As the court noted in Englum v. The Village of Charleston, “while the [Act] contained substantive requirements for section 10 eligibility, the [PSEBA] contained no procedural requirements for determining whether a former employee met the substantive criteria.” Englum v. The Village of Charleston 2017 IL App (4th) 160747 *¶55. This chapter and the application procedure of this section establishes guidance on the proper procedural requirements for public safety officers seeking PSEBA benefits in the village.
(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 filing a pension claim with the village, or within 30 days of the date of the adoption of this chapter in the event that an applicant has filed for a PSEBA claim prior to the date of adoption of this chapter, whichever is later, if the applicant is seeking benefits under PSEBA. The village shall notify applicant if the PSEBA application is incomplete and the 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 the claim);
(2) The applicant’s firsthand knowledge explaining, to the village’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) 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 specifying 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 such representation, and the name and signature of a witness, authorizing the collection of information pertinent to the incident review process;
(5) The name(s) of witness(es) to the incident;
(6) The name(s) of witness(es) 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 Village Services Director 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 village, the completed application shall then be submitted to the village 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 village 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 on that 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 that is within 30 days of the original hearing date. Failure to appear at the administrative hearing shall result in denial of PSEBA benefits.
(Ord. 2411, passed 1-18-2018)