[Adopted 1-14-2019 by Ord. No. 2019-01]
A.
Purpose.
(1)
The purpose of this article is to provide a fair and efficient method
of determining the eligibility of an employee for the continuation
of health insurance coverage as provided under the Public Safety Employee
Benefits Act[1] ("PSEBA" or the "Act") through an administrative process,
including if necessary, an administrative or evidentiary hearing.
[1]
Editor's Note: See 820 ILCS 320/1 et seq.
(2)
All benefits provided to employees pursuant to PSEBA will be consistent
with PSEBA, including the requirement that PSEBA benefits are only
available when the applicant has existing coverage under a Village
health insurance plan at the time of the applicant's PSEBA application,
as well as at the time that the applicant is found to be eligible
for PSEBA benefits. Additionally, PSEBA benefits shall be limited
to paying the entire premium for the Village's basic health insurance
plan. For purposes of this article, the term "basic health insurance
plan" means the health insurance plan available to Village public
safety employees with the lowest monthly premium. Any description
in this article of the benefits available under PSEBA shall be limited
to paying the premium for the Village's basic health insurance
plan.
B.
Application procedure.
(1)
In order to seek benefits under PSEBA, public safety employees or
family members of an injured or deceased public safety officer in
the event the employee is not capable of taking this action ("applicant")
must file with the Village Manager a full and complete written PSEBA
application as further described in this section within 30 calendar
days of filing a disability pension claim, or within 30 calendar days
of the date of the adoption of this article in the event that an applicant
has filed for a disability pension claim prior to the date of the
adoption of this article, whichever is later. Failure to timely file
the full and complete application with the Village Manager shall result
in a forfeiture of the benefits under PSEBA. Upon request, the village
shall furnish a Public Safety Employee Benefit Act application (the
"application form") to the applicant.
(2)
Any applicant seeking benefits under the Act shall complete the application
form provided by the Village, and shall, pursuant to the Act, include
the applicant's or family member's firsthand knowledge explaining
how the disability injury/death directly resulted from the public
safety employee's:
(3)
The application form must be sworn and notarized to certify the truthfulness
of the content of the information contained in the application form
and the additional information required for a completed application,
including without limitation a signed PSEBA medical authorization
release, and a signed PSEBA general information release. Both the
PSEBA medical and PSEBA general information releases authorize the
collection of information related to the incident, including without
limitation the disability pension proceedings, worker's compensation
records, and medical records. A review of the application will not
occur until all elements of the application are complete, including
the medical releases.
(4)
The complete application must include the name of the public safety employee, date of hire, detailed information regarding the incident, (including date, time, place, nature of injury, any other factual circumstances surrounding said incident giving rise to said claim), witnesses to the incident, witnesses the applicant intends to call at any PSEBA hearing, information and supporting pension documentation filed in connection with a disability pension request and any determination or ruling on such request, information supporting the PSEBA eligibility requirements, including a statement that the applicant has existing coverage under the Village's health insurance plan at the time of the applicant's PSEBA application, a signed PSEBA medical authorization release, a PSEBA general information release authorizing the collection of information as set forth in § 67-18B(3) above, and if applicable, other sources of health insurance benefits currently enrolled in or received by the employee and/or family members if the employee is deceased.
(5)
The PSEBA medical information release must specify name and address
information for pertinent health care provider(s) and hospital(s),
along with the employee's and/or his/her authorized representative's
signature and witness signature.
(6)
The PSEBA general information release must specify name and signature
of the employee or his/her authorized representative, along with legal
proof of said representation along with name and signature of witness
authorizing the collection of information pertinent to the incident
review process.
(7)
On the date that the Village receives a complete application, which
will include a completed application form, PSEBA medical release,
PSEBA general information release, and all other supplemental information
supporting the application, the Village shall issue the applicant
a receipt, and the application shall then be submitted to the Village
Manager, as the preliminary administrative record; a copy of the same
shall be date stamped and provided to the applicant.
(8)
Upon receipt of a complete application for PSEBA benefits timely
filed, the Village Manager shall review the application and supporting
documents to make a determination (subject to final approval of the
Board of Trustees) as follows:
(a)
Grant or deny benefits based upon the facts on the application
as it stands;
(b)
Set matter for a final administrative hearing before a hearing
officer to make a determination based on the result of an administrative
hearing;
(c)
Set matter for an evidentiary hearing before a hearing officer
to make a recommendation to the Board of Trustees based on the result
of an evidentiary hearing. Following receipt of the recommendation
of the hearing officer, the board of trustees shall render a determination
rewarding the applicant's eligibility for benefits under PSEBA;
(d)
Enter such other finding as is consistent with the evidence
or by agreement of the applicant and the Village.
(9)
If the Board of Trustees grants the benefit based on the preliminary
record as it stands, the applicant will be contacted by the Village
within 30 days of the decision. The applicant will be required to
contact the finance director for benefit explanation and processing.
