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Home My WebLink AboutTC Res 01-2024Page 1 of 5 Town Council Resolution No. 01-2024 March 6, 2024 RESOLUTION NO. 01-2024 A RESOLUTION OF THE TOWN COUNCI OF THE TOWN OF TIBURON DESIGNATING THE AUTHORITY AND UPDATING THE PROCESS AND PROCEDURES IN THE DETERMINATION OF DISABILITY RETIREMENTS FOR LOCAL SAFETY EMPLOYEES WHEREAS, the Town of Tiburon is a contracting agency of the California Public Employees' Retirement System; and WHEREAS, the Public Employees' Retirement Law ("PERL") requires that a contracting local government agency determine (a) whether an employee of such agency in which he/she is classified as a "local safety member" is disabled for purposes of the Public Employees' Retirement Law and (b) whether such disability is "industrial" within the meaning of the PERL; WHEREAS, the Town Council of the Town of Tiburon may delegate responsibility and authority under section 21173 of the Government Code to a body or officer of the Town. NOW, THEREFORE, BE IT RESOLVED by the Town Council of the Town of Tiburon as set forth: Section 1. The Town Council hereby delegates to the Chief of Police or Town Manager the authority to file local safety disability retirement applications on behalf of all employees pursuant to Government Code section 21173; Section 2. The Town of Tiburon does hereby delegate to the Chief of Police or Town Manager, the authority to make any and all local safety disability retirement determinations on behalf of the Town of Tiburon under section 21152(c) of the Government Code, as it may from time to time be amended, of the existence of a disability and whether such disability is industrial, and to certify such determinations and all other necessary information to the California Public Employees' Retirement System; and Section 3. That the Chief of Police or Town Manager is authorized to make applications on behalf of the Town of Tiburon for local safety disability retirement on behalf of eligible employees and to initiate requests for reinstatement of such employees who have previously been retired for disability; and Section 4. A certified copy of this Resolution must be placed on file with the California Public Employees Retirement System or must accompany all such resolutions or letters of designation signed by the delegate named in this resolution and DocuSign Envelope ID: D2DFD6FF-FD12-4F7A-BFB7-6EAC56CBBB07 Page 2 of 5 Town Council Resolution No. 01-2024 March 6, 2024 be included as part of the submission to the California Public Employees Retirement System. Section 5. The Town of Tiburon hereby adopts the following procedures for processing applications of local safety members for disability retirement: (1) Verification of CalPERS determination of member eligibility Upon receipt of verification from the California Public Employees Retirement System that the member is eligible to apply for disability retirement the Chief of Police will proceed with determination. (2) Contingencies Completed An initial determination will begin after determination that the following conditions have been met: • 4850 payments have been exhausted • Employee has exhausted all leave balances • OR Employee has filed for disability retirement (3) Promissory Note In the event applicant becomes eligible for Advanced Disability Pension Payments. Applicant must sign a promissory note agreeing to repay and Advance disability Pension Payments made by the Town should the applicant later be deemed ineligible for retirement. (4) Determination of Disability An initial determination will be made by the Town upon medical and other available evidence offered by either the applicant or the Town to determine whether the applicant is substantially incapacitated from the performance of his or her duties. The determination shall be made within six months of the date of the Town 's receipt of CalPERS request for such determination unless this time requirement is waived in writing by the applicant. The Chief of Police or Town Manager shall certify the Town 's findings and direct them to CalPERS. A resolution determination for disability retirement will include all the following information statements: • A statement certifying under penalty of perjury that the determination was not used as a substitute for the disciplinary process • A statement certifying under penalty of perjury that the determination was made based on competent medical opinion DocuSign Envelope ID: D2DFD6FF-FD12-4F7A-BFB7-6EAC56CBBB07 Page 3 of 5 Town Council Resolution No. 01-2024 March 6, 2024 • A finding indicating the member has been found substantial incapacitated from the performance of the usual duties of his/her position • A statement that there is competent medical opinion certifying the disability is expected to a) be