Appeals procedure -- Right of appeal to hearing officer -- Board reconsideration -- Judicial review.
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(1)
(a) A member, retiree, participant, alternative payee, covered individual, employer, participating employer, and covered employer shall inform themselves of their benefits, rights, obligations, and employment rights under this title.
(b) Subject to Subsection (8), any dispute regarding a benefit, right, obligation, or employment right under this title is subject to the procedures provided under this section.
(c)
(i) A person who disputes a benefit, right, obligation, or employment right under this title shall request a ruling by the executive director who may delegate the decision to the deputy director.
(ii) A request for a ruling to the executive director under this section shall constitute the initiation of an action for purposes of the limitations periods described in Section 49-11-613.5.
(d) A person who is dissatisfied by a ruling under Subsection (1)(c) with respect to any benefit, right, obligation, or employment right under this title may request a review of that claim by a hearing officer within the time period described in Section 49-11-613.5.
(e)
(i) The executive director, on behalf of the board, may request that the hearing officer review a dispute regarding any benefit, right, obligation, or employment right under this title by filing a notice of board action and providing notice to all affected parties in accordance with rules adopted by the board.
(ii) The filing of a notice of board action shall constitute the initiation of an action for purposes of the limitations periods described in Section 49-11-613.5.
(2) The hearing officer shall:
(a) be hired by the executive director after consultation with the board;
(b) follow and enforce the procedures and requirements of:
(i) this title;
(ii) the rules adopted by the board in accordance with Subsection (9); and
(iii)Title 63G, Chapter 4, Administrative Procedures Act, except as specifically modified under this title or the rules adopted by the board in accordance with Subsection (9);
(c) hear and determine all facts relevant to a decision, including facts pertaining to applications for benefits under any system, plan, or program under this title and all matters pertaining to the administration of the office; and
(d) make conclusions of law in determining the person's rights under any system, plan, or program under this title and matters pertaining to the administration of the office.
(3) The board shall review and approve or deny all decisions of the hearing officer in accordance with rules adopted by the board in accordance with Subsection (9).
(4) The moving party in any proceeding brought under this section shall bear the burden of proof.
(5) A party may file an application for reconsideration by the board upon any of the following grounds:
(a) that the board acted in excess of the board's powers;
(b) that the order or the award was procured by fraud;
(c) that the evidence does not justify the determination of the hearing officer; or
(d) that the party has discovered new material evidence that could not, with reasonable diligence, have been discovered or procured prior to the hearing.
(6) The board shall affirm, reverse, or modify the decision of the hearing officer, or remand the application to the hearing officer for further consideration.
(7) A party aggrieved by the board's final decision under Subsection (6) may obtain judicial review by complying with the procedures and requirements of:
(a) this title;
(b) rules adopted by the board in accordance with Subsection (9); and
(c)Title 63G, Chapter 4, Administrative Procedures Act, except as specifically modified under this title or the rules adopted by the board in accordance with Subsection (9).
(8) The program shall provide an appeals process for medical claims that complies with federal law.
(9)
(a) The board shall make rules to implement this section and to establish procedures and requirements for adjudicative proceedings.
(b) The rules shall be substantially similar to or incorporate provisions of the Utah Rules of Civil Procedure, the Utah Rules of Evidence, and Title 63G, Chapter 4, Administrative Procedures Act.