A. Application For PSEBA Benefits:
1. A PSEBA benefit application form prepared by the Village shall be the standard form required for PSEBA benefit applicants to use in requesting benefits under PSEBA. The form shall be completed and executed by the requesting applicant and delivered to the PSEBA Claims Administrator. Information required by the form shall include, but not be limited to:
a. The full particulars of the employee's claim for benefits, including the date, time, place, and nature of the injury giving rise to the claim for benefits;
b. The names of any witnesses to the injury and the circumstances under which it occurred, together with any other factual circumstances surrounding the incident(s) alleged to have occasioned the injury;
c. The names, ages, and relationship to the applicant of legal dependents for whom PSEBA benefits may be claimed; and
d. Information relating to the existence of health insurance benefits payable from any other source, which information must be current as of the date of application.
2. The application also must be accompanied by:
a. The written decision of any Public Safety Pension Board determining or declaring the injury to have been incurred in the applicant's line of duty as a public safety employee of the Village of Worth;
b. A signed medical authorization release authorizing the collection and production by voluntary agreement or subpoena, of information, including protected medical information, relating to the injury and the incident giving rise to the injury; and
c. If the applicant is seeking reimbursement for health insurance premium payments or out-of-pocket payments for PSEBA-related health insurance coverage or medical expenses, copies of all payment records or receipts for payments made by the applicant.
B. Application Review: The PSEBA Claims Administrator shall review the application for completeness. If incomplete, the PSEBA Claims Administrator shall return the application to the applicant for completion in accordance with the requirements of this section. If complete, the PSEBA Claims Administrator shall forward the completed application to the Hearing Officer and, after determining the availability of the parties, shall give notice concerning the holding of a hearing on the application. No hearing on the application shall be held until the application is complete.
C. Administrative Hearing: The conduct of the administrative hearing shall be as follows:
1. Upon receipt of a completed application, the PSEBA Claims Administrator shall arrange for the posting and publishing of a notice of hearing in accordance with the Illinois Open Meetings Act, 5 Illinois Compiled Statutes 120/1, et seq., notifying the parties and the public of the date, time, and place of a hearing to be held on the application.
2. The parties to the hearing, who may be represented by counsel, shall be the applicant and the Village of Worth. Both the applicant and the Village of Worth are necessary parties to the hearing.
3. Upon motion by a party or determination upon consultation with the parties by the Hearing Officer, the initial hearing date or any subsequent date for the hearing may be reset by the Hearing Officer to mutually convenient dates and times.
4. Hearings shall be held on the date and time and at the place specified in the notice of hearing, as originally set or reset and posted and published in accordance with law.
5. All hearings shall be attended by a certified court reporter whose presence at the hearing has been arranged by the PSEBA Claims Administrator at the direction of the Hearing Officer, and a transcript of all proceedings shall be made and preserved.
6. The applicant and the Village may examine and cross-examine witnesses, introduce exhibits, and request orders or subpoenas compelling the appearance of relevant witnesses or the production of relevant documents.
7. It shall be the applicant's obligation at the hearing to present in evidence any and all documents, including medical records, that were presented to any Public Safety Pension Board that considered the applicant's claim for a duty-related pension. All other medical records, health insurance records (including records relating to health insurance or self-insurance coverage of the applicant as a dependent), employment records, military records, accident reports, witness statements, injury reports (including any or all injury reports prepared or submitted by the applicant, whether or not in conjunction with the injury giving rise to the claim for PSEBA benefits), police reports, workers' compensation claims, reports and records, and records establishing dependency status (including marriage and birth certificates) that are relevant to the applicant's claim for PSEBA benefits shall be admissible at the hearing and shall be obtainable by any party requesting such records in pre-hearing discovery, subject to the requirements of applicable law.
8. Upon conclusion of the hearing, the parties may make closing arguments on the record or, if either party so requests, may submit post-hearing briefs in support of their positions, which briefs may contain appropriate citations to legal authority.
9. The determination by the Hearing Officer as to whether the applicant is eligible for benefits under PSEBA shall be in writing, shall include findings of fact and conclusions of law, and shall be consistent with PSEBA. If the Hearing Officer determines that the applicant is eligible for benefits under PSEBA, the determination shall include a finding as to the extent of the reduction, if any, of PSEBA benefits resulting from the existence of health insurance benefits payable from any other source.
10. Such determination shall constitute a final determination for the purpose of appeal to the Circuit Court of Cook County pursuant to a common law writ of certiorari. (Ord. 2017-23, 9-5-2017)