(10)
If the Board of Trustees determines the matter requires a final
administrative or evidentiary hearing, the applicant will be given
written notice of such decision along with a date for the scheduled
hearing.
(11)
If the applicant, upon receiving written notice of the date
for a final administrative hearing or an evidentiary hearing, cannot
attend said date as indicated in the notice of such hearing, the applicant
must contact the hearing officer within seven days after being served
with notice of the hearing, communicating alternative hearing date(s)
which are within close proximity of the original date indicated by
the hearing officer. Failure to appear may result in denial of benefits.
(12)
If the Board of Trustees denies the benefit based on the preliminary
record as it stands, the applicant will receive written notice of
such denial.
(a)
The applicant shall have the right to request an evidentiary
hearing, which must be served in writing to the Village Manager not
later than 30 calendar days after being served with written notice
of the denial. Upon receipt of a timely notice from the applicant,
the Village Manager shall schedule the evidentiary hearing and serve
the applicant with notice of such hearing.
(b)
If the applicant, upon receiving written notice of denial, chooses
not to request an evidentiary hearing, the applicant will be required
to contact the finance director to discuss other options in which
the applicant may be eligible to participate.
C.
Administrative composition. A final administrative hearing or an evidentiary hearing under this § 67-18 shall be scheduled, which hearing shall be conducted by a hearing officer whose power and authority and limitations are as follows:
(1)
Power of the hearing officer. The hearing officer shall have all
of the powers granted to him or her under common law relative to the
conduct of a final administrative hearing or an evidentiary hearing,
including the power to:
(a)
Preside over all Village 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 in the admissibility of evidence;
(f)
Preserve and authenticate the record of the hearing and all
exhibits in evidence introduced at the hearing;
(g)
Issue a determination (in the case of a final administrative
hearing) or a recommendation (in the event of an evidentiary hearing)
based on the evidence presented at the hearing, which determination
or recommendation shall be in writing and shall include either a written
finding of fact, decision and order or a recommended finding of fact,
decision and order.
(2)
Hearing officer. The Village President with the consent of the Board
of Trustees is hereby authorized to appoint a person to hold the position
of a hearing officer for each and every individual hearing that shall
come before this Village. In making said selection, the Village President
shall consider all pertinent information including, at a minimum:
(a)
The candidate's ability to comply with the job description
as set forth herein;
(b)
Background and performance data made available to the Village
President on file with the Village or otherwise obtained by the Village;
(c)
The candidate must be an attorney licensed to practice law in
the State of Illinois for at least three years and have knowledge
of and experience in employment and labor law, general civil procedure,
the rules of evidence, and administrative practice.
D.
Procedure. An administrative or evidentiary hearing shall be initiated either by the Board of Trustees or by an applicant as described in more detail in § 67-18B, but only after the submission of a full and complete PSEBA application.
E.
Administrative and evidentiary hearings. A final administrative hearing
shall be held to adjudicate and determine whether the applicant is
eligible for benefits under PSEBA. An evidentiary hearing shall be
held to ascertain facts and formulate a recommendation to the Board
of Trustees whether the applicant is eligible for benefits under PSEBA.
If the applicant is ultimately found eligible, the benefits shall
be consistent with the Act.
(1)
Time and date. Hearings shall be held on the date, time and place
as established by the Village with appropriate notice served upon
the applicant.
(2)
Record. The applicant, at applicant's expense, shall ensure
that all hearings shall be attended by a certified court reporter
and a transcript of all proceedings shall be made by said certified
court reporter and a copy be provided to the Village at applicant's
expense within 14 days of the date of the hearing.
(3)
Procedures. The Village and the applicant shall be entitled to representation
by counsel at said hearing and may present witnesses, may present
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. Each party
shall bear the costs of its own counsel and witnesses.
(4)
Evidence. The rules of evidence as set forth in the Illinois Code
of Evidence shall apply.
(5)
Final determination; recommendation.
(a)
For each final administrative hearing, the determination by
the hearing officer of whether the petitioning applicant is eligible
for the benefits under the Public Safety Employee Benefits Act (820
ILCS 320/1 et seq.) shall constitute a final administrative determination
for the purpose of judicial review under the common law writ of certiorari.
(b)
For each evidentiary hearing, the determination of the Board
of Trustees (after receiving the recommendation of the hearing officer)
of whether the petitioning applicant is eligible for the benefits
under the Public Safety Employee Benefits Act (820 ILCS 320/1 et seq.)
shall constitute a final administrative determination for the purpose
of judicial review under the common law writ of certiorari.
(6)
Burden of proof. At any hearing under this § 67-18, the applicant shall have the obligation and burden of proof to establish that the applicant is qualified to receive the benefits.
(7)
Administrative records. All records pertaining to the administrative
process will be held in a separate file in the employee's name
within the management services department of the Village.
