The requirements for entitlement to Disability Benefits are as follows:
- The Claimant must be or have been unable to engage in any substantial gainful activity because of any medically determinable physical or mental impairment(s)
“Medically determinable impairment” is an impairment that results from anatomical, physiological, or psychological abnormalities that can be shown by medically acceptable clinical and laboratory diagnostic techniques. A physical or mental impairment must be established by medical evidence consisting of signs, symptoms, and laboratory findings-not only by the individual’s statement of symptoms.
- The period of disability is expected to result in death or to last for a continuous period of at least 12 months.
- The Claimant must have been both fully and currently insured at the time of becoming disabled.
Currently insured means a worker or a self-employed worker has earned at least six (6) quarters of coverage during the forty (400 quarter period ending with the quarter of retirement, disability or death, whichever first occurs.
- An application must have been filed for Disability Benefits with respect to the Claimant.
Acceptable medical sources:
Documentation of the existence of a claimant’s impairment must come from medical professionals. Once the existence of impairment is established, all the medical and non-medical evidence is considered in assessing impairment severity.
Acceptable medical sources generally include physicians and other medical staff employed by Majuro and Ebeye Hospital. However, if the impairment is related to a medical condition that requires areas of specialization not available in the Marshall Islands, licensed off-island physicians may also be considered. These include, but not limited to, licensed or certified psychologists or psychiatrists (for purposes of establishing the mental condition of the claimant), licensed podiatrists (for purposes of establishing impairment of the foot or ankle), and qualified speech-language pathologists (for establishing speech or language impairments). MISSA may also request for copies of medical evidence from off-island hospitals, clinics, or other health facilities where a claimant has been treated.
Medical reports should include the following information:
- Medical history of the claimant
- Clinical findings (such as the results of physical or mental status examinations)
- Laboratory findings (such as blood pressure, x-rays)
Treatment prescribed with response and prognosis
- A statement providing an opinion about what the claimant can still do despite his or her impairment(s), based on the medical source’s findings on the above factors. This statement should describe, but is not limited to, the individual’s ability to perform work-related activities, such as sitting, standing, walking, lifting, carrying, handling objects, hearing, speaking, and traveling. In cases involving mental impairments, it should describe the individual’s ability to understand, to carry out and remember instructions, and to respond appropriately to supervision, co-workers, and work pressures in a work setting.
- Consultative examinations
- If the evidence provided by the Claimant’s own medical sources is inadequate to determine if he or she is disabled, additional medical information may be sought by communicating with the treating source foradditional information or clarification.
A consultative examination report should include the following elements:
- The claimant’s major or chief complaint(s)
- A detailed description, within the area of specialty of the examination, of the history of the major complaint(s)
- A description and disposition of pertinent positive’ and negative detailed findings based on the history, examination and laboratory tests related to the major complaint(s), and any other abnormalities or lack thereof reported or found during examination or laboratory testing
- Results of laboratory and other tests (e.g. x-rays) performed accord
- A statement about what the claimant can still do despite his or her impairment(s), unless the claim is based on statutory blindness.
Commencement of Disability Benefits:
A Claimant for Disability Benefits becomes entitled to such benefits beginning with the first month of his disability; provided, however, the maximum period for which such benefits shall be paid retroactively before the date of the application is 18 months for claims filed prior to September 30, 1992, and 12 months for claims filed on or after October 1, 1992.
Amount of Disability Benefits:
Subject to Paragraphs 4.b. and 4.c. and the other paragraphs of this Article, the monthly Disability Benefit shall be the Basic Benefit, but in no event shall the Disability Benefit be less than $128.99. The Basic Benefit is as defined in Paragraph 4.a. of Article I.
If a Claimant is receiving periodic workmen’s compensation benefit, the Disability Benefit shall be reduced, in any month, by the amount that the sum of the workmen’s compensation benefit for that month plus the Basic Benefit exceeds eighty percent of one-twelfth of the highest annual earning on which contributions were made in the period consisting of the calendar year in which the disability occurred and the preceding five years,
If a workmen’s compensation benefit was not commuted to a lump sum, it shall be treated as if the periodic benefit, which was originally payable, was in fact paid.
Reduction of Disability Benefits Based upon Subsequent Earnings:
With respect to Claimants under the age of 62, the Disability Benefit amount will be reduced by $1.00 for every $3.00 earned in a quarter in excess of $1,500. The adjustment in benefits will be applied as soon as practicable following the quarter in which the earnings were made and reported. No adjustment is made for Claimants who have attained the age of 62 years.
Suspension of Disability Benefits:
If the Claimant is not a citizen or national of the Marshall Islands, his Disability Benefits will be suspended for any month after the sixth consecutive month during which the Claimant is outside the Marshall Islands.
Paragraph 6.a. of this article does not apply to any Claimant who is a citizen or national of the Federated States of Micronesia, the Republic of Palau, or the United States of America, if the Federated States of Micronesia, the Republic of Palau, and the United States of America, respectively, extend periodic benefits on account of retirement to citizens and nationals of the Marshall Islands who are not citizens of the subject country, who qualify for such benefits, and who are permitted to receive such benefits outside the country without regard to the duration of the absence.
Evidence of Continued Disability:
The Administrator may, at any time, require a Claimant who is receiving a Disability Benefit to provide evidence necessary to confirm his entitlement to that benefit.
Unless otherwise waived by the Administrator, at least once every three-year period, the Administrator shall require the Claimant to undergo an examination by a Medical Examiner(s) selected by the Administrator. If the examination indicates that the Claimant is no longer disabled, payment of the Disability Benefit shall be discontinued.
For the purposes of this Section, recovery from disability shall mean that the Claimant may once again engage in continuous substantial gainful activities.
If the Claimant refuses to be submitted to a medical examination by a duly appointed Medical Examiner(s) or provide other evidence as required by the Administrator, the Disability Benefit shall be discontinued. If the refusal continues for two (2) years, all rights to the Disability Benefit shall be permanently revoked.
In the case of a Claimant who is below the age of 18 years, a requirement under Paragraph 7.a. of this Article may be addressed to a parent or guardian of the said minor Claimant.
Absent evidence of fraud or other wrongdoings, Disability Benefits shall not be discontinued retroactively.
Termination of Disability Benefits:
Disability Benefits terminate the month before the month in which the Claimant recovers from the disability or dies, whichever occurs first. Recovery from disability shall mean the Claimant may once again engage in substantial gainful activity.