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Chapter 1. Teachers' Retirement System. Article 16. Member's Right to Internal Informal Appeal of a Determination by Calstrs Staff of a Right to a Benefit or Obligation. Administrative Remedy for Benefits & Services and Financial Services.   

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(a) Any applicant who disagrees with a Decision, excluding audit findings as referenced in section 27102, may request a review of that Decision by the Program Executive. The request for review must:

(1) Be made in writing;

(2) Be addressed to the Program Executive;

(3) State all facts, any basis in the Education Code or other law that applicant believes are relevant, and any other pertinent information, which may include but is not limited to medical records, which the applicant relies on to dispute the Decision.

(A) The stated facts, law, and pertinent information, which may include but is not limited to medical records, must be submitted with all documentary evidence applicable to the disputed Decision. If there is no documentary evidence, the writing should expressly state there is an absence of such evidence.

(B) It is the applicant's burden to show that the facts, law, and pertinent information would provide a legal basis for CalSTRS to reverse the Decision.

(4) Within forty-five (45) days after the date of the disputed written Decision, be received by the System Headquarters or by a CalSTRS Field Office or at the following email address: [CalSTRSInternalReview@calstrs.com].

(b) CalSTRS will inform the applicant of the applicant's right to an administrative hearing. CalSTRS will also refer the applicant to the Office of Administrative Hearings (OAH) for information pertaining to administrative hearings, notify the applicant that the applicant has a right to self-representation or counsel at their own expense and that CalSTRS will be represented by counsel.

(c) If the applicant's request for review by a Program Executive (?Executive Review?) does not contain additional information or legal basis for review beyond the facts and/or documentary evidence previously provided to or obtained by the program area and merely repeats information previously provided, the applicant's request for Executive Review by the Program Executive shall be denied and the applicant may request an administrative hearing. The Program Executive may consult with CalSTRS staff prior to denying applicant's request for Executive Review.

(d) If the Program Executive determines that the applicant has provided sufficient additional information or legal basis for review, the Program Executive will review the Decision and make one of the following Determinations:

(1) Based upon review of the law and facts, including any additional information provided by applicant, applicant has not provided a legal basis to reverse the Decision and has therefore failed to meet his or her legal burden. The Program Executive shall inform the party in writing of the Determination and the applicant's right to an administrative hearing.

(2) Informal fact finding is necessary in regard to the applicant's dispute with the Decision and the matter is referred to staff for investigation. The informal factual investigation may include, but is not limited to, inquiries made to the applicant and requests for further documentary evidence pursuant to Education Code sections 22207, 22250, 22450, 24003, 24103, and 26002. The applicant must in good faith cooperate with and respond to staff.

(A) The applicant must respond in writing, either through mail, facsimile or email, to any inquiries made and/or requests for further documentary evidence. If the applicant fails to respond in writing or produce documentary evidence within forty-five (45) days after the inquiry or request was made, the applicant shall be deemed to have waived the right to pursue any additional administrative remedies. Accordingly, the Decision will be deemed to be a Determination by the Program Executive.

(B) At the discretion of the Program Executive an extension to respond to any inquiries made and/or requests for further documentary evidence may be granted if the request for an extension is made prior to the last day to respond, in writing, and received at the System Headquarters, at a CalSTRS field office, or at the following email address: [CalSTRSInternalReview@calstrs.com].

(C) Upon completion of the informal factual investigation, the Program Executive will conduct a review of the additional information, the legal basis for review that applicant believes are relevant, and the information gathered through investigation. The review may include consultation with, including but not limited to, staff, the Ombudsman, a Legal Services representative, and a representative from the relevant program area. After the review is complete, the Program Executive shall make a Determination and shall inform the applicant in writing within fifteen (15) days. If the applicant disagrees with the Program Executive's Determination under subdivisions d(1) or d(2)(C) of this section, the applicant may request an administrative hearing.

(e) The request for an administrative hearing shall be directed to CalSTRS Legal Services within ninety (90) days of the date of the Determination signed by the Program Executive. The request shall be in writing and mailed to the following address: CalSTRS Legal Services, PO Box 15275, MS #3, Sacramento, CA 95851. If the applicant fails to make a written request for administrative hearing within the time prescribed, the Program Executive's Determination shall be final and the right to an administrative hearing shall be deemed waived.

Authority cited:

Education Code 17

Education Code 22219

Education Code 26002

Reference:

Education Code 22207

Education Code 22250

Education Code 22303

Education Code 22375

Education Code 22450

Education Code 22455

Education Code 24003

Education Code 24103

Education Code 26002

Education Code 26132

Education Code 26301

Government Code 11415.40

Government Code 11505(b)

(New by Register 2012, No. 6.)