HAR §6-26-3. Contents of application

(a) All applications for retirement benefits shall contain the following information: (1) The member's name, mailing address, and social security number; (2) The date of the application; (3) The member's date of birth; (4) The name of the employing department; (5) The position or job title held by the member; (6) The retirement allowance option that the member elects under any of the plans for receiving retirement allowances described in sections 88-74, 88-83, 88-282, 88-283, 88­ 332, and 88-333, HRS; (7) The name, relationship, social security number, and date of birth of any beneficiary designated to receive the benefit payable upon the death of the member after retirement; (8) The duly notarized signature of the member is required unless: (A) The member executes the application in the presence of a staff member who is authorized by the executive director of the system to accept applications; or (B) The application is for ordinary or service-connected disability retirement and is filed by the member's duly authorized and appointed guardian or legal representative, as provided in section 6-26-l(b). (b) If the application is for disability retirement, the application shall contain the following additional information: (1) Whether the application is for ordinary or service-connected retirement. (2) If the application is for service-connected disability retirement, a brief statement of the accident causing the disability, including 26-4 3·465 the date, time, place, and circumstances of the accident, or a brief statement of the occupational hazard causing the disability. (c) If the application is for service retirement, the application shall also contain the effective date of retirement. [Eff 2/9/89; am 1/29/90; am and comp 11/26/09; am and comp APR 1 1 2017 ] (Auth: HRS §88­ 28) (Imp: HRS §§88-73, 8~-75,. ElB-79, 88-83, 88-281, 88-283, 88-284, 88-286, 88-331, 88-333, 88-334, 88­ 336) §6-26-4 Simultaneous filing of more than one application. A member may file applications for different types of retirement at the same time, subject to the following limitations: (1) The effective date for retirement shall be in accordance with rules governing the effective date for each retirement; (2) The retirement allowance option and beneficiary shall be the same for all applications; and (3) The election of retirement allowance option shall be irrevocable, notwithstanding the subsequent approval of an application for ordinary disability retirement. [Eff 2/9/89; am and comp 11/26/09; comp APR 1 1 ?0?2 ] (Auth: HRS §88-28) (Imp: HRS §§88-73, 88­ 75, 88-79, 88-83, 88-281, 88-283, 88-284, 88-286, 88-331, 88-333, 88-334, 88-336) §6-26-5 Election of retirement allowance option; change; irrevocability. (a) A member may elect only one retirement allowance option. The retirement allowance option elected by the member may be changed to filing with the system's offices in Honolulu, Kauai, Maui, or Hawaii, written notice of change no later than one business day before the effective date of retirement. Any written notice of change sent by 26-5 mail shall not be effective unless it is received by the system no later than one business day before the effective date of retirement. (b) Every written notice of change shall contain the duly notarized signature of the member, or the member may execute the change in the presence of a staff member who is authorized by the administrator of the system to accept changes. If a member does not select a retirement allowance option before the member's effective date of retirement, then the default retirement allowance option shall be the maximum allowance option, and the beneficiary shall be the member's estate, if no beneficiary has been designated on the application. Upon the effective date of retirement, the retirement allowance option is irrevocable and cannot be changed. [Eff 2/9/89; am and comp 11/26/09; comp APR 11 ?O?? ] (Auth: HRS §88­ 28) (Imp: HRS §§88-83, 88-283, 88-333) §6-26-5.01 Spousal or reciprocal beneficiary notification. (a) No election by a member of any retirement allowance option in accordance with section 88-83, 88-283, or 88-333, HRS, shall take effect: (1) Until the system provides the spouse or reciprocal beneficiary of the member written notification that: (A) Specifies the retirement date, the retirement allowance option selected, and the beneficiary designated by the member; and (B) Provides information indicating the effect of the election; (2) Unless the member selects option 2, option 3, including an option that includes options 2 or 3 in combination with some other form of benefit payment, option A or option Band designates the spouse or reciprocal beneficiary as the beneficiary; or 26-6 (3) Unless it is established to the satisfaction of the board that the notice required under paragraph (1) cannot be provided because: (A) There is no spouse or reciprocal beneficiary; (B) The spouse or reciprocal beneficiary cannot be located; or (C) The member has failed to notify the system that the member has a spouse or reciprocal beneficiary or has failed to provide the system with the name and address of the member's spouse or reciprocal beneficiary. (b) The notice shall be in writing and provided in one of the following ways: (1) Via hand-delivery; or (2) By mail. (c) Any notice provided to a spouse or reciprocal beneficiary, or determination that the notification of a spouse or reciprocal beneficiary cannot be provided, shall be effective only with respect to that spouse or reciprocal beneficiary. The system shall rely on the representations made by a member as to whether the member has a spouse or reciprocal beneficiary and the name and