DISABILITY RETIREMENT STATUS REPORT

DISABILITY RETIREMENT STATUS REPORT DISABILITY RETIREMENT APPLICATIONS: OCTOBER 19, 2016 TABAREZ, 01-09-15 Sheriff SCDR Application received on 01-09-15. File under review. POMPEYO, JR. Notice of Filing of Compete Application mailed on 02-10-15. Questionnaire sent to Human Resources on 02-10-15; second request sent on 04-09-15. Questionnaire sent to Dept. Head on 02-10-15; received response on 03-06-15. Request for Workers Comp. records sent to Athens on 02-10-15; second request sent on 04-09-15. Waiting for additional reports from Drs. Couris and Mani. Received Questionnaire from HR on 04-14-15. Third request sent to Athens on 05-07-15. 08-04-15: Phoned MSLA, Justin Fearrington. Receipt of Dr. Glassman s supplement report is still pending. 08-24-15: Dr. Glassman s supplemental QME report received and forwarded to V. Shultz, Esq. 08-27-15: Conference call with V. Shultz, Esq. determined Ophthalmological QME required for further evaluation of claim. 08-31-15: Request emailed to MSLA for Ophthalmologic QME appointment for Applicant, response pending. 09-08-15: Conference call with and email from V. Shultz, Esq. providing list of Applicant s medical records to be forwarded to QME for evaluation prior to appointment. 09-08-15: 2nd email request for QME appointment sent to MSLA. 09-09-15: Email from MSLA: Search for available Ophthalmological QME ongoing; will schedule an appointment as soon as possible. 10-12-15: MSLA email advised that Applicant attended QME Ophthalmological appointment on 10-12-15. S: DISABILITY/STATUS REPORTS/2016/OCT. 19 2016 PAGE 1 10-19-16

TABAREZ, POMPEYO, JR. (cont.) 10-28-15: Conference call between R Rodrigues; K. Kubler; VW Shultz; and Independent Psychiatric Medical Examiner, Dr. Glassman, to address and clarify concerns of Supplemental Report of 06-21-15 and findings of appointment of 07-21-14. Copies requested by Dr. Glassman of most recent (2015) file referenced psychiatric Physician Statement of Alvaro Camacho, M.D., M.P.H., as well as all other available follow-up reports of all other treating physicians seen in 2015. Dr. Glassman agreed to provide a supplemental follow-up examination since year has passed since his initial exam of Member Tabarez. 10-28-15: Member advised to submit to ICERS list of all treating physicians for 2015. ICERS will request copies of 2015 medical records. 11-03-15: Member provided list of treating physicians for 2015. Letters requesting Member s 2015 medical records sent to Physicians. 11-05-15: Ophthalmological, Independent Medical Examination (IME) report for appointment with Dr. Le received from MSLA via email. Copy scanned to V. Shultz, Esq. for review. 12-01-15: 2 nd supplemental report request letter, including records/responses from 2015 treating physicians, mailed to Dr. Glassman, per direction from V. Shultz. 12-23-15: Dr. Glassman, IME 2 nd supplemental report received and forwarded to V. Shultz via email. Per direction from V. Shultz, Supplemental Department Questionnaire forwarded to Sheriff Dept. 01-05-2016: Supplemental Dept. Questionnaire response received and forwarded to V. Shultz. 01-08-16: Per direction from V. Shultz, member medical evaluation request submitted to County Health Officer (CHO). File delivered to CHO. Exam and report are pending.02-05/16: CHO report completed. Recommendation to Board of Retirement is scheduled for March 16, 2016 meeting. 03/16/2016: Member Application for Service- Connected Disability Retirement denied by the Retirement Board with a vote of Yes: 6, No: 2, Absent: 1. S: DISABILITY/STATUS REPORTS/2016/OCT. 19 2016 PAGE 2 10-19-16

