The Public Safety Officers' Benefits (PSOB) Program provides disability benefits to public safety officers who have been permanently and totally disabled by a catastrophic personal injury sustained in the line of duty if that injury permanently prevents the officer from performing any substantial and gainful work. Medical retirement for a line-of-duty disability does not, in and of itself, establish eligibility for PSOB benefits.

Claim Form for PSOB Disability Benefits

Eligibility

PSOB Disability Program beneficiaries must comply with the PSOB Office's administrative review process by producing sufficient evidence to show that the public safety officer suffered a permanent and total disability as the direct and proximate result of a catastrophic injury sustained in the line of duty.

Most public safety officers (federal, state, and local law enforcement officers, firefighters, and members of public rescue squads and ambulance crews) are covered for catastrophic personal injuries sustained on or after November 29, 1990. As of October 30, 2000, employees of the Federal Emergency Management Agency (FEMA) and state, local, and tribal emergency management and civil defense agency employees working in cooperation with FEMA are considered to be public safety officers under the PSOB Program, provided they were performing official, hazardous duties related to a declared major disaster or emergency. Retroactive to September 11, 2001, chaplains also are included in the definition of a public safety officer. All line-of-duty injuries that result in a disability retirement are not necessarily covered under the Public Safety Officers' Disability Program. The injury has to prevent the public safety officer from performing any substantial and gainful work.

Applying for Disability Benefits

IMPORTANT: In general, PSOB claims must be filed within three years of the public safety officer’s disability. For claims that fall outside of this filing period, please call the PSOB Office directly at 888-744-6513 to discuss.

To file a disability claim with the PSOB Office, medically retired officers, or their representatives, and the former employing public safety agency must submit the following documents concerning the line-of-duty injury:

• Report of Public Safety Officer's Permanent and Total Disability Claim Form: This form must be completed and signed by the disabled officer (or representative) and the head of your former employing agency.
• Benefits Provider Information: A letter or affidavit from the agency's benefits provider stating the disabled officer is receiving the maximum allowable disability compensation for public safety officers in the agency. This must be on the provider's letterhead and signed by an authorized official. The benefits provider may be a retirement fund or a government workers' compensation office. Please note that, for purposes of the PSOB Disability Program, Social Security does not qualify as a benefits provider even though the officer may be receiving funds from that source.

• Circumstances of Injuries: A statement signed by the head of the former employing agency, on agency letterhead, including the officer's name and title, when and where the incidents occurred, what initiated them, and the nature of the injuries. This statement must also indicate the date on which the officer was medically retired from the agency.
• Agency Investigation (Accident/Collision/Reconstructive) Reports: These reports should contain information relevant to each incident and injury that contributed to the officer's permanent and total disability. If these reports are unavailable, a statement to that effect must be signed and submitted by the head of the former employing agency.
• Official Toxicology Reports: If available, these reports must be signed by the official who performed the toxicology analysis immediately following each injury. If a toxicology analysis is not available, a statement to that effect must be signed and submitted by the head of the former employing agency.
• Tax Returns: A copy of each state, local, and federal tax return filed by or on behalf of the public safety officer from the year before the injury to the present.
• Medical Documentation: Medical documentation must include admission and discharge summaries from each medical facility in which the officer was treated for each of the injuries, as well as a final medical diagnosis. The medical materials submitted by the disabled officer's physician(s) should also address the following questions:

1. What is the nature of the patient's injuries?
2. What physical and/or mental disabilities resulted from the incidents?
3. What, if any, is the patient's history of physical or mental pre-existing conditions?
4. What types of treatments, including medical rehabilitative treatments, have been implemented for the patient's line-of-duty injuries, and what are their current status?
5. At what stage is the patient in the healing process?
6. What is the patient's current level of ambulatory skills? Are assistive devices required?
7. What is the patient's current daily living capacity, including eating, bathing, toileting, and dressing?
8. What is the patient's prognosis, and what is the basis for this medical decision? Please include medical evaluations for the past six months.
9. What is the patient's residual functional capacity or level of disability?
10. In your opinion, what is the likelihood of the patient performing any type of gainful employment at any time in the future?

• Claimant Statement: A brief statement signed by the disabled officer or representative must also be submitted, addressing the following questions:

1. What is the highest educational level the disabled officer achieved? Has the disabled officer completed any special training or courses, including military training?
2. Has the disabled officer received any formal vocational evaluations or vocational rehabilitative treatment? If so, what is their current status?
3. Has the disabled officer worked at any job following the injuries? If so, where?

Disability Review Process

When the PSOB Office has received all the claimant's documentation, the medical records will be forwarded to its medical consultant. The PSOB Office will prepare a determination based on the medical consultant's findings and other requisite information. The determination is then sent to the Office of Justice Programs' Office of General Counsel for review and concurrence.

Payment of Disability Benefits

The claimant is notified of the decision in writing. If the claim is approved, the payment will be made through the U.S. Department of the Treasury either by direct deposit or by check mailed directly to the claimant's home address (provided on the "Report of Public Safety Officer's Permanent and Total Disability" claim form). If the claim is not approved, the claimant will receive the reasoning for the finding and have 33 days from receipt of the notification to request an appeal or reconsideration of the decision.