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Filing a Public Safety Officers' Benefits (PSOB) Program Disability Claim: Checklist

NCJ Number
Date Published
2 pages
This is a checklist to be used by claimants when filing a disability claim under the Public Safety Officers' Benefits Program administered by the U.S. Justice Department, which provides for disability benefits to medically retired officers or their representatives when the disability occurred in the performance of an officer's duties.
The former employing public safety agency must submit the documents required in the checklist concerning the line-of-duty injury. The report of the public safety officer's permanent and total disability claim form must be completed and signed by the disabled officer (or representative) as well as the head of the officer's former employing agency. A letter of affidavit from the agency's benefits provider must be sent to the PSOB Office, stating that the disabled officer is receiving the maximum allowable disability compensation for public safety officers in the agency. The benefits provider may be a retirement fund or a government workers' compensation office. Social Security does not qualify as a benefits provider. The former employing agency must provide a statement signed by the head of the agency regarding when and where the incidents occurred, what initiated them, and the nature of the injuries, as well as the date when the officer was medically retired from the agency. The agency's investigation of the disabling incidents must also be provided by the agency. Other information required for the disability claim pertains to the official toxicology catastrophic report if available; copy of tax returns filed by or on behalf of the officer from the year before the injury to the current year; medical documentation related to treatment for the officer's injuries; and a claimant statement. The claimant statement relates to the officer's educational level and special training, any formal vocational evaluations or vocational rehabilitative treatment, and work done since the injury.