(A) Purpose. The purpose of this section 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 (PSEBA), through an administrative process, including if necessary, an administrative or evidentiary hearing.
(B) Definitions. For the purpose of this section, the following terms will have the following meanings:
CATASTROPHIC INJURY. An injury, the direct and proximate consequences of which permanently prevent an individual from performing any gainful work.
GAINFUL WORK. Full- or part-time activity that actually is compensated or commonly is compensated.
INJURY. A traumatic physical wound (or a traumatized physical condition of the body) directly and proximately caused by external force (such as bullets, explosives, sharp instruments, blunt objects, or physical blows), chemicals, electricity, climatic conditions, infectious disease, radiation, virii, or bacteria, but does not include:
(a) Any occupational disease; or
(b) Any condition of the body caused or occasioned by stress or strain.
[Note: These definitions are derived from the federal Public Health and Welfare Act, which was enacted in 1944 and amended in 1984.]
(C) Application procedure.
(1) 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 disability pension claim with the city or within 30 days of the date of the adoption of this section in the event that an Applicant has filed for a PSEBA claim prior to the date of adoption of this section, 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.
(2) 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:
1. Response to fresh pursuit;
2. Response to what is reasonably believed to be an emergency;
3. Response to an unlawful act perpetrated by another; or
4. Participation during the investigation of a criminal act;
(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 providers);
(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 name(s) of witnesses to the incident;
(f) The name(s) of witnesses the applicant intends to call at the PSEBA hearing (if any);
(g) Information and supporting pension documentation filed with the appropriate pension board;
(h) Information supporting the PSEBA eligibility requirements;
(i) A statement of whether the applicant is currently enrolled in the city’s health care insurance plan for which continuation of coverage is sought; and
(j) Other sources of health insurance benefits currently enrolled in or received by the applicant and/or family members if the applicant is deceased.
The City Manager is hereby authorized to prepare application and other forms that are necessary or appropriate to simplify the procedures of this section.
(3) The PSEBA application must be submitted to the Office of the City Manager, 220 E. Deerpath, Lake Forest, IL 60045, 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 as the preliminary record (“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 timely filed, the City Manager shall review the application and supporting documents for purposes of making a recommendation that the City Council:
(a) Grant 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 City Council based on the result of an evidentiary hearing. Following receipt of the recommendation of the hearing officer, the City Council shall render a determination regarding 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 city.
Within 30 days following receipt of the recommendation of the City Manager, the City Council shall make a determination regarding the application, which determination may include a direction for further proceedings on the application before a final determination is made.
(7) If the City Council grants the benefit based on the preliminary record as it stands, the applicant will be contacted by the city within 30 days of the decision. The Applicant will be required to contact the City Manager for benefit explanation and processing.
(8) If the City Council 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.
(9) 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.
(10) If the City Council denies the benefit based on the preliminary record as it stands, the applicant will receive written notice of such denial and the applicant shall have the right to request an evidentiary hearing, which request must be served in writing to the City 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 City Manager shall schedule the evidentiary hearing and serve the applicant with notice of such hearing.
(11) If the applicant, upon receiving written notice of denial, chooses not to request an evidentiary hearing, the Applicant will be required to contact the City Manager to discuss other options in which the applicant may be eligible to continue participation in the city’s health care insurance plan.
(D) Administrative hearing composition. A final administrative hearing or an evidentiary 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 authorities granted to her/him under common law relative to the conduct of a final administrative hearing or evidentiary 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 in 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 (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 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, the following information should be considered, at a minimum:
(a) The individual’s ability to comply with the job description as set forth herein; and
(b) 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.
(E) Administrative and evidentiary hearings. As provided herein, an administrative or evidentiary hearing to determine of the applicant’s eligibility for benefits under PSEBA may be initiated either by the City Council or by the applicant after the submission of a full and complete PSEBA application. 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 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) 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 be provided to the applicant within 28 days of the date of the administrative hearing.
(2) Procedures. The city (through the City Manager) 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, by such application, 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; recommendation.
(a) For each final administrative hearing, the 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.
(b) For each evidentiary hearing, the determination of the City Council (after receiving the recommendation of 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.
(F) Burden of proof. At any administrative or evidentiary 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 shall be by the preponderance of the evidence.
(G) Administrative records. All records pertaining to the administrative process shall be held in a separate file under the applicant’s name with the city.
(H) Severability. If any provision of this section or application thereof to any person or circumstance is ruled unconstitutional or otherwise invalid, such
invalidity shall not affect other provisions or applications of this section that can be given effect without the invalid application or provision, and each invalid provision or invalid application of this section is severable.
(I) Conflict of laws. Where the conditions imposed by any provisions of this section are more restrictive than comparable provisions imposed elsewhere in any other local law, ordinance, resolution, rule or regulation, the regulations of this section will govern.
(Ord. 2017-60, passed 10-16-2017)