[Adopted 8-15-1985 by Ord. No. 1350 (Ch. 1, Part 7E, of the
1986 Code of Ordinances)]
To provide policies and procedures for the administration of
certain claims covered by Act 193 of June 28, 1935, P.L. 477, as amended;
53 P.S. § 637 et seq., referred to herein as the Heart and
Lung Act.
This Act covers specified members who are injured in the performance
of their duties and by reason thereof are temporarily incapacitated
from performing their duties. Also, the Act deals with temporary diseases
of the heart and tuberculosis of the respiratory system caused by
extreme overexertion in times of stress and danger or by exposure
to heat, smoke, fumes or gases arising directly out of the employment
of any such member. The Act applies to all enlisted members of the
Police and Fire Department who have served four years of consecutive
or continuous service. All other diseases arising in the performance
of duties are excluded from the scope of this Act.
City Council shall determine the acceptance, rejection, termination,
and modification of claims for Heart and Lung Act benefits for the
temporary disabilities covered by this article.
The following words and phrases, when used in this article,
shall have the meanings given to them in this section, unless the
context clearly indicates otherwise:
Employment amounting to four calendar years of consecutive
or continuous service immediately preceding disability with an agency
covered by the Heart and Lung Act.
Any disability that is not temporary.
A.
Reports. The following reports are necessary to satisfy the requirements
of Heart and Lung Act:
B.
Member's responsibilities. The member, or someone acting in his/her
behalf, must immediately report the existence of the disability and
its possible relationship to his/her employment, in writing, to his/her
immediate supervisor.
(1)
The report must include the following information:
(a)
Date and time the disability occurred or when the member became
aware of the disability.
(b)
Description of the disability.
(c)
Summary of the circumstances which caused the disability, if
known.
(d)
The name and address of the attending physician or hospital
and any known witnesses, if applicable.
(2)
If requested by Council, the member must submit to an examination
administered by a physician selected and paid for by the City of Washington.
Refusal to submit to such examination may deprive the member of the
benefits hereunder.
(3)
It shall be the responsibility of the member to submit through channels
all documents and reports required by Council or any document relevant
to the disability.
(4)
Any related workers' compensation benefits received shall be turned
over to the City. The City may have subrogation interests in any other
benefits that may accrue. Failure to do so, or failure to disclose
the receipt of workers' compensation benefits, shall result in immediate
suspension of Heart and Lung Act benefits.
(5)
The member must return to duty upon the recommendation of the attending
physician and/or the City's Medical Officer with approval of City
Council.
(6)
If a hearing is held by Council, the member shall be responsible
for arranging for his/her own witnesses and their expenses in accordance
with the Judicial Code, 42 Pa.C.S.A. § 5903.
C.
Department responsibilities. The Police and Fire Departments shall
follow established procedures for reporting injuries.
(1)
Each department chief shall forward a copy of all injury reports
to the State Workers' Insurance Fund. SWIF shall determine if the
member is eligible for benefits under the State Workers' Insurance
Act.
(2)
The chief shall make a preliminary determination whether or not the claim falls within the purview of § 44-13 of this article.
(3)
If the claim falls within the purview of § 44-13, the chief shall:
(a)
Send the member a letter of instruction, which shall include
a request for a complete diagnosis and prognosis from his/her physician.
(b)
Request that an investigation be conducted by City Council.
(c)
Advise the member of his appropriate leave status pending acceptance
of the claim by City Council.
(d)
Maintain a copy of all reports for review by each member of
City Council as required.
A.
City Council shall act as the Heart and Lung Review Board and the
Mayor shall act as Chairperson.
B.
Duties and powers. Council shall have sole authority for the acceptance
or rejection of any claim and for the termination and/or modification
of benefits for diseases of the heart and tuberculosis of the respiratory
system under the Heart and Lung Act.
(1)
Council will meet as necessary to hear new claims, review active
and recurring claims, and make determinations.
(2)
The Council shall determine what evidence it needs to make such determinations
and make such requirements known to the chief.
(a)
The member's failure to comply with such requirements may result
in the rejection of his or her claim.
(3)
City Council shall make an initial determination of all cases reviewed
by it. If the claim is approved by a majority of Council members,
a hearing will not be held and the claimant will be notified of his/her
benefits.
(4)
If the claim is not approved, Council shall have the authority to
conduct hearings in accordance with the Local Agency Law.[1] In such cases, the claimant shall be notified of the following
information:
(a)
That the claim was disapproved by the Board and he/she may request
a hearing by notifying the Board, in writing, within 30 days from
the date the disapproval was mailed to the claimant; and
(b)
Although the claim was disapproved by Council, it was forwarded
to SWIF for a determination as to the benefits under the Workers'
Compensation Act.
[1]
Editor's Note: See 2 Pa.C.S.A. §§ 551 et seq.
and 751 et seq.
(5)
In addition to those specified herein, the Council shall have all
powers and duties necessary and proper for the administration of the
Act and this article.
C.
Hearing procedures. City Council shall conduct its hearings in accordance
with the Local Agency Law contained in the Judiciary Act Repealer
Act of April 28, 1978, P.L. 202, No. 53, Section 5, as amended, 2
Pa.C.S.A. § 551 et seq., effective June 27, 1979.
(1)
The Mayor shall be responsible for arranging for the City's witnesses
and evidence, recordkeeping and clerical support. All hearings shall
be recorded and filed with the City Clerk for a period of not less
than one year after conclusion of the case.
(2)
Council shall make a determination and shall notify the claimant
by certified mail.
(3)
All determinations rendered by the Council as a result of the hearing
shall be final, unless appealed to the commonwealth court within 30
days from the date the notice of the determination was mailed.
A.
Salary. Members shall be granted salary benefits as they would otherwise
be entitled to if they had not been temporarily disabled.
B.
Medical expenses. All claims for necessary medical, surgical, hospital
services, supplies and prescription drugs should be submitted in accordance
with existing procedures under this article and the Heart and Lung
Act, 53 P.S. §§ 637 and 638.[1]
C.
Leave. The member shall remain on sick, annual or personal leave
until a determination is made by HLRB. During the benefit period,
sick, annual or personal leave will continue to accrue.
(1)
Accrued leave that normally would be lost at the end of the calendar
year, but cannot be taken during the benefit period, may be taken
in accordance with existing regulations or applicable labor agreements.
D.
Additional benefits.
(1)
Medical/hospital insurance continues.
(2)
Group life insurance continues. However, if the disability is expected
to last six months or longer, the member will receive the necessary
forms from the City Clerk to request a "waiver of premiums."
(3)
Full retirement credit is earned during the disability period.
(4)
Benefits that take effect during the disability period are granted.
A.
Termination of benefits. Heart and Lung Act benefits under this article
will be terminated as follows:
B.
Recurrences. If a member returns to work and suffers a subsequent
temporary disability, a complete medical diagnosis and prognosis must
then be submitted to City Council. The claim shall be reviewed by
the Board, as specified in this article.