TABAREZ POMPEYO, JR. (cont.) 03-18-16: 45 Day Notice to file for Reconsideration or Hearing mailed to Member via Certified Mail, Return Receipt. 05-18-16: Response to notice still pending. 05-23-16: Signed contract agreement established with State Office of Administrative Hearings (OAH) to refer the decision on the disability retirement application to an independent Administrative Law Judge. 06-01-2016: Engagement letter signed with Jennifer S. Creighton, Attorney to represent ICERS before the OAH. 06-02-16: Received via email from OAH authorization to request hearing. 06-03-16: By order of subpoena, duplicate case file of Member s medical records provided for courier pickup. 06-13-16: Duplicate Member file FedEx d to JS Creighton. Any further documents received corresponding to Member s claim will be duplicated and forwarded to JS Creighton. 07-19-16: Confirmation received from Clerk of the Board of Supervisors (CBOS) to reserve the Board of Supervisors (BOS) chambers for five optional dates, as required for selection for the hearing by OAH. 07-27-16: OAH Application/Request for Hearing documents, completed by JS Creighton and by her direction, forwarded via email by ICERS to OAH. OAH e-reply denied Request to Set docs; requires additional documents. Direction received from JS Creighton to stand-by pending her inquiry to OAH. 08/23/16: JS Creighton received notice from OAH that hearing has been scheduled for 11/30/16, at 10:00 a.m. in the BOS chambers. Office of Administrative Hearing scheduled 11/30/2016. S: DISABILITY/STATUS REPORTS/2016/OCT. 19 2016 PAGE 3 10-19-16

McNAY, 03-18-15 Sheriff SCDR Application received on 03-18-15 from the Sheriff s ANN Department. File under review. Notice of Filing of Complete Application mailed on 04-18-15. Questionnaire sent to Human Resources on 05-08-15. Questionnaire sent to Dept. Head on 05-08-15. 05-14-15: Response to HR Questionnaire received; Letter to Member, joining action, mailed. 06-04-15: Signed Authorization to Release Records Info. and Claim Against Third Part received from Member. 06-08-15: Letter request to Athens for records mailed and faxed. 08-05-15: Phone request to Athens for W/C records. 08-24-15: Second phone request to Athens for W/C records. 09-09-15: Call to Athens re: request for records. 09-14-15: Athens W/C records received. 09-30-15: Email request to MSLA for QME appt. still pending. 10-20-15: Called MSLA re: repeated email requests for QME appt. (3). 11-20-15: Member attended IME; report pending. 12-07-15: IME report received; CHO exam requested. 12-16- 15: Member file delivered to CHO for review; exam scheduled for 01-19-16. 02-04-16: CHO exam and report completed. Recommendation to BOR is scheduled for March 16, 2016 meeting. 03/16/2016: Department Application for Service- Connected Disability Retirement denied by the Retirement Board with a unanimous vote. 03-18-16: 45 Day Notice to file for Reconsideration or Hearing mailed to Department and Member via Certified Mail, Return Receipt. 05-13-16: Request for Reconsideration and Request for Hearing received from Member Attorney representative. 06-01-16: ICERS Notices of Receipt of Requests for Reconsideration and Hearing mailed to Member; copies mailed to Member s Attorney, Human Resources (HR), Department Head (DH), ICERS Disability Counsel (DC), and ICERS Board Counsel (BC) (all parties). S: DISABILITY/STATUS REPORTS/2016/OCT. 19 2016 PAGE 4 10-19-16

McNAY, 03-18-15 Sheriff SCDR ANN (cont.) 06-03-16: Received by mail, Member s notice informing ICERS of retention of attorney representation and authorization to release information and records to same. 06-10-16: Received by mail from Member s attorney, notice of representation. Notices of Reconsideration Hearing set for 08-17-16 mailed to all parties. 07-12-16: Notice of Re-scheduled Reconsideration Hearing set for 09-21-16 mailed to all parties. 07-18-16: Received by mail, copy of signed Briefing Schedule agreement between DC and Member s Attorney. 8-9-16: DC to mail Brief to all parties. 08-18-16: Direction from DC to prepare duplicate member file for delivery via FedEx to Member s attorney. 08-24-16: Reconsideration hearing rescheduled for October 19, 2016 per request by Member Attorney; their final medical records review and preparation are still pending. Applicant s reply brief on reconsideration due on or before October 5, 2016. 10/6/2016: Applicant s Brief received; to be included with supporting documents for Reconsideration Hearing 10/19/2016. S: DISABILITY/STATUS REPORTS/2016/OCT. 19 2016 PAGE 5 10-19-16

