Chapter 2.98
ADMINISTRATIVE HEARING PROCEDURE TO DETERMINE ELIGIBILITY
UNDER THE PUBLIC SAFETY EMPLOYEE BENEFITS ACT
Sections:
2.98.020 Application procedure.
2.98.030 Administrative hearing/village adjudicator.
2.98.040 Administrative hearing.
2.98.050 Health insurance benefits.
2.98.060 Other health insurance benefits.
2.98.010 Purpose.
A. The purpose of this chapter is to provide a fair and efficient method of determining the eligibility of a full-time village of Riverdale police officer or firefighter to the benefits enumerated under the Public Safety Employee Benefits Act (“PSEBA”) through an administrative process, including, if necessary, an administrative hearing. All benefits provided employees pursuant to PSEBA must be consistent with the PSEBA.
B. The administrative procedure established herein recognizes the village’s obligations under the Act to provide health insurance benefits to its full-time public safety employees who qualify for, and are determined to be eligible to receive, certain health insurance benefits from the village. This administrative procedure is not a contract that bestows a benefit or entitlement on any particular individual, and may be modified by the village at any time without notice.
C. Any full-time firefighter or police officer who after November 14, 1997, suffers a catastrophic injury or is killed in the line of duty may apply for health insurance benefits under the Act as set forth below. The same benefits may be extended to the spouse and eligible dependent children of the catastrophically injured or deceased public safety employee, provided the conditions as established by the Act are met. (Ord. 2016-22 § 3, 2016)
2.98.020 Application procedure.
A. Application Required. To seek benefits under the Act, a full-time police officer or firefighter, or, in the event of the death or incapacity of the police officer or firefighter, a family member of the injured or deceased police officer or firefighter, must file with the village administrator a fully completed PSEBA application, in writing, within thirty calendar days of filing a pension claim, or within thirty calendar days of the date of the adoption of the ordinance codified in this chapter in the event that the employee has filed a pension claim prior to the date of adoption of the ordinance codified in this chapter, whichever is later. Failure to submit a timely PSEBA application shall result in a waiver of the claim for benefits under the Act.
The application must include the name of 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 the PSEBA hearing, information and supporting documentation filed with the pension board by the applicant or identified as exhibits by the pension board and any pension board determination or ruling, and documents/information supporting the PSEBA eligibility requirements. Failure to timely file the fully completed application along with submittal of other required information shall result in a forfeiture of the benefits under PSEBA. The applicant may submit any additional information that the applicant wants to be considered in support of the application.
Upon request, the village administrator, or his designee, shall furnish a Public Safety Employee Benefits Act application to the applicant.
B. Sworn Statement Required. The PSEBA application shall include a sworn and notarized statement explaining how the disabling injury or death directly resulted from:
1. A police officer’s response to fresh pursuit;
2. A police officer or firefighter’s response to what is reasonably believed to be an emergency;
3. A police officer or firefighter’s response to an unlawful act perpetrated by another; or
4. A police officer or firefighter’s participation during the investigation of a criminal act.
C. Medical Release Required. A signed PSEBA medical authorization release authorizing the collection of medical information related to the incident including, but not limited to, the disability pension proceedings, worker’s compensation records and medical records must be submitted with the PSEBA application. The PSEBA medical information release must specify the name, address, email and phone information for pertinent health care provider(s) and hospital(s), along with employee’s signature and a witness signature. A review of the PSEBA application will not occur until the PSEBA medical authorization release is submitted.
D. General Information Release Required. A signed PSEBA general information release authorizing the collection of general information related to the incident, including, but not limited to, disability pension proceedings, worker’s compensation records and medical records, must be submitted with the application. The PSEBA general information release must specify the name and signature of employee along with name and signature of a witness authorizing the collection of information pertinent to the incident review process.
A review of the PSEBA application will not occur until the PSEBA general information release is submitted.
E. Other Information. The village administrator may require other information necessary to make a determination as to whether or not the application should be granted or denied, including, but not limited to, health insurance benefits the employee is currently receiving or is eligible to receive; or any other health insurance benefits the employee or family members are otherwise entitled. The applicant has an ongoing obligation to update information provided. Failure to do so may result in the denial of benefits.
