Get Lacera

Filling out the Lacera online can be a straightforward process when you have the right guidance. This comprehensive guide will walk you through each section of the Lacera application for disability retirement, ensuring that you provide the necessary information clearly and accurately.

Follow the steps to effectively complete the Lacera form online.

1. Click ‘Get Form’ button to initiate the process and access the application form.
2. Begin by entering the date in the designated field. Make sure to fill in the Social Security number accurately to avoid any processing delays.
3. Complete the personal information section with the employee's full name, including first, middle, and last names. If the employee has used other names during their County employment, please include those as well.
4. Provide the employee's current address, ensuring that all parts are filled in for street, city, state, and ZIP code.
5. Fill in the employee's contact information, including home phone number, work phone number, and cell phone number. If applicable, include the fax number.
6. Indicate the employee's age, sex, birth date, and driver's license number. Additionally, specify if the employee is currently married or registered as a domestic partner, and provide the pertinent details if the answer is yes.
7. List the names and birth dates of any children under the age of 18. Make sure to input this information accurately on the form.
8. Provide details about the position for which the employee claims to be permanently incapacitated. This includes item number, employee number, department number, department name, location, years of service, and last date worked.
9. Select the type of disability retirement being applied for, whether service-connected, nonservice-connected, or supplemental disability allowance.
10. Indicate the current employment status with the County. Check all applicable options and provide any necessary details regarding leaves or terminations.
11. Thoroughly describe the injury or illness causing the employee's permanent disability, including the affected body parts, as well as the date and location of the incident.
12. List any witnesses to the injury or illness, including their contact information, and describe the actual job duties that were performed at the time of disability.
13. State what duties the employee is unable to perform due to the disability, and list all attempts made to accommodate the disability.
14. Answer questions about whether the disability aggravated any preexisting conditions and specify if there are any permanent work restrictions.
15. Include any additional information that may support the application for a disability determination, and provide contact information for the last supervisor of the employee.
16. Once all sections are completed and reviewed, save changes, and choose to download, print, or share the form as needed.

Complete your Lacera application online today to ensure timely processing of your disability retirement request.