JOHNSON, 02-11-16 Sheriff SCDR 02-11-16: Application filed by Safety Member, under GORDON review. 02-11-16: Application consultation with Member: 02-26-15: Notice of Complete Application was sent to Applicant copies forwarded to HR, Ryan Childers ICERS Counsel. Questionnaire sent to Dept. Johnson. 1-25-16: Sent out to letter Dr. Soumekh, MD requesting physician records. 1-25-16: Sent email to H/R requesting inter-active meetings, accommodations, and work restrictions. 2-1-16: received inter-active meetings, accommodations, and work restrictions from H/R. 2-19-16: Received medical records from Dr. Soumekh. 2-29-16 Member submitted medical reports from Dr. Massary. 03-04- 2016: Received questionnaire response from H.R. 03-07-2016: Received questionnaire response from department. 3-17-16: Request granted for IME by MSLA for 3-26-16. Member duplicate records file sent to MSLA via FedEx; 3-26-16: Applicant attended appointment. 4-4-16 IME exam completed, report received. Exam appointment with CHO is pending. 4-20-16: Hand delivered file to V. Shultz, Disability Counsel. 4-22-16 CHO report is complete emailed to V. Shultz, Disability Counsel for review. 4-28-16 Disability Counsel V. Shultz requested a Supplemental report. 4-28-16 Request sent to Dr. Bilezikjian, M.D. 5-12-16: Received supplemental report and emailed to Disability Counsel V. Shultz SCDR Recommendation to the Retirement Board pending for June 15, 2016. 6-15-16: Application for for Service- Connected Disability Retirement was denied by the Retirement Board with a unanimously with a 3 recusals. Further, The Board of Retirement Granted a Non-Service Connected Disability Retirement upon said application by an affirmatively voted unanimously, with 3 recusals. 6-20-16: Notice of Decision with a 45 Day Notice to file for Reconsideration of Hearing mailed to Member. 7-13-16: Received Request For Reconsideration received from Gordon Johnson. 7-19-16: Forwarded the information received by member for re consideration with all attachments to Vivian. S: DISABILITY/STATUS REPORTS/2016/OCT. 19 2016 PAGE 6 10-19-16

JOHNSON GORDON (cont.) 7-21-16: Prepared Notice Of Hearing On Request For Reconsideration. Mailed to Member, and copies to Attorney, H.R., Department, ICERS Counsel, and ICERS Disability Counsel. Recommendation to the Board of Retirement for Reconsideration is scheduled for September 21, 2016 meeting. Document request to Athens Administrators. 8-1-16: Received response from Athens and no documents, voicemail to Athens to request clarification of documents. 8-3-16: Received additional documents from Mr. Johnson in support of reconsideration. 8-18-16: Additional documents received from Athens. 8-29-16: ICERS Response To Request for Reconsideration filed and served. 9-21-16: Applicant s Request for Reconsideration and attachments, along with our Response to the Reconsideration will be attached to the status report for the month and discussed before the Board of Retirement. 9-21-16: Reconsideration filed by the applicant for service-connected disability retirement was denied by the Retirement Board with a vote of 5 to 1 (abstention), with three recusals. 9-23-16: 45 Day Notice to file a Request for Hearing mailed to Member, Department, County Counsel, and Human Resources. CELIS, 03-24-16 FIRE SCDR 03-24-16: Application filed by Safety Member, under ERNESTO review. 03-24-16: Application consultation with Member: 04-14-16: Notice of Complete Application Application was sent to Applicant s attorney, copies forwarded to HR, Ryan Childers ICERS Counsel, Dept. Head: 04-14-16: Worker s Comp. records request mailed to Athens Administrators. Questionnaire sent Inter-Office mail to Dept and H.R. 4-19-16: Received questionnaire from Department. 4-21-16: Received questionnaire from H.R. 5-23-16: Received Worker s Comp. records from Athens. 5-26-16: IME exam pending for 07-13-16 with Dr. Thomas Schweller, M.D. 6-3-16: Confirmed with applicant he will be able to attend the scheduled appointment.6-8-16: Prepared and mailed letter to applicant with confirmation letter confirming S: DISABILITY/STATUS REPORTS/2016/OCT. 19 2016 PAGE 7 10-19-16

