The process for approving or denying an Industrial Disability Retirement (IDR) used to be straightforward and accurate. When treating physicians and evaluating doctors within the workers’ compensation system concluded that a work injury prevented a safety member from performing their usual and customary duties on a permanent basis, local agencies would merely ensure there was a reasonable basis for this medical conclusion. If a reasonable basis existed, the agency would inform CalPERS, and the member would then be entitled to IDR benefits through CalPERS. Alternatively, if the medical evidence suggested the member was not substantially incapacitated from their duties or if the medical opinion lacked a reasonable basis, IDR benefits would be denied. Now, this process has been distorted by the infiltration of outside medical evaluators and the proliferation of The Big Lie.

Instead of relying on the opinions of treating physicians and evaluators from the workers’ compensation system, Cities are now being pressured to use outside medical evaluators to determine whether a given safety member qualifies for an IDR. The claim that this new process is beneficial for local agencies is false. It is The Big Lie.

The reasonable approach is for local agencies to use existing medical reporting and evaluations from contemporaneous workers’ compensation case(s) to support or deny an IDR, saving money, time, and effort. However, this new flawed approach requires cities to ignore existing medical findings and instead forces local agencies to pay for another medical evaluator, wasting additional time and money for underwhelming results. Those pushing this agenda most commonly suggest an evaluator with little experience and a severe lack of expertise for the injuries at issue.

Not only does this approach waste both parties’ time and money, but it can also lead to inconsistent medical findings, which can further complicate and delay resolution. In our experience, the City’s ‘hired gun’ often deny the IDR, forcing the member into a painful and costly litigation process over a medical question. To protect their rights, the member is left to hire their own medical expert to testify at a hearing! 

In the City of Huntington Beach, this approach was used over a couple years and resulted in dozens of safety members being left in limbo regarding their retirement status. In many of these instances, the member’s workers’ compensation doctor(s) concluded the member was “unable to perform essential job duties” while this same “hired gun” asserted the member was completely fine and able to perform all their job requirements – even the emergency response duties – of their job. This meant these safety members – some of whom were suffering from severe orthopedics injuries and others with significant cardiovascular limitations – were physically precluded from performing their job but were not receiving any industrial disability retirement benefits. This flawed approach re-creates the problem the IDR process was meant to resolve.

With our help, the City of Huntington Beach resolved this issue by eliminating outside evaluators who are not connected with the workers’ compensation process and by focusing on finding out the whole and accurate truth regarding whether the member is substantially incapacitated or not. With our system, the City avoided the madness and ensured dozens of officers earned the IDR they deserved.

The Big Lie Exposed:

When an agency chooses to seek additional medical experts, they do so on their own accord. PERS does NOT require a separate medical report outside of the workers’ compensation process. A QME, AME or IME in an underlying workers’ compensation case can meet the PERS’ requirements by simply completing a Physician’s Report on Disability. To ensure that the medical expert will complete the form, the form will need to be included in the Joint letter-medical addendum packet explaining that the parties need this form completed. Nevertheless, the completion of this form by ANY of those evaluators is ALL that PERS requires!!! Local agencies spending thousands of dollars for another medical evaluation in addition to the workers’ compensation evaluators makes no logical or financial sense. Unfortunately, many other PERS agencies have fallen prey to The Big Lie, abandoned logical and financial sense, and ignored The Big Lie’s detrimental impact on agencies and members alike. 

These agencies are being sold a bill of goods while being left entirely unaware of the massive litigation costs and lackluster benefits associated with The Big Lie. PERS does not provide any renumeration or benefits to agencies to contest these IDR cases. Instead, the agencies are left to bear the costs alone. Moreover, costs, inconsistencies, and inaccuracies only increase when this approach is used, further harming the agency. On the other hand, members face a terrible fate where they may wait years for a hearing or be forced back to full duty to risk further injury while their case is pending. The only winners are the vendor law firms that represent the agencies in IDR cases, billing agencies for thousands of dollars for no tangible benefit. A natural question then follows – why are the agencies wasting so much time, money, and resources to deny IDR’s when substantial medical opinions support approving it? The only logical answer is that local agencies are unaware that this approach is deeply flawed. They unknowingly believe The Big Lie.

How To Defend Members From The Big Lie’s Impact:

When an agency seeks out an additional medical opinion, there are several issues that may arise due to the IDR application being stalled. First, we must consider the financial benefits the safety member is currently receiving. When a member is at the IDR stage, this member has typically exhausted their allotted 4850 time and is either burning accrued sick/vacation or being paid Long Term Disability (LTD) to maintain their livelihood. Any delay in the PERS process will necessarily extend the timeline for the safety members burning their own time or extending their LTD benefits. These support systems are not indefinite solutions and can extinguish before IDR entitlement is resolved. The safety member will need to be vigilant in securing the PERS forms and further pressing the city to begin Advanced Disability Pension Payment to avoid any gap in benefits while they wait.

The safety member must also understand the whole Industrial Disability Retirement (IDR) process, which can begin PRIOR to the application process. To qualify for an IDR under PERS, a member must show through a medical evaluation and report that they are permanently and substantially incapacitated from duty and that the disability has lasted or is expected to last more than twelve months. Most often, the medical evidence from a safety member’s workers’ compensation case is relied on to help support the IDR determination. As discussed above, The Big Lie is changing this standardized, substantially procedural process to a ligated and costly one. Nevertheless, the stages from a workers’ compensation evaluation to an Interactive Personnel Meeting (IP Meeting) to the IDR process remain connected. The safety member must have the proper medical evidence from the workers’ compensation evaluation to show at the IP Meeting that the member is unable to work and to justify the agency or city granting the IDR application. 

With the interconnectedness between workers’ compensation evaluations and IDR and the dangers being proliferated by The Big Lie, it is critically important to make sure safety members connect with an expert in workers’ compensation and PERS-IDR to ensure their case is on track and their benefits are properly and timely secured. If the city or PERS agency denies an IDR application, the member may face hiring an additional attorney and a medical expert to handle the administrative hearing, costing the member tens of thousands of dollars. The financial hit to both the city and the member in those cases is massive. 

Even with experts in workers’ compensation and PERS-IDR working to protect members’ rights in each case, the system itself must be addressed to ensure the timely and fair dispersal of benefits. Just as we did with the City of Huntington Beach, we continue to work with cities to expose The Big Lie and implement our efficient solution that is focused on determining an accurate outcome without wasting the city and safety member’s money. We must end The Big Lie.