Who is eligible for benefits?

Any law enforcement officer or firefighter employed by an organization in unincorporated King County before October 1, 1977, is eligible for membership in the LEOFF-1 plan and entitled to the benefits defined under RCW 41.26 and the board's Rules, Policies and Procedures.

IMPORTANT: A claim for reimbursement should be submitted to the board office no later than the second Wednesday of the month in which the claim needs to be reviewed. Claim submission deadline and meeting schedule.

To the extent that information on the claim forms is inconsistent with the King County LEOFF-1 Board rules or with any statute or other legal authority, the inconsistency will be resolved in favor of the board rules and/or legal authority.

• Complete the appropriate Medical | Dental | Disability PRINT forms by hand, or complete the FILL-IN forms electronically and print for your signature.
• Give your completed forms to your employer.
• LEOFF-1 offers long-term care services on a case-by-case basis.

Medical

Submit the required employee and employer forms, plus the appropriate supplemental forms for the service you received.

Submit a claim or preapproval request to your medical insurance first. Only amounts not covered by insurance can be claimed through the LEOFF-1 Disability Board.

Employee

• Member’s Claim for Reimbursement of Medical Expenses - Form 6

Employer

• Employer’s Statement: Claim for Reimbursement of Medical Expenses - Form 5

Medical / vision provider

• Physician/Health Care Provider’s Statement - Form 7

• Physician/Health Care Provider’s Treatment Plan - Form 8

Assisted care facility

• Assessment of Need for Nursing Home or Assisted Living Care - Forms 9A, 9B, and 9C

In-home care provider

• Assessment of Need for Home Health Care - Forms 10A, 10B, and 10C

Dental

Complete all of the forms below.

If you have dental insurance, submit a claim or preapproval request to your insurance first. Only amounts not covered by insurance can be claimed through the LEOFF-1 Disability Board.

Refer to the dental information in Rule 9.9 on page 38 of Rules, Policies and Procedures.

An employer may forward a claim to the board for final approval. If the board questions the reasonableness of charges or necessity of treatment, the board may require an independent evaluation by a board-selected dentist/specialist.

Employee

• Member’s Claim for Reimbursement of Medical Expenses - Form 6


• Police and Firefighters Dental Expense - Form 11

Employer

• Employer’s Statement: Claim for Reimbursement of Medical
  Expenses - Form 5

Provider

• Physician/Health Care Provider’s Statement - Form 7