calendar day waiting period before you can receive disability leave benefits.*Contract exceptions for length of waiting period - Attorney General, FOP 46 and FOP 48 - please refer to your contract.
  • You may use your leave time (sick, personal or vacation) to receive pay during the waiting period. This time will not be restored.
  • After the waiting period, benefits will be paid at 67 percent of your base rate of pay for themaximum 12 months of eligibility. *Contract exceptions for length of lifetime maximum effective percentage paid at what month (Attorney General Office FOP 45, FOP 46, FOP 48; State Treasurer 55) should refer to your contract.
  • Disability benefits can last for a one* year life time maximum.*Contract exceptions for length of lifetime maximum (Attorney General Office, FOP 45, FOP 46, FOP 48; State Treasurer 55) should refer to your contract.
  • You will receive your disability benefits in standard bi-weekly paychecks.
  • Taxes and all regular deductions will be taken from your disability check.
  • If you are eligible forFMLA (Family and Medical Leave Act), the first twelve weeks of the approved disability benefits, including the waiting period, will count concurrently as FMLA.

The disability leave benefit program is a temporary program designed to help you until you are able to get back to work. Your disability benefits will continue until one of the following happens:

  • Your health care provider determines that you are able to return to work;
  • The medical documentation of your injury or condition does not support your claim for disability benefits; or
  • You reach the one* year life time maximum of benefits.*Contract exceptions for length of lifetime maximum effective percentage paid at what month (Attorney General Office FOP 45, FOP 46, FOP 48; State Treasurer 55) should refer to your contract.
Application and Decision Process (2024)
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