CELIS, 03-24-16 FIRE SCDR HARRIS, 05-10-16 Sheriff SCDR THERESA ERNESTO appointment along with driving directions and a blank mileage claim. 6-22-16: Prepared and sent by Federal Express Mail, a letter to the doctor attaching a copy of the Administrative Record. 7-26- 16: Prepared and paid mileage claim for Mr. Celis. 08-18-16: IME report received.received doctor s report 08-29-16: Exam appointment with CHO is pending. 08-30-16: CHO report is complete. 09-07- 16: Mileage claim and reimbursement paid to applicant. 09-09-16: File sent to Vivian via FedEx. 10-19-16: Recommendation to Board of Retirement is scheduled for October 19, 2016 meeting. 04-13-16: Application filed by Member. Notice of Complete Application was sent to member. Copies forwarded to HR, Ryan Childers ICERS Counsel, Dept. Head: 05-10-16: Ms. Harris Amended filed on 4-13-16. 05-25-16: Worker s Comp. records request mailed to Athens Administrators. Questionnaire sent Inter-Office mail to Dept and H.R. 6-07-16: Received Department Head s Questionnaire. 06-13-16: Received Worker s Comp records from Athens and Questionnaire from H.R. 6-27-16: Vivian requested copies of all medical records from Dr. Camacho, member s primary physician. 7-28-16: Received invoice from Dr. Camacho for copies of medical records 08-01-16: Paid invoice received from Dr. Camacho. 8-2-16: Second request to MSLA for IME. Received medical records requested from Dr. Camacho. 8-12-16: Vivian requested an IME appointment with MSLA. 8-24-16: Member duplicate records file sent to MSLA via FedEx. 8-30-16: Applicant attended appointment. IME exam completed waiting for report. 09-07-16: Reimbursement paid to applicant for mileage. 10-3- 16: Vivian requested an IME appointment with an Orthopedist through MSLA. IME exam is scheduled for October 15, 2016. Confirmed by applicant she will be attending scheduled appointment. S: DISABILITY/STATUS REPORTS/2016/OCT. 19 2016 PAGE 8 10-19-16

CEJA, 12-02-15 Public SCDR 12-02-15: Application filed by General Member, GILBERT Works under review. 12-02-15: Application consultation with Member: 12-21-15: Notice of Complete Application was sent to Applicant, copies forwarded to HR, Ryan Childers ICERS Counsel, Dept. Head: 12-23-15: Worker s Comp. records request faxed and mailed to Athens Administrators; Dept. Questionnaire, H.R.. 1-13-16: Questionnaire sent via Inter-Office Mail:. 02-01-16: Questionnaire response received from H.R, Athens W/C records received via Certified Mail. 2-2-16: Second Notice Questionnaire sent to Dept. Head. 2-29-16: Third Department Questionnaire sent via email and Interoffice mail. 3-9-16: Questionnaire response received from department.3-22-16: Request granted for IME by MSLA for 4-23-16. Member duplicate records file sent to MSLA via FedEx. Confirmed by applicant he will be attending scheduled appointment. 04-23- 2016: IME exam completed waiting for report. 4-29- 16 IME report received. 5-25-16 Exam appointment with CHO is pending. 5-31-16 CHO report is complete. 6-15-16: File will be hand delivered to V. Shultz, Disability Counsel. Recommendation to Board of Retirement is scheduled for September 21, 2016 meeting. 9-21-16: Service Connected Disability was granted by the Retirement Board with a unanimous vote. S: DISABILITY/STATUS REPORTS/2016/OCT. 19 2016 PAGE 9 10-19-16