address of the member's spouse or reciprocal beneficiary. The member shall provide the representations to the system on a form prescribed by the system. [Eff and comp 11/26/09; comp APR 11 ?O':'? ] (Auth: HRS §§88-28, 88-83, 88­ 2 8 3 , 8 8 - 3 3 3 ) ( I mp : HRS § § 8 8 - 8 3 , 8 8 - 2 8 3 , 8 8 - 3 3 3 ) §6-26-6 Designated beneficiary; when more than one. If more than one beneficiary is designated to receive benefits payable upon death, the applicant shall indicate the portion of the benefits payable to each beneficiary and to whom benefits will be paid if the beneficiary predeceases the applicant. [Eff 2/9/89; am and comp 11/26/09; comp APR 11 ?O?? (Auth: HRS §88-28) (Imp: HRS §§88-83, 88-283, 88­ 333) 26-7 §6-26-7 Disabi1ity app1ication; medica1 evidence. (a) The applicant for ordinary and service­ connected disability retirement shall have the responsibility of furnishing all medical evidence available or which can be made available to the applicant pertaining to the applicant's disability, including reports of the applicant's personal physician and consultant physicians, hospital and laboratory reports, and x-rays. The applicant for service-connected disability retirement shall also submit, on a form provided by the system, information concerning the applicant's education, work experience, and medical history. (b) If the application is for service-connected disability retirement, the system shall obtain the following: (1) A copy of the employer's report of the accident submitted by the employer to the department of labor and industrial relations, disability compensation division, and any other report of or to the disability compensation division, including medical reports, relating to the accident; (2) A certified statement from the head of the department in which the applicant is employed, stating the date, time, and place of the accident, and the nature of the service being performed when the accident occurred. The statement shall also include an opinion as to whether or not the accident resulted in the applicant's disability and whether or not the disability was the result of willful negligence on the applicant's part; (3) A copy of the latest position description of the applicant's duties and responsibilities; and (4) A release form signed by the applicant which enables the system to obtain any medical and worker's compensation reports. 26-8 (c) The application shall be deemed canceled if: (1) The applicant for ordinary or service­ connected disability retirement fails to file a report from the applicant's personal physician concerning the applicant's medical condition and disability within sixty days from the date of the filing of the application; or (2) Twice fails to keep an appointment with the medical board or with a consultant to whom the applicant may be referred by the medical board or by the system. Written notice of the cancellation shall be sent to the applicant. (d) For the purpose of this subchapter, unless otherwise indicated by the context, the term "service­ connected disability retirement" includes service­ connected total disability retirement and service­ connected occupational disability retirement. [Eff 2/9/89; am and comp 11/26/09; comp APR 11 2022 l (Auth: HRS §88-28) (Imp: HRS §§88-75, 88-79, 88-284) §6-26-8 Application for three-year evaluation; calculation of benefits; cancellation of request for evaluation. (a) A member who has been retired on service-connected occupational disability retirement for accidents occurring before July 7, 1998 shall be notified in writing at least ninety days before the expiration of three years from the effective date of retirement that the member is entitled to be evaluated by the medical board to determine whether the member has become totally incapacitated for gainful employment as a result of the member's service­ connected injuries or job hazard. The member shall notify the system whether the member desires to be evaluated by submitting a written request for evaluation. The written request for evaluation shall be submitted no earlier than the date of the notice from the system that the member is entitled to be evaluated by the medical board and no later than the 26-9 expiration of three years from the effective date of retirement. The member shall submit new medical evidence in support of the member's claim of total disability. (1) After review by the medical board, if the board determines that the member is totally incapacitated for gainful employment as a result of the member's service-connected injuries or job hazard, the board shall award the member a service-connected disability benefit consisting of an annuity plus a pension of sixty-six and two-thirds per cent of the member's average final compensation; (2) After review by the medical board, if the board determines that the member is not totally incapacitated for gainful employment as a result of the member's service­ connected injuries or job hazard, the member's benefit after the completion of three years from the date of retirement shall be the member's annuity plus a pension of thirty-three and one-third per cent of the member's average final compensation. (b) The right to a three-year evaluation shall be deemed waived and the request for an evaluation canceled if the applicant twice fails to keep an appointment with the medical board or with a consultant to whom the applicant may be referred by the medical board or the system for medical evaluation. Written notice of the cancellation shall be sent to the applicant. [Eff 2/9/89; am and comp 11/26 / 0 9; comp APR 1 1 2022 ] (Auth: HRS § 8 8-2 8) (Imp: HRS §§88-77 (1997), 88-79 (1997), 88-80 (1997)) 26-10 SUBCHAPTER 2 PROOF OF AGE