[Added by Ord. No. 11-05-18A]
A.
Purpose. The purpose of this section of the Code is to provide a
fair and efficient method for determining the eligibility of a full-time
employee for the benefits enumerated under the Public Safety Employee
Benefits Act (820 ILCS 320/1 et seq.) (hereinafter "PSEBA" or the
"Act") through an administrative process, including if necessary,
an administrative hearing.
B.
Application procedure.
(1)
Employees or family member(s) of injured or deceased employees, who
may qualify for PSEBA benefits (hereinafter an "applicant") must file
a full and complete application in writing with the City Clerk no
later than 60 days from the date of issuance of a written decision
by the Police Pension Fund Board or Firefighter Pension Fund Board,
whichever is applicable, granting a line of duty disability pension.
Failure to timely file a full and complete application shall result
in a forfeiture of benefits under PSEBA.
(2)
A complete PSEBA application includes the following:
(a)
The name of the applicant, date of hire, detailed information
regarding the incident, including information relating to how the
injury was sustained in the line of duty (date, time, place, nature
of injury, and other factual circumstances surrounding the incident
giving rise to said claim);
(b)
The applicant's firsthand knowledge explaining, to the
City's satisfaction, how the injury/death directly resulted from:
(c)
A signed PSEBA medical authorization release which authorizes
the collection of information related to the incident, including,
but not limited to, disability pension proceedings, worker's
compensation records, and medical records and specifies the name and
address for pertinent health care provider(s);
(d)
A signed PSEBA general information release specifying the name
and signature of the applicant, or her/his authorized representative
along with legal proof of said representation, and name and signature
of witness, authorizing the collection of information pertinent to
the incident review process;
(e)
The names, addresses and telephone numbers of witnesses to the
incident resulting in the injury for which PSEBA benefits are sought,
along with any statements of the witnesses which the applicant either
possesses, may obtain or is aware of;
(f)
The names, addresses, and telephone numbers of witnesses the
applicant intends to call at the PSEBA hearing, along with their anticipated
subjects of testimony and any opinions the witnesses are expected
to give;
(g)
Information and supporting pension documentation filed with
the appropriate pension board;
(h)
Information supporting the PSEBA eligibility requirements; and
(i)
Other sources of health insurance benefits currently enrolled
in or received by the applicant and/or family members if the applicant
is deceased.
(3)
The PSEBA application must be submitted to the City Clerk in its
entirety.
(4)
The PSEBA application must be sworn and notarized to certify the
truthfulness of the content of the information. A review of the application
shall not occur until the application is complete.
(5)
On the date that the PSEBA application is deemed complete by the
City, the completed application shall then be submitted to the City
Clerk as the preliminary record, and a copy of the same shall be date
stamped and provided to the applicant.
(6)
Upon receipt of a complete application for PSEBA benefits, the City
Clerk shall set the matter for an administrative hearing before a
hearing officer to make a determination on whether to grant the applicant
PSEBA benefits based on the result of the administrative hearing.
(7)
The applicant will be given written notice of the date, time and
location for the scheduled administrative hearing to be served not
less than 10 days prior to the commencement of the hearing. If the
applicant, upon receiving written notice of the administrative hearing,
cannot attend said date, the applicant must contact the hearing officer
in writing within seven days after being served. The hearing officer
shall establish an alternative hearing date which is within 30 days
of the original hearing date. Failure to appear at the administrative
hearing shall result in denial of PSEBA benefits.
C.
Administrative Hearing Officer. The administrative hearing shall
be scheduled and conducted by a Hearing Officer whose authority and
limitations are as follows:
(1)
Authority of the Hearing Officer. The Hearing Officer shall have
all of the authority granted to her/him under common law relative
to the conduct of an administrative hearing, including the authority
to:
(a)
Preside over City hearings involving PSEBA;
(b)
Administer oaths;
(c)
Hear testimony and accept evidence that is relevant to the issue
of eligibility under PSEBA;
(d)
Issue subpoenas to secure attendance of witnesses and the production
of relevant papers or documents upon the request of the parties or
their representatives;
(e)
Rule upon objections to the admissibility of evidence;
(f)
Preserve and authenticate the record of the hearing and all
exhibits in evidence introduced at the hearing; and
(g)
Issue a determination based on the evidence presented at the
hearing, the determination of which shall be in writing and shall
include a written finding of fact, decision and order.