INIGUEZ, 07-18-16 PUBLIC NSCDR 07-18-16: Complete application filed by General LIZETH S. DEFENDER Member. 07-19-16: Notice of Complete App. mailed to Member; copies to Department Head (DH), Human Resources (HR), Disability Counsel (DC), Board Counsel (BC) (all parties). DH and HR Questionnaires mailed. File duplicated and FedEx d to DC. 07-22-16: Received Questionnaire response from DH; scanned to DC. 07-26-16: Received Questionnaire response and additional records from HR; scanned to DC. 8/1/16: Received additional medical reports from Applicant, forwarded to DC. 8/29/16: DC request to MSLA for IME (record review only). 8/30/16: Applicant s written confirmation that application was for NSCDR. 9/6/16: Per MSLA, IME report expected to be completed the week of 9/12/16. Recommendation to the Board of Retirement scheduled to be heard 10-19-16. MENDEZ, 08-02-16 PROBATION SCDR 08-02-16: Complete application filed by Safety ANTONIA Member.08-03-16: Notice of Complete App. mailed to Member; copies to Department Head (DH), Human Resources (HR), Disability Counsel (DC), Board Counsel (BC) (all parties). DH and HR Questionnaires mailed. File duplicated and FedEx d to DC. 8-15-16: HR response to Questionnaire with additional Workers Comp. documents received. 8/3/16: Applicant interview scheduled with DC on 9/21/16. 9/9/16: Documents received from Athens. 9/21/2016: Applicant interview conducted by Disability Counsel; records under review. 9/26/2016: IME appointment confirmed; IME examination scheduled for 10/15/2016. NAUD, 08-03-16 SHERIFF SCDR 08-03-16: Complete application filed by Safety YVONNE K. Member. 08-04-16: Notice of Complete App. mailed to Member; copies to Department Head (DH), Human Resources (HR), Disability Counsel (DC), Board Counsel (BC) (all parties). DH and HR Questionnaires mailed. File duplicated and FedEx d to DC. 8/5/16: DC received file from ICERS. 8/29/16: Documents received from Athens. 9/21/2016: Applicant interview conducted by Disability Counsel; records under review. S: DISABILITY/STATUS REPORTS/2016/OCT. 19 2016 PAGE 10 10-19-16

BATMAN 08/15/2016 SUPERIOR SCDR SUSANA S. 08-15-16: Complete application filed by Member. 08-16-16: Notice of Complete Application mailed to Member and all parties; Department and Human Resources Questionnaires delivered via inter-office mail; 08-17-16: Duplicate Member file delivered to DC via FedEx. 08-30-16: Received Questionnaire response from department, sent document request to AIMS for workers compensation records. 10/03/2016: County HR Questionnaire response received; forwarded to DC. Receipt of W/C records pending. MORA IRENE 08/31/2016 SOCICAL SERVICES SCDR 08-31-16: Complete application filed by Member. 09-26-16: Notice of Complete Application mailed to Member and all parties. 10-4-16: Department and Humans Resources Questionnaires delivered via intermail; Interview Appointment with Vivian is scheduled for October 19, 2016 at 1 p.m. ICERS building. Confirmation letter of appointment was mailed to member. 10-6-2016: W/C Records requested. ORENALAS 09/12/2016 PROBATION SCDR VERONICA. 09-12-16: Complete application filed by Member. 09-26-16: Notice of Complete Application mailed to Member and all parties; 10-4-16: Department and Humans Resources Questionnaires delivered via intermail; Interview Appointment with Vivian is scheduled for October 19, 2016 at 2 p.m. ICERS building. Confirmation letter of appointment was mailed to member. 10-6-2016: W/C Record s requested. S: DISABILITY/STATUS REPORTS/2016/OCT. 19 2016 PAGE 11 10-19-16