As noted by the court in Pedersen v. Village of Hoffman Estates, 2014 IL App. 4th 160747, "the Act, however, does not provide any guidance on the proper procedure for seeking [PSEBA] benefits." ¶ 37. Accordingly, the application procedure of this section establishes guidance on the proper procedure for Public Safety Officers seeking PSEBA benefits in the city.
(A) Public Safety Officers, or family member(s) of an injured or deceased Public Safety Officer, ("applicant") must file a full and complete PSEBA application in writing within 30 days of the date of receipt of the pension board's written decision granting a line-of-duty disability pension or within 30 days of the date of the adoption of this subchapter in the event that an applicant has filed for a PSEBA claim prior to the date of adoption of this subchapter, whichever is later, if the applicant is seeking benefits under PSEBA. The city shall notify applicant if the PSEBA application is incomplete and applicant shall have five days to remedy their application. Failure to timely file the full and complete application shall result in a forfeiture of the benefits under PSEBA by failure to properly submit a complete application.
(B) A complete PSEBA application includes the following:
(1) 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);
(2) The applicant's firsthand knowledge explaining, to the city's satisfaction, how the injury/death directly resulted from:
(a) Response to fresh pursuit;
(b) Response to what is reasonably believed to be an emergency;
(c) Response to an unlawful act perpetrated by another; or
(d) Participation during the investigation of a criminal act;
(3) 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);
(4) 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;
(5) The name(s) of witnesses to the incident;
(6) The name(s) of witnesses the applicant intends to call at the PSEBA hearing;
(7) Information and supporting pension documentation filed with the appropriate pension board;
(8) Information supporting the PSEBA eligibility requirements; and
(9) Other sources of health insurance benefits currently enrolled in or received by the applicant and/or family members if the applicant is deceased.
(C) The PSEBA application must be submitted to the City Human Resources Department in its entirety.
(D) 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.
(E) On the date that the PSEBA application is deemed complete by the city, the completed application shall then be submitted to the city as the preliminary record, and a copy of the same shall be date stamped and provided to the applicant.
(F) Upon receipt of a complete application for PSEBA benefits, the city 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.
(G) The applicant will be given written notice of the date for the scheduled administrative hearing to be served not less than ten 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.
(Ord. 9095-2022, passed 11-7-2022)