permanent; b) last at least twelve consecutive months from the date of an application for benefit; c) will result in death. • A statement confirming whether or not the member had filed a workers compensation claim(s) for his or her disabling conditions(s) and if so, whether the claim was accepted. • A finding by the employer as to whether the causation of the disability was industrial. • A statement by the employer documenting the member’s last day on payroll. • A statement by the employer as to whether there is, or is not, a possibility of third-party liability present. • The monthly amount and beginning date of Advance Disability Pension Payments (ADPP) paid or to be paid to the member along with the address where the reimbursement check should be mailed. • A certified copy of this signed resolution must accompany the determination resolution. (5) Appeal Process If the applicant requests a hearing pursuant to the PERL, the hearing shall be held in conformity with Government Code section 21156, as it may from time to time be amended. Once the Town issues its decision following a hearing, the decision and findings will be served on the applicant by certified mail and CalPERS will be notified. If applicant is found to be substantially incapacitated the Town shall so certify to CalPERS. If applicant is found not to be substantially incapacitated the applicant will be further advised that he or she has thirty calendar days to seek judicial review, not including prospective or prophylactic restrictions as defined by CalPERS guidance on disability retirement and in CA Government Code Section 21166 which excludes any determination of disability under Labor Code 4600, 5811 or any other provision of the Labor Code. DocuSign Envelope ID: D2DFD6FF-FD12-4F7A-BFB7-6EAC56CBBB07 Page 4 of 5 Town Council Resolution No. 01-2024 March 6, 2024 RESOLUTION PASSED, APPROVED, AND ADOPTED, at the regular meeting of the Tiburon Town Council on the 6th day of March, 2024 by the following vote: AYES: COUNCILMEMBERS: Fredericks, Nikfar, Ryan, Thier, Welner NAYS: COUNCILMEMBERS: None ____________________________ ALICE FREDERICKS MAYOR ATTEST: _________________________ LEA DILENA, TOWN CLERK EXHIBITS A. Promissory Note DocuSign Envelope ID: D2DFD6FF-FD12-4F7A-BFB7-6EAC56CBBB07 EXHIBIT A: Promissory Note PROMISSORY NOTE I, [NAME], residing at [HOME PHYSICAL ADDRESS], certify that have been employed by Town of Tiburon (hereby known as Agency) located at 1505 Tiburon Boulevard in Tiburon, California and that pursuant to my employment, I am a member of the California Public Employees Retirement System (CalPERS). I further certify that in accord with CalPERS regulations for disability retirement, I am qualified for Advance Disability Pension Payments (ADPP) from Agency. I understand that ADPP payments of $[X,XXX.XX] will begin on MM/DD/YYYY and will continue until either the effective date of my retirement or until the retirement application is denied by CalPERS. In the event of denial of application for disability retirement by CalPERS, I, [NAME] promise to reimburse in full, any and all ADPP received from Agency from the date of my application for disability retirement. I, [NAME], understand that I have 10 business days from the date of denial to contact Agency at the address and phone number listed above to arrange for reimbursement of any and all ADPP as described above, either in one lump sum or a series of payments, not to exceed 12 months from the date of denial. The full amount of ADPP to be reimbursed will be determined at that time and recorded here: Full amount of ADPP to be repaid is $[AMOUNT] (to be entered after denial of application). If I am unable to repay the full amount of the ADPP, I understand that the Agency will attempt to collect the debt using all available means. As the receiver of the ADPP payments I am aware of the right to be informed that this note can be transferred by the Agency to another party. I further understand that this promissory note will become null and void upon receipt of acceptance by CalPERS of the application for disability retirement and an effective date for CalPERS retirement. Signed this ____ day of ___________, XXXX. ___________________________________ __________________________________ Member’s First and Last Name Agency Executive’s Name and Title ___________________________________ __________________________________ Member’s Mailing Address Agency Mailing Address ___________________________________ __________________________________ Member’s Phone Number Agency Contact Number WITNESS ____________________________________ Witness First and Last Name ____________________________________________________________________________ Witness Home Address and Phone Number DocuSign Envelope ID: D2DFD6FF-FD12-4F7A-BFB7-6EAC56CBBB07