(2)
Hearing Officer. The Mayor, with the advice and consent of the City
Council, is hereby authorized to appoint a person to hold the position
of Hearing Officer for each hearing on PSEBA benefits that shall come
before this City. In making said selection, at a minimum, the individual's
ability to comply with the job description as set forth herein should
be considered.
(3)
Additionally, the individual must be an attorney licensed to practice
law in the State of Illinois and have knowledge of and experience
in employment and labor law, general civil procedure, the rules of
evidence, and administrative practice.
D.
Administrative hearing. The system of administrative hearings for
the determination of eligibility for benefits under PSEBA shall be
initiated either by the City or by the applicant after the submission
of a full and complete PSEBA application. An administrative hearing
shall be held to adjudicate and determine whether the applicant is
eligible for benefits under PSEBA. If the applicant is found eligible,
the benefits shall be consistent with the Act.
(1)
Record. The City shall ensure that all hearings are attended by a
certified court reporter and a transcript of all proceedings shall
be made by said certified court reporter and a copy thereof be provided
to the applicant within 28 days of the date of the administrative
hearing.
(2)
Procedures. The City and the applicant shall be entitled to representation
by counsel at said administrative hearing and present witnesses, testimony
and documents, may cross-examine opposing witnesses, and may request
the issuance of subpoenas to compel the appearance of relevant witnesses
or the production of relevant documents.
(3)
Evidence. The Illinois Rules of Evidence shall apply to the extent
practicable, unless the Hearing Officer determines that application
of the rule would be an injustice or preclude the introduction of
evidence of the type commonly relied upon by a reasonably prudent
person in the conduct of her or his affairs. Such determination shall
be in the sole discretion of the Hearing Officer. The Hearing Officer
must state on the record her or his reason for that determination.
(4)
Final determination. A written determination by the Hearing Officer
of whether the petitioning applicant is eligible for the benefits
under PSEBA shall constitute a final administrative determination
for the purpose of judicial review under the common law writ of certiorari.
(5)
Burden of proof. At any administrative hearing, the applicant shall
have the obligation and burden of proof to establish that the applicant
is eligible and qualified to receive PSEBA benefits. The standard
of proof in all hearings conducted under this section of this Code
shall be by the preponderance of the evidence.
(6)
Administrative records. All records pertaining to the administrative
process shall be held in a separate file under the applicant's
name with the City.
E.
PSEBA benefits granted by the City.
(1)
Basic group insurance plan. If an applicant is determined to be eligible
for PSEBA benefits, the applicant will be eligible to receive continued
health coverage consistent with the PSEBA under the City's basic
group health insurance plan. The basic group health insurance plan
shall be the health plan offered to City employees at the time PSEBA
benefits are awarded, with the lowest premium cost to the City, as
determined solely by the City from time to time. PSEBA benefits do
not include benefits not provided in the City's basic group health
insurance plan, such as, but not limited to, dental, vision, life
insurance, etc.
(2)
Reduction or elimination of PSEBA benefits by other health coverage.
If health insurance benefits become payable to an applicant from any
other source, including, but not limited to, Medicare, the applicant's
PSEBA coverage may be reduced or eliminated as determined by the City
consistent with PSEBA.
(3)
Affidavit of continued PSEBA eligibility. All recipients of PSEBA
benefits from the City shall complete and return to the City on an
annual basis an affidavit verifying the recipient's continued
eligibility for PSEBA benefits. The affidavit must be completed and
returned to the City Clerk within 60 calendar days of written notice
from the City. If the recipient does not complete and return the affidavit
within the time required, the City Clerk shall give the recipient
an additional written notice providing an additional 30 calendar days
for the recipient to complete and return the affidavit. Failure to
return the affidavit on or before the 30th calendar day following
the date of the additional written notice shall result in the recipient
incurring responsibility for reimbursing the City for health insurance
premiums paid by the City, relative to the recipient's individual
and/or family health insurance, from the date of the initial sixty-day
written notice until the affidavit is filed.