F. Preliminary Record. On the date that the PSEBA application (along with the releases outlined above) is deemed fully completed by the village administrator, the PSEBA application, PSEBA medical release and PSEBA general information release shall then be identified as the preliminary record, and a copy of the same shall be date stamped and provided to the applicant. (Ord. 2016-22 § 3, 2016)
2.98.030 Administrative hearing/village adjudicator.
A. Upon receipt of a fully completed application for PSEBA benefits timely filed, the village administrator shall request the setting of an administrative hearing before the village adjudicator for a determination, based on the record established at said hearing, as to whether the application should be granted or denied.
B. If the applicant or village, upon receiving written notice of an administrative hearing date, cannot attend said date as indicated in the notice of administrative hearing, the applicant or the village, as the case may be, must contact the village adjudicator within seven calendar days after being served with notice of the administrative hearing, communicating alternative hearing date(s) which are within close proximity of the original hearing date indicated by the village adjudicator. Continuances will be granted for good cause only. Failure to appear and/or cooperate in the hearing process may result in denial of benefits.
C. Power of the Village Adjudicator. The village adjudicator shall have all of the powers granted to him under common law relative to the conduct of an administrative hearing including the power to:
1. Preside over all village hearings involving PSEBA;
2. Administer oaths;
3. Hear testimony taken under oath and affirmation and accept evidence that is relevant to the issue of eligibility under PSEBA;
4. Issue subpoenas to secure attendance of witnesses and the production of relevant papers or documents upon the request of the parties or their representatives;
5. Rule upon objections in the admissibility of evidence and other motions;
6. Preserve and authenticate the record of the hearing and all exhibits in evidence introduced at the hearing;
7. Issue a determination based on the evidence presented at the hearing, after entertaining arguments in either oral or written format, at the discretion of the village adjudicator, the determination of which shall be in writing and shall include a written finding of fact, decision and order. (Ord. 2016-22 § 3, 2016)
2.98.040 Administrative hearing.
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.
A. Time and Date. Hearings shall be held on the date, time and place as established by the village adjudicator with appropriate notice served upon the applicant.
B. 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 fourteen days of the date of the PSEBA hearing.
C. 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.
D. Evidence. In so far as is practical, the rules of evidence as set forth in the Illinois Code of Evidence shall apply.
E. Final Determination. The determination by the village adjudicator of whether the 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.
F. Burden of Proof. The applicant shall have the obligation and burden of proof to establish qualification for benefits by a preponderance of the evidence standard.
G. Administrative Records. All records pertaining to the administrative process will be held in a separate file in the employee’s name within the human resource department of the village. (Ord. 2016-22 § 3, 2016)
2.98.050 Health insurance benefits.
A. If the village adjudicator awards PSEBA benefits, the village’s basic level insurance plan will be the plan offered. The village’s basic level insurance plan may change from time to time. If the applicant chooses to enroll in any other plan available in the village, the applicant must pay any difference in insurance premiums between the village’s basic plan and that of another plan on a monthly basis, due by the fifteenth of each month in which coverage is effective. Failure to pay said premiums by the fifteenth of the month in which coverage is effective may result in cancellation of the health insurance plan.
B. Individuals receiving benefits under PSEBA will only be able to change from one plan to another during the village’s open enrollment period. (Ord. 2016-22 § 3, 2016)
2.98.060 Other health insurance benefits.
A. Health insurance benefits payable from any other source will reduce the benefits payable from the village. Each applicant will be required to sign an affidavit attesting to the fact that he/she is not eligible for insurance benefits from any other source.
B. It is the responsibility of the benefit recipient to notify the village within thirty days of any changes to other sources of health insurance benefits. Receipt of benefits in violation of this provision will require reimbursement to the village of any benefits received. The village reserves the right on an annual basis to have the benefit recipient provide another affidavit affirming whether other health insurance is available or payable to the applicant, his/her spouse and/or his/her qualifying dependent children.
The applicant is also required to notify the village when the applicant becomes Medicare eligible so the village can assist with the transition to Medicare coverage and/or adjust health insurance benefits accordingly. (Ord. 2016-22 § 3, 2016)