(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, waiver for relevant medical information, a general waiver for relevant information and an affidavit for PSEBA coverage with the Village Manager within 60 days of a Pension Board Duty Disability determination. 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 any other factual circumstances surrounding the incident giving rise to said claim. A copy of all required forms is attached hereto and incorporated herein. The Village Manager is hereby authorized to modify aforementioned forms as needed in accordance with Illinois law.
(B) Within 21 days after receipt of the aforesaid PSEBA application, the Village Manager shall determine whether sufficient documentation has been presented to warrant approval of the requested PSEBA benefit. Should the Village Manager approve the PSEBA benefit, the Village Manager shall issue a written decision which shall be deemed a final administrative decision under the Administrative Review Law (ILCS Ch. 735, Act 5, §§ 3-101 et seq.), as amended. Should the Village Manager deny the request for PSEBA benefit, the Village Manager shall issue a written decision to that effect. A copy of the Village Manager's written decision shall be promptly served on the PSEBA applicant by certified mail.
(C) Should the Village Manager determine additional information regarding the circumstances surrounding the incident giving rise to the injury are needed, he or she is hereby authorized to request additional information from the PSEBA applicant within 21 days of receipt of an application. In doing so, the Village Manager shall make a request for additional information in writing, allowing a reasonable amount of time for the applicant to respond to such requests and designating such deadline in the request. Should the Village Manager request additional information, he or she will make a determination regarding benefits within 15 days of receipt of the PSEBA applicant's supplemental documentation.
(Ord. 2016-O-054, passed 9-20-16)