(A) In conjunction with a request for PSEBA benefits, a public safety employee, or his/her representative, shall file a completed, notarized application for PSEBA benefits, relevant medical information and an affidavit for PSEBA coverage with the City Administrator. The application for PSEBA benefits shall include, but shall not be limited to, a fully detailed statement of the nature of the employee's claim giving full particulars thereof, i.e. date, time, place, nature of injury, and other factual circumstances surrounding the incident giving rise to said claim. The application shall also include a signed PSEBA medical authorization release and a signed PSEBA general information release. If the City Administrator decides that additional information is necessary in order to render a decision, he may schedule an informal meeting with the employee or the employee's representative.
(B) Within 20 days after receipt of the aforesaid PSEBA application, the City Administrator shall determine whether sufficient documentation has been presented to warrant approval of the requested PSEBA benefit. Should the City Administrator approve the PSEBA benefit, the city will grant the health insurance benefits consistent with PSEBA. The City Administrator shall issue a written decision which shall be deemed a final administrative decision. Should the City Administrator deny the request for the PSEBA benefit, the City Administrator shall issue a written decision to that effect, and the PSEBA applicant shall have the right to request an administrative hearing which must be served on the City Administrator within 30 days after the date of City Administrator's written decision of denial. A copy of the City Administrator's written decision shall be promptly served on the PSEBA applicant by certified mail. If a request for administrative hearing is made, the City Administrator will notify the applicant, by certified mail, of the date, time and location of the PSEBA administrative hearing. The employee must confirm the receipt of said notice and concur with the date set for the administrative hearing in writing within 30 days after being served notice of the administrative hearing. If the employee fails, or chooses not to confirm the receipt of said hearing notice within 30 days or otherwise refuses to participate in the administrative hearing, the hearing officer will proceed to make a final ruling on the PSEBA application based on his investigation and the evidence that the employee chose to submit for the hearing officer's consideration.
(Ord. 3938, passed 6-6-2016)